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TOP 10

HEALTHY EATING IN HOSPITALS 2018 has seen new rules for hospitals to ban sugary drinks on premises. But which hospitals are leading the fight against obesity?



The money owed across the NHS is in the billions. So how do NHS trusts recover debt from one another and tackle financial deficits?


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Cabinet reshuffle: what’s in a name?


TOP 10


2018 has seen new rules for hospitals to ban sugary drinks on premises. But which hospitals are leading the fight against obesity?





The money owed across the NHS is in the billions. So how do NHS trusts recover debt from one another and tackle financial deficits?


In his famous Romeo and Juliet quote, Shakespeare suggests that a name is merely a label, carrying no extra worth or meaning. Jeremy Hunt might think otherwise having flipped the ministerial table at the Prime Minister’s cabinet reshuffle. Cabinet reshuffles are predominantly about power – an opportunity to ease the load of dead wood and start afresh with new faces to pursue a new agenda. By not only maintaining Jeremy Hunt in his post, but by widening his berth to Secretary of State for Health and Social Care, Theresa May showed a lack of power. Many saw the January reorganisation of Whitehall’s ‘pale, male and stale’ furniture as the time for Hunt, who has been Secretary of State for Health since 2012, to be demoted, many predicting he would fill the void left by Damian Green as First Secretary of State. After an hour of discussion, many were left disappointed.

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The new departmental responsibility for social care again signals the Prime Minister’s desire to reform the troubled system, but, following the disastrous ‘dementia tax’ that derailed her election campaign last year, keeping Hunt as the figurehead is hardly an inspiring move. The reclassification of the Department of Health has widely been recognised as a ‘welcome recognition of the importance of social care’, but adding two underfunded responsibilities together, under the watch of a ‘serial blame-passer’, might not be the equation required to bring about substantial change in our healthcare system.

Michael Lyons, editor

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226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: EDITOR Michael Lyons EDITORIAL ASSISTANT Marianna Chrisostomou PRODUCTION EDITOR Richard Gooding PRODUCTION DESIGN Jo Golding PRODUCTION CONTROL Ella Sawtell WEBSITE PRODUCTION Victoria Casey ADVERTISEMENT SALES Jeremy Cox, Lucy Rowland, Damian Emmins, David Green, Lucy Maynard ADMINISTRATION Vickie Hopkins PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

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Case Study


New Bradford Royal Infirmary ICU features the Touchsafe Pro wireless Nurse Call system The new £28 million hospital wing at Bradford Royal Infirmary was opened in June 2017 by Bradford Teaching Hospitals NHS Foundation Trust and features the Touchsafe Pro wireless Nurse Call system which is designed, manufactured and supplied by Aid Call, a brand of Legrand Assisted Living & Healthcare. Aid Call has supported specialised installations at many NHS sites and, in 2015, the leading wireless Nurse Call provider began designing a system for the large project that includes a 16-bed Intensive Care Unit (ICU), two children’s wards, a dementia-friendly elderly care ward and a retail concourse. The Aid Call Touchsafe Pro Nurse Call system was the obvious choice for the new ICU because its wireless configuration meets the requirements of any project, no matter the size or scale, offering complete flexibility and mobility. The system can facilitate individual patient requirements, adapt to change and be added to over time. It can also be installed quickly and specifically to each site because there is no need to rely on cables and stationary wiring points.



Building Services Consultants DSSR drew up the specification for the new wing with support from the Aid Call and Bradford Teaching Hospitals project manager, Shane Embleton. A bespoke system that could be proven to benefit the staff and patients needed to be designed and the specifications were adapted as the requirements of the hospital altered. Once the plans were in place, a tender was released and Aid Call quoted 24 contractors for the project before meeting with the winning contractor in April 2016. Stuart Barclay, senior business development

manager for Aid Call, said: “The Aid Call team worked with many contractors and suppliers throughout the phased installation of our Touchsafe Pro system. We collaborated with third party Bedhead Trunking suppliers to make sure our products could be mounted to the Bedhead correctly with sufficient capacity remaining to fit the light relays. Bradford Teaching Hospitals also wanted to connect third party telecare products to our Touchsafe Pro system, and although they would normally be plugged in to the bottom of the call points, we worked to make them speak wirelessly to one another from wherever the product was being used.” Aid Call additionally carried out training with the Bradford Royal Infirmary staff over a three-week period prior to the opening, and the company continues to provide support to the hospital on a monthly basis to meet the staff’s needs and management requirements. FURTHER INFORMATION Tel: 01670 357 431



Hunt adopts social care title; ‘watershed moment’ for pressurised NHS; and record margin for missed A&E targets

14 HB TOP 10

NHS England has announced that sugary drinks will be banned from sale across NHS hospitals in England from July. In our first Top 10 list of 2018, Health Business examines the NHS trusts and health organisations that are excelling and exceeding expectations in healthy catering


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Each year, around £2.4 billion is spent on public sector food and catering. Rosemarie Hoyle asks whether the Government Buying Standards have the scope necessary to make a real impact on the catering system?


The development of air conditioning systems has come a long way since the inception of the modern hospital, but how clean are these systems and can they be kept free from bacteria? Mark Walker, chair of the CIBSE Healthcare Group, explains the importance of good design and regular maintenance in keeping these systems bacteria-free



Since the Lord Carter Report in February 2016 outlined opportunities for efficiency savings and environmental benefits within the health care system, the NHS has been supporting the Carbon & Energy Fund in the creation of an essential piece of literature for all trusts. David Mackey outlines the background to the guide, the scope of its contents and usability


As NHS trusts across the country continue to record large financial deficits, the process of recovering debt they are owed takes on added importance. And, as Stephen Sutcliffe, director of Finance and Accounting at NHS Shared Business Services explains, the money owed across the NHS is measured in the eye-watering billions of pounds

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The NHS is encouraged to work collaboratively, drive efficiencies in procurement and aggregate requirements to improve costs. Emma Dunn, of NHS Supply Chain, looks at how trusts can increase their diagnostic capacity, replace old equipment and continue to make savings


A wireless sensor that better detects breathing rate in hospital patients is among the latest innovations set to be spread across the NHS. HB looks at the 11 ground-breaking projects from the third round of the NHS Innovation Accelerator programme

Health Business




Now in its fifth year, the Wearable Technology Show returns to the ExCel on 13-14 March 2018. In conjunction with the Digital Healthcare Show, the event offers an unrivalled breadth and depth of content, providing case-studies from people who have successfully optimised their workstreams with digital


Scan4Safety is a pioneering programme that is improving patient safety, increasing clinical productivity and driving operational efficiency in the NHS. Rob Drag, Scan4Safety programme manager at Salisbury NHS Foundation Trust, shares the progress, learnings and significant benefits being made at one of the six Demonstrator Sites


While the use of electronic media is increasing, people are still printing from the screen to paper, especially in the healthcare environment. James Kelly, chief executive of the British Security Industry Association, discusses some of the key considerations when securing information destruction services


Globalisation has contributed towards rapid growth in the translation and interpreting sector. Catherine Park, Institute of Translation and Interpreting, looks at the impact and benefits of multilingual policies in hospital including translating visiting hours, evacuation plans and signs


The Modular and Portable Building Association believes that the cost-effectiveness and speed with which modular buildings can be used to both construct new state-of-the-art hospitals from scratch and extend existing structures make them ideally suited for the health sector. Jackie Maginnis explains why


Veronica Johnson Roffey, Infection Prevention and Control Commissioning Nurse at Warwickshire North CCG, explains that healthcare environments can only win the fight to reduce HCAIs if staff, patients and visitors work together


There has been a great deal of comment lately about parking in hospitals, leading to many asking whether patients using NHS services should be charged for parking? It is the topic that refuses to drive away. Glenn Dives of the British Parking Association explores the current situation Volume 18.1 | HEALTH BUSINESS MAGAZINE


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Hunt becomes Health and Social Care Secretary In a cabinet reshuffle in which many predicted Jeremy Hunt to lose his job, the Health Secretary has seen his role changed to Health and Social Care Secretary by Prime Minister Theresa May. Hunt, who has been in charge of the health department since 2012, takes over the portfolio responsibility left behind by Marcus Jones, who lost his job in the

reshuffle. While it remains unclear how the responsibility and funding will be spread between the Department of Health & Social Care and the newly named Ministry of Housing, Communities & Local Government, the change could mark a substantial step towards the integration of health and social care, a long-term ambition for policy makers in this area.

Meanwhile, Hunt’s deputy Philip Dunne, who recently received criticism for telling people to sit on seats if there are no hospital beds available, was one of several ministers to lose their positions as May sought change within her government. READ MORE: Jeremy Hunt


‘Watershed moment’ for pressurised NHS NHS Providers has written a letter to Jeremy Hunt to warn that the health service can no longer deliver what is required of it within current funding restrictions. The body, which represents 98 per cent of hospital, mental health, community and ambulance service trusts in England, stressed that the pressures facing front-line health and care services this winter are a watershed moment for the NHS and that there are not enough beds and staff to ensure the expected standards of care and safety remain. Amid concerns over a flu outbreak, the organisation is arguing that urgent decisions on long term funding for health and social care must be taken which

will allow the NHS to either sustainably deliver all that is required of it under its constitutional standards or change them. The NHS Providers letter was followed by another, signed by the heads of 12 health unions, in which an urgent appeal was made to the Health and Social Care Secretary to reverse government cuts and give the health service the money it needs. Leaders tell Hunt the £1.6 billion extra in the Budget came ‘far too late’ and the NHS is surviving only through the dedication of its one million workers. READ MORE:



More EU27 ambulance staff quitting NHS

Three hospital trusts to discuss merger plans Basildon, Southend and Broomfield hospital trusts in Essex are to discuss merger proposals that would create one of the largest NHS trusts. The boards will meet soon to approve the formal start of the process which would ‘modernise services’ and make care ‘more reliable and safe’ for patients, a report said. If approved, the new trust would have to serve over 1.1 million people across Essex, and employ over 14,000 staff, and could be in place by April 2019. The hospitals have worked together since 2016, and are run by a joint executive group. According to board papers, the three trusts have a combined financial deficit of over £49 million. A separate report has identified below-average performance in areas including cancer waiting times and patient experiences.

More and more European Union-trained ambulance staff are quitting the NHS, raising fears of a Brexit drain from the service. There are fears that the departures could exacerbate high vacancy rates in ambulance services in England, which are already one of the most understaffed areas of care. Freedom of information requests, requested by the Liberal Democrats, have revealed what the party says is an ‘alarming’ trend of resignations among ambulance staff trained

in the other 27 EU countries. The responses from England’s 10 ambulance services trusts reveal that 101 paramedics, call handlers and other staff from the rest of the EU left in 2016-17, one in seven of the 688 EU27 personnel who were working for the trusts during that time. Last year was the second in a row in which the number of leavers rose. READ MORE:








Nine in 10 ambulance services under ‘severe pressure’

Missed appointments cost the NHS £1bn last year Almost eight million hospital outpatient appointments were missed due to patients not attending in 2016/17, meaning almost £1 billion worth of appointments were missed. The NHS Digital figures also showed that over nine million people were sent home from A&E in 2016/17 with just guidance and advice, which could have been obtained more conveniently from a pharmacist or by calling 111. With each missed outpatient appointment costing the NHS approximately £120 in 2016/17, it means almost £1 billion worth

of appointments were missed. Therefore, Prof Jane Cummings, chief nursing officer for England, has urged patients to cancel their NHS appointments in good time if they are not able to attend, in order to free up resources for those who need them. Health Secretary Jeremy Hunt has previously hinted at the possibility of charging patients for missed appointments, but such a move has never come to fruition. READ MORE:


Report warns of fatigue threatening patient safety Lack of sleep resulting from long shifts and excessive workloads is jeopardising patient safety, the British Medication Association (BMA) has warned. The BMA have released a report which highlights how long and demanding hours coupled with changes in rotas and insufficient recovery periods mean thousands of doctors are at an increased risk of sleep deprivation and fatigue. Fatigue and sleep deprivation – the impact of different working patterns on doctors warned that inadequately rested doctors were at greater risk of making errors in patient care as well as occupational hazards. The report states that dangers posed by sleep deprivation require the government and employers in the NHS to commit to a comprehensive framework for addressing workplace fatigue.

The BMA has now produced guidance for doctors on managing the risks of fatigue. Published last June, the BMA’s second quarterly survey of 2017 found that 74 per cent of GPs as well as 70 per cent of junior doctors and 65 per cent of consultants reported working beyond their regular hours ‘often’ or ‘very often’. In addition to reviewing working patterns in the health service, the BMA is calling for immediate action from ministers and employers in raising awareness of the risks of fatigue in the workplace, as well as providing greater support for staff. The report advises that the minimisation of fatigue should ultimately become central to future workforce panning. READ MORE:

A Sky News survey has revealed that nine of the 10 ambulance services in England have declared the second-highest level of alert in response to the NHS winter crisis. With only the London Ambulance Service currently operating below Resource Escalation Action Plans (REAP) level three, the remaining nine – East Midlands, East of England, North East, North West, South Central, South East Coast, South Western, West Midlands and Yorkshire ambulance services – are all operating at level three. The survey was published after it was revealed that nurses have been leaving their busy A&E units in order to treat patients stuck in the back of ambulances outside, while paramedics at a Dorset hospital have been triaging patients in the hospital’s A&E units so that they can offhand their patients more quickly and answer other 999 calls earlier. The pressure facing ambulance services was highlighted by the East of England Ambulance Service Trust revealing that it was forced to turn to private ambulance services as the number of calls it received on New Year’s Day was over 50 per cent above normal levels. READ MORE:


Record margin for missed A&E targets Latest figures show that only 85.1 per cent of patients were seen in the targeted four hours in A&E departments, the worst waits since the targets introduction in 2014. This means that more than 300,000 patients waited longer than they should, as the NHS missed its 95 per cent target amid rising pressures on the service this winter. Figures also show that in the week ending 7 January, 16,690 patients were kept in the back of an ambulance for more than 30 minutes while they waited for space in A&E. Additionally, some 5,082 were delayed for more than an hour. The figures coincide with reports that hospitals have run out of beds and cannot cope with the increasing influx of patients. Furthermore, a new study has claimed that rising A&E attendance rates are driven by patients’ long term health conditions, and are not related to lack of GP provision. A new Queen Mary University study, published in the British Journal of General Practice, analysed data from 819,590 GP registered patients in 136 practices in the east London found that having multiple long term health conditions was the strongest predictor of emergency department attendance. READ MORE:



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Sugary drinks to be banned from NHS hospitals

UK flu levels continue to increase

NHS England has announced that sugary drinks will be banned from sale across NHS hospitals in England from July, making England the second country in the world, after Portugal, to introduce such a plan. Retailers including Marks & Spencer, WH Smiths and Subway had already agreed to cut sales of sweet drinks to 10 per cent of their output, but the new rule will stop outlets from selling the drinks at all. New rules will also heavily restrict the sale of any high calorie foods. From next April 60 per cent of sandwiches and pre-packed meals on sale in hospitals must contain a maximum of 400 calories per serving – rising to 75 per cent of cases

a year later. And 60 per cent of sweets and chocolates sold must not exceed 250 calories – rising to 80 per cent by 2019. In other catering news, Tameside hospital in Manchester has become the first in Britain to ban sugar from its restaurant in an effort to tackle growing concerns about obesity among NHS staff. The hospital has removed all added sugar from the meals it prepares for visitors and health service workers, and taken sugary snacks and fizzy drinks off its menu. The only drinks now available are tea, coffee, milk and water.

Public health England statistics have shown that seasonal flu levels have continued to increase in the last week across the UK. The health body has reported that there has been a 78 per cent increase in the GP consultation rate with flu like illness, a 50 per cent increase in the flu hospitalisation rate, and a 65 per cent increase in the flu intensive care admission rate. Seasonal flu, which puts extra pressure on the NHS every year, can live for many hours on hard surfaces, so health bosses and hospitals across the country are encouraging people to practise good hand hygiene to limit the spread of germs and transmission of flu. READ MORE:




Independent doctors to be rated by CQC

NHS still awaiting parity for mental health

Under new changes, all healthcare organisations in England that offer regulated care will be rated by the Care Quality Commission (CQC), including independent doctors that offer primary care online. The CQC’s current ratings programme will be extended to include more than 800 additional providers, and will require providers affected by these changes to publicly display their rating, allowing patients to make an informed choice when deciding which care service they want to use. The changes will bring services in line with the rest of the NHS and reassure patients who use digital GP apps provided by independent doctors about the quality and safety of the service they are choosing. Health Secretary Jeremy Hunt said: “With

our NHS now in its 70th year, we are planning ahead to guarantee safer and better care for patients in the years to come. These changes are a world first for patient safety, modernising our tough Ofsted-style inspection scheme so we keep pace with the changing landscape of healthcare, as well as helping tech-savvy patients to make informed decisions about their care.”





A new report by the Kings Fund has revealed that physical health services are still receiving larger budgets, five years after the government promised ‘parity of esteem’. The paper highlights that 84 per cent of mental health trusts received an increase in funding last year, significantly higher than in previous years. However, income for mental health trusts rose by less than 2.5 per cent in 2016/17 compared to more than six per cent for acute and specialist trusts, continuing a trend of a growing spending gap between mental health and acute trusts. The number of mental health nurses has fallen 13 per cent since 2009, while one in 10 of all posts in specialist mental health services are currently vacant. This has led to an increased risk to patient safety as a result of problems with staffing in more than half of trusts.

One in 10 nurses leaving NHS each year One in 10 nurses leave the NHS in England each year, with new figures revealing that more than 33,000 nurses left the NHS last year, piling pressure on understaffed hospitals and community services. The figures, provided to the BBC by NHS Digital, represent a rise of 20 per cent since 2012-13, and show that there are now more leavers than joiners. The figures reveal that over 10 per cent of the nursing workforce have left NHS employment in each of the past three years, the number of leavers would be enough to staff more than 20 average-sized hospital trusts, and leavers outnumbered joiners by 3,000 last year.

The figures also suggest that Brexit may have had an impact on the number of EU nurses leaving, and the number of joiners has halved since the EU referendum. Nurse leaders said it was a ‘dangerous and downward spiral’, but NHS bosses said the problem was being solved. In Northern Ireland and Scotland, the leaver rates are rising, although the number of joiners did outnumber the leavers. In Wales, however, there were more leavers than joiners, according to freedom of information reports. READ MORE:




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MEETING THE CHALLENGE TO DO MORE WITH LESS IN THE HEALTHCARE INDUSTRY The challenges of providing and funding health care around the globe haven’t changed much over the last few years – and they are unlikely to do so in 2017 Rising demand and associated spending are being fuelled by an aging population; the growing prevalence of chronic diseases and comorbidities; development of costly clinical innovations; increasing patient awareness, knowledge, and expectations; and continued economic uncertainty, say Deloitte in their 2017 global health care outlook. In the UK improvements in healthcare and lifestyle means the old age dependency ratio (OADR) – the proportion of people over 65 for every 1,000 aged between 16 and 64 years – is increasing as the population grows towards a projected 74 million people by 2039. (ONS: Overview of the UK population: July 2017). The numbers of people aged over 85 in England increased by almost a third over the last decade and will more than double over the next two decades, say Age UK, coupled with heavy cuts in real terms on social care for the elderly. The NHS and social care system in the UK is facing a staggering increase in the cost of looking after elderly people within the next few years, according to research led by academics from the University of Liverpool and University College London. They said: “Public and private expenditure on long-term care will need to increase considerably by 2025, in view of the predicted 25 per cent rise in the number of people who will have age-related disability. This situation has serious implications for a cash-strapped and overburdened NHS and an under-resourced social care system.” BUILDING A PICTURE OF MARGINAL GAINS FOR HEALTHCARE In healthcare, traditional cost-cutting techniques – like reducing staff or services – simply do not work. Instead, they place patient and employee health and safety at risk. Instead, those managing healthcare budgets need to put everything under the microscope, from deploying technology to answer the requirements for better access to patient records, to minimising the operational costs of ensuring a comfortable and hygienic



environment to promote healing and wellness. As a healthcare facility, improving facility performance, patient safety, and patient satisfaction in essence comes down to delivering the right information, to the right person, at the right time. To do that, all hospital infrastructure systems need to communicate intelligently as advanced technology is deployed to create more

of ownership over time. And with energy costs soaring, the system also has to be efficient. Availability has to be constant, from patient check-in to checkout. And, at the end of the day, the solution has to ensure compliance with increasingly strict standards and legislation. Schneider Electric has just what the doctor ordered. The easily-installed InfraStruxure

Schneider Electric’s easily-installed InfraStruxure solution enables the benefits of a high-density environment at a lower relative cost than other solutions, and will offer greater operational and energy efficiency efficient, safe, and pleasant healthcare experiences for patients and staff alike. For example, the Internet of Things (IoT) offers new possibilities for healthcare structures of all sizes. The data from all connected things or devices is largely underutilised, but with the right tools and solutions in place, everyone – from patients and nurses to medical practice managers, and those running healthcare trusts – can gain meaningful insights to help improve and customise patient care and optimise facility operation. MAKING DATA CENTRE INFRASTRUCTURE SCALABLE TO HEALTHCARE NEEDS For the healthcare industry, ensuring a quality environment of patient care is paramount. New technologies – from digital imaging to security enhancing baby finders – are helping to reduce errors, improve care, and decrease costs simultaneously. But to enable these technologies, healthcare facilities need a rock-solid physical infrastructure to back up their assets. The challenge, then, is to find a scalable, modular solution with the lowest total cost

solution enables the benefits of a high-density environment at a lower relative cost than other solutions, and will offer you greater operational and energy efficiency. Designed to be scalable and adaptable to need, InfraStruxure provides an integrated solution built from core components such as IT equipment racks, in-row cooling units, power distribution (PDUs) and power protection (UPSs) devices, physical security and management software (including DCIM and its recently introduced DMaaS – data centre management-as-a-service. Because the InfraStruxure architecture has been developed to work together, it eliminates the uncertainties surrounding best-of-breed approaches to deliver an efficient, one-stop-shop solution for a wide range of environments, from wiring closets to data centres and modalities throughout any hospital campus. With reduced risk and installation time, it is quickly scalable up or down. With thousands of proven reference designs, Schneider Electric offers the largest portfolio of physical infrastructure solutions for IT facilities or data centres. Using InfraStruxure, those delivering IT services for healthcare premises can find a solution to eliminate data

centre hot spots, enhance overall efficiency, reduce power consumption, as well as optimising capacity utilisation and availability. EXPANDING YOUR DATA CENTRE Where space is a premium, Schneider Electric prefabricated data centre solutions enable areas such as hospital car parks and even the roofs of buildings to be utilised to create a space for a purpose-built data centre environment in a weather-proof, ISO or non-ISO container. Schneider Electric prefabricated data centre solutions deploy quickly and offer predictable performance from day one, backed by our proven expertise so you can stop problems before they occur. Schneider provides building block units or all-in-one solutions in single enclosures. The solutions are suitable for new builds or to increase capacity for existing infrastructures. With expert, operations, and advisor levels together with Schneider Electric’s legendary supply chain, design, applications and engineering support, prefabricated data centre solutions are pre-engineered and wired with integrated hardware and software. They are factory manufactured and tested, and arrive onsite ready to deploy – overcoming many site engineering and connection challenges. The range includes multiple form factors (all-in-one, power modules, cooling modules, etc.,) in multiple power ranges. As with all Schneider Electric solutions, they are optimised to work together with minimal integration requirements. Schneider Electric prefabricated data centre modules are easily managed using the company’s award-winning DCIM software suite, and are backed by an extensive library of reference designs. MAKING DATA AT THE EDGE OF HEALTHCARE FACILITIES SAFE AND SECURE Designed for smaller IT installations, Schneider Electric’s prefabricated Micro Data Center Xpress can be shipped complete to the

point of use. In corporate applications they are typically used in locations to support on-premise public cloud stacks, private clouds, data aggregation, or local processing of IoT data. In healthcare facilities the possibilities are endless, as space in corridors and in office space can be securely utilised to support data processing requirements without physical security being an issue. Factory-built and tested, easily configurable with various options and shortest possible lead time, preconfigured micro data centres offer the greatest flexibility and customisation. Schneider Electric provides an online configuration for customer modelled solution designs (including IT equipment). Micro Data Centres are certified with IT vendor validated infrastructure and partnerships with IT vendors, designed for the latest converged and hyper-converged IT systems, physically secure to prevent unauthorised access and remote-manageable with alerts and predictive analytics for maximum uptime. ENSURING SECURE, EFFICIENT AND RELIABLE POWER Not all of a hospital’s power protection needs will be based in the data centre. To enhance the availability of utility power to the non-IT aspects of the hospital, Schneider Electric offers a full line of power protection solutions. These single- and three-phase UPSs are ideal for ensuring that only high-quality power reaches the various types of modalities, strengthening your overall availability. Schneider Electric ensures secure power for a range of applications in healthcare facilities, from the data centre which provisions hospital information systems and drives everything from back-office productivity to patient records and imaging, to the operating theatre, radiology, accident & emergency room, nursing stations – even the wastewater plant and utilities room.

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HB Top 10



Catering for a healthier hospital NHS England has announced that sugary drinks will be banned from sale across NHS hospitals in England from July. In our first Top 10 list of 2018, HB examines the NHS trusts and health organisations that are excelling in healthy catering NHS England has reported that around £16 billion a year is spent on the direct medical costs of diabetes and conditions related to being overweight or obese. With a large percentage of hospitals not meeting government food standards and struggling to serve and sell freshly prepared, healthy and ethically-sourced food for patients, staff and hospital visitors, the issue of healthy eating in hospitals themselves has come under inspection. With vending machines in the UK selling over 13 million food and drink items everyday – equating to 93 million a week – NHS England chief executive Simon Stevens has strongly voiced his concerns over the need to fight


obesity, diabetes and tooth decay within NHS premises. At the start of October 2017, Stevens warned that sweet and chocolates sold in hospitals should be 250 calories and under. Just this month it was announced that sugary drinks will be banned from sale across NHS hospitals in England from July. With retailers including Marks & Spencer, WHSmiths and Subway having already agreed to cut sales of sweet drinks to 10 per cent of their output, NHS England has now released an updated contract for hospitals, which, for the first time, includes a clause prohibiting the sale of sweetened beverages, meaning the aforementioned retailers, and any others

operating on hospital premises, will have to stop selling sugary drinks altogether. Additionally, the new rules will also heavily restrict the sale of any high calorie foods. From next April, 60 per cent of sandwiches and pre-packed meals on sale in hospitals must contain a maximum of 400 calories per serving – rising to 75 per cent of cases a year later. And 60 per cent of sweets and chocolates sold must not exceed 250 calories – rising to 80 per cent by 2019. Discussing the announcement, Katherine Button, of the Campaign for Better Hospital Food, said: “We welcome this move by NHS England to ban the sale of sugary drinks in our hospitals. Tooth extraction as a result of tooth decay is the most common cause for hospitalisation of children under five – putting unnecessary pressure on stretched NHS services. This bold leadership from NHS England chief executive Simon Stevens is exactly what we need to tackle these big health challenges.” In preparation of the new rules being enforced, Health Business takes a look at the hospital trusts leading the push for healthier meals on wards, whether that be sugar-free, locally sourced or with limited food waste and packaging. Congratulations to those included! THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST A charity initiative to subsidise the food for parents of children with life-threatening or life-limiting illnesses was launched in 2017. The scheme offers a daily £5 voucher for a meal for families


to have at their child’s bedside. In April last year, the trust’s food was praised by Great British Bake Off judge Prue Leith, who said that the trust ‘should be proud of the freshness, range and quality of the meals and snacks it provides not just to patients but also staff and visitors’. Meanwhile the Soil Association’s ‘Food for Life’ team assisted the trust with its food specification with the recent appointment of a patients meal supplier. Such work saw Hillingdon Hospitals NHS Foundation Trust win the Hospital Catering Award at the 2017 Health Business Awards. All adult patients admitted to the Hillingdon Hospitals NHS Foundation Trust will be screened for malnutrition within 24 hours of admission to hospital and weekly thereafter to ensure patients receive the appropriate nutritional care plan during their inpatient stay. Steve Wedgwood, interim director of Strategic Estate Development and Asset Management, said: “It’s very gratifying for the trust to be recognised in such a way as being a leader in London in terms of meeting hospital food standards, providing good patient meal satisfaction and having a good food ‘culture’. It also complements the recent work the trust has been carrying out in partnership with the Soil Association and its ‘Food for Life’ programme to review and develop our Food and Drink Strategy and transform the food experience for our patients, staff and visitors.” TAUNTON & SOMERSET NHS TRUST Musgrove Park has been developing best practice initiatives in areas such as food waste reduction, and making cost savings of £120,000 per year without any loss in food quality. Moving to a same day system and working closely with its catering provider, housekeeping team and ward nurses, food waste was reduced from 21 per cent to five per cent through effective monitoring of patients’ needs and bed turnover. A new food folder provides housekeeping staff on each ward with a greater clarity on the meals offered. Taunton & Somerset NHS Trust were the recipients of a Health Business Award in 2016 for their catering department, recognising how Musgrove’s food service was rated 93 per cent for food in NHS England’s annual patient-led assessments of the care environment, which put the hospital top in the South West. Linking with the Healthy Food Company, the hospital is now offering a new range of healthier meals on the children’s wards menus, providing the perfect balance of carbohydrates, protein and good fats for children to support them in their development. The hospital has also committed to working


HB Top 10


NHS England has announced that sugary drinks will be banned from sale across NHS hospitals in England from July, with the new rules also heavily restricting the sale of any high calorie foods closely with all food and drink outlets on-site to make sure they continue to promote healthy nutritional choices, including strongly encouraging the sale of non-sugary drinks at Musgrove Park Hospital and not allowing advertisements or promotions of sugary drinks. Hayley Peters, executive director of patient care at Musgrove Park Hospital, said: “This award really is a testament to all the hard work done by staff across the hospital to make sure our patients get the best possible food and drink served to them. Here at Musgrove we have created a culture of catering being everyone’s responsibility, as we know that if we get it right it goes a long way to helping patients’ recovery. Along with the improvements we have made to the way our catering operates, we have also made significant cost savings, which has been reinvested back into patient care at the hospital.” SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST Sheffield Teaching Hospitals NHS Foundation Trust, who recently won a Health Service Journal Award in recognition of its pioneering work to provide nutritious, healthy and sustainably sourced food to patients, produces and delivers 40,000 meals to patients and staff across six hospital and community sites. As well as achieving the Soil Association Food for Life Served Here Silver Award, the trust is one of the first NHS hospital


sites in the UK to pilot and achieve a new Green Kitchen Standard – run by the Soil Association and the Carbon Trust. Sheffield Teaching Hospitals NHS Foundation Trust now produces over 75 per cent of its meals from scratch, reducing waste and packaging. Additionally, 50 newly-trained healthy eating and sustainability champions were given extra training to drive change in working practices and promote the benefits of healthy eating, waste reduction and recycling. Emma Wilson, head of catering for the trust, said: “We’re enormously proud to have won this prestigious award. We are continually working to achieve best practices in all that we do, including providing healthy, high quality food at good cost for our patients and staff and supporting the NHS carbon reduction strategy. Achieving the Food for Life Silver Award and the Green Kitchen Standard has enabled us to completely revisit change in our working practices, which is all the more remarkable when we are one of the largest NHS trusts in the country. Not only has this improved patient satisfaction scores but will inevitably have a wider environmental impact on the community which we serve.” NORTH BRISTOL NHS TRUST North Bristol NHS Trust collected the top prize in the Food Award category at the 2015 NHS Sustainability Awards in recognition for the significant steps the organisation has taken to source local, seasonal, organic and fairly traded food. "




HB Top 10


HEALTHY EATING # As part of this initiative, the trust, which was the first NHS organisation to be awarded a silver catering mark from the Soil Association, now sources all milk from a local dairy farm in Wellington, Somerset, all meat from a local butcher and all eggs are free range. Additionally, the trust’s catering team operate winter and summer menus to make the most of seasonal produce and reduce food miles. Gary Wilkins, head of catering at North Bristol NHS Trust, said: “The Catering Mark is something tangible to show patients, visitors and other interested parties just how important providing improved patient meals is for us here at North Bristol NHS Trust. But it’s not just the patients that benefit, we feel we are really contributing to the local economy and feeding back into our community.” HINCHINGBROOKE HOSPITAL The catering team at Hinchingbrooke Hospital won the catering award at the 2015 Health Business Awards for the ‘high quality and nutritional value of its meals’. Driving towards the use of fresh ingredients in its meals, the meat used in hospital meals is from red tractor farms, milk and eggs are organic and all fish is Marine Steward Certified (MSC), with 80 per cent of ingredients sourced from local suppliers. In June 2016,




Hillingdon’s food was praised by Great British Bake Off judge Prue Leith, who said that the trust ‘should be proud of the freshness, range and quality of the meals and snacks it provides not just to patients but also staff and visitors’ the Garden Restaurant, located on the first floor of the main hospital building, became the first and only in-house NHS service to be awarded the Gold Catering Mark from the Soil Association for the standard and quality of its food. Offering a varied selection of nutritious, freshly prepared food at great value, the organisation prides itself on using only high quality fresh ingredients. Lance McCarthy, chief executive, said: “We were delighted to win the Hospital Catering Award at this year’s Health Business Awards. Good nutrition plays a vital role in a patient’s recovery. Our catering team really understand the importance of good nutrition and are committed to providing the best quality produce to help improve patient and staff well-being. In the last year we have seen patient satisfaction levels rise to more than 96 per cent. This is a result of the team’s determination to provide our patients with high-quality, healthy food that meets their nutritional needs.”

TAMESIDE HOSPITAL Tameside Hospital in Manchester has become the first in Britain to ban sugar from its restaurant in an effort to tackle growing concerns about obesity among NHS staff. The hospital has removed all added sugar from the meals it prepares for visitors and health service workers, and taken sugary snacks and fizzy drinks off its menu. The only drinks now available are tea, coffee, milk and water. Campaigners have welcomed the move and are urging other hospitals to follow in Tameside’s footsteps. Tameside Hospital introduced its ban after an NHS England consultation in November last year found widespread support for a ban on sugary drinks in hospitals and clinics. A successful trial in which 100 staff members signed up for a weight loss scheme also catalysed the move. By following the clinically proven Slimpod programme, they reduced their portion sizes, ate healthier foods and lost weight. The most successful person on


the study lost 13.1kg over the 12 weeks, and one who had been chronically diabetic now has the condition under control. Karen James, chief executive of the hospital, said: “The Slimpod programme gently retrains the brain to change how people think and feel about food, enabling them to instinctively choose to eat better, want to eat less and enjoy moving more. As a result of the programme, many of my staff say their behaviour towards food has changed. Snacking has dramatically reduced, and for many it has stopped completely. They say they are sleeping better and are feeling less anxious and stress at work, which can only have a positive effect on the patients.” UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST In 2015, County Hospital in Stafford became only the third hospital in the country to be awarded the Gold Food for Life Catering Mark by the Soil Association for serving fresh and healthy meals, an accolade that also saw the catering team at the hospital win a Green Award from Stafford Borough Council for local food procurement. However, not content with just winning the award, University Hospitals of North Midlands NHS Trust then invested £2 million in the kitchens at County Hospital, modernising kitchen facilities and allowing for the provision


of locally-sourced produce and greater choice for patients, as well as cutting food waste. Rob Willatt, catering manager at County Hospital, said: “The team have been working to increase the amount of good, quality food we source from local suppliers and these awards are fantastic recognition for that work. It is important that the trust provides sustainable and nutritious food for its patients as well as supporting local businesses in Staffordshire. By replacing current suppliers in favour of local food producers, this improves the economic, social and environmental well-being of the area. It has also allowed us to update the patient menu to provide our patients with more choice than ever before.” GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST The Soil Association’s Food for Life Catering Mark bronze award recognises Guy’s and St Thomas’ progress towards preparing sustainable food for patients which is ethically sourced and meets nutritional guidelines, which also contributes to the lowering of food waste recycling. The trust’s Nutritional Care Strategy, launched in 2016, helps staff prevent malnutrition in vulnerable patients, provides safe specialist nutrition where required and encourages patients, staff and visitors to choose healthier food options. In June, inpatient feedback showed significant improvement in hospital food choice, help from staff to eat meals and quality of food on offer. Robert Cormack, group catering manager at Guy’s and St Thomas’, says: “We are one of the few remaining hospitals making all our food freshly in our kitchen on site – the Catering Mark is the perfect tool to help us take our food to the next level, so we’re delighted to receive it. “We already work closely with clinical staff to ensure that food is as much a part of a patient’s recovery as their treatment. This award is the perfect incentive for improving patient food even further – for example, we have taken out all additives, trans fats and things that aren’t good for patients. Our strategy will help us keep firmly on track. It’s the simple little things that make the patient experience that little bit better.”

8 EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST Working in collaboration with Serco, East Kent Hospitals University NHS Foundation Trust serves up over 1,000 main meals each day to patients across the trust’s three main sites in Ashford,


HB Top 10


Canterbury and Margate. Since 2012, the trust has offered a finger food platter menu for patients with advanced dementia who are less dextrous and may struggle to use cutlery, as well as a picture menu to make it easier for those with communications difficulties to understand and choose their meals, drinks and snacks. Consequently, the inaugural Hospital Caterers’ Association (HCA) ‘6Cs Award’ was awarded for the professional collaboration between Serco and the NHS’s own clinical and dietetic teams to improve the standard of patient catering. Furthermore, almost three in four inpatients consider hospital food to be very good or good (72 per cent) while patient satisfaction levels for hospital food reached 93 per cent in 2016, up from 82 per cent, according to a separate monthly survey of hospital inpatients by Serco, who provide the food. Wendy-Ling Relph, trust Matron for Nutrition & Quality Improvement, said: “Over the last four years, the trust and Serco have worked closely together developing our patient catering services. We are delighted to have our efforts recognised with this prestigious award. The national judging panel were so impressed that they plan to visit East Kent in order to share our innovations and commitment with other hospitals across the country.” BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST Catering staff at Blackpool Victoria Hospital were awarded a five star food rating for the seventh successive year in June last year. Environmental Health inspectors from Blackpool Council checked the kitchens, food preparation and cooking, food hygiene systems and temperature records. Staff at the trust also use Nutrition and Hydration Week to highlight, promote and celebrate improvements in the provision of nutrition and hydration locally, with the catering department named the organisation’s Clinical Team of the Year in the internal Celebrating Success Awards. Yvonne Widdows, senior site services manager for Blackpool Teaching Hospitals NHS Foundation Trust, said: “This award is a real achievement when you think about the amount of food we produce here every day, but it’s important to us that we stay on top of our food safety requirements all the time. “Patients, visitors and staff can continue to have confidence in the standards of catering services they are receiving and that we produce food in a safe manner. We know how important meals are to our patients and it can often be the highlight of their day. I’d like to say thank you to the team for all their hard work; it really is a team effort to achieve these results.”

10 !



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A MARKET SUCCESS FOR GLUTEN AND MSG-FREE There was a time when gluten and MSG-free diets were derided as being nothing more than a swanky food fad propagated by glitzy rich and famous folk and trendy political lefties. But for those suffering the misery, often painful discomfort, caused by eating food containing gluten and or MSG, such derision must have been galling But it seems that gluten and MSG-free foods are now viewed as less a fad and more a sensible lifestyle choice. This is especially so for those intolerant of the glutenin and gliadin proteins in various grains and starches, and those for whom the sodium salt elements of glutamic acid, used by the food industry to intensify the flavour of a wide range of foods, appear to cause a variety of health problems. MARKET EXPLOSION Over the past few years there has been an explosion in the market for gluten and MSG products with one in 10 new food products launched by the food manufacturing industry in 2014 being gluten-free. According to a report by Douglas Faughnan, senior food and drink analyst at market research agency Mintel, sales of gluten-free products in 2014 reached £184 million, up 15 per cent from 2013. The report also found 15 per cent of households were avoiding products containing gluten, and more than half because they believed it was part of a healthy diet. So, for all the past derision, it looks as if gluten and MSG-free diets are here to stay. And that gluten and MSG-free foods are viewed as less a fad and more a lifestyle choice is evidenced by the fact that up and down the country supermarkets such as Sainsbury’s, Tesco, Waitrose and Morrisons are giving over more and more shelf space to gluten and MSG free food products. MARKET FOR GLUTEN & MSG-FREE One company that entered the gluten and MSG-free food market in 2000 is Herefordshire based Bosse Interspice Ltd. Through the close working relationship it had formed with NHS Heartlands Trust’s catering team, Bosse had become aware that caterers throughout the NHS were having trouble finding companies able to manufacture and supply the gluten and MSG-free food stuffs needed to satisfy patient dietary requirements. And so it was that Bosse set about developing a range of gluten and MSG soups, sauces, gravies, custards and dessert sauces to meet the ingredient quality, functionality – convenience, ease of use and cost effectiveness – criteria demanded



by the NHS. Its ingredient quality criteria were easily met because Bosse Interspice is renowned throughout the UK food manufacturing, food service and catering industries for using only the very finest quality natural ingredients in its food seasoning, flavour concentrates and culinary herb and spice products. Bosse met the NHS criteria for functionality by ensuring all its products can be prepared and served either as an instant hot-water ‘whisk and serve’ application at ward level or, prepared as a cold-water application in a hospital’s central kitchen. Finally, patient dietary considerations apart, by far and away the most important NHS criteria Bosse had to meet is patient, or consumer, acceptance. Despite Bosse’s products being instant mixes that are free of the food most industry’s most common taste enhancing ingredient, monosodium glutamate, patients reported that Bosse’s soup, sauce, gravy and custard flavour mixes all tasted great and moreover, that they also feel good in the mouth and smell exactly like proper home-made soup, sauce, gravy and custard should smell. It is now seven years since Bosse first developed its gluten and MSG-free products in conjunction with NHS Heartlands Trust’s catering team, in which time Bosse has gone on to supply the catering teams of many

of the UK’s leading NHS hospital trusts. Bosse’s enduring and trusting relationships with NHS hospital caterers is predicated on its unerring commitment to ensure its products are constantly quality monitored and regulated in order that patient’s dietary requirements are met, and their eating experiences are as pleasurable as possible. SUCCESS The success of Bosse’s gluten and MSG-free products, and its continued growth as a supplier not only to the NHS, but to market sectors such as other health and care organisations, food service companies, professional caterers and restaurateurs is in no small part due to its unerring commitment to highest quality control standards. Bosse Interspice and its manufacturing partners operate to nationally recognised quality control standards such as BRC (British Retail Consortium) manufacturing, storage and distribution systems. ! FURTHER INFORMATION More information about Bosse Interspice’s gluten and MSG-free food service products can be found on its website at or by contacting Jensen Bosse on 01989 565971.


Written by Rosemarie Hoyle, divisional manager, apetito Healthcare

Changing the focus of hospital food standards



Do the Government Buying Standards have the scope and depth necessary to make a real impact on the catering system? Rosemarie Hoyle investigates In 2014, the Hospital Food Standards Panel (HFSP), an independent group established by the Department of Health and led by the chairman of Age UK, published a report on catering standards in NHS hospitals. The main body of the report contained a series of recommendations and five food standards which hospitals should follow. One set of standards were the Government Buying Standards. These cover issues of sustainable procurement, healthier eating across the entire hospital community and the nutritional needs of patients. They were positively received and, from April 2015, were written into the NHS Standard Contract. For the first time, food standards became mandatory for NHS England. Each year, around £2.4 billion is spent on public sector food and catering. How

this money is spent can influence three things: the health of the nation; the use of environmentally sustainable food; and support for the British food and farming industry. Therefore, the introduction of mandatory standards, which affect how this public money is spent, was a significant step in the right direction. Despite this and some reports of rising standards, local and national press continue to report negatively on issues surrounding hospital catering. Meals of substandard quality, with insufficient nutritional value and general lack of choice are reported so often that the standard of hospital food has become something of a talking point. It is no surprise that the first question asked when someone is discharged is: ‘how was the food?’.

Pu sector cblic will alw atering criticism ays face a high sand ensuring food is tandard of s hospitaerved across long anls will be a d diffi battle cult

IMPACTING THE CATERING SYSTEM Two years since the introduction of compulsory standards and negative discourse around hospital food dominates now more than ever. Clearly something is amiss, raising the question: do the Government Buying Standards have the scope and depth necessary to make a real impact on the catering system? Although the standards have set a good foundation for hospital caterers, covering issues such as production, processing and distribution, animal welfare, environment and resource efficiency, there are areas where they arguably fall short. For example, in the social-economic region. The standards cover equality and diversity, inclusion of SMEs and outline at least 50 per cent of tea and coffee should be fairly traded. However, there are no regulations surrounding the ethical trade of other ingredients and hospitals are not encouraged to support movements such as the Ethical Trade Initiative. Furthermore, the standards do not touch upon the fair payment of those in the supply chain, with no proposal of backing Living Wage Employers. Although headway has been made in most "



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STATE-OF-THE-ART HOT FOOD SOLUTION LAUNCHES IN THE UK As we launch into 2018 it’s a great opportunity to look back over the past year and celebrate all those achievements big and small that have helped shape where we are today The recent Health Business Awards on 14 December were a fantastic opportunity xoxoxo for this, and we would like to extend an enormous congratulations to all the award winners, and indeed the individual nominees. It was a brilliant event and the show of talent, passion and dedication amongst everyone taking part was truly commendable. The high-spirited presentation from Dr Phil Hammond also provided an entertaining start to the festive season, and we shall be making careful steps to follow his Daily Clangers in the coming year, and make sure we get our five portions of fun a day! We would like to extend special congratulations to the dedicated staff at Hillingdon Hospitals NHS Foundation Trust, winners of the 2018 Hospital Catering Award. Their work in boosting healthy food provision within their hospitals is admirable, and the team work tirelessly to ensure patients and staff have access to a range of hot and healthy food options around the clock. HEALTHY EATING Here at Ooft Kitchen!, we’re big fans of healthy eating, and we know the difference a simple hot meal can make. Whether its lifting your spirits at 3am when you thought there was no real food in sight, or just keeping you going so you have more time to think about the important things. The days of sitting in A&E with nothing but a vending machine filled with calorie-laden, sugary snacks to eat are over! We’re here to give you hot food at your fingertips, whenever you need it. Our state-of-the-art, fully-automated 24-hour hot food solution has just launched in the UK. Ooft Kitchen! combines state-of-the-art-technology, healthy ingredients and speed to heat wholesome, all-natural, ready-to-eat meals in minutes. Before ordering a meal, users simply browse the onscreen menu which displays each meal’s ingredients, allergens and nutritional information, giving the consumer an opportunity to make a decision before ordering and paying for their meal. Once a meal is chosen, users can pay using cash, a credit or debit card or Apple Pay, and two minutes later a hot, ready-to-eat meal is delivered.



We know that hospitals cater to a spectacular range of individuals on a daily basis. For this reason, we’ve done our best to ensure that the Ooft Kitchen! range caters for all dietary requirements: the entire menu is naturally gluten free (and suitable for coeliacs) with high protein, vegetarian and vegan options available. The ingredients and allergens are all clearly outlined on-screen, along with the calories and key attributes for each recipe. Each meal is prepared by hand in its BRC Grade A+ commercial kitchen using all-natural ingredients. Again, by investing in state-of-the-art technology, the meals can be stored without refrigeration which by default eliminates wastage and dispenses with the use of artificial preservatives or additives. Crucially, Ooft Kitchen! has provided NHS Hospitals with a solution to meet their new CQUIN Indicator 1b criteria (introduced March 2017) to ensure that hot and healthy

options are available to staff, patients and visitors 24 hours a day. The range also meets guidelines for salt and sugar. Ooft Kitchen! has commenced its roll out to hospitals throughout the UK with 100 to be located during 2018. Ooft Kitchen! is locating its kitchens within universities, student halls, the workplace, 24/7 distribution centres, ferries and both NHS and private hospitals, and has appointed leading UK wholesaler Bidfood to deliver its ready meals to its kitchens nationally ensuring consistent supply and availability. So as we enter into the new year, whatever it may hold, we hope that we can all take time to spend on the important things that it has to offer, and appreciate those who work tirelessly inside and alongside the NHS, to help us on our way. ! FURTHER INFORMATION


Campaigners welcome ban on the sale of sugary drinks in hospitals At the start of January, NHS England announced the banning of sales of sugar-sweetened drinks in hospitals from July 2018.

Two years since the introduction of compulsory standards and negative discourse around hospital food continues to dominate. Do the Government Buying Standards have the depth necessary to make a real impact on the catering system? # areas, in particular production, processing, distribution and environment, these are not the most pressing areas in terms of patient satisfaction and health. When the topic of hospital food hits the headlines, for the majority of the time, this is in relation to the quality, nutrition and taste of food. For unwell patients wanting to get better, these are the areas which matter most. Yet they receive little to no focus across the standards. Another of the five standards recommended by the HFSP and made mandatory in 2015 was the British Dietetic Association (BDA) Digest. The Digest is a reference document designed for use in hospital and care settings with sections on nutritional analysis and menu design. However, the procurement of nutritious foods is the first step towards positively influencing a patient’s diet and the Government Buying Standards lack detail in this area. If procurers were given comprehensive guidance on buying nutritious meals and foods, this would set the catering sequence off the best possible start. The current standards give direction on buying foods with reduced salt, saturated fat and increasing fruit and vegetable, fibre and fish consumption. Despite this, menu cycle analysis is only included in the best practise section and is therefore not a legal requirement, meaning ingredient purchases can be made without consideration of the nutritional value towards a meal. Additionally, controversial ingredients such as artificial trans fats and GM ingredients are permitted.

A CHANGE OF FOCUS Furthermore, there are no stipulations in the Government Buying Standards regarding the quality of food procured and served. In fact, this is not touched upon in any of the five standards introduced. For a hospital patient, mealtimes may well be a highlight of the day. Even if meals and ingredients are ethically sourced, kind to the environment and nutritious, if they are badly presented and bad tasting, patients will ultimately be dissatisfied. Clearly, there needs to be a change of focus. The standards cover a range of topics and their introduction was a crucial step towards regulating the food served in hospitals. Yet there are notable gaps and there has been criticism that they are weak, only reflecting basic catering standards. Additionally, a review of progress two years after the HFSP’s report found widespread breaches of what were meant to be mandatory standards. For example, 48 per cent of hospitals were found to be non-compliant with the Government Buying Standards, whilst only 55 per cent of hospitals follow the BDA’s Nutrition and Hydration Digest. Arguably, there are two issues at hand. Firstly, the food standards introduced into the NHS Standard Contract are not comprehensive enough. Secondly, no real regulatory programme has been introduced, this leading to slow adoption of the standards. Public sector catering will always face criticism and ensuring a high standard of food is served across hospitals will be a

NHS England released an updated contract for hospitals, which, for the first time, included a clause prohibiting the sale of sweetened beverages. Retailers including Marks & Spencer, WH Smiths and Subway had already agreed to cut sales of sweet drinks to 10 per cent of their output, but the new rule will stop outlets from selling the drinks at all. It also means a ban for fizzy and sugary drinks in hundreds of NHS cafes and staff canteens. England will be the second country in the world to introduce such a plan, after Portugal. New rules will also heavily restrict the sale of any high calorie foods. From next April 60 per cent of sandwiches and pre-packed meals on sale in hospitals must contain a maximum of 400 calories per serving – rising to 75 per cent of cases a year later. And 60 per cent of sweets and chocolates sold must not exceed 250 calories – rising to 80 per cent by 2019. Katherine Button, Campaign for Better Hospital food Coordinator, said: “We welcome this move by NHS England to ban the sale of sugary drinks in our hospitals. “Tooth extraction as a result of tooth decay is the most common cause for hospitalisation of children under five – putting unnecessary pressure on stretched NHS services. This bold leadership from NHS England chief executive Simon Stevens is exactly what we need to tackle these big health challenges.” Find out more at

long and difficult battle. Great progress has been made, however there needs to be a change of focus – to the needs of the patient. Once patient satisfaction has been improved, so will public opinion. Standards need to be comprehensive across all areas, set down in legislation, with a strict supervisory process. Without this, there is risk they will be only partially adhered to or simply ignored, leaving Trusts in a halfway house. ! FURTHER INFORMATION



Case Study


Wilo takes the lead in search for energy solutions that reduce energy usage, energy bills and emissions Whilst Wilo are renowned the world over as a major pump and pumping system manufacturer, in recent years, the emphasis has been changing from simply being a supplier of pumps, to becoming a supplier of energy solutions. Wilo is increasingly moving away from being a reactive supplier of simply what a specifer requests. Today it is a proactive supplier of solutions where companies and organisations that want to find ways of reducing their energy usage, energy bills and emissions, find a partner in that search. Wilo is knocking on their door with a way of doing just that. less expensively, in a more environmentally Every major building relies heavily on friendly way and more reliably. They aim to pumps of various designs, shapes and sizes offer a win ‘to the power of several’ solution. to run the heating, air conditioning, chilled The key words are ‘lifecycle costs’. Modern water, potable water supply, to distribute pumps are undoubtedly more expensive than harvested rainwater and to remove the their elderly relatives. The new technology sewage and greywater from the building. in the modern pumps has a price. But the Their roles are many and various but all are payback from modern pumps is usually vital. Modern pump technology allows these extremely fast in relation to the capital cost tasks to be undertaken far less expensively, because the energy required to run these simply by replacing elderly existing pumps new pumps is far less, often infinitesimally with modern high efficiency pumps, less, meaning that over a 15-year lifecycle, designed to do their jobs better, quicker, huge savings in terms of energy cost can Health_Business_Magazine_18_01.pdf 1 04/12/2017 15:23:14

be made, large emission reductions can be shown and with far less energy use goes far lower energy bills and far lower operating costs for the building. The process for achieving these huge savings can be disarmingly simple. An initial visit to discuss the requirements. A return visit to survey the plant rooms. A programme to assess the existing set up and to ascertain the most sensible replacements utilising the latest technology. Calculation of the life cycle costing improvements available and presentation of the cost savings and the emission reductions available. It’s a process that Wilo has been through many times, with a number of predefined target buildings – universities and colleges, government buildings, banks, hotels and leisure facilities and manufacturing bases. Visit Wilo’s website for more information or give the company a call today. FURTHER INFORMATION Tel: 01283 523 000

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Go with the the future today 22



Written by Mark Walker, chair of the CIBSE Healthcare Group

Air conditioning and the Clean Air Act

Facilities Management


Air conditioning systems are fundamental to the operation of many healthcare buildings. Mark Walker, chair of the CIBSE Healthcare Group, explains the importance of good design and regular maintenance in keeping these systems bacteria-free The development of air conditioning systems has come a long way since the inception of the modern hospital, but how clean are these systems and can they be kept free from bacteria? Before answering this question, it is important to understand some of the engineering terminology used and the types of bacteria under consideration. The term ‘air conditioning’ can encompass a variety of systems: from a single ‘split’ air conditioning unit, which may only serve one room, to a full air handling system with cooling, heating, filtration, humidification, ductwork and terminal units serving an entire building. This article is based on the latter. In it the terms ‘ventilation’ and ‘air conditioning’ are interchangeable. The primary role of ventilation in a healthcare environment is to dilute and control airborne pathogens, provide thermal comfort and supply fresh air to occupants. Air conditioning systems can take many forms. For example, in general wards areas they will provide fresh air and help in maintaining comfortable conditions for the occupants. However, in isolation rooms and operating theatres the air conditioning system will be part of the infection control solution. Health Technical Memoranda (HTM) 03-01 Specialised Ventilation for Healthcare Premises provides guidance on the design, installation and maintenance of air conditioning systems. Although this document is over seven years old, it still provides an outline of the general principles and philosophy of healthcare ventilation. "

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T F INSTALLATIONS LTD is a dedicated specialist company in Fire Detection, fire alarm system design and Security Systems, founded in 2012. It has quickly become one of the most respected fire system companies in London and the South East following a series of high profile installations and has developed a founding reputation for providing innovative products and superior services that meet and exceed its clients’ expectations. T F INSTALLATIONS LTD predominantly works directly for end user clients in the commercial sector. We offer a complete range of services to our clients; from sales, fire alarm system design, installation, testing, commissioning through to ongoing maintenance and technical support. This includes identifying client needs, determining options and designing systems at the most competitive cost without compromising quality. In 2012, T F INSTALLATIONS were appointed an Engineered Systems Distributor (ESD) for Notifier Fire Systems, a subsidiary of Pittway Corporation of America, one of the world’s leading fire systems manufacturers. Our partnership with Notifier ensures that we are able to offer the best service possible – having become a specialised company with a strong reputation for the quality and reliability of installations with personal service as a local company backed by a multinational company leading the way in fire prevention technology.

AIR CONDITIONING # It is also worth considering that healthcare buildings are a place of work and so the air conditioning systems also need to comply with the Health and Safety at Work Act 1974. The Act places a duty on an employer to maintain plants and systems so that they are, as far as is reasonably practicable, safe and without risks to workers’ health. THE TRACE OF BACTERIA When talking about bacteria in air conditioning systems, it is important to remember that all air conditioning systems will contain traces of bacteria and other organisms. In a well-maintained system the levels of bacteria are likely to be so low that healthy people are, generally, unlikely to be affected. However, in a healthcare building, where there are potentially many vulnerable people, some with compromised immune systems, the issue of bacteria in air conditioning systems can be much more serious. There are many forms of bacteria that can be found in an air conditioning system including MRSA, C. Difficile and Legionella, along with Aspergillus spores in the air itself. In healthy people its spores do not normally cause any harm. However, in a hospital setting with immunocompromised patients, Aspergillus can result in serious diseases including: invasive aspergillosis, allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis and aspergilloma. To minimise the risk of Aspergillus spores, it is particularly important when considering the design or refurbishment of an air conditioning system not to locate the air intakes in the vicinity of compost heaps or any areas where decaying vegetation is present. Legionella is a bacterium which thrives in warm water in dark and dirty conditions, so it is important to ensure that no pools of water are present within an air conditioning system. Generally the occurrence of water will be due to poor system design rather than any shortfall in the maintenance and ductwork cleaning regimes. Split air conditioning units or comfort cooling units can be particularly susceptible to Legionella. These units are allowed by HTM 03-01, but only for non-critical areas. In reality they should be limited to office type accommodation or seminar rooms because split units produce condensate. There can be an issue with these units when small quantities of condensate are produced, which can lead to pooling and puddling of water which can then become stagnant and can increase the possibility of legionella developing. To avoid this, the condensate drains from the

split air-conditioning units should comply with the requirements of HTM 03-01. INSPECTION AND INSTALLATION HTM 03-01 Part B requires all ventilation systems to be subject to at least one visual inspection annually. In the case of critical care ventilation, these systems should be inspected quarterly with their performance measured and verified on an annual basis. Air conditioning systems should be designed as a series of smaller systems specific to a department or area rather than one giant system so that they can be easily managed. In the case of operating theatres, for example, one air conditioning system should be dedicated to each theatre. This will contain any bacteria and reduce the need to close more than one theatre when maintenance is required. Outside air intakes to the air conditioning system must be located in a suitable position and kept clean. The Chartered Institution of Building Services Engineers’ (CIBSE) document TM21 Minimising Pollution at Air Intakes provides designers with the information that will help in locating ventilation inlets. Air exhausts should be a minimum distance of 4m from an air intake and, ideally, 10m apart to stop the exhausted air recirculating into the supply air intake. Air conditioning systems incorporate filters to remove particulates from the air.

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general areas in hospitals; and high, such as laboratories, treatment areas in hospitals and high quality offices. The standard also recommends a system assessment frequency. The standard states that an inspection frequency should be specified and not a cleaning frequency to allow for changing conditions that may actually alter the frequency at which a system needs to be cleaned. Providing correct filtration to the appropriate standard and class for the area served will reduce the possibility of bacteria in the air conditioning system. Filters should be inspected and maintained in accordance with the recommendations of the manufacturers taking into account the location of the hospital and the air intakes. For hospital environments, it is recommended that air handling units (AHUs), ductwork and air terminals be inspected annually, in line with HTM 03-01 for annual inspection and verification of ventilation systems.

Facilities Management


CLEANLINESS QUALITY CLASS In order to reduce the build-up of bacteria in the ventilation system the appropriate ductwork cleaning is required before the system is brought in to use and while the system is in use. Dust can also carry the spores of Aspergillus, so cleaning new installations to reduce the presence of dust is vital at both the installation and commissioning stages of an air conditioning installation. In addition to providing a safe and clean system, ensuing that ductwork is clean from new helps reduce energy use. Apart from obvious clinical benefits it makes

The primary role of ventilation in a healthcare environment is to dilute and control airborne pathogens, provide thermal comfort and supply fresh air to occupants, and, therefore, air conditioning systems can take many forms If the correct filters are used and these are correctly installed then it should not be necessary to clean ductwork on an annual basis. If ductwork is dirty, that would usually signify that the filters are not working correctly or that the filtration is inadequate or has not been properly maintained. Correctly installed filters should keep ductwork clean for up to 10 years. The British Standard, BS EN 15780:2011 categorises the level of cleanliness in ductwork into the three quality classes: low, such as rooms with only intermittent occupancy e.g. storage rooms and technical rooms; medium, such as offices, schools restaurants and

good business sense. Keeping air conditioning systems bacteria free (or as bacteria free as possible) is down to good design, installation and maintenance. In a well-designed system, ductwork cleaning should only be considered where the annual inspection has highlighted a need. Finally, it is worth considering that bacterial contamination in healthcare facilities is far more likely to come from the people in that environment than from a well-designed and maintained air conditioning system. ! FURTHER INFORMATION



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FG Wilson has installed over 600,000 generator sets since 1990 which means quality and in-service reliability are important. With the aid of managing director Ann Brown, the company explain how its generators are key to the critical power needs of an NHS hospital “I think working through a challenge is in our DNA,” says Ann Brown, managing director of FG Wilson. Coming from someone else, this might sound like a cliché, but this time there is some force behind the statement. Just over 50 years ago, FG Wilson was one of many small engineering companies in Northern Ireland, owned and managed by its founder Fred Wilson. Then came the energy crisis of the early 1970s. Turbulence in the Middle East led to restrictions in the supply of oil and higher prices which created huge transport and power infrastructure problems in many western economies. With electricity rationed in the UK, Fred saw an opportunity. He chartered planes and flew in electricity generator sets from the US, auctioning them from a warehouse near Heathrow Airport. A booming global export business followed and FG Wilson quickly found itself on a steep growth curve as Fred began manufacturing himself. Today, FG Wilson manufactures generator sets powered by diesel or gas engines with power ratings from 6.8 – 2,500 kVA for small to very large businesses. In the UK, FG Wilson products are most often installed for standby power in case the mains supply fails or for temporary power on construction sites. Customers with critical power needs have always been a key part of FG Wilson’s business and the brand today has many customers in the healthcare sector, including some of the UK’s largest hospitals. For each, that means a full turnkey power system. That ability to design bespoke power projects has been a core element of FG Wilson from day one. In the early 1970s, FG Wilson built its name designing, building and commissioning mini power stations in the Middle East, often in very inhospitable operating environments. The tradition continues today: in many European and Middle Eastern cities, it’s possible to look across the skyline and pick out large landmark buildings which rely on FG Wilson generator sets for standby power. This custom-engineering business for large generator sets is important to Ann. She comments: “We know this is something which FG Wilson does well. We’ve a long track record of experience, within our organisation and within the dealer network, world class facilities.” FG Wilson has a dedicated engineering

team who work with customers on load requirements, finding the right generator set, designing the complete layout of the generator set including exhaust and fuel systems, control systems, installation and commissioning. Ann says: “Our power systems are designed to accommodate critical loads in key areas of the building, which in a hospital means that during mains power loss, operating theatres, x-ray rooms and medical imaging centres are brought back on line rapidly via generator standby power.” THE IMPORTANCE OF MONITORING Hospitals have critical power needs and constant remote monitoring of the power system is important. The technology to do this is improving rapidly. In 2017, FG Wilson completed a major power project for one of the largest hospitals in Eastern Europe, Ljubljana University Clinical Centre in Slovenia which has 2,000 beds and treats 115,000 in-patients and 1.2 million outpatients each year. FG Wilson installed 5,000 kVA of standby power across four generating sets to provide emergency and standby power anywhere inside the main hospital building and a new Medical Emergency Unit. Ann says: “Our dealer designed and installed complete automation for this power

system, with monitoring software and the complete generator set system is connected to the main Control Centre and to local monitoring computers and smartphones and tablets of the maintenance staff.” FG Wilson has installed over 600,000 generator sets since 1990 which means quality and in-service reliability are important. Every new product goes through rigorous testing at a $26 million Engineering Centre in Larne, about 20 miles north east of Belfast, which also houses Europe’s largest fully automated hemi-anechoic chamber, providing state of the art acoustic research and test capabilities. And every product is released with a full suite of parts at FG Wilson’s aftermarket facility in Desford near Leicester, which stocks 11,500 product lines and ships up to 3 million parts annually. Ann is optimistic for the future: “Today our designs have moved on while the philosophy of our founders remains as strong as ever: self-contained generator sets which are easy to install and operate, designed for a long and productive working life, supported by a wide and professional dealer network and which represent value for money.” ! FURTHER INFORMATION



Energy Written by David Mackey, Carbon & Energy Fund



Implementing energy strategies in healthcare estates A new guide to energy best practice for healthcare estates has been published by the Carbon & Energy Fund. David Mackey outlines the background to the guide, the scope of its contents and usability Since the Lord Carter Report in February 2016 outlined opportunities for efficiency savings and environmental benefits within the health care system, the NHS, social care, and public health system, IHEEM and HEFMA have been supporting the Carbon & Energy Fund (CEF) in the creation of an essential piece of literature for all trusts – Implementing Energy Strategies in Healthcare Estates: A Best Practice Guide to the Model Hospital. Completed towards the end of September 2017, Lord Carter of Coles was so impressed with the final draft, he wrote the foreword: “I am delighted to introduce this best practice guide for developing trust-wide energy strategies for the NHS. This is a key area of strategic investment for trusts in meeting the challenge to reduce their estate operating costs. The economic benefits of strategic investment in energy projects are well known and understood by the NHS. National evidence suggests that there is still a lot more the NHS can do. This guide will provide a valuable source of information

to estates professionals, who have responsibility for developing viable strategic energy solutions for their organisations. “The ongoing revenue savings these schemes release provide much needed extra savings for trust boards. These resources can be utilised directly to improve the delivery of frontline patient care, or as leverage to provide capital funds with which to address the growing critical infrastructure and backlog maintenance risks of the NHS estate. Energy costs are currently rising and the outlook going forward is for that trend to continue. I believe this document, produced by the energy industry in partnership with NHS directors, professional and academic bodies, is the

most comprehensive source of reference material available to trusts, to enable them actively to develop and deliver commercially viable strategic energy solutions to significantly reduce the annual £650 million NHS energy bill.” With input from all of the CEF’s specialist team and suppliers, the guide covers every aspect of the energy infrastructure upgrade process, and clearly demonstrates the financial and environmental benefits of each energy technology and the suitability of those technologies for particular situations. Structured around a ‘Model Hospital’, the guide has been created with exclusive data garnered from over 40 schemes commissioned by NHS trusts that are already in commission, under construction, or, in the initial stages of sign up. Independent of all suppliers and pricing, the guide offers detailed information on the broad spectrum of technologies available to use within today’s health estate. All of the information featured has been tested and verified from ‘live’ schemes ranging in value from £1 million to £32 million – not lab tested or derived from a sales brochure.

The econom benefit ic s o f s t invest ra t e g project ment in energic sa y and undre well known the NHS erstood by evidenc , but nationa es l there is uggests that s more th till a lot eN can do HS

FUTURE INNOVATIONS As well as examining technologies available now, the guide also looks at those available in the future and at recent innovations that are starting to become financially viable. Each technology has its own section featuring: a description of the technology; how it can benefit a trust and what to consider. In order to achieve parity across trusts and technology instruction on calculating savings, it demonstrates what you should expect and


how it can be employed along with other technologies in real situations. By way of balance it also includes candid explanation of any pitfalls. For example, renewable energy is considered with fuel type. With biomass fuel do you opt for pellet or chip? Is there suitable on-site storage space for the fuel? What if the space for storage is near a cancer ward, is there an increased risk of infection? The guide also considers the technology from a technical point of view and provides guidance on how the health estates profession can go about creating a project that may include: procurement, framework or going it alone; the various types of contract available and what works best for what scenario; where the finance may come from and sources of capital available to a trust; what a finance director needs to know – ITFF vs Off Balance Sheet finance; and, the business case procedure and NHSI. Once the scheme is commissioned, the guide explains how to future proof the trust and why some schemes operate at 92 per cent efficiency when the NHS average for CHP is 57 per cent (the difference could be easily in excess of £200,000 per annum). Not forgetting what happens year on year with monitoring and verification, what works and who should be responsible. Looking to the future, the guide investigates innovations that may well be more easily available in the near future, including: thermal and battery storage; capacity markets; heat pumps; and, district heating schemes. Many

trusts have been approached as anchor loads for district heating schemes. The government has committed to provide £300 million of grants and soft loans for these types of projects. What should a trust consider?



Pre-publication, the 116 page document was rigorously examined by a panel of delegates that included: two distinguished Cambridge University professors, representatives from NHS Improvement, NHS Scotland, Heads

Rampton Hospital replaced a coal fired heat plant with a CHP unit, and a wood chip boiler. The trust reduced energy costs by 44 per cent saving around £790,000 per year, cut 8,614 tonnes of CO2e and produces significantly less air pollution The final section looks at how the health estates professional will need to look outwardly for benefit to the NHS in the way it interacts with: the surrounding community via private wire; district heating; and, creating or being part of a virtual power station. In the last few years there has been an increasing take-up of renewable and low-carbon energy generation of electricity at a localised scale and to a lesser extent, there is a move to develop low carbon district heating, energy distribution and storage solutions. This is moving traditional energy delivery away from the total reliance on centralised power generation and more towards an integrated infrastructure, which in the future should be more responsive to consumer demand patterns and renewable energy source availability.

of Estates from several of the larger NHS trusts, the recent and current presidents of both IHEEM and HEFMA, the CEO and FD from CEF and contributing technical authors with more than 50 years’ experience and over 100 projects in the energy services sector. Highly commended for its suitability for a diverse range of audiences as well as its in-depth content, writing style and visual accessibility (navigation, type styling, tables, illustrations, diagrams and info graphics), one academic remarked: “There are many books that are effectively greenwash, finally we have a guide that has real and usable content.” ! FURTHER INFORMATION




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As NHS trusts across the country continue to record large financial deficits, the process of recovering debt they are owed takes on added importance. And, as Stephen Sutcliffe, director of Finance and Accounting at NHS Shared Business Services explains, the money owed across the NHS is measured in the eye-watering billions of pounds Those working outside the NHS may be forgiven for thinking the debate around debt owed to the NHS is mainly concerned with the cost of treatment provided to overseas patients, which is money that, if left unpaid, is almost impossible to recover. Whilst this is certainly a significant issue for today’s NHS – and one that the government seems intent on tackling – the amount due is still only a fraction of that owed by the main NHS debtors. Instead, the vast majority of debt we at NHS Shared Business Services (NHS SBS) work to recover for our clients is actually

from other parts of the NHS. Most of this NHS to NHS debt is between commissioners and provider organisations, where a hospital trust invoices an NHS commissioning organisation for activity it has carried out. However, a considerable amount also stems from funds owed between different NHS providers. This is usually where a consultant is employed by one hospital, which pays their salary, but works some of their contracted hours at a different trust, resulting in their salary needing to be recharged. Whilst much of the money that circulates around the NHS is paid and collected without

e With th debt f yo majoritng within occurri ing around w and flo the process of t , the NHS it for paymen chasingnything but is a forward straight

issue, at any one time the average NHS trust is still likely to be owed around £15 million. Last year, meanwhile, NHS SBS alone was able to recover around £20 billion for the NHS providers, commissioners and arm’s length bodies we partner with. Considering the huge numbers involved, it may come as a surprise to anybody unfamiliar with the unique way the NHS is organised, that this occurs against a backdrop of frequent reports of NHS organisations in serious financial difficulties. RECOVERING DEBT With the majority of debt occurring within and flowing around the NHS, the process of chasing it for payment is anything but straightforward. In a normal commercial environment debt collection is fairly uncomplicated by comparison. After 30 days a debtor is contacted by telephone. This would lead on to a formal letter, before the threat "

Written by Stephen Sutcliffe, director of Finance and Accounting, NHS SBS

Keeping money flowing through the system

Debt Management



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Debt Management


# of court action followed by court action itself and, if necessary, the involvement of bailiffs. Although there are instances of commercial debt in the NHS, the fact that most involves NHS owing to NHS means that this standard process is not appropriate. Instead it requires a different approach to keep money flowing through the system as seamlessly as possible. NHS SBS has a team of around 120 people working to chase and recover debt on behalf of the organisations we work with. Other NHS trusts commit their own resources from their in-house finance teams – not a great use of NHS staff time and expertise when you consider return on investment. Considering, somewhat ironically, the high financial cost and time-intensive nature of just keeping money moving around the healthcare system, it is obvious a more efficient solution will benefit the entire NHS. AN AUTOMATED PROCESS With this in mind, the recent investment NHS SBS has committed to improving the level of sophistication and better segmentation of different types of debt, will hopefully go a long way to solving what is currently a recurring and expensive problem for the NHS. We are focusing more, for instance, on using our national position and market share to identify and target the very worst payers – those that account for most of the debt chasing that takes place in the NHS. By supporting a few NHS organisations to change and improve their practices, we will improve the situation for the majority no end. Our recent investment in the very latest back office technologies, meanwhile, will see NHS SBS automate parts of the process of

We intend to introduce a Clearing House solution to the NHS in 2018, which will effectively mean that cash can flow more quickly and processing times are reduced, by eradicating many of the invoices that currently clog up the system debt collection, for instance, by generating the letters and emails that previously would have needed costly and often protracted manual interventions. We are also looking to introduce new collections functionality to improve effectiveness and efficiency, either as part of our ERP replacement project or on a standalone basis, and are constantly reviewing our processes to seek out automation opportunities in areas such as cash application. Most significantly, perhaps, is our intention to introduce a Clearing House solution to the NHS in 2018. Rather than having lots of invoices and numerous transactions between a local NHS commissioning body and one of its local NHS providers, we would instead facilitate the consolidation of invoices into one weekly or monthly payment that considers the net impact. This will effectively mean that cash can flow more quickly and processing times are reduced, by eradicating many of the invoices that currently clog up the system. It would also ensure that the current need for chasing countless different payments is no longer required. PLANNING AHEAD OF PAYMENT PLANS Meanwhile, returning to the issue of tackling individual debt, the Next Steps on the NHS

Five Year Forward View, published in March last year, said that the government has set the NHS the target of recovering up to £500 million a year in respect of cost recovery from non-UK residents – work that is being led by NHS Improvement. To help NHS trusts in this regard, we are currently piloting an income and receipting tool that provides hospitals with the facility to accept chip and PIN payments ahead of planned treatment. This replaces the need for paper invoices that are both inefficient and less likely to lead to actual payment. It will also allow hospitals to begin to replace paper-based cash systems and instead link payments, for things like prescriptions, directly to the general ledger. With NHS SBS providing a payment platform that is used by 100 per cent of NHS commissioning organisations and around 70 different provider trusts, we have sight of and manage a high percentage of total NHS spend. We are, therefore, better placed than most to develop and implement innovative processes and systems, changing the way the NHS manages and recovers debt across the board in future. ! FURTHER INFORMATION



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The NHS has long been seen as the envy of the world when it comes to the provision of quality care. However, when it comes to being viewed as an efficient mechanism for the funding of health care it is far from the envy of anyone at all

sts NHS tru just d collecteion of at ill £255 m 00 million least £5providing spent to foreign of the best trained nt professionals in the treatments in 2015, world. Nevertheless, e i t a p ng to one thing which hasn’t accordi AO changed so much though the N is the problem of funding.

The NHS is now fast approaching its 70th year. Less than three years after coming into existence in July 1948 the NHS would have its first taste of budgetary problems when it saw the introduction of prescription charges, dental treatment charges and charges for spectacles to help cover the already rapidly growing shortfall in cash needed to fund the health service as a whole. This in turn gave rise to the first resignation of a senior government official as a result of poor funding to the NHS. Seventy years later and the NHS is now bigger and better in lots of ways, providing a much needed and loved service in the UK with some of the most advanced treatment methods available on the planet, and some

The government plans to spend around £122 billion on health in England in 2017/18, or roughly £2,200 per person. Around £108 billion will be spent on the day to day running of the NHS. The rest is spent by the Department of Health on things like public health initiatives, education, training, and infrastructure. NHS OWED £500 MILLION EACH YEAR The NHS of course doesn’t just service the needs of UK residents, it also provides a service to the many thousands of overseas

Written by The Zinc Group

Effective recovery treatments for bad debt

Debt Management


visitors who come to the UK each year and find themselves in need of some form of treatment. This can vary from very minor ailments to very serious treatments such as heart bypasses or serious injury. As a result of some recent calls for action, the government has set a target to recover up to £500 million a year by 2017/18 from all overseas patients, although it is widely expected to miss this target by some considerable margin, but to be fair the NHS is not is the business of recovering money, in fact the NHS has far bigger priorities on its agenda than just cash. But the pressure is now on for the NHS and the many trusts within, to do more when it comes to managing issues such as health tourists and the misuse of the free prescriptions which can result in fines of up to £100.00 per person. !



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The government has set a target to recover up to £500 million a year by 2017/18 from all overseas patients, although it is widely expected to miss this target by some considerable margin

Health tourism scam costing NHS £20 million a year

Debt Management


A probe by The Sun newspaper has revealed how easy it is to get a fake European Health Insurance Card giving unlimited access to treatment. After receiving a European Health Insurance Card, EU hospitals can then claim the cost back from the UK government. It is believed that approximately £200 million, the cost of 8,600 extra nurses, is thought to be fraudulent as the tabloid claimed that the NHS has paid out more than £1 billion over the past decade. The Sun also claims that the NHS has reclaimed just £145 million over the past five years. With the NHS issuing 57 million new European Health Insurance Cards over the past decade, The Sun, who writes that one in five applications are fraudulent, used fake national insurance numbers to get cards issued in the names of Health Secretary Jeremy Hunt, Prime Minister Theresa May and US President Donald Trump. The Department of Health and Social Care said the abused system was being revised, with Conservative MP Sarah Wollaston, chairman of the Commons Health Committee, saying that the report ‘exposes a serious loophole, which needs to be closed immediately’. The Sun has also reported that Hunt and May have ordered NHS bosses to put new checks in place to stop fraudulent applications. Read more: ybp5bud8

" TIME FOR THE NHS TO CONSULT WITH THE EXPERTS NHS trusts collected just £255 million of at least £500 million spent providing treatment to foreign patients in 2015, according to a report by the National Audit Office (NAO). The report which reveals the latest stats available reveals that the NHS is failing to claim back money from foreign patients because half of doctors and a quarter of nurses do not think it is their job to ensure payments were made. It’s not difficult to see why health professionals would think this; after all they are not in the business of money management, they are in the vocation of health care and that’s where their priorities lay. The issues of debt within the NHS is a sensitive one, not just because it’s a

political hot potato, but because when you are dealing with debt and poor health you have to ensure that its handled with extreme sensitivity and understanding while dealing with the patient who has incurred the debt, both domestic and overseas. Some examples of this type of approach can be found at the head office of the Zinc Group, which is home to the aptly named E-Solutions team. Zinc was the first debt recovery agency in the UK to launch a self-service customer portal which allows customers to deal with their debts 24/7 from anywhere in the world, whilst ensuring that customers who need additional assistance are able to get it via Zinc chat – Zinc’s very own Instant Messaging service. As well as its customer portal which is

available online via any desktop service such as pc or Mac, Zinc also offers all of its customers a Smartphone app which is available via Android and Apple Store. Dougie McManus, CEO of The Zinc Group, said: “In 2018 Zinc will likely be the first Debt Recovery agency in the UK to deploy the use of fully interactive video communications to customers, these will be fully personalised videos sent directly to customers who will be able to interact and deal with their account within the video itself, this will be a first for the UK and will vastly improve performance with the late payment sectors by some considerable margin.” # FURTHER INFORMATION



Supply Chain Written by Emma Dunn, head of Capital Planning, NHS Supply Chain



Driving savings through equipment aggregation Emma Dunn, head of Capital Planning at NHS Supply Chain, looks at how trusts can increase their diagnostic capacity, replace old equipment and continue to make savings The NHS is encouraged to work collaboratively, drive efficiencies in procurement and aggregate requirements to improve costs. The introduction of Sustainability and Transformation Partnerships (STPs) provides an increased focus on joined up working whilst addressing factors that influence health and improve patient care such as earlier diagnosis and cancer screening. But with capital expenditure significantly constrained, how can trusts increase their diagnostic capacity, replace old equipment and continue to make savings? This difficult task was answered by NHS Supply Chain, working with the Department of Health and the NHS Business Services Authority (NHSBSA) to deliver significant savings back to the NHS. The NHS faced criticism from the Public Accounts Committee and the National Audit Office about the way it buys capital equipment, in particular, the way that it plans and purchases equipment in a fragmented and uncoordinated fashion. With ‘no explicit incentive to adopt best practice or work together to achieve economies of scale’ trusts are acting independently with concerns growing that the NHS is ‘failing to optimise its purchasing power’ resulting in savings opportunities being missed. In response to these criticisms, the Department of Health, the NHS Business Services Authority (NHSBSA) and NHS Supply Chain set themselves the objective of developing an aggregated purchasing process for NHS Capital equipment. DEPARTMENT OF HEALTH CAPITAL EQUIPMENT FUND The Department of Health Capital Equipment Fund is a £300 million fund set aside for the NHS in March 2012 to support the replacement of equipment by aggregating requirements to reduce costs and make equipment more affordable. The fund is managed on a day-to-day basis by NHS Supply Chain, with the Department of Health and NHSBSA responsible for its strict governance. The aims of the fund are simple: to improve patient care by replacing outdated capital equipment and to make savings by reducing the cost of the equipment to the NHS. Whilst significant savings, circa £73 million,



have been delivered via the fund on large scale diagnostic and cancer screening equipment, it was recognised that NHS buying power was being underutilised for other equipment areas that support patient pathways. MULTI-TRUST AGGREGATION INITIATIVE In order to capitalise on savings outside of large scale equipment the Multi-Trust Aggregation (MTA) initiative was developed. The initiative uses the same methodology as the Department of Health Fund, to deliver savings on capital equipment, and has the support of the Department of Health and the NHSBSA. It aims to: deliver savings back to the NHS; create a mechanism to maximise NHS buying power on capital equipment in conjunction with the Department of Health Fund; improve patient care by replacing outdated capital equipment; engage trusts in the savings process; and design a procurement process that can be replicated across NHS trusts. NHS Supply Chain’s Capital Planning team worked with trusts to gain insight into short term national demand to facilitate the creation of the MTA initiative in November 2014. MTA is a mechanism which combines the requirements for a particular device (that may not have an active deal in place) across multiple trusts. The initiative aligns procurement so trusts can take advantage of saving opportunities, which may otherwise be unavailable to them as a single procurement unit. The MTA initiative enables NHS Supply Chain to place orders on behalf of multiple trusts by utilising the Department of Health Fund. Through collaborative working with the NHS to aggregate requirements, NHS Supply Chain can reduce costs by accessing volume associated discounts that trusts would not receive when purchasing independently. Since November 2014, incremental savings of £2.7 million have been delivered via this process which has enabled further investment in new and replacement equipment to improve health services across the UK. Andrew Hawkins, category manager at

University Hospitals of Leicester NHS Trust, said: “To date we have been involved in eight MTA’s, however, this has the potential to increase as we look to the wider collaborative sharing their plans.” The increasing success of MTA can be largely attributed to the introduction of the Regional Savings and Improvement Workshops. Hosted by the Capital Planning team at NHS Supply Chain, these workshops include stakeholders from Procurement, EBME (electrical and biomedical engineering) and Finance who take a visionary approach to procurement by meeting to discuss

With ca expend pital signific iture an constra ined, hotly trusts in w can diagno crease their replace stic capacity, old and con equipment make satinue to vings?

purchasing requirements and aggregation opportunities in order to generate savings back to their trust. Adam Booth, a buyer at East Kent Hospitals NHS Foundation Trust, said: “I am very happy with the service provided and the proactive approach that NHS Supply Chain has adopted for the MTA and DH deals. It has helped us to achieve savings that otherwise would have alluded us.” As the success of the programme is reliant on aligning the procurement of multiple trusts it is vital that trusts not only engage with the process but can meet other trusts, share ideas and work together to plan their procurement of capital equipment. Simon Walsh, procurement director for Central Manchester University Hospitals NHS Foundation Trust, commented: “It is really positive to see that the NHS Supply Chain Capital team are taking the time to engage with their customers, encouraging dialogue and joint ways of working to support the delivery of the savings agenda.” Following discussions with trusts at the regional workshops, it was agreed that the savings achieved via MTA could be increased by providing timescales that all trusts could work towards in order to increase the volume of equipment. From this an MTA calendar was produced in February 2017.

The MTA calendar provides visible timescales which enables trusts to plan their purchases in advance and combine requirements on a larger scale to maximise savings. The calendar is a new approach to equipment procurement and has been developed with input from customers and stakeholders to drive increased engagement. Kathyrn Potts, contracts development lead at Derby Hospitals NHS Foundation Trust, said: “By attending quarterly collaborative meetings, along with other member trusts, we can draw on a wealth of experience and gain a better understanding of Multi-Trust Aggregation enabling us to plan around them.” Although MTA is still in its infancy, the savings achieved to date demonstrates that the potential for growth will only increase the more trusts, and other public sector organisations, utilise the initiative. Continuing to drive NHS engagement is a key focus for NHS Supply Chain with plans for 2018/2019 involving the introduction of a new, and improved, MTA calendar and the next round of Regional Savings and Improvement Workshops. BENEFITS ACHIEVED Since the first MTA deal, participation has grown to include 30 suppliers

Supply Chain


who have supported the delivery of procurement aggregation across 24 different equipment areas. In total, an incremental saving of £2.7 million has been delivered back to the NHS. Jason Lavery, vice president of Capital Solutions, states: “The initiative has encouraged collaboration between trusts which has led to aggregation and increased savings by procuring as one NHS.” But it’s not just financial savings that the initiative has brought. The introduction of the MTA calendar has also helped trusts to align their capital equipment purchases, and, combined with the Savings and Improvement Workshops, has got trusts working together, talking about aggregated purchasing and sharing best practice. Multi-Trust Aggregation is the best way for trusts to get the best possible prices whilst accessing the latest technology. It also creates reinvestment opportunities to buy additional equipment to help improve patient safety. This type of collaboration and aggregation can be transferred to other public sector organisations that are also experiencing the same financial restraints. Cooperation and aggregated purchasing is the future of procurement. # FURTHER INFORMATION

The NHS faced criticism from the Public Accounts Committee and the National Audit Office about the way it buys capital equipment, in particular, the way that it plans and purchases equipment in a fragmented and uncoordinated fashion




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Enhancing patient care through innovation A wireless sensor that better detects breathing rate in hospital patients and an app to help pregnant women monitor hypertension are among the latest innovations set to be spread across the NHS. Health Business looks at the 11 ground-breaking projects from the third round of the NHS Innovation Accelerator programme First launched in January 2015, the NHS Innovation Accelerator programme (NIA), is an NHS England initiative designed to develop and spread pioneering ideas, equipment and technology that have the potential to save lives as well as millions of pounds. The aim of the NIA is to support delivery of the commitment detailed within the Five Year Forward View: creating the conditions and cultural change necessary for proven innovations to be adopted faster and more systematically through the NHS, and to deliver examples into practice for demonstrable patient and population benefit. It is delivered in partnership with 15 NHS Academic Health Science Networks (AHSN) across England and is hosted at UCL Partners, an academic health science partnership that brings together people and organisations to transform the health and well-being of the population. The 15 NHS AHSN provide a financial contribution to cover bursaries for fellows and support the cost of the NIA, as well as promote the adoption of these innovative ideas across the NHS. They include: Eastern AHSN; East Midlands AHSN; Greater Manchester AHSN; Health Innovation Network; Imperial College Health Partners; Innovation Agency (North West Coast); Kent, Surrey, Sussex AHSN; North East and North Cumbria; Oxford AHSN; South West AHSN; UCL Partners; Wessex; West Midlands AHSN; West of England; and Yorkshire and Humber ASHN. In addition to financially supporting fellows, the NIA and AHSN supports them by giving them access to mentorship from a range of experts and high profile mentors, offering peer to peer learning and support and inviting them to quarterly events. The support also includes access to a bursary of up to £30,000 and regular meeting and critical challenge from the NIA Core Team.

TRANSFORMING DIGITAL HEALTHCARE The latest, third round of the NIA programme saw the introduction of 11 new projects. Five of these projects are similar in that they utilise technology to bring healthcare within the home and reduce traffic in GPs and hospitals. The Common Approach To Children’s Health (CATCH), founded by Damibu CEO Dave Burrows, gives parents the appropriate and understandable information they need and want, in a timely and measured way and via a device they are familiar with, such as a smart phone. CATCH aggregates local and clinical knowledge from their council and GPs, building a region specific, tailored, trusted resource they can reuse, giving them confidence to look after their children at home. Since the launch of the project, there has been a three per cent reduction in overall A&E attendances reported by Eastern Cheshire CCG in winter 2016/17, and based on 284 responses from the CCG’s user satisfaction survey, 47 per cent of users decide on self-care over an A&E visit, 64 per cent decide on self-care over a GP visit, and 91 per cent would recommend CATCH to a friend or relative., created by the chief commercial officer of Katherine Ward, also transforms the patient’s personal device,

The 15 N S NHS AHnancial a fi provide ribution cont ursaries rb to covellows and for fe the cost support e NIA of th

using computer video and user centric design to turn the smartphone into a urinalysis device. complements established clinical efforts by empowering patients to test themselves at home with no quality compromise, and securely share results with a clinician. This project impacts a range of pathways including pre-natal, chronic kidney disease (CKD), and urinary tract infections (UTI). is CE approved and ISO 13485 certified, with 99.5 per cent usability rates in FDA clinical trials covering 500 patients across demographics. A John Hopkins prenatal study demonstrated that less than 10 per cent of respondents preferred testing at the clinic, illustrating that the urinalysis device has had a positive response. Furthermore, the roll out of home-based albumin:creatinine screening for CKD is successfully being used in collaboration with US and Dutch National Kidney Foundations. Asma Khalil, consultant obstetrician at St George’s Hospital and reader at St George’s Medical School, University of London, designed Home monitoring of hypertension in pregnancy (HaMpton). HaMpton is a new care pathway developed by the maternal fatal medicine team at St George’s Hospital which involves the use of an innovative smartphone app for monitoring high blood pressure at home. The app alerts women if they need to attend the hospital, and it also links with a hospital computer system where the data can be monitored by clinicians in real time. HaMpton reduces the number of hospital !


Case Study


Datix outlines the importance of learning from avoidable harm and death in healthcare In recent years, there has been an increasing recognition that the way in which the NHS investigates and learns from instances of avoidable harm and death is extremely variable and often poor. Past reports have highlighted major flaws in the way the NHS investigates and learns from mistakes. Yet despite a widespread awareness of the issues and recommendations for improvement, progress has been limited. The 2016 report published by the Care Quality Commission (CQC) looked at how NHS trusts review and investigate the deaths of patients in England. Some of the key findings of the CQC report stated that families and carers often have a poor experience when it comes to NHS investigations and the quality of those investigations is variable and inconsistent. They also reported that there was no consistent system in place to make sure recommendations are acted on or learning is shared, and there is no single framework

outlining how NHS organisations should identify, analyse and learn from deaths – ultimately leading to missed opportunities to learn and improve as a result. Measures are being taken by the government in response to the CQC review. As of April 2017, boards of all NHS trusts and foundation trusts are now required to carry out a range of new responsibilities and actions. These include: collecting specified information on deaths that were potentially avoidable and consider what lessons need to be learned on a regular basis; publishing information quarterly, in accordance with new regulations, so that local patients and the public can see whether and where progress is being made; publishing evidence of learning and action that is happening in response; following a standardised

national framework for identifying potentially avoidable deaths, reviewing the care provided, and learning from mistakes; and work is also being done with the National Quality Board to ensure that greater support is offered to bereaved families in the future. Datix believes that healthcare organisations are on the cusp of a revolution in their approach to patient safety, learning from things that go wrong and sharing lessons and best practice. New tools and technology are set to play an important role in this journey. Contact Datix for more information about how Datix Cloud IQ Mortality Review can support you in meeting the CQC general guidelines around review and reporting of mortalities. FURTHER INFORMATION Tel: 020 8971 1971

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INNOVATION " visits and has achieved excellent patient and staff satisfaction. Since its launch, there has been a 53 per cent reduction in number of appointments for hypertension monitoring and amount of time per appointment, and a £300 average cost saving per per patient per week, or £50 million potential annual cost saving if scaled up across the UK. My Diabetes My Way (MDMW), founded by CEO of MyWay Digital Health Deborah Wake, is a low-cost, scalable, comprehensive online self-management platform for people with diabetes. It incorporates multimedia education, online health record data access, personalised tailored data-driven advice, communication tools for healthcare professional contact, and links in to social media and peer support. MDMW has been running across NHS Scotland since 2008 and currently has over 30,000 registered users. Its education sites have recently been launched commercially in Somerset and North West London. Based on a recent evaluation survey of 1,098 users, over 88 per cent felt MDMW helped them to manage their diabetes better. The project has also brought about improvements in long-term blood glucose sustained out to three years. An over 5:1 return on investment based on the analysis of outcome data from a long-term user in NHS England has also been achieved. Liz Ashall-Payne founded the Organisation for the Review of Care and Health Application (ORCHA), which provides a live resource of reviewed health and care apps which can be easily searched, compared, recommended and downloaded through an easy-to-use platform. Thorough reviews and a simple scoring system highlight functional capabilities of the apps, making it easier for users to confidently and quickly compare and choose the best apps. ORCHA works with CCGs and providers to develop health app portals which integrate with local systems and strategies. It allows professionals easy and clear access to a verified resource, allowing them to enhance services and outcomes by finding and recommending the best apps to patients. ORCHA collates data and reports app usage by population, patient and professional group to help assess and prove digital strategies, investment and outcomes. It activates over eight million people and patients to use healthcare apps in England. A 2015 Research Now Group study of 500 healthcare professionals and 1,000 health app users showed that over 90 per cent of healthcare professionals believe health apps will increase their knowledge of patients’ conditions. TRANSFORMING PHYSICAL HEALTHCARE Another project included in the third round of the NIA programme is ESCAPE-pain. Michael Hurley, clinical director for the newly-formed Musculoskeletal Programme of the Health Innovation Network South London, founded the six-week programme designed for groups of 10 people, aged 45 years or older, with knee and/or hip osteoarthritis (OA).

It helps people understand their problem, advises them on what to do, and teaches them simple exercises that can alleviate pain, allowing them to do more, change the course of the condition and improve their lives. Behavioural change techniques – including goal-setting, action/coping planning, monitoring – are incorporated to encourage participants to maintain a healthy body weight and exercise regularly. The project proves beneficial for up to two and a half years after completing the programme, and has the potential to save £2.8 million annually in total health and social care for every 1,000 participants who undertake it. Oviva Diabetes Support, founded by head of partnerships at Oviva UK Ltd Olivia Hind, is similar to ESCAPE-pain in that it is a technology-enabled and NICE-aligned programme of type 2 diabetes education that lasts 10-12 weeks. The programme is fully remote and goes beyond information given to patients with individualised care to support goal setting and development of sustainable self-management strategies. Oviva Diabetes Support contains high-frequency one-to-one support from a dietician with highly engaging evidence-based structured education materials that patients can access online at a pace that suits them. Participants also have access to the Oviva app to self-monitor weight, nutrition and progress against goals. This approach builds on evidence regarding improving access and uptake of structured education. The average uptake of Oviva Diabetes Support is 75 per cent, with 85 per cent of participants completing the programme, and 93 per cent of participants said they would recommend the programme to friends and family. It has made clinically meaningful improvements in diabetes treatment targets, as demonstrated by outcome data. Oviva Diabetes Support is estimated to save the NHS £1,000 per participant based on reduced medication need and use of services. Another project that has had a great impact on the NHS and has transformed care for patients is Transforming Systems’ Alistair Martin’s WaitLess. Commissioned by CCGs and co-designed by patients and GPsm WaitLess was launched in east Kent in December 2016. The app allows people with minor injuries to select the location which will get them access to treatment fastest, by combining live feeds from A&E departments and all types of Urgent Treatment Centres, showing the number of people waiting and waiting time. The app then combines this with the travel time to the location and expresses this as a single figure. Since its launch, there has been an 11 per cent reduction in minor injuries activity in A&E, specially during the busiest times of day, and a five per cent reduction in minor injuries activity across the board. To date, WaitLess has been used 125,000 times with a 99.6 per cent patient satisfaction rate. First Episode and Rapid Early Intervention for



Eating Disorders (FREED), founded by clinical psychologist Karina Allen, provides a rapid early response intervention for young people aged 10 to 25 years with short (three years or less) first episode illness duration. FREED overcomes barriers to early treatment and recovery. Components include rapid screening and assessment protocols, evidence-based interventions that specifically attend to the needs of young people and their families (including options for online treatment), and an implementation toolkit. Based on an initial evaluation, FREED reduced waiting times for treatment by approximately 50 per cent compared to audit data from matched patients, and improved treatment uptake by 100 per cent compared to 73 per cent for audit patients. Additionally, FREED helped 59 per cent of patients with anorexia nervosa reach a healthy weight in 12 months, versus 17 per cent of the audit sample. TRANSFORMING CARE FOR STAFF The last of the 11 innovations are designed directly for NHS staff so that they can improve care for patients. Lantum, founded by Melissa Morris, is a cloud-based tool built to help NHS Providers fill empty shifts in their clinical rotas. Designed by doctors and managers over the past five years, the tool has been specifically developed for staffing managers working in the NHS. Lantum offers a secure online environment where providers can advertise shifts for their own clinical staff to book at any time via any device. The tool integrates with clinical staff calendars to efficiently match available clinicians with open shifts, and the app for clinical staff allows them to cover shifts quickly on the go 24/7. Lantum has been adopted by 35 GP Federations, and is estimated to generate £3 million of savings for the NHS in under five years by providing a free platform for providers to manage their existing clinical workforce. As a result of the service, 30-50 per cent more shifts are being filled by providers’ own clinical staff banks, thereby reducing use of agency staff and improving continuity of care. Finally, CEO of PMD Solutions, Myles Murray, founded RespiraSense, a device which offers medical teams the ability to detect signs of patient deterioration 12 hours earlier than the standard of care. It is body-worn and wireless, with a patented sensor to measure the mechanics of chest and abdomen movements during breathing. RespiraSense generates highly accurate respiratory rate data, and can be integrated with electronic health records. It improves patient flow by reducing the rate of preventable escalations of care, and supporting timelier patient discharge, and has the potential to save over £100 million in pneumonia and sepsis pathways, from five per cent reduction in preventable escalations of care. # FURTHER INFORMATION



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Now in its fifth year, The Wearable Technology Show returns to the ExCel on the 13-14 March 2018. In conjunction with the Digital Healthcare Show, the event offers an unrivalled breadth and depth of content At the Digital Health Technology Show, we firmly believe in focusing on patient-centric care. This means not only showcasing health and technology’s heavyweights, but truly empowering our healthcare delegates; our clinicians, our nurses, surgeons, psychiatrists and health admin staff, to provide better care by gaining real, actionable knowledge and insight on the day. Our show features Keynotes delivered by some of the world’s health leaders; case studies from people who have successfully optimised their workstreams with digital; ‘Deep Dive’ sessions which get into the heart of our global health crises, and explain how technology will relieve some of the pressures on our healthcare system. We pride ourselves on being a platform for realisable change, and are committed to our belief that sharing knowledge will inspire a new generation of purposeful technology.

Ventures, analyses the challenge in his session on 13 March. Dr Nick Venters, chief clinical information officer of Leeds and York Partnership NHS Foundation Trust, will also keynote and host an interactive debate on mental health and ‘the Big Plan’. From developing new life-saving techniques and virtual surgical training, to personal health management and behaviour change, biometric sensing, VR, artificial intelligence and other emerging innovations are helping to revolutionise the way healthcare operates and is transforming patient care. Francesca Cormack, director of Research & Innovation at Cambridge Cognition, looks at these innovations in her session on ‘The increasing impact of emerging technology’ in the Disrupt Theatre. Cormack will also be presenting the keynote panel on ‘What if our healthcare system kept us healthy?’, in which the panel discuss the realities of ‘treating the well’, asking if education is the only factor, how mHealth and remote monitoring can empower the

Emer technolging ogy making extraor is dinar impa health a cts on brain y an exci nd opening u t p treatinging frontier in greates some of our t he challen althcare ges

CONFERENCE PROGRAMME The Digital Healthcare Show will take place over four theatres: the Disrupt Theatre, offering a unique look at the role of technology in modern medicine, healthcare and wellness; the Leadership Theatre, bringing together health leaders from across the UK to discuss the pressures of healthcare and explore the solutions required for change; the Innovation Stage, looking at how to commercialise a health initiative; and the Patient Engagement Theatre, providing a deeper look into how the evolution of our healthcare system will effect individuals on a personal level. Here, we look at some of the stand-out talks from across the four theatres. One in four people are affected by mental health disorders, such as autism and Alzheimer’s. Emerging technology is making extraordinary impacts on brain health and opening up an exciting frontier in treating some of our greatest healthcare challenges. Kumar Jacob, CEO of Mindwave

public to take control of their health, and whose job it is to educate and regulate. Artificial intelligence will be further explored by Martin Taylor, CEO of Content Guru and Vili Kellokumpu, an AI specialist from Bittium, in their sessions on ‘Self-triage: the segue into artificial intelligence’ and ‘AI_taking healthcare to another level’. The adoption of artificial intelligence in healthcare is on the rise and solving a variety of problems for patients, hospitals, and the healthcare industry in general. Also in the Disrupt Theatre, the director of Microsoft Health & Life Sciences reveals insight into the corporation’s current health and life sciences research, followed by stirring illumination into the work the team have been doing with Radiomics: Project Inner Eye. WHERE DO YOU START? Rachel Dunscombe, director of Digital for Salford Royal Group, and CEO of the NHS Digital Academy, will be joined on the stage by Dr Jonathon Gray, chair of the National Institute for Innovation, to present ‘The Big Debate’. This will include explorations of: how we can deliver on the future plan; what global strategies we can learn from; how we can transform patient experience !



Wearable Technology Show


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of each and every day. Should you suffer from a long term or chronic condition, if you are rehabilitating from an injury or recovering from a surgical procedure, if you feel vulnerable at home for any reason, CuraGuard enables you to manage your own healthcare while your care and medical support team looks on ready to act as soon as they are needed. Contact the company today for more information. FURTHER INFORMATION Tel: 0330 223 3145

Activinsights delivers patient lifestyle insight to the healthcare sector using accurate and validated wearables. The company builds objective, lifestyle reports which provide invaluable information for both patients and professionals when planning effective interventions. Its technologies and data analysis approaches are supported by over 200 peer-reviewed scientific papers, in over 40 countries worldwide. Activinsights has a unique heritage through its support of health researchers and sports scientists with measurement equipment. This experience has built its knowledge base, validated its products and developed new data analysis tools.The company uses rigorous open protocols to manage sensitive behavioural information giving security and transparency to all data subjects. The global challenges of heart disease, respiratory diseases, obesity, diabetes and ageing populations

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" through digital technology; what the road map ahead is; and how the systems can change to support our future health. Gary will also present the keynote in the Leadership Theatre, in which he will discuss the challenges currently facing healthcare provision and sets the scene in a wider context for why change has to be embraced, what the opportunities, solutions and necessities are as seen from someone who operates on the global stage. Gerry Bolger, CNIO at Imperial College Trust, will chair a keynote panel on ‘The Connected Hospital’, discussing how to achieve sustainable transformation, and how the possibilities of information exchange will enhance future care, and the need for patients to take a more active role in understanding and accessing their health records. A team of panellists in the Innovation Stage will share how to start with a design and then build the technology until ideas become a reality. Touching upon topics such as how to develop a crowdfunding campaign and how to source VC funding, the self-made panellists provide tangible insight into how they launched into the market. With input from NHS England, the ‘What the Health?’ session in the same theatre will explore commercialising digital health initiatives, examining the challenges and how the NHS can overcome them. Healthcare is the one global service that every person on earth will use in their lifetime – so why is it so often that a patient is the afterthought? A panel of speakers in the Patient Experience Theatre will share examples of when the UK’s healthcare system has succeeded, and where it continues to fail patients time and time again. Including poignant examples of real-life cases, the panel discusses how optimising digital

systems will increase the quality of care that patients receive, and the need for encouraging innovation with a consumer focus. Another panel discussion in the Patient Experience Theatre will explore the concept of ‘Not just a patient’. All too often, the

Wearable Technology Show


sophisticated smart building systems. This session, led by Martin Woolley, technical program manager at Bluetooth SIG, explores Bluetooth mesh networking, and how this next evolution of the globally known and trusted technology will make an unparalleled impact

From developing new life-saving techniques to personal health management, biometric sensing, VR, artificial intelligence and other emerging innovations are helping to revolutionise the way healthcare operates people who are receiving care are referred to in statistics as ‘sufferers’, ‘patients’ and similar terms rather than as individuals. The show hosts some of the people whose lives have been directly impacted by technology, discussing the role that technology has played in their physical and mental empowerment, alongside their independence. THE FUTURE OF DIGITAL A panel on 14 Match will share examples of the evolution and disruption in their products, discussing which emerging technologies are currently being used to disrupt current designs, functions and business models. This will include questioning where wearables are heading, how the future will be an evolution of the present, and how products will be incrementally developed. There’s a compelling business case for the smart building. Building regulations and, in particular, energy efficiency regulations are driving the adoption of advanced technologies such as Bluetooth mesh networking in

on the commercial and industrial space. The ‘Digital Health Disruptors’ session will enable delegates to meet the companies that are transforming digital health, outlining their successes, challenges and future? Three companies, Connected Care Solutions, Insource and Molecular Warehouse, showcase this and more with a highly anticipated Q&A. Technology isn’t just for ’milennials’: technology is already achieving improved care and better outcomes within the elderly population. Anne-Christine Hertz discusses the practical, life-enhancing solutions being implemented and developed using her experience at the University of Halland. Professor Toby Jenkins, of the University of Bath, presents a ground breaking prototype wound dressing in the Patient Engagement Theatre, which may result in taking patients out of the hospital setting whilst in the later stages of recovery. # FURTHER INFORMATION




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Rob Drag, Scan4Safety programme manager at Salisbury NHS Foundation Trust, shares the progress, learnings and significant benefits being made at one of the six Scan4Safety Demonstrator Sites as it nears completion of the initial phase of the Department of Health backed Scan4Safety programme Scan4Safety is a pioneering programme led by the Department of Health that is improving patient safety, increasing clinical productivity and driving operational efficiency in the NHS. Scan4Safety is taking learnings from other sectors, such as retail, to improve traceability and efficiency through the use of international barcoding standards (GS1 standards) and common ways of doing business (PEPPOL). Barcodes have already transformed supply chain management across a number of sectors, hugely improving efficiencies and providing greater visibility and traceability of products right through the supply chain. With over five billion barcodes now scanned across the world every single day, barcodes are everywhere and these systems have

developed to a point where we all simply take it for granted that they work. However barcoding has had limited use in healthcare to date. There are pockets of great examples of barcoding being used effectively in some trusts, but until now this has not been consistently applied across the whole NHS. A WORLD FIRST IN HEALTHCARE When barcodes were first introduced in retail in the 1970s, retailers and suppliers had to work together. They understood that one way of working was needed so they could all reap the benefits. What is groundbreaking about the Scan4Safety

programme, and what will ultimately ensure its success, is that the selection and mandated use of a common set of barcoding standards, GS1 standards, for both trusts and suppliers, is a world first in healthcare. By mandating the use of a common set of standards, for the first time the NHS will be using a common language to identify patients (Global Standard Relation Numbers – GSRNs), places (Global Location Numbers – GLNs) and products (Global Trade Item Numbers – GTINs). By being able to better identify and match patients, products, and locations, this in turn will improve how !

Prior Scan4S to we faceafety, d the p ro b l e m o f m product a recalls naging quickly and ef safeguaficiently to r from avd patients oida harm ble


Written by Rob Drag, Scan4Safety programme manager, Salisbury NHS Foundation Trust

Scan4Safety: insight from a demonstrator site







By scanning products at point-of–use, stock is now automatically replenished, releasing time for our clinical staff to care who previously had to complete these stock orders manually " effectively products are recalled and also improve operational efficiencies, freeing up valuable clinical resource and delivering direct cost savings. At Salisbury NHS Foundation Trust we were therefore delighted to be chosen as an early adopter of these standards, one of only six trusts to be selected as a Scan4Safety Demonstrator Site in January 2016. Since our selection, we have been implementing GS1 and PEPPOL standards across the trust and as we now approach successful completion of the initial two year programme, the benefits we are delivering to the trust are significant and exceed our initial predictions. IMPROVING PATIENT SAFETY Prior to Scan4Safety, we faced the problem of managing product recalls quickly and efficiently to safeguard patients from avoidable harm. Although the trust had product recall processes in place, like so many other trusts, these were manual and extremely time-consuming. There was no process or single system in place for identifying or capturing implants used with a patient in a consistent or repeatable way. Whilst hard to quantify the exact amount of time spent on a product recall, anecdotal feedback suggested product recalls could take ‘many hours’ of trawling through patient records and often involved highly skilled and senior members of clinical staff. Through the programme, the trust has introduced point-of-use scanning in operating theatres, enabling implantable devices to be accurately tracked to a patient. In October 2016, the trust launched a new Inventory Management System, Genesis Automation. This offered the ability to scan at point-of-use, so review and labelling of our entire catalogue was completed to understand which departments implanted the most. We subsequently prioritised cardiology and orthopaedics to cover 97 per cent of the trust’s implantable devices. This was followed by all remaining theatre specialties in November 2017 and will shortly be going live in day surgery, endoscopy and radiology to reach 100 per cent traceability. With 154 members of staff fully trained, the trust’s theatre staff now scan the barcodes at point-of-use on all the inputs to patient care – alongside implants (with batch and expiry information), this also includes patient ID, consumables, sterile instrumentation and staff. In the event of a future product recall, the affected product can now be automatically traced to the patient and appropriate action



quickly taken. And if an affected product is scanned at point-of-use, the handheld device alerts the surgical team that the product has now been recalled to prevent it being used on a patient. The same applies to expired products, further safeguarding patients. ENABLING CLINICAL PRODUCTIVITY Prior to implementation, 32 per cent of staff in orthopaedic theatres were spending more than one hour a shift on stock-related duties. By scanning products at point-of-use, stock is now automatically replenished, releasing time for our clinical staff to care who previously had to complete these stock orders manually. For example, in cardiology two hours a week of a band six radiographer’s time has now been released. The system also provides the hospital with accurate patient level costings. By scanning all consumables, implants, and staff to a patient, detailed costs of a procedure are now available at the touch of a button. This helps provide clinical staff with more accurate and timely data, helping them to make better informed decisions. Our consultant cardiologist Tim Wells said: “The recent implementation of the Scan4Safety project in cardiology provides us for the very first time complete traceability of products such as implantable medical devices used with our patients. Knowledge is power – not only does this provide us with a level of data and insight that can be used to better challenge clinical practice and variation, helping us to reduce inefficiencies and improve patient experience and outcomes – more importantly it ultimately helps to safeguard our patients from avoidable harm. In the event of a product recall, we can now easily and quickly track an affected product to the right patient.” DRIVING SUPPLY CHAIN EFFICIENCY Through the programme, we now have a much better understanding of our inventory profile and visibility of our stock – for example consignment versus trust owned stock. We can also better track expiring stock and wastage, including identifying the reasons why items are being discarded. This enables the trust to reduce waste in the future. We have already delivered over £1.2 million in savings, primarily as a result of improved management of our stock. Engagement with key stakeholders from the outset has been hugely important. Clinical engagement is vital and our executive clinical sponsor, our director of Nursing,

Lorna Wilkinson, has played an active and pivotal role in driving internal clinical engagement. Likewise, supplier engagement has also been important to ensure the provision of accurate product-related information into the trust and so we adopted a collaborative and partnership approach to encourage early adoption, building long-lasting relationships with key suppliers. BUILDING CAPABILITY WITHIN THE NHS, FOR THE NHS As a Demonstrator Site, we are committed to sharing such learnings with other trusts and alongside our fellow sites have developed a range of resources to support future trusts. From hosting regular site visits, to publishing ‘How to Guides’ and case


Through the programme, we now have a much better understanding of our inventory profile and visibility of our stock. We have already delivered over £1.2 million in savings, primarily as a result of improved management of our stock studies, to developing a dedicated website, there is a wealth of useful information now available to support other trusts in their Scan4Safety implementation journey. Working with GS1 UK, Salisbury NHS Foundation Trust has also developed a suite of bitesize webinars to introduce trusts to Scan4Safety, which will be launching soon.

We may have nearly completed the initial phase of the programme, but what is exciting is that we believe this is really just the start. By implementing the standards, we’ve laid the foundations for transformational change and we’re confident the trust will now be able to continue to unlock further benefits and other use cases – for

example medical equipment management. If you apply the benefits we’ve seen at Salisbury and those being delivered from across the other Demonstrator Sites, and multiply these across all acute trusts, that’s when you can really understand how impactful the Scan4Safety programme will be to the NHS. #

For further information on point-of-use scanning in operating theatres, please contact implementations lead Adam Parsons: FURTHER INFORMATION



Document Management Written by James Kelly, chief executove, British Security Industry Association




The importance of secure information destruction James Kelly, chief executive of the British Security Industry Association, discusses some of the key considerations when securing information destruction services With the NHS recently being the target of a large scale cyber attack, never has there been a more important time for healthcare professionals to consider the importance of information destruction. Last year, figures released by fraud prevention service Cifas showed worrying figures regarding identity fraud. The statistics, which came from 277 banks and businesses, revealed that there were nearly 173,000 recorded frauds in 2016, reported by the BBC as ‘the highest level since records began 13 years ago’. As such, this increasing risk of fraud means ensuring that patient and staff records, as well as financial documents, are destroyed securely is an absolute necessity. Hospitals and other healthcare establishments contain a wealth of valuable items, such as pharmaceuticals and medical equipment, meaning they are already an attractive target for thieves. However, the personal information stored within the healthcare sector can be an even more lucrative target, providing criminals with the means to commit fraud and identity theft. The information stored within the healthcare sector is vast, including names, addresses, birth dates, National Insurance information, financial details and family histories, which must all be stored securely so as to comply with the Data Protection Act. This compliance applies right down to the destruction of such information, as improper storage or destruction of such information can mean the organisation in question is breaching the Data Protection Act, resulting in hefty fines from the Information Commissioner’s Office (ICO) and huge reputational damage to the establishment.

Under the Data Protection Act 1998, everyone responsible for using data has to follow the specific data protection principles. Such principles include: ensuring that data is used fairly and lawfully, for limited, specifically stated purposes; used in a way that is adequate, relevant and not excessive; accurate; kept for no longer than is absolutely necessary; handled according to people’s data protection rights; kept safe and secure; and is not transferred outside the European Economic Area without adequate protection. The seventh principle of the Data Protection Act stipulates that an organisation must take appropriate measures against accidental loss, destruction, or damage to personal data and against unlawful processing of the data. In order to fully comply with the Data Protection Act, a handler must have a written contract with a company capable of handling confidential waste, which can provide a guarantee that all aspects of collection and destruction are carried out in a secure and compliant manner.

of at some point, such as a computer or laptop that is no longer operational. As such, when looking to destroy both paper and electronic media waste, it is absolutely essential that if you do not have the in-house expertise and knowledge, do not take any risks and make sure you take the time to outsource the destruction to a professional information destruction provider. Information destruction covers a wide range of materials, including paper, computer hard drives, laptops hard disks, CDs, DVDs, USBs, credit cards and SIM cards. It can even be applied to branded products, such as uniforms of badges, which, if in the wrong hands, could allow a criminal to gain entry into restricted areas of a premises undetected. Secure information destruction means that such materials are destroyed to the point that they cannot be reconstructed. Don Robins, chairman of the British Security Industry Association’s (BSIA) Information Destruction Section, provided some essential advice to key decisions that may be looking for a secure information destruction supplier: ELECTRONIC MEDIA AND “When selecting an information destruction INFORMATION DESTRUCTION company, steps should be taken to ensure While the use of electronic media is they will protect your digital data until it has increasing – making cyber crime an even more been safely destroyed. Often, these steps are threatening risk – people are common sense, but surprisingly the major still printing from the screen consideration is the initial financial onto paper, especially cost rather than the positive While t in a healthcare assurance gained from using environment. an accredited destruction use of e he Furthermore, company. Make sure media i lectronic s increa electronic media your choice of company sing, people will also need uses security cleared are still printin to be disposed personnel, that they have

gf to paperom the screen r in the h, especially ea environ lthcare ment

clear and secure procedures from collection through to destruction, that you have selected the appropriate destruction particle size for the material being destroyed and that they provide a destruction certificate.” He went to on to add that: “You should also check for references; make sure you know who the actual information destruction service provider company is, check that they are members of a professional association, such as the BSIA, and draw up a contract with explicit requirements. Possibly, the first step is to make sure you have a person within your organisation that will be responsible for the destruction of media assets and the data contained on them.” CHOOSING A REPUTABLE SUPPLIER In addition to these important steps, the most important factor in secure data destruction is choosing a reputable supplier that complies with the essential European standard BS EN 15713:2009 for security shredding, as well as BS 7858 for staff vetting. Don explains: “It is crucial to keep these standards in mind when sourcing an information destruction supplier, as these standards ensure that the companies providing data destruction services are doing so in a secure manner which provides maximum security for your information.” BS EN 15713:2009 is a crucial requirement

as it provides recommendations for the management and control of collection, transportation and destruction of confidential material and recycling in order to ensure that the materials will be disposed of securely and safely. The BSIA’s Information Destruction Section was actually a key player in the development of the EN 15713 standard and helped provide specifications on how the processes should be handled within the secure data destruction industry. The standard contains specific requirements pertaining to the confidential destruction premises, the contracts between the client and the organisation, the personnel working for the destruction company, the collection and retention of confidential material, the vehicles used, environmental requirements as well as customer due diligence. To help customers gain a full understanding of the requirements set out in EN 15713, the BSIA’s Information Destruction Section created a helpful guide to highlight the essential elements of the standard, as well as providing some best practice advice when procuring an information destruction company. The guide can be downloaded free of charge from the BSIA’s website. Procuring a professional, reputable information destruction company must be at the top of the priorities list for key decision makers and corners must not be cut when it comes to quality. The BSIA

recently commissioned a white paper titled The (Real) Price of Security Solutions – A White Paper on the Challenges of Buying and Selling High-Quality Security Solutions which explores the price versus quality debate from the perspectives of both buyers and sellers of security solutions. The purpose of the paper was to identify the relative advantages and disadvantages between low-priced and high-quality solutions; unsurprisingly one of the key findings of the paper highlighted the fact that end users would find it far more beneficial to invest in high-quality security solutions rather than making decisions on initial purchase price alone. A positive collaboration between the security provider and the buyer is also extremely important, allowing the security buyer to gain a clear understanding of the end user’s needs so that they may provide them with a suitable solution. The results of the white paper serve to reinforce the fact that healthcare professionals must only source an information destruction provider who meets with EN 15713 in order to guarantee a quality service. By working closely with your supplier, they will also be able to develop a good understanding of your destruction requirements, developing a regular schedule and contract to suit your needs. #

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• High Security Shredding • UKAS ISO9001 - EN15718:2009 Accredited • ICO Registered • Safe Contractor Approved • Personnel Checked to BS7858 • Cost Effective & Efficient • Multi-Site Collection Available • Lockable Cabinets/Bins Provided • Approved Certificate of Destruction Provided • We Shred Everything so No Need to Remove Staples/Paperclips/Plastic Wallets • We Shred Media Including Hard Drives, Uniforms, Toys!

0844 880 4991 Volume 18.1 | HEALTH BUSINESS MAGAZINE


Translations Written by Catherine Park, Institute of Translation and Interpreting




Trends in translation and interpreting Catherine Park, Institute of Translation and Interpreting, analyses the benefits of multilingual policies in hospital, including the use of technology and impacts of Brexit Globalisation has contributed towards rapid growth in the translation and interpreting sector. The world has been getting smaller in terms of our need and desire to visit other countries and communicate in other languages, and that has led to an increased demand for the services of professional translators and interpreters. Worldwide, this sector is said to be growing at a rate of 5.52 per cent per annum. This demand is reflected in the UK health sector, where the nationality of patients being treated has become very diverse for a variety of reasons – including increased foreign travel for holiday or business, ‘health tourism’ where people choose to have a medical procedure overseas, and significant representation of different nationalities in particular communities. Material that may need to be translated in the UK includes patient information leaflets, website copy, medical notes and documents that a patient has brought with them relating to their health or medication they have been taking. Where a healthcare provider has a strong representation in their area from particular languagespeaking communities, they may have an extensive collection of translated material readily available for these groups. The typical role of an interpreter would be facilitating face-to-face consultation between a doctor, patient and/or family, or a phone consultation. This could range from quite routine conversations to obtaining and conveying information in more urgent medical situations. While there is a clear desire and obligation to communicate effectively with all patients, certain factors mean that this is not always entirely straightforward. Concerns are commonly expressed about where money is

being allocated when funds are limited, and periodically national and local newspaper articles highlight the amount being spent on translation and interpreting in a particular hospital or area – along with the attendant criticism from politicians and influencers. Another view sometimes expressed is that too much translation is not helpful in relation to people integrating into their communities, and that it may be more beneficial to give more attention to producing

ount The amtten of wri work ion translatmissioned by om being c itals has been he hosp wn, while t g o going dt of interpretin amoun rk has been wo p going u


information in simple, plain English. It is perhaps not surprising, therefore, that approaches may differ significantly from one healthcare provider to another. In 2020health’s research report, Lost in Translation, some responding NHS trusts said they did not translate into any other languages, while some translated into as many as 120, with most saying between five and 25. There are some indications that the amount of written translation work being commissioned by hospitals has been going down, while the amount of interpreting work has been going up. One reason why written translation may have reduced is that some information is available centrally (through government, health service or other sources such as charities in relation to particular conditions) or that something similar has been produced in the organisation previously, and there are more policies and guidance relating to when new translation is appropriate. WORKING CONDITIONS The financial situation has impacted the relationship between language professionals and healthcare providers in other ways. Over 10 years ago, it was probably quite common for interpreters to be directly employed by a healthcare provider. In the light of greater demand for interpreters than ever before, coupled with a drive to cut costs, there has been a tendency to withdraw direct involvement with interpreters and to outsource

to private agencies through procurement. These private companies will feel the pressure to keep prices down – and sometimes unrealistically so. This is then passed onto the freelancers who they employ to do the work. This can lead to poor pay, both in terms of hourly rate and in relation to the conditions they must accept to be employed. The Institute of Translation and Interpreting (ITI) has anecdotal evidence that highly-qualified individuals are sometimes opting to move to other areas where pay will be more in line with their skills and experience, for example clinical trials or pharmaceuticals. The danger is that this will lead to an influx of less qualified and unexperienced interpreters willing to provide services at lower prices and for worse contract conditions. TECHNOLOGY Technology is sometimes heralded as a way to cut costs and time, while still maintaining standards. There is much publicity about Google Translate and similar tools and how they are becoming ever-more reliable and sophisticated. This needs to be viewed with quite a bit of caution. If you just need to get the gist of something, or to double check a spelling, then Google Translate may be fine. It should certainly not be used for important information that needs to be shared with others to give them a completely accurate understanding of something. The most dangerous aspect of this is if such a tool comes back



Language specialists leaving the UK in significant numbers would be detrimental, because it is important that suitably qualified people are available to translate into their own language to provide the best possible service to clients with quite a plausible, but ultimately wrong, translation. Because how are you going to know? Professional translators do use specialist translation tools to hasten and aid the accuracy of their work. These typically store terminology and phrases that they have input previously, so the translator can identify these quickly in new text, thereby saving time. Similar phrases are known as ‘fuzzies’, but just as in the example above of the plausible translation in Google Translate, there could actually be quite a different meaning despite the apparent similarity. A professional translator is needed to make an accurate assessment and an appropriate decision in relation to what the technology is presenting. Machine translation will continue to improve, but it will be a long time before it comes close to being able to deal with context in the way that only a human translator can. IMPROVING AND MAINTAINING SKILLS Language professionals need to keep developing their skills – it is not enough to be excellent at one or more languages (although this, in itself, is a life’s work!). Remaining up to date with translation technology developments will be important for them in continuing to meet the needs of clients in terms of speed and quality of delivery. Medicine is a fast-evolving field and so is the terminology. Where pharmaceuticals were once largely about synthetic chemistry, in recent years we have seen the advent of many biotech products. In surgery, new treatment techniques such as robotics have brought quite technical terminology into the sphere of the medical translator and interpreter. Medical translators and interpreters rarely have a scientific or medical background, so considerable effort has to be expended by them in order to be familiar with the terminology used and the circumstances encountered. On the plus side for linguists trying to keep up with terminology, a wealth of online data – such as textbooks and specialist mono- and multilingual websites – is now at their fingertips. In addition, awareness of research findings can be useful to both clients and language professionals in refining their relationship and the way the service is offered to patients. In the past, interpreting research tended to be about language processing and bilingualism, but much more work is now taking place examining interpreting in a particular workplace context. The British Psychological Society has just produced

guidelines for psychologists working with interpreters, based on extensive desk research. In relation to translation, much research has been focused on getting the most out of machine translation, and ensuring that human translators and technology work as effectively as possible together. This includes Portsmouth University’s recent report When Translation Meets Technologies: Language service providers in the digital age. ITI believes that continuing to upskill and enhance knowledge is essential for any professional translator and interpreter. The institute has a full continuing professional development programme, and a progression of membership categories based on levels of qualification and experience. Qualified members appear in the institute’s public register on its website. ITI’s Medical & Pharmaceutical Network supports translators and interpreters in keeping up to date with the latest developments through workshops, a newsletter, an online forum and an extensive archive of previous questions and answers from linguists specialising in work with the medical sector, as well as comprehensive lists of medical abbreviations and useful and trustworthy websites. BREXIT We started the article with the steady march of globalisation, but will coming out of the EU put the UK in reverse? This seems unlikely, but in relation to the precise impacts of Brexit, it still is a question of – wait and see. The main concern for European citizens living in the UK has been clarifying what they need to do to ensure they retain residency status. It is still a fluid situation but, at time of writing, the first phase negotiated agreement means that EU citizens residing in the UK on the date the UK leaves the EU (currently expected to be 29 March 2019) will be able to remain indefinitely. Language specialists leaving the UK in significant numbers would be detrimental, because it is important that suitably qualified people are available to translate into their own language to provide the best possible service to clients. It does not appear that there will be a mass exodus of translators and interpreters in the short to medium term, but it is unclear how things will evolve further down the line. # FURTHER INFORMATION




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The Modular and Portable Building Association says that hospitals need to ‘act now’ to ensure that they can provide the best possible facilities with the ever increasing need to reduce waiting times and overcrowding The Modular and Portable Building Association (MPBA) believes that the cost-effectiveness and speed with which modular buildings can be used to both construct new state-of-the-art hospitals from scratch and extend existing structures make them ideally suited for the health sector. Jackie Maginnis, chief executive of the MPBA, explains: “Modular buildings provide a perfect solution for hospitals looking to access long-lasting buildings that truly cater for their needs both quickly and painlessly. It’s been well documented that many hospitals and part of the health sector face increasing pressure on their infrastructures over the next few years. “At the MPBA, we want procurement departments/buyers to realise that modular buildings have the potential to be more cost-effective than conventionally built projects. Furthermore, because the structures are made to the highest standards off-site, modular buildings can and are frequently installed causing minimal disruption to staff and the existing patients.” Jackie added that modular building companies specialise in providing a ‘complete service’ to hospitals and a variety of medical facilities from undertaking the initial design and carrying

out all necessary groundwork to construction and final fit out. They can create standalone structures, single-storey ‘cluster’ departments, two-storey schemes or whole hospital configurations. In addition to being fitted-out for, wards, theatres, general offices, kitchen and dining purposes, the expertise also exists to design, create and subsequently install more ‘specialist’ accommodation required by the clients. Jackie continued: “When a hospital appoints a modular building company they know that on an agreed date they’ll be able admit patients to purpose-built, fully functioning premises that have been designed according to their precise requirements and budget. It’s my impression that finally clients are now starting to realise that you don’t have to employ one of the really big contractors and undertake a conventional build to get the premises they require.”

Mo buildingdular a perfec s provide for hos t solution to accespitals looking buildings long-lasting s for thei that cater r ne quickly eds

DID YOU KNOW? Modular buildings are built in controlled, energy-efficient environments. From initial works to completion, it takes up to 67 per cent less energy to produce a modular building compared with a traditionally-built project. Whilst initial, onsite ground works are being completed; modules – which make up a modular building – are manufactured off-site, in a controlled, factory environment. Pre-fitted with electrics, plumbing, heating, doors, windows and internal finishes before they are taken to site, modular buildings can also be installed with energy-efficient systems such as PIR sensors, enhanced ‘U’ values and solar panels. Not only is the off-site manufacture greener, buildings are also designed to be energy-efficient for their entire life cycle, all within the NHS requirements. Modular buildings now come with a range of external options to cater for nearly every look, including brickwork and tiled roofs to give a traditional appearance if that’s what’s required. When you build off-site, you plan and !


Written by the Modular and Portable Building Association

Reducing overcrowding and waiting times in the NHS

Modular Buildings




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DESIGN & BUILD " construct with meticulous precision. It takes strategic thinking and rigorous coordination, but modular construction allows for minimal disruption to staff and patients which is particularly key in the acute care environment. Off-site construction also allows for a 90 per cent reduction of the total number of deliveries to site as well as reducing up to 90 per cent of waste generated as the structure is recyclable. COST-EFFECTIVE AND TIME-SAVING NHS bed availability is at an all-time low, but off-site building techniques are the NHS’s construction dream. Modular buildings can be delivered up to 50 per cent quicker than traditional methods, which affords healthcare establishments a degree of certainty in meeting their needs quickly and efficiently. Although initial costs are comparable with traditional construction, the whole-life efficiencies weigh in favour of off-site. Easily adaptable to any future, changing industry needs and standards, 21st century medical modular buildings are built to stand the test of time. There are also many cost savings associated with modular build, stemming from a reduction in project timeframes, leading to reductions in overall construction costs. DAISY HILL HOSPITAL The McAvoy Group completed a £2.5 million contract to provide additional operating theatres and day surgery facilities at Daisy Hill Hospital in Newry for Southern Health and Social Care Trust in Northern Ireland. This complex 800m2 extension was constructed off-site by McAvoy and installed on a specially engineered steel gantry, 15m above ground level. This solution allowed the new facilities to be connected to the existing theatre complex at first floor level of the main hospital to maintain patient flows. A 230m2 plant room was located on the roof to accommodate specialist air handling equipment and other M&E systems. Designed to provide the highest standards of infection control, the building provides two operating theatre suites which include scrub areas, preparation, utility and anaesthetic rooms; stage one and two recovery wards with discharge lounges and ancillary spaces; an eight-bed day surgery unit, and an endoscopy decontamination suite. The design and specification of the new facilities were in compliance with current Health Technical Memoranda (HTMs) and Health Building Notes (HBNs). McAvoy has extensive experience in developing bespoke building solutions for highly constrained hospital sites and in minimising disruption to patient care during construction. As at Daisy Hill Hospital, sites that are less suited to traditional construction methods can be developed and existing facilities can be expanded rapidly and cost effectively, both vertically and horizontally. McAvoy is accredited under the LHC

Modular buildings now come with a range of external options to cater for nearly every look, including brickwork and tiled roofs to give a traditional appearance if that’s what’s required Modular Buildings Framework, NHS London Procurement Partnership, NHS Shared Business Services, and the Southern Modular Building Framework. Content extracted from company case study – full details are available on the company web site.

built on-site before being craned into position. The approach also meant that three modules could be transported on one lorry, reducing the environmental impact of transportation and pressure on local roads. Temporary foundations were installed to construct the modules.

BASINGSTOKE CONSULTANTS AND RADIOTHERAPY FACILITY, HAMPSHIRE Extraspace were awarded the project to design and build a new, steel framed, consultants building, including demolition of an existing building. Works included MRI and Linac facilities, CT suite, step down facility, X-ray suite and consultant assessment facility at Basingstoke Hospital. The 2,030m² building was delivered in 80 separate modules. The new building comprises of two main elements. Front of house offers a Private Patients Facility which includes 12 Consultant Suites, six secretarial rooms, staff rooms, offices, bespoke main entrance and modern reception area. The second part of the building is a dedicated radiotherapy building which contains CT Room, X-ray room, MRI room and a Linac Bunker. In addition to this, each element of the building has its own dedicated ancillary rooms to accompany the treatment areas. Four internal garden areas were incorporated into the design to get natural light into the building and provide aesthetic focal points. A BREEAM Very Good rating was achieved on this project.

ADDED VALUE The original contract was to design and build the front of house. With their extensive experience in the design and build of healthcare buildings and local supply chain, the company were able to include the radiotherapy building within the programme without delaying the handover of the consultant suites. Modular design is extremely versatile and flexible to support the project requirements. For example, a number of facilities within the building were designed by specialist providers incorporating unique design details such as copper-lined walls and concrete protection from radiation. These were seamlessly incorporated into the design. The company was able to deliver floors without floors, to install concrete floors on-site, and temporarily remove panels once watertight to support the delivery and installation of large, bulky, equipment. In addition, the entrance lobby and reception area was a traditional build. This was seamlessly linked within the modular structures. The site won a Bronze Considerate Constructors Scheme National Site Award in 2014 which was a first for Extraspace Solutions. Basingstoke Consultant & Radiotherapy Facility received a nomination for an LABC Building Excellence Award for Best Public Service Building in 2014. Another key factor for 2017 was the introduction of several framework agreements put in place to make it much easier to choose a supplier, the majority of the work already undertaken to reduce the stress to the end user. Never was there a better time to go modular with everyone now realising the value. #

CHALLENGES AND SOLUTIONS Live healthcare environment: The site was alongside a live hospital and adjacent to a nurse’s accommodation building and mental health hospice which meant security was paramount. In order to protect the surrounding area from the works, the entire site was hoarded with secure fencing and a single, secure, point of access. Regular tests of noise levels to ensure works didn’t exceed maximum levels agreed and implemented dust suppression measures. Module design: A number of the units were 4.2m high which meant they could not be transported to site. The solution was to design a flat pack system which was then

Modular Buildings




Infection Prevention Written by Veronica Johnson Roffey, Infection Prevention and Control Commissioning Nurse, Warwickshire North CCG




Maintaining good hygiene critical to infection prevention Veronica Johnson Roffey, Infection Prevention and Control Commissioning Nurse at Warwickshire North CCG, explains how it is only by staff, patients and visitors working together that healthcare environments can win the fight to reduce HCAIs

Hand is hygiene most le the singmeasure in nt importa ucing the red on nsmissi s a r t f o sm risk -organi on o r c i m f o e pers from onnother to a

Healthcare Associated Infections (HCAIs) can occur following direct contact within healthcare settings or following surgery. These infections, the majority of which are preventable, can cause significant harm to those affected, increase hospital stay and put added pressure on the NHS. There are many reasons a patient may develop a HCAI, including weakened immune defences due to treatment for cancer or leukaemia, complex surgical operations, insertion of medical devices such as catheters, or the over-use of antibiotics. The latter can result in the development of resistance such as meticillin-resistant Staphylococcus aureus (MRSA) making treatment with common antibiotics difficult. The increase in patients with chronic illnesses, such as diabetes, heart and kidney problems, and the increase in the elderly population are also contributing factors that predispose patients to infections. Infection prevention and control measures, such as appropriate hand hygiene, environmental cleanliness, basic precautions during invasive procedures, and education of staff, patients and visitors, are simple and inexpensive measures to help reduce the risk of HCAIs.

to decide what preventative measures they need to take. Spread of infection requires three elements. The first is an infectious agent – a bacteria, virus, fungi or protozoa. The source may be the patients’ own flora, other patients, staff or visitors, or contaminated equipment. The second element is a susceptible host –someone prone to infections because of an underlying disease, surgical procedures or indwelling devices, and the final factor is a means of transmission. There are four main routes of infection transmission:

HOW INFECTIONS ARE SPREAD When healthcare staff are educated about the ways infections are spread it helps them

Airborne/droplet transmission: Droplet transmission: large droplets produced during coughing, sneezing, talking and


Contact transmission (direct or indirect): Direct: body surface to body surface contact and physical transfer of micro-organism between an infected or colonised (carrier) person to another or from one site to another in the same individual. Indirect: contact between a person and contaminated surface or object.

suctioning generate droplets that land on surfaces which when touched can contaminate hands. Airborne transmission: smaller micro-organisms, contaminated water particles or airborne dust particles containing the infectious agent are dispersed by air currents then inhaled or deposited onto horizontal surfaces, equipment etc.

Food and water (Faecal–oral) transmission: Organisms can be transmitted via the food we eat and handle e.g. Campylobacter on raw chicken, by inappropriate handling of contaminated raw food or inadequate cooking. Cross-infection can occur via contaminated surfaces or infected food handlers if their hands are not cleaned after using the toilet. Water provides an ideal breeding ground for some micro-organisms, which can then be ingested, or as in Legionella, inhaled. Vector borne transmission: These are infections transmitted by flies, mosquitoes, and rats, and is rare in the UK.

HAND HYGIENE Hand hygiene is the single most important measure in reducing the risk of transmission of micro-organisms from one person to another or from one site to another on the same person. The World Health Organisation advises that cleaning hands promptly and as thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions and contaminated equipment, is essential in order to minimise the risk of cross-infection in healthcare. The Infection Prevention Society advises that effective hand hygiene involves the use of soap and water or alcohol hand rub. Liquid soap and warm running water can be used to mechanically remove transient micro-organisms from the hands and is perfectly acceptable for the vast majority of healthcare interventions. An alcohol-based product can be used for general hand hygiene in place of a hand-wash but only if hands are visibly clean. Alcohol rub, soap, water and paper towels must be available to encourage hand hygiene, and sinks for handwashing should be used for only that and not washing tea cups, dentures etc. A poster demonstrating the correct hand wash/rub techniques should be displayed at each clinical hand wash basin and a poster encouraging hand washing should be displayed in all patient and visitor toilets.

When building or refurbishing any health care environment provision of proper handwashing facilities must be a priority, therefore the Infection Prevention and Control Nurse (IPCN) should be involved at planning stage. ENVIRONMENTAL CLEANLINESS IN HEALTHCARE Contaminated healthcare surfaces play a huge role in the transmission of dangerous pathogens, including Clostridium difficile and MRSA. These pathogens are capable of prolonged survival on surfaces, therefore appropriate cleaning of those surfaces and equipment which patients and healthcare staff touch is necessary to reduce transmission. Frequently touched surfaces, such as taps, door handles and light switches are more likely to harbour and transmit micro-organisms, so it’s important to ensure these surfaces are cleaned frequently in line with specifications for cleanliness in the NHS (England only, 2007). Public perception is very important and if the environment in which patients or their relatives are cared for appears unclean, it can lead to the perception that care is equally bad. WHAT PATIENTS AND VISITORS CAN DO TO HELP IN PREVENTING HCAIS While it is commonly perceived that HCAIs are attributable to healthcare staff, it is worth remembering that patients and their

visitors also contribute. There are some simple things that patients and visitors should be encouraged to do in the fight to prevent transmission of infections. Patients can: wash hands after using the toilet and before meals; cover mouth and nose with tissue when sneezing or coughing, bin the tissue and wash hands; if socialising at another patient’s bed space, clean hands afterwards; ask staff if they have washed their hands and/or changed their gloves before doing your care; wash/ shower daily using own toiletries; keep locker and table top tidy and free from clutter to help with cleaning; do not interfere with drips, drains or dressings; and report any concerns about cleanliness or care standard. Additionally, visitors can: use the hand sanitiser when entering and leaving the hospital ward or department; not visit if you are unwell especially with colds/flu or stomach upsets; avoid bringing very young children to visit; do not bring in fresh flowers or plants; speak to staff before bringing food into the hospital; and report any concerns about cleanliness or patient care. It is only by staff, patients and visitors working together to do their bit that we will win the fight to reduce HCAIs. #

Infection Prevention



Hygienic Professional and BioCote explain why their new toothbrush and toothpaste holder is ideal for the healthcare environment Hygienic Professional has partnered up with BioCote to create the unique, patented Antibacterial Toothbrush and Toothpaste Holder, ideal for the healthcare environment. In hospitals as in most households, toothbrushes and toothpaste are stored in a huddle in the bathroom cabinet or on a counter-top. During day-to-day bathroom activities, the unprotected brushes and tubes of paste are exposed to the wide variety of microbes which the hospital environment is inevitably exposed to. As they are stored in such close proximity to each other, the potential risk for the transfer of microbes from brush to brush – and ultimately patient to patient – is high. Hygienic Professional and BioCote have invented a solution to this risk: an antimicrobial casing for your toothbrush and toothpaste, which can be given to each in-patient, so as to aid infection prevention and to help minimise the risk of healthcare acquired infections (HAIs). Both in laboratory and real life conditions

BioCote has been proven effective against a wide range of clinically significant bacteria including MRSA, MSSA, E. coli, Legionella, Pseudomonas, Salmonella, Listeria and VRE; as well as mould/fungi and the H1N1 virus. This innovative design is a unique, dental care and oral hygiene product that is a must-have. It holds all brands of toothbrush and toothpaste, and the lid can even be used as a rinse cup. Free standing and in a range of colours, it allows the user to hygienically store their toothbrush and toothpaste

with the knowledge that it is protected by BioCote technology. Once added to the holder, BioCote starts to work with immediate effect and lasts for the lifetime of the casing. Regular quality control testing has shown significant decreases in microbial contamination within just 15 minutes, and reductions of up to 99.5 per cent in two hours and 99.99 per cent in 24 hours. The technology is proven against a wide range of bacteria, so you can be assured that the risk of cross-contamination is significantly reduced by choosing this outstanding product. Hygienic Professional’s mission is to ‘hygienically personalise tooth care worldwide with full BioCote protection’. For any enquiries, please do not hesitate to get in touch. FURTHER INFORMATION Tel: 01708 730 007



Parking Written by Glenn Dives, British Parking Association



Where should NHS budgets be spent? Parking or healthcare? Should patients using NHS services be charged for parking? It is the topic that refuses to drive away. Glenn Dives of the British Parking Association explores the current situation There has been a great deal of comment lately charging for parking, resulting in political and about parking in hospitals. Parking facilities media attention calling for the abolishing of at hospitals are usually oversubscribed with all charges. These calls have crystallised in a demand often outstripping supply, and, for new Bill which begun its progress through this reason, parking facilities and transport the House of Commons on 14 November links need to be effectively 2017, sponsored by Robert Halfon, the managed to provide a better Conservative MP for Harlow. This experience for all, whether Bill seeks to ban outright the Beyond they are a patient, charging for parking spaces in the fina visitor or employee. England’s NHS hospitals and n c i al and budget In some cases, this while it is well intentioned, ary con has led to hospitals it fails to address several cern t

he s real-wo re is some of remorld experience charges ving parking th be cons at should idered


practical issues concerning the provision of parking. Indeed, it may be a case where the proposed cure may be worse than the disease. Before considering the Bill, let’s investigate a philosophical question. Is anything free? I’m sure everyone is familiar with the saying ‘there’s no such thing as a free lunch’. Everything built or maintained by people has a cost associated with it and that goes for parking. There is no such thing as a free parking space – somebody, somewhere is paying for it. This is true everywhere: in town

centres, at the beach, in the countryside and at the hospital. While some NHS car parks and car parks in general may be free at the point of use the upkeep and maintenance is provided from somewhere else. If it is being patrolled to keep users safe, then someone is paying for that too. These operating costs will not disappear if the charges at point of use are abolished. The question of how and ultimately who is funding this service remains. Hospital parking is no exception to this rule. If hospital parking was not charged for at the point of use, as proposed currently by Halfon’s Bill, then where would the costs of maintenance be paid from? Those maintenance costs in the form of surface repairs, painted lines and grass verges would have to come directly from healthcare budgets, either centrally funded or from the operating budget of the local NHS trust. This is unfortunately the reality of the situation – if those sites are not maintained then they can become dangerous. But funding NHS car parks like this is likely to become a contentious issue and is the first reason why we feel free parking at hospitals doesn’t protect the most vulnerable in our society. This issue is not limited to the existing parking infrastructure of hospitals, it is an ongoing one that could have significant effects on the behaviour of administrators for years to come. This was evidenced when the Bill was proposed in the House of Commons. James Duddridge, Conservative MP for Rockford and Southend East, highlighted his concern that capital expenditure will not be found to provide more parking spaces. He believed that future capital expenditure on car parks would be limited, because there would be no revenues associated from the expenditure. He went on to ask the question ‘what happens in cases where existing car parks are being built?’. If those plans anticipated a revenue stream following a car park’s construction, the removal of the charges would undermine the budgeting process for the expenditure, possibly leading to the cancelling of the construction of that car park. He also believed if demand for parking increased in the future, there would be no market mechanism to enable more car parking spaces to be built to cater for it. In the end, he conceded that while the ‘Bill is a popular move – it would be popular with my constituents’, but it didn’t mean it was the right thing to do. PATIENT ACCESSIBILITY Beyond the financial and budgetary concerns there is some real-world experience of removing parking charges, which those supporters of the Bill in Parliament, the media and the wider public space, should consider. 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



Everything built or maintained by people has a cost associated with it and that goes for parking. There is no such thing as a free parking space – somebody, somewhere is paying for it patients. And because demand wasn’t managed properly it spilled onto yellow lines, grass verges and nearby residential streets. In some cases, bus companies refused to offer a service because they couldn’t get through, further disadvantaging the most vulnerable from accessing the hospital. Finally, there are cries all the time for more money to support the NHS, but not one of those desires parking to be the recipient of that money. Someone who needs treatment would not want the hospitals budget to be spent on parking facilities either. What they would want is to receive their treatment and to access the hospital with

as minimal amount of stress as possible. We believe that healthcare budgets are for providing healthcare, not parking spaces, and with that in mind we contend that there should be some exemptions for long term or vulnerable patients who would receive discounted or free parking. But how to achieve this? AVAILABILITY AND DEMAND We would advocate that charges must be reasonable and reflect availability and demand. That a concessionary system should be given to the following people if public transport may be impractical for them or !






No one enjoys a visit to a hospital or a doctor’s surgery. If someone does make that visit, it is generally because they are ill or are visiting a loved one who is ill. Why, on top of that, should they feel stressed about parking? " if parking charges could become a burden over time: disabled people; patients with a long-term illness or serious condition needing regular or long-term treatment (for example, people having dialysis, radiotherapy or chemotherapy); visitors (such as careers) who need to visit patients regularly; staff working shifts that mean public transport cannot be used; and other concessions, e.g. for volunteers or staff who car-share, should be considered locally. Where such a system is in operation, NHS trusts and operators should work together to make sure they give the maximum publicity to such concessions and that they are taken up by eligible patients. We have long been interested in this topic, publishing a Charter for Healthcare Parking in 2010 and working with the Department of Health in updating parking guidelines for NHS trusts, which was published in March 2015. The guidelines include case studies of good practice that other NHS trusts are encouraged to emulate. NHS patient, visitor and staff car parking principles – Rules for managing car parking in the NHS is an excellent guide to good practice that we commend to all trusts and



parking operators to ensure they strike the right balance between being fair to patients, visitors and staff and ensuring facilities are managed effectively for the good of everyone. No one enjoys a visit to a hospital or a doctor’s surgery. If someone does make that visit, it is generally because they are ill or are visiting a loved one who is ill. Why, on top of that, should they feel stressed about parking? It does not help them if a doctor, nurse or surgeon is also stressed about parking too. A professional organisation should look to manage its car parks and take steps to help minimise anxiety. Hospital parking is a complex issue which stirs ups a range of emotions, that is why it should be looked at as dispassionately as possible, weighing up the evidence before deciding. Finding a resolution to this situation is not difficult and our suggestions above could prove the basis for such a solution. The British Parking Association stands ready to work with any and all organisations involved to find a reasonable solution suitable for all parties involved. # FURTHER INFORMATION

Hospitals made £174m through parking charges Data collected by the Press Association has found that hospitals in England made a record £174 million for 2016/17 in charging for parking, an increase of six per cent on the previous financial year. The figures, revealed under a freedom of information request, also showed that a growing amount of revenue was being made from fines – increasing by a third to £950,000 – being branded as a ‘tax on sickness’. The figures, obtained from 111 hospital trusts, indicate that the Heart of England NHS Foundation Trust took the most money through parking charges, reaching over £4.8 million, whilst two-thirds of hospitals made more than £1 million in each of the last three years. The Press Association also revealed that half of all trusts charged disabled people for parking in some or all of their disabled parking spaces. The Patients Association conceded that the current state of NHS finances meant it was difficult to blame hospitals for trying to find money, but warned that current conditions did not make the current situation acceptable. FURTHER INFORMATION



PEA Parking is a member of the British Parking Association and a part of the NCPS Group, a parking operator with clients across Europe, the Middle East, UK and Ireland managing over 1,100 sites with a special focus on healthcare and hospital sites. Staff at PEA Parking understand the emotive and sensitive nature of parking at hospital locations. They also understand the need to have a productive and effective system in place that works for patients, visitors, staff and contractors without penalising them, yet deters illegal or unwanted parking on your hospital estates. PEA Parking’s mission is simple: to deliver an ethical solution that seeks compliance and ultimately leaves the end user with a positive parking experience through clear communication and education. Its ‘Total Solution’ is a bespoke package tailored to the

Grabking is a leading provider of grab hire trucks and aggregate delivery services in London, Essex, Hertfordshire and Cambridgeshire with eight-wheel grabs and tippers for hire. It is a grab hire business formed with customer service in mind. The company prides itself on not only reliability, but also affordability. It supplies services to commercial and domestic customers, and qualified staff will be happy to help you from quote to collection and delivery. Grabking constantly strives to be the best grab hire company in the market place and have over 20 years’ experience in the fields of grab hire, waste disposal, waste recycling and aggregate delivery – including all grades of topsoil, MOT Type1, Shingle, sharp sand, building sand, gravel, cement, crushed concrete, road

Parking solutions for the healthcare sector

unique requirements of your environment. PEA Parking will design and deliver an end-to-end parking solution based on your parking policy enforced either by yourself or the company. Some of PEA Parking’s services include: self-enforcement and back-office management; complete civil enforcement package; real time data and reporting suite; cashless parking system; permit management system; and hardware solutions. FURTHER INFORMATION Tel: 0330 024 5533

The grab hire company tailored to your needs



Spinnaker Waste Management Ltd is a specialist IT disposal and electrical asset management service provider/ From collection to disposal and recycling, Spinnaker’s secure service is designed to remove and dispose of any electrical equipment, all within a secure and environmentally sensitive way under the WEEE directive. With an extensive and successful working knowledge of the health care industry, the Spinnaker team appreciates the disposal of redundant equipment can often be a logistical strain, and with GDPR on the horizon, an outsourced solution such as Spinnaker Waste Management Ltd can prove beneficial for a number of reasons: depending on the value of your redundant equipment, we can often remove it free of charge; complete peace of mind that all data is erased either on or off-site; certificate of Data Destruction issued to the customer; fully accredited

Any public buildings constructed prior to the year 2000 may contain asbestos. As part of your duty of care it is vital that you understand if asbestos is present in your buildings as well as assessing the extent and condition. All building occupants can be exposed to the dangerous fibres that are released when asbestos is disturbed – this becomes a real danger when you are carrying out any repairs, maintenance or construction projects. BAAC has over 44 years of experience in the building industry and is a specialist in the management of asbestos. An initial survey will identify the presence of asbestos, assess the state and provide a plan for short and longer term management. In addition, BAAC is a truly

Specialist services for WEEE and e-waste

& CRB/DBS checked personnel; large or small quantities accepted; high security vaults for complete peace of mind; ISO: 9001, 14001 & 27001 (pending) and B.S EN 15713 accredited; all waste is disposed of under the waste hierarchy policy, so you can be rest assured that from collection to disposal, your carbon footprint is minimal. For more information, please speak to one of Spinnaker’s customer care representatives. FURTHER INFORMATION Tel: 02392 293 234 james.ponsford@

Products & Services


plannings, ballast and much more. By adopting systems and procedures from larger organisations and other areas of the haulage industry, Grabking can streamline its processes in order to make your life easier. And whilst keeping the ‘smaller haulier’ mentality, the company can guarantee all customers a truly personal service. For Grabking the message is really easy: “Keep it simple and deliver”. FURTHER INFORMATION Tel: 01279 734900

Providing a cost-effective solution for asbestos

independent company and will guarantee that the advice given is impartial and pragmatic. The company focuses on providing you with the most appropriate solution for your site. Removal of asbestos is very often the last resort. To arrange a survey get in touch today, quoting reference number BME18. FURTHER INFORMATION Tel: 01733 843 353



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Brinsop Court provides a unique setting for your business to host any type of event, ranging from a board room business meeting and product launches, a theatre style conference, a business overnight retreat or a conference day for up to 100 delegates. Guests continue to be warmly welcomed by the estate, a family-owned and now sought-after wedding, holiday and corporate venue, staffed by a dedicated and passionate team which treats every guest individually. Escape the city business distractions; an opportunity to let creativity and innovation flow. The opportunity to take a step back in time does not come at the expense of convenience, comfort and the modern business facilities available.

Set in the heart of the Cheshire countryside, this delightfully quirky and intimate venue, in addition to providing musical entertainment all year around, is available for external hire. Clonter Opera Theatre offers a wide range of facilities suitable for numerous alternative activities, including conferences, training and away days and fairs. Clonter consists of a 400-seater auditorium in which to make presentations; six adjacent break out rooms of various sizes for more interactive and intimate sessions to take place; a spacious foyer complete with bar to facilitate networking; extensive outdoor space in which to run additional activities (weather permitting) or just to take a break in between sessions surrounded by mature woodland, aiding a true break away from the city. With the wide range of its own events, Clonter is well-equipped, with two kitchens, to arrange catering of every kind and

Brinsop Court, a venue with a difference

Enjoy the extraordinary surroundings taking full advantage of Brinsop Court’s land and outdoor facilities for a range of team-building activities. Unwind in front of the roaring fire in the Oak Parlour, and enjoy a magnificent feat in the 12th Century Banqueting Hall, followed by a great night’s sleep in one of the 18 luxury bedrooms. FURTHER INFORMATION Tel: 01432 509 925

A remarkable venue for conferences and events

organise entertainment, if required, and free car parking. Whilst away from the hustle and bustle of the city, Clonter is only a 10 minute drive from two towns, Holmes Chapel and Congleton, and 20 minutes drive from Macclesfield and all their respective railway stations, and 5.5 miles from the M6. Shuttle minibuses can be arranged. With the increasing speed of life, Clonter’s rural setting is increasingly being identified as the ideal alternative environment in which companies can really get away from the office for a day. FURTHER INFORMATION Tel: 01260 224 514

ADVERTISERS INDEX The publishers accept no responsibility for errors or omissions in this free service Activinsights

44, 46

AGFA Healthcare

Inside Front


Cover ECRI Institute

Inside Back

Miller Castle


National Autistic Society


Octopus Healthcare


Parking & Enforcement




Bosse Interspice


Brand Skout


Elite Systems GB


Riello UPS


Brinsop Court Estate


Evac Chair International


Safeshred UK


C S Shredding




Schneider Electric

Caterpillar (NI)

26, 27

Flypic Aerial Imaging


Spinnaker Waste Management 65


12, 13

Clonter Opera Theatre




Stanley Healthcare


Create a Cabin


Hygienic Professional


TF Installations






The Zinc Group




Integrated Contact Solutions


William Gough & Sons



Back Cover

Drones on Demand





ISS Mediclean


Wilo UK


Legrand Electric


Wudo Solutions


Top 10 Health Technology Hazards for 2018

1.1.Ransomware and other Cybersecurity Ransomware and other Cybersecurity Threats Threats

Endoscope Reprocessing Reprocessing Failures 2.2.Endoscope Failures Contaminated Mattresses Mattresses and Covers 3.3.Contaminated and Covers Alarm Notification Failures 4.4.Alarm Notification Failures

5. Equipment Failures from Improper

Cleaning Failures from Improper 5. Equipment


6. Patient Burns from Upholstered ESU

pencils 6. Patient Burns from Upholstered ESU

pencils 7. Radiation Exposure from Inadequate Use of Digital Imaging Tools

7.Radiation Exposure from Inadequate Use Digital Imaging Tools Medication 8.ofBar-Coded Administration System Workarounds

8.9.Bar-Coded Medication Care Delays from Flaws in Device Administration System Workarounds Networking

9. from Flaws in Device 10.Care SlowDelays Adoption of Safer Enteral Feeding Connectors Networking

10. Slow Adoption of Safer Enteral Feeding

Connectors Download the executive brief for free at

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Health Business 18.1  

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Health Business 18.1  

Business Information for Healthcare Professionals