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BETTER DESIGN FOR A&E DEPARTMENTS Making sure information is accessible and at the point of service is intergral to good A&E design


FINANCE AND FRONTLINE SERVICES The financial perspective on the current NHS landscape


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BETTER DESIGN FOR A&E DEPARTMENTS Making sure information is accessible and at the point of service is intergral to good A&E design



The NHS tide starts to turn as funding pressures mount

The financial perspective on the current NHS landscape


New research has shown that public satisfaction with the NHS has dropped six percentage points in the last year, as funding and workforce concerns continue to harm the service. The National Centre for Social Research’s British Social Attitudes (BSA) survey, analysed by the Nuffield trust and The King’s Fund, highlights how dissatisfaction in the NHS has risen to its highest level in a decade, reaching 29 per cent. Furthermore, in a similarly worrying trend for health services, general practice is no longer the highest rated service, dropping seven percentage points to 65 per cent for public satisfaction. Whilst the results are not necessarily surprising, they do reflect growing national anxiety over NHS staff shortages and chronic lack of funding. Alongside increasing waiting times, John Appleby, director of Research at the Nuffield Trust, was right in saying that ‘the tide has started to turn’ and that the public are right to be anxious.

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NHS Improvement’s latest quarterly report has revealed deficits set to be in the region of a billion pounds this year, as well as a dangerous shortage of nurses and doctors. Unless the two are addressed, with long-term solutions not quick-fire fixes, patient care will remain threatened. 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 PRODUCTION EDITOR Richard Gooding PRODUCTION DESIGN Jo Golding PRODUCTION CONTROL Ella Sawtell WEBSITE PRODUCTION Victoria Casey ADVERTISEMENT SALES Jeremy Cox, Lucy Rowland, Damian Emmins, Lucy Maynard, Ben Plummer ADMINISTRATION Vickie Hopkins PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

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Contents Health Business 18.2 07 News


NHS is ‘dangerously’ short of staff; and senior female doctors earning less than male colleagues

15 Finance

Emma Knowles explains why the finance profession has a major part to play in providing the right financial platform for service delivery and transformation

19 Design & build


There are a number of key requirements for flooring within the healthcare sector – such as ease of cleaning, durability, and versatility

23 Interior design

The interior design of a hospital is important in making sure information is accessible and at the point of service, as well as limiting stress and anger

27 Design in mental health

Alex Caruso explains how designing facilities appropriately can improve safety and patient outcomes, as well as benefit the mental health of patients

31 Debt management 27

The money owed across the NHS is measured in the eye-watering billions of pounds. Stephen Sutcliffe explains the importance of collecting NHS debt

37 Infection control


BioCote has found that the presence of antimicrobial products can lead to a 93 per cent reduction in bacteria

41 Patient safety

The rates of error present a significant challenge to those working in the NHS. Mona Guckian Fisher looks at near miss events within surgery

45 Recruitment

Brexit and poor retention rates threaten to provide further damage to an already struggling workforce. Health Business examines the issue

46 Catering 65

Adrian Roper discusses how to help NHS trusts create a better food experience and support a health-promoting environment for patients and staff alike

Health Business magazine

49 Energy

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

52 Facilities management Russell Beattie reviews the state of the building services sector and some of the ways in which the HVAC industry is pushing towards energy efficiency

56 Waste management

Edward James discusses some of the waste challenges being faced, and the ways in which the London Procurement Partnership supports NHS organisations to overcome them

58 Water management

Elise Maynard outlines the importance of water hygiene awareness training in preventing the outbreak of nfections, such as legionella

61 e-Procurement

Royal Cornwall Hospitals NHS Trust is leading the way in adopting GS1 and PEPPOL standards. Here, the trust discusses how being a Scan4Safety site is helping it release clinician’s time to patient care

65 Communications appointments

With almost eight million hospital appointments missed last year, Peter Akid says the patient communications technology framework can help reduce ‘Did Not Attends’ and save money


Victoria Cetinkaya looks at the main aims and principles of GDPR, and dispels some of the recent misconceptions

72 Telehealth

Health Business talks to Dr Debbie Harvey, of South Sefton CCG, about the CHIP programme and the use of telehealth initiatives in the NHS

75 Digital records

NHS Digital has revealed that increasing the amount of information held in electronic Summary Care Records is improving care and helping to ease winter pressures. Health Business explores Volume 18.2 | HEALTH BUSINESS MAGAZINE


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NHS is ‘dangerously’ short of staff New financial figures have shown that the NHS has nearly 100,000 positions unfulfilled, representing one in 12 posts – enough to staff 10 large hospitals. The financial report has revealed a £931 million deficit this year, which is twice what was planned, and has been partly attributed to the need to cover the vacancies with overtime and temporary staff. NHS Improvement, which released the accounts, said the health service was working hard to tackle the problems and commended staff for their hard work. However, Nigel Edwards, chief executive

of the Nuffield Trust think tank, warned that the NHS was ‘dangerously’ short of staff and claimed that the ‘the lack of crucial workers in the NHS is an even bigger problem than the lack of funding’. Saffron Cordery, NHS Providers’ director of policy and strategy, said: “These figures show how the NHS has been pushed to the limit. Despite working at full stretch with around 100,000 vacancies and a real risk of staff burnout, and despite treating six per cent more emergency patients year on year in December, trusts cannot close the

gap between what they are being asked to deliver and the funding available. “The figures confirm, once again, three key problems the whole NHS provider sector is facing: increases in demand for treatment continue to significantly outstrip increases in NHS funding, trust savings targets remain too ambitious and there are serious ongoing workforce shortages.” READ MORE



People living with diabetes doubles in twenty years

Millions wasted each year on NHS management consultants

Analysis released by Diabetes UK has revealed that the number of people diagnosed with diabetes in the UK has more than doubled in the last twenty years. There are nearly 3.7 million people living with a diagnosis of diabetes in the UK, which the charity says is an increase of 1.9 million since 1998. Broken down, it also shows that the number of people diagnosed with Type 1 or Type 2 diabetes has increased by almost 100,000 since last year. According to Diabetes UK, approximately nine in ten people diagnosed with diabetes have Type 2, although it is estimated that there are nearly another one million people currently living in the UK with the condition who remain unaware that they have it because they haven’t been diagnosed yet. Type 1 diabetes isn’t currently preventable, however three in five cases of Type 2 diabetes can be prevented or delayed by making healthier choices, by helping people understand their own risk of developing the condition and by securing early diagnosis for those known to be at high risk.

Chris Askew, chief executive of Diabetes UK, said: “Diabetes is the fastest growing health crisis of our time; and the fact that diagnoses have doubled in just twenty years should give all of us serious pause for thought. Both Type 1 and Type 2 diabetes are serious conditions that can lead to devastating complications such as amputation, blindness, kidney disease, stroke and heart disease if people don’t receive a timely diagnosis and begin receiving the right care. “With more than 12 million people across the UK at risk of developing Type 2 diabetes, and prevalence of both Type 1 and Type 2 diabetes still on the rise, it’s clear there’s a huge amount of work to be done. We want the government to recognise the seriousness of the growing diabetes crisis, take action to help those at increased risk, and help us turn the tables on this devastating condition.” READ MORE


Senior female doctors earning less than male colleagues A BBC investigation has revealed that senior NHS female doctors are earning less than their male counterparts, with only five women listed in the top 100 earning consultants in England. This is despite more than a third of the workforce being female. Senior female doctors have described the findings as ‘disappointing’, arguing that more needs to be done to tackle the gender pay gap in medicine. With the top-paid man earning £739,460, which is two-and-a-half times that of the top woman (£281,616), the investigation also showed that there was a 12 per cent pay gap in the earnings of male and female consultants, which translates to nearly £14,000 a year.

NHS Employers has said that the consultants’ contract allows high premiums to be charged for overtime and creates a bonus system that is skewed. Dr Anthea Mowat, of the British Medical Association, said: “With women making up the majority of medical graduates in recent years, it’s vitally important that we address the root causes of the gender pay gap, and develop a wider programme of work to eliminate it across the medical workforce.” READ MORE

New research has claimed that NHS management consultants are causing a service already under pressure to be less efficient rather than making things better. Published in the journal Policy & Politics, the universities of Bristol, Seville and Warwick Business School have collected four years of data from 120 hospital trusts in England and discovered that £1.2 million a year is spent on consultants per trust. The research revealed that more spending on management consultants leads overall to a significant rise in inefficiency, ultimately worsening services. With relatively small financial losses – approximately £10,600 for each hospital trust – the research found that the money spent on consulting ranged from zero to £5.6 million per year. Andrew Sturdy, professor in Management at the University of Bristol, said: “Our research has clearly shown that management consultants are not only failing to improve efficiency in the NHS but, in most cases, making the situation worse. Data shows that it’s a system-wide problem. This is money which, many argue, could be better spent on medical services or internal management expertise. “From the study data we can only speculate on what lies behind these findings. One possibility is that consulting projects are highly disruptive, especially if the demand for them has been generated artificially by sophisticated selling, back stage deal-making and revolving doors between politicians, regulators, healthcare managers and civil servants.”




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Better integrated systems for NHS communication NHS Digital has announced new plans to enable NHS staff to communicate with each other through better integrated systems, bringing greater collaboration to the health system. The initiative will integrate NHSmail, which uses Microsoft Exchange and Skype for Business to securely share patient information, with Office 365, synchronising NHSmail to Azure AD and then integration with Office 365 services.

This should be completed by August. Neil Bennett, service director for NHS Digital, said: “This synchronisation of NHSmail to Azure AD and integration with O365 is part of our long-term vision to bring about greater collaboration across the wider health and care system. It means information can be more readily and securely shared between health and care organisations and teams can collaborate more easily. Ultimately it will enable NHS staff to

access multiple applications and services using their NHSmail user name and password which makes their job easier. This benefits patients because it makes the NHS more efficient and they can be assured that their confidentiality continues to be strictly maintained.” READ MORE



Second wave of ‘test beds’ announced

NHS Digital and techUK outline future digital

NHS England and the Office for Life Sciences have launched a new competition to identify a second wave of ‘test beds’ to use technology to address complex health issues. The new competition will allow businesses and NHS organisations to apply for a share of up to £4.5 million to evaluate different combinations of innovations from small and large organisations to address a locally identified clinical challenge. Over 4,000 patients were recruited in seven test bed sites from the first wave of the programme, as well as 51 digital innovations trialled in partnership with 40 innovators.

Lord O’Shaughnessy, Parliamentary Under Secretary of State for Health, said: “The test beds programme has enabled ground-breaking digital innovations to transform the lives of patients with dementia, diabetes and mental illness. Phase two of this pioneering research will allow us to learn even more from emerging technologies so that NHS clinical practice can adapt to the big health challenges we face.” READ MORE


New air ambulance for Midland’s fleet The Midlands Air Ambulance Charity’s fleet has welcomed the arrival of a new, £7 million upgraded air ambulance helicopter. The Airbus helicopter received its medical fit out at Babcock in Gloucestershire and will undertake an average of three air ambulance missions every day and provide a great number of benefits to patient care within the Midlands. It travels greater distances without the need for refuelling and enables the aircrew to respond even faster due to increased speed capability. The larger interior means additional aircrew can be flown to major incident scenes, and further medical equipment can be carried on board to treat

more complex emergencies. Brendan Connor, chairman of Midlands Air Ambulance Charity, said: “Excellent pre-hospital patient care is at the heart of everything we do. To support our mission, build resilience, and strengthen the longterm sustainability of the charity, we made the strategic decision to invest a proportion of donations into a larger, upgraded H145 model. The new airframe will enable us to reduce our operating costs and complements our plans to further improve pre-hospital care in the region.” READ MORE

Agreeing on six main areas to focus on in 2018, NHS Digital and techUK have expressed their views on the future challenges they need to tackle to take their partnership to the next level. Among the focuses, the two organisations highlight working with small and medium enterprises so that they might share in NHS and social care business and continue increasing interoperability in the sector, building flexibility into technology from the outset. Set up at the end of 2016, the partnership will also explore horizon scanning for innovative technologies, supporting the security operation centre procurement to help build on current cyber security work and carrying out a strategic review of NHS Digital’s digital transformation programme. James Hawkins, director of Programmes at NHS Digital said: “The years ahead promise many exciting opportunities to advance technology in the NHS, working closely in partnership with industry. By setting out our priorities, we have created a blueprint for success in the years to come.” Julian David, CEOfficer for techUK added: “Our partnership with NHS Digital has already achieved so much, with 25 market engagements, seven consultations, and over 1,500 delegates through the door, but this is only the start. Now that we have seen a shift towards a more transparent and collaborative way of working with industry, we look forward to deepening that engagement, working together to deliver better health and care outcomes for the whole country.” READ MORE

Volume 18.2 | HEALTH BUSINESS MAGAZINE Credit: Alec Wilson




GPs offered cash incentives to not refer patients Pulse has reported that GPs in five areas of England are being offered cash payments not to refer patients to hospital. The controversial ‘profit share’ agreements see GPs paid up to half the savings if they refrain from referring their patients to hospital. The ‘Cash for Cuts’ investigation follows the Royal College of GPs in raising concerns about the effect of referral restrictions on patient care. With freedom of information responses from 181 CCGs, Pulse claims that a quarter are offering some kind of financial incentive designed to cut referrals to specialists. The five ‘profit sharing’ schemes, include: NHS Coastal West Sussex CCG offering

groups of GP practices 50 per cent of the savings on any reduction in elective activity from the previous year; GP federations in West Leicestershire receiving 30 per cent of savings made on first elective referrals; NHS Vale of York CCG offering GP practices a ‘gain/share’ arrangement for dermatology referrals and ‘a proportion of any savings achieved’; NHS Enfield CCG saying 50 per cent of any cost reduction for GP-referred outpatient attendance ‘will be shared with the locality’; and NHS Wolverhampton CCG considering a profit-sharing scheme. Helen Stokes-Lampard, chair of the RCGP, said: “Reviewing referrals is an important

part of general practice, and a constructive part of professional development for GPs, but it must be proportionate, safe, and put the patient at the heart of the decision. Our recent report highlighted that GPs need support to ensure that referrals are appropriate – not ethically-questionable initiatives that prioritise cost-savings over patient care. Cash incentives based on how many referrals GPs make have no place in the NHS, and frankly, it is insulting to suggest otherwise.” READ MORE


NHS chief warns of ambulances stuck at A&E


Brexit negotiators urged to put patients first The Brexit Health Alliance has urged Brexit negotiations to ‘put patients first’ following warnings children could miss out on lifesaving clinical trials when the UK leaves the EU. Brexit threatens the UK’s ability to participate fully in collaborative trials and research activities, including those supporting children and adults with rare and complex diseases, whilst it also risks losing access to crucial EU infrastructure which implements the legislation authorising and managing clinical trials. The Brexit Health Alliance has highlighted how decision-makers on both sides can mitigate the risks to patient access to medical research, referencing a number of examples exploring the value of UK-EU cooperation on rare diseases, such as a 2013 clinical trial for hemotherapy treatment for children and young adults with recurring neuroblastoma. The alliance is requesting negotiators to secure a positive future cooperation model for research and innovation between the UK and the EU, which includes UK involvement in EU-funding programmes, as well as a welcoming UK migration system to attract researchers, innovators, and their families. READ MORE

Wayne Bartlett-Syree has warned that patients are at risk of harm because too many ambulances are stuck at A&E units and cannot respond quickly enough to 999 calls. In a blogpost written for NHS Providers, the director of strategy and sustainability at the East of England Ambulance Service said that the number of delays ambulance crews have faced this winter was to blame for the increasing number of seriously ill patients who are having to wait several hours for paramedics to arrive. Latest NHS figures indicate that 149,214 patients had to be looked after by ambulance personnel for at least half an hour either in the back of an ambulance or a hospital corridor so far this winter as a result of poor waiting

times and blocked ambulances. Bartlett-Syree said: “It is now commonplace over the winter period for A&E corridors to become full of patients and ambulances to queue outside emergency departments. It means that patients in the community could be having heart attacks and strokes when there are no ambulances available to provide an emergency response. The risk of harm is now transferring from those in [hospital] corridors to patients in the community needing an ambulance.” READ MORE


Public satisfaction with GP services falls to lowest level The annual British Social Attitudes survey has revealed that public satisfaction with GP services has fallen to its lowest level since records began in 1983. The 2017 study showed that satisfaction dropped seven percentage points to 65 per cent, marking the first time general practice has not been the highest-rated NHS service, with waiting times highlighted as a major factor with the dissatisfaction. Overall dissatisfaction levels were also the result of staff shortages, current lack of funding and government reforms. However, the survey highlighted the quality of care and having a service that is free at the point of use as the main reasons for satisfaction. Public satisfaction with the NHS also fell, dropping six percentage points from its 2016 position, with only 57 per cent of those surveyed happy with the service while dissatisfaction has risen to 29 per cent – the highest level in a decade.

The survey was conducted by the National Centre for Social Research (NatCen) and analysed by the Nuffield Trust and the King’s Fund think tanks. Ruth Robertson, fellow at the King’s Fund. “The public used to put GPs on a pedestal. But since 2009, when there was an 80 per cent satisfaction rating, it has been steadily declining. It shows the impact of the huge pressure on GPs and the public is responding to that. “More people are satisfied with the NHS than are dissatisfied. They showed really strong support for the core value principles of the NHS. I think this shows that it is not falling out of favour, but people are worried about the NHS and they are worried about funding and staffing shortages.” READ MORE



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Medicine errors contribute to 22,000 deaths a year Health Secretary Jeremy Hunt has said that up to 237 million drug errors in England are causing appalling levels of harm and deaths. Data suggests that GPs, pharmacists, hospitals and care homes may be making 237 million errors a year, which equates to one mistake made for every five drugs handed out. It is believed that the drug errors could be a factor in more than 22,000 deaths a year. Although the researchers state the figures are based on estimates and previous research, they argue that the data is robust enough to warrant action. With 1.15 billion drug prescriptions made each year, a fifth of the mistakes related to hospital care, including errors made by doctors administering

anaesthetic before surgery, as well as wring medications being given and delays in medication being administered. Hunt said he was concerned by the findings, which he stressed was a global problem, not solely confined to the UK, and emphasised that the study was not about blaming NHS staff, but about creating a culture where checks were in place to stop errors happening. He outlined steps the NHS is taking to reduce mistakes in a speech at a patient safety conference in London on 23 February. Among the steps, it was revealed that funding will be given to accessing prescribing data and NHS electronic prescribing systems. Hunt said: “My mission has always been to make the NHS one of the safest

healthcare systems – and although we do well in international comparisons, this new study shows medication error in the NHS and globally is a far bigger problem than generally recognised, causing appalling levels of harm and death that are totally preventable. “We are taking a number of steps today, but part of the change needs also to be cultural: moving from a blame culture to a learning culture so doctors and nurses are supported to be open about mistakes rather than cover them up for fear of losing their job.” READ MORE


£45 million for brain cancer research The government has announced that the Department of Health and Social Care and Cancer Research UK will release £45 million in funding for brain tumour research in the UK. Approximately 11,400 people in the UK are diagnosed with a brain tumour every year, with just 14 per cent of people surviving their disease for 10 or more years. The funding is to be spilt, with £20 million invested through the National Institute for Health Research over the next five years and £25 million to be invested by Cancer Research UK for research into brain tumours over the same time period. The charity’s funding will support the Children’s Brain Tumour Centre of Excellence, based at the University of Cambridge, and the Institute of Cancer Research, London.

Health Secretary Jeremy Hunt said: “While survival rates for most cancers are at record levels, the prognosis for people with brain tumours has scarcely improved in over a generation. I am grateful to Baroness Jowell and other MPs who have campaigned with great dignity and courage to raise awareness of this issue. Our ambition is to deliver a big uplift in the funding of brain cancer research, while galvanising the clinical and scientific communities to explore new avenues for diagnosis and treatment in the future. It is a chance to create a genuine step change in survival rates for one of the deadliest forms of cancer.” READ MORE


Study into how cancer patients will respond to therapy According to a new study, scientists can now predict how cancer patients will respond to therapy by growing miniature versions of their tumours in a laboratory. Printed in the journal Science, the study claims to be 100 per cent accurate at telling which drugs would fail, sparing patients from unnecessary side-effects and leading to ‘smarter, kinder and more effective treatments’. Biopsies of 71 patients with advanced colorectal cancer were taken and then grown into miniature 3D cancerous organs in the laboratory, with researchers treating each ‘organoid’ with the same drug doctors gave to the patient in the clinic. It found that if the drug worked in the organoids, it worked 88 per cent of the time in the patient, while if the drug failed in the organoids, it failed

100 per cent of the time in the patient. Dr Nicola Valeri, from the Institute of Cancer Research in London, said: “For the first time we proved these organoids not only resembled the biology of metastatic cancer, but also mirror what we see in the clinic.”



Mental health trusts’ income lower than in 2011-12 The Royal College of Psychiatrists has revealed that mental health trusts have less money to spend on patient care in real terms than they did in 2012. Once inflation is taken into account, mental health trusts’ income is lower in England now than it was in 2011-12 despite the government claiming that mental health spending is at ‘record’ levels and pledging to make mental health care on par with physical health. The figures show that 62 per cent of mental health trusts at the end of 2016-17 reported lower income than the amount for 2011-12, with only one trust seeing their income rise all five financial years. The total amount of income that mental health trusts received in 2016-17 was £11.829 billion, £105 million lower than in 2011-12 at today’s prices. Nine trusts – Black Country Partnership NHS Foundation Trust, Coventry and Warwickshire Partnership NHS Trust, Leeds and York Partnership NHS Foundation Trust, Norfolk and Suffolk NHS Foundation Trust, North West Boroughs Partnership NHS Foundation Trust, Rotherham, Doncaster and South Humber NHS Foundation Trust, Solent NHS Trust, South West Yorkshire Partnership NHS Foundation Trust and Worcestershire Health and Care NHS Trust – all saw their income fall for five years in a row over that period. READ MORE


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No-one can be in any doubt that the NHS faces significant financial challenges both in the immediate term and in the long-term as it looks to deliver services that meet rising patient demand in a sustainable way. The quarter three figures published by NHS Improvement spell out exactly the scale of immediate difficulties with NHS providers reporting a year-to-date deficit of £1,281 million – £365 million worse than the plan for

this point in the year. Trusts were also projecting to end the year with a deficit of £931 million – £435 million worse than the planned year-end deficit and £308 million worse than the Q2 forecast deficit. The winter period has been very demanding – ‘one of the most challenging winter periods that the NHS has had’ according to NHS Improvement. The 5.58 million A&E attendances during the quarter were up 4.7 per cent on the same period

A longer winter weekend But the operational pressures have had a very obvious impact on providers’ finances – despite receiving additional winter funding in November’s Budget. While providers have prepared ahead for winter, the significant increase in demand exceeded planned levels. The pressure led to the National Emergency Pressures Panel recommending postponement of elective activity to free up beds and clinical time for the non-elective workload. Many trusts already plan for a reduced !

ts Trus lso a are ting to ith w ec proj e year 31m th £9 end eficit of worse a d 435m lanned – £ the p d than year-enit c defi


Written by Emma Knowles, head of policy and research, Healthcare Financial Management Association

For many, winter pressures have extended across a longer window this year. Emma Knowles, head of policy and research at the Healthcare Financial Management Association, explains why the finance profession has a major part to play in providing the right financial platform for service delivery and transformation


NHS finance staff face twin challenges

in the previous year. The 400,000 emergency admissions via A&E in December were 5.9 per cent more than the final month of 2016. And flu admissions were three times higher than last year – with NHS Improvement suggesting it has been the ‘most significant flu season since the winter of 2010/11’. NHS Improvement paid tribute to hard-working NHS staff for their efforts over the winter. A&E performance remains well below constitutional standards and December saw a further dip in performance compared with November. However the year-to-date performance against the A&E standards was similar to performance for the same period in 2016/17. According to the oversight body, this indicated that the ‘year-on-year decline in performance experienced during this period over the previous four years has halted’.


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" elective workload over the busiest winter months, but for many, winter pressures have extended across a longer window this year, with many reporting a noticeable increase in patient acuity, often leading to longer length of stay and requiring more clinical support. From a financial perspective, providers have seen a decline in elective activity, replaced by non-elective caseload. This has a double whammy. As NHS Improvement acknowledges, elective income typically exceeds expenditure – so trusts are losing this benefit. At the same time, expenditure on non-elective activity typically exceeds income for higher-than-planned levels of activity – thanks in part to a marginal rate policy within the national tariff. So the unplanned change of balance between elective and non-elective tends to increase any deficits. At the same time, high bed occupancy – well above the 85 per cent recognised level – reduces efficiency. Commissioners are also hard pressed. NHS England continued to forecast an overall small underspend for the full year at Q3. But within this clinical commissioning groups were forecasting a £291 million overspend with a bigger underlying deficit. These positions have been delivered while also delivering record levels of efficiencies. Providers reported £2.14 billion cost reductions for the year to date, which while behind plan, were 4.7 per cent higher than the same period last year and an early view of provider productivity of 1.8 per cent means the sector continues to out-perform the wider economy. And NHS England says commissioners have increased the in-year delivery of efficiencies by £519 million. Future challenges Next year looks similarly tough. Welcome additional resources for frontline services – announced in the Budget by the Treasury and topped up by the Department of Health and Social Care – will clearly help. But the challenge of meeting service demand, maintaining quality and restoring access continues to be immensely difficult. Amid all this pressure in the here and now, the NHS also needs to raise its eyes to the horizon. There is broad recognition that the service cannot continue to meet rising demand with the same service model. The population is increasing and ageing and there are higher levels of long-term illness. It needs to develop new, more integrated models of care that put a greater emphasis on prevention and supporting patients in the community where possible to manage their own conditions better.

Integrated care systems should emerge from sustainability and transformation partnership areas – with models of care unveiled in the Five-Year Forward View (such as primary and acute care systems and multi-specialty community providers) having demonstrated they can start to make a reality of delivering better outcomes and better care. It is a daunting challenge, particularly without a significant budget to support transformation. Finance is at the heart of this challenge. This includes both the day-to-day task of delivering operationally – while staying within, or as close as possible to, control totals – and the transformation agenda. New models of care will need new ways of moving funds around the system – ensuring the payment system is aligned with the desired outcomes wanted from new integrated care systems. Capitation budgets with risk share arrangements are already being explored and finance teams also have a role in helping to ensure governance arrangements are sound for broader system working. Helping services to identify opportunities for efficiency and better value and then deliver on those opportunities remains fundamental. National work to reduce the cost of temporary staff has helped many trusts to put the brakes on rising costs in this area. Capped rates and support for NHS trusts to establish or make better use of their own staff banks have shifted some of the balance of power away from typically more expensive agencies. Achievable improvements There is a long way to go with the underlying problem of insufficient staff in some disciplines to meet substantive staff requirements and problems with retention as well as recruitment. Luckily there are a number of tools to support improvement work. The Carter review of productivity has put a huge focus on improving support services. It has triggered an overdue explosion in the compilation of data and metrics to help services better understand current costs and performance. This should allow easier and wider comparison with other organisations to identify opportunities for improvement. Finance managers have a major role in helping services to understand this cost and performance data – ensuring the data is as robust as possible, presenting it in an accessible and meaningful way and then helping services to deliver those savings where appropriate. NHS Improvement’s Model Hospital brings a huge number of these metrics into a single portal to enable organisations to compare and contrast and drill down into their own information.

RightCare and the Getting It Right First Time initiative also take a benchmarking approach to help organisations short-circuit decisions about where to look for achievable improvement. To enable these initiatives to deliver to their maximum value, the NHS needs good, robust cost data. Initiatives such as the Model Hospital already factor in trusts’ submitted reference costs. These annually collected costs have been used for decades to provide average healthcare resource group (HRG) costs for treating patients with similar conditions (the cost of a hip replacement for example) and they are the starting point for the annual tariff that sets prices for acute care. But work is underway to radically overhaul NHS costs as part of NHS Improvement’s Costing Transformation Programme. This aims to get all NHS providers costing care down to the individual patient level using a consistent methodology and approach. While trusts could still see an average HRG cost, this would be based on the individual costs of all patients within that HRG and so trusts could explore where costs were varying from patient to patient. This could help to identify significant opportunities for pathway improvement, improving outcomes, patient experience and cost.


Next year looks tough. Welcome additional resources for frontline services – announced in the Budget by the Treasury – will clearly help. But the challenge of meeting service demand, maintaining quality and restoring access continues to be immensely difficult

Healthcare Costing for Value The Healthcare Financial Management Association (HFMA) has a major part to play in supporting finance managers as they face up to this huge agenda. Its work covers briefings and events to improve understanding of existing policy and its implementation as well as casting its eyes forward to how policies could work in future. Forthcoming work with PwC, for example, will examine how funding flows may need to change to support integrated working within systems. The association’s Healthcare Costing for Value Institute also plays a major role in supporting costing practitioners to meet the requirements of the Costing Transformation Programme and promotes the development of value-based healthcare – taking account of quality and costs in all decision making. It also provides a major support network for finance practitioners and others with an interest in healthcare finance to come together and share ideas. While there is a growing consensus about the future direction of travel and the need for transformation, there are real concerns about the required pace of travel. Providers and commissioners continue to face significant efficiency requirements and the day-to-day operational pressures make it difficult for service managers to look much beyond the immediate must dos. There are understandable growing calls for a long-term settlement for health and social care to enable better planning for long-term sustainability. There is no doubt that the challenges facing NHS finance managers are set to continue. # FURTHER INFORMATION



Design & Build

A firm foundation within healthcare facilities There are a number of key requirements for flooring within the healthcare sector – such as ease of cleaning, durability, and versatility. Health Business examines why hospital flooring must be suitable to accommodate the needs of the environment whilst withstanding the contamination that can be generated While many hospitals across the UK are making their buildings more aesthetically pleasing, the role of flooring in the NHS is far deeper than visual appeal. The type of flooring employed contributes to the cleanliness, hygiene and safety of the environment, which

in the hospital is an important aspect of care. Being able to control the hospital environment usually involves managing the ventilation and heating systems, but looking at appropriate

flooring to maintain temperature, minimise the spread of infection and prevent accidents can actually save hospitals large sums of money. Hospital floors must offer durability, slip resistance, easy maintenance and good hygiene. In hospital operating theatres, where walls, doors, ceilings and floors are regularly cleaned as part of aseptic regimes, the flooring must not only be easy to clean, but also resistant to cleaning chemicals and straining. This is particularly true of flooring in vulnerable cleaning spots, such as below sinks, soap dispensers and other hand washing facilities. Cleaning must be an easy process, so the flooring must be flat and devoid of cracks, joins or edges – as this is where debris, germs and dust will gather.

The ty of floorpe employ ing hospita ed in a l to the c contributes lea hygiene nliness, safety o and environ f the ment

Resin flooring The most important factor of the aforementioned flooring specifications is the hygienic properties of the flooring and its ability to be cleaned and maintained. Seamless resin floors have a proven track record in the strictest of hygiene environments. Resin flooring is applied in situ to a prepared concrete surface either as a flowing or trowelled mortar or as a surface coating. A polymerisation or curing process then takes place to produce the final synthetic resin finish. Large areas of seamless flooring can thus be installed without the need for any joints other than where there are movement joints in the base concrete. The lack of joints is beneficial since such recesses are more difficult to clean and risk harbouring harmful bacteria. The fully cured Resin flooring is impervious, non-absorbent, washable and non-toxic. Typical floor areas in the healthcare sector could be split into public and private, or more likely to be front of house and back of house such as reception areas, waiting rooms, corridors, wards, staff rooms, stock rooms, theatres, X-ray rooms, intensive care units, laboratories, mortuaries, kitchens, canteens, and plant rooms. With the wide range of conditions to be encountered, it is important to identify the specific environment in each case to choose a suitable flooring material. To give good service, the flooring material must satisfy all the mechanical, chemical, physical, biological, and practical requirements of the ! Volume 18.2 | HEALTH BUSINESS MAGAZINE


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Design & Build

" user: mechanical – to support machinery and to withstand impact and abrasion; chemical – to be resistant to (and protect the substrate from) chemicals to be encountered; physical – to withstand temperature changes (thermal shock) and prevent ingress of contaminants; biological – not to support biological growth; and practical – to be easy to clean, to be hygienic, to be slip resistant, to be aesthetically pleasing, and to be durable. A welcoming walkway Much of modern day hospital design is about establishing a relaxing environment for patients, staff and visitors, in the belief that a ‘home-from-home’ feel can aid the healing process and make it more comfortable for long-term patients. Therefore, alongside lighting and furniture choices, the flooring and floor covering can have a major impact on the ‘feel’ of a hospital. An article in the Contract Flooring Journal explains the importance of this ‘feel good’ factor. The Royal Aberdeen Children’s hospital were keen to utilise the colour green in its renovation work due to its symbolic nature to the outside world and nature. Tinto Architecture specified flooring in a palette predominantly consisting of greens and blues to create an interior that is said to have had a profoundly positive effect on patients and staff. Further to this, a large tree structure was created as the centrepiece of the hospital ward, with the architecture firm using green tones to link with the beautiful new hospital garden and reflect its calming nature. Design, colour and the use of patterns can transform any healthcare facility to positively comfort patients, staff and visitors through the creation of welcoming, bright and airy spaces. When part of an overall scheme, colour can assist with way-finding and zoning and help the flow of traffic, supplies and services around a busy healthcare environment. Slips and trips Certain environments are more likely to induce trips, slips and falls, and this is no different in a healthcare setting. Therefore, specific consideration must be taken when planning the flooring and floor covering for all hospital entrance areas, reception points, canteens and bathrooms. The main causes of slips and trips incidents in healthcare are: slippery/wet surfaces, caused by water and other fluids; slippery surfaces caused by dry or dusty floors; contamination, such as plastic, lint or talcum powder; obstructions, both temporary and permanent; and uneven surfaces and changes of level, such as unmarked ramps. However, other factors can be: poor levels of lighting and external glare; human factors such as employees rushing; running or carrying heavy/cumbersome items; the wearing of unsuitable footwear; or the use of improper cleaning regimes. Slip resistance is a measure of the co-efficiency of friction of a floor and is measured in U values. Currently, there are three main testing methods – the Ramp Test, the Pendulum Test, and Tortus. The

The healthcare environment presents a very wide range of diverse requirements for any flooring system. Often regulated under tight budgetary controls, it is important that the correct selection is made to provide a cost effective and practical solution Pendulum test is fast becoming the test of choice, with many leading health and safety experts recommending it as the only test that accurately ensures maximum safety and comfort of flooring. It has a swinging arm with a rubber slider, which mimics the action of heel when walking. The healthcare environment presents a very wide range of diverse requirements for any flooring system. Often regulated under tight budgetary controls, it is important that

the correct selection is made to provide a cost effective and practical solution. The high cost of reinstalling a floor, in terms of disruption, inconvenience, and loss of practical use of a sensitive area such as an operating theatre, makes it important to get the floor right the first time. This requires a thorough understanding of the environment, the best possible design, and the choice of the most suitable product for the job. #

Property deal for Gloucester hospitals Horbury Property Services has been awarded a contract as one of the delivery partners to provide repairs and refurbishment work to Gloucestershire Hospitals NHS Foundation Trust. The property maintenance provider has been given a three-year contract, which began in January, to provide general refurbishment and repairs services across a wide range of NHS buildings, including inspection, installation, maintenance of fire doors and planned preventative maintenance regimes. In addition, the wider Horbury Group will provide dry wall partitioning, painting and decorating, ceiling and flooring upgrades and de-mountable screens. Richard Sutton, general manager at Horbury Property Services, said: “We’re pleased to have secured another major contract within the healthcare sector, following our

recent framework agreement win with NHS Shared Business Services. We demonstrated that we were able to offer a service that is very good value for money, as well as having the expertise to deliver high quality repair and refurbishment services.” Terry Hull, deputy director of Estates for Gloucestershire Hospitals NHS Foundation Trust, added: “Keeping our building stock in good repair is vitally important and we are pleased to be able to proceed with the framework agreement with Horbury Property Services as one of our delivery partners.” FURTHER INFORMATION



The interior design of a hospital is important for a vast number of reasons: from reducing noise to making sure information is accessible and at the point of service, to the importance of visibility of patients to staff and infection prevention At the start of 2018, the Department of Health and Social Care said that an extra £2.8 billion was being allocated to the NHS over the next two years. However, staff within the health system are saying that conditions in the NHS are the worst they have seen. In December last year, Sir Bob Kerslake stepped down as chairman of King’s College Hospital NHS Foundation Trust as a result of the government’s ‘unrealistic expectations’ for the NHS, saying that ‘fundamentally our problems lie in the way that the NHS is funded and organised’. Hospitals recorded their worst performance against the four-hour A&E treatment

target last month as the NHS came under unprecedented strain because of winter and the flu outbreak. The requirement for hospital A&Es, walk-in centres and urgent care centres to deal with 95 per cent of patients within four hours is becoming less achievable, with A&E units only managing to treat, admit, transfer or discharge just 77.1 per cent of arrivals within the four hour target. Peter Homa, who stood down as chief executive of Nottingham University NHS Hospital Trust last October, claimed that departments that were built to see a maximum of 350 patients a day are seeing 500 or 700, leading to reports that doctors

Interior Design

Better design for A&E departments

are having to leave patients on trolleys in A&E departments, when in fact they could, or should, be in a hospital bed or at home. Alongside increasing patient numbers, these pressures are putting A&E departments under strain in the delivery of services, which can negatively affect the experiences of already vulnerable patients, as well as the staff who often bear the brunt of these tensions. Design solutions for A Better A&E In light of this, using a design approach to improve the patient experience, reduce hostility and ease some of these pressures is key. The Design Council’s A Better A&E programme, carried out across Chesterfield Royal Hospital NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust and University Hospital Southampton NHS Foundation Trust, demonstrated an opportunity to use a design approach to improve the patient experience, reduce hostility and aggression and provide solutions which demonstrate value for money to healthcare commissioners. Primarily targeting reducing incidents of aggression, the project reviewed previous attempts to control and reduce aggressive incidents in public-facing services, with more than 300 hours spent conducting observations and interviews in A&E departments. !

Using n a desig to h c approa e patient e th improv nce, reduce experie y and ease hostilit of these some sures pres is key

Boex’s ‘calm and informal’ designed waiting area is populated with their signature furniture and fittings, making best use of available space whilst keeping the look as ‘non-institutional’ as possible



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The patient journey Newham University Hospital was the first hospital in the UK to implement a Design Council and Department of Health initiative to reduce violence and aggression in A&E departments. By breaking down the different key stages of a typical patient journey through A&E, the hospital was able to create an ideal patient experience. This led to solutions on: the arrival experience – creating positive first impressions and managing expectations for patients and other service users; the waiting experience – how to intervene before frustrations accumulate; guidance – providing information to patients and other service users to alleviate the stress of the unknown; and people - building a healthy mutual relationship between the user and the system. Many people become frustrated with the A&E service because of a lack of clear, effective information and guidance, increasing their anxiety causing possible development of aggressive or violent episodes. The primary design output should therefore communicate essential information to the patients and other service users arriving at A&E, containing both generic information relating to the process for receiving treatment, and live information relating to the status of the department and waiting times. The recognition that static, fixed information presented the best opportunity for conveying basic information to patients and other service users in A&E led to the design team developing the concept of the ‘slice’. A narrow vertical slice in each space would be modified to contain all the information relevant to the user at that stage in the treatment process, and become the recognised communication point for patients throughout the department. This meant that rather than redesigning the whole department, or refitting each and every room, a ‘slice’ could be inserted, which would gently guide the patient or other service user along their journey through A&E. To accompany the ‘slices’, a process map was developed, which became the core of the communication language. This illustrated the patient journey as a series of steps moving towards the goal of treatment,

Interior Design

" Amongst the triggers for this type of behaviour was the waiting experience, the effect of the environment on people’s behaviour, and how the intense emotions that play out in A&E create a ‘melting pot’ of anxiety. The final recommendations of the project suggested physical changes within the A&E departments as well as creating behaviour change among patients and staff. This ‘Guidance Solution’ aimed to reduce anxiety levels by using signage, leaflets and digital platforms to provide information about the department, waiting times and treatment processes. The ‘People Solution’ supports frontline staff in their interactions with frustrated and aggressive patients. Staff are given opportunities to discuss issues and concerns, with the aim of boosting morale and reducing staff absence, and an induction booklet introduces new staff to the working culture and dynamics of the department.

Design company Boex completed the redesign of Chelsea and Westminster Hospital NHS Foundation Trust’s A&E paediatric waiting room in 2016

Amongst the triggers for this type of behaviour was the waiting experience, the effect of the environment on people’s behaviour, and how the intense emotions that play out in A&E create a ‘melting pot’ of anxiety with a pause (or wait) before moving onto each step. The steps were categorised into the four larger stages of check-in, assessment, treatment and outcome (or further treatment). Digital content using the same visual language, able to be updated automatically to provide more accurate and relevant information was also developed. The NHS is becoming a more patientcentred healthcare provider. Visitors to A&E still encounter a complex system – and human contact remains the best way to guide, help and reassure them. This human contact provides the interface between service users and the healthcare system, and can be considered to be the ‘customer service’ that they experience. However, the frontline staff providing this service may be subject to many systemic factors which impede their ability to deliver a patient- or service user-focused service, such as understaffing or time constraints. This may also be exacerbated by continuous negative feedback and abuse from those using the A&E service. A two-pronged solution was proposed. The first was an induction pack for staff new to A&E, designed to help individuals joining the department understand the culture of the hospital they are entering, and the other was a system for more established staff members to promote reflection on managing problems when they arise. To enable any NHS trust to implement changes to improve safety in their A&E departments, instead of redesigning just one specific waiting room or department, the designers worked on producing guidance to inspire and enable NHS trusts to implement these changes within their A&E departments. The toolkit is a guidance

document that compiles all the high level design recommendations that can help to reduce aggression and violence in A&E. These are not design solutions in themselves, but may be specifications or service changes. The toolkit breaks the patient journey down into its different stages of the A&E process and presents case studies of best practice that are in place at other NHS trusts. It is intended to be used by all NHS staff, while also providing a reference source for architects or interior designers working on new-build projects. A non-institutional look Design company Boex completed the redesign of Chelsea and Westminster Hospital NHS Foundation Trust’s A&E paediatric waiting room in 2016. Chelsea and Westminster Hospital A&E is one of the top ranked A&E departments in the country, with the recent redevelopment allowing it capacity to increase to 140,000 patients a year. The Boex ‘calm and informal’ designed waiting area is populated with their signature custom designed furniture and fittings, making best use of available space whilst keeping the look as ‘non-institutional’ as possible. Curved wood seating coupled with the latest infection safe fabrics in blues and greens offer comfortable spaces in conversation groups rather than traditional rows. Floor and wall graphics, lighting pillars and artwork will all combine to provide a one-of-a-kind family friendly waiting area. # FURTHER INFORMATION better-design-ae



15-16 MAY 2018 National Motorcycle Museum

BIRMINGHAM Event partner:

In May 2018, connect to the world of mental health design... ‌ make connections, make progress. Make a difference. Design in Mental Health is the only UK event to focus on the design of mental health facilities with a clear focus on creating calm therapeutic environments for the benefit of patients and staff alike.

Main Event Sponsor:

Both conference and exhibition are well attended by NHS trusts and private healthcare providers alongside architects and contractors who design and build the facilities that they manage every day. Supported by:

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On behalf of the Design in Mental Health Network, Alex Caruso explains how designing facilities appropriately can improve safety and patient outcomes, as well as benefit the mental health of patients During the refurbishment of parts of an existing learning disabilities centre a few years ago, in the background at every site visit, I could always hear one of the residents in distress. The area where the works were being carried out was not connected to the residents’ area and I was surprised to find, in an environment where noise is one of the biggest stressors, how easily the sound travelled to different parts of the building. A few years after, on the same campus, I was involved in the design of a new building to replace the old facility. Once the new building was completed and

in use I was delighted to hear from the Modern Matron how well the gentleman had settled into the new building, leading to a drastic reduction in distressful episodes. The observation and collection of feedback from residents, nursing and maintenance staff to understand what triggers distressing behaviours is the base for our design activities. The aim remains to understand how physical surroundings affect emotions, as people’s emotions ultimately can shape a building’s design. An ever more complete body of evidence is emerging to understand how people react to different

The o ability t oice ch exerciseol over the tr and con ent, creating m n environ nal space, is a t a perso ial componen essent od recovery of a go ronment envi


Design in Mental Health

Why design is integral to mental health services

environments before and after a design intervention with health outcome measures such as: length of stay, amount of medications, patient stress and mood. Earlier last year, the publication of Design with People in Mind, based on research led by Professor Paula Reavey and sponsored by the Design in Mental Health Network (DiMHN), set out to provide a practical manual offering links between a high-quality environmental design and mental health services, understanding people’s perceptual experiences focusing on different types of space. Far from supporting one solution that fits all, the comprehensive review of scientific evidence offers a link between design, space and mental health, recognising that we all have precise genetic finger prints that influence our behaviour. A well-designed environment allows us to regain balance and control of our health and condition often in a subliminal way, delaying the escalation of distress and allowing more time for the medical team to treat urgent needs. To research people’s basic needs in the healing journey and understand how good design can reduce stress is a fascinating investigation where empathy is a critical ingredient via every step of the design process, paying attention to the multitude of details and sensory experiences required to craft a people-centred environment that is robust and sustainable. The above-mentioned publication explores critical spaces for a good recovery environment, places that offer people endless opportunities for engagement linking in with past experiences, places designed to support emotions and lift the spirit. They are: !


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This country has a well-deserved cherished tradition of belief and dedication between staff and patients. So, providing a safe environment is of paramount importance to all health providers. Therefore, deploying adequate and ‘proven’ solutions to ensure the safety of patients and staff must be a key consideration for any member of staff involved in security planning. For more than 20 years, Guardian has been leading manufacturers of staff attack systems. The company’s systems not only surpass all relevant standards, but are very user friendly, economic and discrete. This been achieved by listening to customers. Guardian’s development program is driven by a combination of continuing advances in technology and its customer’s needs. Many of the features

which a Guardian system provides were incorporated in response to comments and requests from clients who were looking for solutions to combat particular issues. Guardian’s products are ideal for because they comply with latest regulations and standards, are competitively priced and very user friendly for staff to use. Additionally, the products are designed for easy installation and simple configuration, excellent testing facilities, are low maintenance, and high reliability and provide product longevity. FURTHER INFORMATION Tel: 01386 443539

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Good recovery environments The ability to exercise choice and control over the environment, creating a personal space, is an essential component of a good recovery environment, appreciating and respecting the individual characteristics of the people around. Service users need opportunities to engage with each other and those supporting them within a choice of alternative social spaces. Numerous studies have indicated the value of music therapy to address anxiety and depression, so a range of DVD and music options can have a positive impact on service users’ sense of well-being. In 1860, Florence Nightingale wrote that darkened rooms were harmful and sunlit rooms were healthy. It is also a welldocumented fact that sleep is the most basic of our brain’s restorative needs and the natural light control strategy can be particularly important to restore critical circadian rhythm. A multi-sensory design facilitates a sense of environmental control resulting in a sense of well-being, when interest in the world revives and despair gives way to hope. We all love colours; they can transform, uplift and change an atmosphere. However, ‘in examining the use of colour and lighting within hospital environments, Dalke, Littlefair, Loe and Camog (2004) report that enclosed environments with strong colours may be over-stimulating or threatening to people experiencing mental distress’. Similarly, we all have our colour preferences and the use of appropriate muted colours can help people navigate with their instincts and transform the environment not just through perception but changing the electromagnetic field around them. It is important to consider the power of a simple window in the healing process that goes beyond providing natural light, airflow, access to sounds and smells of nature, awareness of day and night cycle, it provides something more intangible: a distraction from the place, a space for meditation and access to memories of a better time. The best therapeutic space is one were people feel at home. Homelike will differ for all of us, ‘however findings showed the provision of private spaces and homely design to be associated with increased well-being and social interaction’. Furthermore, ‘Lawson, Phiri & Wells-Thorpe (2003) studied the effects of the architectural healthcare environment on well-being and compared service user outcomes between an existing facility and a new build medium secure mental health environment. Whilst the number of instances of physical and verbal aggression remained the same in the two sites, the severity of incidents was reduced in the new facility and there was a two third reduction in service user self-harm. Rates of seclusion also reduced by 70 per cent

and there was a 14 per cent reduction in service user length of stay in the new unit’. The (potential) conflict between security, safety and homeliness will always be there and it is important to work with clinical teams to assess positive risk taking to explore fresh and simple solutions while ensuring compliance with published guidance and regulations. Rather than providing an intimidating large space, the use of furniture, light, texture and colours can help create opportunities for groups to congregate in an inviting environment. ‘Connections between mental health and the natural environment have long been recognised and features of 19th century asylum design which included providing views of natural landscapes from indoors and opportunities for patients to actively engage with nature were considered beneficial to the therapeutic process’. (Hickman, 2009) In line with the biophilic design’s notion that nature itself has a healing effect, a natural space is an important place for service users’ expression and reaffirmation of identity and autonomy. Landscaped outdoors with raised planters allow residents to interact with nature as part of their therapy, feeding constantly on the energy of light and colour that surround them. Selected plants can support the perception of seasonal changes and the soothing sound of a water feature reinforces therapeutic landscape design values. Art installations offer endless opportunities to bring the outside into the building, creating an aesthetic space using themes inspired by local natural surroundings that enable a stronger sense of self and concept of belonging.

with assistive technology can help people with mental health conditions regain control of their behavioural and emotional disorders and assist with cognitive impairments. At the essence of preventive medicine all causes are examined without exclusions. Similarly, in designing a mental health environment we recognise that what has worked for a patient group for a trust may not work entirely in another context. The harmony of all spaces is the key for a sustainable environment focusing on recovery. Like recovery itself, such harmony is often achieved gradually, examining emerging common traits. It is an endless fascinating journey to continuously improve considering the several perspectives of the people using the environment created. A well-designed environment that improves safety and patient outcomes can be described as complementary to preventive medicine and an appropriate way to limit mental health outbreaks, allowing people to be themselves, promoting hope, independence and empowerment. A more detailed and comprehensive review of scientific evidence relating to the link between design, space and mental health has been recently completed and is available on the DiMHN website.

Design in Mental Health

" personal space; therapeutic space; natural space; aesthetic space; and nursing space. “As people move through space, the design can make a real difference to the emotional and social landscape: it can impact on how much people talk to one another, how supported they feel, whether they feel safe, and perhaps most importantly, how valued they feel as an individual.”

Mental Health Rehabilitation & Recovery Facility Alessandro Caruso Architects (ACA) has designed a specialist rehabilitation and recovery facility. The facility caters for people who require an environment for mental health recovery on behalf of Hull and East Yorkshire Mind. The accommodation will provide a therapeutic and safe environment

A well-designed environment allows us to regain balance and control of our health and condition often in a subliminal way, delaying the escalation of distress and allowing more time to the medical team to treat urgent needs ‘Although research to evaluate the impact of art interventions specifically within the mental healthcare settings is limited, the findings of existing studies suggest that environmental enhancements can positively impact on the health and well-being of service users and staff’. (Daykin et al., 2008) The harmony of spaces Another essential place for a recovery environment is the nursing space. It is an ideal place to maximise opportunities for social engagement and partnership working. ‘Whilst empirical research is limited, the findings presented suggest that open nursing stations might lead to greater service users’ satisfaction through improved staff accessibility and service user-staff interaction’. Assistive technology, such as digital hand-held devices, apps and simple note pads, can be integrated to assist staff and service users alike. Numerous research shows that complementing the environmental design

where the residents can build confidence while developing independent living skills to continue the process of recovery. ACA and DiMHN believe in the benefits of user-orientated design. This means developing a thorough understanding of the eventual users and their perceived environment. With this method we can create a space that will promote confidence, comfort and safety. The step-down process integrated into the core of the design gently encourages independence as the residents move through the stages of recovery. User-orientation and way finding is simplified throughout the scheme using colour rather than signage to denote a homely environment. The scheme builds on the psychology of colour to encourage a harmonious and therapeutic atmosphere. To see more please visit # FURTHER INFORMATION




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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 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 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.

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 to NHS means 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

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

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 explains, the money owed across the NHS is measured in the eye-watering billions of pounds

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 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 !

Debt Management

Keeping money flowing through the system

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.

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 of court



Are your Invoices overdue for payment?

We are a regulated legal practice whose experience and knowledge has enabled us to collect debts for many NHS Trusts and Healthcare Organisations We are proud to be part of the NHS Shared Business Services framework Private patient debts Commercial debts Salary over-payments Overseas patient debts Prescription debts

Debt Management

" 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 Meanwhile, returning to the issue of tackling individual debt, the Next Steps on the NHS Five Year Forward View, published

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 NHS problem 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



Scott &


The professional debt recovery specialist

Debt recovery... with us, it’s personal We have helped hundreds of clients to recover millions of pounds from thousands of debtors. Don’t be one of the hundreds of firms that suffer from reduced profits, administration or liquidation because your debtors have stopped paying you. We treat the recovery of our clients’ debts as a personal challenge. All of our actions are undertaken in accordance with Financial Conduct Authority (FCA) guidelines and in compliance with the Credit Services Association (CSA) Code of Conduct.

Call: 01702 466300 Email: Website: 34


can be demoralising and, often, fatally damaging xoxoxoxo to a practice. £38 billion is owed to the nation’s small businesses, including doctors, whilst 25 per cent of all FURTHER INFORMATION businesses going into liquidation do so because they are owed money. Frightening xxx statistics indeed – and ones with which Bill Baddeley is all too familiar with. Do not become part of them – act today. Scott & Mears is a professional debt recovery company that has been assisting its clients for the last 29 years with the age-old problem of collecting money owed for services and products. In that time, Scott & Mears has been providing clients with an unrivalled level of service and professionalism in the recovery of delinquent accounts across a wide range of business sectors including medical, retail, finance, property and manufacturing. It offers a complete range of debt recovery services from tracing absconders to obtaining and enforcing a County Court Judgment. Bill said: “We have helped hundreds of clients to recover millions of pounds from thousands of debtors. Don’t be one of the hundreds of firms or practices that suffer from reduced profits, administration, bankruptcy or liquidation because your debtors have stopped paying you. “We undertake the recovery of our clients’ debts as a personal challenge, one we aim to excel in at every opportunity. Indeed, such is our commitment we consider it a failure if we don’t exceed our clients’ expectations. “Over many years we have evolved our collection methods and documentation to ensure your customer understands that you are serious about the recovery of your debt. We don’t offer a ‘bully boy’ collection service and never will – our experience has proven time and time again that a professional approach is the most effective for recovering debts. All of our actions are undertaken in accordance with FCA (Financial Conduct Authority) guidelines and compliance with the Credit Services Association (CSA) Code of Conduct. “Upon receipt of your instruction, recovery action will be commenced in agreement with the client’s recovery profile. Within 24 hours of receipt of your instruction we will have forwarded your patient/customer

you, the amount of debt, the reason for the debt and a request for payment. “As we are a pro-active telephone/ letter collection agency the location of our clients and their debtors is of no relevance. Should this action fail to elicit a response, our collection negotiators will contact your customer by telephone and attempt to negotiate a full settlement. Dependent on the outcome of these negotiations, further action will be instigated as required to secure your funds in the shortest possible time. Our aim is always to recover your debt as quickly as possible. We aim to ensure all of our staff have the knowledge to be of assistance to both clients and their customers as required.” So what are the advantages of using a debt collection agent rather than a solicitor? Bill said: “We only charge a fee if we are successful in recovering your debt and aim to do so within 90 days. If we are unable to recover your debt then we do not charge you. When debts are recovered, we would take a pre arranged commission percentage. No hidden costs There are no hidden administration or handling costs. A solicitor will charge you an hourly rate and proceedings could take several months. Taking a debtor straight to court does not guarantee success, either. You always run the risk of walking away with nothing but hefty litigation and court costs. “At all times we act in a strictly professional manner, always aware that we are representing your practice/company. By

Written by

Ask medical professional their biggest headache is Udaeany nonsend icidisquid quamwhat elisimincim facepro et et, sed and the chances are they will say that getting paid promptly, quodi blaborum ut molorem aut ationse nos eumque laboribus or indeed at dolo all, isqui very on their list nitibusdae nullacianti et quoditiat dehigh volecab orerisqui rest, sitiatis ut idem quodi consequat facimagnime pernatemquae nimus earibus, tem ipsaest es net that et we are acting for The amount of time spent chasing moneymoluptatium a letter explaining

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ScottWORD 800 & Mears: EDITtaking HEADLINE the headache HERE out of AS TIGHT debt recovery AS POSS acting in this professional manner you will never have to waste your valuable time on resolving customer complaints. We are members of the Credit Services Association and strictly adhere to their Code of Conduct enabling us to collect debts in an ethical and professional manner and you to have complete peace of mind knowing that we are representing you or your practice/ company in the way you would wish us to. “It has long been a philosophy of Scott & Mears that we work as a team alongside and together with our clients. We are there to assist them with a particular part of their business with which they are having a problem; to act as an extension of their own credit control procedures. As such we are very aware that we are representing their company and we will never do or say anything that will damage their reputation. ‘Professionalism’ has long been a maxim of Scott & Mears.” Services offered include:Debt recovery; litigation including enforcement of County Court Judgments tracing; account monitoring; detailed computerised reporting; and worldwide debt recovery. For an initial discussion about how Scott & Mears can help you to recover outstanding debts, please contact the company via the details below. ! FURTHER INFORMATION 01702 466300



A CLEAN SCREEN WITH EVERY SLIDE And antimicrobial protected

About NueVue Our business is to make beautifully designed, handcrafted cases to protect your iPhone or iPad from knocks and bangs of everyday life. We love technology but hate dirt and greasy fingerprints that look horrible, strain your eyes and make the screen difficult to read, and harmful bacteria that can make us ill. So we developed a unique microfibre lining for our cases. This special lining cleans those dirty screens, and uses BioCote premium anti-microbial technology to provide life-long protection against bacteria, and all those other nasty microbes! Our Unique Lining Our cases contain an innovative microfibre lining that keeps your iPhone snug, whilst also eliminating bacteria from your device. No need for wipes - the lining also wipes away unsightly marks that can cause eyestrain, fatigue, and headaches with every swipe. Eliminating bacteria from the device surface helps to prevent the spread of illness, blemish-causing dirt and scratches on your screen. Dirty Screens Cause Eyestrain Research has proven that dirty greasy screens cause eyestrain, blurry vision, red tired eyes and headaches. Nearly 70% of adults experience digital eyestrain. All it takes with our unique microfiber blended lining, is one easy slide, to clean the screen every time you slide the device in and out of the case. NueVue is a lot more effective than rubbing your phone on a sleeve or carrying a cloth, and it avoids scratches. Also, a dirty screen is just plain ugly! Bacteria Makes Us Sick Bacteria is all around us, some keep us healthy, while others make us sick such as various flu strains, superbugs, norovirus, E. coli and salmonella which can live on phones for days and cause tummy upsets, sore throats and worse. So, you don’t want them getting from your hands to iPhone, then straight into your mouth or spreading to others, or patients, in your care. NueVue cases are infused with BioCote’s antibacterial technology, works every time you use your device and starts eliminating harmful germs in seconds. Designed and Developed in the UK. Available for iPhone SE, 6, 7, 8 and X and iPad’s and iPad mini.

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Infection Control

Healthier intelligent surfaces working 24/7 A recent study by biotechnology company BioCote found that the presence of antimicrobial products led to an overall 93 per cent reduction in bacteria in a controlled, office setting. With the dangers of bacteria rife in hospitals, what does the study show us about infection control within NHS wards and theatres? According to the Office for National Statistics, an estimated 34 million working days were lost in the UK last year due to minor illnesses such as coughs and colds, while financial experts reckon it costs UK companies alone some £29 billion a year, so trying to keep the workforce healthy and productive is obviously a costly business. Biotechnology company BioCote has conducted a six-month study in a small, open plan office – optimum conditions for the spread of illness-causing microbes because of hot desking, shared facilities, common contact surfaces and circulated air. Occupied by a maximum of 15 people, existing products within the office environment were removed and replaced with equivalent antimicrobial products. Open plan spaces present the optimum environment for the spread of illness caused by microbes. Each employee’s own unique microbiome contributes and interferes with

the microbiome of the office environment. It is when one person’s microbiome interacts with another’s directly, through person to person contact or indirectly through contact with shared surfaces or products, that cross contamination can occur.

within the same office environment. This includes furniture like adjustable height desks, chairs, computer peripherals (mouse and keyboard) whiteboard and accessories (pens, erasers), a point of use water dispenser and wall mounted liquid hand soap dispensers. The presence of antimicrobial products led to an overall 93 per cent reduction in bacteria. Kimberley Cherrington, sales and marketing manager for BioCote, explains: “Antimicrobial technology makes all kinds of surfaces inhospitable to microbes, various flu strains, plus a wide range of leading superbugs, fungi and mould and is easy to include in any infection control strategy. Simply "

As a part of Cote io recent B presence he study, t timicrobial of an led to an ts produc 93 per cent overall ction in redu ria bacte

Bacteria reductions Specialising in silver-based antimicrobial technology, which significantly reduces the number of contaminating microbes on everyday products/surfaces, the study made comparisons between natural bacteria populations on BioCote protected ‘intelligent surfaces’ against standard non-antimicrobial products



Common disinfectant active substances based on quaternary ammonium compounds can provide immediate antibacterial action, but residual effects are limited due to evaporation or removal from disinfected surfaces and the risk of subsequent recontamination. There is then, the continuous requirement for knowledge of appropriate cleaning and disinfection products within the hospital environment to ensure use of chemical products is optimal for both controls of problem organisms, and to protect surfaces from material damage. Bacterial populations are displaying increased resistance to disinfectants based on quaternary ammonium salts (QUATs) and that resistance to QUATS may evoke further resistance to antimicrobials such as antibiotics. Despite these concerns, disinfectants remain the primary non-antibiotic medicated control mechanism for areas of hygiene concern. Antimicrobial technology With the numbers of antibiotic resistant bacteria continuing to grow, current methods to control them are increasingly limited. However, antimicrobial technology can successfully be combined with thorough hand-washing practices and regular cleaning to minimise cross-contamination and become an essential and proactive element of healthcare infection control. Because it does not wear out or wipe off surfaces, it can provide a continuous decontamination effect and in a ‘live’ 18-month hospital case study, BioCote antimicrobial protected materials regularly demonstrated reductions in bacteria of up to 98 per cent. Indeed, results also indicated lower numbers of bacteria on other untreated

surfaces too, due to the fact there are fewer bacteria being transferred – so using a number of antimicrobial objects in hygiene conscious settings even helps reducing the chance of pathogen spread to the wider untreated environment and causing disease. Since antimicrobials first appeared, there is now the capacity to treat a plethora of material types and silver ions especially, with their very high efficacy and non-toxic properties, can quite easily be manufactured into plastics, polymers, paints, textiles, fabrics, ceramics, paper, board and many other materials. Lots of real data is also available from surfaces prevalent in a host of environments, confirming that the efficacy of antimicrobial technology in real-life healthcare settings is comparable with that shown in laboratory validation testing. Healthcare facilities looking to adopt the technology should choose a product containing a regulated antimicrobial that is compliant with BPR/EPA regulations, plus the additive contained within the product needs to be appropriate for the market sector. It should also be continuously quality control tested to guarantee high levels of antimicrobial performance – and not just during the initial development of the treated product/surface/material. The additive manufactured into the product is best supplied by an experienced and trusted antimicrobial solutions provider too, while the product has to be correctly labelled in line with the classifying, labelling and packaging guidelines for treated articles. !

Infection Control

# put, they cannot survive on BioCote treated surfaces and technically speaking exposure to silver ions renders them all non-infectious - through protein damage, membrane disruption and DNA interference. And the technology typically has a significant impact on microbes after only 15 minutes. “What’s more, these ‘invisible’ additives are simply integrated into everyday products at the time of manufacture. They’re environmentally and ecologically acceptable and can be cost effectively added to plastics, paints, textiles, ceramics, paper, board and many other work place and household materials. Because it does not wear out or wipe off surfaces, BioCote provides a continuous and lifelong decontamination effect. “It’s in winter that seasonal illnesses tend to become more prevalent with high density of office staff increasingly susceptible to contagious norovirus and the flu, which can survive on frequently touched hard surfaces for up to 72 hours. However, silver ions are easily impregnated into paper laminates which make up most desk surfaces and are cited as one of the contaminated areas in an office environment. “I read recently that the average office desk harbours 400 times more bacteria than a toilet seat, so at the very least workers should be encouraged to wipe down theirs at least twice a week with an antibacterial or vinegar-based solution. Regular hand washing is imperative too, but not preventative enough in isolation, as regular soap dispensers are often contaminated with faecal bacteria. “Additionally, the interior tap of a water cooler gathers loads of germs daily so should regularly be cleaned, while computer mice are similar to keyboards and exposed to hand generated bacteria for several hours every day. Even the office pen that one in five workers admits to chewing can be made antimicrobial to stop the transfer of potentially harmful bacteria into the mouth. “Whilst we never discount the importance of a comprehensive cleaning regime and the maintenance of proper hand hygiene, antibacterial sprays and the like have a limited and residual effect while BioCote works 24 hours a day, seven days a week to protect a product from an array of harmful microbes. If the desks, kitchen appliances and bathroom facilities in your office were all protected with antimicrobial technology, surely that would help to minimise the spread of infection, lead to a happier, healthier group of employees who are a lot less likely to fall victim to transmittable infections and, in-turn, reduce the colossal outlays associated with workforce absenteeism?”


Control of bacteria in the hospital usually takes place via the use of antimicrobial agents of varying efficacy depending on the hygienic requirements of the environment

Environmental microorganism control Control of bacteria in the hospital usually takes place via the use of antimicrobial agents of varying efficacy depending on the hygienic requirements of the environment. For example, highly efficacious cleaning agents utilising, strong oxidising agents, may offer both bactericidal and sporicidal solutions but can, in the long term, provoke material damage.


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Surgery is intended to save lives, enhance functionality and provide a number of other positive outcomes. It is never intended to cause harm; yet unsafe surgical care can cause substantial harm and even death. Patients undergoing surgical procedures are inevitably at their most vulnerable and have an expectation and a right to expect a safe and quality experience. Yet, accidents happen and unintended consequences are the result for both patients

and healthcare professionals. A great deal of time and resource has been committed to exploring patient safety incidents for the purpose of gaining a better understanding of the human factors and causative features of such incidents. The NHS deals with over one million patients every 36 hours. In 2015/16 there were 40 per cent more operations (‘procedures and interventions’ as defined by Hospital Episode Statistics, excluding

The NHS is nly the o one of e systems ar healthc orld that is in the w transparent d open anut patient abo ncident safety i rting repo

Near-miss events The importance of robust investigation and analysis to determine contributory factors and provide explanations is vital to prevent re-occurrence and learn important lessons. It has to be acknowledged that a great deal of time and resources is generally committed to this process in the healthcare sector, but all too often this lacks the required rigour to uncover the vital truths; thus missing opportunities for life saving change. It is a recognised fact in the field of risk and safety that the big catastrophic incidents are often the result of numerous small unnoticed and unaddressed issues, often referred to as ‘near-miss’ events. A near-miss is an unplanned event that did not result in injury, illness, or damage – but "


Written by Mona Guckian Fisher, immediate past president, Association for Perioperative Practice

The rates of error present a significant challenge to those working in the NHS. Mona Guckian Fisher, independent healthcare consultant and immediate past president of the Association for Perioperative Practice (AfPP), looks at near miss events within surgery

Patient Safety

Near-miss events in surgery: how safe are you?

diagnostic testing) completed by the NHS compared to 2005/06, with an increase from 7.215 million to 10.119 million. There were 16.252 million total hospital admissions in 2015/16, 28 per cent more than a decade earlier (12.679 million). There is often a gap in understanding amongst healthcare professionals on what constitutes a patient safety incident. A patient safety incident is defined as ‘any unintended or unexpected incident which could have or did lead to harm for one or more patients receiving NHS care’. The top four most commonly reported types of incident continue to be: patient accidents (19.2 per cent), implementation of care and ongoing monitoring/review incidents (13.2 per cent), treatment/procedure incidents (10.6 per cent), and medication incidents (10.2 per cent).


Patient Safety

Near-miss events that are captured in the reporting system should be explored and analysed with much greater attention, and this data exploited to provide the foundations for the prevention of adverse outcomes for patients and staff # had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage; in other words, a miss that was nonetheless very near. Future preventions Reporting on near-miss events is known to be less frequent than for actual incidents for the obvious reason that nothing adverse is seen as an outcome. However, near-miss events that are captured in the reporting system should be explored and analysed with much greater attention, and this data exploited to provide


the foundations for the prevention of adverse outcomes for patients and staff. The aviation industry captures this information and is renowned for investigating near-miss reported incidents with the same strict discipline as actual incidents. This industry understands fully the value of this endeavour in the interests of safety. Whist accepting that there are enormous differences between healthcare and aviation this is one point where opportunities are present to see and pursue the similarities. When incidents occur in healthcare there is often a delay in starting the investigation


and creating the time line that is necessary as part of the forensic examination close to the time of the incident; and where recall and evidence are optimal. Any delay in this is a missed opportunity to undertake the factors that need consideration together with the activities of the people involved. Nowhere is this more clearly seen as with the exploration of ‘never events’. Never events are serious incidents that are wholly preventable as guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers. Professor Sir Ara Darzi, writing in The Times (February 23, 2016), suggests that surgeons should ‘blush at the incidence of never event in the NHS over the past four years’. He states that ‘these appalling errors bring shame on surgeons’. As healthcare professionals we have to be mindful that it is not only the surgeons that are responsible for patient safety in the surgical environment and to this end, perioperative nurses and operating

Patient safety a public priority The statistics available on never events provided on 11 January 2017 for the period between 1 April and 31 December 2016 indicate a total of 314 incidents that appear to meet the definition of a never event as outlined in the Never Events list 2015/16. During this period there were 133 wrong site surgeries, 75 retained foreign objects post procedure and 38 wrong implant/prosthesis insertions. The NHS in England is one of the only healthcare systems in the world that is open and transparent about patient safety incident reporting, particularly around never events. Patient safety is the foundation of good patient care and is defined as: ‘The avoidance, prevention and amelioration of adverse outcomes or injuries stemming from the process of healthcare’. The reference to amelioration of adverse outcomes or injuries broadens the definition beyond traditional safety concerns for many industries up to a category for ‘disaster management’. However in healthcare amelioration firstly refers to the need for rapid medical intervention to deal with the immediate crisis, and also to the need to care for injured patients and to support the staff involved. Encouraging learning Over many decades high profile events, government responses, investigations, enquiries and numerous professional reports have brought patient safety into the forefront of the public domain. We have learned that blame and discipline are an ineffective response to most safety problems. A more appropriate solution is provided by Sidney Dekker who proposes that we need the kind of accountability that encourages learning. He talks about individuals telling their stories, giving their accounts from their perspective of direct or close involvement. This lived experience represents ‘a rich trove of data for how safety is made and broken at the very heart of the organisation’. The rates of error and harm continue to present a significant challenge for those of us who work in the healthcare industry and in particular those within the area of surgery. Undeniably, when looking at the latest data on never events there is a huge chunk of responsibility and accountability for all involved in the operating theatre service. The operating theatre is a complex environment fraught with risk which is managed continuously on a daily basis. There is no denying that managing surgical and anaesthetic services requires skill expertise and a thorough awareness and knowledge of risk, risk mitigation and management. It is imperative that we have the right people with the right skills in place to manage this area of healthcare. Each organisation and operating theatre will have to answer this question individually. Sadly, it is certain that not all will be able to do so in the affirmative.

Case study: The Royal London Hospital The Royal London Hospital, part of Barts Health NHS Trust, is a major teaching hospital with a large emergency department (ED) which includes a regional trauma centre. It is also the home of London’s air ambulance, the London Helicopter Emergency Medical Service (HEMS), which responds to serious trauma emergencies in and around London. Space in the ED is at a premium and at times the ED is crowded, in part due to ongoing challenges with the internal flow of patients, with the result that the ED has little space to assess or accommodate more patients. However, ED staff also recognise that if ambulance staff are not freed quickly to respond to further 999 calls, patients in the community could be put at increased risk. The decision was taken to accept timely ambulance handover whatever the level of ED crowding. ED staff take responsibility for finding space for these new patients. Where possible and appropriate, patients are transferred from the ambulance trolley to a chair, which is more comfortable for them and also helps promote an ambulatory approach to their subsequent care. Any necessary cohorting of patients because of ED crowding happens after ambulance handover and ED staff supervise these patients, not paramedics. ED leadership reinforces timely ambulance handover as the normal way of working. There is never an excuse for ambulance handover to be delayed. The number of ambulance crew hours lost

a capacity of around 65,000 attendances per year. During 2016 the trust started to see a decline in its ambulance handover response time, which had been one of the best in the South Central region. To improve capacity and to meet national clinical quality indicators the trust embarked on a journey to implement senior triage and treatment (STATing) in a new dedicated eight-trolley area. A senior clinical decision-maker was placed at the ED front door between 8am and 10pm to ensure all patients were streamed to the most appropriate area to meet their needs, whether that be: the assessment unit; ambulatory care; emergency nurse practitioner (ENP) led minors area; or into the main ED for further assessment and treatment. An ST4 doctor or above is on duty 24/7 and there is consultant cover 16 hours a day, seven days a week. Consultant-led board rounds are conducted three times a day. Safety huddles involving the consultant in charge, nursing co-ordinator and site manager are held every two hours alongside clinical validation of breaches when these occur. ED clinical quality indicators are visible on the shop floor and staff are more aware of these. Performance against the ED clinical quality indicators is also discussed at the monthly clinical governance meetings. A daily predictor of activity model has been developed to help plan for staffing and variation in demand. Improved patient and staff experience due to reduced crowding in the ED. Sepsis screening standards have been met and exceeded. Ambulance handover

Patient Safety

department practitioners (ODPs) have a clear legal, ethical and professional responsibility to apply and adhere to the existing standards of care and available guidance.

When incidents occur in healthcare there is often a delay in starting the investigation and creating the time line that is necessary as part of the forensic examination close to the time of the incident from ambulance handovers taking over 30 minutes is consistently one of the lowest across London. Senior clinical decisionmakers take the ambulance handovers which has increased patient safety in the ED. Promoting an ambulatory care approach early in the ED pathway has provided benefits to patients while facilitating early release of ambulance crews. Ambulance handover delays can be minimised by developing and maintaining a strong leadership culture in the ED that focuses on reducing clinical risk across the system as a whole. Timely ambulance handovers can be achieved and maintained even in crowded EDs. Case study: Royal Berkshire Royal Berkshire is a large district general hospital with cancer, eye and renal specialist services serving a mixed urban and rural population of over one million. Part of Royal Berkshire NHS Foundation Trust, it receives 125,000 ED attendances a year, 25 per cent of whom are children. The ED was built over 10 years ago with

delays have reduced and the trust is once again a high performer across the South Central region. Both time to assessment and time to treatment have seen an improvement against the previous winter. Dedicated administration staff need to be allocated to the STAT area to support seamless patient registration. Nursing, portering and healthcare assistant staffing levels need to be adequate to support the high turnover acute workload and patient moves. A standard operating protocol can be used to reduce inter-clinician variability in the STAT process. Alternative pathways to which patients can be streamed need to be resilient, robust and accessible. The main ED (majors/resuscitation) must actively ‘pull’ the patients through after initial rapid assessment and treatment. This requires dynamic senior nursing and medical leadership. ! FURTHER INFORMATION




Workplace Doctors was forged through understanding the hardships & budgets faced by clients of both the public and private sector across the UK, Republic of Ireland, Saudi Arabia, Australia & UAE in maintaining their business service standards with rising costs involved in employing the right staff. At Workplace Doctors, we pride ourselves on delivering the very best service to our clients. Whether your organisation is an SME, HSE or NHS Trust to a FTSE company, or anything in-between, we are committed to taking your recruitment to the next level. We know that your investment in personnel is critical to the success of your establishment. Getting your recruitment wrong is often a very expensive exercise.

STAFFING SOLUTIONS - We value our clients and candidates equally and are completely focused on providing a confidential, efficient and professional service that is carefully tailored to your needs quickly. We are committed to working with you to find the best solutions to your recruitment and career requirements.

COMPLAINCE & QUALITY - Workplace Doctors is in the business of patient care and of course it goes without saying that a lot more compliance checks are needed to be done for doctors, nurses, AHP/ HSS Staff than any other profession, where you are not in charge of people’s wellbeing & safety. We adhere to the CCS, HTE, LPP framework standards and we will only send you qualified and vetted, suitable individuals saving you valuable time and money in employing the right staff.

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Following December’s State of Medical Education and Practice report, Brexit and poor retention rates threaten to provide further damage to an already struggling workforce. Health Business examines the issue According to analysis of the National Centre for Social Reearch’s British Social Attitudes survey, undertaken by the Nuffield Trust and The King’s Fund think tanks, dissatisfaction with the NHS has risen to 29 per cent – the highest in a decade. Both organisations claim that the results reflect the public’s growing anxieties over the funding and staffing of the NHS, alongside long waiting times and government reforms. The research is the latest in a long line of warnings over NHS understaffing. The Royal College of Nursing (RCN) is stressing that patient care standards rise and fall with the number of nurses available, and, with many services across the country struggling to recruit and retain nurses, it is becoming clear that workforce problems ate likely to have long-standing consequences. Responding to the General Medical Council’s The state of medical education and practice in the UK report: 2017, the British Medical Association says that ‘decisions made today will have a significant impact on what the health service and patient care will look like in 20 years’ time’. The report, published in December, highlights how the number of doctors has failed to keep up with demand, with many NHS staff worried about their ability to provide safe patient care. An average of approximately 13,000 doctors are entering UK practice every year, a figure which has remained relatively steady since 2012. However, in the same time period there has been as 28 per cent increase in A&E attendances and a 15 per cent increase in the number of GP consultations between 2011 and 2015. Furthermore, there was a 5.4 per cent drop in the number of medical students attending UK universities between 2012-2016. This is compounded by one of the fasting growing health concerns in the UK, which is that the total number of people aged 65 and over is estimated to grow by nearly 50 per cent in the next two decades.

The GMC report notes that ’the medical profession will undoubtedly need to grow to meet this extra demand’, highlighting the importance of location planning as a key step in addressing the concerns. There are projections that depression, stroke, falls and dementia could grow by between 50 per cent and 60 per cent in rural areas, compared to increases of between 34 per cent and 42 per cent in urban areas, yet the numbers of skilled medical professions in remote settings are ‘particularly scarce’. Last year, it was reported that Lincolnshire had a shortage of GPs that was leaving some rural patients waiting four weeks to see their doctor.

The health in system eliant is r the UK tors from on doc and,‘Brexit , abroad compound could culties Dependence on diffi ng’ wider workforce i t i recru The health system in the UK is

reliant on doctors from abroad, and, as Dr Chaand Nagpaul, BMA council chair, highlights, ‘Brexit could compound difficulties recruiting and retaining these staff’. In some hospitals, one in five NHS workers have EU passports. Janet Davies, RCN chief executive, says that ‘if there is a Brexit


The NHS: in the midst of a workforce crisis

cliff-edge in migration, it will be the NHS going over it’. Figures show that the number of nurses coming from EU countries has dropped in the last 18 months, with separate data suggesting that the NHS already has at least 40,000 too few nurses with not enough home grown nurses being trained to fill the gaps. With the NHS having experienced, and in some cases still battling, one of the worst winters on record, there are some saying that winter pressures and the worsening levels of funding are pushing nursing staff to quit. New financial figures, published by NHS Improvement, have shown that the NHS has nearly 100,000 positions unfulfilled, representing one in 12 posts – enough to staff 10 large hospitals. With the report focusing on a £931 million deficit this year, Nigel Edwards, chief executive of the Nuffield Trust, warned that the NHS was ‘dangerously’ short of staff and claimed that ‘the lack of crucial workers in the NHS is an even bigger problem than the lack of funding’. The GMC report finds that 18 per cent of licensed doctors in the South West of England are non-UK graduates compared with 43 per cent in the East of England, 41 per cent in the West Midlands and 38 per cent in the East Midlands. The paper states that ‘international recruitment will always be a feature of workforce planning’, stressing that ‘it is important that we create opportunities where doctors and health professionals from other countries can share in the learning experiences which our health services have to offer’. This is a difficult situation, as the appeal of working in the UK appears to be in decline. ONS figures suggest that net migration is dropping, with 106,000 fewer than the year before and over three quarters of the fall was due to EU citizens. A separate ONS survey from February last year found that 61 per cent of responding doctors were considering leaving the UK at some point in the future, with 90 per cent of those pinpointing the UK’s decision to leave Europe as a factor in their thinking. ! FURTHER INFORMATION



Catering Written by Adrian Roper, development manager, Food for Life


Catering in a health-promoting environment Food for Life’s Adrian Roper discusses how to help NHS trusts create a better food experience and support a health-promoting environment for patients, staff and visitors through shared learning The Soil Association’s Food for Life programme has been working with communities and a range of settings to help make good food the easy choice for everyone – making healthy, tasty and sustainable meals the norm for all to enjoy, reconnecting people with where their food comes from, teaching them how it’s grown and cooked, and championing the importance of well-sourced ingredients. Food for Life works with schools, nurseries, hospitals and care homes, helping them build knowledge and skills through a ‘whole setting approach’. This engages children and parents, staff, patients and visitors, caterers, carers and the wider community to create

a powerful voice for long-term change. One key area of our programme is working with NHS trusts to support them to be consistently health-promoting environments where food plays a central role in recovery of patients, reducing re-admissions, supporting well-being in the community, and where staff and visitors have access to ‘good food’ that supports their well-being. Food for Life’s support also aligns with key national policy initiatives such as the mandatory ‘Healthy food for NHS staff, visitor and patients’ CQUIN, development of a Food and Drink Strategy, as outlined in the NHS Standard Contract, and our industry standard Food for Life Served Here accreditation is cited

Food s ha for Life with worked S trusts NH over 70ng support providi food central e to mak nt of being a eleme promoting health- onment envir


as being evidence of meeting relevant Government Buying Standards. To date, Food for Life has worked with over 70 NHS trusts providing support to them to make food a central element of being a health promoting environment. We do this through a variety of support packages and our expert team are happy to provide bespoke support on key issues pertinent to your trust. Hospitals Food Network Food for Life has recognised that there is no forum for NHS trusts to get together to share learning around a range of food issues and addressed this by developing the Food for Life Hospitals’ Network. Our network includes two seminars which we run every year, three newsletters highlighting policy change, innovative practices and case studies from across the sector as well as access to the national Food for Life conference. All these elements are designed to help trusts create a better food experience and

Reducing food waste workshops Whether you are catered for by an in house team or by external caterers, reducing food waste is a top priority for many NHS trusts as budgets continue to be stretched and costs for waste disposal rise. Bringing multi-disciplinary teams together, Food for Life’s support raises awareness of the financial, nutritional and environmental implications of food waste, looks at current challenges and opportunities for food waste reduction in your NHS trust and builds shared solutions. Additionally, new auditing techniques are taught with food waste audit templates being provided to your trust support a health-promoting environment for patients, staff and visitors through shared learning and with the opportunity to showcase your trust’s achievements. CQUIN Benchmarking and auditing Food for Life’s ‘Healthy food for NHS staff, visitors and patients’ CQUIN bench-marking and audit helps NHS trusts and retail outlets to understand where they are in relation to achieving compliance; making recommendations for change and providing evidence for Clinical Commissioning Groups. Expert staff carry out an in-depth audit of compliance with CQUIN standards and provide a detailed report outlining changes required to meet CQUIN standards as well as providing further recommendations around improving your retail offer and provision of healthy options 24 hours a day. Our reports can be used as evidence to your CCG of compliance with CQUIN or as a means of assessing any changes that may be needed. Food and Drink Strategy Support Food and Drink Strategies are required of each NHS trust under the NHS Standard Contract and our support package is designed to help NHS trusts develop a strategy with multi-disciplinary input, identifying priorities and challenges, and supporting trusts to take a multi-disciplinary approach to drive change. Examples of what might be included to support this include a review of trust wide policies and site

ingredients, in a setting that takes your customer’s health and well-being seriously. It means your staff, visitors and patients know that the majority of food on the menu is freshly prepared, free from undesirable trans fats, sweeteners and additives, and is cooked by trained chefs, and use ingredients from sustainable and ethical sources. Food for Life Served Here is also a recognised accreditation that shows you are meeting Government Buying Standards. Over 1.7 million Food for Life Served Here meals are served every day in the UK and trusts and caterers are increasingly using it as a means to drive positive change and demonstrate their commitment to providing ‘good food’.


visit, benchmarking against national best practice and the requirements of the Food and Drink Strategy, identifying strengths and highlighting opportunities for change. The review will include written feedback. Furthermore, it will include a bespoke multi-disciplinary workshop for key senior staff, bringing together the key stakeholders involved in food, to work in partnership to develop your strategic vision for food, as well as next steps resources, including a report based on the key issues raised in the workshop and action plan templates. Additionally, a draft food and drink strategy, including follow up meeting to finalise the strategy, will be included alongside progress review meetings. This will include facilitation support and input from a Food for Life expert at multi-disciplinary meetings to review your progress and refine next steps.

A healthy environment Food for Life’s work with NHS trusts across the country has supported them to make real change around their food offer and becoming a health promoting environment. The benefits are wide ranging. For sustainability, the Food for Life Served Here certification provides a framework within which hospitals can meet and exceed the mandatory sustainability requirements for food and catering service. Targeting multidisciplinary engagement, our approach is designed to bring together teams including estates and facilities, nursing, dietetics, public health, patient experience and communications. To provide expert training, support and resources, we offer a wealth of resources, specialist support and menu of training, developed and delivered by experts. Enhancing links

Food for Life has recognised that there is no forum for NHS trusts to get together to share learning around a range of food issues and addressed this by developing the Food for Life Hospitals’ Network to be used across the hospital or trust. Support includes: a scoping call, exploring current practice, identifying strategic priorities and understanding your challenges in relation to food waste; a bespoke multi-disciplinary workshop for key staff, supporting you to understand the impact and causes of food waste, the scale of food waste in the trust, and exploring ways to monitor and minimise waste; on-site ward level food waste audit, led by a Food for Life expert, teaching new auditing methods; bespoke food waste report and resources, covering feedback from the audit and recommendations; and progress review meeting, supporting the team once they have begun to put the changes in place. Food for Life Served Here The Food for Life Served Here award, previously known as the Catering Mark, is an independent award scheme that means you can guarantee that the food on your menus meets certain standards. A Food for Life Served Here award means you’re serving local, fresh and honest food cooked by chefs who really care about quality and

beyond the hospital, the Food for Life Hospital framework encourages engagement with public health, the wider community and care settings, whilst to share best practice the Food for Life Hospital Network brings together member trusts to share learning and collectively influence national policy. Trusts Food for Life has worked with have found our partnership to be of huge value. Claire Hinds, associate director for Support Services, South Warwickshire NHS Trust, said: “Food for Life is helping to transform hospital food for patients, staff and visitors. The expert team has helped us to develop new approaches that we are really proud of.” We are really keen to engage and support NHS trusts around making food a central element of being a truly health promoting environment, so please contact us if there is any areas where you feel you would value some support in becoming a good food exemplar. ! FURTHER INFORMATION





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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

Written by David Mackey, the Carbon & Energy Fund

Improving energy strategies for healthcare estates

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 "

The guide s ate investigns that io innovat more easily e could ble in the near availab e, including futur t heating distric mes sche



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. Every major building relies heavily on pumps of various designs, shapes and sizes to run the heating, air conditioning, chilled water, potable water supply, to distribute harvested rainwater and to remove the sewage and greywater from the building. Their roles are many and various but all are vital. Modern pump technology allows these tasks to be undertaken far less expensively, simply by replacing elderly existing pumps with modern high efficiency pumps, designed to do their jobs better, quicker,

less expensively, in a more environmentally friendly way and more reliably. They aim to offer a win ‘to the power of several’ solution. The key words are ‘lifecycle costs’. Modern pumps are undoubtedly more expensive than their elderly relatives. The new technology in the modern pumps has a price. But the payback from modern pumps is usually extremely fast in relation to the capital cost because the energy required to run these new pumps is far less, often infinitesimally less, meaning that over a 15-year lifecycle, huge savings in terms of energy cost can 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

Health_Business_Magazine_18_01.pdf 1 04/12/2017 15:23:14

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# 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.” The ‘Model Hospital’ 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. Future and recent 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? 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. 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 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.” !


Ongoing revenue savings provide much needed extra savings for trust boards, which can be utilised directly to improve the delivery of frontline patient care or backlog maintenance risks of the NHS estate

£6.6 million energy schemes launched at Royal Bolton Hospital A number of energy schemes are now in place at the Royal Bolton Hospital, bringing savings and sustainability while reducing carbon emissions and air pollution. The opening of the John Horlick Energy Centre houses a clean gas-fired combined heat and power plant which produces electricity and uses waste heat to provide heating and hot water for the hospital while reducing carbon emissions. It replaces two coal-fired boilers. The hospital site’s engineering infrastructure has been upgraded to provide modern energy efficient heating and hot water plant. The hospital has also started to extract water from a natural source under its Farnworth site. The water is treated on site that it is suitable for drinking and will provide 95 per cent of the hospital’s usage. It naturally renews itself. In addition, Bolton NHS Foundation Trust gas agreed to offer the hospital’s standby generator electric supplies when not needed, to provide electricity to the National Grid at times of high demand. The work was carried out by iFM Bolton in collaboration with Breathe Energy Ltd, who were awarded a £6.6 million contract and have guaranteed savings of £887,000 a year for a period of 15 years. In addition, the energy programme will reduce carbon emissions by over 7,000 tonnes a year and improve efficiency and safety. Stephen Tyldesley, managing director of iFM Bolton, which is a wholly owned subsidiary of Bolton NHS Foundation Trust, said: “There are so many benefits of this energy programme, both in terms of savings and environmentally. It will provide efficient, safe energy for patients , staff and visitors, reduce carbon emissions and improve air quality for local people.”




Facilities Management Written by Russell Beattie, chief execitive, Federation of Environmental Trade Associations


Pursuing more sustainable building practices Russell Beattie reviews the current state of the building services sector, focusing on some of the ways in which the heating, ventilation and air conditioning industry is contributing in the push towards energy efficiency Last year we witnessed a tumultuous Planet Earth II and Blue Planet II, both 12 months across the political landscape shown on the BBC and narrated by the and we seem no closer to resuming anything legendary Sir David Attenborough, showed approaching normality. The Brexit negotiations us elements of the natural world that filled the headlines, and we endured an fascinated, educated and alerted us in unexpected election call, bringing even equal measure. Both programmes issued less clarity to the situation. some severe warnings about the Along with many of our state of our planet, particularly fellow organisations, relating to climate change. we have continued to The damage caused by The , y r t s work to ensure that plastics has also been u d in our sector is heard brought to public building FETA, is in as myriad details prominence and we can g n e i includ position to b of transitioning expect greater awareness e d r m a i out of the EU are of this to be reflected r d p n a e sta h t worked through. in consumer attitudes. f o e on n i s r Two of last The building industry e r a be ner is in a prime position e year’s most popular e r g g in television programmes, to be one of the y promot

log techno


standard bearers in promoting greener technology, benefiting the environment for generations to come and this remains at the forefront of our thinking at FETA. Minimum Energy Performance Standard Buildings must of course fulfil their primary purpose, providing shelter from the elements, but they must also provide a safe and healthy environment in which occupants can live, work and operate. Soon there will be a new requirement to adhere to as we attempt to increase the role buildings play in protecting the environment. After the Minimum Energy Performance Standard (MEPS) takes effect on 1 April 2018, all commercial leases will need to achieve a minimum Energy Performance Certificate (EPC) rating of ‘E’ before they can be let to new occupiers or renew an existing tenancy. The government estimates that around 18 per cent of current buildings in the UK are currently failing to meet the minimum rating of E for the EPC and hence there is significant pressure on affected landlords and building owners to make the necessary changes. Failing to comply with the upcoming standard will mean landlords no longer being able to let a property until the requirements are met. It could also result in a significant fine. For those less than three months in breach of the MEES Regulations, fines will be equivalent to 10 per cent of the property’s rateable value, subject to a minimum penalty of £5,000, and up to a maximum of £50,000. After three months, the penalty rises to 20 per cent of the rateable value, with a minimum penalty of £10,000 and a maximum of £150,000.

Modern heating systems Another clear move towards more sustainable building practices was announced by the government in October, laying out plans to phase out the use of heating oil for hot water and building heating (domestic and non-domestic) during the 2020s. The details of how this is to be achieved have

yet to be determined, but this declaration is seen as a path to eventual regulation. Focus initially will be towards new build but will then be directed to existing building stock using heating oil. FETA regards this as a clear signal of intent toward ‘cleaner heating’ systems and heat pumps of all genres can contribute significantly to this as low emission technologies. Most heat pumps already have the ability to be switched on or off by external means, such as by an electricity grid during high demand where the spot price

working group and has released a guidance note entitled ‘An introduction to A2L refrigerants and their use in Refrigeration, Air Conditioning and Heat Pump applications’. Introduced in 2015, the F Gas Regulation requires the introduction of refrigerants with significantly lower Global Warming Potential (GWP) and will ban new equipment which uses hydrofluorocarbon (HFC) refrigerants with a GWP of over 2,500 by the year 2020. As a result, new refrigerants are being developed by manufacturers; in many cases these are pure, or blended,

Facilities Management

Building controls In buildings of any age, function and standard, significant reductions of energy consumption and CO2 emissions can be achieved relatively easily. Individual regulation of room temperature using window contacts, daylight-dependent lighting and building automation systems adapted to customer requirements can all contribute towards conserving energy. The use of building automation systems will not only allow for an energy efficient building, but will also save on the overall building operating costs using existing energy resources. It will lower CO2 emissions and will enable the owner/operator to work towards the best possible energy efficiency standards. Innovative building energy management systems influence the energy efficiency of a building in many areas. They can ensure precise control of temperature, humidity and air quality in the room and optimal generation and distribution of heating and cooling. Once automation systems are in place, monitoring and management facilities can be used to calculate and display the total energy consumption within the building, allowing users to analyse energy usage and plan improvement measures.

In buildings of any age, function and standard, significant reductions of energy consumption and CO2 emissions can be achieved relatively easily (that paid by the electricity distributor) is very high. In the future, we can expect to see devices that can monitor the reaction of the building they are heating to the input of heat and calculate the likely degradation profile should the device be disabled for a time due to a high electricity price or high carbon dioxide emission rate. Heat pumps provide real potential for harnessing the benefits of ever-expanding and developing IT capabilities. The only limit is our ability to understand and practically apply such benefits with special consideration for commercial viability. Air conditioning FETA has set up a new A2L refrigerants

HFOs (Hydro Fluoro Olefins). Whilst having much lower GWP rates, some of these new refrigerants do exhibit flammability characteristics (albeit in the lower or ‘mild’ classes). To recognise this, and their difference from higher flammability refrigerants such as hydrocarbons (classified as A3), a new A2L classification has been introduced by ASHRAE. The new working group offers clear guidance on A2L refrigerants and the implications of their use, sharing information and communicating changes and updates as soon as they occur. It is also working with standards bodies to ensure any new standards being developed reflect the need for wider usage and knowledge of such products. Many FETA members are already involved in this process. "



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Is cyber crime really the biggest threat to business resilience? We live in an era of increased business risk. News headlines focus on threats such as cyber crime, but there’s a more immediate issue – energy supply The energy landscape is changing. Global energy consumption is increasing fast – it’s expected to rise 25 per cent by 2040. The demand for electricity will be even higher, up 65 per cent in the same period. Add increasing grid instability, rising fuel costs and strict emissions targets into the mix and the future of traditional energy supplies looks anything but secure. Businesses need to place less reliance on the national grid and start to focus on generating their own energy – and making the energy they currently use go further. However, there is a disparity between the threat posed by energy-related failures and the degree to which businesses are preparing for them. The cost of failure Businesses estimate that, when both direct and indirect costs are taken into consideration, an energy-related failure can total as much as 17 per cent of their annual revenues. But with the right energy solutions, UK businesses can protect their bottom line against energy failures, cut energy costs and improve their business resilience right across the board. 52 per cent of businesses believe that they will experience an energy-related failure in the next year. One solution for business resilience Combined Heat and Power (CHP) from Centrica Business Solutions is a versatile, easy to implement solution that provides an extra layer of energy resilience for businesses. Just as importantly, it can help to drive down operational costs by reducing your power usage andcut energy costs significantly, as gas is far cheaper than electricity. Overall, CHP can reduce your energy costs by as much as 25 per cent.

81 per cent of businesses have experienced at least one energy-related failure in the last 12 months Finding the right CHP partner Centrica Business Solutions have plenty of experience in the sector and will work with you to find the CHP solution that offers maximum savings and efficiencies. But they’re also an all-round energy partner who can not only help you implement resilience solutions, they can also provide you with insights into where the problem areas of your energy usage lie. The cost of resilience Centrica Business Solutions are one of the very few companies who can offer large-scale financing to help reduce risk from purchasing an energy solution. A variety of finance options, including zero capital outlay, mean you control the cost of installation. And with payback in three to five years and an equipment lifespan of up to 15 years, the savings keep coming long after the

Increased resilience CHP gives you a stable and resilient energy source – it can be used to provide electricity if the grid supply fails and also offers a cost-efficient heating method. Reduced running costs By cutting your site’s energy costs by up to 25 per cent, CHP enables you to divert your energy budget to other areas of your business. Lower CO 2 emissions CHP can help reduce your energy consumption and emissions significantly – supporting compliance efforts and unlocking access to certain government incentives.



technology has paid for itself. With so many affordable options available, coupled with the potential cost of an energy failure, the real question is not the cost of an energy resilience solution, but can you afford not to have one? Read the Resilience Report Centrica Business Solutions surveyed energy decision-makers across multiple industries to understand the true scale of the challenges posed by a lack of energy continuity, and the steps businesses are taking to address them. The resulting research report could set your business on the road to resilience. One thing is for certain – it’s never too soon to start. ! FURTHER INFORMATION Visit resilience to find out more and download the report

A leading light It is likely that 2018 will see more of the same in terms of high level

The building services sector can make a real statement on energy efficiency, helping to establish the UK as a leading light in the movement towards more sustainable buildings policy debate and, as ever, it will be the expertise and commitment of our active members which will be key to delivering optimal outputs for our sector. When addressed individually, many building systems and components have some sort of impact on efficiency but grouped together, heating, ventilation and air conditioning can account for a significant proportion of an organisation’s overall energy consumption. By analysing these elements, understanding how they fit into the ecosystem of the building and identifying key legislative requirements and trends, the building services sector can make a real statement on energy efficiency, helping to establish the UK as a leading light in the movement towards more sustainable buildings. 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

Facilities Management

# The indoor environment A property’s duct system is a complex network of tubes in the walls, floors and ceilings; it carries the air, hot and cold, around the building. Ducts are made of sheet metal, fibreglass, or other materials and ductwork air tightness is the fundamental ductwork property that impacts the uncontrolled leakage of air through duct leaks. Ducts that leak heated air into unheated spaces will increase a building’s heating and cooling bills but this can be reduced by professional sealing and insulating practices. Poor duct air tightness can be caused by a variety of factors, including; inadequate or missing sealing media, worn tapes, poor workmanship around duct take-offs and fittings, ill-fitted components and physical damage. As well as the energy saving benefits, the quality of a building’s indoor environment is important to consider too. Reduced leakage helps direct the airflow to go exactly where it is intended, ensuring a good indoor environment. A duct system that is not air tight will allow dust and dirt to enter and circulate throughout the building. The particles could include insulation fibres, pet dander, waste from insects and rodents, or pollen. Ducts also provide comfortable habitats for pests. Both insects and mice can crawl through small cracks and gaps.

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 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

Lift Consultants Our Lift Consultants provide independent advice on all aspects of lift engineering, from conceptual design through to final build. We have expertise on compliance and advice on existing lift portfolios we undertake condition surveys to assist with forward planning and budget management. Phone: 08003029331 Web: Email: Address: 86-90 Paul Street London EC2A 4NE



Waste Management Written by Edward James, Estates, Facilities & Professional Services, London Procurement Partnership

A strategic approach to managing waste in the NHS NHS London Procurement Partnership has been working to support NHS organisations in improving their management of waste since 2012. Edward James, senior workstream lead for Estates, Facilities & Professional Services at LPP, discusses some of the challenges being faced, and the ways in which LPP supports NHS organisations to overcome them

London Procurement Partnership (LPP) has had a waste management framework in place since 2012 and, since then, has supported 45 organisations in awarding contracts worth a total of some £50 million. The contracts which have been awarded include multimillion pound managed service contracts as well as small specific contracts for confidential waste. The framework covers all waste streams that can be produced in the NHS from clinical waste, to recycling and ambulance depot waste such as oils. In the early days of the framework, trusts saw average savings of 25 per cent on waste management costs. What has become apparent over the past few years is that the costs for waste management have stopped reducing, and are now increasing. Suppliers are seeing increases in staff costs, fuel costs and energy costs to run their waste plant, and they are now passing these costs back to their customers. LPP has been working with a number of NHS organisations to benchmark what this means for them and their current contract and contract prices. The chances of NHS organisations going back out to market and achieving a lower price without doing anything different are very low. Consequently, we have supported our members to look strategically at their


waste management, and to consider their recycling rates, in both clinical and non-clinical waste streams, and those of best-in-class NHS organisations. We have shown on a number of occasions that by implementing good waste management strategies, the likely cost pressures can be offset and in some cases savings delivered.

those departments who recycle the most waste, whilst at the same time segregating waste properly. This work has been recognised nationally, with both parties winning a Green Apple Award. As well as supporting large acute hospitals such as Guy’s & St Thomas’, LPP has also supported five ambulance services across the country. The challenges faced by the ambulance service are very different to the challenges of an acute hospital. Ambulance services have a large number of small, geographically dispersed stations which do not produce enough waste to warrant regular collections. They struggle with space to house bins on site, and a lack of availability of staff to sign waste collection notes can result in collections failing to be made. One of the other big issues for the ambulance service is that there is often not enough space on board an ambulance to have different bins allowing for segregation into various streams. LPP worked closely with East Midlands

There a be should aution c level of ith NHS taken wons looking ati organis ollaborate to c te on was ent em manag

Award-winning strategy for GSTT Some of the benefits to be had under the framework are proving to be award-winning. Guy’s & St Thomas’ NHS Foundation Trust, one of the country’s largest acute trusts, awarded a contract to Bywaters. Bywaters provides a complete managed service to Guy’s & St Thomas’, which includes the management of a number of waste operatives on site as well as dedicated ‘green gurus’ supporting the trust to improve its waste management and carbon footprint. The traceability and tracking of waste on site allows the trust to track waste back to department level and reward


The challenge of the public One of the difficulties that the NHS – like all public-facing organisations – has is the public. Organisations can deliver training to in-house staff on how to segregate waste, but the challenge is how to ensure that those visiting your premises support your organisation in waste segregation. To help understand how others are dealing with this issue, LPP joined a supplier on a site visit at Gatwick Airport to look at their approach to engaging the public in waste segregation. What became clear from the site visit was the importance of clear and simple signage, which meant people do not spend long periods of time working out in which bin to place their waste. Simple, but effective. Since we launched the original waste framework in 2012, there have been a number of developments within the clinical waste market. The move towards reusable sharp bins, for example, rather than incinerating has increased in pace significantly over the years, and a number of providers now provide appropriate waste solutions. ‘Offensive’ waste has also become more important to organisations looking to identify lower cost waste streams for their non-infectious clinical waste. There is still a large difference in the approach taken by NHS trusts in the classification of offensive waste and the agreement of infection control practitioners. This seems to be resulting in some trusts not sending any waste to an offensive waste stream. Others, however, are getting close to what the market says is the maximum that can be achieved, with up to 40 per cent of all clinical waste being classified as ‘offensive’. With a £250 per tonne difference between the cost of offensive and infectious waste, it is a savings opportunity which all trusts should be exploring.

members the opportunity to maximise benefits to be had from the deregulation of the non-household water market. In short, we’re developing a further competition to be run under the Crown Commercial Service ‘Water, Wastewater and Ancillary Services framework’ (RM3790). More than 35 London-region local authorities and other public sector bodies have already committed to participating in this contract. If all our London region NHS members joined, that could more than double the number of public sector organisations taking part.

Waste Management

Ambulance Service to find a new solution which would standardise the approach to waste management at their more than 70 locations, and significantly reduce their landfill waste. The resulting service included a standardised collection, changes to the way in which bins could be provided on the vehicles, and how these linked to the bins available on site. A full training package for staff taught them how to optimise the improvements to be had from the changes. This detailed work has seen East Midlands Ambulance Service improve segregation of waste, reduce its landfill waste, and reduce the cost of waste management.

Collaboration can work very well where one trust has a mature waste management policy and training programme, and a neighbour doesn’t. This approach can minimise waste being produced in the first place, drastically cutting costs Savings to be had from the cost of supply are minimal, but what we will be looking to achieve is a contract which brings the benefits of ancillary services at no added cost. These services will include water conservation, leak detection and repair, legionella risk assessments, the reduction of water consumption in order to deliver environmental improvements, efficiency, financial and consumption savings. This is a very exciting project for us to be involved in – one that we believe will have London leading the way in managing water resources for the public. ! FURTHER INFORMATION

Is collaboration on waste management workable? LPP has also noticed a larger number of NHS organisations looking to collaborate on waste management. There should be a level of caution taken with this approach. In any collaboration it is important to look at the cost drivers for suppliers. In the waste market this is people, vehicles, fuel and plant. If collaboration does not reduce the number of resources required to deliver the contract, cost reductions cannot be achieved – more does not mean less. If an acute trust is filling a lorry on each collection, collaborating with the hospital next-door will not deliver savings as there is no reduction in the quantity of waste being generated, the same number of staff are required in the process, and the same number of vehicles and journeys need to be made. For smaller trusts who do not fill a lorry, consideration needs to be given on route planning for the supplier and if resources can actually be removed from collaborative work. On a more positive note, collaboration can work very well where one trust has a mature waste management policy and training programme, and a neighbour doesn’t. Why reinvent the wheel? Learn from those who are doing well. This approach can minimise waste being produced in the first place, drastically cutting cost. The service offered by LPP through our framework is to support customers in awarding contracts, and to provide support in managing those contracts once awarded. This ongoing work within the waste market allows LPP category managers to develop a deep understanding of the market and the opportunities that exist, and enables them to share knowledge between different contracting authorities. LPP renewed its waste framework in 2017 and took a number of the lessons learnt to ensure its new framework was up to date. We are lucky to have been working with a number of fantastic suppliers for a number of years. Before tendering the new framework we undertook a number of 1:1 sessions with suppliers on our framework, and new entrants too, to ensure we built a robust and successful replacement framework. Managing waste water LPP is now in the process of working on waste of another kind. In conjunction with the London Energy Project, we are offering our



Water Management Written by Elise Maynard, immediate past chair, the Water Management Society

Water temperature and delivery devices in hospitals Elise Maynard outlines the importance of water hygiene awareness training and hospital-wide collaboration in preventing the outbreak of infections, such as legionella We often take water for granted. We use it for washing, bathing, showering and drinking, while at home setting the temperature we want is often quite straightforward. But within a hospital or healthcare premises it can be a different matter. Water temperatures in hospitals are kept high to help reduce the risks of bacteria growth. With water circulating around a large building with complex plumbing systems as high as 65 degrees centigrade, there is a potential danger of scalding for vulnerable patients and high temperatures make effective hand washing more difficult. This is the reason why thermostatic mixing valves (TMVs) were brought into hospitals many decades ago. Today, their use and application is


covered in Health Technical Memorandum (HTM) 04 – 01 ‘Safe water in healthcare premises’ with the aim: to help reduce the risk of scalding by full-body immersion for vulnerable patients (never-events); and to help facilitate effective hand washing which is ‘best performed under running water at a safe, stable and comfortable temperature’. Thermal compliance To further protect the user there is a supplement to HTM

04-01 ‘Performance specification D 08: thermostatic mixing valves (healthcare premises) 2017 edition’, which defines how the manufacturer has to prove their products thermal compliance by having their taps approved under the NSF/ Buildcert TMV3 scheme. Within the scheme and in response to NHS user feedback, thermostatic taps have been designed to provide a reliable, consistent, controlled temperature and have safety features that ensure

Effective hand which g in h s a d w erforme ter p t s e b ‘ a is nning w le u r r e d n b u e, sta at a saf fortable and comrature’ tempe


the tap is shut off instantly when there is a cold water interruption in supply. Recently there has been a school of thought that questions whether thermostats should be used as much as they are, by reducing water temperatures to a comfortable temperature for hand washing and safe scalding prevention. It is argued that the lower temperature will give bacteria a better environment to breed in, causing a potential danger to patients with a weak immune system. There are also arguments that say thermostats are expensive to buy and maintain and more basic taps would cut down costs within a budget constrained NHS. All taps, however, regardless of whether manual or thermostatic, are required to be risk assessed for infection/scald risk and to be maintained, cleaned and flushed appropriately. Some innovative manufacturers, understanding the issues involved, have been designing out complexity by creating a simpler structure within the tap body, reducing the amount of plastic components and increasing the amount of brass, as it has natural anti-microbial properties. New thermostats have been designed to have more brass content and a simple one piece design. In addition, some products include smaller waterways to reduce the amount of

Risk assessment and maintenance Some manufacturers have had an integral thermostat within the fitting for many years, set in the body close to the point of delivery, thus cutting out dead legs and reducing warm water left in the fitting. Self-draining spouts, which evacuate any water remaining after use, are another hygienic feature. Furthermore, for easy thermal disinfection, look for cartridges which have a built in thermal cleanse feature. Tap mixers which can be fully dismantled for disinfection, with internal components designed to withstand 90 degrees centigrade and detachable spouts designed to withstand 135 degrees centigrade for autoclaving can provide a very cost-effective way of maintenance. All taps, regardless of whether manual or thermostatic, are required to be risk assessed for infection/scald risk and maintained appropriately. Therefore products which have full access to fittings from the front of the panel, fast isolation of water supply and rapid access to filters, check valves, regulators and thermostat, will make these easier to risk assess and maintain. The HTM 04-01 D 08 supplement now requires a less onerous testing routine, taking on average four minutes to run the testing procedure for some of these new products. The task of risk assessing what fitting to be used is not easy and there is no perfect solution, so check for a range that has been designed especially for hospitals with the aim of addressing a multitude of potential dangers, such as assurance of safe temperature water delivery for all users, that there are multiple built in safeguards to reduce the opportunity for bacteria growth and thus, with a good cleaning and flushing regime, those dangers are reduced further still. The Water Management Society provides a

The Royal United Hospital has admitted to a breach of health and safety law after a 68-year-old patient died from legionnaires’ disease in July 2015. The patient contracted the legionella bacteria from the water supply to the William Budd ward where he was a cancer patient. The Royal United Hospitals Bath NHS Foundation Trust has a turnover of more than £100 million and could be fined millions of pounds for the breach of health and safety law. A spokesman for the trust said: “The case is to be heard in due course and we will continue to co-operate fully and openly with the HSE and the court throughout these proceedings. We are unable to comment further whilst this matter is subject to legal proceedings.”

Water Management

water left in the tap and to create greater turbulence to help scrub the inside of the tap every time it is used, as well as introducing smoother bore waterways to make it more difficult for bacteria to cling to surfaces.

Royal United Hospital law breach

number of courses, delivered by independent experts in their field (many of which have been involved in the creation of both HSE and Healthcare guidance). These are designed to enhance the understanding and awareness of risk assessments as well as water hygiene training. The HTM 04-01 Water Hygiene Training course (W037) will guide the delegate through the relevant regulations and guidance, followed by real-life examples of practical problems and solutions to water related issues within healthcare. The formation of Water Safety Groups and Water Safety Plans to deliver a multi-stakeholder, holistic approach to mitigate environmental and/or clinical outbreaks is also a major feature of this course. ! FURTHER INFORMATION

There has been a school of thought that questions whether thermostats should be used as much as they are, by reducing water temperatures to a comfortable temperature for hand washing and safe scalding prevention


Royal Cornwall Hospitals NHS Trust is one of the trusts leading the way for the NHS in adopting smarter and more effective systems and practices, intended to improve operational efficiency and patient safety. The trust discusses how being a Scan4Safety site is helping it release clinician’s time to patient care


Releasing clinician’s time to patient care

Since Royal Cornwall Hospitals NHS Trust (RCHT) began its Scan4Safety journey in January 2016, a transformation has been underway with the trust’s management of its inventory of medical consumables. RCHT is one of six trusts within the NHS in England selected as one of the Department of Health’s Demonstrator Sites for the adoption of GS1 and PEPPOL. GS1 is best known for its identification standards, now delivering significant benefits across a range of systems and processes at RCHT. The trust began with an inventory management programme, which reviewed and designed standardised layouts for all store rooms to improve the ability of staff to locate stock easily, no matter where they were in the hospital. These standardised layouts were developed with clinical input in order to facilitate easy selection of all products required for particular clinical procedures. The provision of new storage equipment created much more efficient storage areas and a one-off trust-wide ‘stock amnesty’ removed obsolete stock from the trust’s inventory, generating an immediate cash saving. Efficiencies made through the trust’s inventory management programme include: over-stocking in wards to the value of over £1 million; maintaining the recommended level of two weeks of stock on wards; simplified ward store rooms by reducing the number of unique items stocked in medical wards by an average of 22 per cent. In trauma wards, this was reduced even further, by up to 40 per cent; released clinical time to patient care by shifting responsibility for stock management to materials management teams; and reduced year-on-year ordering of medical consumables (for example, plasters and bandages) by 21 per cent for a medical ward.

RCHT ix Inventory s f o management e n is o he t In parallel with the n i h t i ward store reviews, trusts wEngland, the RCHT Scan4Safety n i e S h t f NH o e programme rolled n o as out GS1 standards selectednstrator Sites to their patient o Dem e adoption ID bands, location for th S1 and identification and inventory catalogues. With of G these three core enablers PEPPOL in place, the trust embarked

upon the next stage of inventory management improvements. The recent go-live of a new inventory management system in Royal Cornwall Hospital’s (RCH) cardiac catheter laboratories, marked the next step of this transformation of how the trust manages inventory as part of the Scan4Safety Programme. The new system being used in RCH cardiac catheter laboratories is supplied by Atticus and uses GS1 barcodes and Radio Frequency Identification (RFID) tags to track what stock there is, what has been used and on what patient. This ensures everything is in date whilst making it easy to find what is needed for patient care at all times. The benefits seen by RCH’s cardiac " Volume 18.2 | HEALTH BUSINESS MAGAZINE


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Speed and safety The second area to benefit from the Atticus inventory management system has now gone live in the hospital’s Interventional Radiology Labs. Using simple point and click

scanning, the Atticus system holds data on what item has been used for which patient, allowing staff to quickly and safely track down any products in the event of a product being recalled for safety reasons. The new system uses GS1 Barcodes and ‘hands free’ RFID tags to track what stock there is and what is being used, making sure everything is in date and the right item for patients can be found at all times. By automatically reordering what is used, clinical teams no longer waste time on ordering. Zoe Martin, team lead, said: “The Interventional Radiology team is very excited to implement Scan4Safety’s Inventory management system. The work began by upgrading our store room facilities, which was completed without any impact on the clinical service. The Scan4Safety team were fantastic and supported us though every step of the project. “By using Scan4Safety we are able to track and trace implants to patients, and when stock is used it will automatically be ordered, ensuring stock is replenished without delay. The nursing team previously spent up to six hours per week ordering, unpacking and receipting stock, but this time can now be invested into direct clinical care time which will benefit patients.” The next phase of Scan4Safety’s rollout of the Atticus inventory management system will be St Michael’s Theatres. Eventually Scan4Safety will be implementing

this system departments right across the Royal Cornwall Hospitals Trust. What’s next? During 2018, high value and critical operating theatre inventory will be tagged on arrival with a unique GS1 identifier encoded into an RFID tag. The RFID system automatically identifies and track tags attached to objects. The tags contain electronically stored information and are familiar to everyone for their use in retail environments when they are attached to high value items, setting off an alarm if they are not removed before leaving the store. By using a globally unique GS1 tag, the inventory can always be identified as belonging to RCHT as well as preventing double keying errors which would lead to inaccurate inventory data. The use of RFID means that within operating theatres, clinical staff can record what inventory has been used ‘hands free’ with maximum accuracy and minimum fuss. The inventory improvements made as a result of Scan4Safety are setting standards to ensure staff have what they need, when they need it. These improvements are resulting in improved patient safety, increased time to care for nurses and are providing cost saving efficiencies. !


# catheter laboratories have been immediate. Instead of clinicians wasting valuable time counting stock, manually placing orders, unpacking deliveries, and receipting delivery notes, the team simply scan products as they use them on patients and the system automatically re-orders the goods. Using simple scanning, the system holds data on what implant has been used for which patient, allowing staff to quickly and safely track down any products in the event of an implant being recalled for safety reasons. In RCH’s cardiac catheter laboratories the time released back to patient care, has been calculated as 25 hours per week to spend on improving the quality of patient care – the equivalent of three days of a full-time clinician. Ethna McCarthy, director of Strategy & Business Development at the trust, said: “Releasing clinicians’ time away from administrative tasks such as ordering stock has to be a priority. The Scan4Safety project in RCH’s cardiac catheter laboratories has effectively released three days per week of a full-time clinician back to patient care. In addition this project provides significant benefits for patient safety, providing patient data that will enable a rapid response in the event of any product safety recall.”


Document processing improvements for Plymouth Hospitals Plymouth Hospitals NHS Trust (PHNT) is the largest hospital in the South West Peninsula, providing secondary care to a catchment population of 450,000 and specialist services to a wider peninsula population of almost 2 million. In pharmacy, the use of GS1 Global Trade Item Numbers (GTINs) improves the accuracy of the product catalogue and enables electronic ordering of the right product at the right time for the right department. Transacting electronically and becoming less reliant on paper is a national priority for the NHS. As well as gains inefficiency and productivity, harnessing technology enables a trust to capture and use accurate data more easily. Better data enables better-informed decision-making and thereby empowers better outcomes. Prior to using GHX to improve its capability to send paperless orders and process electronic invoices, the trust had transmitted 478 orders and 395 order responses, which confirm that an order has been received. By August last year, the trust’s trading figures were recorded as 1,193 orders and 700 order responses, an increase of 150 per cent and 77 per cent respectively. PHNT has moved to third on the list of most active electronic trading NHS trusts from being number 100.





Cutting missed appointments and cultivating efficiency

In the last decade the total number of hospital outpatient appointments in England has almost doubled to nearly 94 million. The figures from NHS Digital, meanwhile, show the percentage of ‘Did Not Attends’ or DNAs has headed slowly in the opposite direction. A number of initiatives have been introduced across the NHS in recent years to tackle the ongoing problem of missed appointments – with varying levels of success. Overall, the level of DNAs in hospital outpatient clinics has decreased from 8.4 per cent in 2006/07 to 6.7 per cent in 2016/17. But the fact that this currently equates to almost eight million wasted appointments, at a cost of more than £950 million to our NHS hospitals, highlights

The f no adoptio ologies hn new tecbled some has enaisations to organ umber of n cut the intments appo d by misse ts patien

the need for further action to address this costly issue. When these hospital figures are considered alongside an estimate last year from the General Practitioners Committee (GPC), that around five per cent of GP appointments, equating to more than 10 million, are missed every year in the UK, the potential for huge NHS savings becomes even more apparent. Undoubtedly, the adoption of new technologies in recent years has enabled some forward-thinking organisations to

Written by Peter Akid, director of procurement, NHS Shared Business Services

With almost eight million hospital appointments missed last year, Peter Akid, director of procurement at NHS Shared Business Services, says the patient communications technology framework can help reduce the almost £1 billion cost to the NHS wasted on ‘Did Not Attends’

cut the number of appointments missed by patients. Reminders via text message, for example, have become fairly common and – according to NHS England – can reduce DNAs by 10 per cent.

More efficient services But other parts of the NHS must follow suit and invest in finding the right technology to improve the situation for their own patient populations. Greater investment in new innovative technologies should lead " Volume 18.2 | HEALTH BUSINESS MAGAZINE


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! to lower DNA numbers and bigger savings for health and social care services across the country. Patients, meanwhile, would experience the same high standards of interaction they have come to expect from service providers in other industries. As well as the obvious cost of the appointment itself, which is around £120 for a hospital outpatient consultation, DNAs can often have a knock on negative impact in other areas. Treatment for other patients, for instance, may be unnecessarily delayed. Using technology to communicate with patients and, crucially, making it simple for them to confirm, cancel or reschedule appointments, means slots can be reallocated if necessary and clinics can run more efficiently. CARAS 2 In September last year, NHS SBS launched a new procurement framework for the NHS and wider public sector, known as Communication Appointment Reminder Alert Services 2 (CARAS 2). It was the latest in a series of similar framework agreements we have developed over the last nine years, providing a legally-compliant and cost-effective way for organisations to purchase the most up-to-date and innovative technologies on the market in this area. The products and services available on CARAS 2 are separated into six specialist lots. They include SMS Managed Services, particularly effective for communicating with young adults who are arguably most likely to forget about appointments, Managed Email Solutions, intended for personal computers and hand held devices such as smart phones, Interactive Voice Response (IVR) Systems, for landline and mobile telephones, and Internet Communications, to reach patients via online services such as smartphone apps.

The framework also has a lot for Agent Calls, which uses decentralised remote agents to make outgoing calls only, and a lot for Hybrid Mail, which allows for mail to be sent from an on or off site location to be printed and sent using digital data. Running until 31 August 2021, the agreement allows organisations to specify their exact needs and tailor services to get best value and ‘fit’, as well as the opportunity to bundle service areas together to deliver efficiency and enhance savings. Furthermore, organisations can access innovative solutions and products through suppliers known for technological advancements. Modern communications The chief executive of the TaxPayers’ Alliance said recently that ‘any trusts still relying on letters in the post should look to methods used elsewhere that are cutting missed appointments and saving taxpayers’ cash’. And he was right! Although letters in the post are still essential for reaching many NHS patients, a modern healthcare service can longer rely on this traditional method of communication alone. More NHS organisations should look closely at the technology being used by those at the forefront of addressing the issue. The CARAS 2 framework makes it cheap and easy to purchase bespoke solutions – without having to carry out complex in-house procurement – that suit the individual needs of an organisation and lead to year on year continual savings. " FURTHER INFORMATION proc-framework-agreements-support

As one of the largest UK trusts in the UK, Leeds Teaching Hospitals has over 1.3 million appointments made annually, but loses out on £7 million of income through missed appointments.


Although letters in the post are still essential for reaching many NHS patients, a modern healthcare service can longer rely on this method of communication alone

DNAs reduced to 7.2 per cent in Leeds

In 2013/14, nearly 130,000 patients did not attend appointments with the trust not having a formal patient reminder system in place. With approximately 50 per cent of patients missing appointments simply because they forgot, the trust DNA rate was 12.2 per cent, four per cent higher than peer average, increasing administration resource with the rebooking of missed appointments. Working with Healthcare Communications, one of the organisations in Lot 1 of the Communication Appointment Reminder Alert Services 2 framework, Leeds Teaching Hospitals introduced SMS and IVM appointment reminders, using the most cost efficient contact mode first and automatically switching to IVM if the message is not received or land line only patient details are held. At the end of the first year, DNA’s were recorded at 7.2 per cent, which is 0.8 per cent below peer average, whilst attendance is now over 91 per cent, with 23,000 more patients attending in comparison to the previous year. In 2015/16, the trust generated £1.5 million in efficiencies. A key project success factor was giving patients the opportunity to respond digitally with CANCEL or REBOOK. Replies are reported in real time, meaning slots can easily be rebooked with advance warning.


8 steps to GDPR compliance for health and social care 1

Establish a governance and accountability framework.


Appoint and train a Data Protection Officer (DPO).


Create a data inventory that identifies processors and any data that is held unlawfully.


Conduct a data flow audit.


Conduct a gap analysis to assess your compliance and business processes in accordance with the Regulation.


Develop operational policies, procedures and processes in line with a well-recognised information security framework.


Create a data breach response process and then test it.


Monitor, audit and continually improve each step.



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Not everything you read or hear about the new General Data Protection Regulation (GDPR) is true. For the most part, writers, bloggers and expert speakers have their facts straight. And what they say – and sometimes challenge – helps organisations prepare for what’s ahead. But there’s some misinformation out there too. Examples we’ve seen include ‘GDPR will stop dentists ringing patients to remind them about their appointments’ and we’ve even heard people saying that big fines will fund our work. If this sort of misconception goes unchecked, people lose sight of what the new law is about – greater transparency, enhanced rights for citizens and increased accountability. The level of detail you need about the GDPR will depend on your job but the key principles apply across all sectors and all levels of staff. That means looking after people’s information, being transparent about what you’re doing with it and keeping their privacy rights in mind from the start of any project. Many of the GDPR’s main aims and principles are the same as those in the Data Protection Act. So if you’re complying properly with the current law then most of your approach to compliance will remain valid under the GDPR and can be the starting point to build from. However there are new elements and some significant enhancements, so you will have to do some things for the first time and some things differently. The GDPR will include new obligations for organisations – such as reporting data breaches that pose a risk to individuals to us at the ICO, and in some cases to the individuals affected. Another key change for organisations is understanding the new rights for the public.

Consumers and citizens will have stronger rights to be informed about how organisations use their personal data. They’ll have the right to request that personal data be deleted or removed if there’s no compelling reason for an organisation to carry on processing it, and new rights around data portability and how they give consent. There’s a view from some that the new regime is an onerous imposition of unnecessary and costly red tape. That’s not the case. GDPR is an evolution in data protection, not a revolution. Busting misconceptions It’s this kind of myth we at the Information Commissioner’s Office (ICO) are working to bust as we try to help organisations sort GDPR fact from fiction. The myth suggests that the biggest threat to organisations from the GDPR is massive fines. This law is not about fines. It’s about putting the consumer and citizen first. We can’t lose sight of that. It’s true we’ll have the power to impose fines much bigger than the £500,000 limit the Data Protection Act allows us. It’s also true that companies are fearful of the maximum £17 million or four per cent of turnover allowed under the new law. But it’s scaremongering to suggest that we’ll be making early examples of organisations for minor infringements or that maximum fines will become the norm. The ICO’s commitment to guiding, advising and educating organisations about how to comply with the law will not change under the GDPR. We have always preferred the carrot to the stick. Consent and personal data Headlines about consent often lack context or understanding about all the different lawful

Written by Victoria Cetinkaya, Information Commissioner’s Office

Victoria Cetinkaya, from the Information Commissioner’s Office, looks at the main aims and principles of GDPR, and dispels some of the recent misconceptions

Data Protection

Setting the record straight on data protection

bases businesses and organisations will have for processing personal information under the GDPR. Consent is one way to comply with the GDPR, but it’s not the only way. The new law provides five other ways of processing data that will, in many cases, be more appropriate than consent for public bodies. If you do need to rely on consent for any processing, the GDPR is raising the bar to a higher standard for consent. Consent under the current data protection law has always required a clear, affirmative action – the GDPR clarifies that pre-ticked opt-in boxes are not indications of valid consent. The GDPR is also explicit that you’ve got to make it easy for people to exercise their right to withdraw consent. The requirement for clear and plain language when explaining consent is now strongly emphasised. And you’ve got to make sure the consent you’ve already got meets the standards of the GDPR. If not, you’ll have to refresh it. It will be mandatory to report a personal data breach under the GDPR if it’s likely to result in a risk to people’s rights and freedoms. So if it’s unlikely that there’s a risk to people’s rights and freedoms from the breach, you don’t need to report. Under the current UK data protection law, most personal data breach reporting is good practice but not compulsory. And although certain organisations are required to report under other laws, like the Privacy and Electronic Communications Regulations (PECR), – mandatory reporting of a personal data breach that results in a risk to people’s rights and freedoms under the GDPR will be a new requirement for many. The threshold to determine whether an incident needs to be reported to the ICO depends on the risk it poses to people involved. Pan-European guidelines will assist organisations in determining thresholds for reporting, but the best approach will be to start examining the types of incidents your organisation faces and develop a sense of what constitutes a serious incident in the context of your data and your own customers. And organisations need to remember that if there’s the likelihood of a high risk to people’s rights and freedoms, they will also need to report the breach to the individuals who have been affected. We’ve provided some initial guidance in our GDPR overview that high risk situations are likely to include the potential of people suffering significant detrimental effect – for example, discrimination, damage to reputation, financial loss, or any other significant economic or social disadvantage. If organisations aren’t sure about who is affected, the ICO will be able to advise and, in certain cases, order them to contact the people affected if the incident is judged to be high risk. Our main aim is to help organisations get it right when it comes to using personal data – and that includes preparing for GDPR. There’s a wealth of material on our website to help. " FURTHER INFORMATION



Data Centre World

Data Centre World: a ten-year journey 21-22 March 2018 marks Data Centre World’s 10th year as an industry leading event. With hundreds of leading data centre and technology providers set to be in attendance, Health Business looks at the industry and the show’s conference programme

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Ten years ago, the inaugural Data Centre World event hosted 30 exhibitors and a small number of delegates at the Barbican in London. Pre-dating the likes of WhatsApp, Microsoft Azure and Android, the event has been going strong ever since. Technology and the world at large has changed beyond recognition in that time. Internet-connected smartphones, more powerful than most computers from 2008, now sit in the pockets of billions of people worldwide. The data centre, though, has remained ever-present. 2008 saw the advent of a global financial crisis that toppled major banks and made businesses look more closely at the way they spent their money. The data centre market, in a turn of fate, benefitted from this, as colocation became the order of the day. The effects of a changing world on the data centre More recently, the rise in cloud computing has massively disrupted traditional systems. But still the data centre soldiers on, becoming more relevant than ever as more and more


computing happens at the edge, with billions of internet-connected devices and the promise of self-driving cars moving ever closer to reality. Data Centre World has tracked these changes all the way. Here, partners, exhibitors and industry experts help follow the journey of the industry and how Data Centre World grew to become its number one event across the past decade. Next to death and taxes, there are certain things that those in the data industry can rely on. Jon Summers, scientific leader in Data Centres at Research Institutes of Sweden, argues that the trifecta of availability, resilience and reliability has undeniably been at the forefront of concerns across the last ten years. What’s changed? That may be, but what’s changed? Emma Fryer, associate director at TechUK, said: “Everything! Technologies, business models, service offerings, dominant players. Even the disruptive technologies are different. The only thing that is guaranteed is the continuous speed of those changes.”


Mark King, chairman and managing director at 2bm, who has been exhibiting at the show since its inception, notes the impact that density requirements have had on data centre design. He argues that only five years ago, a six-10kW server rack would have been considered to be medium-density. Now data centres are being designed that are hitting 60kW per cabinet. This, he says, puts a ‘lot more onus on the technical side of data centre design’. Keeping ahead of the curve With many changes to keep up with, Data Centre World has had to work hard to stay relevant. Hard work it may have been, but the event has managed it, according to Socomec’s Elms. “It’s segmented, it’s diversified, it has great workshops and forums, and it’s tracked the industry well.” With 550 world-class speakers, the most comprehensive supplier exhibition in the industry, streams on topics as varied as GDPR, diversity, and artificial intelligence, four unique theatres and the one-of-a-kind Live Green Data Centre feature, the two days in March promise to be the one place to find everything and everyone in the data centre.

using cloud services. Learn how to be GDPR-ready in the dedicated GDPR stream, where confirmed speakers include Dovu, TechUK, DMA Group & Venom IT. Focus areas The focus areas mirror every part of the evolving data centre – it’s technologies, products and processes and the increasing demand for data centre excellence. As part of the Data Centre Design and Build focus area, delegates can learn more about the latest techniques in building and designing the modern data centre, with green business solutions and carbon footprints becoming significantly more important considerations. Sponsored by BSRIA, industry experts will also provide practical case studies and projects as to why it’s so crucial to design and build an efficient, effective and operational cost controlling data centre. Sponsored by the LPCB, the Physical Security focus area will examine how to maintain a secure data centre and tick all the right boxes in making sure it is protected. Protecting data centres is a crucial part in today’s world. Physical security breaches can lead to high value equipment failing into the wrong hands: theft, corporate espionage and terrorism can come to play – these are the major implications for data centres and their customers. In today’s technological environment it’s so crucial to keep up to date with the speed and usage of networks and to make sure your data centre can cope with the demand. In the Data Centre Routing & Switching areas, delegates can discover companies that supply applications which provide simple bandwidth and little delay sensitivity.

AMPS will be heading up the Power & Energy theme of the show, showcasing how its a ‘very important part of our industry with regards to power and generating sets and vital that the two industries work together’. Regardless of what industry you work in, power is a crucial part of our daily lives and without this we are lost, from health right down to our finances, power controls all aspects of our lives. Data Centres simply cannot afford to have any issues with hazards, this is a major consideration for all data centre managers and designers. Whether you are concerned with fire detection, alarm systems or security protection products, you can’t afford to miss the chance to discover the latest improvements in this sector as part of the Fire & Security Protection Products focus. Data Centre automation is becoming an increasingly important aspect of running data centres of all sizes, along with the smaller models. More and more businesses are moving to cloud, this means an increase in data centre demand, and as such an automation is here to make data centres to run better. Come and learn, first hand about solutions like optical switching, which gives full control of physical fibre connections and improves reliability and security, but most importantly future proofs critical infrastructure as part of the Robotics Automation focus. "

Data Centre World

Conference attractions Data Centre World brings together the world’s leading minds, from industry leaders to practitioners, to share their extensive wisdom and discuss the latest topics and concerns surrounding the data centre industry. The 2018 edition will welcome over 550 leading industry speakers, over a jam packed content-led two days. Leading speakers include representatives from UBS, BRE, Deutsche Bank, Ford Motor Company, EURECA Project, as well as many more. Building on the success of what’s now an unstoppable one-of-a-kind feature, the Live Green Data Centre will once again be a working showcase at the heart of Data Centre World. Nowhere in the world will you find this practical implementation of cooling units, fans and cables in this unique way. The very latest products will be showcased from 30 companies, with Live Big Green Data Centre sponsors Cellwatch, Excool, Reilly UPS, Starline, TTK, Stanley Security, OPS, Dunwoody and Socomec all present to showcase the latest products and thinking from the industry. Back for a third consecutive year, the Live Green Data Centre will be joined by new, innovative exhibition features, including a GDPR stream, Diversity & Talent in the data centre industry and an AI & Machine learning stream where you can discover how you can find new trends and patterns from large and diverse data sets which can allow you to deliver new, personalised or differentiated products and services. Efforts to promote diversity in the data centre industry are increasing, but still we still have a long way to go. As part of the Diversity & Talent stream, delegates will hear from industry academics and leaders about the very latest and most pressing matters surrounding diversity and talent within today’s data centre landscape. Speakers include Tech UK, GCHQ, Massive Interaction, CNet Training & Next Tech Girls. With the GDPR deadline fast approaching, the regulation will provide unique challenges and opportunities to organisations

Register your free ticket at: FURTHER INFORMATION

Internet-connected smartphones, more powerful than most computers from 2008, now sit in the pockets of billions of people worldwide




Reducing unnecessary hospital admissions Although unlucky not to win, the Care Home Innovation Programme, run by NHS South Sefton Clinical Commissioning Group, was rightly acknowledged for achieving more than a 30 per cent reduction in 999 calls and ambulance conveyances at the recent Health Business Awards. HB talks to Dr Debbie Harvey about the programme and the use of telehealth initiatives in the NHS A programme set up by health commissioners in South Sefton has been recognised for its innovative use of information and communication technology. The Care Home Innovation Programme (CHIP) was commended for the Telehealth Award, rewarding excellence in delivering health services over distance, at the Health Business Awards at the end of December. This marks the second time in a year that CHIP has been recognised for improving the care of patients having previously won the Best System Improvement Award at the North West Coast Research and Innovation Awards in 2017. CHIP was set up by NHS South Sefton Clinical Commissioning Group (CCG) just over

two years ago as a comprehensive package of support for care homes and their residents. A key part of CHIP was the introduction of a 24/7 televideo system into most care homes across South Sefton. This system allows care home staff to seek medical advice and support using a secure video link. CHIP has been very successful with a 25 per cent reduction in the number of ambulance journeys compared to the 12 months prior to launch. The programme has previously been recognised by the Care Quality Commission as an example of good practice and also picked up an award at the prestigious North West Coast Research and Innovation Awards last year. Dr Debbie Harvey, GP and lead clinician

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for cancer and end of life at NHS South Sefton CCG, said: “We are very proud of the work we have done in bringing together a number of measures which improve standards of health care for our nursing home residents. CHIP allows care home staff to communicate with doctors, nurses and other health care professionals to quickly diagnose problems and prevent the need for residents to visit hospital when they don’t need to. “Other CCGs have also begun to implement similar programmes and we are very happy to share our experiences if this can help improve healthcare for care home residents across the country.” The Care Home Innovation Programme was recently commended for the Telehealth Award at the Health Business Awards at the end of December. Can you tell us a bit about the programme?

CHIP has successfully reduced the number of ambulance journeys by 25 per cent compared to the 12 months prior to launch. What are the benefits of such an alternative to A&E visits? Before we launched CHIP, we found that over half of the ambulance journeys for care home residents were not for urgent need and in all likelihood, the patient didn’t need to go to hospital at all. Reducing these unnecessary trips to hospital reduces the impact on primary care services and enables patients to remain at home. This approach is extremely beneficial to patients, improving the quality

We hope that technology will be used in an array of areas including assessments for social care, further links with secondary care and exploring its place in primary care of their care, and reduces the cost of hospital attendance for both accident and emergency and subsequent admissions. Much of the evolution of care at the moment is likely to journey towards treatment and diagnosis ’at-the-point-of-care’. How does immediate, online video technology enhance this trend? There are many ways technology supports this trend. Some assessments from Airedale provide advice to care home staff which then negates the need to use additional NHS resource at all. This approach can facilitate improved work on the ground by linking local resources rather than the patient being transferred to secondary care. Our community matrons and geriatrician have the technology and in the future we would hope that other sectors within community care will be able to work together more efficiently using this mode of assessment and communication. The programme has previously been highlighted as an example of good practice in the Care


With around 1,200 people living in care homes across Sefton, we found that people were frequently being transferred to hospital unnecessarily and people were not correctly being identified as approaching end of life until their very final days. We introduced CHIP as a way to improve care standards and reduce unnecessary hospital admissions. CHIP also encourages advance care planning through the support of a community multidisciplinary team (MDT). CHIP consists of a number of different initiatives including a telemedicine service that provides MDT support for the care homes 24/7, locally based care home community matrons, community geriatricians, medicines management team, psychiatry care home liaison, standardised protocols and training for healthcare staff in care of the dying.

Quality Commission’s end of life thematic review. How does the programme benefit the elderly population of South Sefton? CHIP has improved care standards for our 1,200 residents in care homes across Sefton, many of whom will have been born and bred in the local area. CHIP has reduced the number of unnecessary hospital admissions, provided training for care home staff and improved access to support services via the use of televideo and our community MDT. Following the success of CHIP, how else is NHS South Sefton CCG planning to use technology to improve its care offering in the next few years? We hope that technology will be used in an array of areas including assessments for social care, further links with secondary are and exploring its place in primary care. " FURTHER INFORMATION

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Digital Records

Using summary care records to improve patient care NHS Digital has revealed that increasing the amount of information held in electronic Summary Care Records (SCR) is improving care and helping to ease winter pressures. Health Business explores Delivering a keynote speech at September’s Transformation and Engagement at NHS UK Health Show in London, NHS Digital Digital, which developed the SCR, said: executive director Eve Roodhouse “This is an invaluable tool which 96 per heralded progress in use of Summary cent of people now benefit from. Uploading Care Records (SCRs), and outlined some additional information to the SCR increases of the work already being done to its benefits and enables clinicians to provide incorporate more information into them. the best care possible to patients as they have The SCR is an electronic record of important more details available at their fingertips. patient information, created automatically “This also means patients won’t have to through clinical systems in GP practices repeatedly provide the same information, and uploaded to the Spine, which allows especially when they are feeling unwell, information to be shared securely through and this can help save time when health national services. It is currently used by services are busy as well as potentially 98 per cent of practices. At a minimum, the avoiding unnecessary hospital admissions.” SCR holds important information about current medication, allergies and details of Centrally delivered any previous bad reactions to medicines, With organisations becoming more and as well as the name, address, date of more aware of the need to join-up care, for birth and NHS number of the patient. The both safety and efficiency, it makes sense patient can also choose to include that services like Spine, the Electronic long-term conditions, significant Prescription Service, e-referrals and medical history, or specific NHS Mail are delivered centrally as Every communications needs. standardised, secure products. Data within the The long-awaited ‘Citizen e v fi SCR is protected by ID’ project, part of NHS a s d secure technology, England’s new digital secon cesses ac as users must have roadmap, will be piloted in n a i c . i R C clin S a smartcard with alpha form in the spring c i n tro the correct codes in a bid to make access an elec tem is now set. Each use is to patient records and s y s The ng i h recorded and a online health services c a o r app patient can ask to easier. The full Citizen ID overage service c l a s r see the record of who is scheduled e iv s n e i u c a m r has looked at their to follow in 2019-20. a h of p SCR, from the viewing Furthermore, the Share Your organisation. Furthermore, Care programme, in place in each organisation using the West Berkshire, electronically includes SCR has at least one privacy officer who information on up to 855,000 residents is responsible for monitoring access and and enables up to 12,000 health and care can generate audits and reports. professionals to have a consented access James Hawkins, director of Digital to the core information about patients.

According to NHS Digital, 45,000 people use its Electronic Referral Service every day but, by October 2018, the department aims to have all first outpatient referrals made electronically. Patients are able to change or cancel their appointments through the system, with analysis showing that use of electronic referrals has halved the rate of patients missing appointments from 10 per cent to five per cent. Sherwood Hospitals NHS Foundation Trust and County Durham and Darlington NHS Foundation Trust have now achieved paper switch off for first outpatient appointments. Speaking at UK Health Show last year, Roodhouse said: “Every five seconds a clinician accesses an electronic SCR. This is important information taken from a patient’s GP medical records, which can be accessed electronically by an authorised clinician anywhere in the country if they are directly involved in that patient’s care. We are approaching universal coverage of pharmacies, with 96 per cent of pharmacies now live with SCR. “We’ve been working with Gloucestershire CCG and the CSU to realise the benefits of uploading and sharing additional information across the health community. More than 16,000 records across the county have been uploaded in addition to the standard SCR data, with Gloucestershire Hospitals Trust leading the way with using this information to care for patients. With the support of the emergency departments, we supported the CSU in engaging with custody suites, the homeless centre and the mental health and community trusts and we are now working with the ambulance trust to extend viewing even further.” " FURTHER INFORMATION


Products & Services


Legionella management and control services

Leaders in energy control for the public sector

P&W Water Hygiene Ltd is a water hygiene company based in Kent covering all of England. P&W carries out all works associated with stored hot and cold water systems and plant, including Legionella Risk Assessments to BS8580 & HTM04-01. With over 15 years experience within the water hygiene industry, the company has clients within: hospital NHS trusts; councils; schools and academies; care homes; hotels; facilities management; and maintenance companies. P&W Water Hygiene Ltd is a member of the Legionella Control Association and the Water Management Society. Services provided include risk assessments in compliance with

CP Electronics is recognised worldwide as a leader in energy saving lighting controls. The company’s systems minimise energy use and cost without affecting user convenience. CP Electronics can work with any light source, in any building and any space, from a sports stadium to a CEO’s boardroom. It works with both private companies and public sector organisations. Its UK-based production team works to BSI/ISO standards, using advanced production techniques. CP Electronics is so confident of its quality and testing regime that it offers a five year warranty across the range. Marcus Martin, managing director of CP Electronics, commented: “When CP Electronics was founded in 1970, awareness of climate change was in its infancy.

ACoP L8 4th Edition, site specific log books, Legionella control systems to ACoP L8 and client specific standards, emergency and routine disinfection in accordance and requirements of the HSG 274 Part 2, UKAS accredited sampling and analysis, risk assessment and control regime remedial actions, Calorifier surveys and inspections, Calorifier and water heater descales, and Legionella awareness training. FURTHER INFORMATION Tel: 01634 722175




Yet even then it was clear that the age of cheap energy was coming to an end. Our vision – to design and make reliable energy-saving controls – found a receptive market. “The drive for innovation, cutting edge technology and ongoing expertise in the energy controls sector are our tools to help you take control of your energy costs and your carbon footprint. “It’s this drive that made us the perfect fit for Legrand, and in 2016 we became part of the Energy Controls business unit of Legrand UK & Ireland.” FURTHER INFORMATION


Patient communications from a single source

A remarkable venue for conferences and events

MBA has over 30 years’ experience in the communications industry, providing a wide-variety of services to improve the effectiveness of customer comms, streamline business processes, consolidate costs and deliver greater returns on investment. MBA’s range of integrated services include: Litho & Digital Print / Envelope Printing / Direct & Transactional Mail / Hybrid Mail / Warehousing and Pick & Pack / Electronic Fulfilment / Postage & Collections Management / Inbound Processing & Returns Management / Customer Communication Management systems / Data Processing & Document Composition / Automated Email & SMS services / Archive & Retrieval

In addition to providing musical entertainment all year around, Clonter Opera Theatre is available for external hire. Set in the heart of the Cheshire countryside, this delightfully quirky and intimate venue 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 or just to take a break in between sessions surrounded by mature woodland, aiding a true break away from the

solutions / Web Services & Electronic Presentment / Business Continuity & Disaster Recovery Services / Personalised & Interactive Videos / Digital Contact Centre / Creative & Design services. MBA’s team possess a great understanding of different communication strategies from across a large portfolio of clients. Their professional service will facilitate cross-sector learning and valuable knowledge-share for your organisation. FURTHER INFORMATION Tel: 020 8376 4300


city. With the wide range of its own events, Clonter is well-equipped, with two kitchens, to arrange catering of every kind and organise entertainment, if required, and free car parking. 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


Ecovolt: specialists in solar power since 2007

Don’t put your buildings or staff at risk

London-based solar electricity installer Ecovolt has traded successfully since 2007, out-living rivals through its excellent customer service. The company has designed, project-managed and installed clean, green electricity systems for clinics, commercial properties and homes. Two linked GP surgeries in rural Hampshire are a repeat Ecovolt customer. They benefit from seven years of lower electricity bills via Ecovoltinstalled PV solar panels and batteries, giving 24/7 power back-up on-site. Ask Ecovolt about linking your health premises into micro-grids; intelligent networks of pro-sumers and their batteries, giving uninterrupted, low carbon electricity at predictable prices, fixed below market rates. Revenues through automated

The fire safety of buildings has probably never been so high in the public consciousness as it is today –for residents, builders, insurance companies and local authorities alike. Checkmate Fire Solutions (Checkmate Fire) has been in the fire prevention business for nearly three decades and is ideally placed to address these issues. Therefore, it is no surprise to learn that as one the most trusted contractors in specialist passive fire protection, it has become the largest and fastest growing fire prevention company in the UK. The company provides its services through two divisions – compliance, which provides inspection and other consultancy services, and solutions, which offers third party accredited installations. Its services include firestopping/air sealing,

trading of green electricity, plus mutual resilience, are an added bonus. Data-rich, instantaneous remote control and monitoring of output, consumption and storage at your premises. Full range of panel and batteries. Full, insurance-backed warranties for design and installation and for all equipment. Integrate Ecovolt‘s green power systems into your clinic’s equipment and mission-critical facilities. FURTHER INFORMATION Tel: 020 7233 3332


fire compartmentation, fire boarding and structural steel protection; as well as fire doors surveying, restoration and installation and a fully bespoke range of fire rated glazing solutions, designed and installed for clients. So, get it right first time, ensure your buildings are safe and compliant and using a third party accredited company such as Checkmate Fire with decades of experience across a wide range of sectors will give you the peace of mind that you are protecting lives and livelihoods. FURTHER INFORMATION Tel: 01422 376436


Interior Film proves a success in demanding NHS

Legionella management and control services

Weybourne Day Unit, part of NHS Norfolk University Hospitals Trust, provides a nurse-led oncology and haematology service. The inspiration for the artwork on the interior walls of the unit was the flora and fauna of the surrounding area of Weybourne. Emma Jarvis, responsible for the project, said: “Our decision to use a film to cover the walls was determined by a number of factors including; infection control, cleaning and fire safety. We trialed a range of films, printing designs directly onto them and then tested with actichlor, a hospital bleach used throughout our hospital. “We selected LG Hausys Interior Film from David Clouting because it not only passed the bleach test but the quality of the white colour of the film was significantly

P&W Water Hygiene Ltd is a water hygiene company based in Kent covering all of England. P&W carries out all works associated with stored hot and cold water systems and plant, including Legionella Risk Assessments to BS8580 & HTM04-01. With over 15 years experience within the water hygiene industry, the company has clients within: hospital NHS trusts; councils; schools and academies; care homes; hotels; facilities management; and maintenance companies. P&W Water Hygiene Ltd is a member of the Legionella Control Association and the Water Management Society. Services provided include risk assessments in compliance with

better than the others we tested. Installation was also a key factor, we needed to ensure that the film would not fall off the wall in any way and also peel off with ease when required. The thickness of Interior Film also helped significantly in ensuring first time placement with no repositioning required.” Available in a range of designs and finishes, Interior Film is CE and IMO Certified. FURTHER INFORMATION

Products & Services


ACoP L8 4th Edition, site specific log books, Legionella control systems to ACoP L8 and client specific standards, emergency and routine disinfection in accordance and requirements of the HSG 274 Part 2, UKAS accredited sampling and analysis, risk assessment and control regime remedial actions, Calorifier surveys and inspections, Calorifier and water heater descales, and Legionella awareness training. FURTHER INFORMATION Tel: 01634 722175



Advertisers Index

If you’re looking for a cost-effective alternative in a city steeped in history, Edinburgh is the obvious choice Famed for its listed buildings, Michelin star restaurants and as one of the UK’s leading cultural hubs, Edinburgh offers an attractive destination for those organising a conference or event. The International Congress and Convention Association (ICCA) has ranked the city as the most popular conference destination in Scotland and the secondmost visited in the whole of the UK. It continues to have an international influence in science, business and education, and hosts the world’s largest annual arts festival. As part of the University of Edinburgh, Edinburgh First offers first-class conference options for those travelling to Scotland’s capital. Based in the heart of the city – just 20 minutes away from Edinburgh Airport by train – Edinburgh First can cater to meetings of all sizes, from small meetings to large conferences for 1,000 delegates. Edinburgh First has 15 venues across the city, providing more than 70 meeting rooms for delegates. They range from historic venues, such as the 19th century McEwan Hall and the neoclassical Playfair Library Hall, to the state-of-the-art John McIntyre Conference Centre. As well as

conference rooms, each venue offers relaxed breakout areas for delegates to unwind. Additionally, Edinburgh First also offers conference accommodation in Edinburgh, with 153 en-suite bedrooms available year-round plus an additional 1,885 bedrooms from June to September. It has private dining rooms, restaurants, bars and cafés too – as well as all of Edinburgh’s attractions right on your doorstep – offering plenty of opportunities for post-conference team-building and networking. Edinburgh First’s event management service provides a one-stop-shop service to host, deliver and manage events at

any one of its facilities in Edinburgh. The service can help provide advice as guidance, as well as designing and supporting events through website building, event registration and payment handling. With a choice of historic mansion houses and modern conference facilities, Edinburgh First delivers an efficient and cost-effective solution for any event in Scotland’s historic capital city. FURTHER INFORMATION Tel: 0131 651 2189


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

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Hear the latest Meet, learn and from national share. From the best health leaders of everyone in health delivering the and technology! digital agenda

3 - 4 May, London Olympia 15-16 May,Olympia, 2018 – Kensington

Responding to Join 3,000 a growing need for delegates at the education, training, most influential networking and e-health event access to resources on implementing in the UK proven solutions, In partnership with BCS – the Chartered Institute to support the for IT – and supported by roll of UK digital NHS England and NHS Digital transformation.

•Network Speakers include Matthew Swindells, with everyone from leaders fromNational the UK Director: health and Commissioning Operations and Information, Keith McNeil, care sector, CIOs, CCIOs, to patients and global leaders too. NHS Chief Clinical Information Officer, Will Smart, NHS From to interoperability. consumer tech to AI. Chiefdata Information Officer, JulietFrom Bauer, Director of Digital Experience,Global Beverley Bryant, of Digital Transformation, Leadership, Lessons andDirector Digital Exemplars, Harpreet Sood, Associate Chief Clinical Information Officer, Digital Transformation, Professional Development, Jane Cummings, Chief Nursing Officer for England and Population Health, Enabling the public, Cyber security and Anne Cooper, Chief Nurse moreSpeakers include: Matthew Swindells, NHSE National •Director, Topics include Global Exemplars, NHS Digital Academy, Operations andDigital Information, Simon Eccles, NHS STPs and roadmaps, cyber security, genomics and interoperability National CCIOJuliet Bauer, NHSE Chief Digital Officer Will •Smart, Dedicated for Officer CIOs and CCIOs, IT leaders, nurses, Chief sessions Information Health & Care England Andy GPs, commissioners managers Kinnear, Director and of Digital Transformation at NHS South, Central & West CSUAnne Cooper, Chief Nurse, NHS Digital . Register at

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When 81% of businesses suffered unplanned power outages last year, how can your business be better protected? We should talk about making your business resilient Source: online survey of energy solution decision-makers and influencers in mid-sized organisations in the USA, UK, Ireland and Italy; conducted by Circle Research for Centrica.

Health Business 18.2  

Business Information for Healthcare Professionals

Health Business 18.2  

Business Information for Healthcare Professionals