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ISSUE 19.3





PAPERLESS HEALTH RECORDS Deploying electronic document management systems to reduce costs and improve care


ADOPTING INNOVATION IN THE NHS Learnings from the NHS Innovation Accelerator on how and why the NHS adopts innovation


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ISSUE 19.3




All roads leading to Brexit


PAPERLESS HEALTH RECORDS Deploying electronic document management systems to reduce costs and improve care


ADOPTING INNOVATION IN THE NHS Learnings from the NHS Innovation Accelerator on how and why the NHS adopts innovation


As we near the 31 October deadline to leave the European Union, with the possibility of a no-deal Brexit looming, health leaders are urging for a government rethink. The Queen has just consented Prime Minister Boris Johnson’s bid to suspend Parliament just days after MPs return to work in September, meaning that MPs are unlikely to have time to pass laws to stop a no-deal Brexit. Meanwhile, health union leaders, including the British Medical Association, Royal College of Nursing and the Royal College of Midwives, have issued a strong warning to the government that a no-deal Brexit could ‘devastate’ the NHS and cause fatal medicine shortages. This echoes the sentiment of an open letter, coordinated by the Royal College of Physicians, sent to the Prime Minister calling for health to be at heart of Brexit negotiations. The bottom line of both warnings is that no responsible government should take the risk. The clock is ticking…

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Elsewhere, I encourage you to read Helen Buckingham’s article (page 15), in which she analyses recent funding pledges and what it will take for the NHS to make a success of January’s Long Term Plan. Michael Lyons, editor

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Contents Health Business 19.3 15

07 News

69 Legionella

£92m spent on private ambulances; nodeal Brexit could ‘devastate’ NHS; and Liverpool hospitals merger a step closer

15 NHS policy It’s easy to see the obstacles in the NHS’s way, despite recent funding announcements and several new plans being published. Helen Buckingham analyses how set the NHS is for success, as well as what it will take to get there


19 Technology Drawing upon this year’s NHS Long Term Plan, Dr Amanda Begley discusses the ways healthcare professionals and innovators can work together to improve how the NHS adopts innovation

25 HETT Matthew Gould, chief executive of the newly formed NHSX, has been announced as one of a host of prolific speakers at HETT, taking place on 1 October

37 Recruitment 45

Pia Subramaniam discusses changes made to the Shortage Occupation List. Plus a look at the Non Medical Temporary and Fixed Term Staff framework

45 Infection control Augmenting hospitals with continuouslyactive antimicrobial copper surfaces offers a simple and effective hygiene boost. We revisit advice from the Copper Development Association


49 Infection Prevention 19 Leading experts in their field will present on the latest current and emerging threats and state-of-the-art research at Infection Prevention 2019

56 Healthcare Estates 89

Set to be the biggest event in its history, Healthcare Estates takes place on 8-9 October. Show organisers, Step, provide a preview

Health Business magazine

The naturally compromised immune systems of many patients in hospitals increases the risk posed by the Legionella bacteria. So how can facilities managers ensure Legionella does not fester and grow within hospital systems?

73 Fire safety

It is incredibly important to get fire safety right, especially in a hospital setting. But, for some larger estates, implementing a fire plan can be a challenge, writes Will Lloyd of the Fire Industry Association

77 Facilities management

Health Business revisits advice from HEVAC, who explain why heating, ventilation and air conditioning should be monitored closely to ensure longterm efficient and effective operation

81 Procurement

With savings expected across the NHS, we outline some examples of how effective procurement and maximising purchasing power from the London Procurement Partnership can produce significant savings

85 Translations

Jakub Sacharczuk looks at interpreting within the NHS, including best practice and technology developments

89 Mental health

Philip Ross and Tony Crumpton discuss care delivery, the physical environment and product suitability for mental health hospitals

93 Modular build

How do manufacturers and installers of volumetric offsite construction ensure sustainability and compliance when the key priority is time? Jackie Maginnis explores

97 NHS fraud

Susan Frith discusses collaborative counter fraud work in the NHS and the importance of reporting fraud Issue 19.3 | HEALTH BUSINESS MAGAZINE


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No-deal Brexit could ‘devastate’ NHS

Health union leaders have issued a strong warning to the government that a nodeal Brexit could ‘devastate’ the NHS and cause fatal medicine shortages. After Prime Minister Boris Johnson received the Queen’s permission to suspend parliament for more than a month ahead of the EU withdrawal date, a joint statement signed by 11 organisations called on the government to take no deal off the table, saying that ‘no responsible government should take that risk’.

The organisations, including the British Medical Association, Royal College of Nursing, Royal College of Midwives, Unison, GMB, Unite and the TUC, argue that such a move could disrupt the supply of life-saving medicines for up to six months and exacerbate the largest staffing crisis in NHS history. The unions said: “Many medicines, including life-saving agents for cancer diagnosis and therapy, cannot be stockpiled and, for those that can, stockpiles could



Liverpool hospitals merger a step closer

Government announces review of hospital food

The Competition and Markets Authority has cleared the proposal for an NHS merger that will create one of the largest university hospital trusts in the North of England. The competition regulator has cleared the proposal which will see the merger of Aintree University Hospital NHS Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals NHS Trust, concluding that the decision would not result in a loss of choice for patients. Instead it insists that merging should ensure patients receive consistent care wherever they are treated and will enable easier sharing of patient information for those receiving care from multiple services which are currently provided by separate trusts. The proposal for the new organisation, which will be called Liverpool University Hospitals NHS Foundation Trust, will now be considered by NHS Improvement, and the trusts are expected to merge formally in October 2019. Steve Warburton, current chief executive of Aintree University Hospital and recently appointed to lead the new merged organisation, said: “I am delighted that the CMA has approved our proposal. By merging, we can work collaboratively to improve quality and consistency of care for our patients and to attract and retain the best staff. This is great news for our staff and our patients.” READ MORE

The Department of Health and Social Care has announced that it will work with the NHS to improve food quality in hospitals and provide consistently safe, nutritious and tasty food. The review will explore how to increase the number of hospitals with their own kitchens and who have their own chefs, as well as considering how food can help aid faster recovery, how to source food services locally and reduce reliance on frozen or packaged foods, alongside new systems to monitor food safety and quality more transparently, including looking at how NHS boards are held to account. Chair of the Hospital Food Review, Phil Shelley, will meet with catering managers at trusts across the country, looking at best practice from those leading the way in food quality and innovation. The review will also analyse more healthy food options for NHS staff, particularly for those working overnight shifts and the sustainability and environmental impact of the whole supply chain.

run out. These kinds of shortages and delays can be fatal. No responsible government should take that risk.” The statement echoes a letter written to Boris Johnson from the heads of 17 royal colleges and charities, in which concerns over medicine shortages were highlighted as a major concern. READ MORE

Matt Hancock, Health and Social Care Secretary, added: “We all know how important the food we eat is to our health. We have a duty to ensure this same level of attention is given to the food served to patients in hospital, or our brilliant NHS staff working tirelessly for patients – and indeed to visitors. “When people are in hospital, they should be given all the help they can to get better – and that includes food. So I’m determined patients enjoy the best, most delicious and nutritious food to help them recover and leave hospital as quickly as possible. I’m delighted we’ve assembled a first-rate group to drive this agenda. I have seen first-hand how using fresh, locally-sourced ingredients and cooking from scratch have improved the quality of their meals and I want to help more hospitals follow suit by sharing what works best across the country.” READ MORE





NHS spends £92 million on private ambulances New research has revealed that major ambulance trusts across England are increasingly relying on private ambulances to attend 999 calls. Press Association research found that England’s ambulance trusts collectively spent more than £92 million in the last year on private ambulances and taxis to transport patients, with some trusts relying on private ambulances due to a chronic shortage of NHS staff and ongoing problems with recruitment. The Care Quality Commission published a damning report earlier this year warning that patients were being put at risk by private ambulances.

The latest research shows that in some parts of the South, almost one in five emergency calls result in a private ambulance being sent to the scene. The South Central Ambulance Service increased its spend on private ambulances for 999 calls in the space of a year, from £12,994,544 to £15,382,218. In total, private ambulances attended 17.69 per cent of incidents following a 999 call in 2018/19, up from 16.19 per cent the year before. The data also showed that the East of England Ambulance Service NHS Trust spent £9.5 million on private ambulances for 999 and non-urgent work in 2018/19,

double the £4.8 million the year before. Its reliance on private ambulances to attend 999 calls rose, with more than double the number of 999 incidents resulting in a private ambulance being sent to the scene. In fact, some 26,428 incidents in 2018/19 involved a private ambulance being required, up from 12,947 the year before. Private ambulances were sent to 5.21 per cent of all 999 incidents in 2018/19, up from 2.59 per cent the year before. READ MORE



Javid pledges spending review cash for NHS

First Outstanding ambulance trust maintains rating

Chancellor Sajid Javid has confirmed that the early Spending Round will be delivered on 4 September, pledging increased spending on health. The former Local Government Secretary said that there would be no blank cheque for departments, promising to stick to the current borrowing rules, limiting the scope for extensive spending increases. Bringing the review forward was intended to provide certainty ahead of Brexit,

but critics have suggested that it proves Prime Minister Boris Johnson is preparing for a general election in the autumn. Writing in the Daily Telegraph, Javid said: “Thanks to the hard work of the British people over the last decade, we can afford to spend more on the people’s priorities - without breaking the rules around what the government should spend - and we’ll do that in a few key areas like schools, hospitals and police. “But at the same time, it’s vital that we continue to live within our means as a country. Unlike the Labour Party, we don’t believe in just throwing money at a problem. And especially at a time when the global economy is slowing, it’s important that we don’t let our public finances get out of control. “ READ MORE


Campaign launched to boost physical activity levels Sport England is working with 15 leading health and social care charities to inspire and support those with long-term health conditions build physical activity into their lives. One in four people in England live with a long-term health condition, and they’re twice as likely to be inactive despite evidence that being active can help manage many conditions and help reduce the impact and severity of some symptoms. The We Are Undefeatable campaign aims to help those with conditions such as diabetes, cancer, arthritis and Parkinson’s to build physical activity into their lives. Research shows the majority of people with a long-term health condition want to be active and are aware of the health benefits. Whilst recognising the unique

barriers people living with long-term health conditions face, the campaign hopes to inspire, reassure and support people to be active by showing the real-life experiences of people living with a variety of conditions – both visible and invisible – on their own journeys to being active. The campaign will run across TV, radio and social media. Campaign support packs are also being distributed to every GP surgery and community pharmacy in England as part of a wider programme to support healthcare professionals to promote physical activity to their patients. READ MORE

West Midlands Ambulance Service University NHS Foundation Trust (WMAS) has been rated as Outstanding for a second time following an inspection by the Care Quality Commission. Serving a population of approximately 5.6 million, covers 5,000 square miles across Shropshire, Herefordshire, Worcestershire, Staffordshire, Warwickshire, Coventry, Birmingham and Black Country, WMAS is rated as Outstanding for whether its services are effective, caring, responsive and well-led, and Good for whether its services are safe. Areas of outstanding practice include the trust provided training for childbirth emergencies in community ‘Baby Lifeline training’, continuing close working with four universities in the education of paramedics, the patient transport service being responsive to the changing needs of patients and provided sufficient vehicles, equipment and staff and key performance indicators met by April 2019, ensuring an effective service that responded to patient needs. READ MORE





More considered approach to prescribing medicines needed Age UK has called for a more considered approach to prescribing medicines for our older population after finding that too many older people are on too many prescribed medicines. The charity’s new report, More Harm than Good, provides evidence showing that prescribing more drugs isn’t always the best option, particularly when it comes to older people as it can put them at risk of side effects that in a worrying number of cases can lead to falls and a range of other serious harms. Nearly two million older people on seven or more prescription medicines at risk of side effects that are severe in some cases, and occasionally even life threatening. This number doubles to approaching four million for those taking at least five medicines. The report also demonstrates that at the moment medicines are sometimes being prescribed: in excessive numbers;

in unsafe combinations; without the consent or involvement of the older people concerned; and without the support and help older people need to take them. The amount the NHS spends on prescriptions has increased by 40 per cent since 2010/11. Because of this, Age UK is calling on the government to fully take into account the harmful effects of inappropriate

‘polypharmacy’ (multiple medicine use) on older people as it carries out a review of overprescribing in the NHS. Older people also need to be fully supported and involved in decisions about their medicines. READ MORE



Greater Manchester unveils plans to transform care

London councils save NHS £4.6 million a year

Greater Manchester’s NHS and councils are collaborating to develop and test new advanced technologies that will join up vital information across public services and empower people to live well, integrate care and save lives. Under the plans, a suite of new technologies will be developed to allow the safe and secure sharing of information between professionals, improve the accuracy of data and provide people with insights to take charge of their own health and well-being. The Greater Manchester Combined Authority (GMCA) is contributing up to £6.8 million as part of the project, with a further £7.5 million coming from the Greater Manchester Health and Social Care Partnership (GMHSCP), under NHS England’s national Local Health and Care Record (LHCR) transformation programme. The technology will first be tested to improve care for people living dementia or who are frail by enabling critical information to be shared between patients, carers and professionals. Approximately 30,000 people are estimated to live with dementia in Greater

Manchester, with around £270 million spent on care and treatment each year. The new technology will support more robust integrated care planning, help people maintain their independence and detect changes in their condition to avoid hospital admission. It will also be used to digitise the paperbased assessments used to review a child’s development up to the age of five. Parents and guardians will be able to complete and review the tests online, which will directly feed into the child’s health record and help identify children who need additional support. It will also free-up valuable clinical time for health visiting teams, equating to around £10 million per year in productivity once rolled out across the city-region. Once developed and tested, the technology platform can then be adopted by other service areas to drive rapid improvements into the health and wealth of Greater Manchester’s 2.8 million citizens. READ MORE

New research from London Councils has revealed that adult social care services in London have saved the NHS around £4.6 million a year through avoiding unnecessary hospital stays. The State of Adult Social Care in London report claims that adult social care services in London have also elivered almost half a billion pounds of efficiencies since 2015. Collectively, London boroughs achieved £480 million in adult social care savings between 2015/16 and 2017/18 through increased efficiency. London is one of England’s top-performing regions in minimising delays to transfers of care from hospital, with boroughs’ adult social care services providing prompt support and care arrangements to help Londoners avoid unnecessary hospital stays. However, even though London has a generally younger population than the rest of the country, the number of Londoners aged 65 and older is expected to increase by 71 per cent by 2039 – a faster rate than any other region in England. As such, London Councils estimates that the gap between adult social care costs and the funding provided to boroughs will reach £540 million by 2025. It is warning that the adult social care sector in the capital faces a funding gap of £540 million by 2025 unless the national shortfall in adult social care finances is addressed.





New measure for cancer services in Wales is UK first All cancer patients in Wales are having their waiting time measured from when their cancer is first suspected rather than from when their referral is received in hospital. The new measure, a first in the UK, aims to speed up diagnosis and ensure people with cancer are treated more quickly. It has been designed and developed by clinicians and is backed by cancer charities. It is hoped that the measure will eventually replace the existing two cancer waiting times, which are based on how a person’s cancer is identified and puts people on either a 31-day pathway or a 62-day pathway.

The first set of statistics for the new measure have now been published and show that 74.4 per cent of people were treated within 62-days of when they were first suspected of having cancer. The Welsh Government is providing an extra £3 million annually to help health boards in Wales implement the new measure. Health Minister Vaughan Gething said: “Cancer is the single biggest cause of premature death in Wales and the UK. It’s highly likely cancer will touch everyone’s lives at some point. I am very pleased Wales



Quarter of hospitals have air pollution at dangerous levels

App trialled to manage patient asthma

Analysis of official data has revealed that more than ten million patients a year are exposed to a dangerous level of air pollution when they visit hospital. The research, carried out by the British Lung Foundation and UK 100, a group of city mayors and council leaders, found that 248 hospitals across Britain (17 per cent) exceed the World Health Organisation limit of 10 micrograms per cubic metre of air (mcg/m3). A quarter of hospitals in England are in areas that exceed the limit for toxic fine particles recommended by WHO. Lowestoft Hospital in Suffolk fared the worst, according to the analysis, with average annual levels of 16.18μg/m3, whilst London was named as the worst region affected, with 72 per cent of hospitals breaching guidelines. Additionally, 36 per cent of hospitals in the East Midlands are above limits, and nearly a third (32.5 per cent) in the East of England. The study also shows that Birmingham, Leeds, Leicester, London, Nottingham, Hull, Chelmsford and Southampton have at least one large NHS trust that is located in an area with unsafe levels of pollution. This means that two of the biggest children’s hospitals in Britain, Great Ormond Street in central London and Birmingham Children’s Hospital, are in areas where pollution levels are deemed unsafe by the WHO.


A new asthma app is being trialled at Sheffield Children’s Hospital to help children manage their severe asthma. A partnership between Sheffield Children’s and technology company Aseptika, the innovative trial uses the newly developed Asthma+me app to help patient and parents better manage severe asthma outside of the hospital. This allows the patient and/ or the family to input information about their asthma and link up their inhalers. The app collects this information and helps educate the child and the family, and can also help automatically warn them when an asthma attack is about to happen. With enough advanced warning, the hope is that families can act sooner and avoid visits to hospital.

is leading the way in the UK by adopting the new Single Cancer Pathway, which has broad support from clinicians and charities. We are supporting health boards to improve performance against the new measure and I’m confident it will lead to an improved service for people affected by cancer. This is a vital step forward in improving cancer outcomes in Wales.” READ MORE

Heather Elphick, paediatric respiratory consultant at Sheffield Children’s Hospital, said: “The app is an innovative way of extending our support at the hospital through technology to children and their families at home. The app can help families further understand when an asthma attack may happen, monitor their child’s asthma consistently through the App and perhaps prevent trips to hospital in the future. It’s a good way to complement the care received from us here at Sheffield Children’s and I’m looking forward to seeing where technology can take us next.” READ MORE


Better use of digital technology preventing sepsis New ‘alert and action’ technology is being introduced in hospitals across the country to help identify sepsis and tell doctors when patients with sepsis are getting worse. NHS England says that the technology, which uses algorithms to read patients’ vital signs and alert medics to worsening conditions that are a warning sign of sepsis, has been trialled across three hospitals ahead of the measures being rolled out across England as part of the NHS Long Term Plan. NHS leaders in Cambridge, Liverpool and Berkshire are now helping the rest of the health service to adopt tools to spot it, which costs 37,000 lives a year and is notoriously difficult to identify. Sepsis – also known as blood poisoning – is a life-threatening response to an infection in the body, where the immune system damages tissues and organs. Screening rates for sepsis in emergency departments have risen from 78 per cent in 2015 to 91 per cent in 2018.

This year the NHS also made it mandatory for all hospitals in England to implement national sepsis guidance, including that hospital staff must alert senior doctors if patients with suspected sepsis do not respond to treatment within an hour. READ MORE



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NHS policy

A coherent NHS narrative that drives change The Nuffield Trust’s Helen Buckingham analyses how set the NHS is for success, as well as what it will take to get there

Written by Helen Buckingham

In his first public statement as Prime Minister, Boris Johnson referred to ‘upgrading 20 hospitals’ and increasing access to GPs, which adds to a flurry of plans and ideas for the NHS in recent months. In January NHS England published the ‘Long Term Plan’, and in June this was followed by both an ‘Interim People Plan’ and an ‘Implementation Framework’. Later this year, following the anticipated Spending Review, we can expect a final ‘People Plan’ and a ‘National Implementation Programme for the Long Term Plan’. National bodies have issued guidance to local systems to plan on a long-term basis many times before – often changing expectations and requiring new fiveyear plans part way through existing five-year plans. The concepts of planning for ‘population health’ and integrated, personalised services aren’t new, even if the words are. So what makes us think that the Long Term Plan might succeed this time? How can we be reassured that NHSEI (if it still exists) won’t be issuing a new set of planning guidance in a couple of years that looks depressingly similar to the old guidance? Fighting fires It’s easy to see the obstacles in the NHS’s way. The more successful changes implemented in the health service in the past were often supported by double-running

funding, the like of which is simply not white paper, Our health, our care, our say, which was aimed at driving integration and available now. Both commissioners and personalised services. But at the same time, providers are in deficit, which creates a the Department was continuing the push difficult environment for discussions to establish more foundation trusts about positive change. The lack – organisations designed to of capital funding for the be relatively autonomous. NHS is not only a barrier The mo That period also saw the to modernisation, it r e success introduction of Payment also risks creating f by Results for acute care, some real patient change ul and a focus on targets safety issues. s implem ented i for improvements But perhaps a health n the service in access to acute more significant in the p were o care – policies that issue is the a f t s combined to result well-rehearsed by dou en supported t ble-ru in increased hospital shortage of staff activity at the expense to deliver services fundingnning of community and in the here and mental health services. now, never mind Although in theory, Payment the next 10 years. We by Results and improvement know the NHS is going targets could have been reconciled to receive a cash injection – with integration and personalisation, in although there is still no hint of the same practice the foundation trust model and for social care – but even if it had that payment systems trumped everything else. money now, in many places the staff simply In 2019 we see a much more aligned policy don’t exist for that money to be spent on. environment. The Department of Health and These are huge issues and require action at Social Care has largely delegated NHS policy to national level as well as in local systems. NHS England, which is merging de facto with NHS Improvement. Broadly speaking, policies Contradictions and cosiness? aimed at commissioners and those aimed at The history of NHS policy is littered with providers are significantly more consistent contradictions. For example, back in 2006 the than they have been for many years. E Department of Health published an ambitious Issue 19.3 | HEALTH BUSINESS MAGAZINE


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NHS policy

 This policy alignment is reflected in the proposed legislative changes set out in the Long Term Plan. Commentators have argued that much of what it seeks to achieve can be done within existing legislation, yet the argument that legislation precludes collaboration persists. The suggestion that new legislation can address this is positive, but there is a risk that collaboration can become cosiness. No partnership is ever going to be able to encompass every organisation that might provide health and care to citizens in a given area. The risk that systems must guard against is that they simply erect new barriers around their organisations, excluding those whose contribution they understand less well – the best collaborations lower walls. And in the end, organisations don’t do things, people do things. The Long Term Plan will be delivered – or not – through the actions of the 1.3 million staff working in the NHS, the 1.5 million workers in

Leaders across the NHS need to work with their staff and their communities to develop a coherent narrative that not only enables change, but which positively drives it social care, and tens of thousands of people working in public health, wider local authority services, the voluntary and independent sectors, and as volunteers and informal carers. As Rebecca Rosen argued in our Lessons from history series last year, ‘you need a plan that staff can follow’. Plus it isn’t just staff who need to be engaged – we mustn’t underestimate the importance of involving the public. As I argued in the same series: ‘many attempts to change the way in which services are delivered at a local level have foundered in the face of public opposition’.

Leading the way Leaders across the NHS need to work with their staff and their communities to develop a coherent narrative that not only enables change, but which positively drives it. We are already seeing leaders in both NHS organisations and local authorities breaking new ground on this. Places like Wigan and West Yorkshire are already making measurable changes to the health of their population, while also delivering financial efficiencies and recognising that they do that best by not simply focusing on the NHS. Rob Webster, chief executive for the West Yorkshire and Harrogate Partnership, said recently that ‘the NHS Long Term Plan is just one chapter in our whole local plan’. So yes it is possible that this plan will succeed where others have failed. But it won’t be easy. And it will require leaders at a national level – including political leaders – to hold their nerve, to address funding and workforce challenges, and to ensure that they model the supportive and collaborative behaviours that they expect to see demonstrated in practice at a local level. L

Helen Buckingham is director of Strategy and Operations at the Nuffield Trust. This article first appeared as a blog post by Helen on the Nuffield Trust website. FURTHER INFORMATION



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Understanding and planning for new and emerging healthcare technology Whether you are a Health Technology Assessment expert, a medical equipment planner or are responsible for high cost, high risk or new technologies, Health Technology Assessment Information Services (HTAIS) membership, from the ECRI Institute, can offer you comprehensive support and assurance Free of hype, full of evidence. As a leader in evidence-based medicine, ECRI Institute researches and monitors how new technologies could affect hospital operations and patient outcomes. Members steer clear of manufacturer hype and head straight toward the evidence based answers on the latest health technologies—even those that are years away from hitting the market. ECRI is a global organisation that began 50 years ago in the US, where 80 per cent of US hospitals are now ECRI customers and HTAIS membership is thought to bring around $100,000 dollars of cost avoidance per hospital on average. The UK has had ECRI members for over 20 years with HTAIS memberships also supporting Horizon Scanning centres. Further afield in Europe, many hospitals and hospital groups in Italy use HTAIS to improve their understanding and planning of healthcare technology implementation. To learn more about the benefits of Health Technology Assessment membership, the topic list, the works in progress, descriptions of the different reports types, the range of accessible webinars and presentations, get in touch via the details below. Using the GRADE-based strengthof-evidence rating system in evidence reports, the multidisciplinary staff analyses the data on the latest drugs, devices, diagnostics, implants, behavioural health procedures, and care processes. Systematic, transparent, and robust process includes clear conclusions on clinical safety and effectiveness. Impact ratings on costs, diffusion, reimbursement, and implementation and care process issues are offered. Are you getting lots of new product requests

or looking to reduce the number of similar products in your health system? Members can request a rapid review of the clinical evidence or issue and receive objective, independent reports to guide your decisions on topics as diverse as cardiovascular device implants, surgical mesh, and bone substitute products. Indeed ECRI UK invites you to contact them and to request information about the variety of healthcare technologies researched to date. What are the other benefits of becoming a member of ECRI’s HTAIS? Understand what you need to successfully implement new and emerging technologies. Find out what that technology costs and what it requires in terms of infrastructure, staffing, and training. Decide whether your best interest lies in being an early adopter or taking a wait-and-see approach as evidence matures or as new and potentially better options appear on the horizon. Be forewarned about new or disruptive technologies. Never be blindsided again by the arrival of novel, minimally invasive devices or care paradigms with our health technology assessment forecasts. Find out what healthcare technology developments are on their way, so you can track and plan for developments that could affect the way care is delivered. Contact ECRI to request some free samples of the ‘Watch Lists’ that forecast new technologies likely to have an impact on healthcare. Stay updated on technology trends in personalized medicine, genetic testing, and new applications for current treatments. Whether you require comprehensive evidence-based reports, literature searches,

custom reports or wish to provide executive summaries, members can access a range of resources and reports. Sometimes custom support is really what you need. You can get more personalized guidance and evidence-based insights from ECRI’s experienced staff, whether it’s help in setting up your technology assessment committee or participating at health policy planning meetings. Access to an experienced, multidisciplinary staff ECRI Institute’s team includes physicians, pharmacists, nurses, biomedical engineers, planners, librarians, and quality, legal and risk management professionals who have decades of experience assessing health technologies and clinical procedures, and performing accident investigations across the globe. They give you access to expertise that’s unrivalled in the market. ECRI’s experts are experienced in performing literature searches and rigorous systematic reviews. 46 per cent of all ECRI Healthcare Technology staff have a Doctorate degree. No other organisation of this type has the breadth of expertise of ECRI Institute. Who is ECRI? ECRI Institute is an independent, non-profit organisation improving the safety, quality, and cost effectiveness of care across all healthcare settings. The combination of evidence-based research, medical device testing, and knowledge of patient safety makes ECRI uniquely respected by healthcare leaders and agencies worldwide. For more than 50 years, ECRI Institute has had an unwavering dedication to transparency and strict conflict-of-interest policies. The organisation has earned a reputation as the trusted voice of unbiased, research‑based assurance for tens of thousands of members around the world using its solutions to minimize risk and improve patient care. ECRI invites you to request some sample materials and information about HTAIS via the email addresses below. L FURTHER INFORMATION



The NHS Innovation Accelerator (NIA) is In the NHS Long Term Plan – published in an NHS England initiative delivered in January this year – it is said that ‘almost partnership with England’s 15 Academic everything in this Plan is already being Health Science Networks and hosted at implemented successfully somewhere in the UCLPartners. Established to help deliver the NHS.’ While innovation is regularly regarded Five Year Forward View, and more recently as part of the solution to challenges facing highlighted in the aforementioned NHS the NHS, adoption of innovation is not easy. Long Term Plan, the national accelerator However, there are an increasing number of supports the uptake and spread of individuals and organisations successfully high impact, evidence-based navigating the complex adoption innovations across England. journey and realising the Since it launched benefits: better patient T he in 2015, the NIA outcomes, improved cost journey has supported 49 effectiveness and savings, t a o d option individuals (or and more equitable and n is dynamic ‘Fellows’) to spread access to care.

requirin on-linear, betwee g flexibility n organis the adopter a the inn tion and ovator

52 innovations – including digital, medtech, workforce and models of care – to over 2,030 NHS sites. To date, NIA innovations have raised over £84.3 millionin external funds, created over 390 new jobs and won 92 awards. The NIA’s unique dual focus offers personal development for Fellows with bespoke support to spread an innovation, recognising that both are critical to scaling innovation in the NHS. To be selected to join the NIA, individuals and innovations undergo a rigorous assessment process including patients, clinicians, NHS England and AHSNs. Fellows come from a variety of backgrounds, ranging from practicing or former NHS clinicians, to academics, to individuals from small and E


Written by Amanda Begley, National Director of the NHS Innovation Accelerator

Drawing upon this year’s NHS Long Term Plan, which underscored the critical need for innovation, Dr Amanda Begley, National Director of the NHS Innovation Accelerator, discusses ways healthcare professionals and innovators can work together to improve how the NHS adopts innovation


How and why the NHS adopts innovation: learnings from the NHS Innovation Accelerator


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The research highlighted a need for mutual adaption and iteration between the innovator and adopter. It was noted that there is a level of disruption to an organisation that occurs as it adopts an innovation. In turn, there is a level of disruption to the innovation. Described in terms of a lock and key, the innovation starts out as an uncut key and, through negotiation and mutual shaping along the journey, it is cut and embedded into the organisational context. For healthcare professionals perhaps the most relevant learnings come from the analysis of the network of champions driving adoption. This ‘adoption network’ includes individuals from within and outside of the adopting organisations undertaking a set of critical adoption tasks.

Champions within adopter organisations In some cases, a single internal champion is able to drive adoption of an innovation. In the research, this is depicted in a case study where a GP Practice Manager identified Lantum, a cloudbased tool used to fill empty slots in clinical rotas, to address the time-consuming challenge of finding locum GPs to fill shifts. He had the autonomy and budgetary control to procure the platform and quickly integrate it into practice. Within larger organisations, and for innovations that directly impact on several different teams within an organisation, successful adoption can require multiple champions working together. In the case of DrDoctor, an online and SMS-based service E


 large companies. What they have in common is a passion for spreading innovation to benefit patients and NHS staff, and for sharing their real-world insights with colleagues across the system. Last year, the NIA conducted research to evaluate how decisions to adopt innovations are made within NHS organisations. The published analysis – Understanding how and why the NHS adopts innovation – captures the real-world insights and learnings of adopter organisations who have successfully implemented innovations supported by the NIA. It also identifies factors that facilitate adoption as well as the impact of adoption on an organisation. It’s widely recognised that the journey to adoption is often not straight-forward: it is dynamic and non-linear, requiring flexibility between the adopter organisation and the innovator. Throughout the journey, a series of push and pull factors were identified as playing an important role at various points. Push factors, those that relate to the innovator and the innovation, include availability of the innovator to adopter sites, flexible training opportunities and the innovation’s interoperability with other systems. Pull factors relate to the adopter organisation and include an existing need for the solution, the capability to manage and coordinate the adoption process, and the opportunity to engage key decision makers and stakeholders.

Push factors, those that relate to the innovator and the innovation, include availability of the innovator to adopter sites, flexible training opportunities and the innovation’s interoperability with other systems



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Champions across organisations and sectors In other cases, where the uptake of an innovation has implications outside of the adopter organisation, the adoption network needs to include internal and external champions. For example, when digital health leaders from the Lancashire and South Cumbria Change Programme (Integrated Care System) wanted to implement the health app portal ORCHA, the involvement of several organisations was necessary. To begin trialling the platform, the original adoption network was expanded to include champions from local GP practices, schools, and the Sustainability and Transformation Partnership’s (STP) Primary Care Digital Exemplar Programme. Including a breadth of expertise and perspectives within the adopter network ensured that ORCHA was adopted as a practical solution for front line staff, was promoted at scale across the STP and became part of the wider digital transformation strategy. Additionally, close working between the NIA Fellow and champions within the adopter network led to the identification of new applications for ORCHA.

Fellows come from a variety of backgrounds, ranging from practicing NHS clinicians, to academics, to individuals from companies. What they have in common is a passion for spreading innovation to benefit patients and NHS staff Ten tips Finally, the research identified a list of ten tips for NHS sites to consider when planning to adopt an innovation. These are summarised below: 1 - Dedicate resources to engage the wide range of staff who will be involved in implementing the innovation. 2 - Understand what data and materials are available to support adoption. 3 - Review and free up the necessary organisational capabilities to engage with and implement the innovation. 4 - Explore the experiences of other organisations in adopting the innovation. 5 - Accept that the adoption process will be iterative, non-linear and uneven in progress.


 for managing patient bookings, a collaboration of individuals drawn from multiple professional groups (clinical, operational, finance and IT) in the adopting hospital was established. This proved essential to navigating an adoption journey that met the needs of all stakeholders and delivered an innovation with relevance throughout the hospital.

6 - Plan for widespread engagement and training within the adoption network. 7 - Develop the local business case and plan for sustainability from the outset. 8 - Work with the innovator to co-develop an adoption roadmap that suits your specific organisational context and adopter network. 9 - Communicate often, clearly and openly. 10 - Be realistic about timescales and availability of resources to shape and implement the innovation. L FURTHER INFORMATION

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RDP was founded in 2000 to design and manufacture its own range of healthcare-specific hardware for the UK market. This led to RDP being the first company in the UK to provide powered carts designed specifically for PCs for use in healthcare environments. RDP prides itself on being truly customer focused, RD designing products to meet the needs of its customers. Factors such as ergonomics, manoeuvrability and user habits are all considered. RDP carts are designed by clinicians for clinicians. Our range of PC Carts, Laptop Carts, Drug Carts and Wall Mounts help facilitate the transition for hospitals from paper to paperless with EPR, EPMA and Phlebotomy projects. We work with our customers to ensure they get exactly what they need.

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The UK’s leading healthcare technology event and Dame Fiona Caldicott, National Data Guardian are some of the big hitters from the government bodies instrumental in delivering the strategic digital health agenda. A huge range of digital leaders and champions including Tracey Watson, CIO of developments and best practice, and Northern Care Alliance; James Reed, CCIO collaborate with the rest of the health of Birmingham & Solihull Mental Health ecosystem to drive transformation.” Foundation Trust; Gareth Thomas, CCIO of Dr Shyamal Mashru, CCIO at Barnet Enfield Salford Royal NHS Foundation Trust and and Haringey Mental Health NHS Trust, James Freed, CIO of Health Education England said: “In my role as CCIO I am looking will also join the line-up of more than 130 primarily for value across my speakers sharing real-life case studies whole Trust. HETT is an and experiences to over 3,000 important event for attendees looking to drive Matthe me; I can source new digital transformation across Gould, w solutions around EPS, the health and care sector. chief executi virtual consultations The launch of the CPD and AI, learn how accredited programme has bee ve of NHSX, n anno to tackle key legacy follows the appointment as one unced and interoperability of a new steering o issues, and committee who have prolific f a host of speake network with other helped HETT to deliver at HETT rs NHS trusts.” in its mission to solve HETT 2019 will the most pressing issues feature over 120 leading facing UK healthcare. and emerging suppliers of Dr Hugh Harvey, Clinical health technology solutions, Director of Kheiron Medical and with the likes of EMIS Health, Toshiba, part of the HETT Steering Committee Bittium, Imprivata, and Servelec already said: “Health technology is a complex confirmed to demonstrate their expertise. and multi-disciplinary field, and HETT is a great event that brings together all Unique programme of events the necessary stakeholders to ensure Matthew Gould, chief executive of the conversations happen to enable innovation newly formed NHSX, has been announced to keep driving the NHS forward.” as one of a host of prolific speakers at HETT. The programme focuses on four Gould, who will discuss the expanding CPD certified content streams role and aims of NHSX, will be joined by Digitally Empowered Patients, Culture Sarah Wilkinson, CEO of NHS Digital; Tara & Implementation, Integration & Donnelly, Chief Digital Officer of NHSX Interoperability and Digital Maturity. E

Govnet Communications is preparing for the launch of its flagship health sector exhibition: HETT - Healthcare Excellence Through Technology 2019 Taking place on the 1-2 October 2019 at ExCeL London, and supported by partners NHS Digital, NHS England, the AHSN Network and techUK, HETT 2019 will connect health technology providers with digital and IT leadership teams from across the public and private healthcare ecosystem. After an extensive consultation period with key health industry stakeholders, HETT 2019 will act as a platform for the health sector’s leading technology suppliers to work with NHS trusts, Clinical Commissioning Groups, national bodies and private hospitals in tackling the biggest tech challenges facing the healthcare sector, including IT legacy issues, system interoperability, data security and implementation. On the new show direction, Corby Ganesh, Portfolio Director for Public Sector Events, said: “Connecting senior leaders with innovative technology suppliers and disruptors from across healthcare to solve the sector’s most pressing challenges, HETT has been designed by the industry, for the industry, with the specific aim of tackling legacy issues, driving interoperability and overcoming financial constraints, to realise the most exciting opportunities to improve healthcare provision and delivery through successful adoption of technology. “Our ambition is for HETT to become the destination of choice for healthcare leaders looking to source the latest health technology solutions, learn about industry



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 Additionally, a range of new exclusive activities will include: the NHS Digital Academy Alumni holding their first official gathering; NHS Digital hosting a breakfast briefing for CIOs and CCIOs on Day 2; the AHSN Network showcasing its Innovation Exchange programme; NHS Clinical Commissioners running their own ‘Commissioning in Practice’ theatre; ORCHA is hosting an App Zone where selected leading app developers with top scores will showcase their health and care apps and share the latest developments; HIMSS offering their latest insights on Digital Maturity in their own, dedicated theatre; and content from NHSX, GS1, INTEROpen and more. Glen Hodgson, of GS1 UK, will be leading a discussion on how to deliver true interoperability, by breaching the data dam across organisations. Alongside Lisa Emery, Chief Information Officer at the Royal Marsden NHS Foundation Trust, and Radhika Rangaraju, head of Integration, Digital Urgent and Emergency Care Operations and Information at NHSX, Hodgson will look at the challenges of integrating services such as e-RS across primary, acute and community care, as well as overcoming the technical challenges to interoperability, including identifying ideal standards such as FHIR or openEHR. Kevin Percival, Chief Nursing Information Officer, Frimley Health NHS Foundation Trust and a regular attendee at the event said: “As a CNIO, attending HETT allows me to sense check the direction

of our digital transformation journey and have those critical conversations with exhibitors to explore the whole market.” Complementing the packed programme, will be the largest exhibition of any digital health event, featuring over 120 exhibitors including NHS trusts, CCGs, CSUs, GPs, local authorities, ASHNs, private hospitals, independent providers and more. The AHSN Network The 15 regional Academic Health Science Networks are uniquely placed to unlock the power of frontline innovation, saving lives and money. Collectively, they bridge gaps and strengthen connections between research, life sciences industry and healthcare, crossing traditional sector boundaries and strengthen partnerships with industry partners so that innovative technology makes a difference to more patients more quickly. England’s 15 AHSNs were set up by NHS England in 2013 and were relicensed from April 2018 to operate as the key innovation arm of the NHS. Nationally, the AHSN Network has helped create over 500 jobs, engaged hundreds of commercial innovators, and leveraged many millions of pounds of investment. It works with many national bodies including the Association of British Healthcare Industries (ABHI), Association of the British Pharmaceutical Industry (ABPI), British In Vitro Diagnostics Association (BIVDA) and the BioIndustry Association (BIA). Locally each AHSN works with many commercial

and development organisations such as MediLinks and Local Enterprise Partnerships. The AHSN’s knowledge and expertise, working with local networks to overcome barriers have led to an acceleration in the adoption and spread of innovation across the country as well as within and between regions. At the AHSN Network Innovation Exchange zone, organisations will showcase the innovators that are being supported to help access the NHS market and grow their businesses. If you are a technology business, come and talk to the AHSN Network team to find out how they can support you. If you work in the NHS, come and talk to them about innovations that could help you. Tony Davis, director of Innovation & Economic Growth, West Midlands Academic Health Science Network, said: “We’ll be hosting our Innovation Exchange zone at HETT. We’re showcasing innovators that we have supported to access the NHS and care sector. If you are a business with a product or service to deploy into the health and care sector, come and talk to the AHSN Network team to find out how we can support you. If you work in the NHS or care sector come and talk to us about the innovations that could help you in a range of areas such as system flow, staff management and improved treatment.” L FURTHER INFORMATION

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RDP group is a UK company founded in 2000. RDP is a specialist in providing mobile IT solutions to aid digital transformations within hospitals. The company’s range of mobile computing solutions and wall mounts are designed for healthcare professionals by healthcare professionals to facilitate IT access at the point of patient care. RDP Group prides itself not only on its consultative approach but also its customer care once the devices have been implemented. The initial concept of RDP was so well received that the company’s production has increased many times over, meaning its workforce has increased from two to

Designed and built with NHS practitioners using Microsoft’s latest technologies, CCube’s award-winning solutions deliver electronic health records to clinicians, secretaries and administrators in the format they require, when and where they are needed. With a proven track record of project success and expertise working with the NHS over 15 years, providing cost effective and scalable solutions, tailored to meet individual requirements, its software suite is used in over 28 NHS organisations around the UK including Aintree, Addenbrooke’s, Aneurin Bevan Health Board, North Bristol Trust, NHS Grampian, NHS Forth Valley, Papworth and St Helens & Knowsley delivering measurable benefits, helping to deliver paperless healthcare within 20 months. With Workflow and Electronic Forms, the solutions are designed to automate defined processes,

more than 20 team members and its recent relocation has seen RDP move into premises 16,000ft2 bigger than before. The way in which the organisation work allows RDP to build incredibly strong working relationships with both customers and suppliers, creating a network of trust and understanding. The company believes this is an imperative asset offering you complete piece of mind and resulting in long-term reassurance.

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including data entry, without any dependency on paper. The Microsoft technologies support use of mobile tablet devices for access and for data entry. CCube Solutions help trusts and Health Boards alike digitise legacy patient medical records and make this information available to clinicians and other health professionals at the point of care. It supports the government’s drive that the NHS should be using technology to improve productivity, reduce costs and ultimately enhance patient care.




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CCube Solutions – UK medical records success CCube Solutions has been around for more than 18 years delivering patient records management solutions based on electronic documents and records management technologies, in NHS trusts and Health Boards across England, Scotland and Wales

The road to the NHS going paperless could yet be a long-term process. In the past ten years, progress towards this has been relatively slow, but we believe this is changing rapidly. When asked what our mission statement is, we provide a simple answer: to drive paperless healthcare in the NHS. Mini case studies In-house scanning at St Helens & Knowsley Teaching Hospitals NHS Trust: St Helens & Knowsley Teaching Hospitals NHS Trust started a project in 2009 to remove paper medical files to guarantee notes availability, improve the quality of patient care and - of course - save money. Its IT resource - called St Helens Health Informatics Service (HIS) - created its own in-house scanning bureau along with CCube Solutions’ EDRMS. The results are impressive: it is the first trust in the UK to stop using paper medical files in clinical practice; has seen £1.4 million annual savings from £1.2 million investment; 500 doctors and 130 secretaries have been trained after a staged rollout taking 22 months; over 155,000 medical records digitised (c.48M pages) stopping 7,000 files per week being hand delivered; and an innovative scan-on-demand model has been developed - only files needed are actually scanned, resulting in huge cost savings. Outsourced scanning at Aintree University Hospital NHS Foundation Trust: This project was handled completely differently. Aintree University Hospital first considered creating its own scanning bureau but then decided to outsource to an external scanning services provider. Again, CCube Solutions EDRM software was installed and used to deliver the digital records at the point-


of-use: first trust to use forms recognition technology to automate the recognition and classification of pre-printed medical forms which make up 95 per cent of medical files; £1 million annual savings from £1.5 million investment; scan-on-demand with a third party - 290,000 patient files digitised; 30 per cent space gained in a new £45 million building from removing paper records so a £13.5 million estate benefit; and three or four mouse clicks to access required information. Hybrid model at North Bristol NHS Trust: North Bristol NHS Trust approached the whole transition from paper to digital medical records by both setting up its own in-house scanning bureau and working with a third party outsourcing specialist, to do the back scanning. The in-house bureau is used for day-to-day scanning and returns from the project have been significant: a scan-on-demand model to digitise patient medical records will save over £1.3 million within four years; EDMS is an ‘invest to save’ initiative with the system paying for itself based on a reduction in operating costs; outsourced digitisation of over 235,000 active patient records, amounting to c.35M pages; in-house scanning of day-forward patient records; 24/7/365 notes availability for multi-disciplinary clinical teams’; project delivered on time and to budget; and auditing and information governance improved as medical records are tracked. Avoiding scanning legacy paper in the first place – the Papworth Hospital model: Tertiary Trust, Papworth Hospital, installed an EDRM, workflow and eForms solution from CCube Solutions to create an electronic medical records system (EMR). Unlike other


trusts who have digitised patient records, Papworth’s EMR is not concerned with scanning legacy records. The focus has been to concentrate on the patient’s pathway from the moment an individual is referred to the hospital so that referral paperwork and medical notes are indexed, shared and information automatically routed to boost efficiency, reduce costs and enhance patient care. Return on investment has been significant: the whole project including software and project management cost under £160,000 plus an annual software licence fee of £25,000. This contrasts with other trusts who have spent over a £1 million back scanning their libraries; significant reduction in operational costs by removing physical paper records storage and management which cost £200,000 per annum; assists Papworth meet government targets to see patients within the set timeframe of 18 weeks from GP to final treatment; and the first deployment of a registration and referral system where letters are scanned and then handled electronically within the trust using workflow. Medical records in primary care – the GPs: The above examples have focused on records management in hospitals. Turning to GPs, CCube Solutions is involved in a significant primary care initiative called eLGS. Capitalising on its experiences digitising records at several hospital sites, CCube Solutions partnered with one of the Trusts to offer its know-how in primary care. We launched a fully managed service to digitise all the patient records which GPs have to keep in their surgeries – colloquially called Lloyd George notes. The eLG service includes collection, digitisation, hosting, training, and the software GPs use to access the information on their desktops. This initiative is about releasing more space in primary care, enhancing GP and practice staff productivity and removing a whole paper shuffling industry in primary care which in itself costs millions and millions. To date, four CCGs have purchased the service with around 120 GP practices now using the system. L FURTHER INFORMATION

The UK’s Leading Healthcare Technology Event HETT is a one-of-a-kind ecosystem event for the healthcare industry, and we’re on a mission to bring together 3,000+ senior leaders from across primary, secondary, tertiary and community care to solve the most pressing technology related-issues facing healthcare today.










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Mid Cheshire Hospitals NHS Foundation Trust employs 4,500 members of staff across three hospital sites in the North West of England. With around 540 hospital beds, its services include A&E, maternity, outpatients, therapies and children’s health. As part of the Central Cheshire Integrated Care Partnership, the trust also provides community health services The Challenge Mid Cheshire NHS Trust’s ageing IT estate was causing significant problems. Amy Freeman, the trust’s Associate Director of IT, identified several challenges when she joined in 2016. More than half of the trust’s 2,500 desktop devices were over 10 years old, with staff waiting 20-25 minutes to log in each day. Many staff were either opening clinics later or beginning work early to start their machines. Even when booted up, many of the devices were slow, which again took time away from patient care. As a result, call volumes on the service desk were high. The team of three first-line staff were handling up to 500 calls per week. A calculation showed £942,000 worth of ‘unproductive’ time being wasted each year due to logging-in times and device usage issues. It was estimated that staff at the Trust were spending around 273 hours per day waiting to access their desktop. There was no standard build, software deployments had become very labour‑intensive, and a number of important security patches could not be applied. Additionally, the IT team’s ability to manage machines remotely was limited. Staff working in the community had devices which lacked the necessary

functionality for simple data input. Details of appointments were therefore handwritten, causing an unserviceable surge in demand for a limited number of desktops when staff returned to type up their notes. Amy and her team recognised that being able to log in from home would reduce staff’s fuel expenses and create more time for patient interaction. It was estimated that, on average, each team member could visit an additional two patients per day. Consultants at the trust were experiencing similar challenges, with no remote working capability. The Solution Formulating a compelling business case was crucial. Amy said: “The key is to articulate why something is important. I don’t ask for new technology, I ask for a programme of change, detailing the specific benefits of each element of the proposal.” The adoption of Microsoft Office 365 was identified as the best way to improve user experience, strengthen security, enable mobility, support collaboration and reduce pressures on the internal IT team. The CDW Software Team managed the deployment of software and migration of user accounts. A number of security enhancements were applied and a new

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Improving patient care at Mid Cheshire NHS Trust

Microsoft SharePoint platform was implemented to drive user collaboration. Moving to Windows 10 and implementing a new password reset tool has removed further pressure from the service desk, and a Device as a Managed Service solution delivered by CDW enabled the trust to establish a new five-year refresh cycle to strengthen future proofing. Lenovo was identified as being the best choice of vendor for the trust’s needs. CDW co-ordinated the ordering and shipment of Lenovo devices to the required locations, handled imaging and asset tagging, managed the migration of mailboxes and even ensured the WEEE compliant disposal of old devices. CDW’s Microsoft Adoption team also provided e-learning courses and collateral to support user enablement training. To facilitate ongoing support and reduce internal help desk calls, the Trust also utilises CDW’s managed services to support its users. This includes 24x7 Service Desk access, with an aligned Service Delivery Manager. The Outcome As soon as the deployment project began, there were clear positive results and a direct impact on levels of patient care. Logging in now takes less than a minute and staff undertake more appointments per day. Renewal of infrastructure is integral to further transformation and the trust is benefitting from CDW’s CloudPlan service as it builds a proposed framework for migration to Microsoft Azure in the near future. CDW is also rolling out new Cisco networking technology, including the replacement of a large number of Wi-Fi access points in hospital buildings, making free Wi-Fi available to patients for the first time. Amy said: “One of the great strengths of CDW is that I can call my Account Director at any time and he will do his very best to resolve an issue. His flexibility and dedication is something I value very highly. Where other problems have arisen, they have been resolved quickly and without any fuss.” Eoin Perera, UK Healthcare Sales Manager at CDW, says: “We are immensely proud to have supported the incredible IT transformation that is taking place at Mid Cheshire NHS Trust. These new technologies are truly changing the way staff work, which in turn is enhancing patient care.” L FURTHER INFORMATION





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Technology Written by Linda Watts

Digital records – just what the doctor ordered Linda Watts, GDE programme manager and head of Health Records at Imperial College Healthcare NHS Trust, shares the trust’s paperless journey to date, and explains how deploying an electronic document management system (EDMS) has resulted in reduced costs and faster patient care Imperial College Healthcare NHS Trust provides care for around a million people over five hospital sites across north-west London every year, and the trust has a long track record in research and education, influencing clinical practice nationally and worldwide. The digitisation of paper health records is a challenge that every healthcare organisation has to face as it moves towards greater use of digitised workflows and electronic access to patient records. As the NHS moves towards greater digitisation of processes, we all go through an awkward period of hybrid working, where we’ve got to marry old paper-based processes with new digital ones. In addition to our new electronic patient record (EPR), there is a huge legacy of paper-based patient records, many of which remain critical to care as we digitise. The longer this hybrid working continues, the more challenging it becomes to the whole programme of digital working within our hospitals.

I joined Imperial in 2016 as the head of Health This came to about 111,661 boxes of physical Records, and my main remit was to manage records, with each box holding an average of the complete digitisation of the trust’s 12 sets of records each. That’s in the region patient records. It soon became apparent of 1.3 million records offsite, with around 150 that we were spending around £500,000 pages per record on average. That’s more than per year – far too much – on storing paper. 350 million pages in total to scan. Our plan is We also had three main record libraries that to scan the first 500 thousand were occupying prime floor space. records, around 75 million These were mainly records of pages, including all onactive patients: anyone who site records, and then As we had had an appointment in, review and work out achieve say, the past 18 months. the best process m ore clinical We had in the region of for handling the one million records in total remainder of our with ou adoption r e on-site. We also had 113 archive after this l e c systems tronic records staff to manage period. As we t h e need to scan m these libraries across all achieve more locations, as well as the clinical adoption notes more of these continual movement of with our electronic ay s files around our hospitals systems the need over timubside e and regular interaction with to scan more of our offsite store for all other these notes may records that were located there. subside over time. E Issue 19.3 | HEALTH BUSINESS MAGAZINE


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As the NHS moves towards greater digitisation of processes, we all go through an awkward period of hybrid working, where we’ve got to marry old paper-based processes with new digital ones Why do we need an EDM? When we started this paperless journey, we were driven by the fact that implementing MediViewer equated to less than the price of storage for our records over the course of five years, but also provided a unique and intuitive platform for our clinical and nonclinical users to retrieve and access records. We were not initially focused on the additional features and functionality that an EDMS can provide to clinicians. I was actually told time and time again by some of our clinical staff that we didn’t need an EDMS, and that there is no value in what we are scanning. Today, however, we can see that the case for investment in an EDMS solution is compelling to clinical staff. It can offer significant improvements in operational efficiency, and improve decision making, as well as associated cash-releasing benefits. We’ve had very positive feedback from our clinicians. The technology is intuitively easy to use and its speed means response time between pages is almost instantaneous. It provides a greater oversight of case notes, regardless of location, ensuring that the documents can be found easily.


 I knew there must be a more efficient way to store our offsite records, and my instinct was confirmed when I reached out to Xerox for advice. I’d worked with Xerox during my time at another trust, and they really stood out for their responsiveness and care, as well as their knowledge about document digitisation. With their expertise to back me up, we moved from box-based to open-rack storage. In the summer of 2019, we will begin using MediViewer by IMMJ Systems. MediViewer’s primary goal is to enable hospitals to scan, index and archive paper medical records and access them quickly through an intuitive user interface. It is fully integrated with our Cerner EPR, and provides a complete view of a patient’s health record. In fact, MediViewer is integrated to the point where not only are patient records loaded in full patient context, but with an embedded window from within our Cerner EPR. For Imperial, IMMJ Systems MediViewer EDMS was the best solution offered in terms of value, speed, functionality, ease of use, mobility, and technical architecture, coupled with the company’s ability to support our change and transformation needs. It’s a software-as-a-service system, which we specifically wanted because it avoids infrastructure investment and is natively designed for scalability and ease of access. It’s accessible via our HSCN networks and is hosted by UKCloud, a specialist provider of hosting services to the UK public sector. So it meets our security and data sovereignty requirements. In fact, when we complete the first phase of scanning, the MediViewer EDMS will host the most amount of scanned digital records from a cloud-based platform in the UK.

Our ambition at Imperial is to get to zero paper records. We have a five-year strategy to achieve this and we’re now very confident about our progress. L FURTHER INFORMATION

Portsmouth CCG Portsmouth has become the first area in the country where prescriptions for all patients can be sent electronically. NHS Digital has revealed that NHS Portsmouth Clinical Commissioning Group (CCG) has been piloting the latest improvement to the Electronic Prescription Services (EPS), known as Phase 41, which allows prescriptions for all patients to be sent using the more efficient digital system and not just those who have chosen a regular nominated dispenser. It has now become the first in the country to have 100 per cent of their GP practices able to use EPS. The technology saves the NHS time and money by reducing the amount of paper processing required by GPs, pharmacists and the NHS Business Services Authority. Once the NHS Digital system is rolled out across England, it is estimated it will save the NHS £130 million a year. Simon Cooper, director of Medicines Optimisation at NHS Portsmouth CCG, said: “Implementing EPS Phase 4 across the city has been a very straightforward process for us and we are already beginning to see the benefits. Moving from what was essentially a paper-driven process to an approach which is primarily digitally-focused means much greater efficiency for our GP practices and dispensing pharmacies in terms of time and accuracy, and this can only be positive for patients, too. “It’s also helping to create a much more accurate picture for us in terms of assessing prescribing data, which we can now do more quickly and with a greater degree of confidence in the information we are reviewing.”



Following warnings from the CBI, which suggested that the health sector could fail due to staff shortages, the Migration Agency Committee (MAC) released a recommended update to the UK’s Shortage Occupation List (SOL) in May. The updated SOL presented much-needed recommendations, to include and extend the roles across the health and social care sector. This comes after health and care professionals suffered severely under staff shortages. While these amendments definitely are a positive step forward, many are still concerned about what will happen to staff after Brexit day. What are the new changes? If an occupation within the UK is on the SOL, individuals seeking jobs from outside the European Economic

Area (EEA) are no longer subject to some visa restrictions. Employers are able to recruit overseas nurses, paramedics, care-workers, technicians and other health professionals more easily. Overseas professionals still have to apply for a Work Visa, however international applicants will receive a reduced visa fee, less waiting time and a lower minimum salary requirement than the current £30,000p. a for the Tier 2 Work Visa. In the healthcare sector, many jobs do not qualify under the current minimum salary requirement, as the average salary of a registered UK nurse is £23,000, while the median salary of a role in the care sector is £16,623. These individuals The MA thereby fall well below C ’s recomm the minimum salary e ndation threshold. If the MAC’s aim to help res s recommendations olve the wo are implemented, rkforce all roles within the gap

within th healthc e are sector

‘medical practitioner’ and ‘nurse’ category will be added to the SOL, making overseas professionals eligible to fill them. The recommendations by the MAC are meant to encourage overseas professionals to migrate to the UK and fill positions that the UK is unable to fill with domestic talent alone. The new update of the UK’s SOL is good news for the health sector, as it welcomes international professionals to apply more easily, which greatly helps resolve the issue of staff shortages within the NHS and the UK health sector as a whole. What happens after Brexit? There is one question, which still remains unanswered: how will staff shortages be covered after Brexit, when the free movement ends, and EU nationals are no longer encouraged to move to the UK? For now, the MAC’s recommendations aim to help resolve the workforce gap within the healthcare sector. However, after Brexit Day E


Written by Pia Subramaniam, from the Immigration Advice Service

Pia Subramaniam, from the Immigration Advice Service, discusses changes made to the Shortage Occupation List and how these are likely to impact individual healthcare professionals. Plus a look at the Non Medical Temporary and Fixed Term Staff framework


The Shortage Occupation List and Brexit




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 on 30 October, 2019, the updated SOL may become invalid, as the free movement laws are no longer implemented. The UK currently employs 62,000 European healthcare professionals, which includes skilled doctors and nurses and any individual from the EEA seeking a job in the UK who are momentarily able to work for an unlimited period under free movement legislations. Regardless of a ‘no-deal’ or ‘hard’ Brexit, free movement will end and healthcare and social care workers are threatened with major workforce shortages, as the same immigration requirements will be implemented for EU nationals. European workers will need to pay visa application and extension fees for themselves as well as for any additional dependent child or dependent spouse visa. They will also need to be sponsored by a Tier 2 registered employer and meet several other requirements if they want to work in the UK health sector permanently. If EU care professionals are subject to the same visa requirements as non-EEA migrants, they will have a complicated route in order to apply for roles in the UK, allowing many EU nationals to seek jobs elsewhere and more shortages to arise. Even in the event of the reduced visa fees for occupations on the SOL, EU health professionals will most likely be put off by the rulings and stop choosing the UK as their professional base - especially when the average wage of a health care worker will be much lower than the national living wage. The health care sector is known for being underfunded. Austerity measures have had a negative impact on most UK industries, effecting both workers and patients. Some residents have even had their social-care budget capped by two-thirds, leading to stretched resources and staff. While the updated SOL makes positive progress within the health sector, the MAC’s efforts do not really go far enough. Once

How will staff shortages be covered after Brexit, when the free movement ends, and EU nationals are no longer encouraged to move to the UK? free movement ends and visa restrictions are implemented for all migrants, the sector will be severely threatened by an even bigger workforce shortage. A clear strategy and more powerful recommendations are strongly required in order to tackle and potentially resolve this crisis, to ensure that the health care sector remains protected after Brexit. A framework to help recruit non-clinical roles Having started in July, the new Workforce Alliance has launched a new framework agreement for the recruitment of Non Medical Temporary and Fixed Term Staff. NHS Procurement in Partnership and Crown Commercial Service (CCS) are two public sector organisations that have come together in collaboration with the intent to explore the whole portfolio of health workforce services as part of a new Workforce Alliance. The collaboration launched a new framework agreement, RM6160 – Non Medical Temporary and Fixed Term Staff (NCS), in July. The agreement is made up of six lots. Lots 1-6 give NHS contracting authorities and all UK public sector bodies, such as local government, universities, charities and blue light services, the ability to secure quality candidates regionally and nationally across the UK under a variety of specialisms including, but not limited to: Lot 1 – administration and secretarial roles; Lot 2 – finance, accounts and audit roles; Lot 3 – IT technicians, analysts and technical engineer specialist; Lot 4 – legal secretaries, paralegals and lawyers; Lot 5 –

clinical coders and health records secretaries; Lot 6 – caterers, drivers, security, estates and maintenance roles, such as general labour, specialist labour e.g. electricians and surveyors, environmental and scientific roles for example EA and senior assistant scientists. Quality assurance inspections are carried out to make sure all temporary and fixed term workers are compliant in accordance with NHS Employers Check Standards and Skills for Health NHS roles. The benefits of the framework are listed by the Crown Commercial Service as: being free of charge: a wide range of suppliers available including SME’s, specialist niche suppliers and managed solution options; quick on-boarding process and direct contact with suppliers to build good working relationships; framework rates are set to a maximum; the Workforce Alliance conduct inspections to ensure compliance in accordance with NHS Employers Check Standards and Skills for Health’ all public sector organisations can use lots 1 – 6 of this agreement; transparent rates and costs show charges for both PAYE and limited company temporary workers, including fixed term appointments; NHS and wider public sector pricing tools; and additional savings: through a range of discounts including nominated worker, volume-based level, prompt payment and length of placement discounts. L FURTHER INFORMATION agreements/RM6160



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Modular data centres – unlocking the true power of digitalisation in healthcare With the health service in the grips of a tech revolution, Leo Craig, Riello UPS general manager, outlines how what at first glance appears to be an upcycled shipping container can help hospital facilities managers harness the full processing power of edge computing At a time when the NHS treats a million patients every 36 hours, digitalisation promises to help ease the almost unbearable burden on our health and social care services. In a world where smartphones and sensors are becoming ubiquitous, apps, wearables, and other technologies are rapidly changing how the healthcare system operates. Video consultations or artificial intelligence‑led chatbot apps are now often a patient’s first port of call. Wearables and connected devices have huge potential to help the 18 million-plus people in the UK living with a long-term ailment monitor and manage their condition. AI trialled by the team at John Radcliffe Hospital in Oxford is improving the diagnosis of heart disease, while robots assist with thousands of operations every year. Away from the front line, the British Medical Association states trainee doctors spend 15 per cent of their day on admin, while the Royal College of Nursing estimates non-essential paperwork accounts for a fifth of nursing time. ‘Virtual assistants’ are automating tasks such as appointment booking, sending out reminders, or composing patient letters to ease the load. And there’s the digitalisation of medical records to consider, along with the new Health and Social Care Network (HSCN) decentralised ‘network of networks’ designed to enable NHS bodies across England to freely share information between each other. This increasing reliance on technology and digital information puts data centres firmly at the heart of the NHS, constantly storing and processing reams of information. But it means those data centres might need to change too. To truly reap the rewards of digital transformation, the petabytes of data produced by all these sensors, connected devices, systems, and equipment need real-time processing. However, sending information to an enterprise data centre or the cloud, processing it, then returning it back just doesn’t cut the mustard when every millisecond matters. Every 1,000 kilometres is said to add a minimum delay of 10 milliseconds per roundtrip,


nothing to the human eye but practically a lifetime in terms of modern computer speed. As AI, machine learning, and automation take on increasingly complex tasks, depending on data connections potentially hundreds or thousands of miles away will inevitably lead to a processing logjam. Think of the potentially catastrophic consequences – essential equipment stops working, robots are fractionally out of synch, highly-controlled pharmaceutical production runs producing life-saving drugs ruined in an instant… Sending vast sums of information far and wide takes up costly bandwidth and poses significant cybersecurity and data protection challenges too. Finding answers at the edge So what’s the solution? Consider mobile


phones. There isn’t just a single aerial which we’re all connected to. There are around 40,000 mobile phone masts spread across the UK, with the majority placed in densely populated areas where the most users are. Rather than transporting data all the way to the data centre, why not bring the data centre closer to where the information’s generated in the first place? That’s what edge computing is – ‘local’ data centres that meet the desire for low latency processing. The information doesn’t need to be transferred back and forth so less bandwidth is required, while it also minimises the threat of the data being hacked or corrupted. Inevitably this requires a completely different infrastructure to the archetypal sprawling data farm chock-full of server racks and IT equipment.

A flexible friend Advances in data centre development mean there’s now a workable way for hospitals and other medical sites to take advantage of the full power of edge computing though. Modular (also known as micro) data centres might look like an upcycled shipping container, but they offer estates professionals a cost-effective, quick, and versatile way to make the most of their space. Micro data centres incorporate all the critical elements you’d find in any data centre run by tech giants like Amazon or Microsoft: server cabinets, air conditioning systems, power distribution units, uninterruptible power supplies, cabling, CCTV security systems and access controls, monitoring and communications software. But there’s a big twist… Everything’s condensed inside a 10, 20, or 40‑foot long weather and fire-proof steel container. This makes it suitable for a wide range of installation environments either inside the building or outside in a car park, even on the roof. Containerised data centres are designed, built, and tested offsite, then transported to

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Edge data centres need to carry out all the same functions but in a much smaller footprint. They’re often installed in a complex environment not designed with the needs of a data centre uppermost in mind. Think of hospitals, often older buildings where there’s seldom the space to put a dedicated server room. IT hardware tends to be hidden away in the ‘broom cupboard’ or in areas shared with other non-IT equipment. It’s not an ideal solution as this can compromise performance, security, and efficiency, but when space – not to mention budget – is scarce, it’s hard not to sympathise with the facilities manager’s plight.

the hospital or laboratory for final installation. From initial design to going live, the entire process typically takes just six-eight weeks, far quicker than carrying out building works or constructing a dedicated extension to house your IT infrastructure. Because they’re classed as temporary structures, in many cases containerised data centres aren’t subject to UK planning regulations, so don’t require formal planning permission. By their nature, modular systems can easily be expanded so facilities managers can ‘pay as they grow’ in the future if processing demands increase. This even extends to stacking containers on top of each other to provide extra capacity, where applicable. Another benefit is they are portable, giving you the option to easily move data centres between various locations. As long as the actual shipping container complies with Lloyd’s Register Container Certification Scheme (LRCCS) requirements, the whole structure can be moved by road, sea, or even air without having to disassemble all the individual components. Powering the revolution Of course, for any medical micro data centre to function properly, it requires clean, continuous, and disruption-free power. That’s why a UPS is an essential part of any ‘data centre in a box’. An uninterruptible power supply is the ultimate insurance against blackouts or problems with the electricity, providing immediate emergency backup so computers and other equipment keep operating seamlessly until the onsite generators kick in. Until the last few years, a typical UPS was a huge black box sat in the corner of an IT room. Most were oversized at installation, so ran inefficiently at low loads wasting energy and churning out lots of heat. In simple terms, an essential yet inefficient and expensive asset. Thankfully, technology has improved considerably, initially with more energy efficient transformerless models, followed by the development of modular systems. The latter replaces the sizeable standalone towers with individual power modules housed in a compact cabinet, which work in tandem to deliver the required power load. This eliminates the problem of wasteful oversizing whilst giving facilities managers the flexibility to expand or downsize if their power requirements change simply by adding or removing individual modules. Combine this scalability with the performance, energy efficiency, and compact footprint of a modular UPS, and

it’s obvious why they’ve proved such a perfect partner for a micro data centre. Reducing risk of downtime As with any equipment – electrical or otherwise – a proactive maintenance regime is crucial to lessen the risk of failure and ensure peak performance. There are a lot of moving parts inside a micro data centre that could go wrong if they’re not looked after properly, which is why we’d recommend a full service at least once a year. In terms of a UPS system, ongoing maintenance can extend the lifespan of certain components by 25-50 per cent, while it also improves energy efficiency, which directly reduces power consumption and saves on energy bills. Basic good housekeeping helps too. Something as innocuous as dirt and dust is proven to cause nearly three-quarters (70 per cent) of IT hardware failures, so keeping data centres clean and ensuring doors or windows closed can make a difference. There are a couple of other factors medical facilities managers should bear in mind too. Firstly, in such a mission-critical sector any data centre should be designed to meet at least Tier III of the Uptime Institute’s classification. This provides a minimum of N+1 redundancy – in other words, any component needed to support the IT processing can fail or be maintained and/or replaced without the entire system falling over. Any UPS should also deliver at least N+1 redundancy too. A second consideration is the rollout of the new Health and Social Care Network (HSCN), the decentralised ‘network of networks’ designed to encourage NHS bodies across England to freely share information between each other. When choosing any prospective data centre designer or provider, it’s crucial to clarify whether they are fully HSCN compliant. With superfast 5G communications just around the corner, the shift towards digitalisation is set to continue at great pace. Respected IT research body Gartner predicts 75 per cent of all data will be processed at the edge by 2022 as we make the most of our IoT-enabled devices – currently the figure stands at just 10 per cent. Containerised data centres provide facilities managers with the most cost-effective and practical way to make sure their hospitals don’t get left behind in the next wave of this ongoing tech revolution. L FURTHER INFORMATION



Lab Innovations

The UK’s only lab-dedicated showcase Lab Innovations will return to the NEC, Birmingham, for its 8th successive year on 30-31 October 2019 adjacent ‘Lab News Village’. Additionally, the SLS pavilion is almost a third larger, showcasing 20 partners of the UK’s largest independent supplier of laboratory equipment, chemicals and consumables.

As the UK’s only trade show dedicated to the laboratory industry and ‘Best Trade Show’ winner at the 2019 Exhibition News awards, it is supported by many of the UK’s leading scientific institutions, including UKAS and the Science Council. Following the show’s increasing popularity, Lab Innovations 2019 will be 10 per cent bigger this year, with more healthcare-related exhibitors and visitors from the NHS, and offering more product launches, innovation and opportunities for networking than ever before. This free-to-attend event is all about the business of the laboratory with almost 80 per cent of the more than 3,000 attendees involved in the purchasing products and services. Last year saw a 43 per cent increase in lab managers, a 53 per cent increase in lab technicians, and an impressive 125 per cent more procurement managers. Key scientific and healthcare companies Over 160 leading science and healthcare suppliers such as Thermo Fisher Scientific, SLS, Kimberley-Clark Professional, Labcold, Haier Biomedical, Contained Air Solutions, Klick Technology and MP Biomedicals are among the many suppliers and manufacturers exhibiting in 2019. All will be presenting cutting-edge equipment and services such as specialist training, recruitment and logistical support, applicable to a broad spectrum of industries, including diagnostics, healthcare and life sciences. Education and CPD points Alongside the extensive product showcase, Lab Innovations offers many CPD-accredited

educational opportunities, enabling visitors to earn CPD points when they visit the show. The Perkin Elmer-sponsored ‘Insights and Innovations’ theatre curated by Laboratory News, will focus on lab management and digitisation, with topics including the use of artificial intelligence in science, virtual reality in the lab, handling big data in the digital age and more.​This year the Royal Society of Chemistry will celebrate the International Year of the Periodic Table in its dedicated theatre and several related networking events. In the ‘Live Lab’ Campden BRI’s Head of Microbiology, Roy Betts, will present on the leading cause of infectious intestinal disease in the UK: Norovirus. With three million cases/year in the UK alone, it is important to keep up to date with the latest knowledge on this pathogen to maximise control over it. Roy will give attendees useful insight to this under-studied pathogen. Novel laboratory and cleanroom products The Cleanroom Hub, in collaboration with Cleanroom Technology magazine, will provide a dedicated zone for cleanroom equipment suppliers. It incorporates a seminar pod, a networking lounge and dedicated exhibitor pavilion. Seminars will focus on regulation and legislation in the cleanroom, and how to ensure sterilisation in environments where contamination needs to be controlled. Visitors can learn how to successfully prepare for audits, to ensure proper quality and specifications are being met. First-time exhibitors will showcase products never seen before at Lab Innovations in the

Major focus on sustainability Lab Innovations is guided by an Advisory Board which steers conference topics and helps to shape the event. Composed of representatives from scientific institutes, suppliers and publications, the Advisory Board meets regularly to consider industry challenges and trends. With sustainability high on the UK agenda, the ‘Sustainable Laboratory’ will return for 2019. Here visitors will be shown how improvements in technology, procurement and best practice can reduce running costs whilst safeguarding the science. They can speak with leading UK universities and institutions on how they are using ‘green’ equipment and processes to achieve sustainable results. Commenting on her visit last year, Carolyn Jones, lab manager at the University of Birmingham said: “I’m very interested in the sustainability side of things and looking at what people are doing to reduce their carbon footprint. It’s good to see all equipment out and working on the stands, from all the big companies as well as smaller start-up companies. It’s been a good day out and well worth attending. I’d definitely recommend this to anyone with a budget to spend.” Enhanced networking opportunities New for 2019, a bespoke meetings concierge service ‘Lab Connect’, will provide visitors and exhibitors with the opportunity to prearrange meaningful meetings with exactly the companies or attendees they want to discover and do business with. This exciting new initiative accentuates the event’s position as the leading meeting place for laboratory professionals and suppliers. Phil Ellis, equipment services manager, Aberystwyth Innovation and Enterprise Campus Ltd summed up his visit to Lab Innovations 2018, and the importance of making connections: “This is the first time I have attended Lab Innovations and I have ended up coming both days due to the amount of connections we were making. Besides networking, Lab Innovations has given me the opportunity to keep up-to-date as the entire market is here. I will definitely come again.” L FURTHER INFORMATION



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Infection control

Copper surfaces: giving patient safety a boost We revisit advice from Bryony Samuel of the Copper Development Association who outlines the use of copper surfaces to boost infection prevention and control in hospitals bacteria, viruses and fungi. No pathogen tested has been able to survive on copper. Claims of antimicrobial efficacy made for many antimicrobial products are based on JIS Z 2801 and ISO 22196 tests, conducted at over 90 per cent humidity, 35°C and over 24 hours under a plastic film. These basic tests are described as a proof of principal, and do not indicate how a material will perform in the field. To better represent actual in-use conditions when testing copper, researchers developed new protocols to reflect typical room temperature and humidity, and used representative contaminants. Laboratory research on the antimicrobial efficacy of copper and copper alloys has been carried out and verified at institutions around the world, with results peer-reviewed and published in respected journals. They exhibit efficacy under typical indoor conditions, unlike silver-containing materials and triclosan, which showed no antimicrobial efficacy under these conditions.

What is antimicrobial copper? There are many technologies and materials currently marketed as being antimicrobial, but none are as effective under typical indoor conditions as copper. Copper rapidly destroys microbes that can be picked up, unseen, from frequently-touched surfaces in the environment, potentially How does antimicrobial spreading infection. These copper work? There include bacteria (such as A leading researcher in are ma E. coli), viruses (such this field is Professor Bill ny techno as Influenza and the lo ‘winter vomiting materia gies and ls bug’ norovirus), and market currently resistant organisms ed as b eing antimic such as MRSA and VRE. Fewer none a robial, but re microbes on surfaces under t as effective mean a lower risk of ypica infections spreading conditio l indoor ns by touch. Copper’s copper as antimicrobial efficacy extends to over 500 copper alloys — including brass and bronze — creating a large family of metals collectively called ‘antimicrobial copper’. Evidence shows that upgrading the most frequently-touched surfaces in a healthcare environment to antimicrobial copper can reduce the spread of costly infections and improve patient outcomes. This article presents a summary of the body of research and considers some of the practicalities and economics of upgrading key surfaces to copper. Effective under typical indoor conditions Copper’s antimicrobial properties have been documented in scientific literature for more than a century, but it was not until 2000 that its efficacy against the pathogens responsible for healthcare-associated infections (HCAIs) began to be assessed. 16 years on, more than 60 papers report copper’s broad-spectrum, rapid efficacy against

Keevil, chair in Environmental Healthcare at the University of Southampton, and his work includes investigation of the mechanisms by which copper exerts its antimicrobial effect. For bacteria, the current consensus among researchers is that there are several interacting mechanisms for socalled contact killing. The nature of these leads researchers to believe it is unlikely bacteria will develop resistance to copper. Professor Keevil explains: “Copper works in completely different ways to antibiotics or common biocides. It punches a hole in the cell membrane, like a balloon, and the bacteria collapse. It stops them respiring, goes into the cell and destroys their DNA. Mutation happens because you get small changes in DNA in cells. The beauty of copper is it destroys the DNA; there is nothing left. We’ve shown this for bacteria, fungi and viruses. They can’t mutate. They have no time.” The Southampton team also investigated the contribution antimicrobial copper surfaces can make to combating the rise of antibiotic resistance — a global threat that a joint UK government and Wellcome Trust review warned could kill 10 million people a year across E


Written by Bryony Samuel

The healthcare environment is increasingly recognised as a significant and continuous reservoir of microbes that can cause infections. Whilst regular cleaning and disinfection, good hand hygiene and other existing measures can be effective, they rely on human intervention and — even when fully implemented — can’t eliminate the risk posed by contaminated surfaces. Augmenting hospitals with continuouslyactive antimicrobial copper surfaces offers a simple and effective hygiene boost, requiring no change in human behaviour, working alongside a bundle of infection prevention and control measures to improve patient safety.


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 the world by 2050. The team assessed the ability of two different strains of bacteria to pass genetic material conveying antibiotic resistance between them on copper and stainless steel. While this took place on stainless steel, it did not happen on copper. Copper could therefore contribute to the fight against antibiotic resistance in two ways - by reducing the spread of infections and thus the need for antibiotics, and by preventing the transfer of resistance between bacteria on surfaces. Effective in challenging clinical conditions Antimicrobial copper has also been put to the test in real clinical environments. Numerous trials have been conducted in different healthcare systems — such as the UK, US, Germany, Finland, Poland, Chile and Japan — and different clinical environments, including nephrology, geriatric, general medical and ICU wards. They report a continuous and greater than 80 per cent reduction in bacterial contamination on antimicrobial copper surfaces compared to non-copper surfaces, with trial leaders concluding that antimicrobial copper can provide an additional measure to reduce the spread of HCAIs. It is important to note that these trials have used solid materials since the effective surface will not wear away, or be susceptible to reduced efficacy over time, unlike coatings and composites. A multi-centre clinical trial in ICUs, funded by the US Department of Defense, explored the effect this reduction in surface bacteria has on HCAI rates. It found that replacing just six key, near-patient touch surfaces reduced the incidence of infections by 58 per cent. Official recognition of copper’s potential to boost infection control is growing as the evidence base and experience of use grows. The evidence-based EPIC 3 guidelines included copper as an emerging technology in 2014 and, last year, the CMJ (Poland’s National Centre for Quality Assessment in Healthcare) recognised copper’s potential to boost infection control in its new hospital accreditation scheme. With this proven efficacy in mind, the next question arising will naturally concern the cost of installing antimicrobial copper touch surfaces. Cost benefits HCAIs are very common and very costly, both financially and in terms of human life. Approximately 20 per cent of ICU patients in

European hospitals get HCAIs, and in 2011 they affected 4.1 million patients, necessitating 16 million extra days in hospital. 37,000 deaths were recorded as being caused by HCAIs, plus 110,000 deaths where they were a contributing factor, and they had a direct clinical cost in excess of €7 billion. York Health Economics Consortium (YHEC), a leading global health economists based at the University of York, developed a fullyreferenced cost benefit model for hospital managers to illustrate the economic rationale of an antimicrobial copper installation. Using researched data for cost of infection, industry data for cost of antimicrobial copper and standard components, and a conservative infection rate reduction of 20 per cent (where the US trial reported a 58 per cent reduction), the model considers a planned refurbishment or new build. It predicts the cost of replacing the six key touch surfaces in a 20-bed ICU with antimicrobial copper equivalents will be recouped in less than two months, based on fewer infections and the resulting shorter lengths of stay. It also calculates a positive impact on bed days and quality-adjusted life years offered by antimicrobial copper. Dr Matthew Taylor, YHEC’s director and one of the model’s authors, concludes: “After the initial two months, ongoing cost savings will accrue from the reduction in blocked beds and better-directed staff resources.” How to prioritise surfaces for upgrade In the copper clinical trials, multi-disciplinary teams have prioritised high frequency touch surfaces to upgrade to copper. The factors considered include known hotspots (from microbiological testing) and likely hotspots (based on experience and understanding of staff/patient/visitor dynamics).

Based on a review of international research, the United States Centers for Disease Control published a checklist of high risk surfaces based upon the likelihood of touch and contamination. These were bed rails, chairs, IV poles, over-bed or tray tables, door and cabinet handles, grab rails, light switches, push plates, sinks, toilet seats and flush handles. From the experience gained by hospitals adopting this technology, it is clear that when considering which components to upgrade in a particular facility, input should be sought from the infection control team and ward staff to ensure that all key touch surfaces are identified. The regular environmental swabbing carried out by infection control teams to assess the state of cleanliness will also indicate contamination. How to specify antimicrobial copper Help with identifying products is available in the form of an industry stewardship scheme: the Antimicrobial Copper brand and Cu+ mark are used by leading manufacturers of hospital equipment, furniture and fittings to indicate their products are made from solid, approved antimicrobial copper alloys, and that the organisation adheres to strict usage rules guiding their understanding of the underlying technology and its deployment. Copper alloys offer a wide palette of colours, from the gold of brasses to the rich brown of bronzes, right through to the silver/white shades of copper-nickels. Copper alloys will naturally darken over time, but this does not impact their antimicrobial efficacy. More colour-stable technical alloys, traditionally used in demanding applications, are available. Conclusion Antimicrobial copper surfaces are an adjunct to, not a replacement for, existing infection control measures. Alongside good hand hygiene and regular surface cleaning and disinfection, they will continuously reduce surface contamination and consequently the risk of infections being passed between people via these surfaces. Installations have already taken place around the world, in more than 25 countries, including several UK facilities. In these places, the importance of taking a multidisciplinary approach to making the decision of where to deploy antimicrobial copper has been clear. L FURTHER INFORMATION



The challenges faced by the NHS have never been greater, hospital acquired infections reach new heights and antimicrobial resistance is of a global concern. The cleanliness of your hospital remains critical to achieving positive patient outcomes. However this is often difficult to achieve with escalating costs and stretched budgets.


For a live demo and to learn more about the FINSEN TECHNOLOGIES’ Strategic Partnership Plan, please visit us on STAND 31 at the IPS Meeting Liverpool 22nd – 24th September

0207 193 5641 • •

Infection Prevention 19

Investigating infection prevention and control Leading experts in their field will present on the latest current and emerging threats and state-of- the-art research to help improve your team, your practice and your patients’ outcomes at Infection Prevention 2019 At the start of the year, the government published a 20-year vision and fiveyear national action plan for how the UK will contribute to containing and controlling AMR by 2040. Antibiotic resistance is predicted to kill 10 million people every year by 2050 without action. Without effective antibiotics, straightforward, everyday operations like caesarean sections or hip replacements could become too dangerous to perform. A major focus of the plan is to make sure current antibiotics stay effective by reducing the number of resistant infections and supporting clinicians to prescribe appropriately. The plans include targets such as: cutting the number of drug-resistant infections by 10 per cent (5,000 infections) by 2025; reducing the use of antibiotics in humans by 15 per cent; and preventing at least 15,000 patients from contracting infections as a result of their healthcare each year by 2024. New technology will also be used to gather real-time patient data, helping clinicians understand when to use and preserve antibiotics in their treatment. This could be followed and adapted all over the world, building the database on antibiotic use and resistance. Cutting antibiotic use Since 2014, the UK has cut the amount of antibiotics it uses by more than seven per

cent and sales of antibiotics for use in foodago. I don’t want it to be the future for my producing animals have dropped by 40 children – yet it may be unless we act. per cent. But the number of drug-resistant As Health Secretary, responsible for one of bloodstream infections have increased the most advanced healthcare systems in the by 35 per cent from 2013 to 2017. world, I could not look my children in the eyes The Department of Health and Social unless I knew I was doing all in my power to Care also outlined in January how the solve this great threat. When we have time pharmaceutical industry will be expected to act. But the urgency is now. Each and to take more responsibility for antibiotic every one of us benefits from antibiotics, resistance. NICE and NHS but we all too easily take them for England will explore a new granted, and I shudder at the payment model that thought of a world in which “Antim pays pharmaceutical their power is diminished. resistan icrobial companies based on Antimicrobial resistance a dang ce is as big how valuable their is as big a danger to er to hu medicines are to the humanity as climate m a s climat anity NHS, rather than change or warfare. e warfare change or on the quantity of That’s why we need an . antibiotics sold. urgent global response.” we nee That’s why d an ur Health and Social ge global r Care Secretary Matt Infection espons nt Hancock said at Prevention 2019 e.” the time: “Imagine a Infection Prevention world without antibiotics. 2019 will bring together Where treatable infections infection prevention and control become untreatable, where routine professionals from around the surgery like a hip operation becomes too world to share and debate best practice, risky to carry out, and where every wound research and discuss issues within the is potentially life-threatening. What would infection prevention field. This year marks a go through your mind if your child cut their special occasion, as we will be celebrating finger and you knew there was no antibiotic 60 years of Infection Control Nursing. left that could treat an infection? This was The three-day conference will present the the human condition until almost a century latest scientific evidence from around the E Issue 19.3 | HEALTH BUSINESS MAGAZINE


Preventable infection The programme has been prepared in furtherance of the IPS Mission Statement: No patient is harmed by a preventable infection. Secondly, the programme has direct relevance to your practice; you will have learning opportunities that will motivate and inspire you to consider how your local infection prevention and control programmes could be modified to improve care and reduce infection risks. You are encouraged to participate in conference by submitting an abstract for

Infection Prevention 2019 includes two supplementary one-day conferences, the first for the Development of Infection Prevention and Control Leaders and the second focusing on Infection Prevention in Paediatrics an oral or poster presentation. Presenting will give you the opportunity to play a key part in conference, whilst also contributing towards your continuous professional development. All abstracts are to be submitted online via the conference website before the closing date on 12 June 2019. You will hear from a wide range of UK based and international speakers including Professor Brett Mitchell, Dr Tim Boswell, Dr Gonzalo Bearman, Professor Claire Rickard, David Green, Professor Jennie Wilson and many others who are acclaimed for their expertise within the infection prevention and control industry. You will gain access to an exceptional educational programme and be able to attend the largest infection prevention exhibition in the UK offering exclusive access each day to learn about new science, technologies, advances, and products that provide solutions to infection prevention challenges and strengthen infection prevention programmes. Application for Continuing Professional Development accreditation from the

Infection Prevention 19

 globe and is expected to attract upwards of 600 professionals. The audience is varied and will include; infection prevention control nurses, DIPCs, infection control managers, microbiologists, antibiotic pharmacists, managers as well as other colleagues in associated professions. There are many professional and business benefits to attending Infection Prevention 2019. The conference offers an excellent environment in which to learn, build relationships, exchange ideas, network and socialise with your colleagues and industry partners. You will learn from leading experts in their field who will present on the latest current and emerging threats and state-of-the-art research to help improve your team, your practice and your patients’ / clients’ outcomes. These will be delivered through a combination of comprehensive presentations, meet-theexpert sessions and specialist streams of: leadership, paediatrics, new to infection prevention and international engagement.

Royal College of Pathologists is underway. In addition, all presentations will be mapped against the IPS competences to facilitate personalised-development and career progression. In addition to the main conference programme, Infection Prevention 2019 will see the return of the greatly received Infection Prevention Show. Dr Phil Hammond - NHS Doctor, BBC Broadcaster, Private Eye Journalist and Comedian, will host this exciting event taking place on 23 September 2019. The audience will be able to interact with experts and personalities whilst discussing new ways to combat infections and how to prepare for the future. Conference agenda Infection Prevention 2019 includes two supplementary one-day conferences which can be attended on their own or as part of the main conference registration. Firstly, the Infection Prevention in Paediatrics one day conference will address paediatric care across areas such as Infection Prevention & Control, E



The UVD Robot has the ability to reposition itself autonomously during disinfection. As the UVD Robot moves between disinfection positions, it continues UV-C irradiation at close proximity, avoiding shadow, on all surfaces it passes. Implementing robotic infection control methods into your cleaning process costs as little as £37 per day* and will significantly reduce staff costs.

*figure based on 5 year leasing agreement



per day

UVD Robots Ltd l 9 Prescott Street l Bolton l Lancashire l BL3 3LZ l England +44 (0) 161 710 0660 l

 Tissue Viability & Wound Care, IV and Infectious Diseases. The programme has been tailored towards all paediatric healthcare workers including: IV Specialist Nurses, ICNs, Tissue Viability Nurses, IPC Link Nurses and Infectious Disease Specialists. The Infection Prevention in Paediatrics will look at issues such as paediatric isolation, the threat of sepsis, medical related pressure ulcers, digitised care IV access pathway and techniques for a calm cannulation. Speakers come from Alder Hey Children’s Hospital, Leeds Teaching Hospitals NHS Trust and the University of West London. Following this, a day for the Development of Infection Prevention & Control Leaders will take place on 22 September. The IPS is presenting here an opportunity without difficulty. This day will support leaders in infection prevention and control (IPC) by providing expert workshops and presentations on behaviour, challenges and quality improvement. At a time when the difficulties facing IPC leaders are legion, new and re-emerging threats continue to develop, IPC leaders themselves require opportunities for advancement. This day is designed for IPC aspiring and experienced leaders to help them approach the challenges ahead - not as another crisis to manage, but as opportunities in a sea of difficulties. The Development of Infection Prevention & Control Leaders will look at issues such as behavioural science for infection prevention and control, lessons in leadership, and emotional intelligence in getting the most out of your team. Speakers come from the Infection Prevention Society, the University of Manchester and Leadership Consultants.

Infection Prevention 19

Threat of sepsis Recent figures have shown that hospital admissions for deadly sepsis in England have more than doubled in three years. NHS Digital data shows there were 350,344 recorded hospital admissions with a first or second diagnosis of sepsis in 2017/18, up from 169,125 three years earlier. This includes 38,401 admissions among those aged four and under, up from 30,981 in 2015/16. The data, obtained by PA, has prompted the head of the UK Sepsis Trust to warn parents they need to be just as vigilant for sepsis as meningitis, given the rise in recorded admissions among all age groups. For all children and young people aged 24 and under, there were 48,647 admissions in 2017/18, marking a 32 per cent rise on the 36,847 hospital admissions for sepsis for this age group in 2015/16. Sepsis is thought to kill 52,000 people a year in the UK. Ron Daniels, chief executive of the UK Sepsis Trust, said: “These potentially alarming data show that the number of recorded episodes of sepsis has more than doubled in just three years, a period coinciding with the recent focus on sepsis by the NHS in England. It’s highly likely that this means that we’re now closer to the true number of cases than we were three years ago.

At the start of the year, the government published a 20-year vision and five-year national action plan for how the UK will contribute to containing and controlling AMR by 2040 Awards Ceremony The Society’s social programme is equally acclaimed – especially the Infection Prevention Society Awards Ceremony and Gala Dinner, which will be held at the Rum Warehouse (Titanic Hotel) on Monday 23 September and recognises the talent and commitment that lies within the membership at a branch, team and an individual practitioner level. The annual Fun Night will be taking place at Revolución de Cuba offering an opportunity for conference delegates and exhibitors to socialise in an informal setting. With all this taking place over a three-day conference, we hope you and your colleagues are able to join us in Liverpool for this exciting, educational and practice-enhancing conference. Microorganisms and healthcare continue to evolve; Infection Prevention 2019 is your best opportunity to stay up to date. The Infection Prevention Society (IPS) represents 2,000 members working in the field of infection prevention and control, and plays a key role in helping to protect the public. Its vision is that no person is harmed by a preventable infection. Its mission is to inform promote and sustain expert infection prevention policy and practice in the pursuit of patient or service user and staff safety wherever care is delivered.

“However, there are other factors at play: The growing and ageing population, the just expectation of more invasive healthcare at greater extremes of life and the currently unquantifiable impact of antibiotic resistance. “A decade or two ago, infections such as urinary tract infections would be controlled by simple antibiotics – not so today. If the antibiotic doesn’t begin to control the infection, it may become more complicated – ideal breeding grounds for the onset of sepsis. A simple urinary tract infection could develop into a complex case in which the kidneys are also involved. Such complex infections, and any infection remaining under-treated, increase the risk of sepsis developing.” Coinciding with the release of the figures, the Royal College of Emergency Medicine has warned that a tool for tracking sepsis in children was not used as often as it should be and A&E departments were struggling to ensure youngsters suspected of having the condition were seen quickly enough and then reviewed by a senior doctor. L FURTHER INFORMATION





Destroying all known germs and pathogens The challenges faced by the NHS have never been greater. Hospital acquired infections are reaching new heights and antimicrobial resistance is of a global concern. The cleanliness of your hospital remains critical to achieving positive patient outcomes. However, this is often difficult to achieve with escalating costs and stretched budgets. Infection Prevention teams across the world are recognising that Ultra Violet C disinfection has an important part to play in augmenting current IPC practices. The introduction of UVC Technologies into the room disinfection process should have the capability of being fast, effective and repeatable. Additionally, they should have the ability to be proactively deployable within a protocolled environment, thereby preventing infections by continuously reducing the bio-burden. Finsen Technologies has

meticulously considered these factors in the design and development of its unique shadow reducing and powerful UVC Disinfection Technology, THOR UVC®. THOR UVC® is truly the most powerful UVC disinfection robot in the world and literally stands tallest in its disinfection class. THOR UVC® is proven to destroy the toughest micro-organisms in your hospital, repeatedly achieving outstanding log reductions. Visit the company on Stand 31 at Infection Prevention 2019.

FURTHER INFORMATION Tel: 0207 193 5641


High performance disinfectants

Tristel is the only company in the world to combine its proprietary chlorine dioxide technology (ClO2) with innovative packaging to deliver high-performance disinfectants. The TristelTM portfolio comprises chlorine dioxidebased disinfectants for semi-critical medical instruments. The Tristel Trio Wipes System is the world’s most widely approved, validated and used high-level disinfection wipes system. The Tristel Sporicidal Wipe is proven effective in a uniform contact time of 30 seconds, the same contact time as used

in each of the tests required by BS EN 14885: 2018. CacheTM is Tristel’s cleaning and disinfection brand for hospital surfaces. JET is a powerful sporicidal disinfectant that can be used on medical device surfaces located near to the patient. It is also a powerful cleaner destroying RNA and DNA in seconds. JET is the best safeguard for patients and staff wherever the risks of infection are highest. Find out more on stand 37 at the IPS 2019 conference.


Disinfection solutions for hospitals with UVD Robots

INFECTION PREVENTION UVD Robots was founded in 2016 by Blue Ocean Robotics with the objective of globally commercialising robotic based UV Disinfection solutions for hospitals. The UVD Robot is used as part of the regular disinfection process and aims to prevent and reduce the spread of infectious diseases and harmful organic microorganisms in the environment by breaking down their DNA-structure. The unique benefit of the UVD Robot is autonomous UV-C disinfection, which eliminates human error factors, allowing room for disinfection to join the list of autonomous decontamination processes

that can be validated, making history in infection prevention. The UVD Robot delivers UV Disinfection like no other system and can be used as part of your daily cleaning routine. The unique Robot can manoeuvre itself around the room, avoiding obstacles, which vastly reduces any shadowing. Furthermore, UVD Robots are user friendly and designed to be operated by every-day cleaning operatives. Please come and say ‘hello’ to the company’s Robot on Stand 65.


Reducing the risk of HAIs in your hospital Bioquell – one of the leading global experts in reducing biocontamination in the healthcare industry – is highlighting its range of bespoke solutions for eliminating healthcareassociated infections (HAIs). The Bioquell BQ-50 is a portable, easy to use biodecontamination system utilising the company’s proven 35 per cent hydrogen peroxide vapour technology. Bioquell’s Proactive service provides a full time, on-site technician to perform daily bio-decontamination with hydrogen peroxide vapour or to ensure a swift response to unplanned emergency scenarios. With infection control priorities shifting at any time, Bioquell’s 24/7 Rapid Biodecontamination Service (RBDS) will react quickly to eliminate pathogens and stop escalated incidents for any size area. The Bioquell BQ-50 is designed to protect

patients, staff and the wider community by creating a fully decontaminated environment anywhere in the hospital. Bioquell Proactive allows hospitals to implement a focused bio-decontamination plan with a full time Bioquell technician based on site to perform daily bio-decontamination. Available on a 24/7 basis, Bioquell RBDS reacts quickly to stop escalated incidents and handle emergency response situations.

FURTHER INFORMATION Tel: 01264 835 835



Healthcare Estates

More, more, more. Are you ready?

solutions to the challenges they face on a daily basis and keep up to date with the latest product innovations. The exhibition offers visitors the opportunity to come and browse new products, new ideas, innovative solutions and talk with experts from over 250 organisations working across the healthcare sector. A packed hall full of interesting ideas and technical expertise for two full days in Manchester. Set to be the biggest event in its history, Healthcare Estates Travel to the venue is easy, direct trains from takes place on 8-9 October at Manchester Central, with more London are still at a surprisingly than 240 exhibitors and over 4,500 attendees expected. affordable rate and parking on site is free for our Show organisers, Step, provide a preview Healthc VIP guests who also are get complimentary Estates is Healthcare Estates 2019 is just a few short director, an apprentice, refreshments and a the only n weeks away, with preparations really ramping or any professional VIP meeting area. a t io confere nal up now for the biggest event yet; more level in between; the The Healthcare n c e t o bring togethe exhibitors, more speakers, more exhibition learning opportunities Estates exhibition, design, r those who theatres, a fabulous new venue for the are many and varied features over build Dinner and Awards, and a very special and this year, and with 200 stands – so and ma manage plenary theatre on the exhibition floor this the event hosting the two days of in year that Keynote presentations will take International Federation your time gives healthc tain are place in. Keynote sessions are open not only of Hospital Engineering, you the complete facilities to delegates to attend, but to VIP visitors, experts from all over the technical, practical, exhibitors and apprentices. The event hosts world are attending and professional and political the International Federation of Hospital speaking at the conference. framework in which to Engineering, and delegates from around make effective decisions. If you the world will be visiting Manchester to Healthcare Estates Exhibition want to know if you’re doing things attend the event, as well as experience Healthcare Estates is a truly unique event right, this is the right place to begin. Manchester’s famous northern hospitality. in the UK market – the only national Healthcare Estates is the unrivalled Healthcare Estates will take place on 8 conference and exhibition to bring platform for estate managers, directors, and and 9 October at Manchester Central, and together those who design, build manage facilities managers running and managing we are certain that over the two days the and maintain healthcare facilities. hospitals to network with industry conference programme and exhibition Healthcare Estates’ visitors make a colleagues, services and other contractors theatres have something of interest for conscious decision to attend the event while sourcing and specifying the latest everyone, whether an estates and facilities setting aside valuable time to find healthcare products and services. E





Lighting Management & Emergency Monitoring SmartScan, from Thorlux Lighting, is a revolutionary wireless lighting management system. Its powerful features not only help save energy, they also make managing and maintaining lighting simple, through energy performance data to complete operational status information. The system will even monitor occupancy and environmental conditions, such as temperature, humidity and CO2 levels. Recognising this technological advancement, SmartScan is a winner of The Queen’s Awards for Enterprise: Innovation 2019. As a complete solutions partner, Thorlux can help with site surveys, lighting design, and installation. A range of funding options are available to help realise your lighting upgrade for zero up front cost.

The Queen’s Awards for Enterprise: Innovation 2019

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Conference streams and keynote speakers The conference has four streams – Strategy and Leadership, Engineering and Facilities Management, Planning Design and Construction, and Innovation. Among the keynote speakers on the 8 October are Simon Corben, director and head of Profession NHS Estates and Facilities, NHS Improvement, Alasdair Coates, CEO Engineering Council, and Darryl Pitcher, President of the IFHE. On 9 October, the keynote speakers are Professor Michail Kagioglou, Dean of the University of Huddersfield, and Alan Sharp, CEO, Mater Hospital Dublin. The Motivational speaker for the second day is Sally Becker, dubbed the ‘Angel of Mostar’. Plenary theatre Keynote sessions in the Plenary Theatre are followed by content that anybody attending the event can go to – a session from the IHEEM Diversity and Inclusion Group on 8 October, and on 9 October, a workshop from NHSI, and an international case study session – all free to attend. In addition, there are seven exhibition theatres to choose from. The presentations in the Plenary Theatre on the first day focus on diversity and inclusion, with speakers from the IHEEM Diversity and Inclusion Working Group; including chairman of the group Dr Manju Patel, Suzie Mertes from Police Scotland, Claire Hennessy from Birmingham Community Healthcare NHS Foundation Trust, Ashley Dunsmore from Kier Construction, and Trish Marchant from Cambridge University Hospitals NHS Foundation Trust. Kim Shelley from ETA Projects, and Elizabeth Donnelley from WES, add to the power of this session, with Simon Adamson from South Tees Hospitals NHS Foundation Trust, and James Chadwick from University Hospitals of Derby and Burton NHS Foundation Trust discussing Engineers of the future. Following Keynote presentations on 9 October, NHSI will be leading a workshop, the focus of which can be dictated in advance by attendees. IHEEM is hosting a survey to establish the most popular topics that visitors to the event would like to be covered. The afternoon of 9 October will feature international case studies from the Falkland Islands, Germany, and Ireland, covering exemplars in hospital design, energy saving, and facilities management.

Healthcare Estates is the unrivalled platform for estate managers, directors and facilities managers managing hospitals to network with industry colleagues, services and other contractors while sourcing and specifying the latest healthcare products and services Conference In the strategy and leadership conference stream, a range of management issues are covered, including Locality Asset Review (LAR), in which public sector assets are assessed against current and projected clinical need and future demographics of the area, to ensure efficiency and make savings. The disposal of trust land to fund clinical facilities, which in itself could be the resulting action following an LAR, is the feature of a presentation, and the staffing, funding and management challenges of bringing more services in-house after the instability in outsourced service providers are discussed. Other sessions include offsite construction and the benefits of extending existing clinical space with minimal disruption to ongoing service. Place-based care is an initiative that is gathering pace, with GP surgeries joining a network to serve a wider geographical area; this theme is followed through in a session on the creation of an index for healthcare planning, to ensure that cities are ready for future healthcare requirements and the rise in urban-based populations. Coupled with planning healthcare infrastructure for the climate of the future, the emphasis is on planning for healthcare provision beyond the decade that is about to begin.

Healthcare Estates

 Plan your visit As a Visitor, you have access to the Healthcare Estates exhibition, plus all the additional supporting content in the hall, seven theatres of high quality free content. To attend the Conference sessions, you need to register as a Delegate. If you’re attending as a Delegate, you can pick whichever sessions you wish from the Conference Programme. Meet the IHEEM team. If you are not already an IHEEM member, Healthcare Estates is a great way to meet the team and learn more about the benefits of membership. IHEEM will be on stands E14 and J1. Go and have a try and mini golf while discussing membership, and having your conference and exhibition theatre attendance CPD accredited.

Translating changing healthcare requirements into the reconfiguration will be unpicked and explained by means of a case study of the reconfiguration of sites within the University of Leicester NHS Trust – learn from those already undertaking such a project, and take forward lessons into your own healthcare setting. Procurement standards will also be discussed, together with the CQC inspection toolbox – how to prepare, what will be inspected, legal accountability, and the consequences of non-compliance. The engineering and facilities management conference sessions on the Tuesday, include ventilation and air quality, cleaning and decontamination, and water hygiene risk assessment. The second day of the event dives deep into the technology of energy saving and electrical safety, covering electrical infrastructure design, low energy buildings with renewable energy technology, and energy saving in compressed air systems. Planning, design and construction will begin with a session by Procure 22, looking at achievements and initiatives within the framework for the past 12 months, an update on the P22 EPP programme, and the Framework in practice, looking at evidencebased frameworks. This will be followed by the importance of art in the healthcare E



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With so much pressure to reduce spend and improve energy efficiency measures, many organisations have been forced to adopt demanding targets to cut greenhouse gas emissions and are therefore looking for alternative solutions to update energy and heating systems. Reliable and resourceful systems Offering reliable and resourceful systems with considerable savings in energy and cost (when compared to more traditional systems such as shell and tube calorifiers), ARI-Armaturen’s ENCOsys® is a compact, low maintenance steam-to-water plate heat exchanger. Suitable for various applications including domestic hot water, low temperature hot water, and process heating, these innovative units are currently in operation in many healthcare sites and hospital plant rooms over the UK. Designed to provide hot water instantaneously whatever the load conditions up to 2100kW, there is no need for a water storage vessel. Having

no water storage vessel is an added advantage because it also helps to eliminate a potential breeding place for Legionella and other bacteria’s, therefore reducing the requirement for regular inspections. Sites with ENCOsys® units installed benefit from improvements to operating efficiency with reduced heat loss from equipment, improved temperature control as well as better thermal efficiency, all resulting in vast improvements to operation efficiency and energy savings. This system is more responsive to changes in the secondary operating conditions resulting in far tighter temperature control. Generally, the water temperature leaving shell and tube heat exchangers tend to cycle in a pattern similar to a sine wave which means the temperature set point may have to be set higher to ensure the unit meets the required load at all times. By using the ARI-ENCOsys®, temperature control is considerably improved, typically providing an estimated three per cent energy saving. Based on these factors, ENCOsys® can

Compact design Another benefit of the ENCOsys® heating systems is that the physical design is extremely compact, with the largest unit occupying around 3m3 and the smallest unit occupying less than 1.5m3 resulting in a smaller footprint than many other alternatives on the market as well as allowing for significant savings in valuable floor space. Nicholas Davies, ARI-Armaturen UK Ltd sales director, said: “By heating the secondary water and sub-cooling the condensate in the same plate heat exchanger, substantial energy savings can be achieved and the cost of ownership is further reduced because improved energy efficiency means lower fuel bills and low CO2 emissions.” ARI-Armaturen boast a wealth of knowledge and technical experience in energy management systems so from assessing your initial requirements, through to conduction of surveys to final commissioning, the installation process can be completed in a short timeframe, leaving you rest assured that you have been provided with a quality product and quality service. This range of well-engineered, packaged solutions from valve specialists ARI-Armaturen UK Ltd come fully assembled to specific requirements and tested ready for connection. See how ARI-Armaturen can help you cope with rising energy costs – contact the UK sales office on 01684 275 752 or email L FURTHER INFORMATION 01684 275 752



BeaconMedaes – New products launching for medical gas, maintenance and installation services

BeaconMedaes, medical gas pipeline specialists will be using the Healthcare Estates exhibition to launch new products and services as well as demonstrate other key products launched in the last few years. The new medical air plant dryer will be showcased with updated state of the art controls as well as a simplified filtration layout for ease of maintenance. The vastly reduced footprint, coupled with the footprint reductions offered with Atlas Copco VSD+ compressors will enable

upgrading old obsolete plant, using the same space constraints. This in lieu of having to include an additional compressor for HTM02-01 compliance. Dedicated oil free dryers will also be launched to couple with class leading oil free air solutions using Atlas Copco scroll or tooth compressors. Central to BeaconMedaes’ service, maintenance and installation business will be their new bespoke cloud based asset management, reporting, compliance and training platform called MyMedGas.

This will enable a facility to keep track of all their equipment and it’s status, reporting open jobs and quotes in a central easy to access location. This will enable a facility to have an on screen summary of the medical gas system and it’s health status. This will all be demonstrated at the show. FURTHER INFORMATION

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Medical Gas Maintenance and Installation Services 20180723 HEJ.indd 1



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 environment to reduce stress and aggression, research into the influence of design on physical and psychological health, and the impact of outside spaces and gardens within hospital settings, on the wellbeing of patients, visitors and healthcare professionals. Hospital accessibility for patients with specific mobility issues is also considered, with a new wayfinding scheme showcased. Mental health and the design that this specialist patient group need in a healthcare setting, including a case study of patientcentred hospital design in Finland, and biophilic design and its impact on the mental health and performance of building users will be discussed. Acoustics and noise in the hospital environment is an important topic, whether noise is in regular wards or the ICU environment, low noise levels and appropriate acoustics are important for patient recovery, relieving pressure on beds and speeding recovery time. With the majority of Europe having regulations on noise levels in hospitals, the UK is lagging behind in not having regulations in force. The conference also features exemplars of hospital planning, design and construction, one covering a brand-new hospital in Strasbourg, and the 10-year planning, design and build process involved, and another example of the integration of new and old healthcare buildings at a maternity and paediatric care facility in Italy. Innovation shines a light on healthcare of the future, encompassing new technology that enables, enhances and facilitates energy saving, connectivity, clinical excellence, and safety testing. A session is included on connected healthcare, which looks at smart hospitals, where digital platforms for all systems can provide data to help integrate and improve systems, enhance efficiency and make savings. The event is sponsored by Armitage Shanks and Bender and will feature exhibitors across a wide range of areas in healthcare: plumbing, training, compliance, management, lighting, engineering, water management, infection control, fire, offsite construction, flooring, sanitary ware, security, doors, windows, ventilation, architecture, technology, and construction.

Exhibition Theatres The seven exhibition theatres give visitors plenty of opportunity to catch up on the latest products, regulations, and best practice with free content for all and relevant exhibitors providing solutions to the many topics discussed.

Training, Staffing and Apprentice Zone – The Troup Bywaters + Anders team will be on hand with key industry representatives discussing their experiences with apprentices, benefits of the government apprentice scheme plus first hand examples from current and past apprentices. There are significant changes on the horizon within the health sector, including the introduction of new roles and changes to how training will be funded. Many trusts are looking at NHS apprenticeships as a way of meeting the challenges that lie ahead. Supported by: IHEEM, National Apprenticeship Service, Apprenticeships Ambassador Network, TROUP BYWATERS +ANDERS and INVESTORS IN PEOPLE. Exhibitors in the zone include; Trade Skills 4U who offer the widest range of courses for the electrical trade in the UK. TClarke exhibiting in our Bitesize area offer one of the most highly sought after Apprenticeship Scheme regarded as one of the best in the UK in the construction and engineering industries.

Healthcare Estates

making the area a ‘must attend’ by architects, contractors and clients. The theatre content is supported by: Architects for Health, Design in Mental Health Network and Procure 22.

In-depth content will be delivered by the Carbon and Energy Fund, which was specifically created to fund, facilitate and project manage complex energy infrastructure upgrades for the NHS HVAC & Engineering Theatre – Sponsored by SolXEnergy, will focus on topics including gas safety, infection control, HVAC, waste management and many more will be covered in a theatre focused on technical content aimed at IHEEM members and their colleagues in the healthcare sector. Supported by: IHEEM, CIBSE and The Society of Public Health Engineers (SoPHE). Infection Control and Water Theatre – The Water Management Society will host meetings and presentations focused on water and infection control. The zone, our biggest in the exhibition, will play host to products and services designed to increase water safety and reduce infection risk in hospital environments. Exhibitors include: Delabie,;Ari-Amaturen; Kemper; and Steris Solutions. The area and theatre is supported by: Closed Systems Control Association: Legionella Control Association, CIBSE, Society of Public Health Engineers (SoPHE), and The Water Management Society. Design and Construction Theatre – The theatre features the latest project case studies, findings from post occupancy evaluation as well as the sharing of best practice in exemplar design and construction, the zone features key exhibitors including; IBI Group, Procure 22, P+HS Architects, Gradus and Tarkett

Energy and Sustainability Theatre – In-depth content will be delivered by the Carbon and Energy Fund, which was specifically created to fund, facilitate and project manage complex energy infrastructure upgrades for the NHS. The Climate Change Act set legally binding targets for carbon reduction, and this zone will showcase the latest techniques and innovation in reducing the carbon footprint across the NHS, enabling it to meet its carbon reduction targets. Supported by: The Carbon and Energy Fund, the zone also includes SHJ Medical Gas Specialists who are committed to developing energy saving systems for a cleaner environment, working with industry leaders in green technologies and Socomec, a specialist of safety, control, continuity, quality and efficiency of low voltage applications alongside major organisations like Siemens, Antas Energy Efficiency and Vital Energy. Facilities Management Theatre – Sponsored by North of England Commercial Procurement Collaborative the area focuses on issues that Facilities Management Personnel face on a day to day basis, including hard and soft FM. Sessions include an exploration of how current digital technology and methodologies can be exploited to maximise efficiencies when managing a Healthcare estate. The use of multiple technologies to deliver a simple, yet comprehensive asset management system E Issue 19.3 | HEALTH BUSINESS MAGAZINE


)3454901 Tel: +44 (0652 652 4901 Tel: 0845 MGPS Services Ltd The Stables, The Kennels Siston Lane, Siston Bristol BS16 9LR

A complete range of HTM 02-01 MGPS Operational Management services:  BTEC Accredited Full and Refresher Authorised Person (AP) training.  BTEC Accredited Competent Person (CP) training.  Competent Person Refresher training.  Cylinder Awareness Porter and Nurse training.  Designated Nursing Officer (DNO) and Designated Medical Officer (DMO) training.  Dental Air and Vacuum training (DAVs).  HTM 02-01 (Part A) Compliance survey, report and risk assessment.  Site-specific Operational Policies & Procedures.  Policy implementation and assistance setting up Medical Gas Committee.

For latest news and courses, visit our website

 Authorising Engineer services (operational management audit (Part B) and AP Assessments).  Authorised Person services (AP cover for your hospital).  Medical Gas project management.

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 MGPS As-Fitted and/or Schematic drawing service.

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Healthcare Estates

 for healthcare and The World’s First Antimicrobial IPS Unit To Contain Biocote Technology. The area is supported by: FM North & HEFMA. Exhibitors in the zone include; Howarth Air Technology – who since their development of the Ultra Clean Ventilation system, have been more closely associated with providing controlled clean air for operating theatres. BioClad is a global supplier of hygienic wall lining and vinyl flooring systems, Marlux Medical Ltd pioneered the world’s first disposable privacy curtains and continues to lead the way in infection control innovation and AVM Services who are decontamination specialists operating commercially within the Estates and Facilities department of Cambridge University Hospitals NHS Foundation Trust. Fire and Security Theatre – Sponsored by Yeoman Shield, following numerous unprecedented disasters in recent times, there is an ever-growing demand to ensure fire safety and security in the public sector. This theatre will present and promote the most recent solutions to fire safety needs. Speakers will be from a wide variety of fire & security companies and associations who have firsthand experience in tackling the complex issues faced within healthcare estates, including active & passive fire protection. Supported by: NAHFO. Exhibitors in the area include Xtralis, part of Honeywell, the leading global provider of powerful solutions for the early detection and visual verifications of smoke, fire, and gas threats. Other exhibitors in the area include Honeywell Gent and Johnson Controls. Awards Dinner The Healthcare Estates IHEEM Awards Dinner takes place on Tuesday 8 October at The fabulous, iconic building, The Principal Manchester.

With an expected 600 guests attending the awards dinner, the night is a fantastic occasion, celebrating excellence and achievement in the industry Principal Manchester is an unmistakable landmark in the city’s skyline, with its clock tower and striking Victorian architecture. A magnificent terracotta Grade II listed building, the hotel has a history dating back to 1890, when it first opened as The Refuge Assurance Company headquarters. The awards ceremony and dinner will take place in the Grand Ballroom, with the pre-dinner drinks reception in the glorious Whitworth Rooms. The Ballroom is the largest single hotel event space in the northwest of England, has its own dedicated private entrance, and its own private bar for postawards ceremony celebrating and networking. With an expected 600 guests attending the awards dinner, the night is a fantastic occasion, celebrating excellence and achievement in the industry. The dinner is a unique opportunity to network with the best in the healthcare sector: award winners and nominees, exhibition and conference attendees, speakers, sponsors and exhibitors, and to continue discussing the day’s topics whilst enjoying a luxurious three course meal with wine. The After-Dinner speaker this year is Peter McDonald, who has been a Consultant General Surgeon at Northwick Park and St. Mark’s (NPM) since 1991. Being a bowel surgeon, he has a well-developed sense of humour that gives his audience a glimpse into both the lighter, and occasionally, more serious side of being a consultant surgeon. Through witty anecdotes and stories,

Peter will confirm that humour is the best medicine and that Voltaire was right when he wrote that ‘the purpose of medicine is to amuse while nature takes its course’. Awards this year are in the following categories: New Build Project of the year, sponsored by Bender; Refurbishment Project of the Year, sponsored by engie; Product Innovation, sponsored by SPIE; Architectural Practice of the Year, sponsored by Rockfon; Apprentice of the Year, sponsored by Troup Bywaters+Anders; Sustainable Achievement, sponsored by bam; Estates and Facilities Team, sponsored by HEJ; Consultancy of the Year, sponsored by Texuna; and IHEEM Lifetime Achievement Award, sponsored by IHEEM. How to register as a VIP? VIPs are attendees either employed directly by the NHS or private medical provider, members of IHEEM or Architects for Health. VIPs are entitled to free access to the VIP area at Healthcare Estates, sponsored by Wandsworth Healthcare. The VIP area has refreshments and seating for those important meetings with current and potential suppliers, VIPs are also entitled to free parking while they are at the venue – just get your parking ticket from the NCP car park underneath Manchester Central validated in the VIP area. L FURTHER INFORMATION




Designing your solution: connecting your world

Protecting the interior of hospital buildings

GlobalView is a UK developer of a range of award-winning safety software to protect your hospital, its patients, visitors and workers. The company provides solutions to keep you in full control, ensuring a swift incident response, whilst maintaining a continuation of services and care to patients. Minimise the impact of any incident with lone worker protection - whether using the two-way radio, mobile phone or PC. Those working independently are often at the highest risk. Intelligent automatic protection, through their existing device. Automatic safety checks, full report, location positioning to safeguarding your workforce. Make sure the right person gets the right message for the most effective response – mitigate

Yeoman Shield is a market leader in the supply and installation of Yeoman Shield wall and door protection products. Based in Leeds, providing national coverage and support from area sales managers, the company provides cost and labour- saving wall and door protection systems specially designed for healthcare environments. Yeoman Shield has a range of over 40 systems available in a choice of 48 colours and three finishes. From protection rails to handrails, wall protection panels to complete door protection systems, and with the capability to manufacture bespoke items, a solution to most impact damage problems is assured. With over 50 years’ experience, Yeoman Shield can provide the right protection system for your building, helping to

potential issues before they become a problem, and respond quickly with minimal disturbance through alarm management. Linking you directly to all your critical and business alarms. Fire, security, BMS, temperature and more. Proactive emergency preparedness to ensure you’ve the right people, with the right skills, to respond under any circumstance. Plus, the ability to alert them simultaneously over many communication devices: two-way radio, mobile phone, PC or pager – no need to carry an additional device.


minimise future repair and redecoration requirements by reducing the effect of impact damage to interior walls and doors, helping to keep buildings looking smart and clean. Free site surveys and samples are available on request with the full product brochure available to download on the Yeoman Shield website.

FURTHER INFORMATION Tel: 0113 279 5854

An independent medical gas consultancy

Trust ARI for economical solutions in healthcare

MGPS Services is proud to be a truly professional and independent medical gas consultancy and training provider working within the UK, Ireland and many countries overseas. The company provides a wide range of medical gas training courses to the healthcare services and to the private sector. MGPS Services is an ISO 9001:2015 registered company, accredited to deliver BTEC training courses and are an IHEEM affiliated company. The organisations also has an IHEEM registered AE(mgps). Training courses are delivered either at a purpose-built training facility or can be delivered at your own offices.

ARI-Armaturen UK Ltd is delighted to be exhibiting again at the Healthcare Estates Exhibition (stand E68), 8-9 October 2019 at Manchester Central, where the company will proudly present a range of economical solutions for healthcare estates and facilities. ARI-Armaturen works with hospitals across UK successfully achieving low maintenance solutions offering maximum sustainability, optimum efficiency, reliability and energy savings. Specialising in control, isolation, safety and steam trapping, ARI offers an impressive range of valves, steam traps and engineered systems. The main features to be showcased include ZETRIX, ENCOsys and CONA Control, among other valves. ARI’s premium triple offset

MGPS Services is your onestop-shop for all your medical gas requirements and is always happy to discuss your requirements or difficulties providing free, friendly advice and guidance. Visit MGPS Services at Stand E11, meet the company’s staff and join in its competition to see if you can win a price.



isolation valve – ZETRIX – will be featured as a double block and bleed arrangement. Boasting zero leakage and emissions, ZETRIX provides guaranteed isolation (conforming to leakage rate A in accordance with DIN EN 12266-1) and is suitable for liquids, gases and vapours. ENCOsys is a compact, low maintenance steam-to-water plate heat exchanger which provides hot water instantaneously up to 2100Kw. The clever design allows for no requirement of a water storage vessel, which is a potential breeding place for Legionella and other bacteria.

FURTHER INFORMATION Tel: 01684 275 752

The largest medical gas service provider BeaconMedæs is the world’s leading supplier of medical gas pipeline equipment (MGPS), including medical air plant, medical vacuum plant, AGS, manifolds and pipeline components to HTM 02-01 standards. The company also supplies patient environment products including trunking and pendants. Certified ISO-13485 quality management, ISO-14001 environmental management and OHSAS-18001 occupational health and safety management systems, underlines the company’s commitment to high quality services and products, whilst aiming to reduce its environmental impact and maintain a safe and healthy workforce. BeaconMedæs products are CE marked to the MDD, further

demonstrating its commitment to quality and enabling the company to stand out from its competitors. The BeaconMedæs installation team is pre-qualified through Safecontractor, CHAS and Constructionline, offering unrivalled expertise with its products. With a proven track record of delivering projects on time, the organisation can help you out. Following installation, BeaconMedæs can also provide preventative maintenance contracts and emergency repair services.

FURTHER INFORMATION Tel: 01246 474 242


Maximising the LED technology opportunities Founded in 1936, Thorlux Lighting is the largest company within the F W Thorpe Plc group, operating from a modern 16,882 square metre self-contained factory in Redditch, Worcestershire. The company designs and manufactures industrial and commercial lighting equipment, with a particular focus on energy saving and through life costs. Thorlux is able to exploit recent advances in LED technology to help meet customer demand for energyefficient solutions. The company’s considerable technical expertise and its ability to invest position it to maximise the opportunities offered by LED technology. The company has developed a revolutionary wireless lighting control system, SmartScan, which allows users to monitor their energy performance data and complete operational status information for all SmartScan standard and emergency

luminaires. This information is displayed on the SmartScan website which can be accessed from anywhere using a computer, laptop, tablet or smart-phone. Thorlux offers a wide range of lighting solutions for the Healthcare sector. Projects combining Thorlux LED luminaires and Smart controls frequently benefit from energy savings in excess of 70 per cent when compared with conventional technology. Smart sensors monitor ambient light and presence, control output to the correct level, dim and switch when there is sufficient daylight and illuminate only when the area is occupied.


Are you safe from laser radiation in your hospital?

Water testing solutions for hospital environments

Ophthalmology, Urology, ENT, Neonatal, Dermatology – wherever you go within a modern hospital environment, lasers are an integral part of patient care and treatment. Ensuring safety is paramount no matter what lasers are used, and your hospital must comply with relevant legislation. To help pass CQC inspections and to help bring your hospital in-line within the surgical and non-surgical environment, Lasermet’s LPAs advise what your staff, Medical Physics Department and the senior management team should do to ensure laser equipment, and the area in which a laser is used, is safe for all personnel. Lasermet’s laser safety training (including Core of Knowledge) and engineered laser safe solutions are critical in these medical environments in preventing inadvertent exposure

IDEXX Water (Stand D50) is a global provider of water testing solutions that deliver easy, rapid, accurate and cost-effective information on water quality to laboratories and public utilities around the world. At Healthcare Estates, IDEXX will be showcasing its portfolio of products, including its most recently launched test, Legiolert®, which is an easy to use culture method for the rapid and accurate detection of Legionella pneumophila, the principal causative agent of Legionnaires’ disease. IDEXX entered the water testing market in 1993 with Colilert®, now one of the most frequently used testing methods for the detection of coliforms and E. coli in water worldwide. In 2014, IDEXX launched Pseudalert® for the 24-hour detection of Pseudomonas aeruginosa in hospital water

to laser radiation. Lasermet’s certified interlock controls, roller blinds, LED signage and related equipment is all designed specifically for theatres to conform to the internationally recognised laser safety standards BS EN IEC 60825-1, 6082514 and related standards. Lasermet is a privately owned UK company covering every aspect of laser safety since 1987. The company’s own manufactured products are used in thousands of hospitals, medical research establishments, clinics and practices worldwide. Visit Lasermet on stand G35 at Healthcare Estates.


systems. Pseudalert, which won the Healthcare Estates IHEEM Product Innovation award in 2014, can be set up with minimal capital expenditure within a facility, to enable in-house testing and monitoring of hospital water systems. Pseudalert gives confirmed results in 24 hours, less than half the time taken by traditional agar culture methods.




WCS Group. Specialist water safety solutions for healthcare providers. WCS Group deliver bespoke, ‘best in class’ water safety solutions and secondary disinfection systems, supporting over 80 NHS Trusts and healthcare providers across the UK to adhere to HTM04. We are specialists in:


• Water Safety Plan Attendance & Consulting • Legionella & Pseudomonas Testing • Waterborne Bacteria & Infection Control Training • Water Purification to Healthcare Standards • Primary & Secondary Water Disinfection • PPM and Reactive Works (Nationally)


Contact or visit


Cert No. 11011 ISO 9001, ISO 14001, OHSAS 18001

The naturally compromised immune systems of many patients in hospitals increases the risk posed by the Legionella bacteria. So how can facilities managers ensure Legionella does not fester and grow within hospital systems? The Health & Safety Executive (HSE) and Wales, commonly manifesting in poorlydefines Legionellosis as a collective term maintained air conditioning and water for diseases caused by Legionella bacteria systems. By ensuring that water temperatures including the most serious Legionnaires’ are kept outside of prime growth disease, as well as the similar but less temperatures (20-50°C) facilities managers serious conditions of Pontiac fever and can ensure Legionella does not fester and Lochgoilhead fever. Legionnaires’ disease grow within their system. Usual practice is a potentially fatal form of pneumonia is to take temperature readings manually and everyone is susceptible to infection. to ensure that this does not happen. The bacterium Legionella pneumophila and related bacteria are common in natural water Common misconceptions sources such as rivers, lakes and reservoirs, Recent doubts over how accurate, and but usually in low numbers. They may also be therefore safe, this is have, however, called found in purpose-built water systems such for a new measurement and monitoring as cooling towers, evaporative condensers, system. As the age of manual data hot and cold water systems and spa pools. If monitoring draws to a close, the benefits conditions are favourable, the bacteria of more accurate systems are being may grow, increasing the risks exploited. An ideal system is of Legionnaires’ disease. It one that automatically is therefore important and consistently takes to control the risks by readings over a regular Partial introducing appropriate time period and k n owledg measures outlined in e can be as d Legionnaires’ disease a n g erous – The Control of as no k n o w Legionella bacteria in led when d water systems (L8). ealing wge ith Although Legionella Legione lla is preventable, there are nearly 6,000 cases a year across Europe, including around 350 in England



Realising the risks of Legionella bacteria

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


Thames Air & Water Tech Ltd are an ambitious Legionella Management Company. We constantly strive to achieve the highest standards for our Clients and best environments for our team here in the UK. Here at Thames Air & Water Tech, we are always looking to enhance our service delivery. We have been using a full range of electronic reporting platforms for several years with the cleaning and disinfection of Cooling Towers & Cold-Water Storage Tanks. These platforms include the upload of photographic evidence to show our Clients, both current and prospective, just how good we are at what we do. We also provide detailed E-reports from TMV servicing to tap temperature monitoring. We aim to help the environment by reducing our carbon footprint. We do this by eliminating paper with our electronic reporting systems and solid based chemicals. The solid chemicals are supplied for Steam Boilers, Cooling Towers and closed loops systems based upon a full FOC site survey. We use an independent UKAS credited laboratory for biological analysis with a full range of testing from a TVC 2&3 day incubation to Legionella. With regard to effluent we can also help from supplying coagulants and polymers to testing for COD’s, BOD’s, TSS and FOG’s. We have experience in a multitude of sectors and cover all industries; ranging from Food & Drink, Education, NHS, MOD, Plastic, Glass and Hospitality. Our passion is helping to improve efficiency of plant and reducing costs with using our experienced staff and programmes specifically tailored to suit your needs. We are registered under the LCA Legionella Control Association to assist with compliance to HSG274 regulations, please visit our website link for our current certificate which is available to see at To keep us and you covered we have Public Liability Insurance to the effect of £10M Employers, £5M Public and £5M Products respectively. If you are interested in more information about our Company, products or services and would like to know more about how we can help you and your site, please get in contact below:

Call: +44 (0800) 410 1103 Email: 24 Oakwood, Flackwell Heath, High Wycombe, Buckinghamshire, HP10 9DW

You or the person responsible for managing risks, need to understand your water systems, the equipment associated with the system such as pumps, heat exchangers, showers etc, and its constituent parts

What you must do If you are an employer, or someone in control of premises, including landlords, you must understand the health risks associated with legionella. Duties under the Health and Safety at Work etc Act 1974 (HSWA) extend to risks from legionella bacteria, which may arise from work activities. The Management of Health and Safety at Work Regulations (MHSWR) provide a broad framework for controlling health and safety at work. More specifically, the Control of Substances Hazardous to Health Regulations 2002 (COSHH) provide a framework of actions designed to assess, prevent or control the risk from bacteria like Legionella and take suitable precautions. The Approved Code of Practice: Legionnaires’ disease: The control of Legionella bacteria in water systems (L8) contains practical guidance on how to manage and control the risks in your system. As an employer, or a person in control of the premises, you are responsible for health and safety and need to take the right precautions to reduce the risks of exposure

to legionella. You must understand how to: identify and assess sources of risk; manage any risks; prevent or control any risks; keep and maintain the correct records; and carry out any other duties you may have. Carrying out a risk assessment is your responsibility. You may be competent to carry out the assessment yourself but, if not, you should call on help and advice from either within your own organisation or from outside sources, e.g. consultancies. You or the person responsible for managing risks, need to understand your water systems, the equipment associated with the system such as pumps, heat exchangers, showers etc, and its constituent parts. Identify whether they are likely to create a risk from exposure to legionella, and whether: the water temperature in all or some parts of the system is between 20–45 °C; water is stored or re-circulated as part of your system; there are sources of nutrients such as rust, sludge, scale, organic matter and biofilms; the conditions are likely to encourage bacteria to multiply; it is possible for water droplets


 the battle against Legionella outbreaks. In producing these guidelines, the government has made us responsible and we must act on the information we have. If you are unsure about whether you have taken the necessary steps to prevent a fatal Legionella outbreak in your building, contact a reputable Legionella specialist or monitoring system supplier for more information. Whatever you do, don’t wait for an outbreak to prompt you.

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

4i Water Services understands that you are looking for a robust 4i Water Services understands dosing. that you are system that is able to provide accurate proportional Februus Range: • ECO Sentinel The Februus Systems has been 4i Water Services• Medi Sentinel developed over a number of years understands that you are insuring the system removes the • Agri Sentinel issues other have suffered from in looking for a robust • Process Sentinel the past and keeping up with modern system that is able to technology available. Installation provide accurate• Pool Sentinel benefits include: proportional dosing. • Mobile Sentinel Februus Range:

Remotely monitored and operated Highly accurate precision dosing Leak detection

looking for a robust system that is able to provide accurate proportional dosing.

Februus Range: ECO Sentinel Medi Sentinel Agri Sentinel Process Sentinel

The Februus Systems has been developed over a number of years insuring the system removes the issues other have suffered from in the past and keeping up with modern technology available. Installation benefits include: Remotely monitored and operated Highly accurate precision dosing Leak detection

The Februus System has been developed over a number of years ensuring the system removes the issues others have suffered from in the past and keeping up with modern technology available. Installation benefits include: Pool Sentinel Mobile Sentinel

4i Water Systems is a highly accredited water treatment company that specialise in Chlorine Dioxide generation and Dosing Systems (CDU). We have developed a robust system that provides proportional dosing to 99.9998% accuracy and that can be remotely monitored and controlled from a variety of platforms and can be easily integrated into any BMS systems.

Smart flushing technology Small installation footprint BMS Link-up

DWI-Approved Method BS 8558:2011 Approved method of continuous disinfection Water Authority approved

We have been able to consistently prove, through an innovative range of precision dosing systems, to ensure that we remain industry specialists & market leaders.

01359 4i Water Systems is a highly • RemotelyTel: monitored and242000 operated Highly Smart flushing technology accredited water treatment accurate precision dosing Leak detection Small installation footprint company thatBMS specialise in • Smart flushing technology Link-up DWI-Approved Method and Pool Sentinel Chlorine Dioxide generation • Small installation footprint BS 8558:2011 Approved method of Mobile Sentinel Dosing Systems (CDU). We have • BMS Link-up continuous disinfection 4i Water Systems is a highly Authority approved developed a Water robust system that • DWI-Approved Method accredited water treatment company that specialise in Chlorine Dioxide provides proportional dosing • BS 8558:2011 Approved method of generation and Dosing Systems We have been able to consistently to 99.9998% accuracy and that continuous disinfection (CDU). We have developed a robust prove, through an innovative range of system that provides proportional precisionmonitored dosing systems, to ensure • Water Authority approved can be remotely dosing to 99.9998% accuracy and that we remain industry specialists & that can be remotely monitored and and controlled marketfrom leaders.a variety controlled from a variety of platforms of platforms and can be easily and can be easily integrated into any BMS systems. integrated into any BMS systems. ECO Sentinel Medi Sentinel Agri Sentinel Process Sentinel We have been able to consistently prove, through an innovative range of precision dosing systems, to ensure that we remain industry specialists & market leaders.

Tel: 01359 242000 Tel: 01359 242000



False fire alarms have risen by 20% in three years at NHS Trusts across England*

Reduce False Fire Alarms

with STI’s range of protective covers which protect a wide range of electrical switches and call points. Ideal for areas which are vulnerable to unwanted activations. Indoor and outdoor models available for a variety of applications.

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Fire safety

The importance of wellmaintained fire alarms It is incredibly important to get fire safety right, especially in a hospital setting. But, for some larger estates, implementing a fire plan can be a challenge, writes Will Lloyd of the Fire Industry Association

Fire safety legislation in the UK places the mean the same thing: the responsible person responsibility of ensuring the people within is the person who will oversee all the fire the premises are safe from fire. There are safety and fire prevention strategies for the various fire safety laws that vary slightly building and be liable should there be a failure depending on location, but they all ostensibly to comply with the law, or if there is a fire. say the same thing. For the sake of That person is usually the employer accuracy and preventing any or building owner. In the case of confusion, here is the full a hospital, this is whoever has list: Regulatory Reform the highest responsibility As muc (Fire Safety) Order and ownership over as 40 p h e 2005 – applicable in the hospital. r c ent of Fire a England and Wales; Fire Whilst protecting the n d Rescue Service (Scotland) Act 2005; hospital and the persons Fire Safety (Scotland) within with appropriate false al callouts are arms w Regulations 2006; fire protection is hich create u The Fire and Rescue vastly important, it is n w Services (Northern also vital to maintain fire sign anted Ireland) Order 2006; and a close watch on false als The Fire Safety Regulations alarms, as these can have (Northern Ireland) 2010. a detrimental effect in many Each piece of legislation ways – taking staff away from refers to the ‘responsible person’, patients and causing unnecessary ‘appropriate person’, or ‘duty holder’. All these hassle whilst the alarm is switched off. terms are different depending on what piece The problem is usually made worse with of legislation you are reading, but they all the installation of automatic fire detection

systems, which will automatically call the fire brigade out to the site in the instance of the alarm being activated (whether this is through the detectors activating or whether someone presses the manual call point button to activate the alarm). Recent government statistics have revealed that as much as 40 per cent of Fire and Rescue Service callouts are false alarms which create unwanted fire signals, so it really is imperative that everyone with responsibility for a building makes the necessary changes to manage their own systems more effectively to prevent further detriment on time and resources to an already stretched Fire and Rescue Service. Automatic fire alarm The false alarms problem is further compounded by the absence of a single automatic fire alarm (AFA) Fire & Rescue Service attendance policy in England. Some Fire and Rescue services will attend AFA incidents, whereas others may not – or there could potentially be a charge for unwanted fire signal callouts after the Localism Bill of 2011. E Issue 19.3 | HEALTH BUSINESS MAGAZINE


Live investigations of false fire alarms One of the most recent advances in this area is in false alarm reduction. The FIA, along with other stakeholders, helped fund a research project conducted by the Building Research Establishment (BRE) back in 2014-

In the incidents of false alarms by accidental activation, the report highlighted that in premises such as hospitals, incidents were commonly triggered by trollies striking the side of a manual call point 2015 called ‘Live investigations of false fire alarms’, which was an investigation into the causes of false alarms at a range of different locations – including hospitals. The investigators noted down the different causes of false alarms and the frequency of these events between December 2014 to March 2015. Whilst many of these events were caused by simple human mistakes such as burning toast, cooking, or smoking, a surprising amount came from accidental activation of the alarm system. In the incidents of false alarms by accidental activation, the report highlighted that in premises such as hospitals, incidents were commonly triggered by trollies striking the side of a manual call point. In a busy hospital environment, this can all too easily be done but the research recommended that protective covers be fitted to prevent false alarms in these cases. The research recommendation was so strong that the FIA then used the research to change the British Standards (codes and guidelines that are best practice and should ideally be adhered to) to include getting covers fitted on manual call points as standard.

Fire safety

 This lack of consistency makes it difficult for both end users and fire alarm maintenance companies; whereas in Scotland there is one policy and this has been further reinforced by the setting up of a single fire service. With that in mind, the ‘responsible person’ should make an active effort to stay abreast of all the major changes within the realm of fire safety (e.g. changes in the law or other guidance issued) and take appropriate action. There are a number of different pieces of guidance available to hospitals, particularly on the topic of false alarms. The UK’s largest not-for-profit trade association for fire protection, the Fire Industry Association (FIA), has a dedicated section on its website for cutting false alarms and unwanted fire signals, as well as resources to help manage the fire protection of the building as a whole, covering a wide range of information – from fire risk assessment and management, to alarm testing and maintenance, as well as portable fire extinguishers (and more). However, one of the key areas that the FIA does is fund vital research into fire protection methods, products, and false alarm prevention. This research is then used as a basis to create further guidance on the subject of fire protection.

Therefore, if false alarms are an issue – it could potentially be down to accidental activation in this manner. As such, having covers fitted may be a useful step towards reducing false alarms. This should also prevent people mistaking the manual call point for the door release button (surprisingly, this is a common error, since the two are often installed next to each other by the door; we recommend correct signage to help with this issue as well as installing covers). The change to the British Standards only officially rolled out this September, so now is the perfect opportunity to reassess the fire protection within your building and see if it needs updating to be more in line with the new guidelines. However, you don’t have to be an expert in the British Standards yourself to know what changes to make to reduce false alarms – you can speak to a professional. The FIA is comprised of over 700 member companies who have been independently audited and checked to assess their quality and professionalism. This is known as Third Party Certification. Companies that have been certificated in this manner have undertaken rigorous checks to ensure that they are able to work on life safety systems such as fire detection and alarm systems safely. Third Party Certification also applies to a range of other fire safety services, such as portable fire extinguisher installation and maintenance, fire extinguishing system design, installation, maintenance, and commissioning, as well as to companies that perform and manage fire risk assessment. The FIA undertakes rigorous checks to ensure that only those with Third Party Certification can join and become members of the Association. These member companies will be able to give you a professional service and will be able to advise you on the best action to take. A full list can be found on the FIA’s website under the ‘Find a Member’ section, where you can search the list by location and by service, to quickly locate the service you need. The website also has a section under the ‘Resources’ tab labelled as ‘Fire Safety Advice’. Head to this section of the website to learn about fire safety legislation, fire risk assessment, and further advice on how to reduce false alarms. The information is designed to help you (if you are the responsible person) to understand your responsibilities and what actions you should take in order to protect your building. L FURTHER INFORMATION



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Health Business revisits advice from HEVAC, who explains why heating, ventilation and air conditioning should be monitored closely to ensure long-term efficient and effective operation The topic of heating, ventilation and air conditioning rarely raises a pulse among national newspaper editors. It is seldom‑mentioned in the popular press unless these essential building services have gone wrong in a high profile setting, such as a hospital. That was the case a few years ago when the air conditioning at the newly-opened £430 million Southmead Hospital in Bristol failed, causing the cancellation of 200 operations before the site had even opened. In the same year the Royal Free Hospital in north London left patients sweltering after the system broke down on two wards. Such stories demonstrate why the end goal for any facilities manager in a healthcare setting should be that no occupant of the premises notices the HVAC system, or their absence, at all. If they are working correctly, everyone Climate from patients c ontro to porters will

simply go about their business in a comfortable environment, without a second thought to the services functioning behind the scenes. It is no secret that, central to any hospital HVAC system’s operation, is its maintenance and cleanliness. Ventilation ductwork provides the ideal breeding ground for potentially harmful bacteria, and hospitals have a responsibility to prevent the spread of infections as stated by the requirements set out in the Health Technical Memorandum 03-01. The document gives comprehensive advice and guidance on the legal requirements, design implications, maintenance and operation of specialised ventilation in all types of healthcare premises. Ventilation hygiene The Workplace (Health, Safety and Welfare) Regulations also cover healthcare and say that mechanical ventilation systems, including air conditioning, are regularly cleaned, tested and maintained to ensure that they are kept clean and free from contaminants.

ventilat l and are respion systems nearly honsible for energy alf of the c in non- onsumption resid building ential s

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

Facilities management

Creating and maintaining a healthy building

Energy usage It is a little known fact that climate control and ventilation systems are responsible for nearly half of the energy consumption in non-residential buildings. What is more of a concern though is the fact that building design expectations in terms of energy consumption can be over-optimistic. E



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 Research done by the Chartered Institute of Building Services Engineers (CIBSE) made a comparison between energy use in a model building as envisaged by Part L of the Building Regulations, and that of a real world example. It found that while hot water and heating performed similarly to the modelled building, annual consumption in Kilowatts per hour per m2 (kWh/m2) for cooling and the operation of fans, pumps and controls were far in excess of the expected levels. Overall, the actual energy consumption was roughly 200kWh/m2 over and above the predicted figure, with cooling and fans, pumps and controls contributing the largest chunks of that usage. The outcome of CIBSE’s research was a document called TM54: Evaluating Operational Energy Performance of Buildings at Design Stage. The idea is that it can be used as a tool at design stage to avoid such vast performance gap between how a building performs on paper and what it does once operational. For new build healthcare projects, such a guide could prove invaluable by facilitating better specification, with clear instruction to ensure the purpose and usage of the building has been understood by the construction team. It can also help to support improved installation and commissioning, which are equally important; and better operation, which requires the end user to have a firm grasp on the control strategy for the building, as well as monitoring and recommissioning where necessary. Existing hospitals, however, are beyond this stage, and so require another set of tools with which to assess and improve energy efficiency. The Energy Performance of Buildings Directive, first introduced in 2010, and the 2012 European Buildings Directive, are the EU’s main legislation concerned with reducing carbon emissions in buildings. These directives have resulted in further work, including the more recent British and European Standard EN15232: Energy performance of buildings. Impact of Building Automation, Controls and Building Management. This paper, as its title suggests, looks closely at how beneficial a robust controls strategy can be in terms of improving energy efficiency. At the heart of BS EN15232 is a structured list of controls and building automation technologies that have an impact on energy use in buildings. The Standard includes a method to define minimum requirements for controls in different types of building, including offices, hospitals, schools, retail and restaurants. The Standard also offers a detailed method for assessing the impact of particular types of building control on the energy performance of a given building, assigning classes A, B, C or D to levels of control in a building and showing the resulting energy savings that can be expected. Although spending hours interrogating such a document is unlikely to be a high priority for a busy building manager in a large healthcare site, it’s a worthwhile investment of time for those offering advice on energy-saving technologies in hospitals where finding savings in every aspect of their operation is on the agenda. The ability to provide evidence supported by a recognised Standard makes BS EN15232 a powerful tool.

It is instructive for today’s hospital facilities managers to perhaps look back at what BEMS in these settings was used for in the early days. Often it would be no more than a glorified on/off switch for plant and central monitoring for faults Going back to CIBSE’s recommendation that clear specification is an essential part of the route to operating a building as closely as possible to its expected efficiency levels, the Standard can also help here. It will assist clear specification of a building energy management system (BEMS), and provides calculations to determine the impact of building controls on the energy efficiency of a building by comparing two energy-demand calculations using different functions. In this way, specifiers can calculate the different potential costs and set these against the potential energy savings in the short and long-term – useful business insights into the effects of investing in BEMS.

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

Intelligent controls Where HVAC is concerned, integrating climate control with other building systems using intelligent controls can improve the overall efficiency of a building and reduce energy use. Intelligent control is crucial, as it allows monitoring zone-by-zone within a building, ensuring that heating, cooling and ventilation levels are optimised to maximise comfort. Intelligent controls, in combination with remote monitoring, provide a comprehensive history of the system, helping to optimise settings and operation to maximise energy savings, improve comfort and enable preventative maintenance. It is instructive for today’s hospital facilities managers to perhaps look back at what BEMS in these settings was used for in the early days. Often it would be no more than a glorified on/off switch for plant and central monitoring for faults. Today, trusts such as Barking, Havering and Redbridge University Hospitals Trust, who oversee Queen’s Hospital in Romford, are taking energy wastage seriously. Jason Davie, energy manager, Queen’s Hospital for contractor Sodexo says: “As part of our drive to help the trust meet its carbon

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



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Managing collaborative procurement projects on behalf of the NHS With savings expected across the NHS, we outline some examples of how effective procurement and maximising purchasing power from the London Procurement Partnership can produce significant savings

Despite increased funding under both Theresa May and, more recently, Boris Johnson, the NHS remains under ever increasing pressure to deliver more for less. Trusts are having to make savings every year to enable them to cope with rising demand and escalating costs. Therefore, trusts need to leverage the maximum savings from procurement to support their savings targets. NHS London Procurement Partnership (LPP) is a member led procurement hub. Established in 2006, The LPP currently saves the NHS around £2 million a week because of the support and engagement of its members from London and beyond who want to collaborate to secure the best deals and services for patients. The work of LPP isn’t just about striving for the lowest price, but improving quality and patient

providing trusts with a compliant and cost outcomes as well. This requires innovation effective way of using local firms who meet beyond the traditional procurement the quality criteria. LPP’s first DPS was for aims of best prices for stock items. Language Services which has 30 suppliers, LPP has been working to introduce the majority of which are SMEs. Dynamic Purchasing Systems (DPS) into Savings on this framework areas that would benefit from this are 20 per cent. A second approach. The DPS process has NHS tru DPS for Minor Building been available since 2006 need to sts Works has more than but uptake has been low. leverag 200 suppliers, 88 per The advantage of the t e he max cent of which are DPS is it can provide a i savings mum SMEs. Having shown large pool of suppliers that this approach as new suppliers procure from ment can be successful, can be added to an to supp LPP is looking at agreement once the their sa ort other areas where it framework has been let. vings could be effective. This encourages small and targets Although NHS medium enterprises (SMEs) procurement traditionally E to be able to join as well as Issue 19.3 | HEALTH BUSINESS MAGAZINE



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Although NHS procurement traditionally works in areas of non pay spend, LPP has shown that opportunities for significant savings exist in the supply of temporary staff to the NHS  works in areas of non pay spend, LPP has shown that opportunities for significant savings exist in the supply of temporary staff to the NHS. Facilitated by LPP, staff bank managers from London trusts have a history of working together to manage the market for agency workers and LPP’s previous London Regional Agency Nursing Framework generated savings of over £25 million as well as ensuring NHS pre-employment check standards. Legal services LPP’s Legal Services framework agreement provides a compliant route to market to procure a range of legal services let as a single lot, removing the limitation of framework providers only being able to deliver services in the lots in which they were successful. Replacing the previous Legal Services Framework, the agreement specialises in corporate and commercial law, employment law, property law, health law, primary care law, mental health law, laws relating to healthcare projects and NHS governance and public law. Among the benefits, LPP lists an initial free consultation of 30 minutes, ceiling rates provided which can be reduced via a further competition, flexibility to contract on a fixed retainer pricing model to achieve reduction in spend and cost assurance and cost savings by managing the balance of senior/ junior resource according to case requirements with a split between complex and non-complex areas of law.

Buyings medicines One of the major areas of cost pressure in the NHS, but equally an area with significant potential savings, is medicines. Since early 2014, the LPP Medicines Optimisation and Pharmacy Procurement team has played a key role in providing clinical, commercial and financial information to trusts and clinical commissioning groups. An area of innovation is biosimilars, where a copy of a biological medicine is substituted for the original. This is not the same as substituting a generic medicine for a branded one. The use of biosimilars has the potential to hugely reduce expenditure on treatment. One biosimilar, infliximab, costs 40 per cent less than the branded original, which the NHS in London spent £32 million on in 2015/16. Introducing a new biosimilar into clinical practice incurs a very significant extra workload for clinical staff. It is important that decisions to start using a biosimilar are approved by trust governance mechanisms, the decision to change treatment is discussed with the patient and that they are monitored closely. As most savings on biosimilars benefit the commissioners, whereas the work to make the change is provided by the trusts, for the changes to be successful, trusts need to retain a proportion of the cost saving. Biosimilars will continue offer major savings opportunities to the NHS for the next five years at least. These are just a few examples of how effective procurement, both internally across trusts and externally through effective


market management and maximising purchasing power can produce significant savings. It requires trusts to be open to new ways of working and being able to involve clinicians in decision making. Without clinical involvement, the most likely outcome for many frameworks is the status quo which will deliver minimal savings. Although procurement can make savings by simply getting better deals on the same items or services, to truly realise the savings needed, procurement departments have to be catalysts for change and be willing to co-operate with other trusts, both locally and beyond. Combining volumes releases significant savings, but the big prizes can come from the intelligent use of data and effective market management. A collaborative effort The Workforce Alliance sees the Crown Commercial Service (CCS) and NHS Procurement in Partnership (NHS PiP) coming together to deliver a portfolio of health workforce services for the benefit of customers and suppliers. Plans for this partnership are progressing well with three frameworks already launched under the new collaboration. The first is the International Recruitment framework, launched to support the NHS and the public sector in its future recruitment strategies. The framework is in response to and aligned with recommendations set out for international recruitment in the NHS Long Term Plan and the NHS Interim People Plan. Secondly, the Flexible Resource Pool - Staff Bank framework is also live and provides the ability to build a flexible staff bank for both clinical and non-clinical temporary staff. Whilst this is largely for the NHS, access to the framework and its services is available to the whole of the public sector. The framework offers a wide choice of suppliers from small regional businesses to national operators. You may be interested to know that this framework is the first of its kind to ensure pre-employment assurance is undertaken against NHS Employers Check Standards for all workers employed by an outsourced bank. The Non-Clinical Temporary and FixedTerm Staff framework agreement launched in July 2019. This replaced the previous CCS Non-Medical Non-Clinical framework and provides access to competitive pricing, with the ability to better use fixed-term appointments and statement of work. It continues to ensure non-clinical workers are subject to NHS Employers check standards. For more information see page 37. A fourth framework National Clinical and Healthcare Staffing Framework went out to tender in mid-August. It will provide high quality, temporary, permanent, and fixedterm clinical and healthcare staffing services. It will replace the CCS Multidisciplinary Temporary Healthcare Personnel and the NHS Procurement in Partnership National Clinical Staffing frameworks. L FURTHER INFORMATION



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Torbay puts trust in WPS’ parking solutions The issue of parking within hospitals is constantly in the news and evokes strong emotions from all sides of the debate. Finding the balance between meeting the cost of delivering a service with providing a customer experience that is sensitive to the environment is no easy task. Convincing employees that parking is not a right, but a privilege, is also a challenge

In the vanguard of industry thinking is Joanne Brimblecombe, the Sustainability and Site Services Lead within the Estates and Facilities Management Division of Torbay Hospital, part of the Torbay & South Devon NHS Foundation Trust. And supporting Joanne and her team in delivering their vision is parking technology specialists, WPS. Jo explains: “Parking should be fair for all not free for all, and we support concessionary parking on our trust site.” Complex site The Torbay Hospital site, while not especially large, is still noticeably complex. The diverse nature of the portfolio required a mix of solutions to be delivered: for the larger car parks, and staff car parks, a Pay on Foot solution is preferred, with barrier controls; for the smaller car parks, typically with a capacity of 20 vehicles or less, Jo has opted for Pay and Display. Jo says: “Department of Health guidance recommends that ‘NHS organisations should consider Pay-on-Exit systems’. This is considered best practice and will improve the patient and visitor experience. Our site does not lend itself to only being able to offer one solution due to car park sizes so an option of both Pay on Foot and Pay and Display has been adopted and WPS has been able to offer Pay-on‑Exit and Pay and Display solutions.” Alongside managing a portfolio of approximately 650 visitor parking spaces, it also had to accommodate large volumes (up to 1,100 spaces) of staff parking. It had to achieve all of this while ensuring vital highways (i.e ‘the blue routes’) were kept clear, so that emergency vehicles would not be held up by vehicles queuing on the surrounding roads.

having reliable systems that are easy to use, and easy to configure to manage concessions and other specific requirements.” The staff parking experience is similarly important: “At Torbay, we provide staff parking, and staff have to pay. They can do so either on a monthly basis, or pay as you go, but in both cases they use their NHS smart card that acts as an ID badge, a payment card, and a card to operate the barrier.” In terms of visitor concessions, Torbay has adopted an innovative approach that gives them total discretion and control. Thanks to the full TCP IP architecture of the WPS ParkAdvance systems installed, concessions can be easily accommodated. Jo explains: “We have three scanners at various reception desks connected over our local network and several hand-held USB devices in the wards simply connected to ward PC’s.” Discretion and control This level of control helps to avoid one of the biggest challenges every hospital faces. On the one hand, revenues are important to meet the cost of managing the parking estate; on the other, a recently bereaved visitor or patient just diagnosed with a serious illness does not need the additional stress of a Penalty Charge Notice.

Customer experience Jo explains: “Parking is the first experience our patients and visitors have of our hospital. It needs to be as smooth, hassle-free and as comfortable as possible, and that means



Unauthorised and unwanted parking also has to be managed, and abuses minimised. Torbay Hospital manages to achieve the balance it needs, thanks in no small way to the flexibility of the WPS technology. Jo concedes: “WPS technology was not the cheapest solution but offers the right level of technology, reliability, and ease of use. Its Pay on Foot systems have undoubtedly helped us to maximise our parking revenues.” In selecting a parking solution, and an equipment provider, Jo considered various options and suppliers. Among them was a system based on Automatic Number Plate Recognition (ANPR): “We did consider ANPR and there is a place for ANPR in hospital parking, perhaps in the future. But operators who install systems that rely on enforcement and PCNs for their revenues can sit very uncomfortably in a hospital scenario.” Another option considered, was one centred around chip coins: “We looked at chip coins but they are very expensive to replace and easily lost,” she says. “They also need to be hygienically cleaned to prevent the spread of infections.” Jo is excited by what the future holds. She says: “The principal advantage of the WPS technology is that it is effectively future proof. That enables us to think freely and differently about what we want to achieve to enhance the customer experience, knowing that whatever we do, the WPS technology will enable us to do it.” L FURTHER INFORMATION Tel: 0845 094 1543 wpsparking

Translations Written by Jakub Sacharczuk

The role of interpreting in the NHS Jakub Sacharczuk, an interpreter and board member of the Institute of Translation and Interpreting, looks at interpreting within the NHS including best practice and technology developments Imagine a scenario. Arriving at the GP practice However, providing this equality of access but unable to speak English, you bring along is complicated for a variety of reasons a friend to help you. The doctor tells you including the proportion of the population that you have ‘angina’ and your friend, not whose main language is not English knowing the right terminology, uses the and the diversity of languages spoken. same word. If you are unlucky enough to be According to the most recent census (2011), a Polish-speaking patient, you were just told around 4.2 million people in England and that you have tonsillitis instead of a heart Wales speak a main language other than problem. ‘Angina’ in English and Polish is English or Welsh; this amounts to eight what is known as a false friend – they sound per cent of the population. In London, the same but mean very different things. more than 300 languages are spoken, This is just one example of how poor-quality and, for many people, English is not the interpreting within a healthcare environment primary language spoken at home. could have negative consequences. We commonly hear the arguments that The NHS is committed to providing people living in the UK should just equality of access to high-quality learn English, and that the NHS healthcare services, including is spending too much on Much to those for whom English interpreting services. commu is not their main language It is important n or whose hearing to note that it can is non-v ication impairment could take a long time meanin erbal, create communication to achieve fluency g by de fault that tele barriers. This principle in a language, phone is enshrined in and that medical interpre ting has legislation and a language is one potentia more number of documents of the last areas l misund to create including the NHS acquired in language erstand Constitution 2012, the learning. In addition, in g Health and Social Care for most people Act 2012 and the Accessible language ability can Information Standard 2016. drop in stressful situations.

Such commentary also fails to consider the cost of not providing professional interpreters. It is not only levels of satisfaction in care that suffer. Academic studies (Flores, 2005 and Karliner et al, 2007) have found that the lack of quality interpreting services can lead to patients’ poor understanding of their diagnosis and planned treatment, and also a higher number of communication errors in total and significant errors (for example, relating to dosage, allergies, past history) which could lead to medical errors. In turn, this can result in sub-optimal care for the patient, higher expenditure due to inefficient diagnosis and treatment, and costly litigation. All these factors highlight the merits of providing a quality interpreting service, but what are the specific challenges in providing such a service? The individual interpreter In addition to being fluent in both English and the patient’s language, the interpreter also needs to have excellent cultural understanding. For example, patients with limited proficiency in English may have health beliefs that stem from their culture or background that are different to the health practitioner’s. The interpreter should remain impartial, but they need to be aware of and able to clarify cultural issues that may result in misunderstandings. The requirement for: excellent language skills; the ability to recognise and deal with cultural nuances; and the need for total impartiality all mean that it is desirable not to use family or friends E Issue 19.3 | HEALTH BUSINESS MAGAZINE


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Meeting the demand for interpreters Ensuring the availability of interpreters in a wide variety of languages requires an appropriate system to be in place. Typically, NHS trusts will have a bank of freelance interpreters; this may be managed inhouse or run by an external agency. In certain cases, for example when very limited, routine information is needed or

Technology developments will continue to offer new opportunities for innovation and efficiencies, but for now cannot diminish the continued importance of face-to-face interpreting within the NHS where someone is in Accident and Emergency and there is no time to bring in an interpreter, the hospital will commonly use an ondemand telephone interpreting service. When it is not possible to source a suitably qualified interpreter from the bank, for example for less common languages or dialects, an agency will typically be contacted to fill the gap. It is important that diversified systems of supply are in place; relying on one source can lead to problems and mean that healthcare professionals find themselves getting bogged down in trying to find a suitable interpreter. Face-to-face consultation The qualified and experienced interpreter can be trusted to arrange seating in a way that works for all the participants and aids effective communication. Above all, the doctor (or anyone else speaking) should talk directly to the patient, not to the person who is facilitating their communication. An interpreted consultation will of necessity be longer than an equivalent meeting with an English-speaking patient. The previously referenced guidance for commissioners in primary care states that the time taken will be ‘typically double that of a regular appointment’. In some cases, it may be desirable to have a pre-session briefing with the interpreter, such as for mental health issues or where there may be discussions about a sensitive or culturally ‘taboo’ issue. The dynamic of the three-way communication involving an interpreter


 as interpreters. The recently published Guidance for commissioners: Interpreting and Translation Services in Primary Care (September 2018) states: “Patients should always be offered a registered interpreter. Reliance on family, friends or unqualified interpreters is strongly discouraged and would not be considered good practice.” While not always possible, it can be valuable to use the same person to interpret if several contacts are required to enable a relationship of trust and understanding to develop between the client and interpreter. As regards achieving satisfactory and consistent competency levels in interpreters working for the NHS, economic constraints create an ongoing tension right across the public sector. On the one hand, there is a desire to only use individuals who fulfil a variety of recognised criteria – as enshrined in NHS guidance and the registration requirements of the National Register of Public Service Interpreters. On the other hand, continued downward pressure on costs within the NHS can lead to low rates of pay and unfavourable working conditions, which is not an incentive for individuals who have spent some years achieving relevant qualifications and membership requirements of industry bodies. The Institute of Translation and Interpreting (ITI) has anecdotal evidence from a number of members who say they have stopped doing such assignments for this reason. The worry is that this effect could lead to an influx of less qualified and experienced practitioners, resulting in a lowering of standards overall.

is very different to that of a conversation between only the healthcare professional and patient. Training medical students and health professionals in how to consult through interpreters using role-play has been shown to significantly improve skills and confidence (Bansal et al 2014). Following a patient consultation, debriefing between interpreter and clinician is also valuable so that the clinician can gain additional relevant information on the linguistics or cultural references that might have affected the communication. This could be particularly useful for follow-up appointments to understand if any parts of the interaction with the patient can be improved. Remote interpreting Remote interpreting, by telephone or some other digital means, is becoming increasingly common and offers a number of advantages in terms of cutting back on travel and therefore time and costs, and enabling communication in situations where it would not otherwise be possible. However, it is important to sound a note of caution; this type of interpreting should only be used to complement the interpretation service in cases when a face-to-face interpreter is not an option rather than as an alternative. Much communication is non-verbal, meaning by default that telephone interpreting has more potential to create misunderstanding. There is also the possibility of communication difficulties arising from the technology and the risk of patients feeling alienated. It should be avoided for complicated procedures, serious diagnoses and mental health encounters. And it is of no use at all to the hearing impaired for whom eye contact, clear expression and non-verbal gestures are essential. Remote technology that offers video has wider potential as it more closely resembles an actual face-to-face meeting. ITI puts forward a number of recommendations about the use of remote interpreting in its recently published (2019) position statement on this subject, including the importance of maintaining identical requirements for interpreters in terms of qualifications, experience and briefing, whether they are working on site or remotely. Technology developments will continue to offer new opportunities for innovation and efficiencies, but will require capital investment to reduce the present limitations and for now cannot diminish the continued importance of face-to-face interpreting within the NHS. L FURTHER INFORMATION



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Leading Digital Change with WellSky EPMA Of all of the digitisation projects currently underway at St Helens and Knowsley Teaching Hospitals (STHK) NHS Trust, electronic prescribing and medicines administration (EPMA) represents the biggest step forward for patient safety, ensuring the right drugs get to the right patient at the right time Reducing prescription errors A recent study by the universities of York, Manchester and Sheffield reported that in NHS England alone some 237 million medication errors occur every year, which, as former Health Secretary Jeremy Hunt estimated, accounts for between four and five deaths a day. Whilst the NHS is committed to reducing these errors by 50%, St Helens & Knowsley with the WellSky EPMA system have challenged themselves to achieve an even higher rate. In April 2017, Whiston, an in-patient hospital, went live with WellSky’s web-based EPMA. In under a year the Trust saw positive results by digitising medicines management. The system links with the WellSky Pharmacy stock control module, and together they create an end-to-end integrated medicines management platform that can interface with their System C Patient Administration System for order communications, admissions/discharge and other functionality. This digital environment enables quick and easy data sharing across wards and other Trust sites, providing nurses and doctors with secure access to patient records even while on the road. Why Wellsky? In addition to already having its pharmacy stock control system, the Trust wanted an electronic prescribing solution with broad functionality, designed by domain specialists and already with a proven user base. At the time of selection, the Trust didn’t have an EPR so were free to choose the EPMA market leader.

of how users navigate screens – greatly simplified the training process. In fact, the speed with which the Trust overcame cultural and technology barriers was especially impressive considering the complexity of electronic prescribing. There is a vast array of medicines, protocols and dose bandings to be custom configured into the drug database, along with exception alerts for the drug allergies and the special sensitivities of individual patients. Given that a single error can be life threatening, this explains why medicines management has one of the lowest tolerances to error: It simply must be safe. Eliminating transcription mistakes “On electronic systems you reduce the amount of hand-written transcription of medications; which significantly reduces the number of prescribing errors.” – Dr Andrew Hill, Clinical Lead for Stroke Services Like all hospitals, the Trust used to have problems with the wrong medicines being delivered to the wards because of the order’s illegible handwriting. And while these were always spotted in time, it posed unnecessary risks. WellSky EPMA eliminates this risk. Other safety features include decision support tools like best practice medicines and dosage defaults. By prescribing electronically, orders no longer go astray and drug administering schedules can be monitored and flagged up if a round is missed. And in cases when care is time critical, a change in prescription or dosage

One of the main priorities was a modern web-based system that was intuitive to use for mobile clinicians and would be easy to deploy, upgrade and interface with other applications as our digitisation programme evolves. With EPMA’s web version updates are done direct from the IT centre with users accessing the system via URLs. Not only does this save a great deal of time, it ensures everyone is always using the same version. The digital transformation “The new system is much more efficient and quicker than other versions that I’ve used previously” - Dr Andrew Hill, Clinical Lead for Stroke Services When WellSky EPMA was introduced to clinicians, the web interface – which was designed following in depth study



can be reviewed and amended remotely in real time. The Trust has noted a marked reduction in medicines incident logged by the Datix incident reporting system. Saving Clinician time With WellSky EPMA clinicians no longer wade through old kardexes to look up a patient’s medication history. Instead, doctors can see a patient’s complete real time prescription sheet on a single consolidated screen; determine when a particular drug was last administered and find out why it was stopped. Because all medicines data is captured within the database, on readmission to the hospital a patient’s treatment history can be called up instantly. The Pharmacy/treatment dispense information interface is allows EPMA data to be downloaded to create discharge letters for the patient’s GP. Digitising the Trust’s medicines management environment has also had a positive impact on operational and financial efficiencies. The wealth of data captured by the WellSky EPMA system is not only clinically rich but enables the generation of a wide range of reports and analysis of both clinical and operational outcomes in a way previously not possible. With future EPMA rollouts planned for St. Helens Hospital, Outpatients and possible outreach into community hospitals, the project is nothing short of transformative. L FURTHER INFORMATION

Mental health Written by Philip Ross, Tony Crumpton

Testing products and the environmental risk continuum Philip Ross and Tony Crumpton, testing and innovation leads at the Design in Mental Health Network, discuss care delivery, the physical environment and product suitability for mental health hospitals Designing mental health hospitals comes with on the built environment, but it’s important numerous challenges, but most significantly to recognise this can only do so much. you are creating a place to care for people There is no such thing as zero risk of harm who, sometimes, due to their current state of within the built environment of mental health psychosis, may not want this support. These hospitals. A lot of good practice guidance people are some of the most vulnerable has been written on how both clinical in society with a wilful intent to staff can identify and manage harm themselves, in some risk of harm to self or others cases, with a goal of ending but much less so in terms There is their life. In heightened of environmental risks. no such mental crisis, their The challenge is to see illness will lead them to environmental risks in as zero thing r i attack the environment context with individual s k of harm w around them. We have clinical risk assessments i t h i n the built en a situation, which is as a fluid integral relatively unique in process rather than as of men vironment tal h design and construction, discrete assessments hospita ealth of creating spaces for that are totally separate. ls people who are, at times, Clinical risk informs determined to make them environmental risk in terms fail. This puts a lot of demand of the likelihood someone will

exploit weaknesses in the environment to cause harm to themselves or others and also ensures there is an understanding of what risks can be managed using products and what must be managed by clinical staff through observation and treatment. For this reason, merely identifying environmental risks in terms of whether they are present or not only serves to quantify potential hazards. Whether these hazards are a risk to an individual is determined by the likelihood of someone acting upon it and the impact of doing so. When assessing ligature anchor points in the environment these are often quantified in terms of whether they are present or not. However, this is a simplistic view further complicated by many other variables which come into play. The robustness of the environment, ingenuity and determination of the service user, and the amount of time available to the task may E Issue 19.3 | HEALTH BUSINESS MAGAZINE



















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A significant future step which should come from this work will be the development of standardisation guidance for identifying risks within patient environments  enable previously unforeseen risks to come to light. Removable or broken fixtures in the environment can be deployed singularly or in combination to exploit other weaknesses in the environment to create further risks. In addition, the fixings used to secure products and substrate to which they are attached are all significant variables which can lead to adverse events such as property damage or the attachment of ligatures. Whilst violence and property damage are often overt acts, taking place in full view, suicidal behaviour is mostly covert and has a low degree of openness by patients who are experiencing hopelessness. Clearly care and understanding developed through therapeutic relationships highlight the true nature of the risk in through evidenced based care and understanding combined with best practice guidance goes some way to reducing/ managing risks. Nursing observation also has a key part to play in helping keep people safe. Changing risk Clinical risk is dynamic not static and whilst generalisations can be made relative to certain patient groups, overgeneralisation can serve to deflect from the acute risks presented by individuals admitted to a ward (e.g. risk of suicide/risk of violence) presented by individuals admitted to a ward at a specific point in time. As changes in the patient group, clinical staff numbers and changes to the environment occur so the real risk will change. Whilst scored risk assessments may identify risks at a point in time risk is fluid and ever changing. These changes should act as prompt to reassessment of environmental risk Over recent years manufacturers have started to rise to the challenge set by policy guidance (CQC, HBN and Medium Secure Guidance) as well as wider alerts where incidents have

exposed new risks (e.g. CAS alerts). This has led to development of new products that are more robust, and either reduce the risk of presenting a ligature anchor point, release when weight is applied (e.g. load release products) or provide a technological solution warning staff to a potential harm event (e.g. door alarms). Throughout these developments the missing piece has been the development of standardised testing methodology that allows architects and estates teams to compare and select products for their new or refurbished facilities. This also impacts clinical staff correctly understanding the risks that remain, creating the dangerous situation of unintentionally complacency that an environment is ‘anti-ligature’, an absolute term that cannot be true based on the variety of factors mentioned above. If risks are correctly understood, better risk management plans can be put in place for different patients, depending on their risk assessment. Mental health facilities Over the past five years, Design in Mental Health Network (DIMHN) has led an industrywide initiative with the Building Research Establishment (BRE) to create a series of standardised test methods to capture the specific challenges present in mental health facilities. These tests will allow all products to be assessed for ligature performance and robustness, with some category specific performance criteria for doors and windows e.g. anti-barricade of the doorset. The ultimate goal is to have a single, and independent, testing body in the UK who be able to carry out all tests on behalf of DIMHN and their partners. Allowing manufacturers to test their products once and share evidence with any clients who want to consider and assess suitability for us in their mental health

facility. This is in stark contrast to the current approach of procuring and testing almost every product used in an environment – adding significant cost and time to any project. The development of standards to test products to allow design teams to assess whether they are fit for purpose is an important step in managing environmental risks and in creating safe and healing environments within mental health care. In addition, this work should help manufacturers understand the true performance of their products to ensure new and innovative products do not create unintended or unknown risks and harm. These standards are a significant step forward in the future development and specification of safe and appropriate fixtures and fittings. It’s also worth highlighting this guidance represents the starting point, not the end. Like the development of a luxury car the quality of the finished product is dependent on the assembly of the components and quality checks at key stages including testing across a range of conditions including customer feedback. Similarly, it will be important for products to be introduced with full knowledge of the building specification and to develop processes which enhance the identification and reporting of remaining environmental risks. A significant future step which should come from this work will be the development of standardisation guidance for identifying risks within patient environments. Whilst there are several environmental suicide risk assessments used across care providers, the process and method by which such assessments are undertaken varies widely across providers and none that we know of use service user intelligence other than through post incident analysis. Lest we forget, no products, fixtures and fittings are infallible. Furthermore the management of environmental risk does benefit from the delivery of good therapeutic care, involvement of key stakeholders in identifying environmental risks and recognition that risk is a dynamic process which requires reassessment when changes to patient and staff groups occur as well structural changes to the ward. L FURTHER INFORMATION



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Volumetric or modular has been supplying education, health and commercial businesses with their much need facilities successfully without many end users realising that they are in this type of building, thus showing the standards and quality that are produced today for many years. Not only do suppliers provide permanent buildings they also supply much needed temporary facilities at a far greater speed than traditional construction with a quality to match. Offsite construction has become a hot topic in the last few years, and sustainability has been the buzzword of the decade (other

than fake news of course) but there is still an element of ‘catch all’ with both words. Offsite means simply, built in the factory and transported to the final destination site where it will be assembled for final occupation. Built, and in most cases, fit out is completed in the factory where a high standard of quality can be achieved. Manufacturers drive quality in the product through ISO9001 accreditation and BBA approvals, and its due to these high standards that when it comes to thermal bridging and air permeability tests show that on average a factory built modular/volumetric

buildings achieves better than traditional construction, good reason for hospitals to be built in this way. There are many examples of where exemplar quality increases carbon performance, leading to a more sustainable building ticking all the boxes for the future.

Written by Jackie Maginnis

How do manufacturers and installers of volumetric offsite construction ensure sustainability and compliance when the key priority is time? Jackie Maginnis CEO of the Modular and Portable Building Association shows how the industry has been leading the way longer than you think

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Leading sustainably That brings us nicely to sustainability, where volumetric construction has long since lead the charge. Back in 2006 as an association we introduced communities and local government to the embodied energy, particularly within the hire and refurbishment markets. When E

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Off-site construction Modular buildings now come with a range of external options to cater for nearly every look, including brickwork and tiled roofs to give a traditional appearance if that’s what’s required. When you build offsite, you plan and construct with meticulous precision. It takes strategic thinking and rigorous co-ordination, but modular construction

Modular build

 a modular building is constructed as an alternative to traditional methods to be a permanent building it is built to the same standards required for all construction, and with the added benefit that the as built performance will match the as designed performance. The speed of manufacture and construction is so impressive it can even keep up with the demands of the modern designs and requirements of end users today. It is important that procurement departments/buyers to realise that modular buildings have the potential to be more cost-effective than conventionally built projects. because the structures are made to the highest standards off-site, modular buildings can and are frequently installed causing minimal disruption to staff and the existing patients. Still today there is a reluctance to not to make the industry sector the first port of call. In doing this it eliminates an expensive part of a project by not going through a third party. Modular building companies specialise in providing a ‘complete service’ to hospitals and a variety of medical facilities from undertaking the initial design and carrying out all necessary groundwork to construction and final fit out. Standalone structures, single-storey ‘cluster’ departments, two-storey schemes or whole hospital configurations to name but a few of what can be provided by the industry. In addition to being fitted-out for, wards, theatres, general offices, kitchen and dining purposes, the expertise also exists to design, create and subsequently install more ‘specialist’ accommodation required by the clients. By placing a contract with a volumetric/ modular building company they know that the date they are given for occupation is the date that they can use the building to admit patients. Modular buildings are built in controlled, energy-efficient environments. From initial works to completion, it takes up to 67 per cent less energy to produce a modular building compared with a traditionally-built project. Whilst initial, onsite ground works are being completed; modules – which make up a modular building – are manufactured offsite, in a controlled, factory environment. Pre-fitted with electrics, plumbing, heating, doors, windows and internal finishes before they are taken to site, modular buildings can also be installed with energy-efficient systems such as PIR sensors, enhanced ‘U’ values and solar panels. Not only is the offsite manufacture greener, buildings are also designed to be energy-efficient for their entire life cycle, all within the NHS requirements.

Modular buildings now come with a range of external options to cater for nearly every look, including brickwork and tiled roofs to give a traditional appearance if that’s what’s required allows for minimal disruption to staff and patients which is particularly key in the acute care environment. Offsite construction also allows for a 90 per cent reduction of the total number of deliveries to site as well as reducing up to 90 per cent of waste generated as the structure is recyclable. Companies have been providing volumetric buildings for hospital facilities for many years and there are many examples of existing hospital today built by the industry and fully compliant with NHS requirements, as an association we

would suggest that if there is any doubt to look at what is already out there. There are now volumetric/modular frameworks in place for the Health sector which enables facilities to be supplied by companies that have been vetted and meet the requirements – using this will give buyers confidence in the knowledge that these companies can supply their needs. L FURTHER INFORMATION



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Eastern Pathology Alliance offers Hepatitus C testing to all NHS Trusts The first and only laboratory in the UK to use equipment from Vela Diagnostics. New testing service delivers huge patient benefits in terms of speed, accuracy and reliability yet with costs significantly reduced The Eastern Pathology Alliance (EPA) announced on 12 August that it is to offer Hepatitis C genotyping testing to the wider NHS nationally leveraging its investment in next generation sequencing assays. Founded in 2012, the EPA has become a centre of excellence for pathology – particularly virology – providing centralised laboratory medicine for the Norfolk and Waveney region. It has selected state of the art equipment from Vela Diagnostics which incorporates Ion Torrent semiconductor sequencing to provide rapid turnaround of results for clinicians and their patients. It is currently the only laboratory in the UK to put this kind of a high tech solution into routine use. Aimed at other acute NHS trusts, CCGs and private healthcare providers, the new service will comprise a whole package involving fast testing, clinical interpretation along with guidance and advice about drug selection. Pricing will be based on a per test fee. HCV infections a major public health threat in the UK Mainly affecting the liver, Hepatitis C is the only blood born virus which is a curable infection with success rates of between 92-95 per cent. Although a national data set is unavailable, most recent estimates by Public Health England (PHE) show that 160,000 people are living with chronic Hepatitis C virus infections in the UK. The use of next generation sequencing assays enables detailed analysis of the genetic material of the Hepatitis C virus (HCV) to confirm its strain – predominantly genotypes 1 and 3 in the UK – and the determination of resistance mutations. This information is crucially important for clinicians so they can then prescribe the optimum mix of drugs to treat the virus. Dr Samir Dervisevic, a Consultant Virologist and the Clinical Lead for Virology at the EPA’s Microbiology Department explains: “In May 2016, the UK signed up to the World Health Organization strategy on viral hepatitis which commits participating countries to the elimination of Hepatitis C virus as a major public health threat by 2030. In England, HCV treatment is centrally funded and the NHS England direct acting antiviral (DAA) treatment programme continues to be rolled out with several medications authorised.


From left to right: Reenesh Prakash, EPA network manager, Stephen Brolly, senior BMS, Dr Samir Dervisevic, EPA clinical lead for virology and Christopher McDonnell, chief virology BMS

Given this, ascertaining the genotype strain before treatment starts is recommended especially as the duration of treatment among other factors depends on the virus genotype.” Samples collected from patients in Norfolk used to be referred to a private laboratory for HCV genotyping. When drugs were prescribed but the treatment failed – which could be due to virus resistance to a particular directly acting antiviral drug – blood samples were then sent to the Reference Laboratory in London for resistance profiling. Due to the turnaround time, some patients actually had to wait a prolonged period in order to receive the results and be re-treated. This time consuming and long winded process – often taking months - slowed down the effective delivery of clinical services. Furthermore, samples were split, testing was overly costly and – most importantly – there was a significant distress for patients given the time involved. Dr Dervisevic adds: “We’ve opted out of referring samples to these two external laboratories and instead invested in the latest cutting edge solution of our own which gives us automated workflow from sample to results within just two days so that patients get the right treatment fast. We’re now happy to offer our clinical colleagues access to this modern technology so that they receive a quick, accurate and reliable diagnostic service combined with clinical backup and expertise.” New HCV testing enabled by vendor neutral managed services With a small physical footprint, the compact Vela Diagnostics technology – a combination of a Sentosa SQ Genotyping Assay and Sentosa ST401 instrument unit - is perfect for


use in a busy space constrained laboratory setting. The EPA has installed both working in close collaboration with its established vendor neutral managed services partner, Genmed. The use of a managed services contract (MSC) has meant that the EPA has been able to introduce the new test equipment rapidly and benefit from a pay-to-use approach. Reenesh Prakash, EPA microbiology network manager explains: “The contract we’ve signed is an interesting one. We’ve agreed with Genmed and Vela Diagnostics the volume of work we’ll deliver over time and adopted a tax efficient MSC where we’re charged per reportable test.” In addition, a MSC provides the EPA with a host of other benefits. First, it is able to reclaim VAT to give the organisation a 20 per cent budget boost. Second, Genmed provides all administrative support related to arranging equipment maintenance and the ordering of consumables. And third, it minimises operational risk as Genmed takes responsibility for equipment uptime with a SLA set at 90 per cent availability. Robin Modak, Genmed’s chief executive officer, said, “We’ve been able to put in place the best, most modern laboratory equipment for the EPA with an innovative and flexible charging model. The EPA’s primary duty is assay performance and the provision of care. But it is the patient who is the real winner from all this - as one would hope - as the time from test to accurate diagnosis has been radically reduced.” L FURTHER INFORMATION Tel: 01603 288587 Email:

Fraud Written by Susan Frith

Leading the fight against NHS fraud Susan Frith, Interim CEO of the NHS Counter Fraud Authority, discusses collaborative counter fraud work and the importance of reporting fraud Launched in 2017, the NHS Counter Fraud Authority (NHSCFA) is the special health authority leading the fight against fraud, bribery and corruption affecting the NHS and wider health service in England. We work closely with the equivalent service in Wales and liaise with our Scottish and Northern Irish counterparts. We also work closely with Local Counter Fraud Specialists (LCFSs) across England. We want to work collaboratively, which is why engaging with stakeholders is so important, including NHS staff, the public, the police, Crown Prosecution Service, members of the government Counter Fraud Profession and the Media. Every year an estimated £1.27 billion is lost to fraud from the NHS budget. We all have a vested interest in the NHS; we all use and rely upon it. While those that defraud the NHS are a minority, it has a significant effect and robs the NHS of vital resources. When fraudsters manipulate the system for their private gain, there is a real impact on patient care- £1.27 billion could fund over 40,000 staff nurses or over 56,000 junior doctors for a year.

We currently categorise fraud types in the following ways:

thematic research and loss measurement exercises to determine how NHS fraud is committed in each area, using this information alongside the referrals we receive to build a better intelligence picture of NHS fraud. This allows us to estimate how much is lost to fraud in each area and informs what measures can be put in place to mitigate the risks. Everybody can play a part in defending the NHS from fraud. Any suspicions of fraud (even if it is unclear whether or not it is fraud) can be reported confidentially using our 24 hour/365 Fraud and Corruption Reporting Line either by phone or online. There is the option to remain anonymous. If you are an NHS employee or contractor, you can also report any incidents to your NHS Local Counter Fraud Specialist (LCFS). The LCFS has a proactive and preventative role too, so get to know your LCFS to understand what systems are in place to help lock out fraud and what good housekeeping rules to follow.

1. Community pharmaceutical contractor fraud 2. Help with health costs (fraud by patients) 3. Procurement and commissioning fraud 4. NHS staff fraud 5. National tariff and performance data manipulation The process after a fraud report 6. General practice fraud Whether made by phone or online, the report 7. European Health Insurance goes directly to our central intelligence Card (EHIC) fraud unit for review. If the issue is 8. Optical contractor fraud within the NHSCFA’s scope to 9. Dental contract fraud investigate, we may do so Accord 10. Fraudulent access directly – generally only for i n g to the N to NHS care more complex, higher value HSCFA, 11. NHS pension fraud fraud cases. Information an estim ated 12. Fraud against NHS about matters not within £1.27 b i l l Resolution (around the NHSCFA’s remit will i o n i s lost to fraud clinical litigation) be passed onto the most f 13. NHS student appropriate body where NHS burom the d bursary fraud appropriate - for example every y get where serious clinical rather e ar The NHSCFA produces an than financial impropriety annual Strategic Intelligence is the issue. Criminal Assessment (SIA). We conduct investigations are launched E



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 wherever appropriate, and files are prepared for the Crown Prosecution Service to decide if going to court is in the public interest and a successful prosecution is likely. The importance of publicity Part of the NHSCFA’s remit is to proactively publicise successful prosecutions. We do so by issuing sentencing press releases to mainstream and health news outlets, giving media interviews and collaborating with TV documentary makers (for example the BBC’s recent hit documentary series Fraud Squad NHS). Publicity is a way of deterring those who wrongly consider the NHS an easy target. It demonstrates that fraud against the NHS will not be tolerated and those that have sought to take advantage of the system will be held to account, which is reassuring to NHS users and UK taxpayers. This year’s priorities The NHSCFA has four priority areas for this year. They are detailed in the 2019-2020 NHSCFA business plan on our website: Procurement and Commissioning fraud; Fraud in relation to General Practice Contractors; Pharmaceutical contractor fraud; and improving fraud outcomes in the NHS. Procurement and Commissioning Fraud Procurement and commissioning fraud is a major problem, costing the NHS £351 million in 2017-18. In July 2018 we issued fresh guidance on pre-contract procurement fraud and corruption. It explains offences such as bribes and kickbacks, conflict of interests and contract splitting and how to prevent these, with the help of case studies. A recent result At any one time, the NHSCFA has numerous investigations in progress and has had some

Publicity demonstrates that fraud against the NHS will not be tolerated and those that have sought to take advantage of the system will be held to account, which is reassuring to NHS users and UK taxpayers notable outcomes since our launch. Recently, following a police-led recovery under POCA (the Proceeds of Crime Act), £1.7 million was received back by the NHS bodies who had been defrauded by an international criminal group. Investigation, intelligence and forensic computing specialists who work in the NHSCFA played a key role in the original fraud investigation. The Forensic Computing Unit analysed over 90,000 documents and files, rapidly and remotely. Lincolnshire Partnership NHS Foundation Trust has received £1.2 million back, North Essex Partnership NHS Foundation Trust has received £298,219.79 and Tees, Esk & Wear Valleys NHS Foundation Trust got back £216,584.76. Support to NHS CFS Wales The NHSCFA is contracted to provide a range of services to NHS CFS Wales including media handling. A recent procurement fraud case that achieved wide media coverage involved three NHS managers who defrauded their health board out of £822,000. The ringleader Mark Evill contracted out work for his NHS employer to his own private company and inflated invoices. He also paid bribes to accomplices Robert Howells and Michael Cope. NHS CFS Wales’ successful investigation resulted in a combined total of 14 years’ imprisonment for the three.

Next steps The NHSCFA will continue to work with national and local level organisations to achieve the common goal of preventing fraud against the NHS and wider health service, and prosecuting the crime where it does occur. We hope you will support us in this ongoing battle. What you can do to help Everybody can play a part in defending the NHS from fraud. Keeping up to date with the latest news in NHS counter fraud and the NHSCFA is a good start by subscribing to our monthly e-newsletter. You can also keep up with us by following our social media output- on Twitter, LinkedIn and Facebook. Any suspicions of fraud (even if it is unclear whether or not it is fraud) can be reported confidentially using our 24 hour/365 Fraud and Corruption Reporting Line either by phone on 0800 028 4060 or online. There is the option to remain anonymous. If you are an NHS employee or contractor, you can also report any incidents to your NHS Local Counter Fraud Specialist (LCFS). The LCFS has a proactive and preventative role too, so get to know your LCFS to understand what systems are in place to help lock out fraud and what good housekeeping rules to follow. L FURTHER INFORMATION



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Reducing business energy costs for over a decade

Sustainable, cost effective environmental systems

Power Solutions UK Ltd is one of the UK’s leading truly independent energy consultants, committed to providing the right solution tailored to your business needs. With a portfolio of over 10,000 supply points and trading 15 years, the company has a proven track record across business of all sizes. With an ever-changing energy landscape and continuous corporate, social pressure to move towards a greener future, Power Solutions UK Ltd places sustainability at the forefront of our bespoke process. The organisation’s methodology is very simple and focuses on four key components: audit, procure, monitor and manage. The first step is to perform both desktop procurement audits and on-site efficiency audits to understand

Hospitals, health centres and care homes will typically exhibit a continuous electrical demand alongside a significant, but varied, hot water and heating usage pattern. With almost 50 years of industry experience, Adveco is the trusted specialist provider of bespoke environmental systems to the building services industry. Committed to partnering with its health care customers, Adveco provides invaluable support in the design, supply, commissioning and service of business-critical hot water, heating, hybrid and low carbon power systems. Since 1971 Adveco has been the distributor of A.O. Smith Water Heating products and is the exclusive provider of TOTEM micro combined heat & power (CHP) units, a technology ranked as one of the most efficient (out of 35 considered) by the

the sites current energy footprint. Based on the information gathered here, Power Solutions UK Ltd can then implement the correct renewable and procurement strategy for your business. From here, the company can install a comprehensive, real-time energy management system to deliver granular insights to quantify the impact of the steps made. Power Solutions UK Ltd continues to manage the energy needs of the business on an ongoing basis seeking continuous improvement towards a goal of cost and carbon neutrality.

FURTHER INFORMATION Tel: 01244 391 547 Luke.rowson@


Sustainable Development Unit (SDU) for NHS England and Public Health England. TOTEM CHP generates energy saving heat and power to provide some of the highest annual cost savings of any technology, with ultra-low levels of NOₓ and CO emissions for reduced environmental impact. Whether new build or refurbishment, Adveco creates bespoke technology implementations to reduce costs and improve sustainability across the health care estate.

FURTHER INFORMATION Tel: 01252 551 540


UK suppliers of waste and recycling products

Tackling the challenges of mattress recycling

Cromwell Polythene is proud to be an independent, familyrun business, committed to supply products for the capture and containment of waste and recyclables. It is the company’s mission to be the most resourceful company in plastics, supplying products that help make the world cleaner, greener, and more resourceful. Cromwell Polythene has an extensive portfolio, from waste and recycling sacks to all bin liners, compactor sacks, clinical waste sacks and compostable liners. That’s in addition to food-grade bags, kerb-side recycling bags, woven sacks, disposable gloves and aprons. The company’s LowCO2t™ refuse sack range is engineered to provide maximum performance using minimal resources, including more than 30 per cent recycled Polythene. Cromwell is also the sole UK distributor for

They said it couldn’t be done – many companies have tried to develop an automated solution for recycling mattresses and bulky waste, but up to now none have yet succeeded. Textek has invested 18 months into the research and development of the first Bespoke Mattress Shredding Line, that will divert a staggering one million mattresses a year from landfill. Its design enables the successful separation of the flock from the steel, ensuring 100 per cent of the mattress can be recycled. Textek believes that this line provides a stable

compostable bags made from Ecopond® biodegradable resin. Complementing Cromwell’s sacks and bags portfolio is the ‘Wave®’ range of latex-free, disposable gloves for professional use. The range incorporates new, eye-catching packaging, with a fresh logo, better promoting the products environmental and performance credentials. Cromwell Polythene is accredited by the CHSA, whose code of practice provides customers with an assurance of professional conduct, customer service and quality, as well as ISO 9001:2015 standards.


future for mattress recycling and reduces the hard, often dangerous, manual work that is required when stripping a mattress by hand. On average a skilled person can strip a mattress in around seven minutes. The Textek Shredding Line is able to dismantle a mattress in under 30 seconds. The company plans to install more TexTek plants around the country to help with the on-going challenges of mattress recycling.





Burrellines: Overcoming language barriers

One stop ethical global healthcare recruitment

The nature of the modern world is such that not only are we all different, we also speak different languages. We are clever that way. Healthcare and justice are two of the areas where speaking the same language is vital. Even people who do not need an interpreter in their daily life, require help to understand a medical report on their health condition, general healthcare communications, legal advice or court proceedings. Come to think of it, most of us could do with a ‘translation’ of ‘legalese’ or even social care terminology. Burrellines Translations (Ines Burrell) has been providing translation services in the UK and interpreting services in the South West since 2004, translating medical reports, healthcare brochures, guidelines, court documents, police reports from English to Latvian and Latvian to English, as well as

The deepening UK healthcare skills crisis urgently demanded an ethical, safe recruitment portal open to the global workforce. Combining twenty five years frontline NHS recruitment experience with best-in-class technology, offers ‘one stop’ to search, secure and deploy high calibre talent from over twelve international destinations. Employers can now securely connect to one strictly vetted network, where all our ‘Endorsed’ agents adhere to WHO standards and the Endorse Code of Practice. Employers can submit international job orders and invite Endorsed agents to respond with proposals to fill your vacancies. They can also request tailored recruitment services for cost-effective recruitment campaigns and best-in-class candidate deployment, as well as reduce time, costs,

from Russian. Having worked in translation sector for almost 30 years, the company offers invaluable expertise and experience, supported by the membership of the Institute of Translation and Interpreting (ITI), as well as current DBS checks for your peace of mind.





overheads and governance with our ‘One Contract’ valid across all Endorsed agencies Julie Chapman, Head of Resourcing at CUH, said: “Endorse have been pivotal in offering a bespoke service which introduced us to alternative legitimate nursing agencies from overseas. “Matthew’s continued support as a conduit between ourselves and the agency enabled our Trust to manage overseas recruitment not only in a more cost-effective way, but also ensure the quality and recruitment experience of every nurse remains the focal point.”



Alpine electrical and mechanical services

World class quality, world class safety

Alpine Works offers a comprehensive mechanical and electrical service that has built an enviable reputation within the healthcare sector for delivering a high-level of performance especially for complexed construction schemes. The company undertakes maintenance projects which will involve pre-defined planned and preventative maintenance with the addition of compliance and emergency works. Alpine assumed a pivotal role in the refurbishment of the East, South and West wards at the Royal Free Hospital. This project is Alpine’s largest project to date and involved a comprehensive range of electrical installation, that spanned two phases of the construction scheme. Alpine’s team were instrumental in the continuation of all adjacent operations for critical care. The project included the construction of open plan and enclosed bed bays, nurse stations,

With a range of over 2,000 products and distribution partners in over 90 countries, Hillbrush is the largest UK manufacturer of brushware and hygienic cleaning tools, selling to a global customer base. Setting the benchmark for quality and innovation across the cleaning, healthcare and food processing industries, the mission for continuous development and outstanding service is as prominent now as it was when the company was founded in 1922. Hillbrush has developed an extensive product line designed for a range of sectors, from hygiene products suitable for food manufacture and healthcare to natural fibre products for the agricultural industry. Hillbrush Hygiene features ground-breaking filament retention technology to help ensure the highest standards of cleanliness and safety in the workplace. The Hygiene range

waiting areas, family interview rooms and all relevant medical spaces. Alpine’s role comprised of the electrical installation of new LV MCB distribution and medical isolated power supply, LV distribution boards, with associated sub-main supplies and metering; lighting installations; new fire alarm detection and nurse call systems; data communication and telecommunication cabinets, hospital television and radio including containment; and security systems.

FURTHER INFORMATION Tel: 020 8644 2014


is manufactured in house in a state-of-the-art factory in Mere, Wiltshire, South West England and boasts up to 12 colours, including Anti-Microbial, Total MDX, Resin-Set DRS® Brushware and Foodservice, allowing customers to colour code their workplace. These product lines cover the three major causes of contamination in the food manufacturing and healthcare industries and along with Shadowboards help organisations comply with BRC Global standards version 8 and HACCP.

FURTHER INFORMATION Tel: +44(0)17 4786 0494



Providing public services with translation skills

Expert linguists for Czech and Slovak translations

My name is Banu Gokberk. I have been working as a Turkish/ English interpreter and translator for 12 years. I have attained qualifications (Community Interpreting Level 3 and Level 6 Diploma in Public Services Interpreting in Law (DPSI) that allow me to work with most frontline services and have many years of experience working for the health sector, as well as other public services. I am a member of the National Register of Public Service Interpreters and Association of Police and Court Interpreters. Over the last decade language services have been outsourced to privately run agencies and the quality and standards of interpreting have decreased due to ‘profit before people’ approach.

Marta Gunn RPSI MCIL is a specialist medical and legal translator and face to face interpreter with over 10 years of experience in the health care and legal systems in the UK and is here to assist in smooth communication with your Czech and Slovak speaking clients and patients. Marta Gunn is a full member of National Register of Public Service Interpreters (NRPSI) and full member of Chartered Institute of Linguists (CIOL). Marta Gunn can assist with any translation (written material) such as medical reports and assessments and any certified translation as well as interpretation (spoken word) at medical meetings with patients and their families, medical conferences and gatherings. Marta Gunn can also assist with telephone conference calls and video links. Please contact via the details below for professional service from an expert linguist

As a professional freelance interpreter, I take pride and responsibility for my work. I want my skill and experience to bring value to the providers and users of public services. Together with other colleagues I have been involved in setting up a linguist owned digital platform cooperative to provide language services of the highest quality for affordable and competitive rates. Our application to form a linguist co-op (start- up) has been accepted by Cooperatives UK (HIVE) and currently we are receiving support.



that is available nationwide. NRPSI is the UK’s independent voluntary regulator of professional interpreters specialising in public service. It maintains a public register of professional, qualified and accountable interpreters. It only use interpreters with proven competence and skills, who are governed by a nationally recognised code of conduct.



Professional translations from English to German

Providing a range of language solutions

SDG Translations is a language specialist for medical content, having served the medical sector for over 10 years. The company translates documents for clinical trials, study reports, systematic reviews, healthcare marketing, HCP surveys, patient apps, e-detailers, SmPCs and more. All of its translations are rigorously checked and carefully revised by a second linguist before being dispatched to the client. For you, this means peace of mind. SDG Translations also provides checking of proofs and a bespoke copy-writing service. Amongst the company’s customers are renowned contract research organisations and pharmaceutical companies, as well as large market research institutes and individual clients. SDG Translations is aware of the challenges you face: sophisticated translations demand not only expert

My Language Hub Limited (MLH) is a Language Service Company (LSC) based in Letchworth Garden City in North Hertfordshire. The organisation provides a wide range of language solutions in the health, medical and pharmaceutical industries. With 20 years of medical translation experience, MLH has an extensive team of associate clinicians and its database for interviewees covers a wide range of conditions. MLH feels uniquely qualified to undertake this specialist service. The company is comprised of members of the Chartered Institute of Linguists (CIOL), which provides proof of accreditation and assists it in locating qualified associates in diverse language pairs. MLH is a proud member of the American Translators Association (ATA), validating the high standards of its certified medical translations.

knowledge, but also linguistic skill and an understanding of the intended audience. That’s why the organisation doesn’t simply translate – it conveys your message with a culturally sensitive approach, making sure SDG Translations connects you. SDG Translations helps you speak to your clients in their language, with target-group tailored translations that work. Choose SDG Translations as your language expert for medical content. Contact the company via the details below.

FURTHER INFORMATION Tel: 0044 1584 879990

My Language Hub

Translation | Education | Business

The ethos of MLH revolves around providing the best service possible in its work. It believes that understanding its clients’ detailed business requirements enables it to tailor its work efficiently. This allows MLH to make progress autonomously, without having to constantly refer back to the client for clarification or further guidance. A member of both the Hertfordshire and the Welwyn and Hatfield Chambers of Commerce, MLH is committed to supporting companies not just in its local area, but across the UK.





Why work at height – send a drone to do it

Fresh food in convenient vending machines

Quayle Industries Ltd provides aerial photography using drones for businesses and individuals in Nottingham and across the UK. The company is proud to be Civil Aviation Authority approved, meaning that it is fully licensed and works to the highest standards. Before Quayle Industries undertakes any project, the organisation seeks appropriate clearance from the authorities to operate the drone. Quayle Industries works with you to plan what is needed and how the footage will be used to give you the result you need. There are many instances where drone photography or filming is the best option: drones are costeffective and reduce the need for scaffolding or helicopters; the quality of the photographyand videos is of a very high standard; drones can be used to access hard to reach areas inside and outside; data and images can be relayed to you within 24 hours ready to download.

The Jar - Healthy Vending manufactures modern vending machines in London. The Jar provides fully serviced vending machines which are replenished regularly, with delicious fresh food, snacks and drinks. The company has a selection of gluten free, vegan, vegetarian, low sugar diet products and many more. You can conveniently filter dietary preferences on its touch screen to show only the products that suit your taste. The Jar’s fresh and healthy food vending machines come with a large touch screen, user friendly interface, contactless card payments are accepted as well as Google and Apple Pay. The products are kept refrigerated at 4°C at all times and monitored 24/7 using the integrated telematics. The integrated telematics system allows the company to remotely monitor stock levels and any issues with

Quayle Industries can provide stunning photography and videos for a wide range of purposes from, property developers wanting to showcase their properties for sale, individuals that need a roof inspection through to companies that want some aerial views as part of their marketing campaigns. ‘Why work at height, send a drone to do it!’



Your parking and access problems, solved Your parking and accessibility problems solved. The Parking Consultancy (TPC) is a small, independent consultancy whose staff have more than 50 years of combined experience solving parking and accessibility problems. With hands-on experience in the health, education and public sectors, as well as airports and private sector institutions, TPC’s consultants are experts at solving issues relating to parking shortages, site redevelopment, optimising revenue, enforcement, technology, operations and sustainable transport planning. After careful research and evaluation, TPC will be able to advise you on the best solutions for your site. Furthermore, the fact that the company is a specialist consultancy, rather than a department in a larger firm, means that it can be flexible in its approach to suit your needs and budget.



its machines, allowing for smooth, uninterrupted operations. The Jar – Healthy Vending machine is a very convenient and very secure point of sale. Moreover, it provides its vending machines fully serviced and at no cost to the business, aiming to provide superior service to its clients.

FURTHER INFORMATION Tel: 020 3727 5435

Are you prepared for safe emergency evacuation?

the parking consultancy Numerous healthcare and higher education sites have already sought the help of TPC. David Cohen, Capital Project Manager for East Suffolk and North Essex NHS Foundation Trust, one of TPC’s clients, said: “Having worked with TPC over the last two years they have provided excellent support, technical guidance and their knowledge of the parking industry has been invaluable in procuring a suitable mixed methods solution to address the onsite parking issues the trust had at Colchester Hospital.”

FURTHER INFORMATION Tel: 01430 650343 Tel: 07410 117 113

Evac + Chair is the world’s number one supplier and original manufacturer of evacuation chairs. The chairs are designed to accommodate disabled or mobility impaired people, allowing them to descend a staircase in an emergency situation without the need of great physical strength or lifting. With over 35 years’ experience, and more than 30 distributors worldwide, including in the USA, Germany, and South Africa, Evac + Chair has become a leading specialist in emergency evacuation, providing comprehensive education, ensuring its customers comply fully with health and safety regulations. This can range from providing products,


advising on the legalities that surround evacuation planning and deployment to specific and regular maintenance. The company’s most popular Evac + Chair is the 300H MK4 model which can take a 182kg payload capacity and is also available in AMB format which has larger rear wheels for prolonged/external rough terrain use. It is used as Evac + Chair’s standard model as it can be used as a one person operation, meaning it is easy to use and light weight at only 9.5kg.

FURTHER INFORMATION Tel: 0121 706 6744



Professional language translation services

LED lighting solutions from dedicated professionals

Established in 1990, Lifeline Language Services has delivered over 11,000 translation and interpreting assignments for the medical and care sector including interpreting for procedures, medical report translation, training material, social care and pharmaceutical projects. With a 100 per cent professionally-qualified interpreter and translator base across the UK and Europe, Lifeline supports over 100 languages working with hospitals, clinics, care homes, dentists and social services to improve outcomes for patients. Healthcare environments are scary, especially when you can’t communicate. Missed appointments are a huge burden on medical resources, but for non-English speakers many happen because patients fear not understanding or being misunderstood. Ensuring easy communication, with in-language

The Venture story: Since the early 1980s, Venture Lighting has been a pioneer of light source technology, transforming the HID lighting market with the introduction of the revolutionary UNI-FORM arc tube in Metal Halide lamps. Driven by the increasing demand for energy efficient lighting, Venture has taken advantage of the rapid developments in technology by offering its customers a class leading range of LED lighting solutions suitable for indoor and outdoor lighting applications.   The company’s purpose is to provide lighting solutions that have a positive impact on the environment, whilst enhancing the way that people live and interact with lit spaces. In today’s world light has endless possibilities for new value creation; way beyond the boundaries of illumination. The organisation’s mission is to be the preferred and trusted lighting solution partner to its

appointment reminders, reduces missed appointments and improves expensive resource utilisation. Lifeline’s professional interpreters help health professionals achieve more effective consultations, better following of medication and better keeping of subsequent appointments, delivering better outcomes while wasting less time. Better patient trust, better outcomes and more satisfied people means better performance. A little language goes a really long way.

FURTHER INFORMATION Tel: 0800 7834678 healthcare@lifelinelanguage www.lifelinelanguage


customers, offering a commitment to deliver a quality range of products and solutions through continuous innovation. Venture Lighting’s dedicated team of professionals puts customers at the heart of everything it does. The business is built on lasting relationships. As a Venture Lighting customer, you’re assured the very best technology combined with the highest level of service, from a global leader in the lighting industry. When its customers succeed, Venture Lighting succeed.

FURTHER INFORMATION www.venturelightingeurope. com


Property surveying and consultancy services

Saving businesses money on energy bills

Pennington Choices has worked with asbestos for over 30 years, helping clients across a host of sectors including: healthcare, transport, local government, blue light services, social housing, construction and retail. The company is an expert in asbestos management not by its own words but by its clients. Asbestos services at Pennington Choices include: surveying, air monitoring and four stage clearance testing, sampling and laboratory analysis, project management and remediation, auditing, procurement, consultancy, asbestos management plans and training. The organisation is accredited to ISO17020 and ISO17025 by UKAS and UKATA accredited for training. Pennington Choices has dedicated UKAS accredited laboratories, provides an emergency out of hour’s asbestos service, which operates

Bamford Lighting is one of the UK’s leading LED lighting companies providing without obligation lighting surveys nationwide. As a leading supplier of LED lighting, the company offers an outstanding competitive service designing, supplying and installing LED lighting luminaires for every application. Compared to standard incandescent lighting the LED replacement is much more efficient and friendly to the environment, typically saving 70 per cent in lighting energy bills. LED lighting produces much less heat than traditional lighting with a guaranteed lifespan of three years, which in the long term with annual rising energy costs gives year on year energy savings. A typical return on investment for an LED lighting replacement project is 2.5 years. Benefits include much brighter, efficient and maintenance free lighting with

24/7, and offers nationwide coverage meaning that, no matter where you are in the UK, its expert teams can help you. Alongside providing a wide range of asbestos services, Pennington Choices’ teams also deliver: fire risk assessment services; electrical and gas auditing; legionella services; stock condition surveys; energy performance certificates (EPCs); strategic consultancy and chartered building surveying services. The company’s full breadth of services makes it unique and provides its clients with a cost and time effective solution.

FURTHER INFORMATION Tel: 0800 883 0334

a much lower level of generated heat which is safer and much more environmentally friendly. Bamford Lighting has carried out lighting projects to a broad range of industries including warehouses, hospitals, airports, schools, colleges, sports stadiums, car dealerships and many more happy clients. The organisation installs the very latest state of the art products, bespoke to each individual client, offering the very best in lighting technology.




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