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ISSUE 21.1 www.healthbusinessuk.net





THE END OF THE TRANSITION PERIOD What does the end of the Brexit transition period mean for the health and care system?

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ISSUE 21.1 www.healthbusinessuk.net





THE END OF THE TRANSITION PERIOD What does the end of the Brexit transition period mean for the health and care system?

WE GET HEALTHCARE INNOVATION. Read how CDW helped Stockport NHS Foundation Trust overcome backup and disaster recovery concerns. healthcare@uk.cdw.com


Mental health support vital moving forward Amid all the positive news stories lately, with the vaccination programme exceeding expectations and NHS Test and Trace finally beginning to show its worth, the announcement that healthcare staff will be offered access to evidence-based mental health services at one of 40 new hubs should be celebrated. The strain that our healthcare staff face in normal circumstances is more than most of us can imagine and it only emphasises the care, compassion and drive to help people that makes it such a rewarding vocation. But this last year that strain has become unbearable. As Claire Murdoch said, staff have put their minds and bodies to the limit treating hundreds of thousands of seriously ill-patients with coronavirus. The free-of-charge hubs will help to offer advice and support, but more importantly their aim is to proactively contact staff groups who are most at-risk to offer them support so they get the care they need as quickly as possible.

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It has been disappointing to read the health staff are unlikely to see the pay rise they deserve in the upcoming Budget, as it is only right they they receive all the support that they need as we head towards an end of lockdown, the next stages of the vaccination drive and, hopefully, a return to normality. Michael Lyons, editor

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226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Web: www.psi-media.co.uk EDITOR Michael Lyons PRODUCTION MANAGER/DESIGNER Dan Kanolik PRODUCTION CONTROL Lucy Maynard WEBSITE PRODUCTION & ADMINISTRATION Victoria Casey SALES SUPERVISOR Damian Emmins, Azad Miah, Maziar Movassagh PUBLISHER Karen Hopps

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Contents Health Business 21.1 07 News

NHS leaders call for a new deal to protect NHS workers; vaccine roll-out campaign gets social media backing; and doctors ‘running on empty’, says RCP

14 Brexit 14 20

Ilse Bosch, Brexit policy consultant in the NHS Confederation’s international office, writes for Health Business about what the end of the transition period means for the health and care system

20 HB Awards

The winners of the 2020 Health Business Awards were announced during the event’s first ever digital ceremony on 10 December 2020

26 NWAS Interview

Following their success at the 2020 Health Business Awards, we speak to Daren J Mochrie, Chief Executive Officer at North West Ambulance Service


31 Covid-19 update

After 12 months of little else making the news headlines, how are our hospitals coping with coronavirus? Are cases dropping? Are staff protected? Have we turned a corner?

37 Facilities management

Delivering a net zero health service will require work to ensure new hospitals and buildings are net zero compatible, as well as improvements to the existing estate

42 Finance


Mark Smith, Chief Finance Officer (CFO) at NHS Property Services speaks about his time in NHSPS and the changes that have helped to save the NHS £48 million this year

47 Technology

Valerie Phillips explains how remote healthcare solutions are leading to greater empowerment for patients, clinicians and healthcare professionals

55 Digital security


NHS Digital has successfully completed the world’s largest ever enterprise email migration, alongside the largest known public sector data network transition programme

Health Business magazine

65 Digital transformation In this digital transformation article, Tom Russell, Programme Manager for Health and Social Care at techUK, explains why 2020 was the year of digital health... or was it?

68 Expert Panel: Parking

Following previous panel discussions with those involved in hospital parking, Health Business gets the views of Gareth Brierley, deputy managing director of Debt Recovery Plus, on parking, facilities and collecting payments

71 Infection control

We revisit the thoughts of Dr. Stephanie Taylor, where she discusses the need to ensure public buildings, such as schools and hospitals, have a humidity level so that viruses cannot spread

74 Furniture

Healthcare professionals play an increasingly important role in the selection of hospital furniture. Here we take a look at the advice of Nigel Davis on the issues that should be considered when selecting hospital furniture

78 Buildings

In our latest PA Consulting article, Christian Norris and Stephen Farrington explain how Covid-19 has changed hospital infrastructure needs for good

83 Assistive technologies

The NHS SBS Digital Dictation, Speech Recognition and Outsourced Transcription framework provides a wide range of technology solutions to meet the evolving needs of NHS and wider public sector organisations

85 Medical equipment

Barbara Harpham, chair of the Medical Technology Group, wrote for Health Business on the need for equal access to medical technology. We take a look back at her thoughts, in which she says that treatment should be based on their clinical needs, not patient postcode

www.healthbusinessuk.net Issue 21.1 | HEALTH BUSINESS MAGAZINE



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NHS leaders call for a new deal to protect NHS workers

In a letter to the Prime Minister, leaders from all parts of the NHS are calling for a period of ‘recuperation’ for staff after the extreme and sustained pressures of the pandemic. Organised by the NHS Confederation, the letter warns that although cases of coronavirus are continuing to drop

nationally, as are the numbers of patients in hospital with the virus, they are still very high and are placing significant strain on patient services and staff. While there is commitment to resume elective and other services that have been disrupted, NHS leaders want staff to be able to take time off to recover and for them to receive ongoing mental health support. Therefore, NHS leaders are calling on the government to set out clear expectations to the public on when routine procedures and other treatments will be fully back online. This will take many months given



Test and Trace passes six million contacts reached

London ambulance crews given body cameras

NHS Test and Trace has now reached more than six million contacts, including 90 per cent of close contacts for whom communication details were provided. The latest weekly statistics reveal a continued strong performance into February, reaching more than 210,000 people, and testing more than 2.5 million people for coronavirus. The data shows that the service successfully reached 87.9 per cent of cases and 93.6 per cent of their contacts, making a real impact in breaking chains of transmission. Since its launch last May, NHS Test and Trace has now reached more than six million contacts. The Department of Health and Social Care has also announced that local authority level data will be available alongside national app data for England and Wales on the NHS COVID-19 app website. This includes the number of users who have completed the symptoms checker and notified to self-isolate, the number of test results received through the app, both positive and negative, the number of users notified to self-isolate by the app as a result of risky contacts, and the number of check-in events that have taken place per local authority. READ MORE

Ambulance crews in London have begun wearing body cameras to protect them from violent assaults and threats. The new kit is being rolled out as part of a trial, starting in areas where London Ambulance Service staff and volunteers are considered to be most at risk, based on previous incidents. Medics can press a button to start recording if patients or members of the public become aggressive or abusive. The latest figures from London Ambulance Service show there have been 529 violent incidents between April 2020 and January this year. Those attacks include kicking, punching, head-butting, biting and spitting and there have also been 31 assaults with weapons.

the NHS will be operating with reduced capacity due to the ongoing impact of the virus and with an exhausted workforce. The letter also calls for the 52-week waiting time standard for non-urgent treatments to be suspended and be replaced with a more patient-centred approach that enables the NHS to focus on clinical need and avoids enforcing unattainable expectations on the NHS. The standard was introduced in 2010, when this list was over 20,800. READ MORE

Meanwhile, during the same period, there have been 834 incidents of verbal abuse and threats. There are concerns that many more incidents go unreported, despite a campaign to encourage staff and volunteers to report all abuse. So far this financial year, 27 people have been successfully prosecuted for attacks on ambulance staff – 18 of those were jailed. As well as the cameras, London Ambulance Service has recruited two violence reduction officers and launched the #NotPartoftheJob campaign, as part of its ongoing work to protect staff and volunteers. READ MORE


NHS expands mental health support for staff NHS England has announced that healthcare staff will be offered access to evidence-based mental health services at one of 40 hubs. Seeking to support staff who have pushed their minds and bodies to the limit over the last year to look after their mental health, the 40 new dedicated hubs will enable staff to access services over the phone with onward referral to online and

one-to-one expert help from qualified mental health clinicians, therapists, recovery workers and psychologists. The hubs are free of charge and offer confidential advice and support to NHS staff who for the last year have cared for millions of people with coronavirus while keeping vital services like maternity, mental health and cancer care going.

NHS staff will be encouraged to reach out directly for help, but hubs will proactively contact staff groups who are most atrisk to offer them support so they get the care they need as quickly as possible. The hubs have been modelled on the success of The Greater Manchester Resilience Hub which was set up to treat all those affected by the Manchester terrorist attack in 2017, including NHS staff. READ MORE




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Vaccine roll-out campaign gets social media backing

Social media platforms are backing a new nationwide social media campaign launched by government and the NHS for people to show their support for the vaccine roll-out. Alongside Facebook and Instagram, the campaign has also been supported

by the Premier League and author and illustrator Charlie Mackesy. The new initiative allows users to update their profiles with a range of specially designed profile frames and graphics, that indicate that either ‘I’ve

had my vaccine’ or a pledge that ‘I will get my vaccine’ when their time comes. During the pandemic social media has been a vital tool for people to connect and share updates with their loved ones. The new collection of graphics will allow people to celebrate getting the vaccine with their family, friends and followers and say thank you to the hard work of our NHS heroes. Over 16 million people have now received their first dose of the vaccine across the UK, and this week people in priority groups 5 and 6 started to receive their jabs as the roll-out expands further. READ MORE



Large-scale vaccination centres trialled in Hampshire

Pfizer-BioNTech vaccine provides high levels of protection

Eligible people are able to walk-in for their coronavirus vaccination at four large-scale vaccination centres across Hampshire and the Isle of Wight. For a trial period of seven days, walk-in appointments will be offered at Solent NHS Trust run centres including: Basingstoke Fire Station, St James’s Hospital in Portsmouth, The Riverside Centre in Newport on the Isle of Wight and Oakley Road in Millbrook, Southampton. The walk-in service is being offered to people in line with recommendations from the JCVI: people age 64 and over; people who have received a letter from the government saying they are at

high risk from coronavirus (clinically extremely vulnerable); and adults in receipt of Carer’s Allowance. David Noyes, Chief Operating Officer at Solent NHS Trust, said: “We know that the vaccination programme is our way out of this pandemic. Opening the walk-in appointments at the four largescale vaccination centres for this group of people will help us to vaccinate even more people with the highest need quicker. We are delighted to be able to offer this service for a trial period.” READ MORE


£18.5 million to tackle long Covid through research

People experiencing the longer-term effects of long Covid to benefit from research projects to help better understand the causes, symptoms and treatment.

The Department of Health and Social Care has said that the funding will be given to four studies to identify the causes of long Covid and effective therapies to treat people who experience chronic symptoms of the disease. Long Covid can present with clusters of symptoms that are often overlapping and/ or fluctuating. A systematic review has highlighted 55 different long-term effects but common symptoms of long Covid include breathlessness, headaches, cough, fatigue and cognitive impairment or ‘brain fog’. There is also emerging evidence that some people experience organ damage. It is reported that approximately one in 10 people with coronavirus continue to experience symptoms and impaired quality of life beyond 12 weeks. READ MORE

Public Health England has published the first independent analysis in the UK showing the Pfizer-BioNTech vaccine is effective against coronavirus from the first dose. Early data from PHE’s SIREN study shows a promising impact on infection in healthcare workers aged under 65. Healthcare workers in the study are tested for coronavirus every two weeks – whether or not they have symptoms. Data shows one dose reduces the risk of catching infection by more than 70 per cent, rising to 85 per cent after the second dose. This suggests the vaccine may also help to interrupt virus transmission, as you cannot spread the virus if you do not have infection. PHE is also monitoring the real-world impact of the AstraZeneca vaccine and will publish these findings in due course – but early signals in the data suggest it’s providing good levels of protection from the first dose. READ MORE



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Doctors ‘running on empty’ says RCP

The Royal College of Physicians has warned that physicians who have worked tirelessly throughout the pandemic are now in urgent need of rest and recuperation. According to their latest coronavirus survey, 49 per cent of the UK’s doctors are

not getting enough sleep, as the emotional and physical toll of working through a global pandemic for almost a year has left doctors exhausted and in desperate need of rest. London’s clinicians were the worst affected, with only 42 per cent getting the amount of

sleep they need all or most of the time, and 11 per cent saying they never get the amount of sleep they need, compared to eight per cent for doctors elsewhere in the UK. While morale appears to have slightly improved, with only 28 per cent of doctors feeling worried this month compared to 48 per cent last month, a large proportion (63 per cent) still felt tired or exhausted and 27 per cent said they felt demoralised. Worryingly, 63 per cent of doctors said that there had been no discussion in their organisation about timetabled time off to recuperate. READ MORE



NHS waiting list could reach 10 million by April

Home smear tests to be trialled in parts of London

A new report has warned that waiting lists for NHS surgery in England could hit 10 million by April, meaning one in six people could be waiting for treatment in a few months time. Reform said that the impact of the coronavirus pandemic had turned the NHS into a ‘national Covid service’ with six million fewer referrals for treatment in 2020. The publications claims that delays in treatments could have dire consequences for patients with an estimated 1,660 additional lung cancer deaths. Therefore, the right-wing think tank has called for NHS hospitals to use more private sector capacity to reduce delays

for patients. Reform claims capacity in private sector hospitals, where NHS England has secured new contracts to take on additional work during the virus surge, have not been effectively used. The report calls for structural issues in the health service to be addressed and highlights 141,808 worth of hospital beddays caused by delayed discharges. It said the lack of capacity in social care and community services was a primary reason for delays and called for more funding for non-hospital settings. READ MORE


Very few NHS staff think government has handled pandemic well

A new poll has revealed that less than five per cent of NHS staff think that the government has handled the coronavirus pandemic well. In the survey of almost 3,500 health workers, the GMB union reports that

only 4.9 per cent answered that the government was doing a good job during the crisis. Almost half said they thought the government had handled the pandemic badly and had made the situation worse. Rachel Harrison, GMB National Officer, said: “NHS staff have been badly let down by Ministers throughout this pandemic – it’s no wonder they don’t think the government is doing a good job. It’s a year into the crisis and we’ve still got ambulance workers attending patients with flimsy gowns and paper masks instead of proper PPE and nurses in hospitals working amongst covid patients given only the most basic of surgical masks.” READ MORE

NHS England has announced that more than 31,000 women will be offered kits to carry out smear tests in the privacy and convenience of their own homes in a trial. The swab tests will be posted to women or given out by a GP to increase take-up of screening for the Human Papillomavirus Virus (HPV), which can lead to cervical cancer. It provides a simple way for women to do the test themselves, rather than have one done for them by a general practice nurse. NHS England says that the trial will target women aged 25-64 years who are 15 months overdue for a check and live in Barnet, Camden, Islington, Newham and Tower Hamlets where screening appointment attendance is low. The trial marks the first time home smear tests have been trialled in England, with tests being rolled out through 166 GP practices, as part of the national NHS Cervical Screening Programme. As well as those who are 15 months overdue a check, women who attend a GP appointment for another reason and are at least six months overdue a test will also be offered a home kit. In total, 19,000 women will be posted a kit and 12,000 will be given one by their GP. READ MORE



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Nursing applications in England up by over a third

The latest UCAS figures show that the number of applications to undergraduate nursing courses this year is a third higher than last year. UCAS has received 48,830 applications to nursing courses in England, up from 35,960 at the same point last year,

representing a 34 per cent rise. Within the latest data there has also been a 41 per cent rise in male applicants. Last year, the number of people accepting a place on a nursing course increased by 27 per cent compared to 2019. Health Education England has said that it is working with

health and education sector partners to make sure there are enough places for all suitable applicants who will go on to take up vital jobs in the NHS or social care sector. The government introduced a new training grant for eligible nursing, midwifery and allied health profession (including paramedic) students last year of at least £5,000 a year, which does not need to be paid back. Nursing students will also benefit from additional financial support for childcare and for those who study specialisms which typically have fewer applicants such as mental health or learning disability nursing. READ MORE



Half of people with cancer symptoms didn’t see GP

Framework to help reduce pressure on hospital beds

Cancer Research UK has reported that almost half of people with possible cancer symptoms didn’t see GP in first wave of the coronavirus pandemic. Initial findings of the UK-wide survey, carried out alongside Cardiff University, found that possible cancer symptoms were common during the first wave, with 40 per

cent of people saying they had experienced at least one potential cancer symptom. Of those who experienced symptoms, 45 per cent admitted to not contacting their GP for any symptom. People did not seek help even for ‘red flag symptoms’ – 31 per cent of those who experienced coughing up blood, 41 per cent of those who had an unexplained lump or swelling and 59 per cent of those who noticed a change in the appearance of a mole did not contact their GP. People gave a variety of reasons for putting off seeking medical help, including not wanted to burden the NHS. Nearly three quarters of people were worried about delayed cancer tests and investigations due to the pandemic. READ MORE


£10.9m investment for 84 new ambulances in Wales

It has been announced that the Welsh Ambulance Service will receive 84 new operational vehicles thanks to a £10.9 million investment from the Welsh Government. Vaughan Gething, the Welsh Minister for Health and Social Services, also announced that a further £1.6 million in funding is being allocated to the Emergency Medical Retrieval and Transfer Service (EMRTS) to expand the service into a 24/7 operation and establish the Critical Care Transfer

NHS England and NHS Improvement (NHSEI) has recommended the national Patient Discharge Services Framework as a route to reducing the length of stay for people in hospital. With recent reports that more than a fifth of all general and acute beds in England are occupied by patients staying two weeks or more - rising to almost a third in some regions - NHS systems have been encouraged to use the framework, managed by NHS Shared Business Services, to help discharge patients who no longer need to be in hospital. In a letter outlining the immediate steps NHS systems can take to tackle the issue, NHSEI advises that the NHS SBS framework can be used to secure additional capacity from independent providers of ‘hospital at home’ and rehab services - and that this can be funded from the £588 million hospital discharge ‘scheme two’ fund up until 31 March 2021. The two relevant framework lots referred to in the new NHSEI guidance are: Discharge to Assess Services: to support the recovery and rehabilitation needs of those discharged home. Medical Care at Home: to support a wide range of subacute health services in a person’s home.

Service. This is additional money following the £1.7 million already given to the service and will help support the national transfer of critically ill adults across Wales. The funding will be used to fund three specialist critical care ambulances and will see investment in equipment to support the expansion of the EMRTS service. READ MORE





Brexit and the end of the transition period Ilse Bosch, Brexit policy consultant in the NHS Confederation’s international office, writes for Health Business about what the end of the transition period means for the health and care system The story started with the UK’s vote to leave the EU in 2016, triggering three-and-a-half years of broad, complex, and often tense negotiations. After eventually signing the Withdrawal Agreement, the UK formally left the EU on 31 January 2020. This marked the beginning of an 11-month transition period, during which the UK continued to adhere to EU rules and remained part of the single market, while negotiating a new long-term trading relationship with the bloc. After many twists and turns, and passing many deadlines, the EU-UK trade and cooperation agreement (TCA) was secured on Christmas Eve 2020, to take effect from 1 January 2021. While the agreement provides some welcome certainty, in effect removing the prospect of a ‘no-deal’ cliff edge, it also introduces a range of changes for health and care organisations, patients,


and manufacturers of medical products and scientific research, now and into the future.

is not yet clear. However, it includes some important areas of co-operation for health.

Access to medicines and devices What is in the deal and what The TCA centres on UK-EU trade in does that mean? goods. Looking at the implications Compared to the levels of for health, this is a good place co-operation and coMany t to start. With EU imports of ordination on a structural medical products valued at and regulatory level betwee ies £18 billion (2019), the UK that the UK had with UK and n the E relies on trade with the the EU before now, U w away a i EU for security of supplies. the TCA maintains nd ther ll fall some a e are About 70 per cent of only some alignment reas wh products coming to the to the previous regime the futu e NHS are ultimately imported – as expected, we re is no re t from the EU, and one in five have ended up with a yet clea r devices used in specialised ‘light’ deal. Many ties procedures arrive overnight. between the UK and EU This is a sensitive, vital part of will fall away and there are what makes our health system work. some areas where the future


NHS staff and patients The good news on the infamous ‘level playing field’ is that the deal commits to protect workers’ rights and to maintain current standards, providing legal protection and support for well-being and patient safety. Additionally, although mutual recognition of professional qualifications between the UK and EU has ended, the UK has offered recognition for EU healthcare qualifications for two years. International recruitment into the NHS will be governed by the new UK points-based immigration system rather than the trade deal, but there are implications for the workforce, as the arrangements come into force simultaneously. The new immigration system makes it relatively straightforward for most professionals to come to work in the UK via the Health and Care Worker

The good news on the infamous ‘level playing field’ is that the deal commits to protect workers’ rights and to maintain current standards, providing legal protection and support for well-being and patient safety Visa. However, for a number of social care roles, it will become more difficult to meet the criteria for immigration. With 112,000 unfilled posts in adult social care according to Skills for Care, and ever-increasing demand for services, this is a major concern. The TCA was positive for reciprocal healthcare rights for patients. For UK citizens in the EU, and vice versa, the deal agrees not only a continuation of free emergency care via the European Health Insurance Card, but also allows people who need pre-planned treatment to access care. This provision also means the NHS does not have to implement 27 new processes for recovering cost for treating patients visiting from each EU member state. Wider areas of co-operation In terms of medical research, the TCA states the UK will join the Horizon Europe research programme, which will spend €85 billion over seven years. This means British scientists can continue to participate in EU-wide research and testing of new treatments and that patients can benefit as soon as they are available. The UK and EU have also agreed to facilitate movement of researchers with as few barriers as possible, including a new UK global talent visa. Although co-operation on health security will largely end as the UK will no longer


Leaving the single market, customs union and EU framework for the regulation of these products brings bureaucratic changes to moving them across the border, including new customs checks and paperwork. There will also no longer be mutual recognition of conformity assessment, so both sides now have to assess that products are safe to be marketed in their territories. However, the deal does include some provisions that help to facilitate trade by softening some border and regulatory barriers. For instance, it agrees zero tariffs and quotas on imports and exports for goods meeting rules of origin requirements and contains specific clauses that mean the UK and EEA states formally recognise each other’s good practice in medicine manufacturing (GMP). The latter allows each side to accept the other’s regulatory authority assessment that manufacturing facilities comply with GMP, which effectively reduces duplication for supply chains.

be a member of the European Centre for Disease Prevention and Control, it will be able to request access to the Early Warning Response system database for exchanging intelligence, to tackle ‘serious health threat’ comparable to Covid-19. What is next? The TCA’s full impact on the health sector will not be immediately apparent. This is largely because of the unilateral decisions by the UK to ‘phase in’ changes over the next few years. Mostly notably, the UK’s Border Operating Model is not yet fully implemented. Some customs formalities will be brought in gradually up to July 2021. As a result, although contingency measures, such as stockpiling, appear robust, the risk of supply-chain disruption remains. This is particularly important for the DoverCalais route, through which three-quarters of medicine imports enter the UK. More ‘behind the scenes’, various regulatory changes relating to medical products will be introduced over time. This includes a phased process for implementing medicines regulation in Northern Ireland up to December 2021; the UK’s unilateral agreement to continue to accept batch testing conducted in the EU until 1 January 2023; and recognition of CE marks for devices for two-and-ahalf years. This allows companies more time to prepare for new arrangements. Last, but not least, a final agreement on data has not yet been reached. This requires an EU decision to confirm that the UK data protection regime is ‘adequate’ to allow personal data to flow from the EU to the UK. In its place, the deal temporarily agrees to allow continued transfers for up to six months. If there is no agreement in that time, alternative transfer mechanisms will need to be put in place for personal data to continue to flow for medical care and research purposes. For health, the deal sets out only a template for our future relationship with the EU. We now need to agree our future priorities for collaboration and alignment with the bloc. The TCA proposes no fewer than 19 specialised committees and four working groups through which to do this. The relationship is likely to shift and be shaped over the next five years until the next official scheduled review of the deal. L FURTHER INFORMATION www.nhsconfed.org/europe



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ISS Healthcare launch new focused cleaning strategy “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.” [Florence Nightingale1859]

Over 150 years ago Florence Nightingale proclaimed that first and foremost a hospital should do the sick no harm. Amid a global pandemic where the importance of cleaning has been elevated, the spotlight turns to healthcare cleaning services, which are critical to the safe delivery of care to patients. Ensuring the environment is clean and safe for everyone using, visiting, or working in healthcare facilities is paramount. Donna Brown, Divisional Director at ISS Healthcare looks at how her company is leading the way in developing strategies to ensure that they meet Florence Nightingale’s first requirement in the modern age. She explains: Our customers are changing and adapting the way they deliver their services, expedited by the pandemic. Identifying how technology can drive efficiency, safety, and innovation is becoming increasingly important. As a service provider we need to be at the heart of supporting this change agenda. We need to constantly evolve our services and create new ways of thinking, which is why a collaborative approach is essential to continuously improve cleanliness.

The ISS healthcare cleaning model, ASSURECLEAN, is built on the foundation of assurance, excellence, and safety. The Covid-19 global pandemic has accelerated the need for us to adapt and respond, to assure our clients, customers and building users that their hospitals are safe to be treated in, work in, visit and use, which is why we have launched our healthcare cleaning strategy and focus 2021-2022. ISS is serious about cleaning. Cleaning is at the heart of our facilities provision and has never been more important within healthcare. The service is directly linked to patient safety and assurance, and in these times of uncertainty the eyes of the world are firmly set on creating healthier and safer environments through cleaning. Professional healthcare cleaning is a vital part of the overall infection prevention and control process which aims to provide clinically clean and safe environments for delivering patient care. Safe standards of cleanliness minimise the risk to patient safety from inadequate cleaning. By updating our processes, we can continue to provide decontaminated, clean, and safe healthcare environments for the future. The purpose of our strategy is to underpin how ISS will deliver cleaning services into the future. We have updated our guidance, training, and control tools to provide evidence, assurance and the continued promise of consistently safe buildings for patients to be cared in. Our strategy ensures the delivery of cleaning innovation, collaboration, and excellence across our entire, market leading healthcare

portfolio. By providing a compliant service each time, we can continue to deliver consistently safe environments for our customers. The key benefits of delivering our strategy centre on assurance, operational excellence, productivity, and efficiency. ISS customers demand clean, safe, and predictable outcomes. The efficacy of the cleaning process is critical to achieving this, which is why we have advanced our training, and enhanced our focus on technology and digitalisation. We have produced standardised, informative cleaning documentation and guidance and will be using the latest scientific testing to evidence proof of methodology. We will be delivering these elements as part of an up-to-date, highquality cleaning solution for our customers. Highlights of the ISS Healthcare cleaning strategy deliverables include new multilingual modules for our cleaning operations manual in both digital and hard formats. A handy digital healthcare cleaners quick reference pocket guide for every operative, who will receive improved training to reflect the new National Standards. Interactive method statements, task cards, process maps and work schedules have been created to reflect best practice along with efficacy checks throughout the entire cleaning process. ISS has used their vast experience in healthcare to develop a range of productivity KPIs specific to services they provide the NHS. New healthcare cleaning documentation and guidance is being made available locally, reflecting the latest advice, that will also be incorporated into transparent auditing solutions. An updated infection prevention and control manual with the latest decontamination processes and technologies is being introduced, aligning the ISS strategy with the new National Standards of Healthcare Cleanliness 2021, due to be published by NHS England. Donna concludes: “ISS is a long-term supply partner to the NHS with over 35 years’ experience in providing healthcare Soft and Hard FM services. We are committed to ensuring we provide the very best healthcare cleaning service for patients, staff, and visitors. Our dedicated cleaning experts, led by Collette Sweeney, head of Healthcare cleaning, deliver innovative and tailored solutions that prioritise wellbeing, safety, and quality of care. By evidencing our success and demonstrating continuing excellence in cleaning, we will lead the industry into the future as the healthcare cleaning provider of choice.”L FURTHER INFORMATION www.uk.issworld.com enquiries@uk.issworld.com





Improve patient flow This is Nisha... She’s just experienced clear, intuitive and frictionless communications during each stage of care for her recent hip replacement. From initial referral, to appointment management, right through to post-op. The right use of technology enabled this to happen.

Our patient experience platform Liberty helps you improve patient flow and use resources more effectively. Talk to us to find out more: netcall.com | 0330 333 6100

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Celebrating successful digital transformation at NHS acute trusts Over 75 per cent of NHS acute trusts, 100 per cent of Scottish NHS Boards and more than 475 UK hospitals already trust in Netcall, the headline sponsor of the 2020 Health Business Awards

As digital leaders in healthcare, it’s likely you’ll be focusing on improving efficiencies and patient experience as your teams support others to make the best use of your clinical and non-clinical resources. And, you need to provide timely access to accurate information, for patients, staff and other stakeholders. All while saving costs. That’s a big ask. Interoperability and collaboration are vital for NHS trusts. Taking steps to digitise health systems, to bring data together from multiple back-end systems, and use communication channels, to fix the processes that are currently hindering your patient and staff experience is key. A UK company, Netcall, is proud to support 75 per cent of NHS Acute Trusts across the country with their digital transformation journeys. We support our NHS customers to save their precious resources, while improving every patient experience. In 2020, despite unrelenting pandemic pressure, our customers achieved amazing results. We’d like to take you on a virtual UK tour to share in some of their successes. We begin with our stars of 2020, Health Business 2020 award winners Chesterfield Royal Hospital NHS Foundation Trust. They gave their patients an improved experience

and more control over their appointments with an online portal. Patient Hub gives patients instant access to appointment information and relevant materials in one place, 24/7. All types of appointments are covered; whether in-person, by phone or via video. And patients simply click an integrated Attend Anywhere link for a video consultation. In the first four months, 66 per cent of Chesterfield‘s patients chose digital. Heading north, Sheffield Children’s NHS Foundation Trust has made it easier for parents and carers to focus on their children. They have a digital patient portal, too. In a next step, Sheffield have reduced their letter templates by 99 per cent to just 4 digital templates. These conditionally formatted templates meet every clinical department’s needs. Updates and changes are fast and easy. With over a 60 per cent uptake, digital letters mean a big saving in postage costs! Moving to the south coast, University Hospital Southampton NHS Foundation Trust needed to report up-to-date operation waiting list data fast. Their Waiting List app went from ‘design to live’ in just one week. Since its launch, 88 per cent of patients invited by SMS on their mobiles have interacted digitally. The Trust has seen a reduction in the volume of calls as a result. The data is gathered and quickly fed back, providing results to the NHS England directive.

The Waiting List App is in our AppShare and available for any NHS trust to download and use; visit https://community.netcall. com/appshare/waiting-list-management/ Lancashire Teaching Hospital successfully managed the Covid-19 surge in switchboard calls. In a week, they introduced a speech bot, ContactPortal, and it’s now answering 85 per cent of internal calls and over 53,000 calls monthly. The added benefits include the time saved by Junior doctors or Clinical staff who don’t have to wait for 10 minutes or more as a busy switchboard hunts for a consultant. Moving west to St Helens and Knowsley Teaching Hospitals NHS Trust who have gone digital for Covid test results. Over 90 per cent of test results are delivered through Patient Hub Result. Patients and staff can securely track the progress of their test, reducing the impact of calls on the Trust. In beautiful Cornwall, Royal Cornwall Hospitals NHS Trust has recently rolled out an app that manages the flow of outpatients coming to in-person appointments. It helps staff to facilitate social distancing and gives everyone peace of mind. In the first eight weeks, 55 per cent of patients invited by SMS on their mobiles have used the app. If you are considering robotic process automation (RPA), the results from Belgian hospital Maria Middelares are outstanding. They’re using RPA robots for complex and repetitive tasks. After scanning patient records, the robots highlight medication anomalies to pharmacists. It saves time and money, and improves patient safety. All this is possible with Liberty Platform. It’s technology that improves patient flow and uses NHS resources more effectively. One platform with many solutions. Liberty is interoperable and integrates with many third parties. If you are looking to replace your bleeps with Medical Messaging, link through to Patients Know Best (PKB), use HCI Digital videos with your patient pathways or integrate with Microsoft Teams. Got challenges on your to-do list? If you’d like to see how we took one common NHS challenge, and built it collaboratively within seven days, take a look here (https://www.netcall.com/ nhs-appinaweek). It’s an On Demand event summary and a demo of the final App. We’d be happy to answer any questions. You can get in touch with us by email hello@ netcall.com, or use webchat at netcall.com. L FURTHER INFORMATION www.netcall.com/industries/nhs/ request a demo: www.netcall.com/demo/



HB Awards

Celebrating the winners of the 2020 Health Business Awards The winners of the 2020 Health Business Awards were announced during the event’s first ever digital ceremony on 10 December 2020. This year, more so than ever before, the recognition of the hard work and dedication of our health care staff has been pushed to the front of the national agenda. And rightly so. 2020 has been a year unlike any other in living memory, putting incredible strain on the health service, its staff and its resources. But, the tide is turning and the road to recovery is slowly making itself known. That road to recovery would not be possible without the efforts of NHS organisations up and down the country, and, in that light, it is with great pleasure that we have once again been able to host the Health Business Awards and announce our 18 winning organisations. Sponsored by Netcall and presented by GP, TV Presenter, Medical Broadcaster, Author and Public Speaker Dr Hilary Jones, the online awards for 2020 acknowledged outstanding work across a number of areas, from innovation in IT to game-changing transport initiatives, from collaborative efforts to coronavirus responses. All of our shortlisted have gone above and beyond in the last 12 months, but none more so than our 2020 winners.


by NHS England just 24 hours before. Among the successful this year are NHS Volunteer Responders, run by the Riyal Chesterfield Royal Hospital NHS Foundation Voluntary Service, offers help to people in Trust, NHS Kernow CCG, Somerset NHS need of support or who are avoiding public Foundation Trust, the winners of the places during the coronavirus pandemic. Its new Covid Response Award, and South aims are to supplement existing voluntary Warwickshire Hospitals NHS Foundation support within communities, help people to Trust, the winners of the Outstanding stay well, and reduce avoidable Achievement in Healthcare Award. demand on NHS services. A full list of winners can More than a million tasks be found on the next few We loo including shopping and pages, or alternatively forward k medication deliveries, on the Health Business lifts to medical Awards website. witness to ing the inspirin appointments or g a telephone chats to NHS Publicity n d work o combat loneliness Campaign f the N innovative HS in 2 and ho – have already Award: 0 p been completed The Royal celebra e to be able t 21 o by the 360,000 Voluntary te with person y NHS Volunteer Service once agou in Responders By the end of March a later th who have put 2020, 405,724 is year in themselves on duty. people had signed up In November, it to volunteer for the NHS was revealed that the to help in its fight against NHS Volunteer Responders coronavirus, highlighting the scheme would be extended to support ‘overwhelming response’ to a call made


Healthcare IT Award: Chesterfield Royal Hospital NHS Foundation Trust The NHS has an ongoing challenge with reminding patients about appointments and managing DNA rates. Reminder text messages support posted letters, but that’s not enough. Situations change rapidly and relying on the postal services is no longer sufficient. Chesterfield Royal Hospitals want to improve their patient’s experience along with utilisation rates for appointments and launched a digital portal; Patient Hub. It can be used on any device and has two-factor security offering patients 24/7 access to their appointment information. Patient Hub went live as the coronavirus lockdown began. The trust used a phase roll-out for the best results and Chesterfield quickly transitioned to 80 per cent nonface-to-face appointments. It was easy for patients to make a mistake when typing in a long video link from a letter. Now they click on a button and they are in Attend Anywhere’s video portal. Booking team advisors help patients to go digital with phone support. There are banners, posters and website section. Chesterfield is also using radio, press, Facebook and Social Media. Chesterfield Royal Hospitals believes that the initial quarter’s success of 66 per cent of new appointments managed digitally is just the start. Telehealth Award: Newcastle upon Tyne Hospitals NHS Foundation Trust Traditionally, patients attending their outpatient appointment would be assessed and supplied with a prescription to be taken to the outpatient pharmacy. However due to the pandemic, the majority of outpatient consultations have been taking place over the phone or using other technology, meaning it is not as easy to get medication to patients who need it. Pharmacists at Newcastle Hospitals were the first in the UK to use an ‘electronic prescription service’ for their patients during the coronavirus pandemic. The service – previously only available to GP practices and community pharmacies – allows electronic prescriptions to be sent to any community pharmacy in the country. As teams looked to explore new ways of working due to coronavirus and fewer patients coming into hospital, the pharmacy team at the RVI were given the opportunity to use the scheme as a pilot. As part of the trial, prescriptions were sent electronically to the patient’s community pharmacy where they were dispensed to be collected or delivered to their address if people were unable to leave home due to shielding.

“This year more than ever, with the continuing service and financial pressures we have been under, to be able to continue to modernise our fleet in the way that we have is fantastic.”

HB Awards

the public and NHS staff over winter. The programme will also be expanded to offer volunteers new ways in which they can support their communities and NHS staff, including helping to run large flu vaccination clinics as part of the NHS’ largest ever winter protection drive.

Chris Turley, Welsh Ambulance Service Hospital Procurement Award: NHS Supply Chain NHS Supply Chain’s route to market delivers not only cash releasing savings but wider sustainability benefits for NHS customers. As an organisation linked to the NHS and to public health, NHS Supply Chain is committed to ensure the most environmentally and costefficient services across the supply chain. In 2019 more than 200 NHS trusts had made huge environmental savings by simply switching their copier paper. The move from A4 virgin fibre copier paper to A4 recycled paper saved the equivalent of: watching 85,503 hours of a plasma TV in energy; filling 161 Olympic size swimming pools with water; felling 20,000 trees in wood; and travelling 10 times around the world in an aeroplane in Co2. The switch to recycled copier paper not only delivered environmental savings, it has also driven financial savings to the NHS. By channelling national commitment, reducing variety from two lines of paper (70gsm and 80gsm) to one (80gsm) and changing from virgin to recycled paper, £256,000 has been saved in the first year with a cost avoidance to the NHS of £1,410,000. As an organisation, NHS SUpply Chain continues to drive activities in: reducing waste, saving money and minimising environmental impacts; improving delivery efficiencies and ensuring continuity of supply; procuring and operating responsibly and ethically; and building supply chain resilience. Martin Toomey, Head of Sustainability, NHS Supply Chain, said: “A simple switch from recycled paper has made a big difference to the environmental footprint of NHS trusts. Procurement accounts for 58 per cent of the NHS’s total carbon footprint so there’s huge potential to effect change and help the NHS to become a low carbon anchor institute. We want to use the purchasing power of the NHS more assertively to drive change in supply chains and embed sustainability within the procurement process.” Hospital Building Award: The Clatterbridge Cancer Centre The Clatterbridge Cancer Centre NHS Foundation Trust is one of the UK’s leading cancer centres providing highly specialist cancer care to a population of 2.4 million people across Cheshire, Merseyside and the surrounding areas, including the Isle of Man. Clatterbridge Cancer Centre – Liverpool is the flagship new hospital providing specialist cancer care for people in Cheshire & Merseyside and beyond.

The new hospital is part of a £162 million investment in expanding and transforming cancer services across Cheshire and Merseyside, a region where people are more likely to develop the disease than almost anywhere else in the country. The 11-storey building, which opened in June, has state-of-the-art facilities and will deliver a wide range of highlyspecialist care including pioneering chemotherapy, immunotherapy, bone marrow transplant, gene therapy and radiotherapy. The services also include diagnostics and imaging, outpatients, daycase treatments, a Teenage & Young Adult Unit, clinical therapies, and a wide range of cancer information and support. Bringing cancer experts from the NHS and the University of Liverpool together on the same site will also significantly enhance opportunities for leading-edge cancer research, including early-phase clinical trials of new treatments. Healthcare Recruitment Award: South Tyneside and Sunderland NHS Foundation Trust South Tyneside and Sunderland NHS Foundation Trust has embedded the recruitment of veterans and their families into its recruitment processes and, this year, has been recognised for acting as an exemplar and sharing good practice with other employers. Step into Health recognises the transferable skills and cultural values that Armed Forces personnel have developed and how these are compatible with working in the NHS. It highlights the many career opportunities available and supports them in gaining employment within the NHS which offers over 350 different careers, clinical and non-clinical. South Tyneside and Sunderland NHS Foundation Trust is a leading Armed Forcesfriendly employer. It was the first NHS employer in the region to achieve the Ministry of Defence’s Employer Recognition Gold Award - the highest badge of honour available to those that employ and support those who serve, as well as veterans, and their families. It was also among the first to sign-up to the national Step into Health initiative and has a dedicated Step into Health lead to help ensure that it is fulfilling its pledge to the initiative. NHS Collaboration Award: NHS Kernow Clinical Commissioning Group Cornwall has a ‘super-ageing’ population and as people live longer there will be an increased demand on health and social E Issue 21.1 | HEALTH BUSINESS MAGAZINE


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“We knew we’d developed a great piece of kit, but we didn’t think it would have this impact. The success of CareScan+ has really taken us by surprise.” Graham Evans, North Tees and Hartlepool NHS Foundation Trust  care services. NHS Kernow Clinical Commissioning Group and Cornwall Council announced an agreement in February for a new approach to working together on social care, health commissioning and public health services. The new joint ‘Accountable Officer’ role will incorporate the duties currently undertaken by Cornwall Council’s Strategic Director of Adult Care and Health and those of NHS Kernow’s Chief Officer to provide joined-up leadership to deliver on the new vision for Health and Well-Being for the next decade. The creation of a joint role built on the alreadyclose working between the two organisations and has the potential to deliver far-reaching benefits to local people by providing joint oversight, leadership, and focus to allow public health and social care services to develop and deliver services to meet the needs and promote the wider health and well-being of people and communities. Transport & Logistics Award: The Welsh Ambulance Service In October, the Welsh Ambulance Service unveiled ultra-modern additions to


its 799-strong fleet, including a lowemission hybrid rapid response car, the first of its kind for the service. The trust has also commissioned new and improved emergency and nonemergency ambulances, as well as a fleet maintenance vehicle to help with the upkeep of its new haul. It is hoped the more fuel efficient vehicles will drive down CO2 emissions and improve the experience of both staff and patients. Forty six of the new Toyota Rav4 Hybrid rapid response cars are now on the road across Wales, replacing some of the Trust’s older diesel-powered vehicles. The mile-pergallon of the new rapid response car will increase from around 22mpg to 31mpg, which equates to a reduction of around 125 tonnes of CO2 emitted per year. Chris Turley, the Trust’s Director of Finance, said: “I’m immensely proud that the work of the trust’s Fleet Department has been recognised by the Health Business Awards in this way. This year more than ever, with the continuing service and financial pressures we have been under, to be


able to continue to modernise our fleet in the way that we have is fantastic. “We have introduced our first Toyota Rav4 hybrid Rapid Response cars and have commissioned new and improved emergency and non-emergency ambulances. This has been no easy task and it is great to see the team’s efforts recognised. “We can still further modernise the trust’s fleet and work towards our recently published Environment Strategy, but this recognition proves we are moving in the right direction. We continue to strive to provide the best for our patients and staff, which I am sure was a key factor in the Health Business Awards nomination and award.”

You can read more from Chris Turley in our interview on page 28. Estates & Facilities Innovation Award: United Lincolnshire Hospitals NHS Trust 2020 saw United Lincolnshire Hospitals NHS Trust embark upon three major energy-saving projects across its main hospital sites to slash carbon emissions. The trust, one of the biggest acute hospital trusts in England, serving a local population of 720,000, is working with Veolia to introduce a new Combined Heat and Power (CHP) centre at Lincoln County Hospital, funded by Salix Finance. This will provide more efficient heating and hot water facilities for its patients and staff at lower cost. The new centre is expected to be operational by mid-2020.

HB Awards

“This award means a great deal to the team, over a number of years we have worked to develop projects with Veolia to invest in our energy infrastructure to improve our sustainability and resilience.” Claire Hall, United Lincolnshire Hospitals NHS Trust

It will also be installing energy-efficient LED lighting across its main hospital sites – Lincoln County, Grantham Hospital, and Pilgrim Hospital in Boston. The LEDs, funded through the NHSI Energy Efficiency Fund, are expected to last longer than conventional lighting, saving up to 70 per cent in money and energy and creating a better environment for patients and staff. Finally, the trust intends to utilise Salix Finance to convert the main energy supply at Pilgrim Hospital to gas from heavy fuel oil. This will ensure there is a reliable, lower carbon supply of energy to the site, which is currently working on plans to increase services at the site. Together, the three projects are expected to save the United Lincolnshire Hospitals NHS Trust more than £1.2 million a year. Claire Hall, Associate Director of Strategic Business Planning, said: “This award means a great deal to the team, over a number of years we have worked to develop projects with Veolia to invest in our energy infrastructure to improve our sustainability and resilience. “The trust received a grant from the National Energy Efficiency Fund for £2.6 million enabling the replacement of around 12,000 light fittings with modern LED fittings with smart technology that mean lights turn off after a period of inactivity saving energy and money for the Trust.” Patient Safety Award: North Tees and Hartlepool NHS Foundation Trust In May this year, North Tees and Hartlepool NHS Foundation Trust announced that it

had developed CareScan+, a point of care scanning solution used to enhance patient safety. CareScan+ uses the information contained within barcodes to identify patients and staff. It is also used to track and monitor the use of medical equipment, surgical implants and other medical supplies. CareScan+ was trialled in late 2019 and was used by clinical staff to scan items, such as replacement hip and knee joints prior to being used in the operating theatre. After a successful trial, the Project team were tasked with adapting CareScan+ for monitoring the location and usage of non-invasive ventilators during the coronavirus pandemic. Each portable ventilator device is given a unique barcode, which is scanned every time it is allocated to a patient, removed for cleaning or maintenance or put back in storage. Whenever a member of staff requires one of the ventilators, they just check a simple online dashboard which shows the location and current usage of every ventilator in the hospital. CareScan+ is solely owned by North Tees and Hartlepool NHS Foundation Trust, who are one of the six Scan4Safety demonstrator sites. Professor Graham Evans, trust chief information and technology officer, said: “We knew we’d developed a great piece of kit, but we didn’t think it would have this impact. The success of CareScan+ has really taken us by surprise. “It’s been embraced by the staff in the Trust and to win two major awards in one year is incredible. I’m so happy for the team and proud of what they’ve

achieved. They took a great idea and made it reality. It’s just overwhelming!” Hospital Catering Award: West Suffolk Hospital Great British Bake Off judge Prue Lieth has been identifying the best catering at hospitals and how to improve them in the future for NHS England, and she highlighted food at West Suffolk Hospital for particular praise. According to her report, the hospital in Bury St Edmunds is one of their top picks, named as one of two dozen best practice sites nationally. Patients, staff, and visitors are all served the same food across West Suffolk Hospital, with the trust going above and beyond this year to provide arrangements for overnight staff, who have access to hot meals via vending machines and microwave, as well as the introduction of an ‘afternoon tea’ service as a special culinary treat for inpatients. The review also calls the trust ‘an exemplar site for using volunteers’, with around 50,000 hours of volunteer time a year given to help patients with their meals. Catering manager Vanessa Theobald said: “We are really proud to have won this the award. The catering staff at our trust have a very important job of preparing healthy and delicious food for not just the staff but also for the patients we care for. “This year has been very testing for all of the NHS so to have won the Hospital Catering Award is very special. Having our staff being able to access food that’s tasty but convenient means it’s one less thing they need to worry about in a year that has been difficult for everyone.” E Issue 21.1 | HEALTH BUSINESS MAGAZINE


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“Having our staff being able to access food that’s tasty but convenient means it’s one less thing they need to worry about in a year that has been difficult for everyone.” Vanessa Theobald, Catering Manager, West Suffolk Hospital  Patient Data Award: NHS Arden & GEM CSU As a temporary measure to finding a definitive source for the daily reporting of deaths brought about at the start of the pandemic, providers were using a manual data return spreadsheet to record deaths over email. The NHS Chief Executive’s Office wanted to replace this with a timely and accurate system as quickly as possible and approached Arden & GEM’s Data and Systems team, with its successful track record of building, deploying and hosting similar applications. By bringing together development, user support, data management and reporting expertise from within its business intelligence service, the CSU was able to quickly define system needs and begin development,


establishing the system requirements at pace by setting up a series of rapid discovery sessions with key stakeholders. The sessions identified the key system functionality and outputs required. The application was built using a web form which can be accessed on any internet connected device, with the majority of fields auto-filled once the appropriate NHS number has been entered, reducing data entry errors and improving data quality. The system is hosted within Arden & GEM’s robust application and data warehouse environment while the user registration process is managed through NHS Improvement using OKTA authentication. All entries are validated at both a regional and national level to corroborate notifications. It has now been rolled out to over 1,600 users from


675 organisations, and has been endorsed by the UK Statistics Authority as proving ‘critical for decision-makers and scientists’. Ayub Bhayat, Chief Data Officer at Arden & GEM, said: “This is a hugely welcome recognition for the team’s tireless work to support the response to the coronavirus pandemic. The CPNS provides accurate, timely information which has proved critical for decision-makers and scientists. By bringing together development, user support, data management and reporting expertise from within our business intelligence service and working in close partnership with key stakeholders, we were able to build a robust system in just five days.” Hospital Security Award: South London and Maudsley NHS Foundation Trust Over the last three years, the number of violent attacks in health and social care was three times as high as other industries. Figures by Unison reveal that across the UK there were more than 56,000 physical assaults on NHS workers. Experts from the NHS, Metropolitan Police Service, and Crown Prosecution Service are working together to improve the prosecution rates of criminal investigations following assaults on NHS workers. The pilot scheme,

Ambulance Trust Award: North West Ambulance Service NHS Trust People aged 65 and older have the highest risk of falling; around a third of people aged 65 and over, and around half of people aged 80 and over, fall at least once a year. Unaddressed fall hazards in the home are estimated to cost NHS England a staggering £435 million. The East Lancashire Falls Response Service Team, part of NWAS, sees the collaboration of a Paramedic and an Occupational Therapist who respond to non-life threatening 999 calls for falls, so that patients can be treated at home without having to go to hospital or can be referred to an appropriate community service. The partnership between NWAS and East Lancashire Hospitals NHS Trust has seen 83 per cent of the patients treated by the FRS, some 4,946 incidents, remain at home, many were referred onwards to community teams and specialist nursing teams. For the first six months of 2020, the team attended 487 patients and 84 per cent of those patients remained at home and avoiding the need to attend the Emergency Department, which was particularly important during the peak of first wave of the coronavirus pandemic. Daren Mochrie, NWAS chief executive, commented, “I’m so pleased to have picked up this award. It makes it even more special because we did not put ourselves forward for this, which shows other people and organisations are seeing the fantastic work we do, especially that of the falls team in Burnley. This is a great initiative which puts patient care right at the heart of what we do – ensuring they have a better experience and outcome without compromising on the care they receive. “I want to thank the team and everyone else for their hard work, in what’s been an extremely challenging 2020. I’m tremendously proud of the efforts of all staff and the professionalism and determination shown this year, and I hope they can all enjoy in the success of this award.”

You can read more from Daren Mochrie in our interview on page 26. COVID Response Award: Somerset NHS Foundation Trust Following the outbreak of coronavirus earlier this year, general practices made a sudden switch from traditional consultations to telephone consultations, and, as a short term measure this worked. However a number of patients, many with respiratory

problems were considered as possible coronavirus infections, therefore requiring a detailed direct clinical assessment. At Bridgwater Community Hospital, which is managed by the Somerset NHS Foundation Trust, nurse practitioners and colleagues from the community urgent care service collaborated with the local Primary Care Network and the local CCG to set up and run a safe Primary Assessment Centre (PAC). This involved all GP practices in the network conducting remote consultations and any patient who gave cause for clinical concern being directed to the PAC where they underwent a comprehensive assessment and, if required, treatment. Fortunately very few patients required onward referral to specialist services at the acute hospital. The majority of patients were seen and cared for, in isolation, in their local communities. This service was set up in mid April and remained operational until the end of June when the local infection rates fell. During this time local practices were able to focus on remote working and keep their practices safe for seeing patients who had been carefully screened and judged a low infection risk. Whilst similar processes were adopted elsewhere in primary care the PAC at Bridgwater Community Hospital demonstrated successful collaborative working access traditional boundaries and helped forge meaningful professional relationships. Like many coronavirus responses the community hospital service remains on standby and ready to stand up as and when local infection rates dictate. Sustainable Hospital Award: Northumbria Healthcare NHS Foundation Trust Across hospitals and community sites in Northumberland and North Tyneside, Northumbria Healthcare achieved an annual reduction of 6,440 tonnes of CO2e (carbon dioxide equivalent) based on energy, waste and travel last year. This was a 17 per cent reduction from the previous year with energy consumption being cut by almost half. Northumbria Healthcare has reduced its energy consumption by installing LED lighting and improving heating and ventilation systems. Additionally, less of the trust’s waste is now being sent to landfill and for high temperature treatment with significant improvements in recycling, especially in clinical areas, thanks to the efforts of staff. A key focus of the Northumbria’s carbon reduction efforts is travel and transport and alongside its fleet of fully-electric vans, it has increased its electric vehicle infrastructure with almost 80 charging spaces trustwide, with at least two on each of its sites. Northumbria also supports cycle to work schemes and car sharing for its staff. Innovation in Mental Health Award: Leeds and York Partnership NHS Foundation Trust Leeds and York Partnership NHS Foundation Trust runs the CONNECT: West Yorkshire Adult Eating Disorders Service, which provides

early intervention, outpatient, inpatient and intensive home-based treatment for people aged 18 and over with eating disorders from across West Yorkshire. In order to meet national guidelines and restrictions the service had to make some significant changes to how care and support was delivered. This included innovations in the use of social media channels and other methods to keep in touch with service users. The service offered #ConnectConversations three times daily via Instagram to provide additional support and resources for those suffering with eating disorders. They also converted all of their usual therapy to ‘teletherapy’ within a week of lockdown commencing and moved their open access support group ‘The Hub’ online and promoted this via Instagram.

HB Awards

called Operation Cavell, will help to protect health workers on the frontline, ensuring that senior investigators review all crimes against NHS workers and will use the experience of specialised and dedicated police investigators. From October, the scheme ran for an introductory period of four months for investigations of assaults on emergency workers across five boroughs, Lambeth, Southwark, Bromley, Croydon and Sutton.

Outstanding Achievement in Healthcare Award: South Warwickshire Hospitals NHS Foundation Trust In December 2019, the Care Quality Commission rated South Warwickshire Hospitals NHS Foundation Trust as Outstanding overall, making it the first ‘Outstanding’ acute and community healthcare provider in the Midlands. The inspectorate said that the Midlandsbased trust was seen to have made several improvements since its last inspection in January 2018, when it was rated as Good overall. Among the positives highlighted in the CQC’s report was leaders having the experience, commitment, integrity and skills to run a high quality and proactive service that was fully patient-centred, and the organisation promoting equality and diversity in daily work and provided opportunities for career development. The rating follows inspections of a number of clinical services across the organisation’s acute hospital and community services. In addition, the CQC carried out ‘Well Led’ and ‘Use of Resources’ inspections. All areas inspected were given ‘outstanding’ ratings. Glen Burley, chief executive, said: “We are delighted to receive this national award that recognises our outstanding performance. Our staff work extremely hard to maintain the highest standards and this award highlights their commitment to providing high quality care for our patients even in the most challenging of times. I want to thank our staff for their enthusiasm, for always going the extra mile and for helping us to be the outstanding organisation we are. They have responded heroically to this pandemic and I will always be grateful for their efforts and their resilience.” A huge congratulations to all of our winners, and a special thank you to Netcall and our other Award Sponsors: BigDug, Debt Recovery Plus, Jones AV, PFU, Philips Monitors and Sundown Services. We look forward to witnessing the inspiring and innovative work of the NHS in 2021 and hope to be able to celebrate with you in person once again next year. Until then, one last thank you and a final congratulations. L Issue 21.1 | HEALTH BUSINESS MAGAZINE


HB Awards

HB Q&A: North West Ambulance Service Following their success at the 2020 Health Business Awards, we speak to Daren J Mochrie, Chief Executive Officer at North West Ambulance Service HB: NWAS and East Lancashire Hospitals NHS Trust has seen almost 5,000 treated by the East Lancashire Falls Response Service Team. Given the current unprecedented pressures on the hospital, how important is it that patients can be treated at the scene? And what role does the initiative have to play in this? DM: Patients are far better placed when they remain in their own home, an environment they are used to and feel safe in where they are less likely to pick up hospital acquired infections. By enabling people to remain at home, our Falls Response Service (FRS) is helping to maintain capacity within hospitals, which is particularly important during this busy and challenging time. It is also much more beneficial to patients, particularly older people or those living with dementia, to stay in a familiar environment wherever possible. If a patient does need to go to A&E for further assessment such as an x-ray, the hospital can be contacted by the FRS who can provide information beforehand to enable a quicker turnaround for discharge home, hopefully the same day. By working together to form the FRS, a paramedic and occupational therapist can offer patients specialised care in the community. The paramedic assesses the patient from a medical perspective to determine whether treatment at home is appropriate. The occupational


therapist, trained in both physical and mental health, can then complete a holistic assessment taking into account the person’s physical and psychological needs. Where appropriate, patients can safely remain at home with additional support; this could be through provision of equipment, request for crisis carers or referral to other relevant services.

HB: What is the partnership doing to ensure that the right balance is achieved between a better patient experience and the right patient care? DM: Working in partnership, the team allows a balance to be achieved for a better patient care experience and outcome. By putting the patient at the centre of their care and ensuring that their needs are met, the team supports them both medically and holistically. O ccupational therapists possess the critical skills needed to address fall prevention with older adults. Research finds that falls are often a result of multiple factors such as individual conditions, their environment, or as a result of the interaction between the two. The most successful falls prevention initiatives are those that use a varied approach. Following a medical assessment from the paramedic, the occupational therapist evaluates lifestyle factors such as the patient’s daily routines and environment as well as their individual goals and priorities. They can then make suggestions such as


modifications and adaptations aimed at maximising independence for older adults. By providing wrap around care and support, not only at the point of crisis but also for the future, the team can ensure that the patient receives the right care for their needs. Another benefit of this taking place in the community is that family members can also be involved, again particularly important during the pandemic due to visitor restrictions in hospitals.

HB: The most effective form of care, especially when treating the elderly and frail, is not only to respond to incidents but also to help ensure they are prevented from happening again. How is this implemented in the work of the Falls Response Service Team? DM: The FRS team takes into account multiple factors to form the falls assessment. A patientcentred approach is used to try and reduce their risk of future falls by helping to prevent some of the causes whilst at scene. This could include onward referral to specialist community teams such as physiotherapists, medicine management, Parkinson’s nurses or additional support such equipment and carers. Another benefit of the FRS is that referrals can be made by paramedic crews to try and prevent future falls occurring. These referrals are triaged by the team and information is gathered to consider whether an urgent response is required or if a referral to the

HB Awards

By working together to form the FRS, a paramedic and occupational therapist can offer patients specialised care in the community. The paramedic assesses the patient from a medical perspective to determine whether treatment at home is appropriate community therapy team to support their ongoing needs is more appropriate. The team receives 120-140 of these referrals per month and is used as a point of contact for ambulance crews for telephone advice and any further needs they may have. They communicate with a wide number of organisations to assist with reducing the number of falls. Occupational therapists work with patients and their caregivers to review the home environment for hazards and evaluate individuals for limitations that contribute to falls. Recommendations often include a combination of interventions that target improving the patient’s physical ability to safely perform daily tasks. This may include modifying the home or changing activity patterns and behaviours to support these initiatives to prevent falls in the future. The fear of falling can be both a risk factor for falls and a consequence of falling. It can lead to individuals avoiding activities that they are capable of and need to complete in order to remain as independent as possible. The FRS team assists older adults in recognising and addressing their fear of falling by focusing on individual and specific concerns.

HB: Unaddressed fall hazards in the home are estimated to cost NHS England a staggering £435 million. With lockdown causing more people to become isolated and socially distant, how has the team adapted to ensure this doesn’t worsen?

DM: Falls information is given verbally and by written documentation. Falls hazards and risks are discussed with each patient and a joint plan of intervention and action is documented to confirm the information given. The team can supply a basic exercise programme for patients to do in their home with either a referral to a physiotherapist for a follow up or, where appropriate, information for the patient to complete a self-referral. For those with access to a computer there are online programmes available to maintain social interaction. Age UK has provided vital support during the pandemic and the team is able to refer patients there for further support as well as other local services available to help those who are becoming more isolated due to the pandemic.

HB: The model incorporated by the team five years ago has since been replicated elsewhere across the country. In the healthcare sector, how important is sharing best practice, especially when the issue is not restricted to region or hospital? DM: Sharing good practice has enabled other teams to develop more efficient, cost effective methods helping to develop a better service all round. This benefits the wider NHS and supports as many patients as possible to maintain as much independence and wellness for as long as possible.

HB: Given the unprecedented pressures facing the trust this Winter, how has the ambulance service worked to continue providing a safe service, both across the 999 emergency service, but also the 111 and Patient Transport services? DM: Winter is always a busy time for the ambulance service, but this year is like no other. We have been experiencing extremely high levels of activity throughout the North West alongside a number of staff isolating or shielding as well as increased pressure on local hospitals. In response to this, we have maximised our resources in a number of ways. All clinically trained staff have been supporting on the frontline, we have increased our use of private providers and are working with our healthcare partners to safely help us guide patients who don’t require urgent assistance to more appropriate healthcare services. Staff from our patient transport service and volunteers have also been assisting our 999 service, receiving additional training to do so. We have also been heavily involved in the national roll out of NHS 111 First which encourages people to contact 111 for urgent care needs rather than turning up at A&E. Where appropriate, we’re able to book people in to be seen quickly and safely or direct them to the care they need. To support this we’ve undertaken a largescale recruitment drive within our 111 contact centres to help us manage the extra demand. As always, the public can help us by only calling 999 in serious or lifethreatening emergencies, checking their symptoms on 111 online when they need urgent care and acting within government Covid-19 guidelines. L FURTHER INFORMATION www.nwas.nhs.uk




Artificial Intelligence how to navigate a brand-new marketplace Maija Banks, Crown Commercial Service’s Category Manager - Artificial Intelligence and Automation, explains the long road to develop the UK’s first artificial intelligence public procurement framework Across the public sector, organisations are exploring how artificial intelligence (AI) solutions can help them to embrace change and future-proof the way they work. AI can help the public sector to manage and use data better, and make public services more accessible. It can also support frontline service delivery, enabling staff to spend more time delivering services. In the healthcare sector, AI is already being used to improve diagnoses, uncovering new insights into chronic illnesses through the analysis of DNA sequencing, and offering more practical help, such as in the field of medical image readers. As far back as August 2019, the NHS AI Lab was set up to accelerate the safe deployment of AI technology across the healthcare system. With the use of AI in the delivery of public services only likely to grow in the coming years, Crown Commercial Service is supporting potential buyers of AI services to get informed about the potential of the new technology and how to ensure your eventual solution is aligned with the best guidance and standards.


Throughout the guidelines, messages are The Guidelines on AI Procurement repeated that should apply to all procurements The Government’s Guidelines for AI - that you should start from a problem, Procurement, published in June 2020, were rather than a solution, that it is the people developed by the Office for Artificial Intelligence of your organisation who will in the end be in collaboration with the World Economic Forum responsible for the success or otherwise of Centre for the Fourth Industrial Revolution, your eventual product or service, and that Crown Commercial Service, Government you must, where possible, plan Digital Service, and the Government for an end-to-end lifecycle. Commercial Function. The guidelines, it is hoped, The guidelines are intended AI can will eventually drive the to advise public sector help th responsible adoption of AI buyers of AI solutions on sector t e public across all sectors of the UK the guiding principles economy, with the public of AI procurement. and use o manage sector leading the way. They focus mainly d a t a better, and ma That is crucial in a on machine learning k sector where standards as a subset of AI, and servicese public and regulations are advise on strategy, m accessib ore often playing catch decision making, data, le up with technology. benefits and risks, effective market engagement, The AI Marketplace routes to market, governance, At the same time as the Guidelines lifecycle management, and on AI Procurement were being written, the all-important question of ethics.



the project team were developing what would become Crown Commercial Service’s Artificial Intelligence Marketplace. This procurement agreement (technically a Dynamic Purchasing System) is the UK government’s first attempt to design a framework for best practice in AI procurement in the public sector. It gives buyers the opportunity to work with suppliers of AI solutions within the guidelines set out by the Government - requirements which will develop and grow as the technology does the same. All suppliers on the agreement need to identify ethical considerations in relation to data limitations, fairness and bias. In line with the guidelines, they need to demonstrate

With the use of AI in the delivery of public services only likely to grow in the coming years, CCS is supporting potential buyers of AI services to get informed about the potential of the new technology how the skills, qualifications and diversity of teams developing and deploying AI have been considered, and ensure the outputs of the AI technology are transparent and explainable to a non-expert audience. They also need to be able to describe how data

will be protected and set out the level of human decision-making at critical points. And because the agreement is a Dynamic Purchasing System, new suppliers can join at any time during its duration, and existing suppliers can add new services, increasing opportunities for innovation. Find out more Crown Commercial Service’s team of experts is on hand to offer public sector buyers support and guidance along your journey to AI discovery. We understand that there is still a lot of uncertainty around AI, but we’re here to talk you through the process. If you are new to AI you will be able to procure services through a discovery phase, to get an understanding of AI and how it can benefit your organisation. If you have experience in AI, you will be able to buy licensing, customisation and support directly from suppliers. If you would like both of these things, you will have access to end-to-end partnerships. L

Crown Commercial Service supports the public sector to achieve maximum commercial value when procuring common goods and services. In 2019/20, CCS helped the public sector to achieve commercial benefits worth over £1 billion - supporting world-class public services that offer best value for taxpayers. FURTHER INFORMATION www.crowncommercial.gov.uk/AI



Covid-19 update

Vaccinations, PPE and the road out of lockdown After 12 months of little else making the news headlines, how are our hospitals coping with coronavirus? Are cases dropping? Are staff protected? Have we turned a corner? It was not that long ago that everything Contracts seemed doom and gloom. In fact, when we A court has ruled that Health Secretary printed our last issue at the start of December Matt Hancock acted unlawfully when the uncertainty and a lack of trust were still the Department of Health and Social Care did not main concerns of the British public. Although reveal details of contracts it had signed during the first vaccines were to be administered the coronavirus pandemic. The Conservative shortly after we went to press, the more Party has regularly been accused of favouring concerning news was that the UK had the friends in their contracts concerning the virus, highest death rate from coronavirus in all of as well as wasting money on expensive deals Europe and the fifth highest in the world. rather than tendering opportunities more Now, nearly three months on the outlook fairly. In November the Good Law Project and is far more positive. Only last week it was Runnymede Trust challenged the appointment revealed that over two thirds of people of Dido Harding as head of NHS Test and aged between 65 and 69 have Trace, who herself has been forced to now had their first coronavirus defend the decision to outsource vaccination, and the NHS consultancy roles with an O ver has begun vaccinating average day rate of £1,000. two thi people aged 64 and the The latest issue concerns r d s of peop lower age brackets. Hancock and his neighbour betwee le aged Additionally, NHS Test Alex Bourne, after the and Trace has now latter was handed a £30 have non 65 and 69 w had reached more than million contract to supply th first cor six million contacts, a distributor contracted by onaviru eir including 90 per cent of the NHS with two million s v a ccinatio close contacts for whom test tubes a week, as well as n communication details were around 500,000 plastic funnels provided. The much maligned for test samples. It was later programme appears to finally revealed that Bourne’s company, be turning a corner, with the latest Hinpeck, had no previous experience of weekly statistics revealing a continued strong making medical supplies prior to the pandemic performance into February, reaching more than and is friends with the Health Secretary 210,000 people, and testing more than 2.5 following his job running the Cock Inn in million people for coronavirus. Thurlow, West Suffolk. Here, we take a look at some areas of success Hancock has been found to have ‘breached and concern. his legal obligation’ by not publishing details

within 30 days of contracts being signed. The DHSC said the government had been ‘working tirelessly’ to deliver what was needed to protect health and social care staff during the pandemic. A “spokesperson for Hancock said that this often meant having to award contracts at speed to secure the vital supplies required to protect NHS workers and the public. PPE The issue of PPE, which also ties in with dodgy contracts, continues to cause problems for healthcare staff. In a joint letter to Prime Minister Boris Johnson on 19 February, a number of leading health organisations demanded ‘a change in approach implemented at speed’ to protect health care staff and patients. The letter, signed by the Royal College of Nursing and the British Medical Association, amongst others, says that Johnson must respond to evidence on airborne transmission of coronavirus by upgrading the UK’s outdated infection prevention and control (IPC) guidance, which currently leaves staff exposed to infection. Research indicates that health and care workers are at three to four times greater risk of developing and dying from coronavirus than the general public and deliver care at ‘huge personal risk’. Since the pandemic began, more than 900 health and care workers in the UK have lost their lives to the virus, while many more are suffering from its long-term effects. E Issue 21.1 | HEALTH BUSINESS MAGAZINE


Autism and Mental Health Conference 2021 11 March | Online conference Gain tools and strategies to provide targeted support for autistic children and adults with mental health difficulties. Including these fantastic sessions • Coping with uncertainty - strategies for wellbeing Dr Peter Vermeulen - PhD in Psychology and Pedagogical Sciences, founder and CEO of Autism in Context. • Advancing the assessment and treatment of mental health conditions for autistic people Professor Jacqui Rodgers - Psychology and Mental Health, University of Newcastle.

www.autism.org.uk/conferences Scan the code to book your place and find out more. The National Autistic Society is a charity registered in England and Wales (269425) and in Scotland (SC039427) NAS SEN MentalHealth 181x127_V2.indd 1



14/12/2020 11:21

 Amongst the recommendations, the letter urges the Prime Minister and his government to collect and publish consistent data on health care workers who have contracted coronavirus from likely occupational exposure so that staff can be better protected, as well as provide a precautionary higher level of respiratory protection for all health care professionals caring for people with known or suspected coronavirus, including in community settings and homes. The fact that this remains an issue is concerning, but not surprising. A poll conducted in mid-February found that less than five per cent of NHS staff think that the government has handled the coronavirus pandemic well. n the survey of almost 3,500 health workers, the GMB union reports that only 4.9 per cent answered that the government was doing a good job during the crisis. Almost half said they thought the government had handled the pandemic badly and had made the situation worse. The poll and letter followed a report from the BMA that claimed that thousands of doctors do not feel they are fully protected from coronavirus in their place of work and for many, it’s likely to have been the case since the onset of the pandemic.

The BMA is calling for better access to more protective face masks, Covid-secure rest facilities and for doctors to be able to take the leave they haven’t been able to, so far. The association has seen a steady increase in the number of doctors being supported by the association’s well-being services as well as those contacting the 24-hour helpline. Since the onset of the pandemic, the BMA has consistently lobbied and gained improvements in PPE provision, in testing for health workers, better support and risk assessments for BAME doctors and improved terms and conditions. Vaccinations Following the calls of the Prime Minister, the chief medical advisors, government ministers and healthcare bosses up and down the country, the Queen has now urged people to get vaccinated against coronavirus. Since receiving her first jab in January, she says she feels ‘protected’ and encouraged others to help themselves, and others, by getting it done. Dr Emily Lawson, believes the monarch’s comments are an ‘incredibly important vote of confidence’. A vote of confidence is exactly what the success of the vaccination programme

Covid-19 update

The government successfully reached its target of offering the first vaccine dose to everyone in the top four priority groups, which included those aged 70 and over, care home residents and staff, the extremely clinically vulnerable and NHS staff, by mid-February appears to be providing, with nearly 30 per cent of the population now inoculated against the virus, having had the first dose of the vaccine. The rollout of the vaccination programme is now nearly at 450,000 daily vaccinations. The government plans to offer 32 million people, which is nearly half the population, a first dose of the vaccine by the middle of April. This would mean vaccinating all nine priority groups, including everyone over 50 years old, all clinically vulnerable people and frontline health and social care workers. The government successfully reached its target of offering the first vaccine dose to everyone in the top four priority groups, which included those aged 70 and over, care home residents and staff, the extremely clinically vulnerable and NHS staff, by mid-February. Vaccines are currently being administered at over 1,500 sites across the country including mosques and museums to rugby grounds and cathedrals, with the spread of sites chosen to ensure that more than 98 per cent of the country lives within 10 miles of at least one vaccination service. L

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A solution to improve air quality and protect our NHS staff and patients Why negatively-pressurised hospital ICU wards need Portascanner®COVID-19 and what does it give that current solutions do not? Regardless of the ‘air quality’ within an ICU ward, minimising the airflow out of it is essential for reducing the risk of airborne contagion spread. One way this is achieved is through minimising the air permeability of a room, another is by negatively-pressurising a room which in itself cannot be effectively achieved without a suitably low air permeability value. Minimising air permeability is therefore doubly essential. Air permeability is defined as the volume of air entering or exiting a room per hour per square metre of room envelope given a certain differential pressure, usually taken to be 50 Pa (Pascals are a unit of measure for air pressure). Currently, when hospitals monitor the efficacy of their negative pressurisation, they do so using a pressure monitor. This tells hospital staff, providing they are checking it regularly, whether the air pressure in the ICU ward is at a suitable level. If the pressure drops below a certain level, sometimes these monitors are set up to an alarm system. There are three problems with this:

It allows operators to detect leakage points, meaning that they can be addressed to prevent dips in the required pressurisation which regularly occur. It also quantifies the airflow rate through leakage points and the air permeability of a room, providing surety that the room is sufficiently airtight for the FPE (Fan Pressurisation Equipment) to operate consistently. Pressure monitors cannot do these things. According to an independent review by the Building Services Research and Information Association, reducing the air permeability of an isolation suite has a number of distinct benefits:

One is that the indication of the current pressure is not an indication of future ability to maintain that pressure. Secondly, if the pressure does drop, no matter how infrequently, it undermines the ability of the ward to prevent airborne infection spread and the pressure monitors provide no means of addressing that problem. If hospital staff do take action as a result of pressure drops, it is often to employ what might be called a ‘Patch & Hope’ response. Thirdly, pressure monitors only measure the air pressure at a localised point in space. If the correct air pressure is found in one part of a room, this is no guarantee that it may be found elsewhere.

The hand-held, ergonomic Portascanner® COVID-19 instrument provides a capability that compliments and goes far beyond what a simple air pressure monitor can do.


• • • • •

A degree of passive protection is provided against contamination to or from adjacent areas. The ventilation system is able to be balanced and commissioned correctly. The pressure stabiliser can be specified accurately and can operate correctly. During fumigation, less fumigant will escape to adjacent areas. In the event of fan failure, the walls will become the first barrier against infection. If the leakage through the fabric is too high, the design supply and extract airflow rates may not be sufficient to pressurise the rooms or for the pressure stabiliser to operate correctly. Making up for high air permeability by increasing supply and extract flow rates is not considered desirable. A better option would be to achieve lower air permeability.

An ICU ward is therefore far safer in terms of risk of infection spread, if the air permeability of its envelope can be quantified and if crucial leakage points can be identified and repaired. It is for this reason that Coltraco Ultrasonics won the right to a competitive government grant to innovate in this area and for this reason too that the end product has been independently declared outstanding in its field. A recent paper collating 24 cross-sectional studies across eight separate countries has found that significant levels of SARS-CoV-2 RNA


particles were circulating in the air within 25 per cent of ICU wards, 24 per cent of hospital toilets, and 56 per cent of hospital hallways. Hospitals, therefore, present a huge risk of crossinfection via airborne transmission. The most effective way to prevent airborne transmission from isolation wards is to ensure they are adequately negatively-pressurised at all times; the fact that these statistics exist, however, suggests that negative pressurisation, which might be taken for granted by hospital staff and monitored using pressure gauges, is in actuality not effectively achieved in a significant proportion of facilities, at least some of the time. This is why the Portascanner® COVID-19, as the only reasonable solution to a problem that some, but not all, are aware of, is such a breakthrough technology in reducing airborne cross-infection within the hospital sector. The ‘Patch & Hope’ Problem In March 2020 the world was forced to stop, readjust, and overcome the barriers this virus has inflicted upon us all. Whilst it has sadly been a tragedy for so many people, businesses, households, and livelihoods, it has by no means stopped great British ideas, ingenuity, and innovation. The 5.9 million UK SMEs, which make up 99 per cent of all business, generating 54 per cent of all UK employment, have demonstrated remarkable resilience in the face of such adversity, and are at the forefront of the government’s Levelling-Up agenda in the postCovid-19 world that we are all so looking forward to. The NHS went into this crisis with 10,000 ICU beds. Today it is managing over 30,000. Our NHS are struggling to bear the brunt of this virus, and the staff should not also have to constantly concern themselves with the risks of being additionally exposed to the virus. Existing taping measures are not allowing this concern to be allayed. In Intensive Care Units (ICU) the NHS has to ‘negativelypressurise’ each ICU Ward to prevent COVID19 infection contagion to the rest of the hospital. However, if the air permeability of ICU Wards is not sufficiently low, negative-pressurisation

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cannot be achieved effectively. The methods presently being undertaken to verify air permeability, are disruptive, costly and do not allow operators to identify specific areas of leakage. The maintenance teams have limited means to monitor the airflow that sustains that negative-pressurisation or identify the location and size of any specific leaks, leaving any remedial action down to mere speculation. So limited are these means that NHS personnel are forced to adopt an approach that can only be described as ‘Patch and Hope’. What is the solution? Our Portascanner® COVID-19 brings a noninvasive answer to this ‘patch and hope’ measure, and with minimal training, allows ICU personnel to locate and then quantify the leaks in hospital wards. The user can calculate the air flow rate through these leaks, generating an air permeability value for an entire ICU ward which the user can compare against the required value for negative pressurisation. Quantifying the extent of the leak, or the air permeability rate, is crucial to ensuring negative-pressurisation in order to help prevent the spread of disease. During Covid-19 maintenance of the ICU ward has never been more important, and this new hand-held instrument significantly improves the efficiency and air quality of the room, providing confidence in ability of a ward to contain the virus. Furthermore, it saves considerable time and resources in preventing FPE (fan pressurisation equipment) from being installed within an unsuitable room. The downtime required for existing test procedures is simply infeasible given the disruption to treatment this would cause in ICU wards. So, through using ultrasound, this innovation ensures minimum disruption to any room or facility, lending more time for the staff to treat their patients.

Overcoming a global pandemic Coltraco Ultrasonics have proudly developed Portascanner® COVID19 from its rich heritage in Naval ultrasonic technologies to monitor watertightness in warships and submarines. At the beginning of 2020, we were predominantly a two-market sector company. However, in March we realised the vulnerability that this posed, and the possible opportunity for change. So, through great diversification we are now a multi sectoral one, working across 28 different sectors, delivered by an exclusive global distribution network. One of these new sectors that we are most proud to support, is the healthcare sector. During the coronavirus crisis, Coltraco Ultrasonics worked tirelessly to fulfil a UK-Government funded Covid-19 emergency technology requirement in June 2020, to design the Portascanner® COVID19, which we have now successfully done, with our first prototype completed in 20 weeks, created by a team of British Physicists working at the cutting edge of compartmentation integrity.

Go above and beyond compliance According to BSRIA³, the air permeability of a negatively pressurised isolation ward must not exceed 2.5m³/(h-m²) at a reference pressure of 50 Pascals. It is this value that is used in the reporting feature of the Portascanner® COVID-19. The user can provide evidence of the maintenance programme, through the camera feature, and with the tap of a finger, export a test report, all in one small portable instrument. Each leak is therefore marked and quantified in terms of the air flow rate, and its contribution to the total air permeability. This is then calculated and compared to the threshold value, whilst the cross-sectional area of the leak is also recorded. No third party is required, and all the user has to do, is a quick test, scanning any possible leak sites with the receiver, whilst the generator is directed at the structure from the opposite side. Any peaks in the received intensity should be marked as a leak for potential investigation and remedial measures undertaken if necessary. A full test is then carried out to decipher the leak size. Sufficient airtightness is required to facilitate good ventilation and filtration practices, so that ‘safe working’ conditions be achieved, which is at the heart of improving the ‘health’ of a building. This simple instrument can be used regularly by in-house maintenance teams when required, with no disruption, enabling leaks to be detected and remedied as they occur.

Helping our NHS build resilience and security within Our primary aim with this exciting new technology, is to support our NHS: to protect the lives of both our staff, and patients. The Portascanner® COVID-19 is based on the technology of our award winning globally recognised Portascanner® WATERTIGHT, an ultrasonic watertight integrity monitor used by our Royal Navy, which has been redesigned specifically for our NHS hospital ICU wards. It aims to reduce the spread of airborne disease by inspecting rooms for any leakage and establishing the negativelypressurised airflow rates that, unless identified can place staff and patients at risk. A December 2020 study on Covid-19 and air contamination indicates that 56 per cent of air samples taken from hospital hallways and 24 per cent from hospital bathrooms, have high levels of coronavirus (JAMA Network Open). Samples from ICU rooms were more than twice as likely to be positive, at a rate of 25.2 per cent compared to 10.7 per cent for non-ICU rooms. There is evidently a pressing need for the virus to be contained. In order to reduce the spread, Hospital ICU wards rely on negative-pressurisation, and only when this state is achieved, can there be a reduction of airborne infectious diseases. NHS Hospitals have ‘infection targets’ and Portascanner® COVID19 help them achieve these.

Why we Designed Portascanner® COVID-19? In June 2020 the government invited us to support their Emergency COVID19 Technology award and design this unique solution. During the height of the pandemic, every Thursday evening the moving sound of our Clap for Heroes’ would resonate, as we all applauded and showed our appreciation for our NHS. 2020 highlighted just how much we rely on our unique healthcare system. At Coltraco Ultrasonics, we were simply fortunate enough that we could put our heads together, and realise that we could play our small part in supporting our NHS, from within their very walls. This Emergency Covid-19 Technology grant enabled us to develop a technology to assist with problems relating directly or indirectly to this pandemic. We realised we could contribute to the prevention of the spread of airborne pathogens, and thereby significantly reduce the contamination between wards, which also includes harmful substances such as bacteria, gases, chemicals etc. In our research we have been able to measure to a high accuracy holes as small as 0.5mm in diameter. Coltraco Ultrasonics have 30 years’ experience of designing and manufacturing world leading ultrasonic equipment, and have been able to apply our technological expertise in this area to provide a unique and optimal solution to a new critical problem in our world. Applying ultrasonics to this new application has never been done before. This will allow the first means of reliably and conveniently testing a key requirement for effective negative pressurisation. We are proud to be able to present a solution, to improve air quality and protect our NHS’s staff and patients against the spread of airborne diseases, such as SARS-CoV-2. Whilst this past year has proved an insurmountable obstacle to overcome for so many, there is now light at the end of the tunnel, that through innovation and collective unity, we can all come together and rebuild stronger than before. L FURTHER INFORMATION www.cdc.gov/infectioncontrol/guidelines/ environmental/background/air.html www.news-medical.net/health/Whatare-Negative-Pressure-Rooms.aspx



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New and enhanced FM Software Solutions Asckey has partnered with NHS trusts around the UK to provide a software solution that collates the data they need in order to make better-informed operational decisions Over the last 12 months, organisations have come up against many challenges surrounding Covid-19 particularly around creating and maintaining safe working environments. Hygiene and safety have been priority but alongside that, they have had to re-evaluate internal processes to better allocate resources whilst tightening budgets. One of the ways organisations have adopted to do this is by investing in a software solution that collates the data they need in order to make better-informed operational decisions. Asckey has partnered with NHS trusts around the UK to provide applications that do just this. These applications include our comprehensive CAFM software, fmfirst Estates®, our cleaning audit software, fmfirst® Cleaning and our survey software, fmfirst® Survey. fmfirst® Estates comes with a tasking module but the application itself is too comprehensive for what some of our clients need. As a result of conversations with some of our NHS clients, Asckey has extended their fmfirst® product portfolio and developed a simplified task management system, fmfirst® Tasking. fmfirst® Tasking has been designed to offer potential users an alternative, costeffective, stand-alone task management solution to help streamline internal tasking processes. Although built originally to support NHS clients, the software can be used by smaller FM service providers as an easy to use digital task management tool for managing external workloads.


What does fmfirst® Tasking offer? This cloud-based task management software provides businesses with a multi discipline, simplified, platform for creation of defect and planned work. It also offers the following: • • • • • •

The ability to manage tasks digitally Users can track and update jobs when out in the field Simple creation of jobs based on task definable fields Manage defect, reactive and pro-active maintenance Easy to use platform with drag and drop capability Provides full audit trails

The simplified task management system helps users to better collate and analyse data. By doing so, resources can be allocated better, life-cycle of assets can be extended and overall costs can be reduced. fmfirst® Tasking can be fully integrated with the other applications from our fmfirst® product suite, allowing you to build your own facilities management toolkit. Enhanced Estates Management As well as developing a new task management system, Asckey has enhanced their CAFM software, fmfirst® Estates, with two new modules; Risk Assessment and Permits to Work. The new Risk Assessment module has been developed in conjunction with Canty


Compliance. It provides their licensed users with the ability to import appropriate Canty risk assessment templates directly into the system. This simplifies the process of including vital and consistent risk management processes as part of key maintenance activity, thereby minimising compliance failures. The Permit to Work module allows for the creation, issuing and storage of permits to work, such as hot work, electrical, confined spaces, working at height etc. It also provides authorised users with remote access to the permit system when needed. Single ‘one-off’ permits can be created based on the type of work for opening and closing jobs. The module also provides the ability to create custom permits which can be printed, if needed. Safety and compliance are covered as users can identify all statutory and mandatory safety requirements when creating permits. Permits are numbered to support auditing processes and the module allows for comments on work performance. The facilities management landscape is always changing and digitising processes can help drive operational efficiencies. It can also help employees to manage workloads better and provide a better employee experience which creates a better customer experience. L FURTHER INFORMATION www.asckey.com 01480 469001 | sales@asckey.com

Facilities management

Ensuring new hospital buildings are net zero compatible Delivering a net zero health service will require work to ensure new hospitals and buildings are net zero compatible, as well as improvements to the existing estate In November, Prime Minister Boris Johnson set out his ten point plan for a green industrial revolution which he hopes will create and support up to 250,000 British jobs. Covering clean energy, transport, nature and innovative technologies, the government says that the Prime Minister’s blueprint will allow the UK to forge ahead with eradicating its contribution to climate change by 2050, particularly crucial in the run up to the COP26 climate summit in Glasgow next year. One of the ten points is the improvement of homes and public buildings, including hospitals, greener, warmer and more energy efficient. This is predominantly to be done via the Public Sector Decarbonisation Scheme, part of the Chancellor’s ‘Plan for Jobs 2020’ commitment to support the UK’s economic recovery from coronavirus, which provides grants for public sector bodies to fund energy efficiency and heat decarbonisation measures. It will also depend a lot on the success of the Greener NHS programme, which pledged in 2020 to work with NHS staff, hospitals and partners to build on the great work being done by trusts across the country,

Over the last 10 years, the NHS has become a world leader in the response to climate change, taking action to cut carbon emissions while building capacity and resilience into the way sharing ideas on how to reduce the impact that healthcare is provided. on public health and the environment, At the national level, the NHS will save money and reach net carbon zero. monitor and report on its emissions Sir Simon Stevens, NHS Chief Executive, reductions in-line with the timeline, said at its launch: “While the NHS is methods and approach laid out by the already a world leader in sustainability, as UK Committee on Climate Change. the biggest employer in this country and The Delivering a Net Zero NHS report comprising nearly a tenth of the UK demonstrated that the NHS has both economy, we’re both part met and exceeded the 2020 targets of the problem and part outlined in the Climate Change of the solution. Act. However, meeting the NHS A new “Indeed if health England net zero ambitions N Zero Ca et services across the will only be possible if Hospita rbon world were their every part of the NHS own country, is working together. will be l Standard availab they’d be the le from spring 2 fifth-largest Targets 0 2 1 a , and pplied a emitter on the Identifying a route to cr planet. That’s why net zero emissions for a new hooss the 40 complex we are mobilising system as large spitals our 1.3 million as the NHS is particularly staff to take action challenging. To understand how for a greener NHS, and when the NHS can reach net and it’s why we have zero, NHS England established an NHS worked with the world’s leading Net Zero Expert Panel, reviewed nearly 600 experts to help set a practical, evidencepieces of evidence and conducted extensive based and ambitious route map and analysis and modelling. The organisation date for the NHS to reach net zero.” claims that the targets set are as E Issue 21.1 | HEALTH BUSINESS MAGAZINE


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A wide range of interventions focused on air conditioning and cooling, building fabric, space heating, ventilation and hot water could all be rolled out throughout the secondary care estate over the next five to 10 years for what would be the world’s first zeroemission ambulance by 2022, with a shift to zero-emission vehicles by 2032 feasible for the rest of the fleet; implementing a net zero horizon scanning function to identify future pipeline innovations; and supporting the construction of 40 new ‘net zero hospitals’ as part of the government’s

Facilities management

 ambitious as possible, while remaining realistic; and are supported by immediate action and a commitment to continuous monitoring, evaluation and innovation. It has therefore set two targets: for the emissions which it controls directly (the NHS Carbon Footprint) to reach net zero by 2040, with an ambition to reach an 80 per cent reduction by 2028 to 2032; and for the emissions it can influence (the NHS Carbon Footprint Plus) to reach net zero by 2045, with an ambition to reach an 80 per cent reduction by 2036 to 2039. The report sets out a number of early steps that will be taken. This includes: developing a framework to evaluate carbon reduction associated with new models of care being considered and implemented as part of the NHS Long Term Plan; working towards road-testing

Health Infrastructure Plan with a new Net Zero Carbon Hospital Standard. This will complement ambitions to complete a £50 million LED lighting replacement programme, which, expanded across the entire NHS, would improve patient comfort and save over £3 billion during the coming three decades. E



Facilities management

 New buildings Delivering a net zero health service will require work to ensure new hospitals and buildings are net zero compatible, as well as improvements to the existing estate.To support this, a new Net Zero Carbon Hospital Standard will be available from spring 2021, and applied across the 40 new hospitals to be built as part of the government’s Health Infrastructure Plan. This will involve both the use of innovative, low-carbon materials, as well as new design that allows for flexibility and shifts in how care will be delivered in the future. While these new hospitals will need to meet the Net Zero Carbon Hospital Standard, they form less than a fifth of the secondary care estate and so significant interventions will also be required in the retained estate. Engineering solutions to upgrade NHS buildings represents a total of 473 ktCO2e in potential emissions savings. Here, the £50 million NHS Energy Efficiency Fund (NEEF) will upgrade lighting across the NHS estate, acting as a pilot for future work and saving £14.3 million and 34 ktCO2e per year. Delivering 100 per cent LED lighting could be achieved with an additional nonrecurrent investment of £492 million, which would be paid back over a 3.7 year period, providing an estimated net saving of over £3 billion during the next three decades. A wide range of interventions focused on air conditioning and cooling, building fabric, space heating, ventilation and hot water could all be rolled out throughout the secondary care estate over the next five to 10 years, saving some £250 million per year (once all interventions are implemented by 2034). Crucially, a significant portion of the investment required to deliver this will overlap with that for work underway as part of the regular maintenance and upkeep of the estate.

Better use of roofs and adjacent ground space will support a shift to on-site renewable energy and heat generation across the estate, bringing a potential saving of 580 ktCO2e per year A range of socio-technical interventions will also be required to optimise the way the NHS uses its buildings. Intelligent, real-time energy monitoring and control, including the use of artificial intelligence, would contribute up to 2.3 per cent of the total required reduction in carbon emissions, with an upfront investment of £259 million paid back within two years, and a net annual saving of £120 million once all interventions are implemented by 2034. Finally, better use of roofs and adjacent ground space will support a shift to on-site renewable energy and heat generation across the estate, bringing a potential saving of 580 ktCO2e per year. Royal Manchester Children’s Hospital has invested in an onsite renewable energy project and saved £80,000 in lifetime energy costs and 380 tonnes of carbon, and increased the resilience of its power supply. Installation of photovoltaics across the entire NHS estate would reduce the NHS Carbon Footprint by 1.6 per cent. However, investment costs for this are high – £1.9 billion paid back over 15 years, with a net saving of £1.2 billion –and would need to be considered for early implementation to maximise benefits. In the first instance, the NHS will remove all coal and oil heating systems from its sites as soon as possible, with complete phase-out over the coming years. Finally, the NHS will purchase 100 per cent renewable energy from April 2021. While

we are aware this creates no additionality (and hence have not been built any reductions for this shift in purchasing into the existing modelling), it does demonstrate the system’s commitment to net zero. The primary care estate There are approximately 7,000 GP practices in England, spread over some 9,000 buildings. Total emissions for the primary care estate last year were167 ktCO2e. Additional resource will be required to support older primary care buildings across England to become more energy efficient: engineering interventions such as improved building insulation, lighting and heating could save 59 ktCO2e annually; improvements to building instrumentation and energy management could save 34ktCO2e annually; while the installation of photovoltaics and heat pumps could save 7ktCO2e annually. Although further work is required here, one important resource is the Green Impact for Health toolkit, produced by the Royal College of General Practitioners and the educational charity SOS-UK. It was used by 754 GP practices in 2019/20, and provides accessible and comprehensive guidance on available emissions reductions interventions. L FURTHER INFORMATION www.england.nhs.uk/greenernhs/




The successes and learnings as CFO of NHSPS Mark Smith, Chief Finance Officer (CFO) at NHS Property Services speaks about his time in NHSPS and the changes that have helped to save the NHS £48 million this year I began my journey with NHS Property Services time when arguably, it needs it more than (NHSPS) in May 2019 by setting out an ever. We have also got back to the basics ambitious roadmap in the hope of delivering to ensure we are working as efficiently as significant improvements across the business. possible at every stage of the financial process. It has been challenging, and we are not We are a patient and customer-led yet at the finish line, but we are organisation, so we’ve worked hard to travelling in the right direction. listen to our customers to ensure NHSPS owns 10 per any changes we make provide N HSPS cent of the NHS a real benefit to them. We’ve owns 1 estate, managing, done this through the 0 p er cent of maintaining, and launch of initiatives like estate, the NHS improving properties our Annual Charging m a n and facilities across Schedules check-in and a g mainta ing, England. We work improving the endi n i n g improv in partnership to-end billing process. ing pro , and p and fac with NHS England, These have the aim of ilities acerties CCGs and others, to providing our customers England ross create safe, efficient, with more accurate, easily sustainable and modern digestible information healthcare environments, in a timely manner. all with the goal of enabling However, as I know has been the excellent patient care. case throughout the industry, this year This fiscal year (2020/21) has been one of has not been without its challenges. There are continued progression for NHSPS. We are a number of learnings we can take from the incredibly proud of the savings we’ve been past 18 months which are already helping able to obtain for the NHS through our cost us continue to drive improvements forward transformation programmes this year, at a into 2021 for our customers and patients.



The importance of delivering cost transformation Ensuring we deliver value and efficiency across the NHS estate has been a key focus of our strategy. However, we could never have guessed what this year would entail. The pandemic has shone a light on the important work that our NHS staff do daily across the nation, and this has put even more emphasis on ensuring money is reinvested back into the NHS to support the delivery of excellent patient care at this time. This year, we delivered savings of £48 million as part of our cost transformation programme. With over 300 initiatives across the business, we have been able to surpass our target by £5 million. Through these projects we have also been able to invest £90 million back into the healthcare estate to help ensure it is fit for purpose and meets the needs of local populations. As an example, one of the cost transformation projects we have focused on this year is around the disposal of surplus property. This means reducing the number of properties that we have sitting empty, such as office space that is

Improving our financial governance and control Financial governance is important for any business and is an area I was particularly keen to progress as I entered this role. Strong governance and control allow us to identify risks faster, manage cash more effectively and deliver more successfully. This covers all aspects of our financial information, from how we track transactions, to how we manage performance and control data. We should never underestimate the importance of good control: it’s an essential backbone needed to ensure we deliver excellent patient care. We have reshaped our processes in several areas to improve the value and effectiveness of these controls. One area of notable change is our supplier reconciliation and duplicate payment assurance. We have completely changed how we control these areas using technology, tools and process to forensically understand supplier spend and payments. The result is an improved cashflow position and very high confidence that we are only paying for services that have been delivered. We have also reviewed policies in some areas including our ‘No PO No Pay’ Policy which was introduced in September 2018, under which invoices are not paid unless it is accompanied by a valid, authorised purchase order. This has resulted in greater visibility of supplier spend which means we can make better informed business decisions and also


no longer used. This resulted in £4.7million of savings from the disposal of 34 freehold properties and exit of 44 leasehold properties. One such property was our site at Slyne Road, which had long standing issues that made it no longer fit for purpose to accommodate the NHS University Hospitals of Morecambe Bay Foundation Trust (UHMB) offices. We prepared a financial viability study for the proposal to help Morecambe Bay Clinical Commissioning Group (CCG) make an informed decision and worked with the CCG and UHMB to come to an agreement on a subsidy to enable this move. The move from UHMB into its new facility in Moor Lane Mills has allowed for better use of NHS space and budget, as well as generating additional revenue for reinvestment. It will enable a saving of £45,000 in running costs per annum on Slyne Road, negate the need to spend upwards of £1 million on backlog maintenance, and – once Slyne Road is sold – will generate much needed funds to reinvest in the NHS. Ensuring that Moor Lane Mills is fully occupied will also remove the vacant space issue, which had a liability of £159,000 per annum. This project highlights just how important the life cycle of our cost savings is to the nation’s health service. This project, and many like it, allow our profits to be reinvested into the NHS estate. This in turn enables the development of new healthcare facilities, health centre refurbishments and reconfiguring space to improve the experience of patients and healthcare colleagues that work there. Going forward, we will look to these projects as a benchmark for the future, so that we may continue to meet and exceed targets set for the organisation as it faces continued pressures from the ongoing pandemic.

The pandemic has shone a light on the important work that our NHS staff do daily across the nation, and this has put even more emphasis on ensuring money is reinvested back into the NHS to support the delivery of excellent patient care at this time see a significant reduction in days taken to pay suppliers, which is key to ensure our suppliers continue to deliver the great services essential to effectively supporting the NHS. Improving our billing processes Going into this year, billing was one of the biggest areas we wanted to improve for our customers. To do this, we took time to listen to them, take on board their feedback and worked hard to improve our processes to help them with their planning and budgeting from start to finish in a timely manner. Resetting the billing cycle was critical in helping us to issue billing documents with three key improvements: timeliness, transparency, and accuracy. A key area where customers wanted to see changes was in the Annual Charging Schedule (ACS), a budget document that sets out the estimated costs of occupation for our customers, such as expected cost of services. Following conversations with our customers, we knew they wanted their ACS earlier to budget more effectively, so we changed our process to issue ACSs in advance of the beginning of the financial year to better support customers’ budgeting and planning. In 2019/20, we provided 92 per cent of the 2020/2021 ACSs ahead of the beginning of the financial year and hope to continue these improvements. We also launched the ACS check-in initiative, where NHSPS colleagues contact customers to discuss their ACSs with them. This provides an opportunity for customers to ask questions and raise any changes that they think need to be made to their ACS,

ensuring full transparency. This initiative has enabled us to better engage with our customers, as well as helping us to provide more accurate ACSs and bills to our customers and building stronger relationships with them. In addition, we reviewed our approach to true-up – the end of year evaluation final costs – to understand how we could better align with industry standards. Our customers had also told us they wanted clearer statements to better understand the cost differences. In line with this, we amended the true-up statement to show the estimated costs from the ACS against the actual costs in the true-up to make it clear for customers where any differences lie in the two totals, helping to ensure greater transparency in our billing process. It has been a challenging 18 months, but I am pleased with the progress that has been made. While this could not have been done without the hard work of everyone within our finance team, these savings and improvements would not be possible without the additional support from our colleagues in the wider business and of course, our customers. We are on this journey together, and we are determined to continue working in close collaboration with our customers, listening to them, building their trust and maintaining the improvements to our billing services. It is only with continued collaboration, every step of the way, that we will be able to provide the best care for patients, in buildings that are fit for purpose. L FURTHER INFORMATION www.property.nhs.uk



GS1 Standards

How information sharing is a matter of patient safety Following the HETT Reset e-learning event, Glen Hodgson, chair of the interoperability and integration theatre and GS1 UK’s head of healthcare, shares a summary of discussion from the GS1 panel: How information sharing is a matter of patient safety One of the most prominent topics of recent sharing became a matter not just of months has been the accelerated digital patient safety, but of population safety. transformation of the healthcare landscape. This brought into sharp relief, the balance The emergence of Covid-19 propelled the between data sharing as a duty of care National Health Services into the versus the duty of confidentiality or patient unknown, and the system – privacy. In the case of the pandemic, often maligned as slow information sharing had become a As to innovate and adapt matter of population safety and B a roness – suddenly became the scales were firmly tipped Cumbe quite the opposite. in favour of duty of care. This r le highligh ge Telehealth quickly was made markedly clear by healthc ts, ‘the became the first the temporary suspension a r e point of contact of Section 251 of the s y stem is disjoin for patient care, National Health Service Act t e d , siloed, unrespo and the reliance on 2006, regulating the control nsive an virtual consultations of patient information. d e f e nsive’ d and remote patient In England and Wales, the monitoring became suspension of Section 251 ‘requires business as usual. All care NHS trusts, local authorities and others organisations soon ended to process confidential patient information up in a position where vital information (CPI) without consent for Covid-19 public



health, surveillance and research purposes’. These organisations were given authorisation to access, use and share any relevant patient information that was deemed critical for the management of the pandemic. For Professor Sir Terence Stephenson, Nuffield professor of child health at University College London and chair of The Health Research Authority, the advantages have been clear. He said: “Suspending Section 251 has been crucial over the past year. It has enabled us to expedite many research projects and enabled vital data sharing during this time to improve patient care.” Exposing siloes The pandemic has shone a spotlight on the siloed nature of our health and care system, highlighting the challenges that exist around integration and interoperability.

GS1 Standards

Pockets of excellence do exist in this fragmented network – integrated-care systems (ICSs) and local health and carerecord exemplars (LHCREs) are prime examples of this. However, being able to reach a stage where this is successfully scaled up and joined up on a national level, will involve the collaborative efforts of NHS arm’s length bodies, regulators, suppliers, and providers alike. Huge strides have been taken and much progress has already been made in this regard, but now the sector is tasked with embedding this across the healthcare system of tomorrow. This is where the need for structured data comes in. Only with universal data standards in place will healthcare be in a position to exchange information seamlessly. This is a crucial patient safety requirement, and the consequences of failing to do adopt a standardised approach, was brought to the forefront in Baroness Cumberlege’s Independent Medicines and Medical Devices Safety Review (IMMDSR), First Do No Harm, published in July last year. First Do No Harm The founding purpose of the IMMDSR was to ‘examine how the healthcare system in England responds to reports about harmful side effects from medicines and medical devices and to consider how to respond to them more quickly and effectively in the future’. This was after hundreds of patients were deemed to have suffered avoidable harm due to the system’s failings.

Using GS1 standards allows for the unique identification of every person, every product, and every place, throughout the supply chain and patient-care pathway As Baroness Cumberlege highlights, ‘the healthcare system – in which I include the NHS, private providers, the regulators and professional bodies, pharmaceutical and device manufacturers, and policymakers – is disjointed, siloed, unresponsive and defensive’. Additionally, ‘the system is not good enough at spotting trends in practice and outcomes that give rise to safety concernst. One of the key recommendations made in the report centred on the need for a national perioperative database – one that captures information for procedures carried out, including details of the patient, surgeon, and any medical devices used. The database, now referred to as The Medical Device Information System (MDIS), forms part of the amendments made to The Medicines and Medical Devices Bill (The MMD Bill). The MDIS will serve as a national registry for medical devices, capturing manufacturer, batch number, lot number and expiry dates for all medical devices used across the UK. This will be used to better monitor the use, as well as any potential side-effects, of any such products on the UK market. Graeme Tunbridge, director of devices for The Medicines and Healthcare products Regulatory Agency, highlighted the significance of the MDIS: “It’s all about joining up the information we obtain, linking together the unique device identifier and the patient information to improve traceability and patient safety. If we can crack this

and capture this data right as part of the future regulatory pathway, the UK will be leading the way on the effective post market surveillance of medical devices.” However, this is not, and should not, just be about product safety. Helen Hughes, chief executive of Patient Safety Learning, explained: “It’s not just about the safety of the devices, it’s about their safety in use – how is it being used? And is it being used safely?” Access to this information will serve to drive traceability in a clinical setting. When asked whether this would lead to better patient outcomes, Professor Andrew Goddard, president of The Royal College of Physicians answered: “Undoubtedly, yes. Linking the patient, to the event, and then to the clinician, is hugely beneficial. It’s a core part of improving the patient journey.” Using GS1 standards allows for the unique identification of every person, every product, and every place, throughout the supply chain and patient-care pathway. The tangible benefits to patient safety are evidenced in our Scan4Safety report, which provides key examples of how harnessing structured data enables information sharing to the benefit of overall patient safety. Thank you to all the speakers referenced for participating in the panel discussion. L FURTHER INFORMATION www.gs1uk.org/healthcare.org



Advertisement Feature

12 months into the pandemic A year into the pandemic; here are the three lessons we have learnt supporting health care professionals in maintaining their compliance obligations.

It goes without saying that healthcare professionals have been at the front of the battle against the Covid-19 pandemic, but aside from the business of saving people, the health care sector still has to maintain compliance with regulations such as the Data Protection Act to ensure that all data, particularly personal health data, is protected and made available to those who are authorised to access it. Regulators (the Information Commissioner’s Office in the UK for example) have shown empathy to the challenges that the pandemic has brought about and has said that for the time being, they will exercise leniency on organisations, however, there will come a time where such regulators will expect organisations to have adapted their processes and procedures to the new reality that we all now live in. So what can we take away from 12 months living with and supporting health care professionals through the Pandemic and what processes should be adopting? 1. Paper-based record keeping We at Guardum understand the reasons why paper is such an important part of the records keeping environment within the UK healthcare sector, however many different types of documents from employee records to patient records that are held in paper format, present many logistical challenges to meeting the required compliance standards. The pandemic has exposed the need to accelerate the move from paper-based records filing to electronic systems. Departments who could otherwise be working from home have had to continue to work from an office simply because of the need to access paper records. Digitising your organisation’s paper records takes effort but it comes with many advantages, including the ability to find and locate records in a heartbeat (including


those that had been historically misfiled or misplaced) by performing a simple search. Simple customisation of specific health care information that needs to be captured such as patient ID or family associations can further improve the accuracy and speed of data location and therein protection. Why pay high paper storage costs, when investment into scalable software will improve conditions for compliance professionals exponentially. 2. Inefficient compliance processes There is a saying amongst those who improve processes for a living: ‘even the best processes have a lifespan’. This acknowledges that processes interconnect and the needs that an organisation has of those processes change over time, this is not to mention that technology’s ability to help improve processes is also a factor. The reality is that processes are often used well beyond their best before date, this results in cost and time inefficiencies and can even lead to people in the worst cases maintaining secondary copies of records or creating spreadsheets containing health, personal or sensitive data, to help mitigate the shortcomings of a process or system. For organisations who haven’t undertaken process improvement for a while, the secret is to start small, but focus on an area or process that can obviously be improved. Implementing change or process improvement is rarely an easy job, but with organisations needing to be as efficient as possible the need to understand that processes have a lifespan has never been more likely to provide organisations with such large improvements in their efficiency. 3. Better use of technology to improve accuracy and efficiency Access to technology for compliance purposes, particularly in the realm of data protection,


data privacy and automated redaction has come a long way over the last few years. If, for example, you are dealing with a data subject access request, a patient information request or a freedom of information request, it is likely that there is a technology that can help your organisation to find the information required and to redact the critical third party data about people that don’t need to be included, far faster and in some cases over 95 per cent more efficiently. I was recently told a story of a hospital that was removing personal and sensitive information from documents using scalpels to physically remove the words from the pages. Such practises perhaps once had their place, but these days, there is no reason why anyone working on such documents should need to use a scalpel or even draw rectangles over words in an attempt to hide them from a reader. Given the recent ‘redaction’ failure by the EU in its handling of the AstraZeneca contract which exposed many of the key details in a bookmark, compliance teams should be looking at tools that not only make them more cost and time-efficient but also ensure that the information in redacted documents can’t be accessed by unauthorised people, thus alleviating the likelihood of an accidental breach. Darren Wray is the Co-Founder of Guardum, a software business which has designed tools for Healthcare professionals that specialises in locating and anonymising personal and sensitive data. He is an expert in data privacy and change management. L FURTHER INFORMATION www.Guardum.com info@guardum.com 020 3633 8878


Greater empowerment through remote healthcare solutions Valerie Phillips, healthcare expert at PA Consulting, explains how remote healthcare solutions are leading to greater empowerment for patients, clinicians and healthcare professionals It is widely accepted by clinicians, academics, policy makers and patient representatives that empowerment in healthcare is desirable and can result in many advantages, such as improved health outcomes, quality of life, patient well-being, professional satisfaction and system efficiencies. However, despite these agreed objectives, and rapid technical advancements to facilitate progress, frustratingly little progress has been made in recent years. Until 2020, when Covid-19, acting as a transformation catalyst, accelerated the implementation and adoption of changes in healthcare delivery at an unprecedented scale. The rising infection rate due to the new strain of the virus has further highlighted the desire for change. Currently, our health system is under severe strain, with over 30,000 Covid-19 patients now in hospital (as of 6 January 2021) and the press reporting that we are only a week away from system breakdown, if infection rates

What does empowerment mean continue to spread. Health care needs to in the context of healthcare? be delivered in a new way, using remote In general terms, empowered individuals methods as far as possible, to alleviate the can prioritise their own needs and take burden on hospitals and care providers. the necessary action to suit their unique New models of healthcare delivery, based situation. Empowerment is situation-specific on remote healthcare solutions, are emerging and, usually, highly individualistic. across the care continuum, with In the context of healthcare, an increased emphasis on however, empowerment has preventive measures, been difficult to achieve. This rapid diagnosis, virtual E m powere is due to the breadth of care, an increase in d individu needs across a wide range self-management, a ls can prioritis of stakeholder groups, the and personalised, diverse needs of caregivers adaptable needs a e their own n and care recipients, and treatments. Not d t ake necessa the presence of national only do these bring ry actio the suit the infrastructures and numerous benefits n to ir u centralised management in terms of cost, situationique of resources. There has speed and efficiencies, n always been a balancing act they are also leading between what may work best at to greater empowerment an individual level versus what is for patients, clinicians and feasible within the larger system. E healthcare professionals. Issue 21.1 | HEALTH BUSINESS MAGAZINE



Your business-critical documents such as contracts and regulations are complex. This complexity represents a real and significant risk not only to the NHS and Healthcare Providers, but to the reputation and personal liability of those responsible for compliance. The risk of misinterpretation, the loss of corporate knowledge and instances of nonconformance have for too long been treated as being part and parcel of business.


To date, organisations have been forced to attempt to manage this complexity using traditional, pre-web technology (namely, MS Word and PDF). The Solution Affinitext’s Intelligent Document Format (IDF) transforms the ease of understanding and managing complex contracts; securely, intelligently and collaboratively. The unique features of IDF include: Navigation - pop-up defined terms and 100% hyperlinking of clause-to-clause references within and between documents. Amendments - IDF documents are always the up-to-date “single source of truth” for all parties. Search - instantly pinpoint relevant information within and across your contracts/projects. Compliance - identify your rights and obligations and manage them in real time. Knowledge - share knowledge against the paragraph to which it relates. Collaborate - on a permissions basis with stakeholders and advisors. Be informed. Be consistent. PFI Expiry While complex contracts and regulations underpin healthcare organisations in every area, a much publicised example is PFIs, which the collapse of Carillion brought into sharp focus, leaving unfinished hospitals in its wake. There are currently more than 700 operational PFIs in the UK, with a capital value of £57 billion. In the next decade, over 200 PFIs will expire, with the NAO observing that ‘systems for maintaining up-to-date versions of contracts remain weak’. Affinitext makes it easy to extract all contractual obligations at your desk in seconds and ensure that projects are managed and returned to public ownership in accordance with the contract. REQUEST YOUR DEMONSTRATION NOW

www.affinitext.com contact@affinitext.com 020 3667 4866

Collaborative Contract Management Collaboration and the building of trust with your industry partners is for the benefit of healthcare users and the longer term use of assets, especially relating to PFI expiry. Some projects now see 3rd parties engaged on a partisan basis to maximise penalties on claims relating to operational noncompliance, whether trivial or not. An alternate, collaborative approach to contract management and compliance is generally preferable and is empowered with Affinitext. G-Cloud Affinitext is available for all government entities through the G-Cloud 12 framework. Affinitext is redefining the industry standard for contract management: sleep easy at night, perform better during the day.

Remote healthcare solutions are enabling personalised patientcentric solutions At first glance, remote solutions may appear impersonal, given the lack of face-to-care interaction. However, remote solutions, such as virtual health, digital health and telehealth, enable a greater range of possibilities, both in clinician terms and engagement terms, increasing touchpoints and interactions, with many associated patient benefits. For instance, telehealth solutions give the patient access to a wide range of clinical specialists and care providers, in a rapid and time efficient manner, from the comfort of their home. It also removes the need to enter a hospital, which reduces the possibility of

Health care needs to be delivered in a new way, using remote methods as far as possible, to alleviate the burden on hospitals and care providers infection. Patients can discuss their diagnostic information, review it in conjunction with a range of health care specialists, discuss and review their treatment and prescription needs and manage their care provision through online portals. They can also ensure their care records are made available to a wide range of clinical stakeholders, whose interaction determines the appropriate treatment path and best outcome. Remote monitoring enables personalisation and adjustment of treatment plans at an individual level. Treatment is moving away from one-size-fits-all to highly customised and regularly adapted treatment protocols. This is made possible through digitally connected remote monitoring devices, such as digital inhalers, wearable cardiac monitors, biosensors, pulse oximeters, weight and exercise tracking devices, and connected glucose monitors. Moreover, the developers of connected medical devices now recognise that patients are fast becoming consumers and administrators


 One of the outcomes of the Covid-19 pandemic has been wide-ranging transformation across the healthcare system, and notably the adoption of remote solutions. For example, according to the Royal College of General Practitioners, 71 per cent of routine consultations were remote in the four weeks leading up to 12 April, compared to 25 per cent in the same period last year. This is a tremendous shift. The adoption of remote healthcare solutions is enabling personalised care and empowerment for both caregivers and care recipients. Patients, clinicians and healthcare professionals are benefitting in a variety of ways.

of their own care in remote care situations and are incorporating consumer-centric product design principles from the outset. Advancements such as these are enabling the personalised treatment of chronic conditions where there has been great variation in care standards and outcomes. Connected medical devices can help patients proactively predict and identify episodes, manage their own care, avoid hospital stays and access healthcare professionals when required. Improving the management and outcomes of chronic conditions has the potential to greatly impact the health of the nation and the total healthcare budget. 26 million people in the UK have at least one long term chronic condition and 10 million people suffer from two or more. According to NHSE, long-term conditions account for 70 per cent of total health and care spend. Remote healthcare solutions are providing patients with a host of benefits which extend beyond improved health outcomes. Patients now have better and speedier access E



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Helping to migrate your data platform to the cloud Data is fundamental in health care, and the NHS and getting your data platform in state support the needs of your trust will be vital in delivering value to your customers. You might be under pressure to make of cloud technology. You might also know that even if you don’t migrate to the cloud, you need to upgrade to a new database platform version. So, you have an old version of Server. It might even be out of support. You know you need to upgrade. However, it stills works fine. Yes, you know you’re not getting any security updates, and it houses the most critical data, but it still

IT leaders and technology decision in makers in the NHS have a pretty tricky job right now. Balancing all the data requirements and needs that dealing with the pandemic brings along with striking a balance of keeping costs down and delivering real value for your organisations. You have to make critical decisions on where to spend your budget. It would be best to strike a balance between cost-effectiveness and provide solutions that add value to your organisation. Throw in security and keeping your data safe, secure and protected there is no question that you have a lot to navigate and get right.



works ok. You might need to evaluate a cloud provider or two. If you are looking to migrate your on-premises SQL Servers to a cloud provider, such as Azure or AWS, we can help you. We can help you migrate your SQL Server to, the latest on-premises version of SQL Server or help you make that step to the cloud. Talk to one of our experienced consultants about migrating your data platform to the cloud. FURTHER INFORMATION www.gethynellis.com


 to healthcare, improved quality of care, greater engagement and participation in formulating and modifying personal health plans, regular timely feedback, peace of mind and daily assurance for condition management, support to self-manage, less travel to specialised centres, notification of timely interventions and improved education and support. New patient-centric care models, enabled by remote solutions, are delivering patient empowerment on a large scale, across a wide range of clinical conditions. How remote healthcare solutions are empowering clinicians and healthcare professionals Clinicians and healthcare professionals wish to both save and improve the lives of their patients by bringing their expertise and knowledge to bear in a timely manner. In short, they wish to be able to diagnose accurately and speedily, and treat precisely and personally, to deliver the best health outcomes. Remote healthcare solutions are enabling clinical decision-making across the care pathway from preventive care, to diagnosis, treatment, maintenance and prevention of recurrence. Connected health solutions can feed information back to both frontline healthcare professionals and expert clinicians, enabling treatments to be adjusted as necessary, and providing tailored and personalised treatment plans. For example, by remotely monitoring a patient’s use of an asthma inhaler, the respiratory specialist can see how frequently the inhaler is being used and whether it is being used correctly. Feedback can be provided to the patient to improve compliance and outcomes, avoiding acute attacks, hospital admissions and condition deterioration. In addition, remote healthcare solutions can help healthcare systems become more efficient and assist healthcare staff manage increasing demand without overstretching already strained clinic and staff resources. They reduce footfall to healthcare facilities, allowing resources to be focused on where they are needed most. Remote health solutions also have the potential to greatly improve the day to day working experience of healthcare professionals, enabling them to focus their time and expertise where the need is greatest, and improve overall work satisfaction. According to a survey undertaken by BMA in April 2020, 44 per cent of doctors said that they were currently suffering from depression, anxiety, stress, burnout or other mental health conditions relating to or made worse by their work. These factors in turn make the profession less attractive and cause many to leave, due to undue stress and dissatisfaction. A Nuffield survey, published in 2019, stated that there were around 100,000 full-time equivalent advertised vacancies in NHS hospital and community services, equating to an estimated shortfall of 8.1 per cent (around one in 12 posts). Remote healthcare solutions can greatly contribute to alleviating causes of low morale, high attrition and

New models of healthcare delivery, based on remote healthcare solutions, are emerging across the care continuum, with an increased emphasis on preventive measures, rapid diagnosis, virtual care, an increase in self-management, and personalised, adaptable treatments burnout in the medical workforce by reducing the burden of administrative and basic clinical tasks, enabling medical professionals to focus on patients’ needs. What is the future for remote healthcare solutions and stakeholder empowerment? Given the system-wide adoption of remote healthcare solutions, propelled by the imperative of the Covid-19 pandemic, we are unlikely to see a return to old ways of delivering care in person. There is motivation from all stakeholders to embrace digital-first care models, built on remote care solutions. NHS Digital estimates that half of the 102 million GP appointments from March to July 2020 were by video or phone call. Virtual consultations are now being rolled out to other community care practitioners including optometrists, pharmacists and dentists. Technology will continue to deliver new possibilities for remote healthcare delivery, with MarketsandMarkets forecasting that the IoT medical devices market will grow to USD 63.43 billion by 2023 from USD 20.59 billion in 2018, at a CAGR of 25.2 per cent. The connected medical device market is expanding with the evolution of high speed networking technologies and increasing penetration of smartphones, tablets, and other mobile platforms in healthcare. As with other areas in life, patients are increasingly

embracing technology to manage their health; they are accepting the remote delivery of care and are becoming more engaged with their health management. As a result of these combined factors, the ability to analyse vast amounts of health data will continuously inform and develop the system, support the development of new remote care models and further advance benefits and empowerment for all stakeholders. A rich pattern of behaviours and insights can be gathered via data analytics and AI tools. This informs clinicians on rapid diagnoses, case triage, personalised treatment protocols, and informs frontline healthcare professionals on the appropriate, most effective care. It also helps drug and device companies innovate more effectively. Data sharing will continue to enable innovation across the care continuum and efficient skill and knowledge transfer. The adoption of remote healthcare solutions is finally realising the delivery of healthcare on an individual basis, on a global scale, leading to greater empowerment for both patients and medical professionals. As we navigate such turbulent times, this shift has arguably never been more imperative. L FURTHER INFORMATION www.paconsulting.com/ industries/healthcare



WE GET TECHNOLOGY AT THE POINT OF CARE. STOCKPORT NHS FOUNDATION TRUST REDUCES DATA CENTRE COSTS BY £100,000 PER YEAR. CDW data protection solution enables Stockport NHS Foundation Trust to overcome backup and disaster recovery concerns. Stockport NHS Trust Foundation Trust depends heavily on its IT estate to provide vital healthcare services to more than 500,000 patients per year. However, the combination of ageing infrastructure and an overstretched IT team comprising 25 people to cover 6,000 employees was causing a number of operarational challenges. With a commitment to providing the highest levels of support to healthcare teams delivering critical patient care, the Trust recognised that it had to embrace new technologies to improve results. Stockport NHS Foundation Trust’s existing ageing technology could only provide the most basic functionality, and it was taking the IT team an enormous amount of time to restore systems when they failed. The Trust identified a need to invest in a modern solution that would provide both security and compliance, while also being future-proofed to meet a requirement for ease of scalability and adaptibility to the cloud. CDW worked with the Trust to design and implement a data protection solution that would fully address backup and disaster recovery requirements.Taking an agnostic approach to technology partner selection, CDW identified Cisco and Cohesity as the standout solution that would provide the Trust with the opportunity to unify its end-to-end data protection infrastructure. Since the solution has been implemented, Stockport NHS Foundation Trust has recognised numerous benefits including excellent backup and recovery capabilities ‘out of the box’ helping its IT team become far more agile and flexible. The Trust also has the confidence to perform upgrade procedures that previously would have required external vendor support, safe in the knowledge that data is protected which has already helped it save a considerable amount of money Additionally, by bringing the technologies in-house and standardising IT operations, the Trust has been able to reduce its support and licensing costs by nearly £100,000 a year. Find out more at www.uk.cdw.com/about/case-studies/stockport-nhs-foundation-trust.

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“We had worked with CDW previously and it had always provided an excellent level of service. What we had always liked was the fact there was a consistency of contact, you work with the same team all the way through a project.” PETER HUGHES Head of IT Stockport NHS Foundation Trust


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Public sector data network migration NHS Digital has successfully completed the world’s largest ever enterprise email migration, alongside the largest known public sector data network transition programme In November, NHS Digital announced that it had completed the largest known public sector data network transition programme, saving the NHS an estimated £75 million a year and providing organisations with faster connectivity at reduced cost. At that date, approximately 12,000 sites belonging to 950 NHS, social care, private sector and local authority organisations had moved from the legacy N3 network to the new Health and Social Care Network (HSCN), giving them great value, highly reliable connectivity with improved security capabilities. Thanks to the network migration, organisations can now pick from a marketplace of 21 different suppliers, who compete to provide standardised network services. This enables organisations to obtain the public internet and private network connectivity services they need over a single connection at highly competitive prices. NHS Digital says that the value for money generated by the new HSCN marketplace has enabled many organisations to significantly upgrade their connectivity in order to adopt more digital and cloud-based services, cope with rising levels of online activity,

support their coronavirus response and services affordably – in many cases obtaining ultimately realise their digital ambitions. far greater bandwidth for less money. Patrick Clark, HSCN Programme Director at “Good connectivity is vital for healthcare NHS Digital said: “This is a hugely significant practitioners, supporting them with faster, achievement both in terms of the scale and more reliable access to the information the benefit of what has been delivered. and services they need, when they need Reforming long-standing services in order to it. HSCN now provides organisations promote real choice, competition, with the ideal way to obtain the innovation and value for best connectivity for their money is always difficult staff at the best price.” but the HSCN initiative Dan Parry, HSCN Lead Unsurp demonstrates what Migration Programme can be achieved Manager at NHS digital srisingly, ervices when you work Digital said: “The provide collaboratively completion of the have se d by the N H across the health HSCN migration e n S a huge in usag and care system, and legacy network i n c e r e and industry. termination ahead as a resthroughout 20ase ult of th “The Covid-19 of schedule and 2 0 to acce pandemic has within budget ss healt e need demonstrated is an incredible h c a re remote how important it is achievement, given ly to underpin online, the project’s size and digital services with the complexity. A great success right connectivity and I’m is seeing the number of local delighted that the HSCN initiative NHS organisations benefiting from has enabled so many organisations to significant savings as a result of the HSCN upgrade and future-proof their connectivity marketplace whilst still being able to E Issue 21.1 | HEALTH BUSINESS MAGAZINE


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A simple solution to a waiting room headache As healthcare services are facing overcrowding, social distancing issues, and ultimately more pressure, for both staff and patients - have you considered a patient paging solution? numbers, foot flow has increased on sites, all whilst still trying to manage social distancing. A Midlands trust based Matron advised that they are seeing between 80-100 patients per day and are having to continually juggle social distancing, the available space within their waiting areas, and the volume of patients, on top of carrying out their normal duties. Many trusts have been adopting a patient paging solution to help with these social distancing issues.

Doors remain open We came out of 2020 leaving behind two lockdowns and the various tiers 1, 2, 3, and 4, then went headfirst into lockdown 3 - school closures, strict only leave home for essential reasons policy, and infection numbers rising. Forced again to turn our attention to the impact the pandemic is having on some of our key services; hospitals, GP practices, and pharmacies, which even in the middle of this pandemic still have a continual flow of people through their doors every day. The message for lockdown 3, as with previous lockdown 2, that hospitals, in particular, will remain open, meaning that routine services, wherever possible, will be unaffected. This has meant outpatient appointments for the various clinics and services are increasing in

Providing patients and staff with care and safety The MediCall™ patient paging solution enables flexibility on where a patient waits for their appointment. All it requires is for the patient to receive a pager upon check-in. The patient then has peace of mind that they are on the waiting list, whilst having the freedom to wait in surroundings they feel most comfortable with; whether this is relaxing in their car, grabbing a drink in the café or heading to the on-site restaurant. It also allows for vulnerable, or less able-bodied, to wait within the normal waiting areas but feel safe within the space, because of minimal people waiting. Trusts adopting the MediCall patient paging solution know that this can improve the waiting experience of their patients. It not only ensures the patient feels safe and at ease whilst on their site, but it helps their staff as well. Their team knows that they can disperse people quickly and easily once patients are checked-in, but have the ease of calling them back to the clinic when they are ready to see them. We must not

compromise the care and safety of patients and staff during these ever-changing and challenging times. Tools such as MediCall help to solve this. When looking at pharmacies, they’re often places without sufficient waiting space available indoors. The volume of people attending pharmacies sees further increases during October through March as we dispense the winter flu jab - besides the Covid-19 vaccination rollout. The facility of giving people a MediCall pager so they can wait in their vehicle or socially distanced outside again provides the customer peace of mind that they are in a queue, their order is being dealt with, and can socially distance safely. As with the hospital trusts, pharmacy companies provide the best care they can to their customers and staff by utilising the paging solution. A system simple to deploy, easy to use, but provides so much Crucially MediCall is a simple solution to install; it doesn’t require connection into any IT network and engineered to give you the site coverage you need. Ensuring nobody misses an alert, the MediCall provides an audible tone, flash and vibration; a sensory combination providing DDA compliance. It also features an ergonomic design for safety hygiene - enabling a fast turnaround at busy times. The simplicity of its function means training and ongoing use is simple to grasp. And therefore easily integrates with existing on-site processes. Don’t just take our word for it Feedback from those using the patient paging solution have commented about its ease of use, the headache it has removed for them, and quick and easy installation. Sarah Rees of the Surgical Assessment Unit at University Hospital of Wales, Cardiff & Vale, said: “The system has been the best investment to improve the patient experience in the hospital during Covid-19. We have proposed your system for our improved patient waiting experience award.” Passionate people. Proven solutions Call Systems Technology (CST) has been supplying patient paging solutions for over 20 years to hospital trusts up and down the UK. The knowledge and experience built up over this time prove invaluable to customers as they trust that CST will provide them with a solution that works, meets their budgets, and will last. As UK leaders in on-site paging, CST provide customers with the best solution, service, and experience. L FURTHER INFORMATION Tel: 020 8381 1338 www.call-systems.com



Digital security

 upgrade their capacity to fibrebase products. This will enable them to make better use of digital tools not only during the pandemic but as part of their longer-term digital ambitions. “This has been a mammoth task and as we switch the lights off on the legacy network and bring HSCN migration activity to a close, I look forward to supporting the development of the next generation network connectivity so that health and care sector organisations continue to fulfil their digital ambitions.” NHSmail More recently, NHS Digital also confirmed that it had successfully completed the world’s largest ever enterprise email migration after moving 2.1 million NHSmail mailboxes over to Microsoft’s Exchange Online platform. The organisation claims that the large-scale migration marks an important step towards creating a joined-up NHS and equipping frontline services with the latest digital tools and services available. The migration aligns the NHSmail system with the Secretary of State Matt Hancock’s vision for a cloud-first NHS. Moving to Microsoft’s Exchange Online platform will enable frontline staff to communicate more effectively and support them as they continue to respond to the pandemic - reducing the burden of administration and ultimately improving patient safety. The work, which began in August 2020, was undertaken in collaboration with Accenture and Microsoft and completed today with the vast majority of users experiencing no interruption in service. Approximately 22,000 NHSmail accounts were moved over to the cloud every evening and 83,000 accounts across each weekend. One of the benefits of NHSmail now being cloud based is it will automatically update to the latest version of Microsoft’s Office 365 collaboration suite, so users will always have access to the latest tools and capabilities. It also enables NHSmail to now provide Office 365 services, building on the deployment of Microsoft Teams, which was first deployed at the start of the pandemic

The number of NHS login verified identities increased by 660 per cent over the course of last year - from 238,638 at the start of January 2020 to 1,815,220 by mid-December and is currently used to send almost 1m messages across the NHS every day. Sarah Wilkinson said: “The migration of NHSmail to Exchange Online has enabled us to provide staff across the NHS with a mail system which is functionally richer, more secure and lower cost. We have also deployed a Microsoft Hybrid implementation of Office 365 to the NHSmail platform, which is allowing NHS organisations to provision O365 services much faster, integrate with the existing NHSmail identity, and collaborate more easily. These additional Office365 services build on the deployment of Microsoft Teams, which we rolled-out at the start of the Covid-19 pandemic and is currently used to send almost one million messages across the NHS every day. “I’m very proud of the Collaboration Services Team at NHS Digital for delivering the world’s largest ever Microsoft email migration, in the middle of the pandemic, when the organisation, and many of our staff, have been under so many other pressures.” NHS tech during coronavirus The above announcements are especially welcome given the global pandemic that the NHS is tackling. The need to have secure, fast and reliable technologies has never been more important. Unsurprisingly, digital services provided by the NHS have seen a huge increase in usage throughout 2020 as a result of social distancing and the need to access healthcare remotely. As a result, NHS Digital has recorded unprecedented levels of usage by both patients and frontline staff. At the end of last year, NHS digital shared some data concerning its technologies and

the usage increases they had experienced. For example, the NHS website experienced more than 800 million visits in 2020, compared with an average 360 million visits a year for the years preceding it. The number of users peaked in March 2020 with 120 million estimated visits (the highest ever) and again in September 2020 with 81 million estimated visits. The NHS App provides a simple and secure way for people to access a range of NHS services on their smartphone or tablet – from ordering repeat prescriptions to booking and cancelling GP appointments. In December 2019, there were 192,676 people using the NHS App. Fast forward to December 2020 and this figure had increased by 912 per cent to 1,951,640 users. Similarly, NHS 111 online allows patients to get urgent healthcare online, whilst also helping to manage increasing demand on 111 telephone services. In the six months from June to November 2020, 111 online recorded 3,569,917 sessions, which is a 257 per cent increase on the same period in 2019 when there were 999,150 recorded sessions. In total, 860,213 of all sessions during June to November 2020 were coronavirus related. NHS login provides patients with a simple, secure and re-usable way to access multiple digital health and care services such as the NHS App. The number of NHS login verified identities increased by 660 per cent over the course of last year - from 238,638 at the start of January 2020 to 1,815,220 by mid-December. L FURTHER INFORMATION www.digital.nhs.uk



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CyberGuard Technologies provides high level protection for the NHS CyberGuard’s cyber security solutions are designed around a trust’s current services to centralise alerts and activity into a single location The NHS is a constant target for cyber criminals so robust cyber security is critical for the future of the service. Not only because of the volume of personal and sensitive data that it holds, but also the significant impact that bringing NHS organisations to a stand-still has on the wider community. Often trusts are faced with legacy and outdated systems with are not patched exposing vulnerabilities in their networks. At the same time, they have stretched internal IT resources that do not have the knowledge or the capacity to handle the huge volume and complexity of incoming threat feeds. CyberGuard is working with a number of NHS trusts to deliver enhanced cyber security through world-class security technologies including Palo Alto, Microsoft (inc. ATP), Kaspersky, VMware Carbon Black among others, as well as help them work towards achieving compliance to the Data Security Protection Toolkit (DSPT). With the deadline for compliance being extended to 30 June 2021, there is still time to tighten up security protocols in the 10 key areas. All our solutions are designed around a trust’s current services to centralise alerts and activity into a single location. We also provide full proof of concept for all our proposed solutions to ensure the proposed solution delivers on their requirements. How we’ve helped a Midlands-based trust meet the requirements laid out by NHS Digital and the DSPT Initially we set up a critical Incident Response service for the trust. This allowed our SOC Team to investigate, react and remediate any threats at the source. This provided the Trust with a reactive service that they can call upon in the event of a cyber incident. The second phase of the project was designed to improve the communication between all existing security products. Utilising their current method, we created a SIEM (Security Information and Event Management) solution whereby all security products communicate and send alerts to a centralised location. This provided us with a clearer picture of any potential threats to the trust and removed any duplication of checking the same threat picked up on multiple devices. CyberGuard provides a fully managed end-to-end service and works seamlessly alongside internal IT teams providing added resource, reassurance and expertise as required. Our teams provide a proactive service monitoring alerts, patch updates and policy changes which are reviewed and implemented as agreed with the trust. Each project is tailored to provide the services and specialist resources as required by the Trust. Whilst we have access to an extensive team

of experts, we pride ourselves on maintaining a personal level of service with small teams assigned to individual Trusts to provide continuity and an in-depth knowledge of their specific infrastructure and internal set up. “As a trust we have been very impressed with CyberGuard’s knowledge, response and proactivity. While this has only been in place for a short period of time, we have full confidence that our security has been strengthened and will continue to be on the forefront.” NHS trust, Midlands Experienced and qualified team of experts CyberGuard’s CREST accredited security consultants and analysts are highly experienced and work with global threat intelligence feeds to ensure that all our security services are ready to prevent, detect and protect against the latest evolving threats. We have experience of working with a range of organisations across the Public Sector, including NHS trusts, local councils and education providers and understand the needs of the sector. We also have specific experience of helping NHS trusts to comply with the requirements of the Data Security and Protection Toolkit. Every organisation is different and that is why we work closely with our customers to design and implement a suite of services that best meet your needs. These include: • • • • • •

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Digital Health Rewired

Celebrating the best of digital health Digital Health Rewired 2021, 15-19 March, will feature some of the biggest names in health IT offering inspiration and insights into tackling current and future challenges of digital and data against the backdrop of a pandemic which has changed the world

remains a fundamental challenge to The Covid-19 pandemic has changed the enabling the delivery of joined up health way we deliver care, expediting digital and care services. Significant progress has transformation in a way that no-one could been made in recent years, particularly on have envisaged just one year earlier. standards such as FHIR (Fast Healthcare Barriers to new technologies have been Interoperability Resources), the key eroded in the efforts to galvanise remote interoperability standard being adopted teams to keep the NHS afloat and continue by the NHS and healthcare systems to deliver care at the point of need. across the world, but far more remains Digital Health Rewired - which is to be to be done. There will be keynotes from delivered virtually for the first time - will the pioneer of interoperability Grahame unpack the challenges that the sector has Grieve, Founder of HL7 FHIR, grappled over the past year and followed by Irina Bolychevsky shine a light on the new - director of standards and technologies that have The she interoperability at NHSX. emerged as a result. er volume The Digital Responses The expanded o f activity is likely to Covid-19 half day programme will virtual event will be feature more than degree to cause a o f delivered as a series 300 speakers b u the syst r of short video best over five days em adjun out as to som s practice case-studies from 15-19 t s b ack and ething lightning talks, March 2021, split c l oser to resem interspersed with across 11 festival b interactive break-out events. Previous normal ling ity sessions. Confirmed attendees will be keynote for the summit familiar with the is Saffron Cordery, deputy popular summit format CEO of NHS Providers. and will see the return of Pitchfest, where 16 of the best startDay two: for digital leaders ups will be battling it out to be crowned now and of the future the winner. Online quick-fire heats will The prestigious Digital Leadership Summit, be held between 15-18 March with the now in its sixth year, is dedicated to NHS grand final taking place on 19 March. CIOs, CCIOs, CNIOs and future digital leaders and is only open only to public Day one: delivering sector delegates. It will focus on the joined up care challenges of digital leadership in the The festival kicks off on 15 March with NHS, with inspirational international the Interoperability Summit and Digital and UK speakers, workshops and Responses to Covid-19. Interoperability



leadership masterclass sessions. It will feature keynotes from Sarah Wilkinson, CEO of NHS Digital and Matthew Gould, CEO of NHSX. They will be joined by Dr Navina Evans, CEO of Health Education England, who will discuss developing future digital leaders. Day three: Cloud, mobile and virtual - quality care anywhere Wednesday (17 March) sees another two summits packed with content; Cloud and Mobile and Virtual Care. The Covid-19 crisis has dramatically accelerated the NHS’s journey to cloud and mobile-based solutions and working, starting with the need to mobile enable workforces and provide staff with the ability to work remotely. As NHS organisations review their digital strategies following the pandemic cloud-based infrastructure and services look certain to play a far greater role. Keynotes on the day will include Professor Joe Harrison, CEO of Milton Keynes Hospital NHS Foundation Trust and Frank Hester, founder and CEO of TPP. Day four: large-scale digital transformation - lessons from the UK and beyond The Digital Transformation Summit on 18 March launches with a joint keynote from the NHSX leadership team where Dr Simon Eccles - deputy CEO, Sonia Patel – CIO, and Natasha Phillips - CNIO, will provide updates and then take part in a Q&A. Then in the afternoon there is a not-to-bemissed session on digital transformation

Digital Health Rewired

of medicine, with speakers including Professor Henrietta Bowden-Jones OBE, consultant psychiatrist and honorary professor at University College London. Day five: AI and Data and the new normal The final two sessions to round up the extensive programme are the AI and Data Summit in the morning of 19 March, followed by The New Normal in the afternoon where Chris Hopson, CEO of NHS Providers will deliver a keynote on ‘The NHS and Digital – Where Next?’. The packed programme will feature video case studies, lightening talks, online networking, video chat with

The pandemic has exposed many of the systemic challenges that have held back the pace of digital transformation in the past, such as a fear of failure and a general risk aversion that stymies progress fellow delegates, panel discussions, interactive round-tables and workshops. Digital Health Rewired is free for everyone from NHS, public sector, independent providers, charities and education sectors, plus start-ups less than three-years old. Access more than 3,000 attendees via

the virtual event platform, video chat with fellow delegates and take part in a lively social programme. L FURTHER INFORMATION www.digitalhealthrewired.com



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What we still need to use AI safely and quickly in healthcare Rachel Dunscombe and Jane Rendall examine what needs to happen to make sure extremely important algorithms can be introduced rapidly, and in a way that is clinically safe for populations

When one NHS trust in the North of England started to introduce artificial intelligence several years ago, hospital clinicians needed to sit postgraduate data science courses in order to understand how algorithms worked. Like most healthcare organisations, the trust didn’t have a uniformed approach to onboarding algorithms and applying necessary supervision to how they performed. It became a manually intensive operation for clinicians to carry out the necessary clinical safety checks on algorithms, requiring a huge amount of overhead and in turn significantly limiting the organisation’s ability to scale the use of AI. AI needs supervision AI in many ways needs to be managed like a junior member of staff. It needs supervision. Hospitals need to be able to audit its activity, just as they would a junior doctor or junior nurse, and they need sufficient transparency of how an algorithm works in order to provide necessary oversight and assess if and when intervention is needed to improve its performance and ensure it is safe.

So, how can we do this in a scalable way? Expecting doctors to do a master’s degree in data science isn’t the answer. But developing a standard approach to managing the lifecycle of algorithms could be. In the UK, organisations like NHSX are making progress. But the real opportunity is to develop an internationally accepted approach. If we are to adopt AI at the pace and scale now needed to improve care, and to address widening workforce and capacity gaps, we need to address the current absence of international standards on AI adoption. This could help to inform developers before they start to produce algorithms, and inform the safe application of those algorithms to specific populations. Put simply, this is about what we need to do in order to make sure we adopt AI with similar diligence that we apply to safely adopting new medicines, but without having to wait the years it can take to get important medicines to patients. A starter for 10 – thinking about an international approach to AI Arriving at that international consensus will mean a lot of rapid progress and dialogue – and will most likely involve sharing lessons from across different sectors beyond healthcare. But here are six suggestions of some of the components that could underpin a model and help healthcare to safely accelerate adoption:

1. Clinical safety. We need to embed AI into tools that can allow hospitals to examine the clinical safety of an algorithm. Healthcare organisations already have tools for clinical safety in their organisation – systems that gather data on the performance of doctors and nurses. Interfaces from AI algorithms should feed those same systems. We should report on AI in the same way as a jdoctor or nurse. There has been a lot of work from the Royal College of Radiologists about supporting junior colleagues to evolve in their career. Similar mechanisms could help to peer review the work done by the AI. This is about creating the same feedback cycles that we have for humans to understand where AI may have faltered or misinterpreted, so that we know where improvement is needed. 2. Bias detection. This is about examining demographics based on age, gender, ethnicity, other factors and determining where bias might exist. Hospitals need to understand if there are people for whom an algorithm might work differently, or not work as effectively. It might not be suitable for paediatrics for example. Skin colour, and a great many other factors can also potentially be significant. If a bias is detected – two options then exist: training that bias out of the algorithm, or creating a set of acceptable pathways for people with whom it won’t work and continue to use it for groups where a bias isn’t present. This could mean answering some big practical and ethical questions around access and equity. For example, is it appropriate to have a manual pathway for someone if the algorithm doesn’t work safely for them, and to use the AI for the remainder of the population? But to even get to those questions requires transparency. Algorithm developers need to be transparent on the cohorts used to train the algorithm. As a healthcare provider you can consider if this matches your cohort, or if there is a mismatch you should be aware of. You can then choose to segment your cohorts or your population, or capacity accordingly, or choose a different algorithm. 3. New demographic validation. One local geography might have two demographic minorities. Another, only a few miles away, might have a significant mix of ethnic minorities making up around half the population. Healthcare systems, like the NHS in the UK for example, usually buy technology before extending it over other geographies.



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This requires looking at new demographic validation. If the population in question changes – for example through immigration an extension of services, or something else happening: an algorithm needs to be validated against a new dataset. Something that can operate safely in the UK, might not operate safely in parts of South America, or China. Bias detection has allowed for validation in your original population, but you can’t test it on day one against every set of demographics where it might be used. There are so many ethnicities and groups on this planet that this has to be done in stages. So, as you extend the algorithm across new demographics, you need to validate. If a service in Mersey extended out to Manchester, then it would need to be tested again. 4. Explainable un-blackboxing. Having to send doctors on data science degrees isn’t practical. But we don’t have a standard way of drawing pictures or

writing words to say what an algorithm is doing at the moment. If you think about a packet of food, you get an ingredient list. We need a a similar standardised approach for AI. We need to work towards explainable un-blackboxing that will include clinical terminology, but it will also include common measures we find across different industries in terms of performance. If you are going to get a CE mark or certification – it could be standard across health, nuclear, aviation and other sectors. The EU is early in its thinking on how that can work, but discussion has started. 5. Clinical audit. We need a clinical audit capability in algorithms. If a case is taken to a coroner’s court, if there has been an untoward incident, we will have to show how an algorithm contributed towards care. This is something we already do with human doctors and nurses. We need to do it with algorithms.

6. Pathway performance overtime. In areas like radiology there is an opportunity to examine the performance of an algorithm compared with human reporting. This isn’t about AI replacing humans, but it can help healthcare organisations to make decisions about where and how to make best use of the human in the pathway. For disciplines like radiology this is key, given the significant human resource challenge faced in some countries. We also need to think about this from the perspective of the patient. If algorithms can report a lot faster than humans, could humans delay the diagnosis, particularly when humans are being used for double reading? Could that impact the surgery or treatment? Are there opportunities to change that pathway, or to potentially use AI to help free up the human resource to focus on diagnosing more complex cases more quickly? This is about looking at the performance of the pathway and measuring outcomes where AI can make a difference. Playing that back to citizens at a time when trust issues are still prevalent around algorithms, can help to demonstrate how AI is being used to improve healthcare. Healthcare organisations are looking to AI to help to address a significant number of matters. Not bringing AI will mean that we will otherwise hit crisis points – especially in areas like radiology, where in some countries demand continues to grow by around 10 per cent year-on-year, whilst the number of trainees continues to decline. But the situation is more complex than simply acquiring algorithms. A standard approach to managing algorithm lifecycle could make all the difference for successful adoption at the pace required. L

Rachel Dunscombe is a director for Tektology. Jane Rendall is UK managing director for Sectra. FURTHER INFORMATION medical.sectra.com



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How OPEX is providing digitisation solutions for the NHS Staff shortages, social distancing and a new way of working have brought on additional challenges to the NHS and OPEX has the solution to help minimise these pressures

As we readjust and revaluate best business practises instigated by the coronavirus pandemic, it has never been a more crucial time to address the digitisation of healthcare records. Staff shortages, social distancing and a new way of working have brought on additional challenges to the NHS and OPEX has the solution to help minimise these pressures. As a results-driven, solutions-based organisation, OPEX has already helped over 30 NHS trusts across the UK streamline medical records in-house by making the digitisation process as seamless as possible. With an innovative approach, OPEX is best placed to supply a variety of unique, automated solutions with proven experience in the healthcare industry. Key benefits of digitisation for both providers and patients include creating additional physical space and increased work-flow efficiency. Digitalisation not only saves time, reduces the margin for human error, eliminates missing or misplaced files but also provides round the clock access to healthcare records. Hospitals can also expect regulatory compliance and the elimination of warehouses full of records, creating a substantial cost saving on operating expenses. Eradicating physical paper will free up valuable space needed for patient care and will allow doctors to instantly view records and files directly from their computers.

Digitisation can feel like a daunting task however with the right equipment and business partner, the entire process is a lot easier than anticipated and will have a tremendous impact on patient care and internal efficiencies. By working with industry experts who understand digital transformation challenges and who have successfully delivered both onsite projects within hospital premises and offsite projects, OPEX uses next generation technology and state-of-the-art equipment that can easily handle the most challenging of tasks. While some hospitals have completely transitioned to electronic medical records, many others are overwhelmed by the formidable task of digitising warehouses full of patient records. However, the sheer costs, risks and inefficiencies of using a paperbased system are not sustainable, and many government and public sector bodies are mandating the use of digital medical records. It was for those precise reasons that North Bristol Hospital NHS Trust (NBT), one of the largest hospitals in the UK with 1,300 outpatient and 200 inpatient attendances, decided to embark on the journey to digitisation. Over the past five years, successive Government Ministers for Health have been driving a digital agenda, initially setting a NHS goal of going paperless by 2020. The current long-term plan encourages all NHS organisations, from large hospital trusts to small practices, to reduce and ultimately eliminate the trail of paper that follows every patient’s journey through the healthcare system.

Before they embarked on their digitisation strategy, NBT stored a total of 400,000 medical records in two warehouses, as well as 800,000 additional records at off-site storage facilities. The hospital received daily deliveries of approximately 850 paper files to prepare for upcoming appointments. On occasion, patient records were not delivered or found in time, which meant that the clinicians were unable to access historical information during the appointment. To address the excess costs and barriers to effective patient care, NBT introduced an Electronic Document Management System (EDMS), which would provide instant access to patient medical records for the hospital’s 6,000 clinicians, nursing, and administrative staff. The NHS Business Services Authority (NHSBSA), an organisation that provides back-end support to the NHS, determined that OPEX Falcon scanners were the best available product in the market for the complex, challenging task at hand. The scale of the digitisation process was enormous and many of the legacy documents were in poor condition, ripped, torn or worn with age and in an unstructured format. Such difficult-to-scan documents could not quickly and easily be captured by a typical scanner however the OPEX Falcon scanning solution handled the entire process efficiently and with ease. Commenting on the digitisation, Vinny Butler, Head of Scanning Services, NHS Business Authority, said: “We recognised that OPEX’s Falcon is the go-to product for scanning medical records and patient files, due to the significant labour savings, increased security and document integrity, combined with a powerful chain of custody associated with all records”. Digitisation will not only help create a more efficient NHS which in turn will improve care and outcomes for patients. OPEX currently deals directly with 30 NHS customers across the UK, and many more BPO’s. Each capture and transform a vast array of unstructured paper workflows into structured digital output for onward ingestion into back-end systems, with hundreds of OPEX’s machines already installed across the UK and Ireland, creating billions of images annually.

For an informal chat to discuss how OPEX can help with your digitisation, please contact us below. L FURTHER INFORMATION www.digitiseyourdocuments.co.uk DMA_EMEA@opex.com



Digital health

Why 2020 was the year of digital health In this article, Tom Russell, Programme Manager for Health and Social Care at techUK, explains why 2020 was the year of digital health... or was it? Undoubtedly, the past year, by anyone’s standards, was not a normal one, and much has been made of the response to Covid-19 from across many sectors such as Education and Financial Services. Health has been an important outlier given how much Covid-19 has been affecting the way that health and social care services are delivered as well as the obvious strain that a global pandemic places on the people who work within it. It has been through a general ‘can-do’ attitude that much has been achieved, and as we have seen from the public’s enthusiastic adoption of digital services, once the genie is out of the box it is hard to go back.

or economic reasons. Health technology has a role to play in helping to alleviate this fact, as well as ensuring that the decision-making processes are carried out with diversity and inclusion as a core component, rather than an afterthought. Moreover, it has also exposed many of the systemic challenges that have held back the pace of digital transformation in the past, such as a fear of failure and a general risk aversion that stymies progress.

The successes For the most part, digital health has been successful where organisations and individuals have taken steps Undoubtedly, the health and to dissolve the structural social care workers who and cultural barriers The she have unreservedly put that have unduly held e r v o lume o themselves in harm’s back the potential of is likely f activity way have made a health technology to degree to cause a sacrifice that will be make a meaningful long remembered. The difference in the the syst of burn out as em adju pandemic has also way that care is to som sts back exposed inequalities delivered. The e thing c within the system biggest changes to resem loser that continue to this year have taken b disproportionately place in how the NHS normal ling ity harm those from ethnic and industry work minorities, as well as others together more effectively, who are digitally excluded across boundaries and in for social, geographical, ethnic collaboration with each other. E Issue 21.1 | HEALTH BUSINESS MAGAZINE


Digital health

The pandemic has exposed many of the systemic challenges that have held back the pace of digital transformation in the past, such as a fear of failure and a general risk aversion that stymies progress  Out of necessity, many clinicians and technologists have had to change their attitudes to digital health, such as through widespread adoption of video consultations. Indeed, 2020 has been the year when the roles of the Chief Clinical Information Officer (CCIO), Chief Information Officer (CIO) and Chief Nursing Information Officer (CNIO) have come to the fore and their critical importance has come to be recognised. Although there are many such examples, one of the standout cases is the relaxation of the COPI notices that have allowed faster information sharing across the system, which has enabled clinicians to deliver care without the fear of prosecution for breaching information governance rules. What this has enabled is the bringing together of data and data sets to enable more advanced and useful insights from different parts of the system.


At the outset of the pandemic, it became clear that Covid-19 had created a surge of interest in the potential uses of technology across health and care, which led many suppliers to make offers of products and services to NHSX, NHS Digital and other local organisations. With the volume of offers available, the triaging and organisation became something of a challenge - enter Tech4CV19. A team of James Norman (Dell CIO and techUK Health and Social Care Council member), Hassan Chaudhury (Department for International Trade) and Nicola Haywood-Alexander (Healthcare CIO) came together to form Tech4CV19, now a Community Interest Company (CIC). The community helps to ‘match-make the health and care challenges with the technology offers to ensure we can work together to benefit all’ . They are


supported by Highland Marketing, a specialist health tech PR and marketing agency who have helped to guide their communications work as well as provide the logistically support to get this sort of project off the ground. With 2020 in the rear-view mirror, this sort of community driven model has highlighted the best of a British response to the pandemic. While regular face to face meetings have seemingly disappeared into memory, it is Microsoft Teams that has been adopted across the NHS since March 2020. Used as a platform to enable collaboration and secure information sharing, reducing face-to-face contact, and maintaining social distancing. The solution has played a key role in ensuring the NHS can still care for its patients accordingly, with over 65 million messages exchanged on the platform by staff by October. In the social care sphere, NHSX have been working with tech companies to roll out the deployment of iPads to enable the most vulnerable to maintain contact with their families. Facebook has provided up to 2,050 of its Portal video calling devices for free to hospitals, care homes and other settings including hospices, in-patient learning disability and autism units. Before the start of the pandemic, NHSX had already been working with

Digital health

NHS Digital to improve access to the internet in care homes and had negotiated a range of connectivity offers to help staff in care homes and their residents to stay connected. Quoting Matthew Gould, the CEO of NHSX, who spoke at a recent techUK event; ‘although progress has been made this year, it was a bit in the spirit of a faster horse rather than in different vehicle’. This sentiment is one that is echoed by many parts of the system, as in many cases it was the wider adoption of existing technology and the refinement of current processes that made the difference rather than a hitherto unknown Deus ex machina-esque intervention. The near misses Through an exhausting nine-month sprint, the sheer volume of activity is likely to cause a degree of burn out as the system adjusts back to something

closer to resembling normality. Continuous innovation and change tend to have a built in time limit before there is a readjustment and it is probably that there are a number of unseen costs coming down the line. Projects and initiatives are coming to the end of their free use period and plans to either sunset them or pay will come into play. What 2021 has in store In line with NHS England and Improvement’s plans for the future, digital transformation in 2021 will focus on the roll out of Shared Care Records across the country and the role of Integrated Care Systems (ICSs) as they move to a legal footing. This pivot to the local and regional as the primary place for transformation will reflect many of the changes that have taken place during this past year, as well as helping to put public need first when designing systems. Continuing digitisation of health will be accelerated

and as services move to the Cloud the important of data utilisation, analytics and Robotic Process Automation will increase. Furthermore, the move to remote working has also made the NHS and care workforce more flexible, and allowed industry to operate with clients remotely, which is a change that will be tough to unpick. Remote ‘go-lives’ of electronic patient records have been successful enough to make an argument for that to be the default in the future. Ultimately, the key to the success of digital health in the future will be embedding the positive, can-do attitude that was established in 2020. As people have become more confident in their ability to adapt at pace, this confidence will ensure the hard work and success continue. L FURTHER INFORMATION www.techuk.org



Panel of Experts

EXPERT PANEL PARKING Following previous panel discussions with those involved in hospital parking, Health Business gets the views of Gareth Brierley, deputy managing director of Debt Recovery Plus, on parking, facilities and collecting payments

Gareth Brierley, Debt Recovery Plus This last year, perhaps more than ever before, budgets within the NHS have been stretched to their limit to tackle the coronavirus pandemic. Amongst the public, much of the discussion has been centred on free parking, but with NHS organisations themselves, and particularly within finance departments, the arguments for spending tight budgets on parking has accelerated. Gareth Brierley, deputy managing director of Debt Recovery Plus, is clear that good parking provisions are a key component of a fully holistic approach to healthcare. He tells us that, for many patients, the first physical interaction that they will have with the NHS will be when they park their car to attend an appointment. Therefore, if the parking experience is a positive one then chances are the patient will walk through the door in a better frame of mind than if they have had a negative experience parking their car. Given the current health climate and the impact that the coronavirus


pandemic has had on the nation’s health, both physical and mental, Gareth stresses that it is even more essential to continue funding parking provisions at this time when so many patients and visitors are reluctant to use public transport due to fears around the spread of coronavirus. Parking charges It has previously been announced that hospital car parking charges will be removed for those in greatest need, in addition to charges for NHS staff having been dropped for the duration of pandemic. As clarity on this remains lost, we asked Gareth what the ongoing arguments were for keeping charges for other patients/visitors during such an unprecedented period. He says that, with government finances stretched to breaking point, and with the Chancellor needing to make touch spending decisions in March’s budget, it would be wrong to further burden the public purse


by rolling out free parking to all hospital users. As parking professionals are keen to point out, there is no such thing as ‘free’ parking – ultimately somebody has to pay, whether that be the taxpayer, landowner or the end user. While some NHS car parks and car parks in general may be free at the point of use the upkeep and maintenance is provided from somewhere else. If it is being patrolled to keep users safe, then someone is paying for that too. These operating costs will not disappear if the charges at point of use are abolished. The question of how and ultimately who is funding this service remains. There is also an argument, says Gareth, that it is unfair to penalise taxpayers who do not use hospital car parks, such as those who visit hospital using public transport or on foot. Therefore a direct ‘taxation’ through a pay and display model appears to be the fairest approach, albeit one that will never prove popular in the emotive world of parking. It also is worth remembering that if hospital parking was not charged for at the point of use, then where would the costs of maintenance be paid from? Those maintenance costs in the form of surface repairs, painted lines and grass verges would have to come directly from healthcare budgets, either centrally funded or from the operating budget of the local NHS trust. This is unfortunately the reality of the situation - if those sites are not maintained then they can become dangerous. Demand and supply Hospital parking facilities represent demand outstripping supply, especially this year. Which raises the question of how can parking facilities and transport links around hospitals be better managed to provide a better experience for all? Gareth says that this increasing problem cannot simply be solved overnight. Many parking facilities are located in areas with no space for further expansion, therefore NHS trusts and parking operators need to become more creative with how they tackle this historic problem. Encouraging more public transport options seems a logical approach, alongside park-and-ride options.

Panel of Experts

Additionally, the advent of technology to encourage higher bay turnover, such as ANPR and greater and more convenient payment options, has also helped alleviate some of the pressure. Debt Recovery Plus is also of the view that expectations need to be better managed – there is simply not enough space at some hospitals to expect a free parking space at certain times of the day, but the communication of this to patients is sometimes poor or non-existent. If patients who are able are more aware of the challenges that they may face if they choose to drive to the hospital at certain times of the day, then they may be encouraged to find alternative ways to travel (if available) so that parking provisions can remain available for the most vulnerable car users.

So, who better to ask about how debt collection for NHS parking facilities helps keep money flowing through the health system than Gareth. He told us that parking debt collection is an important cog in the overall parking management process. Without an effective deterrent mechanism, there would be little incentive to follow the parking rules or to pay to use the parking facilities. Debt Recovery Plus has seen with some NHS trusts who have not allowed debt collection that the word quickly gets around that there are no consequences for not following the parking rules, leading to more inconsiderate or dangerous parking, less

spaces being available and less parking revenue for the NHS. Debt collection agencies are a clear escalation from the parking operator, and help to free up the operator’s time and resource into more productive matters for the NHS, such as managing and maintaining hospital car parks. The debt collector can then put their own resources into contacting non-payers and providing that effective deterrent mechanism, and ultimately to help channel back much needed resources into the NHS. L FURTHER INFORMATION www.debtrecoveryplus.co.uk

Debt collection Debt Recovery Plus is the leading provider of debt recovery services for the private parking sector, nationwide. The company’s specialist knowledge and market-leading technology allowed it to recover over £2 million in unpaid parking tariff fees on NHS sites during the 12 months before coronavirus.



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Infection control

Maintaining indoor humidity levels key to fighting the virus We revisit the thoughts of Dr. Stephanie Taylor, where she discusses the need to ensure public buildings, such as schools and hospitals, have a humidity level so that viruses cannot spread To manage the spread of Covid-19, we are all working as a global collective to manage our behaviours responsibly, such as through meticulous attention to hand hygiene and social distancing. As individuals, these are undeniably key steps for us to protect ourselves and each other as we fight the current pandemic. However, individual behaviour is just one factor in our efforts to contain the virus and limit subsequent disease. The environment surrounding us plays a lesser-known, yet essential role in the degree of viral spread and in the severity of Covid-19 illness. Since we spend most of our lives in buildings – such as schools and workplaces and our homes – we could and should be doing more to ensure the conditions of these indoor environments are optimal for human health. The simple factor of maintaining healthy levels of indoor humidity is something that would benefit our health through reducing the burden of Covid19 as well as other seasonal viral illnesses. In my practice as a paediatric oncologist, I was alarmed by how many of my young patients came down with infections during their hospitalisation despite our best medical treatments. It was at this time that I became concerned that there might be

another factor at play; the indoor climate and the hospital building itself. After years of work, including obtaining a master’s degree in architecture, reviewing numerous studies of patient infections and the built environment and undertaking my own research, my suspicion was confirmed. Among the indoor variables that increase the likelihood of infection, from hand hygiene to room cleaning, one astounding common factor stands out: dry indoor air.

many viruses and bacteria floating in the air and settled on surfaces. When this optimal range of relative humidity is not maintained, it becomes harder for our immune systems to defend against respiratory viral infections even if we maintain high personal hygiene standards. Public buildings like schools, workplaces and hospitals have undoubtedly been hotspots for the spread of the Covid19 outbreak, not just because of viral cross infection via physical contact, but in large part due to the airborne transmission of Indoor relative humidity infectious droplets, aggravated by An abundance of data from low indoor humidity levels. research in infection control, Despite this, there are microbiology and building currently no regulations science show that on minimum indoor The env i maintaining indoor humidity levels in the r o n surroun ment relative humidity between UK and many other d ing us plays a 40-60 per cent improves countries. In fact, lesser-k human health through regulations focused n y o e w t essen n , several mechanisms. on reducing energy t in the d ial role This relative humidity consumptions zone optimises the ability in buildings of viral egree spread of our immune system have resulted in to fight viral infections, the lowering of decreases the bio-burden permitted minimum of infectious particles in our indoor humidity levels, breathing zone (the air) and unfortunately at the expense actually decreases the infectivity of of occupant health. A lack of E Issue 21.1 | HEALTH BUSINESS MAGAZINE


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Inivos launches Test Labs The leading infection prevention and control company has launched Test Labs, a centre of excellence uniquely dedicated to providing a range of decontamination tests to support the healthcare sector

As the pandemic continues, we’ve become all too aware of the highlighted issues and obstacles encountered within hospital settings. Hospital equipment and products are becoming inefficient due to repeated use, incompatibility with disinfection processes and ineffective cleaning procedures. Testing and maintenance is required to ensure equipment remains effective and reliable when you need it most, at this difficult time of increased pressure and beyond. Through feedback from industry specialists, we recognise that healthcare is changing and achieving the bare minimum is not enough. Covid-19 has transformed the healthcare world, and decontamination in particular. Before the pandemic, hospitals might source products first, then consider how to decontaminate them. But now, that’s no longer enough and to combat this, we’re pleased to introduce Test Labs. This new innovative Peterborough-based research laboratory is designed specifically for testing and researching questions around

infection prevention and control with particular focus around healthcare environment. Test Labs aim to provide healthcare providers with reassurance that their medical devices meet the required standards and are fit for decontamination against exposure to harmful contaminants, including the SARSCoV-2 pathogen which causes Covid-19.

physical properties during the test. The efficacy testing will ensure your cleaning protocols using surface disinfectants are in line with requirements and the regulations of biocides imposed by the EN. They also offer both VHP and UV-C technology testing capability, with specialised test cabinets that meet all the relevant EN standards.

The benefits of Test Labs With the assistance of Test Labs, manufacturers can integrate decontamination into their product-development processes. That way, they can ensure that even newly launched products have proven compatibility with the main cleaning and decontamination technologies and come complete with ready-to-use decontamination protocols. Created to ease the bottleneck in decontamination technology testing, Test Labs’ comprehensive range of services will ensure that all businesses needing to incorporate infection prevention and control can rely on the products they buy or manufacture to withstand decontamination practices in eliminating opportunities for users to acquire infection. Test Labs offer a full range of tests within their state-of-the-art facilities, including HALT testing, efficacy testing and material compatibility testing. They also work with you to develop best-practice cleaning protocols that are unique to you and your exact needs. Their HALT testing exposes materials, devices or entire systems to the most commonly used cleaning and decontamination technologies, in order to assess how they would perform in real-world settings to determine whether they’re suitable for use in a healthcare environment. In conjunction with HALT testing, they perform material compatibility testing where they can process samples of a material to assess changes in

Why use Test Labs The laboratory is proud to be one of the few facilities in the UK to offer testing for systems based on both UV-C and hydrogen peroxide vapour, with proven, in-depth knowledge of hospital decontamination, acquired through over 12 years’ experience in the field. With their expertise in infection control and prevention, their testing services can ensure your products and equipment will perform effectively, withstanding a range of decontamination and cleaning technologies, and meet industry requirements. As the healthcare landscape changes, decontamination processes must also, and Test Labs welcomes the opportunity of becoming your partner in testing suitability of products and equipment throughout the duration of these changes and beyond. The Peterborough lab was opened by Paul Bristow, Conservative MP for Peterborough, and Rob Hughes, chairman of Peterborough City Hospital, in a controlled, socially distanced ribbon-cutting ceremony. He commented: “This really is cutting edge stuff, some of the technology and some of the equipment here is unique, not only here in the UK but also unique in Europe. What’s really impressed me is the innovation- the fact that we’re not just trying to create something that already exists; this is trying to find new solutions to new problems we’ve encountered.” Tautvydas Karitonas, head of Research and Development at Inivos, said: “The opening of our Test Labs is great news for the healthcare industry. The Covid-19 pandemic has imposed a huge extra burden on both commercial and government testing facilities. Yet manufacturers still need to test their products – including pandemic responses, which should always be a priority. No matter how high our standards were before, they now have to be higher than ever. “Hospitals and manufacturers must work together to keep infection rates as low as possible – which is where Test Labs can play a vital role. Together, we can provide hospitals, key workers and their patients with reassurance that the medical devices and products being used meet the required European standards.”L FURTHER INFORMATION https://testlabsuk.com



Infection control

There are currently no regulations on minimum indoor humidity levels in the UK and many other countries. In fact, regulations focused on reducing energy consumptions in buildings have resulted in the lowering of permitted minimum indoor humidity levels, unfortunately at the expense of occupant health  humidity standards means that building occupants like the hospital workers who have been on the frontlines of the Covid-19 pandemic and patients with compromised immune systems have limited defence against further respiratory viral infection, despite hand washing and social distancing measures. It is long-established knowledge that viruses can be spread through short distance droplet splashing. But the transmission pathway we must now take into serious consideration is distant spread of infectious aerosols travelling through the air. When droplets are released into the air by an infected person sneezing, coughing, or simply breathing, dry air causes these droplets to shrink and desiccate to reach a moisture equilibrium. We now know that viruses carried in those tiny desiccated particles can travel through the air into an HVAC system and re-infect people from a distance and despite having had no immediate contact. This transmission route is one of the factors that makes this virus particularly alarming. The concept of airborne transmission is intimidating, but we can help control it

by keeping the relative humidity in our breathing zone or in our buildings in the magic zone of 40-60 per cent. Existing regulations on indoor air quality should be updated to reflect the significant body of scientific evidence that 40-60 per centRH is the ideal indoor humidity for health. These improved humidity standards would have numerous positive effects on human health and well-being. Not only would it reduce the burden on society of Covid-19 disease and other upcoming seasonal viral illnesses, but research shows that it would also reduce absenteeism and improve productivity in offices and schools. A recent study of a nursery school found that fewer children missed school when the classroom humidity was maintained above 40 per centRH. (Rieman J, ‘Humidity as a nonpharmaceutical intervention for influenza A’, 2018 ASHRAE abstract). Studies support projected reduction of absenteeism by at least 20 per cent by simply maintaining healthy humidity levels in buildings. Governments set indoor air quality standards for temperature, fresh air

introduction and pollutants. Setting a minimum indoor humidity level in public buildings is easily achievable, will result in net profit for society through increased productivity and reduced healthcare costs. Most importantly, it will save lives. We must push for these standards to be set to protect ourselves, our children, the elderly, and the health care professionals who are on the frontline protecting us all in the face of the global pandemic. L

Dr. Stephanie Taylor, a graduate of Harvard Medical School, is the CEO of Taylor Healthcare Commissioning Inc. After working as a physician for many decades, Dr. Taylor obtained a master’s in architecture as well as an infection control certification. Her lifelong commitment to patient care includes focusing on improving the health care physical environment and clinical work processes to help patients heal quickly. FURTHER INFORMATION www.taylorcx.com




Key issues for selection of hospital furniture Healthcare professionals play an increasingly important role in the selection of hospital furniture. Here we take a look at the advice of Nigel Davis on the issues that should be considered when selecting hospital furniture Walk in to any hospital today and you are likely to find a mixture of ward furniture, sourced over many years and from a growing number of NHS contract approved suppliers. But hospitals like the spectacular Queen Elizabeth Hospital Birmingham, equipped with individual rooms, or four-bed rooms with en-suite facilities are well placed to equip with new furniture, including patient seating throughout. So which factors are influential in the furniture selection process for both refurbishment or new build projects? Effective cleaning services Tackling cleanliness and infection control is the responsibility of everyone who comes into contact with the NHS – from visitors to managers to nurses to surgeons. Healthcare

Wood finishes and vinyls Associated Infections (HCAI) continue to To aid infection control, surfaces and furniture receive high priority and more action has been need to be both durable and easily cleaned. announced to tackle HCAI, with reporting Wood finishes should be sealed using a high processes to trust boards by matrons and quality clear lacquer, which is not only durable clinical directors on infection control and but incorporates antimicrobial agents that cleanliness. Further action will involve specialist suppress the growth of micro organisms. inspectors and tough new powers to inspect, In the fight against HCAIs fabric choice also investigate and intervene where hospitals are plays an integral part. High performance vinyls failing to meet hygiene and infection control are ideal in extreme hospital environments, standards. Given this background, infection with their anti-microbial and anti-fungal control practitioners play an increasingly protection (tested to NHS specified requirement important role in influencing those AATCC147) that prohibits growth of involved in the procurement bacteria and associated odours, of furniture for hospital Which infection and cross-contamination. environments. It has been The fabric does not absorb argued that routes to factors are spills and is easily wiped clean, infection are diverse. influen making it ideal for use in furnitur tial in the high risk infection control e select process ion areas. Regular cleaning with warm soapy water refurbisfor both and clean water rinse is h or new ment sufficient to retain the fabric’s b appearance and durability. projectsuild The upholstery maintains ? its appearance over long periods of time, provided it is cleaned in line with the vinyl manufacturer’s instructions. Bariatric products The Health and Safety Executive reports that 40-70 per cent of trusts do not have a bariatric policy in place, an important process which helps amongst other things to manage manual handling risks when dealing with bariatric patients. Specialist bariatric seating, designed and tested to handle patients up to 300+ kilos (50 stones) is available with fixed and drop arms and in a choice of seat heights dependent on client and carer requirements. Integral housekeeping wheels, allow what are essentially large, bulky items of furniture to be repositioned, without the need for manual handling. BB pressure cushions aid pressure relief and comfort. Pressure relief and comfort To meet the needs of a variety of client groups, patient seating can be supplied in a number of seat grades, depending on the risk of tissue breakdown, following a clinical assessment. High grade polyurethane foams are often supplied as standard, with the option to upgrade to a low/medium risk comfort cushion, or for high risk environments to pressure relieving foams, such as Reflexion foam, which helps prevent the development of pressure ulcers, but also reduce sliding




Infection control practitioners play an increasingly important role in influencing those involved in the procurement of furniture for hospital environments and improve posture. This is achieved by helping to distribute body weight across a greater surface area, avoiding localised interface pressure by responding to body heat and forming to the body’s shape. Reflexion foam features two layers (the upper layer is Vasco, a Visco elastic which is both temperature sensitive and energy absorbing, while the lower layer is Reflex, providing support and flexibility for the upper layer). Seat height and depth adjustment How do you ensure that the patient seating provided for clients in specialist units or at ward level have the correct seat height to suit a variety of clients? Clients with varying posture, leg lengths and physical abilities mean that a standard seat height may not be appropriate in all situations. Simple accessories such as height adjusters can provide the answer, offering a variable seat height, with adjustment in increments up to 100mm (4”) maximum, allowing bespoke seat heights to be created, along a preset range. Housekeeping wheels can also be added to seat height adjusters, which offer height adjustment, but with the added

benefit of improved mobility, allowing the chair to be easily positioned and without the need for manual handling. Many NHS trusts in specialist areas such as admissions, mental health, oncology or in more general ward applications choose to order chairs both with and without seat height adjusters, to suit a variety of clients. A simple pin adjustment allows for seat height adjustment in-situ, helping to avoid situations where the seat is too high and the clients’ feet are not in contact with the floor, or where the seat is too low, making it difficult to get out of the chair for those with impaired strength or mobility. Clients encouraged out of bed during a period of recuperation may also spend extended lengths of time in a patient chair. For this reason correct height adjustment and ergonomically designed furniture to ensure correct support and posture are also important factors. A removable seat option can also provide seat depth adjustment and with a wipe down rigid base it allows for easy cleaning and hygiene control. Similarly, a removable seat platform allows seat cushions to be interchanged for specific pressure reducing needs and can be used in conjunction with suitably inflated air cushions.

Cleaning and decontamination Removable seat bases allow seats soiled with bodily fluids including urine, mild acids and alkalis, drinks and beverages to be changed and cleaned in line with current guidelines to prevent and manage the spread of infection. Effective cleaning services always need to be available and a piece of equipment used for more than one patient should be decontaminated according to current guidelines following each use. Clinical teams must ensure that equipment is clean, maintained and fit for purpose. L

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How digital communications can help fight the pandemic and beyond

Written by Dave O’Shaughnessy, Avaya Healthcare Solutions Consultant

People are suffering due to Covid-19, but they are also suffering because communications are being stretched to the limit. Avaya’s Dave O’Shaughnessy writes that there are solutions available a few of the services developed and made available to help organisations and patients adapt around the challenges of the pandemic.

Healthcare services across the world could have never foreseen, just 12 months ago, the unprecedented level of disruption and immense challenges they would be facing throughout 2020 and now continuing into 2021. Additionally during this time, there’s been significant disruption and equally transformative innovation in how technology has helped to evolve and adapt the access to, and delivery of, a range of healthcare services. Just like how hundreds of millions of people around the world have switched to a workfrom-home model, so healthcare has had to rapidly evolve to a digitally delivered virtual service where it was practical to do so. Avaya has been working with healthcare services across the globe to help this evolution in virtual services. From automated video services that maintain precious contact between Covid19 patients and their families unable to visit them; to developing a video-enabled chatbot service which helps share Covid-19 information to deaf and hard-of-hearing patients; or creating Artificial Intelligence-enabled services that help reduce the huge volume of calls into hospitals from the public while also informing the public of vaccination plans. These are just

A citizen’s healthcare and vaccination journey The most immediate challenge facing healthcare services will be the huge administrative job of vaccine roll-out while simultaneously providing their normal day-today patient services. To effectively immunise the population, healthcare providers need to quickly engage and communicate with those who need the vaccine while responding to the massive influx of enquiries and ongoing healthcare services simultaneously. The engagement tools to help healthcare organisations carry out these tasks need to leverage automation and provide continual monitoring and reporting. This will optimise those communications services and workflows and eliminate the need to dedicate valuable healthcare staff resources to manual, timeconsuming tasks while also helping to keep citizens informed and assured. A solution is needed that allows health providers to quickly customise and deploy automated services to address the complexities of the vaccine roll-out along with all other healthcare services which Avaya defines as comprising the following components: Citizen awareness: citizen outreach (advising specific individuals which phase of the rollout they qualify for), eligibility checks, rollout phase registration and answering vaccine-FAQs.

Rollout coordination: practitionerresource recruitment via outbound messages (‘can you come in and administer the vaccine?’) and inbound messages (‘sign up for administering the vaccine’), vaccine FAQs for practitioners, etc. Appointment management: qualification registration, locating closest vaccine site for a candidate, scheduling patient appointments and appointment reminders. First vaccination shot: contactless screening, arrival check-in, vaccination confirmation, post-shot instructions. Between/post shot: post-shot FAQ, reporting of possible side effects, reporting of Covid symptoms/status (if a positive case), reminder to get second dose of vaccine and by what date, site locator for where you can get it, scheduling the visit, and reminder once appointment is made. Second vaccination shot: same process as first shot appointment. Avaya’s Healthcare solutions enable health service providers to proactively engage with citizens via automated voice calls, e-mail, Chatbot, SMS and MMS notifications to generate better awareness of the healthcare services such as Covid-19 and get more people signed up in a timely fashion. These notifications can be used for appointment reminders, follow-ups (‘You’re due for your second dose on XXX date’), arrival check-ins, contactless screening, and can also include post-vaccine surveys for recipients to safely report side effects. These notifications can be sent to both individuals and groups with optional response tracking, text interaction, and auto-forms to capture information that helps improve critical decision-making. How Avaya OneCloud is assisting the fight Avaya is talking from experience as its solutions include many innovations that have been on the front lines of the Covid-19 response. For example, Nebraska Medicine, the state’s largest healthcare system with a network of nearly 40 specialty and primary care health centres, prepared for expected increases in call volume by using Avaya OneCloud to rapidly deploy a cloud-based conversational platform to help them prioritise essential calls and reduce workload on their customer service agents while continuing to deliver outstanding patient care.



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Avaya’s virtual care solutions have also been at the forefront of helping infected patients and their families to maintain critical, supportive communication. Avaya Video solutions were deployed at a number of hospitals across China that helped staff as well as patients to communicate and collaborate during very difficult, demanding times. For example, Avaya deployed a fully-automated video conferencing solution at the Huoshenshan Hospital in the Wuhan province, which was famously fully constructed and admitting patients within nine days. This solution was designed to allow patients in enclosed ICU clinics to have secure, quality video calls with their family in the hope that such communications could help boost a patient’s positivity and motivation in fighting the virus. In another example of the Covid-19 battle, the features such as symptom-checking, testing, and then vaccine adoption are elements of combating the pandemic which are accelerated by enabling citizens to self-qualify via automated services such as an AI-assisted chatbots. As an example of this, Avaya partnered with the Ministry of Communication and Information in Egypt to develop and roll out a user-friendly chatbot service designed to help citizens who were deaf and hard of hearing overcome challenges with Covid-19. The chatbot service uses sign language with artificial intelligence to help citizens to receive advice and guidance in relation to healthcare services and Covid-19 on a mobile app or web browser, a service which was a first of its kind in the Arabic or African world. In Saudi Arabia, King Abdullah Medical City has been successful in coordinating an effective Covid-19 response, helping to slow its spread and meeting the population’s medical needs while keeping healthcare providers safe by setting up expert steering committees that can meet and collaborate safely through Avaya Spaces. Avaya Spaces Video Consultation, an Avaya Spaces add-on specifically designed to enable safe healthcare virtual consultations, puts safety and security first. Although customers can access their video consultation from any connected device, it is only a one-link invite that allows them to connect to a virtual waiting room before being seen by a member of the medical team. The same link can permit a patient to reconnect to the session should they be disconnected due to bandwidth or connectivity issues. Once the patient has completed their session and disconnected, all data associated with session, such as chat history, patient name, and shares files, are destroyed in order to protect patient data rules and regulations. Avaya Spaces Video Consultation

makes it easy and quick to schedule, queue, and conduct video consultations without needing to download apps or plugins. Avaya OneCloud and healthcare continuity Avaya OneCloud healthcare solutions are also playing a vital role in enhancing the experience for patients, families, care teams and all others that touch the patient journey. Avaya enables healthcare organisations to engage across the care continuum delivering experiences that matter when they truly matter most. By connecting people, resources, data, and more, Avaya is helping customers optimise their operations and reduce risk while strengthening the level of care they can provide to patients and customers. American Hospital Dubai (AHD), one of the pioneering private healthcare providers in the Middle East distinguished for its outstanding facilities and care standards, recently partnered with Avaya to improve patient outcomes. With superior call centre operations and customer relationship management capabilities, AHD has personalised the patient experience, simplified access to care and helped streamline operations. The technologies implemented align with the hospital’s healthcare delivery transformation journey by enabling it to serve patients with the most appropriate, convenient, and cost-effective care, making sure care providers are with them at every step of the journey, on the communications channels they choose. The Avaya solution has helped AHD aggregate various data – such as patients’ demographics, interactions with its website and call centre, and financial and other relevant details – to create a comprehensive profile for its patients. The digital solutions implemented by American Hospital Dubai give patients a range of ways to connect with the provider, supporting multiple inbound and outbound communication channels. They also streamline behind-thescenes systems that keep up with data and information. Through a CRM connector that integrates with the Hospital Information System, the hospital has shortened patient call response times. This is supplemented with an extensive knowledge base, which drastically reduces call times, ticket-issuing time, and improves patient satisfaction. By connecting people, resources, data, and solutions, Avaya helps American Hospital Dubai optimise its operations

and helps care team members communicate seamlessly so that they are more accessible. What has arguably been the most difficult time in public health history has become a defining moment of reform in health services, not just related to epidemics but also to serve the basic needs of patients. Beyond Covid-19, healthcare providers such as Shared Health Manitoba are using Avaya OneCloud solutions to automatically triage calls and help customers get the services they need. Avaya solutions are also assisting with the proactive engagement of patients to support with general appointment reminders, follow-ups and costly patient no-shows. Even healthcare adjacent institutions, such as Olmsted County in Minnesota, are experiencing great success with virtual waiting rooms. People are suffering due to Covid-19, but they are also suffering because communications are being stretched to the limit. Healthcare providers need to be able to handle more interactions, over distance, with fewer human resources. They need to have more creative options to engage and inform. They need a more elastic communications network. Not just now during crisis mode, but long-term. By embracing digital communications as a service, healthcare providers can hasten and streamline the rollout of this life-saving vaccine as well as creating a communications service that enables a more interactive, engaged patient with their healthcare services, that ultimately will better protect the patient and our populations. Find out more at Avaya. L FURTHER INFORMATION www.avaya.com

Dave O’Shaughnessy




Building hospitals of the future In our latest PA Consulting article, Christian Norris and Stephen Farrington explain how Covid-19 has changed hospital infrastructure needs for good Before Covid-19, the government announced plans to build 48 new hospitals by 2030, supported by an initial investment of £3.7 billion. While the NHS has responded to the challenges of the pandemic, these investment programmes have continued. Our work with a number of the largest new hospital programmes over the past year – where development plans have progressed despite the disruption of Covid-19 – mean we’ve seen first-hand how hospitals have had to quickly adapt their plans to respond to changing needs. The pandemic has accelerated a number of trends in the delivery of healthcare, which now need to be supported by appropriate infrastructure. It has taught us that we can – and should - work differently to deliver healthcare, and exposed the need for some fundamental changes to hospital infrastructure going forward: We need to accelerate the delivery of out of hospital care The pandemic forced the NHS to work very differently. Communities were mobilised to provide mental and physical care, with 4,300 community support groups recruiting three million people; community providers also took an enhanced role in discharging hospital patients. Meanwhile, patients avoided hospital and sought advice elsewhere – A&E attendances dropped by 42 per cent while 111 calls increased by 33 per cent. Whilst not all of these changes were appropriate, and in some instances led to delays in patient treatment, they succeeded in improving efficiency and freeing up vital NHS capacity for emergency care. As such, many will be sustained in the long term, which will require a different type of hospital infrastructure in the future. Hospitals will still exist, but they will need to be supported by better preventative care, community discharge and alternatives to A&E.


We can deliver the majority of needed for efficiency and flow, but also elective care virtually – except to ensure effective infection control. diagnostics This means future hospital infrastructure We also saw the rapid uptake of patients needs to accommodate separate elective on virtual channels. The proportion of faceand emergency flows and access points; this to-face GP appointments dropped from 70 could also mean more use of designated per cent pre-pandemic to 23 per cent during elective sites, separate from emergency the pandemic. Registrations on the NHS App sites. Another key learning of the pandemic increased 111 per cent and any outpatient is that our buildings need to be different to appointments took place virtually. accommodate the unpredictable demands of Virtual appointments are not without risk or the future and to respond to changing needs. consequence; patients missed out on essential diagnostics, including up to 50,000 cancer Offering flexible and diagnoses and elective admissions dropped adaptable capacity by 72 per cent. The impact of these delayed Covid-19 tested the ability of the NHS to rapidly diagnoses and treatments will be long-standing. respond to unexpected demands. The system was The opportunity for broadening the scope and able to increase capacity, including increasing complexity of virtual care in the future adult critical care capacity from c. 4,100 is great, and we now need the beds to c. 6,800 beds. However, the digitally enabled infrastructure spiralling rate of infection meant The to leverage it. This needs to hospital capacity was quickly pandem be combined with early limited and the NHS required i c has acc diagnosis and effective 11 Nightingale hospitals to e l e r ated a numb elective capacity to provide additional capacity e ensure patients have for up to c. 16,000 beds. in the d r of trends elivery access to physical In future, hospital healthc of a r infrastructure when infrastructure must be e , w hich no need to they need it. adaptable to fluctuations w be supp We need to be able in demand – not just o b r y t ed appr to separate elective to equip them to handle infrastr opriate and emergency flows future pandemics but u cture During the pandemic, also to pre-empt longour hospitals were not able term trends in healthcare to effectively protect elective need (including an ageing (non-Covid-19) patient flows from population, rising acuity of hospital emergency (potential Covid-19) flows. As a admissions, the expansion of diagnostics result, elective work was cancelled, and hospitals and increasing pace of clinical innovation). were designated as ‘Covid’ or ‘non-Covid’. Protecting elective capacity from emergency Providing enhanced demands has been a long-standing aim of infection control many hospital reconfigurations. Covid-19 Currently, c. 30 per cent of hospital beds are in demonstrated this separation is not only single rooms. Before the pandemic, the NHS


during the pandemic were those that maintained their dedicated programme teams – who were protected from the Covid-19 response. This reinforces the need for dedicated programme teams to support infrastructure delivery, supported by senior cover, so they are not compromised and distracted by the wider environment

Contributing to a net zero future The NHS currently comprises c. four - five per cent of UK carbon emissions, including 6.1 million tonnes of direct CO2 emissions (tCO2e). The NHS has committed to carbon net zero by 2040, with an 80 per cent reduction by 2032. Infrastructure is a significant part of this, with NHS buildings comprising c. 62 per cent of the direct carbon emissions of the NHS. The New Hospitals Programme has committed to a Net Zero Carbon Hospital Standard by Spring 2021 (a hospital development could generate >300,000 tCO2e without mitigation, for example). This will involve both the use of innovative, low-carbon materials, and new designs. This means infrastructure has a big role in reducing carbon emissions, including through net zero developments, efficient energy and water use, reducing waste and supporting sustainable transport infrastructure.

Operating within a limited economic envelope The economic consequences of the pandemic are huge, and there is a need for infrastructure to support the wider economy as we recover from Covid-19. The economy has shrunk by 11 per cent while the deficit has risen to £394 billion (19 per cent of GDP) and the national debt has risen by £2.3 trillion (>100 per cent of GDP). Unemployment is forecast to rise to 7.2 per cent in 2021. In this context, infrastructure investment will need to demonstrate excellent value for money. This can be achieved by maximising the returns (including healthcare benefits, cashable savings and wider economic impacts), reducing cost (through modern methods of construction and effective demand management), and demonstrating significant incremental value for money. Modern methods of construction (including off-site construction and modular buildings) have the potential to deliver quickly and reduce capital costs by 10–20 per cent through economies of scale and better use of space. As a result, infrastructure investment needs a robust business case that impresses

Delivering at pace The critical Nightingale hospitals were primarily delivered within three weeks, demonstrating that changes can – with the right conditions – be delivered at great pace. Similarly, the new hospital programmes that made most progress

the imperative for hospital infrastructure in comparison to other public sector priorities.


was targeting at least 50 per cent single rooms to provide protection from infection but offer privacy and dignity. Covid-19 has reinforced the need for such infection control; the need for single rooms post-pandemic is likely to be even greater. This means future hospital infrastructure needs to provide more single rooms, with implications for design and staffing.

Supporting a wider recovery As part of this, we know hospital infrastructure can make a big contribution to the local economy and national economic recovery. Hospitals are anchor institutions and make a big difference to the places they serve. This is amplified by investment in infrastructure; investment in the New Hospitals Programme could generate 14–17,000 new jobs. Much of this benefit can support the government’s aim of ‘levelling up’. 36 of the 48 new hospitals are outside of London and the South East, including large towns and cities outside of London, former industrial regions, coastal regions, and isolated rural areas. This shows that hospital infrastructure investment can help support wider economic recovery and direct this recovery to the areas most in need of support. Towards new hospital infrastructure These lessons of 2020 have reinforced the need for a flexible infrastructure that can meet modern healthcare needs for integrated, virtual and safe care. They have demonstrated that it is possible to rapidly introduce big changes to how hospitals are designed and operate, leading to improved flexibility, sustainability and a more positive wider societal and economic impact of our hospitals. L

By Christian Norris, Head Economist, and Stephen Farrington, economics expert, at PA Consulting.

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Recruiting clinical and healthcare staff NHS Workforce Alliance recently launched the Clinical and Healthcare Staffing framework, a streamlined service for the recruitment of all clinical and healthcare staff

Written by the NHS Workforce Alliuance

The NHS has been under immeasurable pressure in the last 12 months, the Covid19 pandemic has seen hospitals dealing with unprecedented levels of patients and the biggest vaccination rollout the health service has ever seen. According to a recent poll by the Health Care Supply Association (HCSA), the primary concern for trusts is staffing. The NHS is reliant on people to keep its critical services running and a high vacancy rate, a drop in the number of people choosing nursing as a career, and a rising demand for complex services and care has created a perfect storm. In a report published by the Health Foundation in December 2020, authors raised concerns that nursing shortfalls coupled with the backlog in routine care and growing need for healthcare is likely to make recovering from the pandemic slow, complex, and challenging. The NHS requires a flexible workforce to meet the changing requirements and cover areas such as sickness and long-term leave. The NHS Workforce Alliance offers a solution for trusts to plug that gap and ensure critical health services continue. NHS Workforce Alliance has been using specialist category knowledge to develop frameworks that support the NHS and wider public sector to ensure a sustainable workforce model for the future. Clinical and Healthcare Staffing NHS Workforce Alliance recently launched the Clinical and Healthcare Staffing framework, a streamlined service for the recruitment of all clinical and healthcare staff. The new agreement replaces the CPP/PiP National Clinical Staffing and

the Crown Commercial Service RM3711 Multi-Disciplinary framework. Tim Smith, Assistant Director of Workforce at NHS London Procurement Partnership led the procurement on behalf of the NHS Workforce Alliance. He said: “Bringing the best parts of these two frameworks into one agreement has enabled us to make improvements in specific areas such as incorporating lots that cover social care and emergency services that were not available under either of the previous frameworks. The new Clinical and Healthcare Staffing framework has been designed to meet the temporary staffing demands of the NHS. As well as offering a mix of nationally recognised suppliers, the agreement also offers the NHS and wider public sector a choice of niche regional and niche discipline suppliers; keeping the service responsive to need and allowing trusts to find the best possible solution.” The NHS Workforce Alliance puts patient safety at the heart of all our frameworks and services and the safeguarding of patients is key to our audit strategy. Joanne Barton, who oversees the NHS Workforce Alliance audit programme, said: “As part of our efforts to create strong relationships within the industry, we have developed a robust supplier relationship management programme that includes a rigorous audit programme. All suppliers appointed to the framework have a dedicated point of contact within the Alliance enabling them to better inform us of any issues or market trends to be aware of. “All suppliers on this framework were subject to pre-award and had to pass with a minimum 80 per cent score. We take

great pride in the robust nature of our audit process; all suppliers on the Clinical and Healthcare Staffing framework are subject to the full audit regime and customers can also request an ad-hoc audit of a supplier that they have concerns over, and any supplier who fails their audit is suspended, until the necessary improvements can be demonstrated through a re-audit. Customers have full access to all audit reports, enabling them to manage any local risks as appropriate.” As an NHS organisation, we understand the pressures and complex, changing demands faced by trusts, and we can help support you with your temporary staffing requirements. As well as supporting you with workforce issues, any potential savings we help you generate can be invested back into the NHS. Tim Smith added: “As well as being approved by NHS England and NHS Improvement, our framework rate cards are in line with their caps, ensuring trusts are able to fill roles while maintaining compliance with spend caps. We have also made the transfer fees terms and conditions clear and simple to understand, allowing trusts to facilitate agency worker transfers appropriately and compliantly. “As part of our coming together as an Alliance, we have a much bigger field of data available, which we use to plot regional and national trends, supplier trends and opportunities, as well as to support local and regional strategy development. There’s a lot we can contribute to the market and the NHS with the information available to us.” L FURTHER INFORMATION www.workforcealliance.nhs.uk



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The NHS SBS Digital Dictation, Speech Recognition and Outsourced Transcription framework provides a wide range of technology solutions to meet the evolving needs of NHS and wider public sector organisations The Digital Dictation, Speech Recognition and Outsourced Transcription framework, launched last June, offers a wide range of technology solutions to meet the evolving needs of NHS & wider public sector organisations for Digital Dictation, Speech Recognition and Outsourced Transcription Services. Running until June 2022, innovative pricing options provide organisations with the flexibility to either invest in a capital purchase of hardware and solutions or alternatively purchase the services on a subscription model where hosting options can be discussed or through a price per line basis (i.e. software as a service SaaS) where greater flexibility is a key driver. The framework helps NHS organisations reduce document turnaround time, thereby saving valuable time for staff - meaning no more hunting for tapes or hunting for secretaries to type urgent transcriptions. In turn, it also streamlines the document management process improving staff productivity by allowing secretaries visibility of workloads. With regards to wider IT and digital programmes, the framework enables seamless

integration with IT systems such as EPR, Encrypted Data Files for added security and minimal ongoing support overheads. The framework was developed with stakeholders from the following NHS Trusts: Hertfordshire Partnership, Northern Devon Healthcare, Pennine Care, South West & St Georges, and Surrey & Sussex. Translation difficulties Globalisation has contributed towards rapid growth in the translation and interpreting sector. The world has been getting smaller in terms of our need and desire to visit other countries and communicate in other languages, and that has led to an increased demand for the services of professional translators and interpreters. Worldwide, this sector is said to be growing at a rate of 5.52 per cent per annum. This demand is reflected in the UK health sector, where the nationality of patients being treated has become very diverse for a variety of reasons – including increased foreign travel for holiday or business, ‘health tourism’ where people choose to have a medical procedure


Assistive technology

Digital dictation and translation within the NHS

overseas, and significant representation of different nationalities in particular communities. Material that may need to be translated in the UK includes patient information leaflets, website copy, medical notes, documents that a patient has brought with them relating to their health or medication they have been taking. Where a healthcare provider has a strong representation in their area from particular language-speaking communities, they may have an extensive collection of translated material readily available for these groups. The NHS is committed to providing equality of access to high-quality healthcare services, including to those for whom English is not their main language or whose hearing impairment could create communication barriers. This principle is enshrined in legislation and a number of documents including the NHS Constitution 2012, the Health and Social Care Act 2012 and the Accessible Information Standard 2016. However, providing this equality of access is complicated for a variety of reasons including the proportion of the population whose main language is not English and the diversity of languages spoken. According to the most recent census (2011), around 4.2 million people in England and Wales speak a main language other than English or Welsh; this amounts to eight per cent of the population. In London, more than 300 languages are spoken, and, for many people, English is not the primary language spoken at home. 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. The 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


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Advantages: • Reduced risk of contamination • Simple and time-saving procedure • Stable and natural physical posture for men, women and children • Hidden built-in sensors in a ceramic bowl • Realtime curves and registration of the flow displayed on the computer • Automatic flushing after registration of the flow • Effortlessly flushing, even faeces and toilet paper • Compact set-up and can be placed in small rooms • Interfacing with EMR systems For further information: See the article elsewhere in this publication and/or visit www.urosciences.nl Distributor UK: Key Health Solutions LTD T: +44 8700 420735| E: helpdesk@keyhealthsolutions.co.uk | www. www.keyhealthsolutions.co.uk Manufacturer NL: Urosciences B.V. T +31 317 61 38 42 | E: info@urotex.nl | www.urosciences.nl

Medical equipment

Base clinical decisions on patients’ needs,not postcodes Barbara Harpham, chair of the Medical Technology Group, wrote for Health Business on the need for equal access to medical technology. We take a look back at her thoughts, in which she says that treatment should be based on their clinical needs, not patient postcode ‘The most cutting-edge system in the world for the use of technology to improve our health, make our lives easier, and make money go further’. That’s Secretary of State for Health Matt Hancock’s vision for the NHS, whose ambitions include modernising the way the health service delivers care to patients through cutting-edge mobile and IT solutions. Medical technology however - from medical devices to in-vitro diagnostics, imaging equipment and ehealth - already plays an enormous role in serving NHS patients. In fact, around half-a-million different technologies are available, with the health service allocating around £6 billion a year to this area. This technology delivers considerable benefit to the NHS. It often increases efficiency, reducing the need for further intervention and long-term treatment, reduces costs by limiting hospitalisations, and improves patients’ quality of life. It can also deliver wider societal benefits, helping people return to work and care for family members. In fact, studies by the Work Foundation and the Medical Technology Group have quantified the financial impact of just some of the available technologies. Our Keeping Britain Working report revealed that just eight technologies - including sepsis diagnosis equipment, coronary angioplasty, and hip and knee replacements - have the potential to save the economy almost half a billion pounds a year from reduced healthcare costs and benefit payment savings.

The postcode lottery alive and well still It would make sense for patients to have equal access to medical technology regardless of where they live. Sadly though, this has long been a challenge for the NHS. The main reason is the way the health service is structured. Devolution of decision-making to local NHS organisations means that the final decisions on which treatments are offered locally and under what circumstances is governed by individual Clinical Commissioning Groups and hospital trusts. The existing organisation - alongside budget constraints - only serves to prolong the postcode lottery, as local health services find increasingly more creative ways of controlling spending by restricting access to treatments and technologies. An investigation by the Medical Technology Group has revealed that CCGs are failing to comply with national guidelines on which treatments should be made available. What’s more, when a CCG restricts access, there’s very little the local population can do to change policies. Our study, conducted in October 2018, took four common proven treatments: cataract surgery, hernia repair, Continuous Glucose Monitoring, and hip and knee replacement. We then looked at the lists of treatments restricted by CCGs. These ‘Procedures of Limited Clinical Value’ (PoLCV) - which are normally reserved for complementary therapies or cosmetic

procedures where there is little or no clinical evidence to prove their cost effectiveness or clinical benefit - are, according to the Royal College of Surgeons, generally not funded by commissioners. The results were startling. We found that, despite all four treatments being recommended by NICE, CCGs across the country are deliberately restricting access to them or applying high thresholds to limit the number that are carried out. Cataract surgery Our research revealed that 104 out of 195 CCGs include cataract surgery on their PoLCV lists. Cataract surgery is the most common operation performed in the UK, and NICE national guidelines clearly reinforce its costeffectiveness, indicating that it has a ‘high success rate in improving visual function, with low morbidity and mortality.’ Under current national guidelines, the extent to which a patient’s eyesight is affected by cataracts should not determine whether or not they receive treatment. Instead the condition’s impact on patients’ quality of life should be the determining factor. Nevertheless, a third of CCGs list a visual acuity threshold as a requirement for receiving treatment. While this is a valuable assessment, playing an important role in evaluating a patient’s condition, visual acuity alone should not determine whether a patient is treated. E




producing quality




Medical equipment

 As well as contravening national guidelines, restriction of cataract surgery can also lead to further patient complications. The Royal College of Ophthalmology states that the ‘presence of cataract causes disability and increases the likelihood that individuals will suffer adverse events’, while the Royal National Institute for Blind People confirms that patients with cataracts are twice as likely to experience a fall. Continuous Glucose Monitoring (CGM) Continuous glucose monitors have become an important tool for people with Type 1 diabetes, allowing them to constantly track their blood sugar levels, identify high and low trends and sound an alarm at high levels. The devices, worn just under the skin, measure glucose levels in interstitial fluid, providing more information than fingerprint blood tests and enabling the user to make better treatment decisions. NICE guidelines on the management of diabetes in adults include guidance on how to commission CGM, setting out clear criteria for commissioning and the type of user that should be considered. However, we found 12 CCGs who do not commission CGM and a further seven that will only do so following an independent funding request from the patient. In other words, around 10 per cent of CCGs are placing some form of barrier to CGM. Hernia surgery Hernia repair is one of the most common surgical procedures in the UK, with around 80,000 performed every year. NICE states that it should be undertaken in most individuals with an inguinal hernia in order to close the defect, alleviate symptoms of discomfort and/or prevent serious complications, such as obstruction or strangulation of the hernia. The Royal College of Surgeons’ guidance is clear on the impact of delaying treatment, stating that ‘CCGs should not set criteria for referral and treatment for inguinal hernias’ outside that recommended in its guidance, as this approach ‘produces worse clinical outcomes and has not been shown to be cost effective’. Despite this guidance and proven record of successful outcomes following hernia repair operations, our research found that 95 CCGs – almost half – include hernia repair on their PoLCV or Threshold Policies lists. These thresholds mean that many CCGs take a ‘watchful waiting’ approach, where time is allowed to pass while further tests are carried out. While this might be appropriate for some patients, a more widespread adoption of this policy could mean an increasing number of patients only receive treatment when their condition deteriorates, and they require emergency intervention. Hip and knee replacement Around 200,000 hip and knee replacements take place in England every year, according to the National Joint Registry, which found that 92 per cent of patients report high levels of satisfaction six months after treatment. In addition, the British Hip Society’s guidelines describe Total Hip Replacement (THR) as cost effective, returning 90 per cent of patients to their previous employment, while

We want to see CCGs taking a longer-term view that looks beyond the immediate cost of a procedure. Instead, they must consider the longer-term impact on a patient’s quality of life and on wider society while assessing the ongoing cost of treating chronic conditions enabling elderly patients to maintain their independence. Previous widespread restriction on access to treatment has prompted the RCS to speak out, stating that ‘blanket bans do not best serve patient care’. Yet, despite the supporting evidence and hip and knee replacements being used effectively for decades, we found 78 CCGs that include the surgery on the PoLCV or threshold lists. They often apply a Body Mass Index threshold, contrary to advice from the RCS. Analysis of the National Tariff reveals that THR is cheaper than long term conservative treatment for osteoarthritis of the hip. Clinical value undermined The inclusion of common proven treatments on CCGs’ lists of restricted procedures is resulting in a huge variation in the treatment that patients receive. We found, for example, that access to cataract surgery for patients falling under Basildon and Brentwood CCG is restricted, while nearby Barking and Dagenham CCG offers the treatment. Not only does this create inequality for patients, it also undermines NHS England’s drive to assess treatments of limited clinical value. This work, which is clinically-led and based on the available evidence, sets out 17 treatments that are not clinically-effective or are only effective when they are performed in specific circumstances. By taking apparently random and inconsistent decisions on what procedures to restrict, CCGs are rendering this exercise pointless.

Ration Watch – calling CCGs to account The Medical Technology Group is extremely concerned by the findings of this research. It has long been our mission to ensure that patients have equal access to medical technology and that treatment should be based on their clinical needs, not their postcode. We have responded by creating Ration Watch, a campaign focused on highlighting variation in local commissioning. Ration Watch is calling on CCGs across the country to follow national clinical guidelines on commissioning, and to ensure patients receive the treatment to which they are entitled. Meanwhile, NHS England needs to set clear guidelines on which procedures should be classed as having limited clinical value and where viable thresholds can be applied. A national body, with the power to intervene when unfair policies are being adopted, should also be created to oversee local commissioning practices. Above all, we want to see CCGs taking a longer-term view that looks beyond the immediate cost of a procedure. Instead, they must consider the longer-term impact on a patient’s quality of life and on wider society while assessing the ongoing cost of treating chronic conditions. Only then will we see a fair NHS that finally kicks the postcode lottery into touch, improves NHS efficiency, and delivers what patients deserve. L Issue 21.1 | HEALTH BUSINESS MAGAZINE



UK manufactured bins with antimicrobial protection Leafield Environmental is pleased to announce that an antimicrobial protection can be added to the company’s internal and external bins to inhibit the growth of microbes by up to 99.9 per cent*. Leafield Environmental joined forces with Biomaster, the recognised leader of antimicrobial technology for polymers, in 2015 when they launched a new bin designed for the health sector. Following its successful launch, many customers across different sectors have been ordering the bins with the antimicrobial additive. The Biomaster antimicrobial additive is added during Leafield’s manufacturing process and is dispersed throughout the entire bin. It is durable, it will not wash off and will last its active lifetime. Tested on over 50

* Tested by Europe’s top independent microbiology laboratories to ISO 22196:2011. FURTHER INFORMATION Tel: 01225 816541 recycle@leafieldenv.com www.leafieldrecycle.com

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A manufacturer of quality shading and privacy products, Yewdale offers a range of healthcare products that are simple to install, hygienic, durable and all with a lifetime guarantee. Made in the UK, Yewdale’s range of eco-friendly disposable curtains are up to 40 per cent stronger than other disposable curtains on the market. For socially distancing beds but still offering privacy and visibility, the company produces a reusable PVC cubicle vision panel screen made with an anti-microbial wipe-clean surface. All easily fit onto the maintenance-free cubicle tracking for hospital wards. If you require quick privacy


different bacteria species in over 2,000 applications. It has been proven to remove over 80 per cent of bacteria in as little as 15 minutes. The active ingredient in the Biomaster antimicrobial technology is silver which provides an antimicrobial protection without allowing bacteria to develop resistance.


screens, Yewdale’s range of freestanding protective screens are ideal for between beds where you can’t utilise curtains and need to quickly deploy extra bed or waiting space. With a comprehensive range of blind systems, Yewdale offers miniature spring rollers for door vision panels through to heavyduty electric blinds, utilising a vast range of fabrics including PVC anti-bacterial. Many systems can be used in mental health settings as Yewdale has a wide range of anti-ligature products which include fail-safe magnetic anti-ligature blinds, curtain tracks and accessories. Finally, Yewdale stocks NHS approved PPE, from gloves and masks to full body gowns and coveralls - all for immediate delivery.

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AND TELL HIM THE RISK ISN’T REAL. Tony Covid-19 patient

Around 1 in 3 people who have Covid-19 have no symptoms and are spreading it without knowing. Are you absolutely positive you’re not one of them? Only go out if essential. Sticking to the rules stops the spread.

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Fairford Medical offers the highest-quality mobile and relocatable CT and MRI systems for interim rental or longer term lease. • Choose a Fairford mobile unit and you’ll have the scanner you need, when and where you need it. If you are planning the replacement of your Diagnostic Imaging equipment please call Fairford for a valuation or firm purchase offer with a fully project-managed removal. Whether it is the simple purchase of an ultrasound or working with you to remove and buy an MRI or CT scanner with an interim rental scanner, our experienced team is there to ensure you get the best value and the best equipment. Please contact us for a no obligation chat +44 20 7317 3000 for more information or email: info@fairfordmedical.com or visit: www.fairfordmedical.com

FAIRFORD MEDICAL LTD THOMAS HOUSE, 84 ECCLESTON SQUARE, LONDON, SW1V 1PX T: +44 20 7317 3000 E: info@fairfordmedical.com W: www.fairfordmedical.com

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