Health Business 22.2

ISSUE 22.2 www.healthbusinessuk.net

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Comment

A change in weather brings no change in pressures For the last few weeks the strain on hospitals across the country has become more pronounced, with calls for government assistance growing.

During the first week of April, at least 20 NHS Accident and Emergency departments in England issued diverts, with patients taken elsewhere.

Those still admitting patients have witnessed long delays, with more than a quarter of ambulances waiting at least 30 minutes to handover patients.

NHS bosses in West Yorkshire and the south central area of England - covering Hampshire, the Isle of Wight, Oxfordshire and Berkshire - have reported particularly severe strain.

More than 20,000 patients are now in hospital with Covid (or who have Covid but are in hospital for other reasons). Alongside high staff absences, the NHS Confederation says that this continues to pose huge operational challenges for the NHS and is harming efforts to reduce waiting times in other areas.

Follow and interact with us on Twitter: @HealthBusiness_

As the NHS Confederation’s chief executive, Matthew Taylor, said this week: ‘The brutal reality for staff and patients is that this Easter in the NHS is as bad as any winter’.

Michael Lyons, editor

P ONLINE P IN PRINT P MOBILE P FACE-TO-FACE If you would like to receive all issues of Health Business magazine for £100 a year, please contact Public Sector Information Limited, 226 High Road, Loughton, Essex IG10 1ET. Tel: 020 8532 0055, or visit the Health Business website at:

www.healthbusinessuk.net PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED

226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Web: www.psi-media.co.uk EDITOR Michael Lyons PRODUCTION MANAGER/DESIGNER Dan Kanolik PRODUCTION DESIGNER Jo Golding PRODUCTION CONTROL Danielle Giambrone ADMINISTRATION Amy Hinds WEBSITE PRODUCTION Victoria Casey ADVERTISEMENT SALES Azad Miah, Maziar Movassagh PUBLISHER Damian Emmins GROUP PUBLISHER Karen Hopps

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Issue 22.2 | HEALTH BUSINESS MAGAZINE

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Contents

Contents Health Business 22.2 07 News

37 Estate management

15 Cyber security

Mark Smith, Chief Financial Officer at NHS Property Services, explains how the NHS can maximise efficiencies, meet new cost savings targets and drive value for patients and communities

Calls grow for a revamp of the ‘Living with Covid’ plan; NHS pressures show no sign of abating; and top jobs in NHS more diverse than ever before

15 25

Richard Staynings discusses the challenges of protecting our NHS and healthcare system against the real world threat of cyber attacks, as the NHS continues to strive to digitally transform

41 Air quality

21 Technology

ICS are a new way of organising health and social care in England that will gain statutory footing later this year. Sarah Boyd explores how her ICS is using digital to improve patient inclusion and help reduce health inequalities

Sponsored by

25 The Healthcare Show

33

The Healthcare Show in 2022 provides that long-awaited opportunity for the NHS to come together to reflect, respond and reorganise, in the face of the monumental challenge it has endured over the past two years

44 Translations Alan White explains why translation technology needs to be uppermost in the thoughts of decision makers in the healthcare sector and how effective translation can be vital in ensuring medical information is accessible to all, regardless of language

47 Risk management

29 Facilities management 37

Whilst it is imperative that we improve the air quality in healthcare environments, tackling air pollution goes beyond the boundaries of the hospital, writes Larissa Lockwood, Director of Clean Air at Global Action Plan

The question of how organisations get the best from their people has never been more important than it is today, writes Linda Hausmanis, CEO of the Institute of Workplace and Facilities Management

On behalf of the Emergency Planning Society, Stephen Arundell, Barry Moss and Claire Penellum analyse how hospital trusts can show that they can deal with a range of incidents while maintaining services

51 HB Q&A Health Business talks to Chris Kelly, Associate Director - Estates Compliance & Risk at Leeds Teaching Hospitals NHS Trust, about the organisation’s sustainability achievements

33 Design & build

Richard Hipkiss, Development Director of the Modular and Portable Building Association, discusses how volumetric manufactured buildings are meeting the needs of the health sector

54 Catering Caterers within the healthcare setting have a role in assisting staff and visitors to make healthier choices, including promoting vegan options

Sponsored by

57 Medical technology 41

Health Business magazine

57

Alistair Fleming, healthcare expert at PA Consulting, argues that digitising surgery offers the potential to improve outcomes and enhance the reach of surgery

www.healthbusinessuk.net Issue 22.2 | HEALTH BUSINESS MAGAZINE

5

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News

LIVING WITH COVID

Calls grow for a revamp of the ‘Living with Covid’ plan In the past week, around 20 accident and emergency departments in England have issued diverts, with patients having to be taken elsewhere. The NHS is operating at extremely high bed occupancy levels and continued staff absence rates are well above the average for this time of year.

NHS Confederation is calling for the government to reconsider its ‘Living with Covid’ plan and introduce mitigating actions that will help avoid further critical incidents being declared at the NHS front-line. This includes reinvigorating its public information campaign on Covid to be clearer about the rates of infection and impact and infection prevention control measures being reviewed to better balance risk.

The government has been urged to revamp its ‘Living with Covid’ plan as NHS leaders stress that the government risks abandoning the health service amid continued high infection rates.

While the severity of the virus has been reduced due to the success of the vaccine roll-out, hospitals are continuing to see high

numbers of people with Covid. More than 20,000 patients are now in hospital with Covid (or who have Covid but are in hospital for other reasons). Alongside high staff absences, NHS Confederation say that this continues to pose huge operational challenges for the NHS and is harming efforts to reduce waiting times in other areas.

NHS PRESSURES

DATA

NHS pressures show no sign of abating, says SAM

Recommendations made to improve care through data

The president of the Society for Acute Medicine has warned that NHS pressures show no sign of abating and the system is becoming ‘increasingly compromised’.

Dr Tim Cooksley said patients were being put at risk due to overcrowding in hospitals and long handover delays preventing ambulances from getting back on the road.

He said that staffing and capacity issues were the two ‘fundamental issues’ and ‘honest discussions’ were required to resolve them.

The Society for Acute Medicine deals with the immediate and early treatment of adult patients with a variety of medical conditions who present to hospital as emergencies. The speciality receives the majority of patients admitted from A&E and helps maintain the flow of patients through emergency departments to avoid exit block, the term used when patients cannot be moved into a hospital bed.

READ MORE

Ben Goldacre has published the findings from his independent review to drive innovation and improve healthcare through safer use of health data.

Learning lessons from the pandemic, the review advises how to utilise health data in healthcare and sets out 185 recommendations to the government.

The pandemic has demonstrated the immense value of health data in driving research to improve patient outcomes and save lives. Large scale data analysis enabled better understanding of patient outcomes more rapidly than previously possible The speed and scale of this data analysis was possible through the interconnected nature of NHS systems, as well as specific legal measures to enable data access quickly.

READ MORE

The review makes a range of proposals, including: increasing data transparency by adopting Trusted Research Environments (TREs) as secure virtual spaces for verified researchers to access health data which will reduce the risk of data breaches; improving opportunities for data analysts within the NHS by modernising their job and career development, including improving salaries, training, structure, community and best practice; and encouraging open working for all NHS data analysis, for instance through the use of a shared library of data analysis tools, reducing duplication and increasing consistency of results.

READ MORE

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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News

HEALTH INEQUALITIES

Tackling health inequalities ‘core business’ for NHS

A survey of NHS trust leaders has shown that driving change to tackle unequal healthcare experiences and outcomes is high on the dayto-day business plan for the NHS. With trusts now committed to taking action on health inequalities as part of their ‘core

business’, NHS Providers is calling for an ‘honest debate’ about the wider picture and the need for cross-government action.

The organisation’s new report found high board-level commitment and strategic emphasis on tackling health inequalities and

a commitment to making action on health inequalities ‘core business’.

However, trust leaders described several barriers to progress with 65 per cent saying that wider pressures on the system and operational challenges hinder their ability to progress work on reducing health inequalities.

Nearly half of trust leaders expressed concerns about the lack of access to data about health inequalities within trusts (49 per cent) and across the health system (48 per cent).

READ MORE

BAME

Top jobs in NHS more diverse than ever before The NHS Workforce Race Equality Standard shows that black and minority ethnic (BME) representation in senior positions in the NHS are at their highest ever level.

The publication shows that the number of BME staff at very senior manager level has more than doubled between 2020 to 2021 – up from 153 to 298.

Additionally, the number of BME board members across all NHS trusts has increased by a quarter between 2020 and 2021, and are up by three quarters on 2018 when the data was first shared.

However, BME staff remain underrepresented in senior positions – particularly in board executive roles – which is why the Long Term Plan has called on every NHS trust to set its own target on senior BME representation by the end of 2022, to reflect their overall workforce.

NHS England has also highlighted that the NHS workforce is more diverse than at

any point in NHS history with more than 300,000 staff from a BME background – the equivalent of 22.4 per cent of all NHS staff.

The survey also shows that 29 per cent of BME staff experienced bullying, harassment

of abuse from patients last year, three per cent higher than white staff.

READ MORE

CANCER

More than a third of cancer patients diagnosed in A&E

A new study has revealed that more patients are diagnosed with cancer in A&E in Britain than in other comparable high-income countries.

More than a third of patients in England, Scotland and Wales only find out they have the disease once they are in hospital. Data suggests that those who end up in A&E, sometimes after multiple trips to their GP, are less likely to survive the disease, particularly if they have stomach, bowel, liver, pancreatic, lung or ovarian cancer.

The findings are the result of research undertaken by the International Cancer Benchmarking Partnership and Cancer Research UK, who together examined cancer data and linked hospital admissions across 14 regions in six countries: Australia, Canada, Denmark, New Zealand, Norway and the UK.

The data was collected between 2012 and 2017, but CRUK said it feared the outlook is now even worse after the Covid-19 pandemic.

The study, which looked at eight major cancers, found that more than a third of patients in England (37 per cent), Wales (37 per cent) and Scotland (39 per cent) were diagnosed after being rushed to hospital. The three nations ranked worse than all other regions and countries in the study except New Zealand, where the rate was 43 per cent.

READ MORE

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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D A V F E

News

MEDICAL EDUCATION

Plans announced for new medical school in Carlisle

The University of Cumbria and Imperial College London are working together to launch a new graduate entry medical school in Carlisle.

Aiming to enrol its first students in autumn 2025, the new school will train new doctors for Cumbria and North West England to transform healthcare in local communities.

The partnership is the result of a shared vision to educate more medical professionals

to serve their local communities, in regions with the greatest need. The school will be situated in an area of England where the recruitment and retention of medical staff remains a significant challenge.

The new school aims to drive innovation in medical education, transforming the way medicine is taught and delivered. The development of a course specifically designed to meet the needs of the region will support

medical education with a true community focus. Students will receive the best possible preparation for medical practice in the future NHS through inter-professional, communitybased learning that harnesses local resources and the use of digital technologies.

The school’s medical students will gain clinical experience through partnerships with local NHS providers across the region. A sustainable supply of medical professionals will benefit the local health and social care economy following the school’s establishment. It will educate and train generalist doctors who are grounded in the scientific method to deliver healthcare in community-based, rural, and disadvantaged settings where health and social inequalities are well documented.

READ MORE

DIGITAL

MENTAL HEALTH

Newcastle Hospitals achieves prestigious global standard

CBT helping overcome mental health problems

Newcastle Hospitals has achieved an international standard for its use of electronic patient record technology to drive transformational change in all aspects of inpatient care.

The trust becomes one of only eight NHS organisations to have achieved HIMSS Stage 6 across all its sites, having been measured against the international standard for Electronic Medical Record Adoption Model (EMRAM) by the international Healthcare Information and Management Systems Society (HIMSS). The model is made up of seven levels (0 progressing to 7) and each must be implemented and in use to progress.

Assessors told the trust that it had ‘clearly demonstrated its commitment to improving patient safety and the overall quality of clinical care through the effective use and deployment of Electronic Medical Record technology’.

Newcastle Hospitals has also been officially accredited as a Global Digital Exemplar for fulfilling its commitments as part of the Global Digital Exemplar (GDE) programme with NHS England. Exemplars share their learning and experiences through the creation of blueprints to enable other trusts to follow in their footsteps as quickly and effectively as possible.

READ MORE

New data analysed by the Royal College of Psychiatrists shows a record number of annual appointments for those accessing cognitive behavioural therapy (CBT) across England.

Statistics show that there were more CBT appointments taken than any previous year on record, as findings showed 1,961,096 appointments registered overall for the calendar year 2021. The therapy has been shown to help with many different mental health conditions including: depression; anxiety, panic and phobias; eating disorders; obsessive compulsive disorder; post-traumatic stress disorder; bipolar disorder; and psychosis.

Unlike some other talking therapies, CBT focuses on current challenges rather than on past experiences. The treatment is aimed at improving someone’s state of mind by teaching them to spot the links between thoughts, actions and feelings.

Those receiving CBT treatment during December 2021 had an average of 6.8 sessions. A course of CBT usually lasts for between six weeks and six months, with weekly or fortnightly sessions running between 30 and 60 minutes.

READ MORE

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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News

MENTAL HEALTH

NHS mental health services turning away children

GPs have revealed that children and young people who are anxious, depressed or are self-harming are being denied help from overwhelmed NHS child and adolescent mental health services.

The current state of CAMHS care is laid bare in a survey for the youth mental health charity stem4 of 1,001 GPs across the UK who have sought urgent help for under-18s who are struggling mentally.

CAMHS teams, already unable to cope with the rising need for treatment before the pandemic struck, have become even more overloaded because of the impact of the last two years on youth mental health.

Shared with the Guardian, the stem4 findings also show that in some areas it takes children and young people two years after being referred by their GP to start receiving help.

NHS PERFORMANCE

NHS WORKFORCE

Satisfaction with the NHS at lowest level in 25 years

GP numbers in England down every year since 2015

Public satisfaction with the NHS has fallen to its lowest level since 1997, according to analysis of the 2021 British Social Attitudes survey.

The King’s Fund and the Nuffield Trust found that public satisfaction with how the health service runs has fallen sharply to 36 per cent – an unprecedented drop of 17 percentage points from 2020 and the lowest level of satisfaction recorded since 1997. Record falls in satisfaction were also seen across all individual NHS services, including GP and hospital services.

Witnessed across all ages, income groups, sexes and supporters of different political parties, the survey indicates that more people (41 per cent) are now dissatisfied with the NHS than satisfied. Concerns over long waiting times (65 per cent), NHS staff shortages (46 per cent) and inadequate government funding (40 per cent) remained the top reasons people gave for being dissatisfied with the NHS in 2021.

However, support for the principles of the NHS is as strong as ever. The overwhelming majority of people expressed high levels of support for the founding principles of the NHS when asked if they should still apply in 2021: that it is free of charge when you need it (94 per cent), primarily funded through taxation (86 per cent) and available to everyone (84 per cent).

READ MORE

It has been revealed that the number of GPs in England has fallen every year since the government first pledged to increase the family doctor workforce by 5,000.

In September 2015 there were 29,364 fulltime-equivalent GPs in post, when the then Health Secretary Jeremy Hunt first promised to increase the total by 5,000 by 2020.

However, Health Minister Maria Caulfield disclosed in a parliamentary answer that by September 2020 the number of family doctors had dropped to 27,939, a fall of 1,425. She also confirmed that the number has fallen even further since then, to 27,920.

In 2019, Prime Minister Boris Johnson replaced Hunt’s pledge with a new commitment to increase the number of GPs in

The widespread inability to access CAMHS care is leading to young people’s already fragile mental health deteriorating even further and then selfharming, dropping out of school, feeling uncared for and having to seek help at A&E. Many GPs were scathing about CAMHS provision in their area. Some said problems accessing services means they are unsafe or even dangerous, because many under-18s get worse while they wait and can feel angry, overlooked and let down by being left without specialist help.

READ MORE

England by 6,000 by 2024. However, current Health Secretary Sajid Javid admitted at the end of last year that this pledge was unlikely to be met because so many family doctors were retiring early.

Organisations representing GPs say their heavy workloads, rising expectations among patients, excess bureaucracy, a lack of other health professionals working alongside them in surgeries, and concern that overwork may lead to them making mistakes are prompting experienced family doctors to quit in order to improve their mental health and work-life balance.

READ MORE

OBESITY

Size of waist should be less than half of height, says NICE New recommendations in an updated NICE draft guideline has encouraged people to keep their waist measurement to less than half their height to reduce the risk of potential health problems.

For the first time, this update encourages adults with a body mass index (BMI) below 35 kg/m² (obesity class 2) to measure their own waist-to-height ratio.

Using the waist-to-height ratio, in conjunction with BMI, can help to provide a practical estimate of central adiposity, which is the accumulation of fat around the abdomen, to help to assess and predict health risks, such as type 2 diabetes, hypertension or cardiovascular disease.

The 2019 Health Survey for England estimated the prevalence of obesity in adults in England to be 28 per cent, with overweight affecting a further 36 per cent.

Government estimates indicate that the current costs of obesity in the UK are £6.1 billion to the NHS and £27 billion to wider society.

The guideline highlights the importance of healthcare professionals asking permission before any discussions with people that are linked to being overweight, obese or central adiposity, and to ensure they do so in a sensitive and positive manner.

READ MORE

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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Advertisement Feature

Predictive Analytics: An emerging asset in the healthcare industry Predictive analytics is a fast-growing area of informatics which is being strategically applied across a significant number of sectors in the UK and globally Examples range from local authorities using predictive analytics to process data on commuter traffic to support the roll-out of the charging infrastructure for electric cars, to hospitals using insights to plan optimum patient care and efficient use of resources, most recently during the Covid-19 pandemic.

In healthcare, predictive analytics can process and evaluate enormous amounts of historic and real-time information to create valuable forecasts, predictions and recommendations on anything from individual patient care to wider public health trends.

Elland-based The Health Informatics Service (THIS), which is hosted by the Calderdale and Huddersfield NHS Foundation Trust (CHFT), has developed and delivered predictive analytics models to improve care and services at the trust’s two hospitals - Calderdale Royal Hospital and Huddersfield Royal Infirmary and its community health services.

It can assess tens of thousands of data points ranging from a patient’s condition on arrival at hospital, including whether they arrived in an ambulance, car or by foot, to their individual medical records and broader socio-economic or demographic information, such as their home postcode and ethnicity.

With this data, predictive analytics can be used to identify the best course of treatment for that patient. What’s more, it also helps to predict patient outcomes such as short-term risks, like heart failure; and the likelihood of any longer-term obstacles, such as a patient being re-admitted to hospital, or even missing a future medical appointment. These are insights which provide the opportunity for healthcare organisations to be more proactive and more effective overall.

Pressures, trends and developments In 2020-2021, CHFT cared for more than 80,500 men, women and children as inpatients, spending at least one night in hospital, or as day cases. There were also 348,000 outpatient attendances; 125,000 A&E attendances and 4,500 babies delivered.

There were some 273,500 adult services contacts by its community teams as well as 54,500 contacts with its therapy services.

Predictive analytics has helped hospital teams estimate bed occupancies and staffing requirements from different departments through the turbulent peaks and troughs of the pandemic. It contributed significantly to decisions needed on, for

example, when to transfer surgeons out of operating theatres or endoscopy into ICU services for patients with Covid-19.

As Covid-19 cases began to decline, predictive analytics was used to plan for deescalation across the hospitals, which included the return of surgeons to their usual operating theatre roles for elective surgeries; important data given the backlog in elective care.

Julian Bates is THIS’s Director of Information.

He says: “Predictive analytics is developing all the time. Some work we’ve done recently analysed patients coming into A&E. Because of all the data we now have, and based on half a dozen criteria, we can predict with 90 per cent accuracy whether a patient will be admitted to hospital, or sent home.

“We’ve also done another piece of work looking at the mortality rates of patients admitted to hospital, and even if they are then sent home. Based on what information has been captured about their stay in care, we can predict mortality rates to quite an accurate level.

“We are speaking to clinicians regularly to get more ideas of how predictive analytics can help them.”

Hardware, software and bespoke solutions Having reliable, secure and intelligent hardware and software is a crucial requirement to enable healthcare organisations to take full advantage of predictive analytics.

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By partnering with THIS, predictive analytics can be easily co-ordinated to help reduce operational costs, improve patient outcomes, and increase the effectiveness of an organisation’s resourcing. L FURTHER INFORMATION Contact us to find out how we can help you: https://www.this.nhs.uk/contact-us

14

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

Cyber security

How can the NHS prepare for a possible WannaCry 2?

Richard Staynings discusses the challenges of protecting our NHS and healthcare system against the real world threat of cyber attacks, as the NHS continues to strive to digitally transform The Russian attack against Ukraine has begun, amplifying the real risk of a cyber attack upon Western public services. In addition, the government recently launched its first cyber strategy to increase protection for these very same services – critical services like our healthcare system, that patients rely upon 24/7. A cyber attack, penetrating our healthcare data, could mean critical patient data is held to ransom, ambulances are rerouted, medical IoT devices are compromised, and the hospital’s network of mobile devices are breached. Hackers are playing with life or death at the click of a button.

Elevated cyber threat landscape Vladimir Putin’s invasion of Ukraine has made headline news the world over. A few hours before Russian tanks began rolling into Ukraine, Microsoft raised the alarm warning of a never-before-seen piece of ‘wiper’ malware FoxBlade that appeared aimed at the country’s government ministries and financial institutions. ESET Research Labs, a Slovakia-based cyber security company, said it too had discovered another new ‘wiper’ while

also a major patient safety scare, as those in need of medical intervention were in many cases denied immediate treatment.

When the dust finally settled, an investigation determined that a large amount of the IT and IoT NHS systems were endof-life and needed to be replaced, while other systems had not been updated or patched with critical security updates in accordance with recommendations from Microsoft and other vendors. The government So, could another cyber attack like intervened, making new finances available WannaCry take down the NHS? for equipment replacement, while NHS The global WannaCry ransomware attack in trusts and NHS Digital put in place improved 2017 was devastating to the NHS and many practices around patching of IT systems and of its hospitals and clinics. The cyber attack security. But addressing the security caused critical healthcare IT and IoT systems vulnerabilities in highly regulated to be unavailable to caregivers IoT equipment like medical resulting in hospitals being devices was, and still is, unable to treat patients and Medical another matter. causing the diversion of Medical and other emergency ambulances, other he and a lt healthcare IoT (HIoT) the postponement h c are IoT (HIoT devices comprise of scheduled ) d evices comprise systems that are procedures, and the used to diagnose, inconveniencing of the are used systems that t o monitor, manage, E general-public. It was d ia g m Symantec’s threat intelligence team said the malware had affected Ukrainian government contractors in Latvia and Lithuania and a financial institution in Ukraine. ESET has called the malware which renders computers inoperable by disabling rebooting, HermeticWiper. As part of its offensive, Russia combined military and cyber weapons to engage in a multi-front hybrid war.

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Issue 22.2 | HEALTH BUSINESS MAGAZINE

15

I Bet You Never WannaCry Again In 2017, the WannaCry ransomware attack ripped across more than 250,000 devices in over 150 countries and impacted large organisations like the UK HNS. Ransomware can be defined as malicious software that can impact devices such as smartphones, laptops, desktops and many other devices. After entering a system, it can encrypt data that it interacts with and then produces a ransom notification to users, demanding a form of payment. A payment would typically result in a decryption key allowing the retrieval of data. Common trends show when deadlines are missed, the threat of enhanced payments or ev deletion of the data, are present. A piece of ransomware, known as WannaCry, impacted over 150 even countries and cost the UK an estimated £92M. It is thought that the total global cost of this event was as high as £6B. This type of ransomware is often distributed through an email system and can typically promote the opening of an attachment which then releases malware into a system. You may know this as Phishing. Unfortunately, once your device has been impacted, your data can become encrypted without your control, and you may then receive a notification associated with some form of a request to pay.

The NHS was brought to a halt on Friday 12th May 2017 for days followingWannaCry and this impacted GPs and hospitals in England and Scotland. Thousands of appointments were cancelled, emergency patients had to be relocated in some cases, and generally, chaos was created. Some staff ditched electronic forms of operation and began working with notepads and pens to uphold some form of patient care. WannaCry exposed a specific vulnerability with Windows, a very popular and maintained sys system. Most of the devices impacted within the NHS were running an unpatched operating system and it is thought that around 80 from the 236 trusts were impacted. A further 603 primary care units and other NHS units were also impacted. In this case, no NHS ransom was paid although disruption to services cost an estimated £92M. After desperate efforts, a computer security researcher accidentally figured out a way to halt the attack.

A piece of ransomware, known as WannaCry, impacted over 150 countries and cost the UK an estimated £92M. It is thought that the total global cost of this event was as high as £6B.

Ransomware remains the most popular choice of weapons by criminals and security experts continually promote the needs to secure NHS type organisations as they are targets because of the critical information held on patients which can cause disaster if unavailable. As a comparison, some experts report health data being around ten times more valuable to criminal hacker groups than banking details.

In the future, future NHS staff who lead on IT security have the support of increased NHS funding to secure systems and data from the UK Government in a bid to reduce risk. Utilising specialist cyber security experts from the IT security industry with this finance is critical to ensure a robust, future-proofed system is in place which can be relied on, and quick. The best in this specialist area has operated across multiple industry sectors problem solving highly complex organisational security issues to form positive strategies and successful operations.

Hire the best people in the cyber to get the best security for patients and staff members. sales@bramfitt-tech-labs.com +44 (0) 208 187 4234

Cyber security

 and treat patients. They are more than often connected directly to the patient on one side and to hospital networks on the other side. They include everything from infusion pumps used to administer drugs to patients, to large imaging systems used for diagnosis, to radiological cancer treatment systems used to shrink tumours. Many of these systems if compromised by cyber attack could result in significant damage to patients and those treating them. The risk impact therefore is high.

HIoT devices demand special security considerations and compensating security controls such as isolation and network segmentation. But before that can happen, security administrators need to accurately identify, profile, and risk assess each device connecting to the network so that segmentation doesn’t break the functionality of devices. The medical device profile is also used as a baseline such that abnormal behaviour can quickly be identified by SIEM tools and the security operations center (SOC) alerted.

As part of the government’s strategy of increasing the security of the health service, it recently implemented the Data Security and Protection Toolkit (DSPT), an assessment tool for the NHS to measure and understand its security standpoint against the National Data Guardian’s 10 data security standards.

Thankfully, Cylera customers can pull the asset-risk data needed for DSPT reporting easily from the Cylera reporting console.

Trusts are also required to respond to NHS Digital Cyber Alerts with details, quantity of affected devices, mitigation plans, etc. To facilitate this, Cylera recently announced the launch of its Cylera Cyber Alert Dashboard.

Customers can search by CA number and see immediately if they have any devices affected.

The dashboard also has a unique feature that provides suggested remediation measures,

Royal Bolton wanted a solution that could understand the behaviours and patterns on the network, perform analytics, and automatically solve issues where necessary.

In the event of WannaCry part 2, they didn’t want to be underprepared mitigation plans, and interim compensating security controls.

However, compliance is one thing, security is another. To be secure, administrators need good visibility into what and who is connected to hospital networks and what each of those systems and users is doing. That’s why Royal Bolton Hospital, Cylera, and Core to Cloud, joined forces to protect patients against another devastating cyber attack.

The Royal Bolton team was conscious that they didn’t have the time to be actively searching for breaches and attacks 24/7. They wanted a solution that could understand the behaviours and patterns on the network, perform analytics, and automatically solve issues where necessary. In the event of WannaCry part 2, they didn’t want to be underprepared. The Core to Cloud team combined Cylera with Vectra and Pentera, allowing the detection of threats in realtime and conduct automatic pen tests to uncover exploitable weaknesses on the network. The end solution resulted in zero impact to existing systems and processes during deployment or ongoing operation, thus removing concerns about disruptions to patient care.

Commenting on the Bolton NHS implementation, Mark Liddle, COO of Core to

Cloud, said: “Our dedicated healthcare team have a depth of knowledge from working within this sector for many years and we are delighted to be working with Richard Staynings and all his Cylera colleagues. The senior team at Core to Cloud work closely with some of the central teams in around 45 of the UK’s largest NHS trusts to help ensure our technology solutions are aligned to the needs of the health sector.”

Thanks to the implemented real-time threat detection software (a combination of Vectra, Pentera, and Cylera), the solution now quarantines hostile threats with industryleading accuracy rates. L

Richard Staynings is an internationally renowned expert in the field of healthcare cyber security, is an Adjunct Professor of cyber security and health informatics at University College Denver, and serves as Chief Security Strategist for Cylera, a pioneer in the space of medical device security. Richard has served on various government committees of Inquiry into some of the largest healthcare breaches and is a regular presenter at healthcare and security conferences across the world.

FURTHER INFORMATION www.coretocloud.co.uk

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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Technology

How can Integrated Care Systems improve digital inclusion?

ICS are a new way of organising health and social care in England that will gain statutory footing later this year. Sarah Boyd explores how her ICS is using digital to improve patient inclusion and help reduce health inequalities Health inequality is a growing problem but is still too often discussed separately from the core business of the NHS. Patients are treated through siloed care pathways, with conversations about why some populations have poorer health outcomes often treated as an aside.

The pandemic brought this into greater focus, especially around digital inclusion.

Technology rolled out across the NHS in response to Covid-19 often widened the gap between those who could access online services and those who couldn’t.

The benefits of ICS So, what can we do? I’ve always been passionate about digital inclusion and equitable access and outcomes. When I came into post two years ago, I was excited by the freshness of

working for an ICS and the opportunities it created.

We’re a new type of organisation, working as a system across Norfolk and Waveney. We work across the public sector, with health and social care, councils and with voluntary organisations. What this means is we can tackle health inequality and exclusion in a person-centred way.

The ICS gives us the opportunity to work across organisational boundaries, to test our assumptions about exclusion, and to leverage the work that happens at the level of individual places.

Fixing existing digital inequalities Our At every stage, we’re plan is to ensuring that our gain the digital projects fix digital inequalities. benefits wider We’re planning on inclusion of digital implementing a pan b y people – engaging public sector hub-and-

health se not only in rv more broices – but adly society in

spoke model that provides personalised support to our excluded groups. Our plan is to gain the wider benefits of digital inclusion by engaging people – not only in health services – but more broadly in society.

If you’re an elderly person, for example, and your GP detects you’re socially isolated, they can refer you to a central digital inclusion service. From there, you might get passed to a library or voluntary service who can provide connectivity or a device with 5G, plus the ongoing support to use it. This allows you to order a repeat prescription, but also to food shop online or video call your family, with positive benefits for wider well-being and health.

Asking people to go to an appointment at an unfamiliar location can create unnecessary barriers. Our ambition, going forwards, is to work towards using services that people already access to provide a trusted contact point. If you’re already known to a church group or domestic violence shelter, for example, you might receive support there. E

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Technology

Digital health training for all NHS frontline staff launched The UK’s first Digital Health Academy, aiming to help build a digital-ready frontline workforce, is now open to all health and care staff across the UK.

The ICS gives us the opportunity to work across organisational boundaries, to test our assumptions about exclusion, and to leverage the work that happens at the level of individual places  Through our community partnerships, we can build a network of digital tools and skill provision. If a partially-sighted person, or family member, needs a speech-to-text reader, then we’d like to be in a position to point them to our trusted toolkit. Once a person has access to our network, they can download tools ahead of health need.

Building an inclusive service We need to build a future where every service is digitally inclusive. As the Good Things Foundation Widening Digital Participation report found in March 2020, digital inclusion pays for itself in better mental and physical health, and stronger participation in the economy. For every pound spent, £6.20 is made back.

With this in mind, I’ve been using my personal learning network to identify new ways to increase inclusivity. I’ve followed companies, such as ThriveByDesign and CardMedic, an award-winning digital tool that provides instant access to communications options to improve engagement with healthcare professionals.

CardMedic is designed to help patients with a language barrier, visual, hearing or cognitive impairment, or to communicate through PPE. It’s unique in its space and caught my attention immediately.

One of the issues with digital inclusivity tools, is that they’re often seen as only affecting excluded communities, but digital

inclusivity applies to everyone. People often struggle to retain emotionally-sensitive medical information, such as a cancer diagnosis. Tools like CardMedic allow any patient to review the basics of a hospital procedure or consultation – helping them to feel more secure in their care.

Applying innovation We’ve been lucky to have built a great team and strong relationships at our ICS. The public sectors and voluntary organisations in our region have pulled together to implement a digital transformation agenda.

As we move forwards with the ICS on a statutory footing, we hope to build on that by hiring good people and implementing innovative technology.

But there’s only so much we can do as a system organisation and, on my wish list for the NHS nationally is a better system for picking up on digital innovation. It shouldn’t be up to us to find products, such as CardMedic, via Twitter. Digital inclusivity should be available to all. L

Sarah Boyd is Head of Digital Experience and Transformation at Norfolk & Waveney Health and Social Care Partnership.

FURTHER INFORMATION

According to the Organisation for the Review of Care and Health Apps (ORCHA), whilst 65 per cent of the public are open to trying digital health technologies, only a fraction of tools are recommended by health or care professionals. In total, amongst those using digital health, only a small proportion of recommendations came from healthcare professionals, with 17 per cent of recommendations coming from GPs, eight per cent from hospital doctors, and two per cent from nurses.

There is still no mandatory digital health training for health and care professionals, and the courses that frontline workers can attend are often scarcely available.

To combat this, ORCHA developed the Digital Health Academy, the foundation level modules of which will be freely available at orcha-academy.com and on the Health Education England NHS Learning Hub (learninghub.nhs. uk). The academy’s online training modules are designed specifically for frontline health and care professionals who want to use and recommend digital health tools but have been struggling to access the knowledge to do so safely.

The CPD-accredited Digital Health Academy programme includes two foundation modules which explain the function of health apps, the current digital health landscape, the barriers to using and adopting digital health and the importance of prescribing good quality digital health products.

Dr Neil Ralph, head of Health Education England Technology Enhanced Learning, said: “Covid19 accelerated the rapid adoption of digital health across health and care services and the need to embed digital health in the long term. We are delighted that ORCHA has contributed its Digital Health Academy foundation content to the Learning Hub and look forward to hosting new content in the future, further supporting health and care professionals in their roles.”

www.norfolkandwaveneypartnership.org.uk

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The Healthcare Show

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The Healthcare Show: striving to transform care The Healthcare Show in 2022 provides that long-awaited opportunity for the NHS to come together to reflect, respond and reorganise, in the face of the monumental challenge it has endured over the past two years Back in 2020 when the pandemic was raging, a popular school of thought emerged: virtual learning was the future, and in-person events belonged to the past. A hasty judgement?

Well, let’s see.

Fast forward to 2022. “The rumours of my death are greatly exaggerated.” A famous Mark Twain quote (well misquote, but that’s another story) and definitely applicable to face-to-face events.

Why is this the case?

Nothing can quite beat human interaction. We all learn and process information differently.

Screen time can affect our concentration and limit our attention spans. Zoom and Microsoft Teams are great tools and brilliant for the environment and allow us to be more efficient with our time. They’re certainly a key part of the mix but not a proper replacement for valuable in-person learning.

Also, uniquely for healthcare professionals, the last two years have been traumatic, which makes the opportunity to reconnect with people and properly network in-person all the more important. That chance to meet fellow professionals again and reconnect will prove a very cathartic experience.

The Healthcare Show returns to London Excel on 18-19 May 2022 and as you’d imagine, our central theme is around recovery from Covid-19 and the restoration of services. We’re examining what has been learned and what needs to be done

If you want to get a better handle on what’s differently as a result. Before the pandemic, happening with Integrated Care Systems NHS England and NHS Improvement had (ICSs) and new legislation and funding for a brand new Long Term Plan. What has the NHS we also have that covered. happened to that and how can it get back It would be an understatement to say on track? there’s a lot to talk about. The pandemic has Unfortunately, the reservoirs of good will rocked the NHS and tested it to its limits. toward the NHS appear to be running dry in However, by coming to the Excel comparison to the early stages of the on 18-19 May, we’ll hopefully pandemic when people were provide optimism alongside showing their appreciation on the fantastic and free CPD the doorstep.

‘The accredited content. We’ll In 2021, according to breadth be getting the answers to the British Attitudes o f content, all your crucial questions Survey, satisfaction r of topics ange with the brilliant with the NHS has former BBC breakfast suffered its largest diversity and o broadcaster Louise ever fall. The records f h ig h quality s Minchin as chair. go back to the peakers is Across six theatres, 1950s. People are unparall eled’ which encompass our waiting too long for GP Keynote Theatre, Integrated appointments, too long for Care, Clinical Priorities, Patient hospital appointments and a Safety and Infection Prevention, Care common complaint is there are Quality and Efficiency, and Transformation not enough staff. The whole situation we’re hosting over 100 different sessions is exacerbated by major problems in social with more than 200 speakers. care where satisfaction is even lower, at just 15 per cent approval.

The Keynote Theatre With this gloomy backdrop, it is really The Healthcare Show’s main stage, the important to better understand the direction Keynote Theatre, plays host to a lively, of travel post-pandemic for healthcare policy provocative, and inspirational set of talks, and we’re pleased to feature a whole range panel discussions and presentations from the of critical updates from ALBs (arm’s length leading lights from health, social care and bodies) and equally vital critiques from beyond. Sessions will focus on the bigger E healthcare commentators.

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Combating Healthcare-associated Infections (HAI) Healthcare-associated infections are often linked to environmental reservoirs like colonized sink traps.

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 picture for healthcare as the country recovers from the Covid-19 pandemic and the NHS seeks to get its policy agenda back on track.

Sessions will focus on major policy updates around the NHS Long Term Plan and the NHS People Plan as well as illuminating fireside chats with the most prominent leaders from the NHS and government.

Inspiring and heart-breaking stories from the frontline will help us reflect and learn from the challenges faced by our workforce during Covid-19 and we’ll find out more about the UK’s response and next steps in relation to the pandemic. Fascinating case studies from international countries will relay their experiences and learning from coronavirus so we can be better prepared and ready for future events.

The pandemic has also shone a light on how more needs to be done in terms of prevention and a better joined-up approach between health and social care. After many false dawns a panel of experts will debate what integration is possible and what needs to happen. We’ll also cover further detail on the successor agency to Public Health England – the National Institute for Health Protection.

The breadth of content, range of topics and diversity of high-quality speakers is unparalleled. At the heart of The Healthcare Show is a packed, two-day agenda focused on all aspects of integrated care with leading experts from the world of integrated care providing tangible, real world, successful examples of population health management that could be adopted in your own organisation.

Despite the difficulties faced during the pandemic all Integrated Care Systems (ICSs) are expected to come online by April and Primary Care Networks (PCNs) are slowly taking shape and developing. You’ll find out more on all aspects of this from a policy perspective, including developments regarding funding and legislation.

Attendees will learn from trailblazing and aspirant ICSs what effective integration really looks like, how it is being achieved and what tangible benefits are being realised as a result.

Brand new for 2022, the Transformation Theatre will take audiences on a journey of discovery to find out the most innovative examples of transformation taking place in hospitals and in primary care.

Sessions will focus on truly ground-breaking pieces of work related to organisational development, implementation of new technologies, changes to existing care pathways and major capital projects related to the NHS estate and infrastructure.

The reason why The Healthcare Show is held in such high regard is the fact it is completely independent. We have no editorial axe to grind, no political agendas to promote or government campaigns to push.

That is what sets us apart. The content is created for and by healthcare practitioners. Our focus is on practical solutions, relevant

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case studies and essential updates. We bring people together, so they have the opportunity to collaborate. People can share inspiration and insight. This year, all those qualities are even more important and even more necessary. L FURTHER INFORMATION www.healthpluscare.co.uk

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Radar Healthcare can be used for everything from board assurance frameworks, preparing

for CQC inspections, clinical audits and incident management; to improving communication, managing complaints, or running patient satisfaction and staff surveys. Dashboard and reports offer real-time oversight of an entire system or drilling down to a place, neighbourhood, or an individual organisation. This works alongside an unrivalled analytics engine which enables unparalleled insight and informed decision making.

Examples of excellence, best practice and lessons learned can also be found within this data and shared throughout the organisation; helping you take a more proactive approach to delivering patient care. L Visit Radar Healthcare at Health Plus Care, stand K55, to see the system.

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Facilities management

Reimagining the workplace: the opportunity and the change agents The question of how organisations get the best from their people has never been more important than it is today, writes Linda Hausmanis, CEO of the Institute of Workplace and Facilities Management The pandemic has forced on us the dubbed ‘the great resignation;’ and many opportunity to reimagine the workplace. As are seeking permanent flexible working we move into new modes of working, we are arrangements having experienced benefits seeing organisations adapt physical space, from home-working, albeit enforced by working culture and technology. In many lockdowns. organisations the workplace and facilities teams are leading this change.

‘How hybrid will the future be?’

The question of how organisations get the is one way to frame the future best from their people has never been more of work question important than it is today.

While the hybrid set up has emerged as With Covid-19 restrictions lifted the dominant workplace model, as the government nudges underpinning it is a growing us towards treating the recognition of a shifting focus A s virus as something we from where people work the spac live with and work to how people work. As e , technolo around and offices the space, technology g buzz again, we may and culture of our culture o y and f our workpla be approaching a workplaces evolves, the ces evolv crunch point as rules of engagement e rules of e s, the employers grapple and the borders of and the ngagement with the question this new frontier will borders of what the future remain fluid. o f th new fron of work will look like, For instance, we know tier will is and what will be best that home working is remain f luid for organisations and not a panacea. Indeed, their people. many people have struggled Employers are grappling with with Covid-imposed working a lot right now. Even before the arrangements. Last December, in crisis in Ukraine a squeeze on supply chains IWFM’s survey of UK office workers about and a serious skills shortage has made for a their experiences of remote working, one challenging operating environment. A post in five said their overall well-being had pandemic exodus by many workers has been worsened in the prior year due to changed

working practices. The figures for women (26 per cent), part-timers (27 per cent) and over 55s (31 per cent) underlined the problem.

There will be other factors at play, not least the pandemic itself, but whatever the causes, it is clear that individuals have different circumstances and preferences which require due consideration if we are to emerge from the pandemic equipped to prosper.

The same research found that up to 83 per cent of full-time office-based workers expected to spend all or most of their time in the office in future – often in a mandated schedule, suggesting that for many, the notion of ‘work’ happening only in a dedicated workspace persists; the idea of work as an activity, not a destination seemingly unlikely to be adopted by some organisations.

Yet the swiftness and flexibility shown by thousands of organisations in transitioning to full remote working when the first lockdown commenced, and continuing in hybrid setups beyond the crisis, remains a powerful illustration of the workplace discipline’s triad of people, technology and workspace converging to enable collaboration and productivity from multiple locations.

Workplace principles in action So, how hybrid will the future workplace be?

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The triad of people, technology and workspace A key finding was that the technologyenabled workplace actually brings people together, facilitating greater levels of collaboration and innovation, underlining the very purpose of the workplace as a productivity enabler.

The pandemic was a good backdrop to the speed of technological development. It saw tools like Microsoft Teams and Zoom emerge as crucial enablers to engagement, teamwork and business continuity. We will continue to see technology’s impact in the shift from managing buildings better to enhanced experiences in the longer term insights coming from data-driven design and experiential analysis.

The response to Covid has brought us closer to workplace than we have yet been. It’s been said that it changed the office more in one year than in the previous hundred. It has forced on us the opportunity to reimagine the workplace. As we move into new modes of working, and we see organisations adapt physical spaces, working culture and technologies, we see that in many of them the workplace and facilities teams are the agents of this change.

Commenting in IWFM’s magazine Facilitate recently, Martin Read observed that in contrast to previous opportunities

Up to 83 per cent of full-time office-based workers expected to spend all or most of their time in the office in future – often in a mandated schedule, suggesting that for many, the notion of ‘work’ happening only in a dedicated workspace persists for the workplace profession to see through transformational change, the C suite has been attuned to hybrid working from the start as business owners have seen workers adapt easily to sudden relocation causing them to reconsider long held perceptions of where office work is done.

It is still early days. The future of work and the hybrid/non hybrid debate will continue: how will more distributed working patterns impact in the longer term? Where does the workspace and responsibility for it begin and end? How will organisations manage their property portfolios? In our 2021 Outlook Report, 84 per cent of client side respondents had changed their flexible working strategies and nearly 60 per cent said they would reduce the amount of space they occupy.

What will happen to our town centres? How will these changes influence our carbon and climate goals? Much to think about.

What we do know is that each organisation is unique and will require a bespoke approach to optimise productivity, underpinned by meaningful engagement. Facilities professionals can be front and centre of that, assisted by technology.

What we expect to see is more skilled facilities professionals continuing to make a difference by using the experience of the pandemic to devise integrated property or workplace user strategies

Facilities management

 but hybrid is neither a new concept nor is it a template solution. It is an example of workplace principles in action. What do I mean by that?

In December 2016, a report called The Workplace Advantage was published by the Stoddart Review. Five years on, this landmark work remains a beacon for demonstrating the contribution that the workplace can make to organisational success.

that can blend a number of factors. These include the future demands of a (probable) smaller office footprint, the impacts of businesses rationalising and refocusing service requirements and the changing expectations of the physical workspace as somewhere to bring people together differently than before; underpinned, of course, by clear purpose.

And organisations must use these agents of change to develop and review their workplace strategies with learning and meaningful engagement.

Some organisations are leading the charge in this area. Some are even actively aiming to attract talent with their forward-looking culture and ways of working.

This is a moment for workplace. Adapting workspaces, culture and technology to empower people to work wherever they are most productive should be the goal, because fundamentally workplace is driven by how people work, not where people work. That is workplace in action. L

IWFM’s Conference Agents of Change: Workplace and facilities management’s role in an ethical, sustainable future is on 8 June.

FURTHER INFORMATION www.iwfm.org.uk

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Design & build

Vanguard Healthcare Solutions has supported the NHS in addressing the need for additional clinical infrastructure during periods of rising capacity

Providing rapid and agile healthcare solutions Richard Hipkiss, Development Director of the Modular and Portable Building Association (MPBA), discusses how volumetric manufactured buildings are meeting the needs of the health sector Covid-19 has had a dramatic effect on the way we live, work and socialise but one of the unforeseen consequences is the wider adoption of modern methods of construction.

It’s no secret that NHS trusts across the UK are struggling to find enough space. In a market where material and workforce shortages exist and building standards are extremely high – this can prove particularly challenging for NHS estate managers.

The health sector demands buildings that are flexible and adaptable in use, and which can be constructed rapidly to meet tight programmes. Sustainability, comfort and infection control are all crucial, but budgets are tight.

Volumetric modular manufactured buildings are now becoming a greater part of the solution. Large-scale modular building projects offer the possibility of freeing up space within the main hospital to help reduce disruption, cut waiting times and improve the patient experience for urgent care services.

I’m pleased to report that MPBA members operating in both the portable and volumetric modular sectors have been making huge efforts not only during the height of the pandemic but are now vital in bringing much needed facilities rapidly on stream to alleviate pressure and help improve waiting times.

Premier Modular for example has recently Modern methods of construction installed the final modules on site for a new From increasing the space in emergency departments and acute care to improving 3,450sqm outpatient services building at facilities and bringing them up to date – the King’s College Hospital in London, being health sector is benefiting greatly from delivered with construction partner Claritas. modern methods of construction.

This involved careful logistics planning to Throughout the past year another MPBA maintain access through the hospital campus member Vanguard Healthcare Solutions has at all times, and to co-ordinate cranage to supported the NHS in addressing the need avoid any disruption to the helipad and air for additional clinical infrastructure during ambulance helicopters. periods of rising capacity demands The King’s College Hospital site in the wake of the pandemic. is highly constrained with Vanguard Health Solutions roads to three sides and has had considerable is immediately adjacent A marke success in implementing to another hospital where m t a number of surgical building, but this is a t e rial and wor hubs across the where volumetric k f orce shortage country to help modular technology tackle elective care really comes to the building s exist and s t a waiting times to fore. When complete n d a extreme ultimately reduce later this year, the ly high c rds are an prove particula the backlog. These building will provide rly challe bespoke modular 48 consulting rooms n f o r N solutions not only and eight procedure HS estat ging increase capacity rooms for a range manage e rs but maximise infection of outpatient services, control. including dermatology, A notable example of this is rheumatology, neurosciences, the modular surgical hub installed at as well as other aspects of surgery Queen Mary’s Hospital in Roehampton. E and therapy.

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 In this instance, the St George’s University Hospital NHS Foundation Trust was performing fewer than 10,608 procedures between March 2020 and May 2021 as a result of the shutdown of elective care during the initial stages of the pandemic.

To address the growing surgical backlog and increase capacity, the Trust commissioned Vanguard to design and install a bespoke modular solution. The Vanguard volumetric modular surgical hub was installed in just five months from initial design and consisted of four dedicated operating rooms, a recovery ward, consulting rooms, staff welfare facilities and utility areas. The complex was designed with patient flow and infection control in mind, with the Head of Surgery and Theatre Managers consulted throughout the design process to ensure maximum efficiency and improve the patient journey.

The four theatre day surgery complex is capable of completing in excess of 120 weekly procedures, helping to tackle the elective care backlog in South West London and highlighting the importance of the implementation of further surgical hubs across the country.

Revolutionising the construction industry The use of modern methods of construction is pivotal in accelerating the build process with theatre complexes such as that in Roehampton, being installed in a matter of months. It is now established that volumetric modular approaches are a game changer in reducing build times, increasing quality, productivity and safety. But what is not so widely understood are the sustainability benefits – an important factor following the NHS’s pledge for carbon neutrality by 2040.

Modular approaches are revolutionising the construction industry. Whilst traditional build processes are laced with pitfalls, hidden costs and are highly disruptive – volumetric modular buildings are easy to plan, budget, and are quick to install. Modular technology brings a host of benefits to health businesses by contributing to safer and more costefficient environments but often the sustainability gains are overlooked.

According to the World Green Building Council, construction and buildings in use are responsible for 39 per cent of all carbon emissions in the world. This is broken down into two elements with 11 per cent being linked to the manufacture of materials and construction processes known as embodied carbon emissions and 28 per cent associated with operational emissions caused by heating, cooling and lighting systems when a building is in use.

The challenge is therefore two-fold. Whilst there has been a drive to reduce operational emissions through the implementation of government legislation such as the changes to Part L of Building Regulations to improve the building fabric and the wider use of innovative technologies – little has been done to address the carbon inefficiencies in the construction process.

Compared to traditionally built projects it is easier to control energy use in factory settings than in an open construction site. On average 67 per cent less energy is required to produce a volumetric manufactured building and up to 50 per cent less time is spent onsite, resulting in up to 90 per cent fewer vehicle movements which is less disruptive for the healthcare facility whilst also reducing carbon emissions.

Volumetric modular buildings are less susceptible to poorly specified manufacturers’ products as time can be taken upfront to validate the correct specification of materials.

Designs are digitally constructed and virtually tested before they move onto the manufacturing phase. This process eliminates waste and achieves highly accurate and airtight building envelopes designed and manufactured to higher sustainability requirements. This allows NHS estate managers to have confidence in the quality and performance that they can expect from their new building.

Not only is the actual construction of the building ‘greener’ but volumetric manufactured buildings are also more energy efficient – reducing carbon emissions and ongoing operational energy costs for the lifetime of the building.

With the NHS facing an unprecedented backlog in patient care and building maintenance, the British Journal of Healthcare Management recently published a series of papers exploring how modular facilities help healthcare services overcome these challenges. Setting out a case for the use of modular infrastructure solutions to help healthcare services to increase their capacity to overcome them stating ‘innovative solutions to increase capacity in NHS hospitals have never been more sorely needed.’

Modern volumetric modular methods of construction are providing rapid, agile solutions to the healthcare crisis and the reusability of the facilities enables NHS trusts to move towards a more sustainable infrastructure, contributing to the net zero goal by 2040.

Design & build

Large-scale modular building projects offer the possibility of freeing up space within the main hospital to help reduce disruption, cut waiting times and improve the patient experience for urgent care services

The MPBA The Modular and Portable Building Association leads best practice protocols, the development of standards and is represented on many government committees for the benefit of members. The association collaborates with specialist technical advisors to enhance innovation in the design and manufacture of volumetric modular buildings.

These can be designed and manufactured from timber or steel in any size and shape to meet individual client needs while ensuring full compliance with Building Regulations. L FURTHER INFORMATION www.mpba.biz

The final modules are lifted into position by Premier Modular for the 3,450sqm scheme – a major milestone for the project

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Estates management

Managing the NHS estate to drive value for communities Mark Smith, Chief Financial Officer at NHS Property Services, explains how the NHS can maximise efficiencies, meet new cost savings targets and drive value for patients and communities Last month, the government detailed In this article, I will reflect on how ambitious targets for savings and NHSPS has delivered these savings and efficiencies across the NHS in the Spring will continue to support ambitious NHS Budget. NHS annual saving targets are to be saving targets in the coming years whilst doubled from 1.1 per cent to 2.2 per cent, navigating these ongoing challenges. delivering an estimated saving of £4.75 billion over the next three years.

Creating efficiencies As owners of approximately 12 per cent across the NHS estate of the NHS estate, and with one of the At NHSPS, we leverage our property expertise largest portfolios across the UK (including to help the NHS get the most of its estate, around 3,000 properties and c. 7,000 in line with the NHS Long Term Plan. We are tenants), we at NHSPS strive to create safe, continually reviewing our space to make sure efficient, sustainable, and modern that it is being used to its advantage. healthcare environments, After all, if our sites sit empty and so every patient can get unused then no one can benefit the care they need in from them.

At NHSP the best place for One of our solutions to we lever S, them. We are also this is NHS Open Space, property age our favourably placed where NHS bodies and expertise to be able to wider health and wellh e lp the NH to deliver efficiencies being services can rent most of S get the for the NHS vacant spaces. Not only through optimal does this make better in line w its estate, ith management of use of the estate and Long Ter the NHS our estates and m Plan facilities services.

For 2020/21, we had a savings target of £32.9 million. As Chief Finance Officer at NHSPS, I am proud to say that at the year end, we exceeded this target and achieved savings totalling over £50 million, which has allowed us to mitigate inflation. Maximising efficiencies across the NHS estate, whilst maintaining safe and compliant facilities and delivering quality, sustainable services, has never been more important in light of the ongoing challenges faced by the NHS from the Covid-19 pandemic and pressures to meet the growing waiting list in elective care.

mean communities can access more services from one local hub, but it also helps generate money which can be reinvested directly back into the NHS and to improve services for our customers. This year, we will be continuing to grow the Open Space offering, currently at over 1,100 rooms over 190 sites nationwide, to be able to benefit more people across the country. Creating efficiencies across the NHS estate can therefore be done without the need for selling or completely rebuilding a site, but through repurposing and redeveloping space.

In some cases, however, reducing the number of properties that we have sitting empty is important to raise valuable funds that can be invested back into the NHS. Since 2013, NHSPS has raised £381 million for the NHS through disposal of surplus properties. As the NHS faces a backlog of more than two million operations, the money raised through the disposal of surplus properties and saved on running costs and backlog maintenance would total E

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Estates management

 £226.6 million and could fund the building of 68 new GP surgeries and hiring of almost 4,000 doctors for a year.

For example, our Slyne Road site 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. The use of a previously vacant facility in Moor Lane Mills has allowed for better use of NHS space and budget, and has generated additional revenue for reinvestment. It has enabled a saving of £45,000 in running costs per annum on Slyne Road, negated the need to spend upwards of £1 million on backlog maintenance, and the selling of the site generated much needed funds to reinvest in the NHS. Repurposing Moor Lane Mills also eliminated the costs associated with the vacant space, which had a liability of £159,000 per annum.

Towards a sustainable future The efforts we have made to maximise efficiencies are crucial not only to save money, but also our planet. At NHSPS, we have an important role in helping the UK’s health services achieve net zero by 2045.

During 2020/2021, Covid-19 measures such as flexible working policies and a reduction of business activities in offices and healthcare facilities decreased total energy use in respect to 2019/2020 by 16m kWh, resulting in £1.5 million savings and a reduction of our carbon footprint of almost 3,500 tonnes.

At NHSPS we are working to ensure these savings continue as we recover from the Covid-19 pandemic through our energy and environment strategy which includes around 200 actions, such as improving transport and water efficiencies, increasing recycling, reducing waste and single-use plastic, and, importantly, reducing carbon emission.

Reinvestment to benefit patients, customers and communities Ultimately, we make these efficiencies to benefit patients, customers and communities.

Our customers include GPs, Foundation and NHS Trusts as well as local authorities, pharmacies, dentists, and others which can be benefit through improvements to the services we deliver.

For example, we have recently launched ‘Connect’, our online portal for raising queries, reporting facilities management

In some cases, however, reducing the number of properties that we have sitting empty is important to raise valuable funds that can be invested back into the NHS issues and logging complaints. Through Connect, customers can track the status of their interaction 24/7, giving them more time to focus on patient care which will improve overall customer experience.

To support communities, we have continued to develop social prescribing hubs across England which offer a range of local, nonclinical services to support individuals’ health and well-being. As part of the NHS, we are helping to achieve the target laid out in the NHS Long-Term Plan to refer at least 900,000 people to social prescribing services by 2023/24. We have now refurbished a total of 34 spaces for social prescribing use and are on the way to achieve our target of 50 in the coming months.

Plus, our new disposals policy, developed alongside the DHSC and NHSE&I, means that 50 per cent of the proceeds of disposals from

surplus properties within the NHSPS estate are shared with local health economies for reinvestment.

Looking to the future Despite the many challenges we’ve faced during my time so far at NHSPS, I am proud of the achievements we have been able to deliver. As we move forward to support these new ambitious targets as part of the NHS, we will continue to work to deliver savings through close collaboration with our customers. It is through this that the NHS will be able to provide the best care for patients, with an efficient and sustainable NHS estate. L FURTHER INFORMATION www.property.nhs.uk

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Air quality

The role of health professionals in tackling air pollution Whilst it is imperative that we improve the air quality in healthcare environments, tackling air pollution goes beyond the boundaries of the hospital, writes Larissa Lockwood, Director of Clean Air at Global Action Plan In line with new World Health Organization (WHO) guideline limits launched in September 2021, every hospital in London is now located in areas that breach limits for toxic air pollution.

Clean air in and around healthcare settings is crucial as patients in hospitals or GP surgeries are some of the most vulnerable to air pollution. Furthermore, healthcare professionals themselves should not be forced to care for patients in environments that can not only worsen their symptoms, but also put them at risk of a whole range of other health problems.

This all being off the back of a respiratory pandemic, which we know the symptoms of can be exacerbated by air pollution.

Every year, air pollution causes up to 36,000 deaths in the UK and at least four million early deaths globally. This is hardly surprising since air pollution can affect every organ in the body.

When we breathe polluted air, it can inflame the lining of our lungs and move into our bloodstream ending up in the heart and brain, causing lung disease, heart disease, dementia and even strokes.

With the WHO and UK government recognising air pollution as the ‘largest environmental health risk we face today’, you would not be wrong to presume that the health sector plays a critical role in responding to air pollution. This is currently not the case.

Champions: supporting policy measures at Legal history was made last year when a national and local levels that will help ensure coroner ruled that air pollution was a cause of improvements to air quality. the death of nine-year-old Ella Kissi-Debrah. In the subsequent Future Prevention of Deaths Health professionals Report shared by the coroner, one of the as educators key recommendations was a call for health For health professionals in primary and professionals in the UK to be trained to talk to secondary care to advise patients on the patients about air pollution. impacts of air pollution and how to protect their At Global Action Plan we are making health, they must be trained to do so. concerted effort across public health The serious gap in current medical and frontline healthcare services training highlighted in the Future to turn this recommendation While Prevention Deaths Report into a reality. r e sources, came to light through We believe materials our Mobilising Health healthcare a nd educatio Professionals project in professionals play a partnership with the vital role in tackling arm the n help to h e a UK Health Alliance air pollution as: lt h in the ba sector on Climate Change t t le a gainst air pollution (UKHACC).

Educators: as Throughout 2020 trusted messengers not suffic, this alone is ient for m we worked with 40 in society, they play ass adoption respiratory and paediatric an important role to and health professionals to train inform the public of action the group on the impacts of the health risks from air air pollution on patient health pollution. and the measures people can take to reduce their exposure to this hazard.

Role models: showing leadership by While health professionals already provide minimising the amount of air pollution the NHS health advice around lots of lifestyle issues E creates and influences.

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Advertisement Feature

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Health professionals as role models Despite being overlooked, equipping hospitals to respond to air pollution in and around the hospital, as well as surrounding communities is important when looking to improve air quality. Free initiatives such as the Clean Air Hospital Framework enable health professionals to set ambitions and self-assess progress on tackling air pollution in seven key areas: travel, procurement and supply chain, construction, energy, local air quality, communication and training, and hospital outreach and leadership.

Global Action Plan partnered with Great Ormond Street Hospital (GOSH) to develop this framework, which empowered GOSH to launch the first ever hospital clean air strategy. Using the framework, air quality has since been built into GOSH’s new building developments, both within building design and during construction activities. The new buildings are designed to emphasise green spaces, use low polluting materials, and incorporate energy efficiency measures to reduce local fossil fuel energy generation. On the construction site ‘no idling’ messaging is provided to all vehicles arriving at the site, dust levels are monitored, and deliveries are restricted as much as possible.

Around the hospital, there are also now signs discouraging idling that have been co-created with patients. Play specialists and play workers have been engaging with children on clean air, including designing their own clean air

Free initiatives such as the Clean Air Hospital Framework enable health professionals to set ambitions and self-assess progress on tackling air pollution in seven key areas superheroes, and a Young People’s Forum have been sharing why they think it is important for hospitals to take action on air quality.

Going forward, GOSH is further embedding clean air requirements within new contracts and tenders, bringing clean air messaging into the GOSH school, training staff, reviewing cleaning products, and continuing to encourage other hospitals to take more action to make the air cleaner for everyone. Their action has further acted as a catalyst to help other hospitals across the UK to tackle similar barriers.

Health professionals as champions While resources, materials and education help to arm the health sector in the battle against air pollution, this alone is not sufficient for mass adoption and action. UK leaders still need to implement a nationwide programme to support the inclusion and integration of air pollution into patient advice and health sector practice at a top-level, as per the coroner’s guidance in the Future Prevention of Deaths Report.

To help achieve this, we must work with national bodies and local authorities to promote collaboration across the public sector to increase awareness and encourage action.

An example of this was the Clean Air Health Sector Summit that was held ahead of Clean Air Day 2020. The Summit brought together decision-makers across the health sector to discuss and agree the action needed from the sector to tackle air pollution.

The event resulted in immediate opportunities across the following areas: Reducing emissions: reducing patient travel, supply chain innovation, setting targets for management, and incorporating clean air in the NHS Net Zero Plan.

Air quality

 including smoking, exercise and diet, health professionals reported that: they are not talking to or advising patients about air pollution; air pollution is not uniformly integrated into healthcare professional training; and materials are not readily available for health professionals to share with their patients on air pollution.

Harnessing this insight, we worked with these health professionals to understand what types of materials and resources would be most useful to share with patients on air pollution, and where in the patient pathway conversations could be best held. As a result of the project a selection of resources are now available for colleagues across the health sector to use and the pilot is now being rolled out again in Islington in partnership with the council.

Advising patients: updating healthcare professionals’ practices, providing educational materials for patients in health centres, launching a national public health campaign.

Education: raising understanding of air quality inequalities and the need to protect those most at risk of health issues caused by pollution.

Collating experiences to influence policy: sharing the real and personal impacts that air pollution is having on patients to ensure the need for comprehensive and urgent action is understood across the political spectrum across the country.

Looking ahead Despite the success of our pilot projects and events, we need to move this from testing to the mainstream and real action committed to within the health sector. The onus to act on air pollution cannot be put on healthcare professionals and patients alone – we need an accompanying, sustained public health campaign so that collectively everyone does more to cut air pollution.

To tie all these roles together, this Clean Air Day on 16 June 2022 we are asking everyone to play their part. For health professionals in particular, the key asks are: talking to their patients about the health harms of air pollution; encouraging staff, visitors and patients to walk those short distance trips and leave the car at home, where they can; and asking local and national decision makers for what would make it easier for them and their patients to walk more and have clean air in your community.

Clean air in and around healthcare settings is crucial, but no one should have to breathe dirty air. Whilst it is imperative that we improve the air quality in healthcare environments, tackling air pollution goes beyond the boundaries of the hospital, clinic room or GP practice. By improving the air quality in healthcare environments, the positive impacts will impact everyone. L

Global Action Plan is an environmental charity working towards a green and thriving planet where everyone can enjoy happy and healthy lives within the Earth’s limits. We tackle the root causes of our climate and nature crises through research, campaigns and collective action that reconnect human and planetary health.

FURTHER INFORMATION www.actionforcleanair.org.uk/health

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Translations

How translation can help support digital healthcare Alan White explains why translation technology needs to be uppermost in the thoughts of decision makers in the healthcare sector and how effective translation can be vital in ensuring medical information is accessible to all, regardless of language The healthcare sector, perhaps more than any other, must ensure that translated material is of the highest quality – and there’s no margin for error.

Miscommunication, misunderstanding or misdirection because of poorly translated materials can have severe consequences, including misdiagnosis or malpractice.

The result could be legal action or worse, a compromise to quality of care and even endangerment to human life.

With around £2.1 billion to be invested in IT, technology and digitising the NHS, it’s imperative that translation companies are not only experts in medical translations, but that they keep up with the pace of digital transformation, so that when healthcare companies need to produce content in multiple languages, streamlined workflows exist that make translation a quick and easy process. pre

environment, services such as multilingual remote conferencing and interpreting platforms have seen an increase in demand over the last two years.

These facilitate virtual interpreting booths, accessed remotely by organisers and participants around the world. Users are allocated a qualified linguist who not only translates in whatever language they select as their preferred choice, but who is highly experienced in the healthcare sector, so they can translate even the most complex of sector terminology in real-time.

In another illustration of the ways methods of communication are changing, The Translation People recently supported a company that Transla has developed memo tion a clinical

r securel y tools ferred t y store and comerminology ple translat ions in ted sec client-s pecific ure, databa se

Addressing digital change The Covid-19 pandemic demonstrated the value of digital technology; it spurred a demand for digital transformation, particularly in the area of diagnosis and a need for surveillance and other solutions, such as telemedicine, to tend to patient needs.

With the potential of key technologies, such as artificial intelligence and wearable tech, having significant potential to shape the future of care, this will bring further demand for translation companies to provide effective solutions for translating content in different formats and platforms.

Over the last two years, translation services have played a key role in supporting healthcare companies across the globe; from support for clinical trials and regulatory submissions to producing multilingual marketing content and interpretation at global pharma conferences.

Accurate translations are essential for the healthcare industry to ensure that digital tools, marketing materials, research and development, and much more are accessible to as many people as possible, whatever language they speak.

Solutions for a changed world In a bid to save costs and time, as well as striving to reduce the impact on the

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

trials app, where patients can receive instructions and record their own results digitally and remotely. The app is available in multiple languages and allows data to be recorded quickly and efficiently, whatever the user’s language.

The pandemic has changed the world, not least from a digital technology standpoint.

Therefore, to continue to serve the healthcare industry as we move forward, translation providers must adapt to new ways of producing digital content, interfacing with different systems and platforms to ensure that translations can be published in the most efficient way possible.

additional specialist skills, knowledge and expertise. Specific translation technology is needed to prevent code disruption and software translators require an understanding of the language used in software strings.

Having a service that works with a variety of different file types, such as .xml, .xlf and .json, and has integration tools that dovetail with many content management systems achieves a certain level of efficiency; but such tools must also be armed with human expertise to manage the most complex of translations.

In particular, translators with highly specialist knowledge of the healthcare sector are required to ensure they are translating items such as medical conditions, scientific terminology and medical procedures with accuracy. Marketing content will also require input from translators with a creative touch to ensure the translations are compelling and achieve the desired impact with the target audience. As such, any investment into digital translation technology in the healthcare industry – which centres on human interaction – should be made with the reassurance that a personal insight and expertise sits at its core.

More companies are using AI-powered translation concepts such as multilingual chatbots, while the prospect of virtual events being held in the metaverse is fast becoming

a reality. By their very nature, these virtual reality settings could be accessed by anyone from around the world, thus requiring some form of multilingual communication.

At The Translation People, we teamed up with digital therapeutics platform, Xploro, to translate an app that empowers child cancer patients with information about their treatment, to help thousands of young people with the disease around the world.

The platform uses artificial intelligence, augmented reality and gaming to teach young cancer patients about their condition, enabling them to ‘meet’ the people who’ll be treating them and ask questions about their treatment to minimise anxiety about the disease and make receiving care a more comfortable experience, whatever their language.

Innovations in medical technology are of global relevance, and to make sure that they are safe and accessible to all, language, technology and communication must go hand-in-hand as we continue to make progress in a post-pandemic world. L

Translations

Future translation trends Given the global expansion of the medical industry, medical translation is a key component for success on the international stage. Much of the work we do supports the progression of new medicines in different countries through regulatory approval and marketing.

We’re seeing easier communication, accuracy and speed through translation services.

Technology is also developing at a rapid pace in the translation world. The advances in machine translation, for example, will prove invaluable in terms of improving turnaround times and reducing costs, especially with the development of enterprise-level machine translation engines, which offer higher levels of quality and advanced security settings.

In addition, translation memory tools securely store preferred terminology and completed translations in secure, client-specific databases. This allows linguists to draw on a bank of previous work and phrases, which can then be reused where applicable on future assignments, allowing clients to benefit from reduced costs and increased consistency.

However, medical language is complex and cannot be processed accurately by machines alone, or by non-qualified translators, for that matter. There are other factors to consider, too: translating an app, for example, requires

Alan White is business development director at The Translation People.

FURTHER INFORMATION www.thetranslationpeople.com

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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CLOUD-BASED HEALTHCARE SAFETY MANAGEMENT PLATFORM 46 Issue 22.2 | HEALTH BUSINESS MAGAZINE

Risk management

Emergency planning within the busy hospital building On behalf of the Emergency Planning Society, Stephen Arundell, Barry Moss and Claire Penellum analyse how hospital trusts can show that they can deal with a range of incidents while maintaining services In an emergency with health consequences or injury, a hospital is likely to be the first place we turn to for help. They’re seen as steadfast and secure; a place of safety and a source of support.

But what happens when the hospital itself is the location of the emergency, or is impacted by one? It’s a thought that was brought into sharp focus recently by the terrorist incident at Liverpool Women’s Hospital.

On 14 November last year, a taxi carrying a passenger arrived at the main entrance of the hospital. An improvised explosive device carried by the passenger ignited. The passenger was killed and the driver injured.

Thankfully, further injury was prevented due to the quick thinking and bravery of the

patients inside the building to continue driver. In response to the incident, the with as little interruption as possible. hospital was placed in lockdown, roads Where new patients were not able to come were closed, a cordon was in place around into the building, they would have been the hospital and armed police maintained diverted elsewhere using a pre-planned set a presence. NHS systems were stood up of protocols and agreements. to respond over a wider geographical Evacuation of the whole, or parts, of the footprint. hospital would have been planned for, Inside the hospital, a variety of considered and actioned where needed. The emergency planning and business team would have been working with continuity policies and protocols driven emergency service partners – and by the trust’s resilience teams other hospitals – to consider: would have also swung The “What is the target, where into action to safeguard is the threat? Do we have patients and staff Liverpoo l to lockdown, do we have and to allow, as Women’s to move people, do much as possible, issue last Hospital we have to evacuate? the essential care y e a r showed that hos Where to? E and treatment of p

so often itals, while hope in the beacon of t of situat he most dire ions impenet , are not rable

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Are You Prepared?

ISDN / PSTN Switch-Off 2025 Have you considered what exposure or risks the ISDN / PSTN Switch-Off 2025 poses to your organisation?

Your telecoms network will have been built historically on these technologies. However, what you are using and where it is located may be an enigma.

Voice calls, security, well-being and any equipment reliant on these services will be affected. The longer action is delayed, the more problematic the situation may become.

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01215599000

The risk register Firstly, it’s important to remember that incidents such as the bombing example are rare. While clearly the potential impact was massive, the odds of this happening were small. The hospital and the wider trust, as well as their partners in emergency response and others will have factored a potential terror incident into their on-going emergency and business continuity plans, but it wouldn’t have been top of the ‘list’. Terror threat risk assessment and planning is based in the UK’s terror threat level, which was raised following this incident. However, Pandemic Influenza remains the UK’s top projected risk and has been for many years. Severe weather events and flooding are next highest on the risk register.

In an ideal world, resilience teams would be running regular practice exercises to test the effectiveness of their planning. But working on ‘Reasonable Worst Case Scenario’ exercise scenarios are sometimes regarded as ‘extreme’ with people saying things like ‘that’ll never happen!’

In a perfect resilience world, hospital teams look at the individual function each department performs, what the potential impact would be if that had to shut down for any unpredicted reason and how they would replicate it should the worst case happen.

Hospital response planning would look at what they would do if there was a huge influx of people due to business-as-usual surge pressures, or a large-scale accident, terror attack or other incident. And planning should encompass what should be done if the hospital itself is the centre of the crisis.

It’s fair to say there are emergencies and crisis which can impact patient care and business continuity within every hospital in every town and city, every single day.

The NHS deals with incidents which can affect its capacity and ability to provide services continually. In any hospital, there are numerous events, of varying degrees of severity, that need to be dealt with. With thousands of people in a building, it’s really just a town with a roof. But whether the emergency is an external or an internal event matters less, it’s how the trust and wider NHS is geared up to respond and react that’s important.

Incidents can be large-scale like severe weather which directly affect the hospital and its infrastructure, they’re not impervious to damage any more than a school or threebedroom house is. There are considerations around staff safety and if they can get to work, supply chain, power supply etc.

In a perfect resilience world, hospital teams look at the individual function each department performs, what the potential impact would be if that had to shut down for any unpredicted reason and how they would replicate it should the worst case happen Within the hospital, if there’s been damage to infrastructure, the emergency planning and business continuity teams, again in that ideal world, would work with the clinical teams, and partners to plan for evacuating people to other areas of the hospital or indeed to other hospitals.

Other threats can be just as, if not more, dangerous. Take cyber threats for example.

They could potentially be even more deadly than a physical attack on an individual hospital. There’s also fires, road traffic accidents, community disease outbreaks.

And there’s the hospital community to consider too; there are thousands of people in one relatively small space. Where there has been a significant event, there is the potential to be dealing with patients and staff who are traumatised. The media will be interested. These unintended consequences also have an impact and should form part of the response planning considerations.

In that ideal world again, all of these would be planned for in a way that means essential patient care would be maintained, and the day-to-day work of the hospital could continue, with adjustments that are laid out in its response protocols – no matter what happens. Just because there’s been an emergency doesn’t mean other aspects of the hospital’s work stop; women will keep having babies, children will fall from swings, adults will not handle power tools safely.

What is key to consider then?

Partnership working and understanding is vital; both within the hospital and external to it. Within the trust or individual hospital, the emergency planning, resilience and response team along with business continuity professionals should, in that ideal world, be working collaboratively, in line with their designated plans to identify how and where they are able to relocate patients to in the event of evacuation being needed, for example, if we need to move patients from the front of the building which is subject to a terror threat?

Outside the hospital, relationships with key partners are essential, and again, in that ideal world, a multi-agency approach would be taken. There should be a defined command and control escalation framework which shouldn’t just include local emergency services partners, but also local and national government. Everyone should understand how it all fits together

Risk management

 What provisions or networks do we need to stand up? What command and control is required for this incident?”

This incident showed clearly that hospitals, while so often the beacon of hope in the most dire of situations, are not impenetrable.

Nor are they invulnerable to the same sort of emergencies and threats which any building, organisation or community may find itself dealing with. They like all organisations want to be prepared for anything – but is that possible, and is it happening?

and what their role in the response is – and be able to predict what the other party will do. Communication is key. Every plan should contain a set of action cards that define individual roles during the response.

But it should be said that we don’t operate or live in an ideal world, in resilience or any other terms. Many trusts don’t have all of it planned and haven’t trained for multiple scenarios - especially in a coordinated with partners manner.

Most haven’t exercised in a way that would prove competency – and we could write a whole other article on proving competency in the Resilience space!

Much like everywhere these days, capacity and prioritisation of all NHS outputs compete, and resilience mostly takes second place to clinical exigencies.

In addition, there is little recognition or specification of what a ‘good’ plan or response looks like; mostly they are generic and based on what we want to happen, not what will happen. There is little recourse to a ‘Red Team’ who provide the independent challenge to the complacency of risk assessments, to contingency plans or the operational response.

The issue is that NHS EPRR is seen as a separate emergency response output and doesn’t link well to the rest of the resilience spectrum; intelligence gathering, modelling and analysis, to risk assessments, to business continuity or to recovery.

The need for NHS organisations to be prepared is enshrined in law and the NHS Constitution, but it is more than just a legal duty. It is also a moral duty. Incident response needs to be planned to be scalable so that we are able to deal with the smaller events and the larger incidents – which means trusts and hospitals can continue to deliver essential patient care with minimal disruption. L

Stephen Arundell is Director for Governance at The Emergency Planning Society.

Barry Moss is co-chair of the Emergency Planning Society CBRN Professional Working Group.

Claire Penellum is EPS Director and a EPRR manager within the NHS. FURTHER INFORMATION www.the-eps.org

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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HB Q&A

HB Q&A: Leeds Teaching Hospitals NHS Trust Health Business talks to Chris Kelly, Associate Director - Estates Compliance & Risk at Leeds Teaching Hospitals NHS Trust, about the organisation’s sustainability achievements HB: Last year, Leeds Teaching Hospitals NHS Trust became the first NHS hospital trust to officially become Carbon Literate. What practical outcomes are likely to be seen as a result of this step?

sustainable practices within every clinical unit, and emphasise the importance of acting now to address climate change.

By committing to these tangible actions, our Carbon Literacy training has encouraged positive behaviour change throughout our organisation to drive a reduction in emissions.

The actions of individuals can and do make During the Carbon Literacy training, staff a difference. Staff who have completed a days’ learn about the impacts of climate change worth of approved Carbon Literacy learning in healthcare, breaking them down by sector can be certified as Carbon Literate, and each and learning what the big emissions in the Carbon Literate individual is expected to reduce NHS are and what targets are in place to their carbon footprint by five-15 per cent. So tackle them. They also learn about practical, it’s easy to see why it’s so important that we everyday ways to meet these targets. educate our teams on climate change.

All participants are required to We believe this training, make an individual and group this deepening of awareness, action pledge as part of the is a valuable tool in helping As a training. This encourages us become a greener Carbon them to commit to organisation and L it e rate organisa taking action within embed sustainability their job role to reduce across the trust. We trust has tion, the p carbon emissions. have now undertaken le d ge analyse t Examples of pledges training throughout he oppo d to rtunity Estates and Facilities, to reduc include developing a e the foo plan to decarbonise ICU, Theatres m il e s and carb d the heating and and Anaesthesia, hot water across the with more teams foot prin on t hospital sites, promote planned this year.

HB: As a Carbon Literate organisation, the trust has pledged to analyse the opportunity to reduce the food miles and carbon foot print. How important is this in pursuing a more sustainable way of working?

It is estimated that food and catering services in the NHS account for approximately six per cent of the NHS’ Carbon Footprint.

When you consider the farming, production, distribution and delivery of food, the carbon footprint quickly adds up; you then need to factor in the amount of food wasted.

A balanced meal is also a low carbon meal, combining seasonal and locally sourced fruit and vegetables and reduced processed foods high in sugar, salt and fats. The trust catering teams provide over two million nutritious meals every year to meet the needs of our diverse range of patients. We do not underestimate the role that healthy meals play in our patients’ recovery.

Food and nutrition will be a key theme within the next revision of our Green Plan, and it will include a suite of actions to address key issues, including waste, the carbon E

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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Millions of people are at risk of the deadly consequences of conflict in Ukraine.

People are fleeing their homes and families are being separated. Many are going without food or clean water.

We must get critical support to those who need it most, in Ukraine and its bordering countries.

Please donate to the DEC Ukraine Humanitarian Appeal, if you can.

redcross.org.uk/shelter or text SHELTER to 70141 to Visit

make a £10 donation.

By texting, you consent to future telephone and SMS marketing contact from British Red Cross.

Text SHELTER NO to 70141 to give £10 without consenting to calls and texts.*

Keeping in touch Your support makes a life-changing difference to people in crisis. We write to our supporters to update you about the work of the British Red Cross, and how you can help and donate in other ways. You can change the way we contact you at any time by visiting redcross.org.uk/keepingintouch or calling Freephone 0800 2800 491.

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The DEC Ukraine Humanitarian Appeal will support people in areas currently affected and those potentially affected in the future by the crisis. In the unlikely event that we raise more money than can be reasonably and efficiently spent, any surplus funds will be used to help us prepare for and respond to other humanitarian disasters anywhere in the world. For more information visit https://donate. redcross.org.uk/appeal/disaster-fund *Texts cost £10 +1 standard message (we receive 100%). For full T&Cs visit redcross.org.uk/mobile, must be 16+.

The British Red Cross Society, incorporated by Royal Charter 1908, is a charity registered in England and Wales (220949), Scotland (SC037738), Isle of Man (0752) and Jersey (430).

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We need your help

 impact of food and the types of food we are procuring. We already aim to source food locally and will take this further by ensuring we monitor our food miles and reduce the carbon footprint across the entire supply chain.

We will also look at encouraging more staff and patients to choose plant-based meals.

Food waste is another significant source of carbon, by 2024 the trust will have implemented a separate food waste stream in accordance with the Environment Bill.

Reducing our food waste reduces our environmental impact and costs, enabling us to provide healthier, locally sourced food to patients, staff, and visitors.

HB: The trust has invested over £700,000 in upgrading the lighting across the estate, saving an estimated £60,000 a year. What are the next steps in improving energy efficiency within the hospital estate?

We have one of the largest estates in the NHS, and our buildings range from Victorian listed properties to brand new developments, with challenges and opportunities across all six of our sites.

All senior members of the Estates and Facilities team have undertaken Carbon Literacy training and now understand the importance of improving the efficiency of our estate, with energy playing a significant role in this.

Currently, we are undertaking a comprehensive programme of works to improve energy efficiency across our estate. Funded through the Salix Public Sector Decarbonisation Scheme, and to date, over £13 million has been spent on energy improvements.

Projects include installing air and water source heat pumps, replacing single glazed windows with low ‘U’ value double glazing and upgrading the Building Management Systems (BMS) to Building Energy Management Systems (BeMS). As

well as roofing insulation upgrades and the installation of solar photovoltaics In addition, we have connected Beckett Wing, part of the trust’s estate at St James’s Hospital to the district heating network. This means that the waste we send to the Leeds Recycling & Energy Recovery Facility generates low carbon heat for the Trust and the local area.

The combined projects will save approximately 2,358 tonnes of carbon a year and be complete in Spring 2022. We will then commence work on phase 3 of the Public Sector Decarbonisation Scheme.

Mott MacDonald has also been appointed by the trust to produce a Net Zero Strategy and undertake a detailed review of the existing estate infrastructure across all our sites. They will be modelling current energy and carbon demands to identify opportunities for targeted investment, setting our future performance parameters that are aligned to the trust’s Green Plan, Leeds City Council, and partner organisations.

HB: The Sustainable Action Plan commits Leeds Teaching Hospitals to a range of actions that will help move the organisation forward on its pathway to netzero. How is this to be monitored and managed?

Our Sustainable Action Plan sets out 105 actions, split across ten key focus areas. These actions range from energy saving initiatives to staff engagement and education campaigns that will drive fundamental changes to how the trust operates and improve our environmental, social and economic performance.

The plan was developed through extensive staff engagement, and the actions are ambitious but achievable, allowing us to meet our net zero targets whilst providing high-quality care.

For ease of implementation, each action has a designated lead and timescale.

Progress is reviewed quarterly by the

Strategic Sustainability Group and reported annually to the trust board.

The Sustainable Action Plan will be updated to coincide with the launch of the revised Green Plan, and will be implemented over the next three years.

By trying to embed sustainability in all activities, we have seen reductions in carbon emissions, water consumption and our contribution to air pollution.

The successful implementation of the plan has required a collaborative effort from all of our colleagues, and we continue to work with partners across Leeds to support and progress sustainability within the city.

HB Q&A

Food waste is another significant source of carbon, by 2024 the trust will have implemented a separate food waste stream in accordance with the Environment Bill

HB: How central is sustainability in the Building the Leeds Way vision?

Building the Leeds Way is a long-term vision to transform healthcare facilities across Leeds Teaching Hospitals for our patients and staff.

This incorporates the trust’s Hospitals of the Future Project, which will see the construction of two new state-of-the-art hospitals in Leeds.

We knew from the outset that it is vital that the new hospitals should be designed and constructed to a rigorous set of requirements, to ensure the construction of environmentally responsible buildings, not just for today but for the next 60 years and beyond.

Our design brief stated the need for an integrated approach that provides world class patient facilities and minimises waste and energy use by using renewable energy sources, construction materials and methods.

The approved designs by architects Perkins & Will, seek to address our sustainability criteria with a holistic, whole life-cycle approach to focusing on net zero carbon and delivering against construction industry benchmark standards such as WELL and BREEAM. The buildings will feature lots of natural light and the carbon impact will be minimised through the careful selection of materials, such as high levels of insulation window areas that efficiently balance the penetration of daylight and heat loss.

Sustainability has also played an important role in demolishing parts of the Leeds General Infirmary site that are being cleared to make way for the two new hospitals, with DSM Demolition aiming to recycle between 95 per cent and 99 per cent of the old buildings.

Some of the sustainability measures that are being considered include rainwater collection and bio-filtration, onsite solar energy harvesting, passive design and energy re-capture, bird, bat and bee hotels, outdoor gardens and terraces and sophisticated energy management systems that maximise energy efficiency and minimise waste.

Collaboration between the trust and the designers has ensured sustainable practice is embedded throughout both new hospitals and will create life-long buildings that are adaptable to the changing nature of healthcare. L FURTHER INFORMATION www.leedsth.nhs.uk

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Catering

Promoting good nutrition for staff and visitors Caterers within the healthcare setting have a role in assisting staff and visitors to make healthier choices, including promoting vegan options The number of vegans in Great Britain has upon us, it is important to consider building quadrupled between the years 2014 to 2019, a sustainable food system for future according to information from The Vegan generations. A strong vegan offering can Society. The UK was also the most popular help institutions like hospitals to provide country for veganism according to Google nutritious, sustainable and inclusive food for Trends. In May 2021, a survey by The Vegan staff, visitors and service users.

Society revealed one in four population had reduced the amount of animal products they How do vegan options promote were consuming since the start of the good nutrition for staff and Covid-19 pandemic. visitors?

A well-planned, balanced healthy vegan The Eatwell Guide recommends that we diet is rich in fibre, and can be low eat at least five portions of fruit in saturated fat. Studies show and vegetables per day, eat that vegetarians and vegans more pulses (e.g. kidney are more likely to have a beans, lentils and peas) With lower body mass index and choose wholegrain the clim ate and reduced incidence versions of starchy emerge n of hypertension, carbohydrates. These c y upon us, it is high cholesterol and recommendations are i m portant to cons Type 2 diabetes. A useful for meeting i growing body of daily fibre targets. a susta der building inable f evidence shows that Fibre is important for system o a healthy vegan diet helping to reduce the for futu od not only has a positive risk of chronic disease, r e genera impact on human health benefit gut health and tions but also on the planet. prevent constipation.

Adopting a vegan diet The Eatwell Guide also is one of the most effective emphasises the importance ways to significantly reduce one’s of opting for unsaturated oils and carbon footprint. With the climate emergency spreads and reducing red and processed

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meat consumption. Based on data collected in 2020 as part of the National Diet and Nutrition Survey, fibre, fruit and vegetable intake were below the recommendations for all age groups. The mean intake of saturated fat exceeded the recommendation in all groups.

In keeping with public health guidance, The Government Buying Standards nutritional guidance states that main meals containing beans and/or pulses should be made available at least once a week along with encouragement towards reducing saturated fat, which can be found in baked goods, oils, fats, meat and dairy products. Over half of all the food provided in NHS hospitals is served to staff and visitors. Government statistics for 2019 state that 28 per cent of adults are living with obesity and a survey from 2017 show that 25 per cent of nurses in England are living with obesity.

Caterers within the healthcare setting have a role in assisting staff and visitors to make healthier choices. Increasing good vegan meal options within this sector can be one way in which caterers meet this aim. A balanced vegan diet can help to reduce the risk of chronic disease and can also help to reduce the numbers of those that need to access healthcare services in the future. Increasing

Can vegan offerings promote good nutrition for patients?

Sound vegan offerings are not only beneficial for staff and visitors but can also be nutritious for those that are acutely unwell; if higher calorie and protein meals, snacks and drinks are made available. Crucially, vegan menu options ensure that vegans can practice their ethical beliefs by consuming a diet that aligns with their values.

Dr Jeanette Rowley, from the International Rights Network at The Vegan Society, states that ‘public bodies have legal duties under human rights and equality law, to do everything reasonably possible to ensure that vegans have access to a diet that aligns with their ethical convictions’.

Not only are vegan choices suitable for vegans but they encourage inclusivity on the menu – for example, certain options may be acceptable to those who do not eat meat for religious reasons. If vegan meals meet the relevant allergy standards, these meals can also be suitable for people with milk or egg allergies without the need for a special request.

The Nutrition and Hydration Digest produced by the British Dietetic Association’s Food Services Specialist Group gives guidance on how vegan offerings can meet nutritional targets such as increased protein and calorie needs. Recommendations include using vegan QuornTM and soya products which are examples of high-quality protein substitutes for meat. Anglia Crown is an example of a manufacturing company that has worked

with The Vegan Society to provide vegan meals that meet nutritional standards for hospital patients.

Ruth Smith, Company Dietitian, commented: “Working with The Vegan Society during the enhancement of our vegan range was really insightful and helped provide practical tips on how to easily create tasty, vegan-suitable dishes that are popular across the board. It was also helpful to ensure that nutritionally these products achieve the necessary energy and protein levels.”

What are the benefits of vegan diets on the environment?

Increasing vegan offerings in the healthcare setting is not only beneficial for people, but also the planet. Research published in the journal Global Food Security estimated that animal products account for 83 per cent of the emissions caused by EU diets.

The government aims to reach net zero greenhouse gases by 2050 which means a significant reduction in carbon emissions requiring that emissions produced must be equal to or less than what is removed from the atmosphere. If the government is to reach this target, the food system must change. There is growing evidence that switching to a plant-based diet is one of the most effective ways for reducing an individual’s carbon footprint. Vegan diets can help to meet this ambition.

How can vegan offerings help to meet sustainability targets?

When looking to meet sustainability targets, vegan offerings can be more sustainable long term as plant agriculture generally uses less resources than animal farming. Keeping this in mind will help us to ensure that there are enough resources available for future

generations. In fact, The Vegan Society’s ‘Grow Green’ campaign highlights that ‘the UK provides good growing conditions for plant proteins for direct human consumption, such as fava beans, peas, hemp seed or sweet lupin’. Choosing to support British farmers can help us to build a sustainable food system.

Other factors to be considered are reducing food waste as this can contribute to greenhouse gases when food is discarded in landfills. Buying seasonal and local produce can also help to limit the carbon footprint caused by the transportation of food from other countries.

In the Delivering a ‘Net Zero’ National Health Service report, it is highlighted that ‘healthier, locally sourced food can improve well-being while cutting emissions related to agriculture, transport, storage and waste across the supply chain and on NHS estate’.

This further demonstrates how vegan food utilising plant protein sources can assist in delivering outcomes for individuals and also institutions at large.

Catering

the vegan offerings to staff and visitors not only helps caterers to meet healthy eating guidance but also provides tasty and nutritious options to the growing number of vegans in the UK.

It is time for action The Vegan Society’s ‘Catering for Everyone’ campaign calls for good-quality, nutritious vegan options to be available on every public sector menu. Whether you are a health professional, administrator or caterer within the healthcare setting, you can do your part.

Here are some suggestions that can get you started: • Offer more tasty and nutritious vegan options.

• Utilise tasty descriptors for plant-based food.

• Give vegan options a default presence on menus which can influence the subconscious choice of the consumer. Vegan options can be enjoyed by everyone.

• Employ more sustainable buying practices, e.g. local and seasonal produce.

• Contact The Vegan Society for support on how you can provide vegan offerings that are tasty and meet nutritional targets.

Take-home messages • There is a growing number of vegans and those that are choosing to eat more plantbased foods.

• Well-planned and balanced vegan offerings can be nutritious and promote healthier eating principles regardless of dietary pattern.

• Vegan offerings can help to reduce carbon emissions and help meet government targets to be net zero by 2050.

• Utilising more beans and pulses in meals is one way to employ more sustainable food practices as well as being a big part of healthy vegan offerings.

• ‘Catering for Everyone’ calls for good vegan food to be available on every public sector menu. L FURTHER INFORMATION www.vegansociety.com

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Advertisement Feature

The safe, time- and cost efficient setup of IAP measurement in ICU After thousands of treatments were performed with preOx-IAP-Adapter Set in Germany and Austria, it is now available in the UK

To ease Intra Abdominal Pressure (IAP) measurment, preOx.RS GmbH has launched a new treatment kit. Medical professionals in ICU are looking for easy and quick handling products to achive reliable and replicable results.

Abdominal compartment syndrome (ACS) is defined as an increase of intra abdominal pressure (IAP) >20mmHG. Organ failure, respiratory and renal dysfunction are possible consequences of a non identified intra abdominal hypertension (IAH).

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are common and associated with substantial morbidity and mortality among critically ill adults [1-4]. These conditions have been linked with acute and chronic renal failure [5-9], multiorgan dysfunction syndrome (MODS) [10], increased lengths of intensive care unit (ICU) and hospital stay [10], and elevated mortality [5,7,10] . Unfortunately, it remains unknown if prevention or treatment (either surgical or medical) of IAH/ACS among these patients improves patient-important outcomes. Identifying critically ill patients at risk for IAH/ACS is therefore important.

Close monitoring of organ function and intra-abdominal pressure (IAP) allows clinicians to diagnose ACS rapidly and intervene with targetspecific management to reduce IAP. For more than 15 years, the WSACS (World Society of Abdominal Compartment Syndrome) published studies and consensus definitions of ACS and IAH less than 50 per cent of ICU clinicians know how to measure IAP. Self constructed measure equipment is used without considering the consequeces of non reliable and replicable measurement methods. Missinterpretation is often the result and could lead to wrong treatment.

The most common and cost effective way (90 per cent) of IAP measurement is the intravesicular way. The bladder is used as a pressure sensor by using a foley catheter connected to a pressure transducer.

Few medical device manufacturers developed IAP measurement devices with various success. Since the new Medical Device Regulation (MDR) is in place many medical devices were discontinued due to increased regulatory requirements.

Niche products such as IAP measurement devices or thoracic lavage catheters were discontinued by the big players as they do not create enough commercial value for them.

This is the time for small medical device manufacturers. preOx.RS GmbH is known as a company which transfers medical professional needs into an easy to use medical device. The focus is always on patient and user safety as well as easy handling. preOx-IAP-Adapter Set has been developed with this focus. This kit includes all necessary components for a safe, time- and cost efficient setup of IAP measurement in ICU. Clearly colour coded tubing lines guarantee a self explaining sequence. Paired with a step by step video instruction it is the perfect kit for easy understanding and use.

After thousands of treatments were performed with preOx-IAPAdapter Set in Germany and Austria, now it is available in the UK. L FURTHER INFORMATION https://en.preox.de/intensivmedizin https://www.wsacs.org/ References:

1. Malbrain MLNG, Chiumello D, Pelosi P, Wilmer A, Brienza N, Malcangi V, Bihari D, Innes R, Cohen J, Singer P, et al: Prevalence of intra-abdominal hypertension in critically ill patients: a multi centre epidemiological study. Intensive Care Med 2004, 30:822–829.

2. Vidal MG, Weisser JR, Gonzalez F, Toro MA, Loudet C, Balasini C, Canales H, Reina R, Estenssoro E: Incidence and clinical effects of intra-abdominal hypertension in critically ill patients. Crit Care Med 2008, 36:1823–1831.

3. McBeth PB, Leger C, Ball CG, Ouelett J-F, Laupland KB, Kubes P, Roberts DJ, Shahpori R, Kirkpatrick AW: Intraabdominal hypertension and intra-abdominal sepsis: critical concepts and possibilities. Int J Intensive Care 2011, Spring:10–19.

4. Reintam A, Parm P, Kitus R, Kern H, Starkopf J: Primary and secondary intraabdominal hypertension – different impact on ICU outcome. Intensive Care Med 2008, 34:1624–1631.

5. Malbrain MLNG, De Laet IE: Intra-abdominal hypertension: evolving concepts. Crit Care Nurs Clin North Am 2012, 24:275–309.

6. De Waele JJ, De Laet I, Kirkpatrick AW, Hoste E: Intraabdominal hypertension and abdominal compartment syndrome. Am J Kidney Dis 2011, 57:159–169.

7. Sugrue M, Buist MD, Hourihan F, Deane SA, Bauman A, HIllman K: Prospective study of intra-abdominal hypertension and renal function after laparotomy. Br J Surg 1995, 82:235–238.

8. Sugrue M, Jones F, Deane SA, Bishop G, Bauman A, HIllman K: Intra-abdominal hypertension is an independent cause of postoperative renal impairment. Arch Surg 1999, 134:1082–1085.

9. Dalfino L, Tullo L, Donadio I, Malcangi V, Brienza N: Intraabdominal hypertension and acute renal failure in critically ill patients. Intensive Care Med 2008, 34:707–713.

10. Ke L, Ni HB, Sun JK, Tong ZH, Li WQ, Li N, Li JS: Risk factors and outcomes of intra-abdominal hypertension in patients with severe acute pancreatitis. World J Surg 2012, 36:171–178

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Medical technology

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Operating in the dark: Casting light on digital surgery Alistair Fleming, healthcare expert at PA Consulting, argues that digitising surgery offers the potential to improve outcomes and enhance the reach of surgery We’re on the cusp of a digital surgery One way to help address these challenges revolution that will democratise access, drive is through Robotic-Assisted Surgery (RAS). efficiency and improve outcomes. Connected, Promising reduced fatigue, a steadier ‘hand’ patient-centric digital solutions are helping and a shorter learning curve, RAS is already to address increasing pressures across helping to extend surgeons’ careers much of the care continuum. and facilitate more consistent However, surgery is still results.

Full relatively data-poor.

RAS also offers the integratio Despite advances, surgeons tantalising potential and regis n still mostly rely on their to extend not only t r a t io n of patien own skill and judgement. the career but within su t data Identifying which critical also the reach of structures to avoid and surgeons, through finally givrgery could diseased tissues to target remote operation. e s u r g eons the infor requires years of training Historically, m and experience but doesn’t communication need whation they en they guarantee outcomes. This technology couldn’t need it skill barrier, coupled with offer the reliability and aging populations, is creating low latency remote surgery a gap between the supply of, and needs (in the order of 1-10ms), demand for, surgeons. but 5G mobile networks and edge Yet MedTech innovation could change this. computing could. Indeed, isolated showcase Data-driven tools can help address skills surgeries have already been performed. shortages, improve outcomes and reduce cost.

This opens intriguing possibilities. Research by the WHO has exposed massive disparities Treat more patients by extending in access to surgery across the globe – the reach and working life of on average, high income countries have surgeons more than 80x more specialist healthcare Surgeons are some of the most highly skilled professionals per-capita than low-income and respected professionals, saving countless countries. Densely populated areas also tend lives and improving the wellbeing of many to be better served than rural communities. more. But the need for such expertise means Telesurgery offers the potential for surgeons they’re in short supply. At the same time, to deliver their skills into these underserved skill and experience levels can vary, and the communities, despite being in a different part physical demands of the job can limit careers. of the world.

Capitalising on the potential of 5G will require broad collaboration. The ITU (a specialised agency of the UN) helps to guide technical communications standards. They identified the ‘Tactile Internet’ as a concept embodying reliability and imperceptible time-lag, possibly using predictive AI, to enable remote haptic interactions, with application from healthcare to transport, education and culture. Since every link in the chain must support the requisite speed and robustness, RAS developers will need to engage with technology specialists, becoming systems integrator between hospitals, communications and cloud providers and regulators.

Optimise treatments though access to real time information Robotic arms can make the job of operating easier, but the surgeon still needs to know what to target, how to get there and what to avoid, and technologies are coming to aid these decisions.

Already, pre-operative imaging is continuously improving diagnostics, enabling detailed planning, and this data is finding its way into the operating room (OR).

In orthopaedics and neurosurgery, intraoperative registration (overlaying scan data in real time) is relatively easy and has enabled solutions to guide, or even automate, aspects of surgery. But for most soft tissue procedures, registration is a much bigger challenge. Effective solutions in this space E Issue 22.2 | HEALTH BUSINESS MAGAZINE

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DermaBlade®

Flexible one-piece device Designed by a dermatologist Smooth, clean excisions Individually packaged Our DermaBlade® for shave biopsy is designed to give you the flexibility to remove surface protuberances or deep lesions, while maintaining control throughout the incision.

This blade was designed with the input of a dermatologist and through a proprietary process involving steel selection, heat treatment, polymer coating and precision edging to create a controlled excision tool with a sharp, smooth, resistance-free shave biopsy.

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BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

 might require a mixture of pre-operative data and multi, or hyper-spectral, imaging, with the associated image processing and modelling. Hybrid ORs add the potential to incorporate other imaging such as CT and MRI, but these suites are costly and limited to larger institutions.

Aside from imaging, real time data acquisition can include signals from biomarkers, electrochemical responses, vitals and mechanical feedback. The objective with all these technologies is to help surgeons navigate their way to better outcomes.

Bringing this wealth of patient data and live feedback into the OR can also create challenges. Surgery requires intense focus, so information provision must meet three basic tenets: it must be timely, relevant and easily assimilated.

For example, solutions are appearing that use Augmented Reality to overlay visual feeds with imaging data, real-time feature identification and procedure metrics. These tools promise much, but innovators will need to engage clinicians throughout the development process to ensure the right balance of value to cognitive load.

Reduce the economic burden by personalising care and optimising resources From genomic profiling to symptom tracking, the proliferation of digital health solutions is generating deeper insight that can steer treatment towards more precise care and more cost-effective approaches. This is just as relevant in the OR as it is in the wider care-continuum. Patient history can impact surgical events, and the outcomes of specific

Promising reduced fatigue, a steadier ‘hand’ and a shorter learning curve, Robotic-Assisted Surgery is already helping to extend surgeons’ careers and facilitate more consistent results surgical interventions could drive bespoke rehabilitation plans.

To extract the most valuable insights and unlock the greatest benefits from digital surgery, datasets from diverse sources will need to combine. This presents some tough challenges. The security, (and public perception of the security) of patient data is paramount and has led to increasing regulation.

Meanwhile, common data standards are yet to crystalise. As a result, data controllers and processors are grappling with how best to access and share information effectively.

From technology developer to provider, payer to government, and in the current rush for data, all stakeholders have a part to play in solving these challenges. We have seen that with clever use of anonymisation, population-level aggregation and consentbased access to patient data, new insights can drive more precise care without compromising patient privacy.

This requires collaboration and the onboarding of people with new skills and capabilities, such as data scientists, machine learning engineers and cyber and privacy experts. Obtaining such a range of new expertise might require partnerships with third parties.

Medical technology

Sponsored by

The holy grail for surgery remains to be true intraoperative, patient-specific knowledge that guides surgeons to the best possible outcomes. Surgery offers infinitely more certainty than in its early days, but it’s still hugely challenging to navigate delicate vessels and nerves, to find malignancies and disease with pinpoint accuracy, and to precisely deliver the right intervention. Full integration and registration of patient data within surgery could finally give surgeons the information they need when they need it.

Digitising surgery offers the potential to improve outcomes, reduce costs, extend careers, enhance the reach of surgery, improve rehabilitation, aid training and lower the bar to proficient 21st century surgery. To realise this potential will require careful selection and deployment of leading-edge technologies alongside creative collaborations and a comprehensive appreciation of the unique complexities and pressures of the OR. L FURTHER INFORMATION www.paconsulting.com/ industries/healthcare

Issue 22.2 | HEALTH BUSINESS MAGAZINE

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DESIGN & BUILD

Yewdale launches new anti-ligature curtain track

Leading shading and privacy manufacturer Yewdale has introduced the new K2500 safety curtain track to its YewdaleKestrel® anti-ligature range to help keep staff and service users safe from harm in high-risk mental health settings.

Designed with safety in mind, the new track fits flush to the wall eliminating the risk of its use as a weapon. Unlike similar tracks, the curtains are attached to the anti-ligature gliders so when put under an excess load of 20kg or more the curtains will fall away from the gliders leaving them securely in place on the track.

The curtain is then easy for staff to re-install to the gliders.

Wipe clean and simple to install the track requires no maintenance apart from regular damage inspection. The K2500 is ideal for high-risk mental health settings, care homes, and detention centres where there is a risk of violence.

Yewdale has extensive experience and expertise in manufacturing fail-safe antiligature products including blinds, curtain tracks, shower tracks, en-suite safedoors and room/ en-suite accessories such as towel rails, shelves, coats hook etc.

For more information on this new reduced-ligature track or to receive a demonstration, contact Grant below.

FURTHER INFORMATION Tel: 01268 570900 enquiries@yewdale.co.uk www.yewdale.co.uk

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

58

Alpine HC Limited

IFC

Asckey Data Services

30

B Medical Systems Sarl

IBC

Bramfitt Technology Labs

16

Call-Systems Technology

20

CloserStill Media

25

Connected Safety Net Ltd

46

Cornerstone DM

14

Dukefield Group

36, 50

Fellowes Ltd

40

Focus Games Mtd

12

Glasdon UK Ltd

34

Honeywell Commercial

4

INFORMATION TECHNOLOGY

4C Strategies – Independent ICT Consultants 4C Strategies is an independent ICT consultancy specialising in technology and infrastructure projects.

The company covers all aspects of technology and infrastructure in the enterprise environment, with consultants showing demonstrable experience in helping clients to procure new technologies to meet their business requirements, providing endto-end support on ICT projects by delivering a portfolio of consultancy services to meet client requirements, from audit and strategy through to procurement, implementation and resourcing.

4C Strategies has been assisting organisations in the healthcare industry for over 20 years. Expertise covers

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all aspects of IT technology and infrastructure, including: digital strategy, IT and technology strategy, data centres, servers and storage, patient data security, desktop telephony, Microsoft Teams and wide area networks.

Trevor Nelms, Director from West London Mental Health Trust, said: “4C Strategies has assisted in a range of complex ICT projects, from inception through to deployment, and demonstrated a rare ability to bring together technical expertise with business acumen and tight project management skills.”

Contact one of 4C Strategies’ qualified healthcare technology consultants today. L FURTHER INFORMATION Tel: 01858 438938 nhs@4c.co.uk www.4c.co.uk

ISS Mediclean Ltd

28

Jones AV Ltd

22

Keytracker Ltd

48

Media Space Ltd (Big Dug)

34

Murray Equiptment Co Ltd

38

Philips Monitors MMD Monitors

preOx.RS GmbH

Radar Healthcare

Randstad Solutions Limited

18, 19

OBC, 56

24, 27

8

Saville Group Ltd

42

Segmentation Group Ltd

48

Venesta

10

Yeoman Shield

32

Yewdale Corp

6, 60

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net

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preOx.RS GmbH

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for health

• german medical device manufacturer • focus on patient and user safety as well as easy handling • produce high quality products such as Intraabdominal Pressure Monitoring Device or Thoracic Lavage Catheters • provide alternatives for discontinued medical devices by big players due to new Medical Device Regulation (MDR)

preOx IAP-Adapter-Set treatment kit for measurement of Intra Abdominal Pressure (IAP) during Abdominal Compartment Syndrome (ACS).

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preOx IPS-CATH • double lumen 26CH Thoracic catheter without trocar • 2 mm flushing channel • Luer Lock injection valve • 50 cm long • used for pleural lavage e.g after thoracic surgerery.

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