ISSUE 22.3 www.healthbusinessuk.net
A PERMANENT SOLUTION Crown Commercial Service launches its new Permanent Recruitment Framework
PLUS: DESIGN & BUILD | PROCUREMENT | PARKING | FACILITIES MANAGEMENT
THE K08 FIXED MOUNTING PLATE Keeping staff and service users safe from harm in high-risk mental health environments Antitamper fixings
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The decision making process is final Collaboration is certainly nothing new to the NHS, but the debate about whether another round of structural reorganisation is the best way to augment this has already been had and is happening on 1 July when 42 Integrated Care Systems come into play. They vary widely in size and structure, and at the time of writing, half have not yet selected a chair of their partnership board. In any organisation, large or small, the decision making process is key. Some ICS will cover more than 10 upper-tier local authorities, with vast regional disparities and varied political interests to consider. Aligning these in order to address chronic workforce shortages, a huge patient backlog and the urgent need to join-up information systems (four out of five ICS are a ‘long way off’ electronic patient record convergence, according to the HSJ) is a challenge in itself. Thankfully, the frontline NHS has a long history of coping with challenges. From the get-go, the ICS boards need to be exemplary in collaborative efforts to provide it with the means to do so. Both the Health and Care Act and The Fuller Stocktake (p11) recommendations are light on detail regarding this. Action to address NHS workforce issues is critical. In this issue, we detail CCS’s new Permanent Recruitment framework (p19) and take a brief look at how recruitment and retention premia can be used to attract staff (p15). The NHS is ahead of the net-zero game, but to get there you’ll need the right measuring tools says Stephen Lowndes of the Carbon & Energy Fund (p33).
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In technology, NHS Digital Security Specialist Victoria Axon details how collaboration is key to addressing cyber security concerns (p51), we take a look at the BCS’s ideas for a ‘clinical satnav’ (p61), plus James Foster of Hill Dickinson explains how procurement changes could affect how IT contracts are awarded (67). We welcome your feedback. Danny Wright, acting editor
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Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Contents Health Business 22.3
Capital funding delays stall backlog progress; New pharma deal for antimicrobials; MHRA to amend medical device regulations
The British Parking Association explains
parking since the pandemic
Set to have a profound affect on the way the NHS operates, HB reviews the final Fuller Stocktake
45 Medical Equipment
HB details the Crown Commercial Services new Permanent Recruitment Framework plus news on overseas recruitment and staff incentives
25 Procurement Recent developments in the government’s post-brexit shake up of NHS buying include the formation of a Central Commercial Function
29 Facilities Management NHS Shared Business Service’s new Hard FM Framework includes a provision for low-carbon supplier reporting as well as Covid-secure access control
various reorganisations of hospital
Medical Technology Group calls for a ringfenced medical devices fund to stimulate
47 Healthcare Technology Data Saves Lives strategy looks to reassure the public; US firm Palantir expected to land Federated Data Platform contract
51 Cyber Security NHS Digital security specialist Victoria Axon explains how the NHS Cyber Associates Network (CAN) plays a big part in making sure the NHS remains vigilant to the latest cyber threats
61 Technology A dive into the BCS, the Chartered
31 Design & Build
Institute of IT’s thought-provoking
The latest on NHS Property Services’ Whitechapel development, which brings together a number of partners to develop a life sciences cluster next to the Royal London Hospital
document on computer-driven clinical
Stephen Lowndes of the Carbon & Energy Fund explains how the NHS can continue to lead the way towards net zero with the use of sophisticated reporting tools
37 Fire Safety New and existing NHS buildings need to ensure compliance with two separate pieces of legislation which meet recommendations from Phase 1 of the Grenfell enquiry
Health Business magazine
support - the ‘clinical satnav’
67 Tech Procurement New procurement regulations are coming into force as the pandemic has
how its members have responded to
accelerated the adoption of digital technologies by the NHS. James Foster of Hill Dickinson explains the rules and how they might change when awarding contracts for technology
71 Technology News A new GP Services framework from NHS Digital; UK Health Security Agency licenses AI-driven reader
www.healthbusinessuk.net Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Lack of capital investment hindering progress on backlog, say leaders Nine in ten health sector leaders say their efforts to reduce the size of the waiting list are being hindered by a decade-long lack of investment in buildings and estate. The latest flash poll of NHS Confederation members reveals that a lack of capital funding is putting paitent safety at risk, and that plans for patient services to meet current NHS Long Term Plan targets cannot be met without further capital. Over the ten years to 2020, capital spending in the NHS has been around half that of other OECD countries. The Confederation says that increases in the 2021 Spending Review fall short of what is required to stem the tide of underinvestment racked up over the last decade.
As well as urging the government to revisit capital funding in the Autumn Budget to address the shortfall, the Confederation stresses that already promised funding should be released immediately for work to begin on new builds and address the maintenance backlog. In East London, it has been reported that work on developing the ‘not fit for purpose’ Whipps Cross Hospital has ground to a halt due to delays in the release of funding which was agreed in October 2020. The hospital, run by Barts Health NHS Trust and one of eight ‘Pathfinder’ projects, is now unlikely to be finished before 2027, NHS Confederation chief executive Matthew Taylor said: “The government launched these
flagship new builds with much fanfare, but NHS leaders are becoming increasingly frustrated that the money isn’t following through. The fear now is that some of these schemes may never see the light of day.” Shadow health secretary Wes Streeting has written to the National Audit Office to call for an enquiry into the delays. He said: “NHS trusts are still waiting to be allocated funds to begin construction two and a half years on from the general election. This is despite many of these planned building works only being alterations or refurbishments, not in fact ‘new hospitals’. READ MORE
NHSPS makes new pledge towards net-zero with Green Plan NHS Property Services, which manages more than 10 per cent of the NHS Estate, has published its ‘Green Plan’, which outlines steps to be taken before the end of the 2024-25 financial year to support the NHS’s transition to net-zero emissions by 2040. The NHS has reduced its emissions by three per cent on average each year since 2010, but that rate will need to reach eight per cent to achieve the long-term climate target. The plan includes a commitment to transition its 800 service vehicles and 130 company cars to electric. The organisation is in the process of developing an EV strategy, detailing plans for installing vehicle charging points and for procuring new vehicles. Also planned is a review of the staff travel policy, to better encourage other lower-emission methods of transportation like walking, cycling, car sharing and using public transport. Other key commitments from NHSPS include using technology to help mitigate paper use and
provide web-based patient services; creating biodiverse outdoor spaces; ensuring the efficient use of indoor spaces, and promoting low-carbon approaches to construction and minor works. There are no new major targets on waste and renewables. NHSPS has achieved a 99 per cent diversion rate from landfill for waste and switched to 100 per cent renewable electricity. Nonetheless, the Green Plan document states that plans are in place to continue optimising waste and energy management. NHSPS’s head of energy and environment Cameron Hawkins said: “The
relationship between our health and our environment are inherently linked. It is vital that sustainability values are embedded in everything the NHS does, so that together we can improve the health and wellbeing of the communities we serve.” NHSPS is also opening one of the first net zero health facilities this summer. The Devizes Health Centre in Wiltshire will use heat pumps and solar panels, reducing fossil fuel reliance. READ MORE
Moderna strikes deal to bring vaccine manufacture to the UK Moderna will start to build both a new mRNA research-and-development center and a large manufacturing facility this year, the government has announced. The outlined agreement lays the groundwork for detailed talks with the intention of establishing a long-term partnership, the government said. While the location of the facility and the terms of the deal were not disclosed, the government said the deal will provide UK patients with “guaranteed access to Moderna’s COVID19 vaccine” and the ability to produce jabs targeting a range of other illnesses, such as flu and respiratory syncytial virus (RSV). The mRNA Innovation and Technology Center will develop new vaccines for COVID-19 that
can protect against multiple variants, as well as build on existing mRNA research into cancer, dementia and heart disease. The manufacturing facility will also be able to scale up production rapidly in the event of a health emergency. The facility is intended to also be activated on an urgent basis to support the UK with direct access to rapid pandemic response capabilities and will support the UK in its global efforts as part of its ‘100 Days Mission’ to reduce the impact of future pandemics. Clinical trials will also be carried out in the UK, as part of the deal. In April, Moderna announced plans for a manufacturing facility in Quebec, Canada, which is expected to become operational in 2024.
Issue 22.3 | HEALTH BUSINESS MAGAZINE
PRIMARY CARE REFORM
New strategy for Allied Health Professionals In advance of Integrated Care Systems coming online, the Allied Health Professionals (AHP) has published its latest strategy document, handbook and guidance for senior leaders. The strategy ‘AHPs Deliver’ aims to reflect how AHPs in all areas of practice should work in multidisciplinary teams and takes considerations from over 21,000 stakeholders. AHPs are the third largest clinical workforce in the NHS. The new strategy sets the scene for the imminent NHS structural changes and takes into account experiences from the impact of COVID-19 on its 14 professional services. Looking forward to the next five years until 2027, it builds on the inaugural ‘AHPs into Action’ strategy which articulated how each profession could be deployed to transform health, care and wellbeing.
Chief Allied Health Professions Officer Suzanne Rastrick OBE, said: “The strategy is a catalyst for change. Wherever you work, every member of our AHP community has a part in realising our collective ambitions through its delivery.” Alongside the new strategy, Allied Health Professionals within Integrated Care Systems leadership guidance details the importance of including the professions in collective decision making and how to maximise the opportunities to improve the NHS that the new ICS structure should create. The Chief Allied Health Professionals handbook will help Trusts and ICS looking to create a chief AHP role. It notes that despite a growing body of evidence, there is still wide variation in the approach trusts are taking when developing these roles and their position in the organisational structure. The Chief Allied Health Professions Officer
Government plans to reduce Friday prisoner releases
MHRA to amend Medical Device Regulations
Selected offenders’ releases will be brought forward to prevent release on a Friday when support services shut down for the weekend. Figures show that around a third of offenders currently leave prison on a Friday – giving them little time to arrange accommodation, register with a GP and sign-up for job support, which can lead to early re-offending. Under plans announced by Prisons Minister Victoria Atkins, offenders with severe mental health needs, addiction or mobility problems will be released up to 48 hours before their Friday release date, with strict security screenings in place. British Medical Association forensic and secure environments committee chair Marcus Bicknell said: “The committee has actively lobbied the Ministry of Justice to avoid releasing prisoners close to weekends and bank holidays when access to key services such as drug treatment agencies, pharmacies, the NHS, social support and accommodation is typically reduced.” READ MORE
Follwing the UK’s exit from the EU, the Medicines and Healthcare products Regulatory Agency is to amend the Medical Devices Regulations 2002 and introduce a new regulatory framework. It will extend the scope of regulations to capture certain non-medical products with similar risk profiles to medical devices. The MHRA says that the new regulations will provide greater assurance on both the performance and safety of the highest-risk medical devices, such as those which need to be implanted. To signify products have met the new standards, they will carry the UK Confirmty Assesed (UKCA) marking, replacing the CE mark. In the response to a consultation last year, which asked for views on how devices
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(CAHPO) Awards will this year be held on 13 October. Now in its sixth year, the Awards demonstrate the role AHPs play in helping to deliver the ambitions set out in the NHS Long Term Plan. This year, categories include the innovation and improvement within integrated care systems award. READ MORE
are assessed before being placed on the market including importer and distributor obligations and post-market safety monitoring, Health Secretary Sajid Javid said: “I am also determined to eradicate bias, however inadvertent, when it comes to medical devices, and I have appointed Dame Margaret Whitehead to establish the extent of this issue and recommend what action can be taken.” Engaging with industry and stakeholders, the MHRA plans to gradually phase in new requirements with transitional arrangements to provide enough time to adapt to the changes. READ MORE
Javid accepts recommendations of health and care leadership review which NCF chief says “does little to inspire confidence” Health and Social Care Secretary Sajid Javid has announced his department’s acceptance of all seven transformative recommendations put forward in the recent ‘independent’ review of health and adult social care leadership, published on 8 June. While Sir Gordon Messenger and Dame Linda Pollard’s review recognised current pressures faced by the workforce and identified many examples of inspirational leadership, it found overall there was a lack of consistency and coordination - in particular that there has developed over time an “institutional inadequacy” in the way that leadership and management is trained, developed and valued. The review recommends a new entrylevel induction for all who join health and social care, and a mid-career programme for managers along with action to improve
equality; consistent management standards and training; a simplified appraisal system; more effective recruitment of non-executive directors, and; incentives to encourage top talent into leadership roles. The report will be followed by a delivery plan with clear timelines on implementing agreed recommendations. Professor Vic Rayner OBE, chief executive officer of the National Care Forum, said: “While Sir Gordon Messenger is right in his assertion that there is support for greater parity of investment in social care leadership, it is a completely wasted opportunity that this report does not highlight how and where that should happen. With just over three weeks to go until the new Integrated Care Systems are put on a statutory footing, it does little to inspire confidence. The report struggles to
Vic Rayner OBE
identify how to translate a single message about collaborative leadership into action across an entire system that stands or falls on collaboration.” READ MORE
Two new antimicrobials to be made available under groundbreaking NHS pharma deal
UK must focus on diagnostics to cut AMR, says review chair
The NHS has signed a deal for two antimicrobial drugs for use where current treatments are no longer effective. Announced at the recent NHS ConfedExpo, Shionogi’s Fetcroja (cefiderocol) and Pfizer’s Zavicefta (ceftazidime–avibactam) will be made available to treat increasing numbers of people developing antibiotic resistance. In a new type of pharma deal, the firms will receive a fixed yearly fee based on a health technology assessment of their value to the NHS, rather than the volumes used. NHS England says this ‘reimbursement model’ represents value to taxpayers. Issued in April this year, draft NICE guidance specifies that the drugs should be restricted for use as risk-based empiric treatment, or in cases of difficult to treat resistant infections, where few alternative treatment options exist. This restriction makes investment unattractive for pharma, but in the new deal, payments
will reflect the value of holding back new antimicrobials that infections have not become resistant to. NICE is the first health technology assessment organisation in the world to attempt to estimate the full value of an antimicrobial in this way. The maximum contract value is set at a level where payments would represent an incentive for investment should other countries pay similar sums, up to a maximum of £10 million a year for up to 10 years. Blake Dark, NHS commercial medicines director, said: “Working closely with partners at NICE and with Shionogi and Pfizer, we know we’ve done something really special here and I’ve been delighted by the number of countries contacting us to ask how they can learn from this revolutionary approach”. READ MORE
Politicians have failed to grasp the importance of new diagnostics to cut unnecessary use of antibiotics, the chair of a government commissioned review on antimicrobial resistance (AMR) has told MPs. Antibiotics make up one in five prescriptions in healthcare. Baron Jim O’Neill of Gatley’s Review in 2016 concluded that, if left unchecked, AMR could account for an estimated 10 million deaths globally per year by 2050. Giving evidence to the Science and Technology Committee, O’Neill said the latest research suggests the figure could be twice as high. He said he was pleased that there had been progress on some of the 2016 report’s recommendations, particularly reducing unnecessary use of antimicrobials in agriculture, but stressed the importance of diagnostic technology in reducing antibiotic use: “Where it has been woeful is on diagnostics. It is alarming to me that we are not embedding state-of-the-art technology in the middle of our systems. This can really make a huge difference about whether an antibiotic is necessary or not.” O’Neill also called for a greater use of vaccines in agriculture to prevent antibiotic use as a treatment, and suggested pharma could be incentivised to research this, as there are “very few infectious diseases that warrant the same attention as AMR.” Lord O’Neill’s book Superbugs: an Arms Race Against Bacteria was published in 2018. READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Connecting people and places to make the world work better www.uk.issworld.com
Fuller Stocktake: No shortage of ambition Perhaps one of the most important documents in recent health service history, the Fuller Stocktake: Next Steps for Integrating Primary Care throws down highly ambitious plans to improve population health by streamlining access to care and advice The Fuller Stocktake Report, Next Steps for Integrating Primary Care, landed in late May to a fairly warm reception. Commissioned by NHS England and NHS Improvement with the aim to find out what is working well in integrated primary care, why it is working, and how implementation of integrated primary care can be accelerated, it provides recommendations for how the newly formed Integrated Care Systems (ICS) can support integrating primary care with a focus on local population-based care. Dr Claire Fuller, who is herself the chief executive of an ICS in Surrey, and a GP, engaged with around 1000 people across the health sector. The ‘new vision’ is built around three main offers: to streamline access for people who get ill but use health services infrequently, providing them with more choice and ensuring care is always available when needed; to provide proactive and personalised care from multidisciplinary teams for people with complex needs; and to help people stay well for longer with an ambitious and joined-up approach to prevention.
Set out in four main sections, building integrated teams in every neighbourhood; improving same-day access for urgent care; creating the national environment to support locally driven change; and hard-wiring the system to support change, it concludes with a framework of 15 actions by which to track progress, with most of the detail to be thrashed out by the 42 ICBs as they come online on July 1st.
Avoiding peverse incentives On publication, Professor Martin Marshall, chair of the Royal College of GPs, said: “We need further detail about the proposals around streamlining urgent access. Any new metrics will need to be thought through carefully so they have a positive impact on patient care, and avoid any duplication or perverse incentives across the system. Addressing workforce and workload pressures, improving staff morale and investing in support for change will be particularly key to achieving the report’s aspirations.” ICBs - an opportunity Professor David Colin-Thomé OBE, chair of It’s fair to say the report landed at a highly PCC and formerly a GP for 36 years: “When challenging time. With significant I read this stocktake admittedly backlogs of care, major rapidly, I thought a ‘same old’ workforce challenges, NHS document in which as A d dressing rapidly rising demand usual primary care must workforce and a tight financial be subsumed into a pressures, settlement, it can faceless big is beautiful im be difficult to bureaucracy. On a staff mora proving envisage how most more thorough read, I le a nd investing of the stocktake’s was wrong and feel it in s u pport for change w recommendations a positive contribution ill be partic can be addressed respecting what u la k rly ey to achie without a different primary care has kind of stocktake. the repor ving t However, the document aspiration ’s acknowledges this and s does well to articulate the collaborative processes and neighbourhood level integrations that have given rise to its recommendations. The report states that ICBs have an opportunity to use their scale and combined power to develop relationships between sectors, but that integrated working needs to be “rooted in a sense of shared ownership for improving the health and wellbeing of the population. They should promote a culture of collaboration and pride and build relationships and trust between primary care and other system partners and communities.”
achieved, and the opportunity for it to be a real leader in improving the ailing NHS.” “The stocktake is just that, a taking of stock, but the message is clear as to me it always has been – do not abdicate sole responsibility to government and then complain about the ensuing policy. It is up to all of us to be the policy developers by utilising the vehicle of change being offered. The Fuller stocktake is of great value but only if it ensures the commitment that is seemingly promised, of ‘buy in’ by current senior leaders and thereby enabling local services to have a locus of control. The best leaders keep control by letting go.” The stocktake was accompanied on publication by The King’s Fund report Levers for change in primary care: a review of the literature, which, near conclusion, makes a general point about NHS reform: “While the delivery models in primary care have only changed in a limited way since the creation of the NHS, structural change in the commissioning and oversight of primary care has been a constant theme. There is limited research evaluating the precise effects of the various structural reforms to the NHS over the last decade in terms of their effects on change and improvement in primary care.”L FURTHER INFORMATION The Fuller Stocktake: tinyurl.com/yc2k5y6a Kings Fund: Levers for change in primary care: a review of the literature tinyurl.com/mwjbtpcm
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Take the next step on your net zero journey The NHS alone contributes 4% to the nation’s carbon emissions, and over a third of the public sector’s emissions. However, this has certainly not gone unnoticed, as efforts to tackle its emissions are underway in earnest
The follow up to COP26 has seen 47 countries, including the UK, sign up to its COP26 Health Programme, following the initiatives to build climate resilient health systems; develop low carbon sustainable health systems; conduct adaptation Research for Health; include health priorities in Nationally Determined Contributions and raise the voice of health professionals as advocates for stronger ambition on climate change. The NHS itself has been working on its own commitments through its Green Plan, unveiling its ambition to be the first healthcare service to become net zero. But, in order to achieve this goal, NHS estates must be equipped with the right people that have the time, the expertise and the experience to drive net zero goals. Going back to basics To maximise investment in energy efficiency, there is plenty that can be done to engage staff and change behaviours. Effective behaviour change can reduce energy usage by up to 20%, and with this opportunity at arm’s reach, it can be hugely beneficial to implement a strategic staff behavioural training programme. Holding regular workshops is an engaging way to educate staff members on the importance of energyefficient habits. But consistency is key, which is why regular training must be scheduled into annual plans. Having this in place will ensure staff are frequently educated on the topic and are more likely to turn learnt behaviour into long-term habits. Nominating an energy champion can ensure the best success, helping to ensure that energy efficiency training is being monitored and enforced, while setting challenges can be a fun and engaging way to eliminate any unnecessary energy wastage in NHS estates.
technology that relieves their staff of any further pressures. Estates managers now need to urgently put their heat decarbonisation plans into action and act quickly to respond to new rounds of public sector funding or engage a partner to support them in their efforts to rapidly move towards a low-carbon heated NHS estate that will help accelerate their progress against net zero targets. The time is now Taking the next step forward is crucial to fulfil the NHS’s ambitions to be the first net zero healthcare service, but it requires the correct resources. It takes time and the right people with the right skills and expertise to guide your path to net zero. There are plenty of energy efficient technologies out there, but identifying what is best for your estate, to create the best opportunities for reducing carbon emissions and achieving net zero targets, is a difficult task. The vital question is whether estates have the internal team to measure, prepare and deliver these strategies. And in a time where the NHS is battling crisis after crisis, engaging a partner could put your estate on the fast track to net zero. Zen Zero If it hasn’t already, your journey to net zero can start today and Zenergi can support your organisation every step of the way. We pride ourselves on delivering reliable and practical advice, which is then underpinned by credible
Taking the next step: Decarbonising heat Although effective, energy efficiency training can only take net zero goals to a certain point. With staff overwhelmed and overworked and the ongoing effects of COVID-19 still being felt, estates managers need to implement
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solutions with clearly identifiable benefits. Put simply, not only does this mean we can help you get started by creating a baseline and setting a net zero target, but we can also work with you to define and achieve the roadmap that meets your objectives. Zenergi’s Zen Zero framework is a proven approach that will deliver sustained benefits across your organisation – from increased profit through strategic energy efficiency programmes, while reducing the risk from rising energy and carbon prices, to assisting the UK nationally to provide security of energy supplies and supporting the transition to a low-carbon economy. Powering a sustainable future Zenergi Group is also proud to have launched our social value strategy, ‘Powering a Sustainable Future’. This ambitious plan confirms our numerous commitments to helping reduce our own impact on the planet. For this reason we are proud to have committed to be net zero for Scope 1 and 2 by 2025. This means we can share experiences from our own personal journey, in addition to bringing the knowledge we’ve built by helping organisations of all shapes and sizes. L FURTHER INFORMATION www.zenergi.co.uk/our-services/zen-zero www.zenergi.co.uk/social-value 023 8028 6300
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RUH celebrates arrival of 300th international nurse
(l to r) Edah Bellezar, Mandy Rumble, Mark Doblas, Carla Cadano. Photo © RUH
A recruitment strategy by the Royal United Hospital (RUH) in Bath has seen the 300th nurse relocate from overseas to work at the hospital. The milestone comes after the RUH launched an international recruitment campaign in 2018, which has seen it welcome nurses from countries all across the world including the Philippines, India and Tibet. International recruitment is one part of the RUH’s overall recruitment strategy, which includes apprenticeships, supported re-entry
routes for qualified nurses and midwives who have left the profession but wish to return, and supervision and mentorship for students taking a traditional degree-led training pathway. Mandy Rumble, divisional director of nursing, who led the launch of international recruitment at the Trust said: “Since the inception of the NHS, patients have benefited from the expertise, commitment and compassion of staff who have come to work in the NHS from around the world. Our
international nurses make such a difference to both our staff and patients and we are so grateful for the enormous contribution they make to the RUH.” Mark Doblas, lead clinical practice facilitator, who leads the team that supports international nurses at the RUH, said: “When nurses come from overseas to work with us, we want to make sure they settle into their new country and job as easily as possible.” “Many of our international nurses come to Bath alone, without any family or friends, so another key focus for us is making sure we provide opportunities for people to meet other staff across the hospital and build support networks.” An event to celebrate the 300th international nurse at RUH was attended by 170 members and included a performance from a band of international nurses called ‘Are you Okay’. Flowers were given to Edah Bellezar and Carla Cadano (pictured) in recognition of their positions as the first and 300th international nurses to join the RUH Trust. READ MORE
Large rise in nurses recruited from countries with severe workforce shortages Figures from the Nursing and Midwifery Council (NMC) show a ten-fold increase since the 2019 general election in the number of nurses joining the register from countries currently identified as having the most severe workforce shortages. New joiners to the UK nursing workforce include recruits from 14 countries on a ‘red list’ of 47 that the UK government insists should not be actively recruited from. The analysis comes weeks after the NMC confirmed almost half of all new joiners to its register were from overseas in the most recent 12 months. The increases have led the RCN to call for investment to expand the domestic workforce and to introduce bilateral agreements – with the involvement of national nursing associations – to ensure all international recruitment is mutually beneficial for these countries. RCN general secretary & chief executive Pat Cullen said: “Ministers are overly reliant on nurses from countries with critical workforce shortages. Meanwhile, their lack of investment in UK nursing staff – both today’s and those of the future – is deeply concerning. “Our health and care workforce is proudly diverse. International recruitment must be ethical, beyond reproach and come at the same time as increased investment in education and domestic professionals.”
International Council of Nurses (ICN) chief executive officer Howard Catton said: “Individual nurses who aspire to live and work overseas must have the freedom of movement to do so, but the countries that are driving the process need to be sure they are not exacerbating shortages in lower income countries and widening existing global inequalities. They can do this by educating more nurses and aiming for self-sufficiency in their domestic supply line, improving the retention of those they already have and by looking at how they can offset and compensate the costs of training nurses, which they are, in effect, currently exporting to less wealthy countries.” Caroline Waterfield, director of development and employment at NHS Employers, said: “The Government’s Code of Practice for international recruitment into the NHS helps employers ensure they are adhering to ethical recruitment practices. However, it is important to acknowledge that people from any country can apply for NHS jobs individually. “Whilst international recruitment has played a valuable role in helping to grow the nursing workforce this has been coupled with an emphasis on recruitment into university nurse training programmes and the degree apprenticeship scheme.” “Nurse degree apprenticeships have been very successful and NHS employers would
welcome continued support and funding to grow both this model and sustain placements for university students, especially in mental health and community settings.” READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
RCGP members survey warns of severe GP shortage
The latest Royal College of General Practioner’s survey warns of a mass exodus of GPs over the next five years if steps are not taken to address intense workload and workforce pressures. There are currently more GPs in training than ever before, with an intake of 4,000 last year. If this level of intake is maintained over the next five years and all trainees enter the profession, it won’t be enough to counter the numbers planning to leave. The College survey of members asked 1,262 GP and trainee respondents, 42 per cent say they are likely to quit the profession in the next
five years, with 10 per cent in the next year and 19 per cent in the next two years. With a workforce headcount of around 45,000 GPs and trainees currently this could mean that patients are set to lose almost 19,000 GPs and trainees. Of those not planning to retire, 60 per cent cite stress, working hours, and lack of job satisfaction as their reasons to quit. 68 per cent say they don’t have enough time to properly assess their patients, with 65 per cent saying patient safety is being compromised due to appointments being too short; 80 per cent expect working in general practice to get
worse over the next few years, compared to only six per cent who expect it to get better. In response, the College is launching Fit for the Future: a new plan for GPs and their patients, which sets out urgent actions for Government to tackle the workforce and workload crisis. It recommends a new recruitment and retention strategy that goes beyond the target of 6000 more GPs. It also asks to return funding for general practice to 11 per cent of total health spend, including £1billion additional investment in GP premises. Professor Martin Marshall, Chair of the Royal College of GPs, said: “The College has been sounding alarm bells about the intense pressures GPs and our teams are working under, and the urgent need for support, since well before the pandemic, but Covid has only exacerbated the situation.” “Our survey results should act as a stark warning for politicians and decision-makers – and we urge them to take heed of our campaign. This outlines what is needed to make general practice fit for the future”. READ MORE
Nuffield Trust research examines the use of recruitment and retention premia Research from the Nuffield Trust explores how supplementary payments, or recruitment and retention premia, have been used by NHS organisations across England over the last few decades and how they can present an opportunity to ensure a fairer distribution of staff, or to keep staff working in certain services, locations or specialties. Th research, authored by Lucina Rolewicz and Billy Palmer, states that regional variation in NHS staffing levels can lead to inequalities in people’s ability to access services, care quality and health outcomes. For example, the number of patients per GP varies more than two-fold between local areas, from 2,804 in Hull to 1,318 in Wirral as of June 2021. The research finds that one in 174 hospital and community staff currently receive specific recruitment and retention premia, accounting for some £28 million annually. With NHS funding allocations adjusted to reflect increased reliance on agency staff, higher vacancy and turnover rates and differences in staff productivity in areas with more challenging labour markets, the research estimates that this staffing adjustment had the effect of redistributing £1.5bn of trusts’ total operating income in 2016/17, with Sheffield Teaching Hospitals NHS Foundation Trust receiving £37m (3.4 per cent) less and Barts Health NHS Trust receiving £107m (7.8 per cent) more than
they would without these adjustments. Pay supplements such as ‘London weighting’, first received by NHS staff in 1974, can be considered a form of recruitment and retention premia. Some £986 million was spent on staff who received a ‘high cost area’ supplement such as this in 2021. Recruitment and retention premia across hospital and community health staff costs considerably less at around £28 million. These are offered by individual trusts with value of up to 30 per cent of basic salary While there have been numerous schemes in the NHS that have made use of premia over the last few decades, the research says little is known about the impact and cost-effectiveness of these initiatives. The
policies vary in complexity, scope and nature. Introduced in 2020, the New to Partnership Payment Scheme gives eligible participants a sum of up to £20,000 available to support establishment as a partner, as well as up to £3,000 in a training fund to develop nonclinical partnership skills. In conculsion, the research stresses that a lack of evaluation makes it difficult to see which financial incentives could help solve NHS staff shortages, and the importance of recognsising non-financial incentives that are valued by NHS staff that can be used instead of, or in addition to, premia. READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Permanent Recruitment: Making the framework work Launched in March, Crown Commercial Services new Permanent Recruitment Framework RM6229 lets all NHS organisations with access to recruitment agencies hire permanent, fixed term and internal secondment roles. It replaces the current framework, which expires on 12 November 2022, and provides a way to hire clinical roles through the general recruitment service CCS’s new Permanent Recruitment framework will utilise external agencies on more complex provides access to individual candidate and niche requirements. Whilst placements for clinical and non-clinical it is anticipated that most roles, as well as access to all services in clinical roles requested Early a modular format if required. Core under Lot 1 of the engagem modules include Search, Evaluation Agreement will with sup ent & Appointment while non-core come from NHS p li e r modules are available for Strategy organisations, s before is & Planning, Talent Development with pay s u in g t ender do and Technology Services. and grading can help cuments aligned to them be Regional suppliers those suggested t understa t Suppliers are not required to below, any public nd your er organisa be able to provide on a national sector hirer of tions basis but shall be able to provide clinical and social needs recruitment services in locations in care staff may access and outside of London & The South East, the agreement and where civil service and wider public servants therefore placements may are located throughout the UK, not restricted to be made in accordance with any large cities, and adapting to changing locations applicable pay and grading system of the hiring for Public Bodies. organisation. The framework is divided into two lots - Lot 1, for Clinical General Recruitment, lists 52 Prices suppliers while Lot 2 focuses on non-clinical Framework prices are those submitted by general recruitment, and lists 119 suppliers. suppliers during their framework tender. These Services under Lot 1 and 2 are deemed as Core are based on the salary bandings. Under all Modular or Non Core Modular. Suppliers must call-off contracts, suppliers must not apply provide Core Modular Services if requested by any charges above these framework prices the customer but can indicate whether they are to their call-off contracts, and must use these able to provide non-core modular services at framework prices in calculating the costs of a framework tender. direct award. However, it is possible to agree Most NHS Authorities and Trusts have other fee structures and suppliers are able to dedicated internal resourcing teams that run all apply rates lower than their framework prices general recruitment in-house where possible and during further competitions.
Standards All suppliers must comply with a range of standards. For instance, ISO 9001Quality Management Systems, or equivalent, are required to be in place, as is ISO 22313:2020 Business Continuity. All framework suppliers will hold a Cyber Essentials certificate or equivalent (e.g. ISO 27001) and where customers require Cyber Essentials Plus certification in line with the services set out in the specification, this must be evidenced before services commence. Professional indemnity insurance, public liability insurance and employers’ liability insurance are all required as a minimum. Further competion/direct award There are two ways in which you can instruct a supplier to act under this framework - a further competition, or a direct award. A further competition is when you invite two or more suppliers to bid for your requirement. You will ask these suppliers a number of questions and ask for a price for their services. This is your ‘award criteria’. You will then award a call-off contract to the supplier(s) who best meets your award criteria. A further competition is when you invite two or more suppliers to bid for your requirement. You will ask these suppliers a number of questions and ask for a price for their services. This is your award criteria, which should be in line with the award criteria for this framework. You will then award a call-off contract to the supplier(s) who best meet your award criteria. E Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Supplier engagement Early engagement with suppliers before issuing tender documents can help suppliers better understand your needs, whilst helping you develop a more focused specification. This could lead to a more efficient tendering process and has the potential to increase supplier interest, attract innovative solutions and reduce potential clarifications. If sharing sensitive information, you may want the suppliers to sign a nondisclosure agreement (NDA). You need to ensure that you retain control of your requirements and that they are not dictated by suppliers or provide an unfair advantage to one particular supplier. Capability Matrix There are a number of ways available to help you identify the right supplier(s) for your requirements.The Supplier Capability Matrix is a table that identifies which supplier is able to offer each of the core/non-core modules for the professions and regions you wish to recruit to. Currently available as a spreadsheet, an interactive tool is in development and is expected to be available to download from the CCS website in July. Prospectuses Each supplier has developed an up to date prospectus setting out information on their organisation and details of their experience and expertise in relation to each specialism they provide. Prospectuses should be used to select suppliers for direct awards and can be used to invite suppliers to EOIs and further competitions. Expression of Interest (EoI) EoIs can be very useful at shortlisting suppliers to invite to a further competition, understanding supplier’s capacity and capability restrictions and also gauging any potential conflicts of interest. Following an EoI, you are able to invite suppliers to attend a conference call. During this call you can share further details of your requirement with suppliers. During this call suppliers will have the opportunity to ask questions based on your requirements. E
Features and benefits of using the CCS Permament Recruitment Framework Compliant route to candidates for permanent roles via recruitment agencies Flexibility for hiring managers and departments to choose how and who they engage with from the supplier list
During a further competition, suppliers may be able to offer discounted rates than those provided in their framework prices. A successful further competition does not need to be complicated, or take a long time, but will take some planning and consideration.
Access to capable suppliers leading to increased fill rates and avoidance of repeated campaign costs Ability to direct award – saving time and cost of competing all requirements Capped maximum rates, protecting contracting authorities to market increases Mandatory Core Services covering the identification, attraction, evaluation and offer stages of recruitment activity Access to Core Services in modular fashion Access to non-core modular services covering Strategy and Planning, Talent Development Services, Technology Service, Project PRO etc. Attraction methods (social media, microsites, job boards etc.) built into the cost of the services – no hidden costs Requirement for suppliers to work towards Civil Service Diversity & Inclusion requirements and help contracting authorities to achieve their own D&I ambitions Suppliers required to develop Employer Value Proposition (EVP) to ensure contracting authorities are attractive to the candidate market Supplier Specialisms detailed to ensure access to niche and boutique specialist recruitment agencies including SMEs Discounts built into the pricing for volume and multiple hires Support from the Crown Commercial Service customer team and framework management team is available Management Information is available on demand for all customers to detail reported spend and market analysis Consistent Terms and Conditions Dedicated supplier management from CCS, with KPIs at framework and calloff level Civil Service Recruitment Principles built into the framework
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Need assistance with your recruitment needs? Head Medical, an official CCS Supplier, are experts in recruiting Doctors and Nurses for positions in NHS Hospitals and Clinics across the UK. We can supply Nurses, GPs and Doctors of all grades and specialties from the UK and internationally. Get in touch to find out how we can help you with your requirements. www.headmedical.com 0131 226 2200 firstname.lastname@example.org
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You have a number of similar requirements (matters) that can be included in an overarching call-off contract You feel that a competition will help you differentiate between suppliers in terms of the quality of their ability to act in your matter
You should consider a further competition if:
You feel that a competition will be able to demonstrate savings that will exceed the cost of the time spent in running the procurement
Each supplier has developed an up to date prospectus setting out information on their organisation and details of their experience and expertise in relation to each specialism they provide. Prospectuses should be used to select suppliers for direct awards and can be used to invite suppliers to EOIs and further competitions
There are a number of suppliers that could undertake the work to an acceptable quality standard, in around the same amount of time
Call-off duration Call-off contracts can be of any duration, providing they expire/conclude no later than four years following the framework’s expiry date. Where the duration of the services is to coincide with the end of a project instead of a specific date, you should provide an indicative only date to suppliers, for planning and reporting purposes.
You wish to engage a number of suppliers as a result of the competition (such as co-partnering)
Developing your award criteria Your award criteria set out how you intend to evaluate the tender submission of each supplier or select a supplier for a direct award. You will need to clearly outline your intended award criteria in your tender documentation so that suppliers understand how their tender will be evaluated before submitting a bid. You should award your call-off contracts on the basis of most economically advantageous tender (MEAT). For each direct award and further competition call, you will need to apply the following award criteria: Price - a minimum of 10 per cent and maximum of 90 per cent of total available evaluation scores (relative weighting percentage), and Quality - a minimum of 10 per cent and a maximum of 90 per cent of total available evaluation scores. Direct award criteria When evaluating price in your direct award procedures, you may consider framework prices and the likely time it may take a supplier to undertake the work. When evaluating Quality, you should include an assessment based on the relevant sections of the prospectus such as overview, social value and applicable specialisms. Further competition award criteria When evaluating price in your further competition procedures you may consider life cycle costs, cost effectiveness and price, and
price and running costs. When evaluating quality in your further competition procedures you should concentrate your questioning on those areas which differentiate between each supplier. Social value Regardless of which call-off procedure you use, you will need to consider the inclusion of Social Value, which is defined through the Public Services (Social Value) Act 2013. This requires all public sector organisations and their suppliers to look beyond the financial cost of a contract to consider how the services they commission and procure can improve the economic, social and environmental wellbeing of an area. The key social value priorities set out in this framework are effective stewardship of the environment; tackle workforce inequality and improve diversity; and improve health and wellbeing. Each supplier has committed to delivering against these policy outcomes in each call-off contract under this framework, and has provided information on their social value commitments in their prospectuses. Proportionate committments Ask suppliers to outline what they are willing to commit to in the delivery of your social value priorities during your evaluation. You should consider what would be an appropriate and proportionate commitment from them whilst fulfilling your requirements. This commitment will form part of your calloff contract. However, when you decide to evaluate social value, you should ensure that this is proportionate to the value of your contract and your individual requirements. About CCS The Crown Commercial Service commercial agreements use competition among suppliers
You are seeking to understand the different ways that suppliers could approach the matter, and the benefits each could have (for example, use of automation or process workflows for more routine matters) Your requirement/project will be ongoing for a number of months or even years
You should consider a direct award if: The cost of running a further competition is likely to outweigh any savings that you could get from a competition (typically, you should consider this route if you expect the legal fees to be lower than £50k in total) You need to engage a supplier relatively quickly, and don’t have the time to undertake a further competition procedure You are satisfied from the prospectuses that you can select a supplier to perform the work to the requisite standard using the direct award criteria A specific supplier is undertaking the work, or has previous experience/background of doing so, and engaging them represents better value for money than engaging a new supplier to increase quality and value. In 2019/20, CCS helped more than 18,000 customers achieve commercial benefits totalling over £1 billion of public money by using its framework agreements. L FURTHER INFORMATION https://tinyurl.com/44empuhs
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Buying - the way forward With the introduction the Health & Care Act, new procurement legislation and now the development of NHS England’s new Central Commercial Function, procurement in the NHS is set for big changes over the next two years. Health Business examines recent developments in the government’s post-brexit shake up of NHS buying
The NHS commits over £38 billion each year to running its estates and procuring and managing contracts across primary and secondary care. This covers medical and clinical equipment, devices and consumables along with other capital equipment. In January, NHS England appointed a new chief commercial officer in Jacqui Rock, a member of the NHS Test & Trace Executive Team and a former director of the Defence Infrastructure Organisation where she was responsible for £4bn annual investment across the UK and Overseas Defence estate. She led delivery on hard & soft FM, construction projects across the full military estate. She started public service after 30 years in the Financial Services industry for organisations such as Credit Suisse, JP Morgan, Barclays and Bank of America Merrill Lynch. Her previous roles at the UK Health Security Agency were Chief Commercial Officer, Head of Corporate Services and Transition Director. Central Commercial Function Rock has recently confirmed that a new Central Commercial Function is currently being developed by NHS England which has multiple
Guiding Procurement Pathways aims. These include setting a national NHS Rock was keen to point out that the CCF will commercial strategy, simplifying the multiple not look to make it mandatory for procurement routes through which trusts and the new teams to buy through specified routes. She said: integrated care systems (will eventually) buy ““It’s much more about guiding the goods and services, improving the quality procurement pathways than it of procurement data flowing to the is mandating them. If you centre and ‘professionalising’ Among start trying to mandate, the procurement and the Cent it will actually have a commercial workforce. It r a l Commer negative effect. This will be formally launch cial Function is about helping on 8th July following ’s and facilitating and NHS England’s Public improvin aims will be g making sure that Board approval of hight h e q uality of procu we give them the level intentions. Some and ‘pro rement data pathway and the elements of the service fessiona route to what the are expected to ‘go ‘live’ lisin the proc best options are. in the Autumn. Speaking urement g’ and com On the formation of with Health Service mercial the CCF, The Health Journal, Rock said that workforc Care Supply Association, she envigages “One central e. which supports and advises commercial function that has NHS Procurement Professionals, a service offering, that is branded, commented: “Our organisation that is easy to access, that people know welcomes plans that recognise the unique and is there, that offers all of these different types invaluable contribution of NHS procurement of services. Government Commercial Function. professionals at local, regional, and national E This is being built by the NHS for the NHS.” Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Decision Making An overview of each of the circumstances where the Provider Selection Regime applies, and the kinds of decisions that could be taken – e.g. to continue with existing providers, to select the most suitable provider without competition, or to run a competitive process. Key Criteria Overview Understanding the key criteria that must be considered when selecting healthcare providers, and how to apply these to decisions. Transparency Understanding the transparency requirements of the regime Scrutiny requirements Understanding how decisions can be scrutinised, and how compliance with the regime should be monitored. level and are pleased to see initiatives which help to raise the commercial and professional capability of the NHS procurement profession. At this early stage, we are supportive of what we have seen so far, but we will, as always, be gauging member feedback to ensure we are representing the views of the NHS procurement community as a whole.” Provider Selection Regime The Health and Care Act 2022 will have a major effect on NHS procurement, not least of which to clinical services. The government believes that the new Provider Selection Regime (PSR) will ensure these services are procured in the best interests of patients. The PSR is intended to provide a regulatory framework for the award of healthcare contracts by NHS commissioners and local authorities that sits outside the formal public procurement regime and means that those contracts will not need to be procured in accordance with the rules in the Public Contracts Regulations 2015 or their successor legislation. Current procurement rules can sometimes create a competitive dynamic between NHS organisations and can cause needless disruption due to having to re-tender contracts when services are already working well, or there is no market alternative. The current rules also bring about legal challenges, which drives risk averse commissioning behaviour. These changes to clinical service procurement brought in by the Act will aim to reduce transaction costs and give NHS and public health commissioners greater flexibility over when to use competitive procurement processes. To address concerns that these changes would allow contracts to be awarded to new providers without sufficient scrutiny, the PSR include safeguards such as transparency expectations and a process for decision making.
Current procurement rules can sometimes create a competitive dynamic between NHS organisations and can cause needless disruption due to having to re-tender contracts when services are already working well, or there is no market alternative. Compliance Once it is introduced, organisations, or ‘decisionmaking bodies’ who will have to comply with the PSR include Integrated Care Boards; NHS trusts and foundation trusts when subcontracting the provision of healthcare services to other providers, and; Local authorities and combined authorities when arranging healthcare services as part of their public health functions and as part of section 75 partnership arrangements with the NHS. PSR will not apply to the procurement of goods or medicines, pharmaceutical services arranged under the terms of the community pharmacy contract framework (CPCF) or social care services when not procured alongside healthcare services in a single contract. Recognising that there will be situations where contracts will combine health and social care services, the government is planning consultation on a mixed procurement procedure. Integrated Care Systems come online at the beginning of July this year, and as they develop, commissioners and providers will increasingly work together to design new pathways. PSR will not be established at the same time as integrated care boards, but it is expected to be in place later this year. In the meantime, health commissioners are encouraged not to make future commissioning plans on the assumption that the PSR will come into effect by any particular date. NHS England’s draft guidance “Who Pays” determines which NHS commissioner is responsible for commissioning healthcare services and making payments to providers. Buying digital In March this year, NHS England also issued guidance on the procurement of digital and IT services, endorsing 36 of the 57 frameworks currently in use. These are categorised into six ‘pillars’, with key technical, data and digital standards aligned to each pillar. As Jamie Foster, Commercial lawyer at Hills Dickinson points out, a potential difficulty arises when awarding contracts for technology services because it is not always clear whether what is being procured is a “pure” technology service or clinical service delivered through technology. Foster states: “Until the granular detail of both the PSR and the final text of the Procurement Bill are clear, the rules applying to digital technology and mixed procurement remain unclear.” For now, Foster sees the best option for NHS buyers is to continue to consider the ‘dominant’ aspect principle when awarding contracts, and to look to the growing number of frameworks as the easiest way of awarding them.
A series of overview webinars which explain Provider Selection Regime are currently being planned. These will cover:
Procurement Bill Currently over 350 different procurement regulations spread over a number of different regimes for different types of procurement including defence and security. The introduction of the Procurement bill aims to simplify these and includes a change of evaluation methodology from MEAT to MAT. Evaluating tenders via MAT (Most Advantageous Tender), as opposed to MEAT (Most Economically Advantageous Tender) will allow public sector bodies to include consideration of benefits other than direct cost, such as social value, environmental, or community-based benefits where appropriate. Although not yet available, a learning and development programme, operated by the Government Commercial College (GCC) will be rolled out across the public sector to meet the varying needs of stakeholders. It aims to provide ‘knowledge drop’ and ‘deep dive’ webinars, along with selfguided e-learning. Communities of practice will be established to allowing individuals to reflect on, discuss and embed their learning on the regime change. L FURTHER INFORMATION PSR Training webinars tinyurl.com/4yh3pxc2 Procurement Bill tinyurl.com/2p9byy5c Who Pays? Draft Guidance tinyurl.com/yeyj77wt Applying net zero and social value in the procurement of NHS goods and services tinyurl.com/3ybpwxwb
Issue 22.3 | HEALTH BUSINESS MAGAZINE
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net
A new generation of Hard FM services Made up of 154 suppliers of FM services and able to achieve between five and ten per cent savings, NHS Shared Business Services’ new Hard FM Framework includes a provision for low carbon supplier reporting as well as covid-secure access control From infection control through to the maintenance and upkeep of medical facilities and equipment, keeping a safe environment in healthcare settings has a direct bearing on patient safety and care, the wellbeing of the NHS workforce and that of the wider public. Data from NHS Digital’s 2020/21 Estates Return Information Collection shows that the annual cost of running the NHS Estate stands at £10.2 billion - a four per cent increase on 2019/2020, with the cost of clearing the required maintenance backlog having risen 2.2 per cent to £9.2 billion. Broadened scope With this in mind, NHS Shared Business Services (NHS SBS) has launched its second-generation Hard Facilities Management The (Hard FM) Framework framewo committed to tackling Agreement, which has inclusion rk’s climate change by reducing a broadened scope o f a range of its direct emissions to ‘net to encompass Covidzero’ by 2040 and 2045 19 safety provisions services, supplier for those emissions it can and includes a touch-fre such as influence. specific emphasis e e n t r ance technolo With 60 per cent of the on sustainability the new gy, supports NHS carbon footprint and innovation. Cov occurring within the The framework requirem id-safety NHS supply chain, public agreement has been e nts procurement will be leveraged specifically designed for to effect change. Therefore, the NHS and healthcare commencing in April 2022, NHS sector, with inputs from England extended the reach of the NHS trusts (procurement, estate Government’s model to deliver social value management and capital development through its commercial activities to the personnel), the wider healthcare community commissioning and purchase of goods and and other public sector bodies. It can provide services by NHS organisations. up to 10 per cent savings for estate, facilities and capital development teams that buy Low carbon provision services through it. With £800m expected The Hard FM Framework makes provision spend via the framework over the next four for this, via the 154 suppliers awarded a years, it could potentially equate to public place across its 46 specialist lots. This mix sector savings of up to £80m. of expertise spans the provision of low carbon energy infrastructure (incorporating Automation smart microgrids with on-site generation of The new framework caters for the significant renewable energy), alongside air cleaning, developments in the digitisation and decontamination and infection control automation of systems and access control systems. The framework also includes Covidwhich have come to the fore since its previous secure queue management systems and iteration. For example, contactless preliminary access control, partitioning, isolation and temperature screenings at entry points in social distancing systems, and integrated hospitals and healthcare settings, which detect workplace management systems. individuals attempting to access the building Brendan Griffin-Ryan, NHS SBS senior who may have elevated body temperature. category manager, Estates & Facilities, said: As the UK’s largest employer, the NHS is “The management of NHS estates and responsible for around 4 per cent of the facilities demands specialist expertise in nation’s carbon emissions. It is, therefore,
areas such as strategic planning alongside comprehensive knowledge of the estate’s condition. Compliance, with an ever-increasing list of regulations, places further pressure on teams managing these vital services. This framework is designed to support estate managers meet these targets and provide a compliant route for reactive, planned and new installations of equipment and infrastructure. “With an approach heavily focused on sustainability, NHS SBS’s new framework agreement ensures broader ethical environmental objectives are considered and met, tying into the strategies and ambitions detailed in NHS England’s ‘Delivering a ‘Net Zero’ National Health Service’ plan. “The Covid-19 pandemic has presented new safety and infection control challenges and led to healthcare providers having to significantly adapt to ensure they can maintain Covid-safe environments. Hence the framework’s inclusion of a range of supplier services and innovative solutions, such as touch-free entrance technology, to support the new Covid-safety requirements.” About NHS SBS Established in 2005 by the Department of Health and Social Care in a partnership with Sopra Steria, NHS SBS reinvests a high percentage of revenue back into its services, allowing it to make significant capital investments at scale and at its own risk. L FURTHER INFORMATION https://tinyurl.com/4k8jba44
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Design & Build
A design for life Adrian Powell, development and planning director at NHS Property Services, shares further insight around the organisation’s latest development in Whitechapel which will take the UK’s growing life science industry to new heights. Life sciences have been critical to bringing in new innovations and treatments, as well as transforming patient care. The past two years in particular have highlighted the importance of this sector, as it led to the rapid development of the COVID-19 vaccine. In 2021, the UK government published the UK Life Sciences Vision, setting out a 10-year strategy to build on and maximise the full potential of this sector, emphasising how critical life sciences will be in future proofing the health system. Having the right space for life sciences companies to have a base to innovate is essential to the growth of this sector. Recently, NHS Property Services (NHSPS) submitted plans to redevelop five underused and vacant plots of land in the heart of Whitechapel, to create a new life sciences cluster next to the Royal London Hospital. This plan will deliver a long-standing vision from a number of partners – Barts Health NHS Trust, Queen Mary University London (QMUL), the Greater London Authority and the London Borough of Tower Hamlets – to see this area become a hub for life sciences companies of various sizes and expertise. Creating a space to grow This ambitious plan aims to transform a series of outdated buildings and empty sites around the Royal London Hospital, with a new masterplan that provides life sciences office space, as well as new public amenities such as cafés and community spaces. The proposals will see the demolition of some of the underused buildings on site and the creation of modern, fit for purpose lab-enabled life sciences buildings, as well as the provision of commercial and community space and a potential gallery at
our partners for this development – QMUL ground floor level. Our role will be to ensure – recently announced a property deal with that we maximise the full potential of this new the DHSC for the university to take a major space so that we and our partners can achieve stake and operate a new life sciences facility the ultimate goal of having a vibrant life in one of the new buildings. The new sciences hub. facility will bolster QMUL’s already As the NHS faces a backlog strong presence in Whitechapel of more than two million This for life sciences research, operations, the money plan will innovation, education and raised through the deliver a engagement. disposal of land and longstanding saved on running Health costs and backlog a numbe vision from r of part outcomes maintenance would t o ners see the a While the Whitechapel total £226.6 million, a hub fo rea become plan is ambitious, which could fund r life scie it also represents the building of 68 nces compan an enormous new GP surgeries and ie s of various s opportunity to create a hiring of almost 4,000 izes and vibrant community and doctors for a year. This expertise commercial cluster that we significant investment . hope will support a broadlycan enable the NHS to based life sciences, technology, build from the advances and and innovation ecosystem, providing learnings from the pandemic and quality jobs in the area and the best health transform the way care is being delivered. outcomes for local people. Additionally, the proposed improvements to the street scene Community investment and public areas will also provide a safe, green This development will have a transformational and attractive place for locals to work, relax impact on the local area and community. It and meet. L is expected to create between 3,470 and 5,660 full time jobs and further training opportunities for people in the local area that range across the life science sector and FURTHER INFORMATION beyond. Additionally, those working in the new UK Life Sciences Vision life science cluster could spend between £7 to tinyurl.com/2b7nnw9p2 12 million per year in the local area, boosting local traders’ activity and businesses. NHS Property Services Collaboration with key partners is crucial www.property.nhs.uk to bringing this development to life. One of
Issue 22.3 | HEALTH BUSINESS MAGAZINE
51% of UK workers* who currently choose to mix remote & office working, would consider quitting if this option was removed. Find out how organisations like yours have created a workplace their team love.
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*Microsoft & YouGov 2021 Research
Working with flexibility; the future of workspace management COVID-19 set off a series of fundamental changes in how we work and function as humans. No longer confined to the ‘workplace’, teams rose to the challenge of business continuity with vigour and strength by embracing a combination of working environments. The pandemic proved that many work activities could be done remotely, prompting people to reflect on their previous working habits and routines. This empowerment has brought an abrupt change in employee attitudes, as demonstrated in the Cloudbooking 2021, Workplace Census: 55% of UK workers want flexibility in where they work with a mix of office and home working; and 71% of 18- to 24-year-olds agree they would be more likely to return to the office
environment if they could pre-book safe, socially distanced workspaces. As we shake off the COVID cobwebs, the time has come for organisations to take stock and process the unprecedented period of workplace change that has just occurred. And for many, the question will be, “What do we do next?”. Who will have the courage to continue on this path and deliver true workplace transformation? One thing’s for sure, those who think that reverting to our old ways is an option should think again. More than half (51%) of UK workers who currently choose to mix remote and office working would consider leaving their organisation if this option was removed, according to new research by Microsoft and YouGov. As key workers across health
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care and other sectors were forced to change how they work at the height of the pandemic, the demand for more agile and flexible working is very likely to remain. By nurturing a workplace that supports this approach, public sector organisations can improve building efficiency, operations, and the employee experience. The question, however, is how organisations can facilitate a smooth and successful shift to this type of workplace? With teamwork, clear communications and the right supporting technology, the possibilities are endless. We’re delighted to share a real-life view into an NHS organisation that has embraced workspace management technology, and how they adapted their work environment for the benefit of both the employees and the organisation. Download the case study here. L FURTHER INFORMATION www.cloudbooking.com
Measuring the distance towards a net-zero NHS The NHS has made an impressive start towards net zero, but with less than ten years left to achieve an 80 per cent emissions reduction against 1990 baselines, tools that are sophisticated enough to assist in understanding your current and future emissions will increasingly become a necessity, says Stephen Lowndes of the Carbon & Energy Fund On the face of it, net zero carbon should be Ahead of the game a relatively straightforward definition, in so Fortunately, the NHS is ahead of the game, much that it means avoiding carbon emissions at least in its aspiration and in identifying associated with all your organisation’s its responsibilities with regards to delivering activities, resources and assets included net zero. In October 2020, the NHS in your ‘carbon footprint’. declared its aspiration to In practice it is more nuanced become the world’s first The and potentially open to net-zero health service by NHS is misunderstanding or even 2040. To this end, it has looking a used to misrepresent targeted the reduction the real situation, or to of emissions zero sup t a net plier road justify actions or activity produced by its m ap, whic that are not really services, buildings, h requires suppliers helping carbon emission and vehicles by 80 mitigations at all. per cent, compared carbon re to publish a duction p People can also to a 1990 baseline, la for all co become confused as by the end of this ntracts n they see big corporates decade, and by above £5 making big claims that 2032 at the latest. m they are net zero or ‘carbon So, we have now less than neutral’ already. What does this 10 years to deliver one of mean and how can they be so far the most fundamental and farahead of the game than the rest of us? reaching changes to the way we procure,
manage, operate and deliver services within the NHS to achieve this goal. These aspirations also recognise that it will take a further five years, until 2045, to reach net zero for all the emissions over which the NHS has widest influence relating to its full supply chain. To truly grasp the extent of impact and to try and see how best to manage a way forward, we need to understand our carbon footprint to appreciate what aspects of our footprint have the biggest influence, so that we can start to plan and budget for the adjustments and changes we are going to have to make. The NHS carbon footprint Our footprint relates to the impact we have on carbon emissions that we have control or influence over. The NHS Delivering a ‘Net Zero’ National Health Service report identifies a core carbon footprint as well as an ‘NHS Carbon Footprint Plus’. The core footprint considers emissions from NHS facilities, including fuel used for heating as well as E Issue 22.3 | HEALTH BUSINESS MAGAZINE
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electricity use, water consumption, waste management and treatment, medical gases and fuel used in fleet vehicles. These emission sources are categorised as either Scope 1, Scope 2 or Scope 3 to align with the Greenhouse Gas Protocol, which is the internationally recognised greenhouse gas management reporting standard. Generally speaking, Scope 1 covers fuels and refrigerants and Scope 2 electricity, with Scope 3 everything else. All organisations need to establish a boundary around what they have influence and control over and while the NHS core footprint is by no means minimal, the NHS’s ultimate aim is to cover the ‘NHS Carbon Footprint Plus’. This plus size footprint covers much more of the supply chain including medical devices, food and catering, commissioned health services outside of the NHS, business services, manufacturing, and construction too To this end the NHS is looking at a net zero supplier road map, which from April next year, requires all contracts above £5 million to ensure suppliers publish a carbon reduction plan for their UK Scope 1 and 2 emissions, and this will apply to all procurements from April 2024. From 2027, all suppliers will be required to publicly report carbon reduction plans for global emissions aligned to the NHS net zero target, for all of their Scope 1, 2 and 3 emissions and from 2030, suppliers will only be able to qualify for NHS contracts if they can demonstrate their progress through published progress reports and continued carbon emissions reporting.
Top-down verses bottom up Knowing the full extent of emissions therefore will become key to manging the journey to 2040 net zero and beyond. It is essential that there is an ability to count emissions from each area within the NHS footprint as you cannot manage the unknown. Key influences associated with energy use in buildings, even at a basic utility supply point level, can be readily assessed as long as the kilowatt hours are recorded. This could be as simple as recording meter readings on a spreadsheet and then calculating the carbon emissions from this information. Other emissions from medical gas usage or waste treatment can be calculated in a similar way, by recording quantity and calculating emissions using carbon emission factors published by the UK government. These are bottom-up calculations, whereas in order to calculate emissions from medicines, medical devices, or business services, we need a top-down approach, generally based upon parameters assigned at the level of monitory expenditure, as realistically they cannot be calculated in a more detailed way. Both the bottom-up or the top-down emission assessments for each area of the carbon footprint will need to be ‘backcast’ to assess the equivalent baseline aligned with the NHS 1990 baseline which defines the 80 per cent reduction pathway to be achieved by 2032 and therefore also forecastable into the future, to see if the footprint is on track,
or what intervening measures might be needed to get to 2040 net zero.
The ability to see what might happen to your future emissions pathway to net zero by 2040 if certain strategic decisions are made now, or in a few years’ time, will be as vital as understanding the impact to your organisation’s expenditures and revenues
Pathway influences on 2040 Having the emissions calculated for each element in your carbon footprint immediately paints the picture of where your key areas of influence lie. If its energy that has the lion’s share, then clearly these are aspects of the footprint which will need to be seriously addressed and improvements budgeted for. Other areas related to Scope 3 activities that may include business services or commissioned health services outside of the NHS may need a more strategic approach. The pathway to 2040 is of course not fixed. Your carbon footprint does not stay static and is heavily influenced by factors inside and outside of your organisation. The net zero reduction pathway therefore needs to be strategically linked to general and medical policies, which will influence decisions made at organisational levels and at individual site and estate planning levels going forward into the future. The ability to see what might happen to your future emissions pathway to net zero by 2040 if certain strategic decisions are made now, or in a few years’ time, will be as vital as understanding the impact to your organisation’s expenditures and revenues. Having tools that are sophisticated enough to assist in understanding your current emissions and future emissions with the ability to see the impacts of future plans to your 2040 net zero goals is therefore going to become increasingly useful and a necessity if organisations are not to lose their way, or if they are to plan strategically with carbon emission reductions an intrinsic part of their decision making. L About the Author Stephen Lowndes BEng (Hons), MSc, CEng, MCIBSE, MEI, has many years’ experience of energy project design, as well as supporting operational management, including carbon and energy management within the public sector that started with NHS projects in the 1980s. A Chartered Engineer and Certified Measurement and Verification Professional, he leads the Carbon & Energy Fund technical delivery team, working on all aspects of project feasibility, through to construction and operational delivery. FURTHER INFORMATION The GHG Protocol Corporate Accounting and Reporting Standard tinyurl.com/2s3xfd28 Greener NHS tinyurl.com/mr2tn8du Government conversion factors for company reporting of greenhouse gas emissions tinyurl.com/76hnxyxf
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Action on fire safety New and existing NHS buildings need to ensure compliance with two separate pieces of legislation - the Building Safety and Fire Safety Acts - which meet recommendations from Phase 1 of the Grenfell enquiry Five years on from the Grenfell Tower disaster, the Building Safety Act 2022, which ushers in the biggest swathe of regulatory changes to the UK built environment in almost 40 years, became law in April. The 262-page document aims to reduce safety risks related to fire spread and structural failure through greater planning scrutiny, increased regulation of professional competence and the creation of new statutory roles during the design and construction of ‘higher-risk’ buildings. It runs alongside the Fire Safety Act, which finally came into force on 16 May 2022, over a year after it received royal assent. Comprising four brief sections, the Fire Safety Act has significant ramifications for ‘Responsible Persons’ as it essentially extends the scope of fire risk assessments to assess the safety of a building’s external wall system (including attachments such as balconies) on any building with two or more residential premises, including hospitals and care homes. The Act also introduces a requirement to assess fire doors in both communal and flat entrances. Guidance At the same time as the Act comes into force, new improvements to fire safety guidance form part of the wider update to tighten building regulations and provide clearer fire safety rules for the design or construction of residential developments. The latest changes meet recommendations from Phase One of the Grenfell Tower Inquiry. Under the regulations, responsible persons for high-rise residential buildings will be required to provide their local fire and rescue services with up-to-date electronic building floor plans and to place a hard copy of these plans in a secure information box on site. Local fire services will
also be provided with up-to-date information about the design and materials of a high-rise building’s external wall system, and the level of risk that the design and materials of the external wall structure gives rise to.
safety records monitored and procedures in place to ensure equipment such as fire extinguishers, sprinkler systems, alarms and other safety mechanisms are in operational condition at all times. John O’Sullivan, technical director for fire consultancy at Bureau Veritas Responsible persons Inspection, said: “With these new Responsible persons will also changes now officially law and risk have to carry out monthly assessments to be scrutinised checks on the operation by Fire and Rescue Services, New of lifts intended for the onus for building im proveme use by firefighters, safety is now firmly nts to fire safet evacuation lifts, and placed on the shoulders y guidanc form pa the functionality of of duty holders. It may e rt of the other key pieces seem like a daunting w update t ider of firefighting task to keep on top of o tighten building equipment, with the regulations, but it’s r e regular checks on an essential one.” provide gulations and clea fire doors and flat Fire safety safety rurer fire entrance doors also considerations need les required for buildings to be implemented of more than 11 storeys. at every stage of Other updates include a building development and requirement of wayfinding maintenance. With the current signage to make it visible in low light backlog of maintenance work that or smoke. needs to be actioned, trusts need to ensure A Fire Risk Assessment Prioritisation Tool, that fire safety compliance is kept up to date designed to help responsible persons prioritise and that any upgrades to existing buildings the review of the assessments required under prioritise patient safety. L the new legislation, has been made available. While use of the tool isn’t mandatory, health FURTHER INFORMATION and safety expert Katherine Metcalfe of Pinsent Fire Safety (England) Regulations 2022 Masons said: “The Fire Risk Assessment https://tinyurl.com/mrxr45um Prioritisation Tool is backed up by Article 50 guidance, which has a special legal status. If Fire Safety Act prioritisation guidance you use the tool, you will be well placed to https://tinyurl.com/2zm64tfc demonstrate compliance with fire safety law,” Metcalfe said. Fire Risk Assessment Prioritisation Tool Trusts will need to ensure that NHS asset https://tinyurl.com/379tcbva information is fully up to date, with all fire
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Fire Doors in the Health Sector Managing the Risks What ever your needs regarding timber-based or composite construction fire doors and escape doors, Fire Doors Complete Ltd is here to help
Without doubt the single most influential event regarding the building of fire safety in to new and refurbished buildings has been the Grenfell Tower Fire. The effects of that tragedy will be felt for many years and the construction industry will feel them more keenly than most other industries. Since that event there has been much greater focus on the importance of fire resisting doors and escape doors in both new and existing buildings. Building operators have a legal responsibility to maintain fire doors and escape doors in efficient working order and good repair. At Fire Doors Complete Ltd, we specialise in helping our clients meet the requirements of the applicable legal requirements, regulations and standards. We can do that for existing buildings, new buildings and for refurbishment works. There are three key areas where we can help: fire door training for installation and maintenance operatives; fire door surveys and inspection; and fire door consultancy. Fire door training for installation and maintenance operatives During the course of their life fire doors will require routine maintenance and repairs.
We provide training for installation and maintenance operatives so that they can understand the standards and requirements for the doors at your building to meet compliance requirements. We specialise in fire door installation and fire door maintenance training at your premises anywhere in the UK and at our training centre in Queniborough near Leicester. We can accommodate the needs of your personnel so that they are able to install fire doors and maintain them to prolong the service life of the doors. Approved training courses Our complete portfolio of fire door training has been approved by FireQual and we are very pleased to have received excellent feedback from NHS estates and facilities managers: Rae Jarvis at NHS Lothian, after training for his maintenance team, said: “The consensus from the group is that the course went really well, everyone came out with a good understanding of what’s required and how we can move on. They thought the course was presented really well and having the textbooks and memory stick was a good way of doing the course.”
Jon Freeman at Doncaster & Bassetlaw said: “I have found the course easy to navigate and very informative as to what can and cannot be carried out when installing fire doors. The learning module with the textbook and video work well, I found the course interesting.“ How can fire door improvements be delivered? Estates departments are now seeking dedicated training so that they better understand the particular requirements necessary for fire doors over normal doors. Trained operatives having a better understanding of the requirements can then achieve higher compliance levels. Furthermore, in-house operatives are invested in the fire door works they carry out because they are employed at the building full time whereas an outside contractor will leave the building once their work is complete. So, it’s worth investing in some training for inhouse teams as the pay-back has potential to be several-fold. In providing training services that can improve standards of installation and maintenance of fire doors we can help to make buildings safer. That matters now and it will matter again in future. Fire door surveys and inspections Fire doors should be inspected periodically for compliance in existing buildings and it is advisable to inspect new fire doors during and post installation works. We provide these services across many sectors including healthcare, housing, education and commercial and industrial properties. With regard to existing doors at healthcare buildings it is important to identify the fire doors that are key to the safety of the people that use the buildings, we can help you identify the most critical fire doors and set-up an inspection and
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maintenance program to meet your obligations and help to keep the fire doors in efficient working order and good repair. Our inspection reports are easy to understand and will clearly identify which doors are compliant and which are not. We will not bombard you with unnecessary jargon but where doors are found to be non-compliant our reports will be clear about describing the necessary work required in order to make them compliant. The period of time between inspections should reflect the importance of the particular doors in terms of how critical they are to safety of the people at the building and the type of wear and tear they are subject to. By helping you to plan inspection intervals and by providing clear and concise inspection reports we can help you target resources to where they are needed and help you to avoid unnecessary expense. Where healthcare providers engage contractors to carry out refurbishments and to install new doors we can help to ensure the works are carried out correctly so that the doors meet compliance requirements and that the contractor delivers in accordance with the specification. Very often, new fire doors are not installed correctly and the building owner or operator is left with unsatisfactory fire doors and has to meet the cost of the necessary remedial works. Our fire door inspection services will help you to stay legal, to stay safe and avoid unnecessary expense. Many building owners now engage inspectors to undertake post-works inspections so that contractors may be held accountable and brought back to rectify non-compliances. Building operators are consulting Inspectors to assist with specifications so that compliant installation can be better achieved. What is a competent fire door inspector? The ‘Fire Safety Order’ became law in England & Wales in 2006 and the fire and rescue authority ceased to provide fire certificates. Any certificate previously issued under the Fire Precautions Act 1971 is no longer valid. This means building owners, occupiers and managers carry legal responsibility for fire safety at their buildings. Once the completed building is handed over the person or entity that controls the building must by law take reasonable precautions to ensure people are adequately protected, in a fire.
So, where fire doors have been incorrectly installed at construction stage it’s the building owner, occupier or manager that is potentially liable where issues come to light. This may be due to a fire at the building or because of a visit from the local fire authorities. Any search of media stories covering prosecutions under fire safety law will reveal that such breaches are severely punished and more common than you might think. Especially where there’s sleeping accommodation such as in the housing, healthcare and leisure sectors. Our professional fire door inspectors services are in demand to help building owners, occupiers and managers to improve standards. Their inspection reports carefully and comprehensively detail any installation faults, non-compliances and maintenance issues. Inspector’s findings are that the most common faults with fire doors stem from poor quality installation. These faults are often as basic as doors failing to self-close or having ineffective cold-smoke seals. So, the Inspector is the Competent Person under fire safety law that has brought these important issues to light. Why do professional fire door inspectors findings matter? Inspectors’ reports show that often installation faults are so basic that fire doors fail to self-close correctly and that the smoke seals, although installed in the door frame or door leaf, would fail to correctly restrict spread of cold smoke. Where such faults exist, the building would be unsafe in a fire and a threat to life could exist. Thick black smoke could spread and have a huge effect on safety of people trying to escape. If the fire door fails to self-close its not just the smoke that may spread and cause death or injury, the fire itself would be allowed to spread and may render the escape route unusable. Where stayput or staged evacuation strategies exist people seeking safety would be placed at risk because the spread of thick smoke is allowed to reach socalled places of refuge. An inspection of newly installed fire doors at a high-rise block of flats revealed that the contractor performed so badly that they had to be brought back for a large program of remedial works. The fire door inspectors report revealed that: door and frame misaligned; door to frame gaps too large; doors failed to self-close because closing-devices were installed incorrectly; door leaves unsuitable to meet the severity of use in common areas; glazing
Fire door consultancy Of course, the best way to achieve compliance is to ensure the fire doors are specified and installed correctly from day one. Our consultancy service provides you with an efficient way to help ensure that the doors will meet the requirements of the building users and be compliant with the necessary standards and regulations. Not only that but because we have complete understanding and experience of the many different types of door construction available, we can help to ensure the doors will be durable enough to meet the demands of the building users. Too often, the specification is not sufficiently detailed and unsuitable fire doors are supplied and installed. Again, the end result is often that the building owner or operator is left with unsatisfactory fire doors and has to meet the cost of the necessary remedial works. We have a complete knowledge of the available fire door related products and our consultancy services will help to ensure new or replacement fire doors are suitable for the type of use to which they will be put.
not securely held in place; and no fire stopping to large gaps behind door frames. Here problems stemmed from a combination of incorrect specification, incorrect product selection and poor installation. The same issues as highlighted by the Hackitt Review.
Our credentials Of paramount importance to us as a company is that our clients are always satisfied with the service we provide. We always work hard to do our best for our clients and help them to avoid the pitfalls of non-compliance with legal requirements, regulations and standards. We are able to do that every time for every client because we have many, many years of experience and because we possess the necessary qualifications. All inspectors are individually certificated and as a company we are certificated to a UKAS accredited third party certification scheme for fire door inspections and with regard to our training services we are approved by FireQual for our fire door training portfolio.
Whatever your needs regarding timber-based or composite construction fire doors and escape doors, we are here to help. Contact us today to discuss your requirements and find out how we can help. L FURTHER INFORMATION Tel: 07970 201231 email@example.com www.firedoorscomplete.com
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Adapting to swift changes in parking demand How have NHS trust parking managers adapted to the changes in parking demand, implemented the parking concessions one year on from their introduction, and reintroduced staff paying for parking? Sarah Greenslade, Public Affairs and Communications Officer at the British Parking Association, answers. You might think that parking at hospital trusts shifts concession has perhaps differed the most. has been one of those few areas within the Some have taken the view that if staff work NHS that’s been relatively unaffected by the some night shifts in a month they receive a pandemic. Far from it — the BPA NHS trust proportionate discount and a few have taken it parking managers met virtually every month to mean those working permanent night shifts. during COVID 19 to support each other, and Many trusts saw these concessions as simply continue to do so. formalising their existing parking concessions, Keith Fowler, Associate Director of Facilities especially the case with frequent outpatient & Sustainability at North Lincolnshire and attenders and parents of Goole Hospital Trust and chair of the BPA sick children staying Healthcare Group, reflects: “Everyone overnight. M any [among trust parking managers] trusts sa brought fresh ideas and new ways Pressure on w t h e s e conces of thinking to the meetings, and spaces are still doing so as we now At the peak as forma sions lising learn to live with COVID”. of the their exis t At the start of the pandemic pandemic, in g p a concessio rking trusts were on their way to the number the case ns, especially implementing four new parking of parking with freq concessions in England (see spaces outpatie box on the following page). shrunk and nt attenduent a ers nd paren This was after much discussion expanded over with government, trusts and car time. Whilst children ts of sick park operators over what the full visitor numbers staying definitions would be. dropped to zero, staff parking increased Adoption of the new concessions due to free parking being 97 per cent of trusts in England have now introduced in England and some lost space due implemented these according to NHS England. to Nightingale hospitals and mortuaries being Trusts’ interpretation of the staff working night fitted into car parks. Many trusts struggled to
manage the increased demand for staff parking. Some trusts were due to open new multi storey car parks for staff but wondered how it would be paid for whilst staff parking was free. Thanks to Government compensation for trusts in England this loss was made up for. Review of parking It has been a good opportunity for trusts in England to review and reset their systems. One of these is South Warwickshire NHS Foundation Trust. Sean Mitchell, the trust’s security and parking services manager reflects that “it started out being straight forward when free staff parking was introduced and then in April 2021 it got a bit more complicated when the four new parking concessions were brought in.” These needed to be swiftly implemented in a way that avoided placing extra burdens on overstretched reception and ward staff. Mitchell proudly highlights two significant changes in the way the trust manages its parking promoted by the new concessions. Both involved adding to their existing Automatic Number Plate Recognition (ANPR) system. “With just 2-3 weeks’ notice our parking operator added a disabled Blue Badge scanner to the ANPR entry system which is able to tell if the badge is valid or expired. This saves disabled E Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Parking concessions implemented from April 2021 Disabled Blue Badge holders including staff Frequent outpatient attenders – appointments at least three times within a month and for an overall period of at least three months Parents of sick children staying overnight Staff working night shifts - after 7.30pm and ending before 8am
blue badge holders the hassle of having to go to our security office and get it manually checked before giving the parking concession. We now issue fewer fines as a result. It also saves us from having to cancel them later when challenged.” He goes on to say: “Parents who stay overnight at the childrens’ ward and intensive babycare unit now also benefit from a new device [also installed by the parking operator], that allows ward staff to print tickets with scannable bar codes for parents to get the free parking when exiting the ANPR car parks. This new system has replaced the need for ward staff having to phone security for free passes. Both of these things just take the stress out of a hospital visit when people have other more important things to worry about.” Staff permits Before the pandemic, Warwickshire had committed to building a state-of-the-art multi storey car park, located off-site, which they have recently opened. Mitchell says: “This gave us the opportunity to improve our staff permit system. It is working well using a self-service online platform with staff now being responsible for
Many trusts struggled to manage the increased demand for staff parking. Some trusts were due to open new multi-storey car parks for staff but wondered how could it to be paid for whilst staff parking was free. Thanks to Government compensation for trusts in England this loss was made up for. keeping their vehicle details up to date, which helps to reduce the administrative burden. Times have changed. Ten to fifteen years ago, staff lived relatively locally, whereas now an hour-long commute is not unusual and these improvements make a difference.” The reintroduction of charging for staff parking has been a key discussion point in the BPA Healthcare meetings recently. Care has been taken by trusts to give staff plenty of notice of when they will be introduced with many choosing to delay it until 1 July. Very few reported receiving complaints. Technological advances For trusts that do not yet have barriers or ANPR systems to manage their parking it has been more labour intensive. When the new parking concessions were being discussed with NHS England back in 2019/20 prior to the pandemic, Manny Rasores, BPA Technology Group Chair and parking consultant talked to parking technology suppliers to bring them on board with changing their existing technology to deal with the new NHS England concessions. This was to see how entering, paying and exiting a car park could be made much easier and seamless for staff, visitors and patients. Twenty years ago, the great revolution in hospital parking was the move away from pay-and-display systems to paying using barriers and ticket-operated pay-on-foot systems, adopted from airport parking and large shopping centres. Fast forward to the last two years and more trusts are using ANPR systems with and without barriers that can read parking
concession bar codes, going cashless and even more radically, removing the need for any physical ticket. Rasores says: “The hospital environment is generally not suitable for pay and display as it’s difficult for some people to estimate how long they will need parking for.” He added: “There needs to be a move away from the traditional staff parking season tickets, which actually encourages travel by car and discourages using public transport, or active travel and change season tickets to a pay-asyou-go staff-discounted daily rate system. This would allow staff to save money when they come to work using active travel and could also encourage staff to car share.” On a positive note A year ago, Keith Fowler believed COVID had set back the progress made on encouraging sustainable travel, but is now more optimistic. He believes: “It has had a reset effect and helped to catapult us out of this, with finding new ways of working, including working from home and holding virtual consultations.” That‘s a nice positive place to be after all the turmoil of the last two years. Importantly, as a big employer, the NHS can help the UK to reach net zero by 2050 and NHS parking and the parking sector as a whole has an important part to play in this. L FURTHER INFORMATION www.britishparking.co.uk
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MTG group calls for ring-fenced medical devices fund
Ring-fenced funding for medical devices is urgently needed to help transform the health service and clear the backlog, says The Medical Technology Group (MTG) group, which campaigns for better patient access to worldclass medical technology on the NHS. MTG Chair Barbara Harpham: “Why is there no scheme, similar to the Innovative Medicines Fund, to ensure long term investment in medical
technology for the NHS? The MTG has long called for better funding of transformative medical device treatments, yet there is still a funding gap for ensuring this on the NHS. “Last September, the Government announced it would aim to provide £36 billion over the next three years for innovation and new technology aimed at tackling the crisis of waiting lists on the NHS. We saw this plan continue to come to
fruition this week with the latest round of £340 million in funding for the Innovative Medicines Fund. This is fantastic news for patients on NHS waiting lists awaiting life-saving and lifeenhancing treatment. “We now need a similar Medical Devices Fund for medical technology. At present, there is no ring-fenced funding for the uptake of medical technology, meaning patients are losing out on backlog busting innovation that will see worldclass technology diagnose, treat and return them to normal life as fast as possible. “A Medical Devices Fund that values long-term investment will help the Government achieve its ambitious plans to clear the backlog, level up quality of care across the country, and ensure NHS patients have timely and equitable access to the most pioneering medical technology in the world.” READ MORE
Heriot-Watt University partners with dentist to launch strength-building sandal A device which is designed to build strength in the muscles of the feet, including the intrinsic muscles inside the foot, is set to launch following an injection of specialist support from Heriot-Watt University. The Novabow device is designed to prevent and treat sporting injuries and a range of foot complications and disease. Research conducted in recent years has revealed the vital role played by the intrinsic foot muscles, demonstrating their role in running injuries, conditions relating to diabetes including neuropathy (foot numbness) and ulcers, alongside more common yet painful complaints like bunions. Gerry Farrell, a practising dentist, managing director of Jomarg Innovation and inventor of the Novabow, aims to transform foot health with an exercise device which builds foot muscle strength. Working with specialist designers and advisers from the Medical Device Manufacturing Centre at Heriot-Watt University, the device is expected to launch this summer. Farrell said: “In recent years, our understanding of the vital role that intrinsic foot muscles play has grown exponentially. Modern footwear weakens the feet so most of us lack the strength we need for correct balance and exercise. This can contribute to a range of toe deformities, pain, and injury. “One of the main reasons people stop playing a sport or enjoying exercise is because of pain. Many of the foot exercises available focus on the wrong muscles or don’t adequately or easily reach the intrinsic muscles. As an amateur athlete, I wanted to prevent sporting injuries and the results of our pilot studies at Napier and Stirling
Universities have been extremely positive. We have also tested the device long-term with Olympic hammer thrower Chris Bennett who was set to have surgery before resolving his knee and back issues using the Novabow device. He now uses it daily.” Those living with diabetes are at a particularly high risk of complicated foot conditions including neuropathy which leads to severe numbness in the feet. A diabetic with this condition is 20 times more likely to fall than someone without diabetes. This significantly increases the risk of injury, particularly as an individual gets older foot and ankle exercise programs have significantly improved and even reversed neuropathy. A second challenge for those living with diabetes is ulceration which, in some cases, can lead to infection and eventual amputation. Research shows that ulcer recurrence is dramatically reduced using foot and ankle exercise from 72 per cent down to
just 16 per cent with this type of exercise. Professor Marc Desmulliez, manager of the Medical Device Manufacturing Centre (MDMC) at Heriot-Watt University, said: “We can see enormous potential for the Novabow device to address and prevent a wide range of health conditions as well as support both amateur and professional sportspeople to exercise safety. As we mark the official launch of the MDMC at Heriot-Watt University, we hope many more companies like Novabow will access our free specialist medical device manufacturing support. The Novabow Foot Exercise System holds patents for Europe and the USA. It has been supported by collaborators including the Medical Device Manufacturing Centre based at Heriot-Watt University, Scottish Enterprise, Napier and Stirling Universities, Interface, and Business Gateway (Glasgow City Council). READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Palantir expected to land Federated Data Platform contract The Financial Times recently reported that US software firm Palantir’s Foundry is about to become the underlying data operating system for the NHS’s Federated Data Platform (FDP), which will aggregate data from multiple sources onto a single platform. In recent months, the firm has poached two top executives from the NHS. It was announced in April that Indra Joshi, former NHSX director of AI, would be joining the US firm. Harjeet Dhaliwal, deputy director of data services at NHS England and NHS Improvement will follow Joshi. Less than two months later it as announced that Harjeet Dhaliwal, deputy director of data services at NHS England and NHS Improvement will follow Joshi. Foundry is Palantir’s data collection, processing and visualisation software. It was used in a £23m three-year contract by NHS England in 2020 to provide the Covid-19 Data Store, one of the tools used to help manage the distribution of the Covid-19 vaccine. It is expected that FDP will also be built with Foundry. Concerns raised by Foxglove, a legal campaign group that focuses on accountability in the technology industry, centre on two aspects: the safety of patient data, and the nature of the company that will set up the data framework and seek to exploit it. Phil Booth, founder of medConfidential, which campaigns for confidentiality in healthcare, said: “Palantir is already doing many of the things which are going to be done by the platform. To move away from something that is already deeply embedded into NHS England’s systems would be a significant shift.”
Dean Sabri, Principal Analyst for UK Health and Social Care at GlobalData, commented: “Supplying short-term data analytic platforms results in being awarded larger, more valuable contracts further down the line. On four occasions over the previous two years, short-term deals for data integration services have been awarded by the MoD to Palantir. Consequently, earlier this year, Palantir won a longer, £10 million contract to provide the same service. Therefore, it is likely that Palantir will secure the contract to provide the FDP to the NHS following its work on the data management platform. “Once in situ, the FDP will combine all data on individual patients, waiting lists and medical trials from various sources and formats into a single platform. It will rely on the data platforms deployed at Trust and integrated care system (ICS) level to gather and correctly input the information accurately. Those systems will also need to have standards in place which enable open working through APIs. “This, combined with the recent Data Saves Lives strategy for ‘smaller discrete services built to work with national systems’, could see reduced opportunities for new entrants to the NHS data platform market as more Trusts opt for systems provided at a national level.” Palantir was co-founded by Peter Thiel, 54 who financed rightwing candidates in the US, including Trump’s successful bid for the presidency in 2016. Louis Mosley, grandson of Oswald Mosley and nephew of the late former president of Formula One’s governing body, Max Mosley, runs the London operation. The
Peter Theil, Palantir co-founder Credit:Gage Skidmore
company plans to hire an additional 250 UK staff this year. Other potential bidders for the FDP contract could include consulting firms such as Accenture, PwC and KPMG, who have technology partners such as Oracle and Microsoft. READ MORE
Data Saves Lives strategy hopes to nuture public trust over NHS data use The Department of Health and Social Care has released the newly updated version of the Data saves lives: reshaping health and care with data strategy for the NHS. First released in draft form in June 2021, and updated in February 2022, this final version of the policy paper follows the Goldacre Review into the use of health data for research. Published in April. It includes concrete, time-specific commitments for action and seeks to ensure that both the technical infrastructure for NHS data and public trust in how that data is used are improved. The strategy aims to develop a ‘pact’ with the public to ‘reset the conversation on health data’ and agree clear, shared expectations including a transparency statement, new information governance frameworks and guidance, a clear ‘opt-out’ choice for citizens, and a plan for maintaining and measuring public trust including standards for public engagement – all by the end of 2022. Launching the strategy at London Tech Week’s HealthTech Summit, health secretary
Sajid Javid announced that following a £200 million investment, trusted research environments (TREs) - a form of secure data environments - would be established “to better enable researchers to securely access linked NHS data while maintaining the highest levels of privacy and security.” With an ambition for the NHS App to be a one-stop shop for health needs, the strategy commits to a target of 75 per cent of the adult population to be registered to use the NHS App by March 2024. The strategy also highlighted its NHS COVID-19 Data Store as an example of how data should be managed in the NHS. However, the Data Store has come under
scrutiny of late given the involvement of US analytics firm Palantir (see story above}, particularly in relation to who has access to health data and a lack of transparency surrounding government contracts. £25 million is pledged over the current financial year to accelerate digital social care records, and this marks part of Javid’s plan for 80 per cent of social care providers to be using digitised records by March 2024. “IIt answers the tricky questions about data architecture – and in doing so, it sets out a clearly achievable and importantly a deliverable goal of unlocking the NHS data and the benefits this will translate too,” said David Walliker, chief digital and partnerships officer (CDPO) at Oxford University Hospitals NHS Foundation Trust. A digital health and care plan which hopefully contains more detail on delivery, is expected imminently after being announced in February. READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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Understanding healthcare workers’ confidence in AI
In partnership with NHS AI Lab at the NHS Transformation Directorate, Health Education England (HEE) has published the first of two reports looking at the use and understanding Artificial Intelligence (AI) in the NHS. AI has the potential to relieve pressures on the NHS and its workforce, but ‘frontline healthcare staff will need bespoke and specialised support before they will confidently use it’, the
Understanding healthcare workers’ confidence in AI’ report says. In 2019, HEE was commissioned by the then Secretary of State to deliver the Topol Review recommendations looking at the impact of leading-edge digital technologies on the workforce. The Digital, Artificial Intelligence and Robotics Technologies in Education (DART-Ed) programme picks up from this in 2021 to explore the linkage between mature evidenced AI and its workforce impact and required training and education. The research involved a review of academic literature and semistructured interviews exploring experiences of developing and using AI technologies in healthcare settings. Interviewees included healthcare workers in primary and hospital care settings; industry innovators; representatives of related regulatory and arm’s length bodies; and academics who work at the intersection of AI, healthcare, education and clinical confidence.
The second report will determine educational and training needs and present pathways to develop related education and training offerings. Dr Hatim Abdulhussein, National Clinical Lead for AI and Digital Medical Workforce at HEE, said: “Understanding clinician confidence in AI is a vital step on the road to the introduction of technological systems that can benefit the delivery of healthcare in the future. Clinicians need to be assured that they can rely on these systems to perform to levels expected to make safe, ethical and effective clinical decisions in the best interests of their patients. “However, the onus isn’t only on clinicians to upskill; it’s important the NHS can reassure the workforce that these systems can be trusted by ensuring we have a culture that supports staff to adopt innovative technologies” READ MORE
NHS Highland reports shorter hospital stays due to surgical robots Since the first Robotic-assisted Surgery (RAS) was carried out at Raigmore Hospital in August last year the programme has gone from strength to strength with three surgical specialities now up and running. NHS Highland took delivery of the DaVinci Xi robotic system in 2021. Robotic surgery, using articulated ‘keyhole’ instruments controlled remotely by the surgeon from a console next to the operating table, allows complex surgical procedures to be performed in a minimally invasive manner. As a consequence, patients require smaller incisions, tend to have less post-operative pain and recover quicker. Since August there has now been almost 100 RAS procedures carried out in NHS Highland. Initially starting in the Colorectal Unit, the programme has now been expanded to both Gynaecological and Urological surgery. Early results are encouraging and show that patients undergoing major bowel cancer surgery are spending significantly less time in hospital. For patients undergoing open surgery, the average length of hospital stay was eight days and this has now reduced to four days following RAS surgery. Far fewer patients also require critical care following surgery with high dependency unit (HDU) admissions dropping from 70 per cent to less than 10 per cent. Following substantial investment from both the Scottish Government and individual health boards, the use of surgical robots has increased significantly in Scotland since 2020 and it is hoped that the type of benefits already being seen in Highland will be mirrored across the country.
Priorities for the first phase of the rollout are procedures where there are likely to be the greatest benefits for patients such as operations for colorectal, gynaecological and urological cancers. The second phase will expand RAS use to other surgical specialties, including patients with complex benign conditions. Colin Richards, Colorectal Consultant at Raigmore Hospital, led the team who carried out the first of these operations last year and is delighted with progress so far. He said: “Investing in robotics means that patients in NHS Highland now have access to world-class surgical technology and we have already shown that this is making a real and measurable difference to patient outcomes.” “Having used the system for the last six months, I would describe it as nothing short of transformative - we are able to perform
surgery that is less invasive than ever before but with a level of precision that I never thought possible.” A recent US study found that the risk for hip instability when the procedure was performed robotically was 3.5 times less than the traditional method when controlling for gender, race, age, prior spine surgery and other accepted factors that can contribute to instability. “Patients, in consultation with their joint replacement surgeon, should decide which surgical option is best for them Robotic surgery for hip replacement surgery continues to evolve and more larger studies are needed to better define the advantages,” said Jason Davis, a Henry Ford joint replacement surgeon. READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
NHS Digital updates Keep IT Confidential campaign
NHS Digital’s flagship security awareness toolkit, Keep IT Confidential has been updated to help support social care organisations to improve security culture within their care settings. First launched in 2019 to clinical staff in healthcare organisations, the campaign has now been updated to meet some of the challenges faced by the social care sector. Free campaign materials, which include screensavers, web banners, social media graphics and suggested copy for bulletins and newsletters, have been developed in partnership with Digital Social Care, are specifically designed to help improve staff knowledge of cyber security concerns such as phishing, data
sharing, unlocked screens and weak passwords. NHS Digital’s Executive Director of Cyber Operations, Mike Fell, said: “Good security practices are our shared responsibility and being cyber aware can significantly reduce the chance of cyber events affecting people’s care. “We know how busy staff are, but we encourage everyone to prioritise cyber hygiene as much as they can to protect the NHS and social care against vulnerabilities. “Taking small, simple steps and considering security in your day-to-day work can make a huge difference and we hope this campaign can really drive that change.”
CYBER SECURITY AWARENESS
Michelle Corrigan, Programme Director, Better Security, Better Care, said: “The Better Security, Better Care programme welcomes the strong messages for social care providers and their staff in the Keep I.T. Confidential campaign. Protecting people’s data is really a safeguarding issue as we all store and share more and more information digitally. “Our sector is making good progress, with increasing numbers of care providers demonstrating that they have good data and cyber security arrangements in place, by using the official Data Security and Protection Toolkit. The Data Security and Protection Toolkit is an online selfassessment tool that allows health and social care organisations to provide assurance that they are undertaking good data security and that personal information is handled correctly.” “The Keep I.T. Confidential campaign provides valuable, clear advice for care staff and we encourage everyone to share these messages widely.” READ MORE
CYBER SECURITY COLLABORATION
NHS National Services Scotland’s Cyber Security wing beds down at Abertay University NHS National Services Scotland’s cybersecurity wing will be among the first residents of the new Abertay cyberQuarter at Abertay University, bringing an initial 30 jobs to Dundee. Further partnership announcements are due in the coming weeks. The £18m hub in Abertay University’s Annie Lamont Building has been jointly funded by the University and the UK Government (£5.7m) and Scottish Government (£6m) through the Tay Cities Region Deal, providing a new model for supporting the rapidly growing cyber sector in a facility that’s the first of its kind in the country. In addition to a physical space for collaboration and experimentation between industry and academia, the Abertay cyberQuarter has a secure cloud-computing infrastructure that will be used for specialist online teaching and provision of R&D and knowledge exchange activities. Operating over four floors, the centre provides a flexible range of open plan spaces for group working, private office accommodation for use by established businesses or new start-up companies, seminar rooms for training and CPD delivery, an events space, an outdoor terrace and a cinema/lecture theatre. Abertay University is a UK leader in cybersecurity education and is the only
institution in Scotland to have received goldlevel recognition as an Academic Centre for Excellence in Cyber Security Education from the National Cyber Security Centre (part of GCHQ). Students from the University’s Ethical Hacking, Computing and Cybersecurity programmes will have first-hand access to Abertay cyberQuarter, learning directly from industry professionals while also bringing fresh thinking and new approaches to joint projects. UK Government Minister for Scotland Iain Stewart said:“The growing use of online platforms, cloud computing and online shopping means cyber security is more important than ever. There were more than 400 cyberattacks in Scotland in 2020-21, and more than a million incidents of computer
misuse are reported across the UK each year. Abertay was the first UK university to be awarded Academic Centre of Excellence in Cyber Security Education by the UK Government’s National Cyber Security Centre. The launch of the cyberQuarter further strengthens its reputation as the place to come for research and expertise on cyber security — an industry which will bring highskilled work and investment to the region. The UK Government is contributing £5.7m towards this fantastic facility as part of our £2 billion support for levelling-up initiatives right across Scotland.” READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
CAN do attitude to cyber security in the NHS How does collaboration help keep the NHS secure? One of NHS Digital’s Principal Security Specialists Victoria Axon talks about why the NHS must be resilient to cyber security threats and is joined by Martin Price from Royal Cornwall Hospital NHS Trust and Tony Cobain of assurance specialists MIAA to discuss how networking and the NHS Cyber Associates Network (CAN) plays a big part in that There is a saying in cyber security that if Threat landscape you’re standing still, you’re actually moving The threat landscape is forever evolving, backwards. Cyber threats are always and this is increasingly influenced by the developing, and tens of thousands of new changing geopolitical landscape. Whereas vulnerabilities are found in systems every year. previously, political events were seen as So, it’s crucial that the NHS does not stand independent of cyber security issues, the still, but instead improves its cyber resilience in line is now blurring so it is important that order to continue to keep patient records safe. as threats change, our cyber resilience also changes to counter that threat. The NHS handles some of the most sensitive The NHS is at the forefront of medical personal data that exists about people so it research, and this is increasingly is attractive to attackers who may seek facilitated by innovative to exploit that data for monetary or political gain. This is why technology, both in terms we take cyber security of ground-breaking The so seriously within the medical devices as c oronavir NHS and why there well as the computer u s pandem is an ambitious aim systems developed ic c e rtainly has drive to ensure all public for processing and n sector organisations the Cybe the need for analysing results. are resilient to known So, as we cross Network r Associates vulnerabilities and new technological . It like a self is almost attack methods, no frontiers, we need -help gro later than 2030. to ensure that these
for cybe r
systems are protected from the start and that we don’t undermine our cyber security by introducing new potential backdoors. Cyber Associates Network In the ever-growing world of cyber security, it is vital we learn from each other and share experiences across the health and care sector in order to battle increasingly complex cyber threats and test and deploy solutions. This is why in 2019, NHS Digital and NHSX established the Cyber Associates Network (CAN). Three years down the line, the network has more than 2,000 members across publicsector health and care, who support each other both on a local and national level. The group is aimed at professionals with responsibility for, or a professional interest in, cyber security and provides people with opportunities to shape and influence the cyber-security landscape, by sharing best practice, lessons and advice. There are a lot of other benefits of being a E
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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member of the CAN, including exclusive masterclasses on topics such as backups, cyber incidents and risk management. Plans are also in place to expand the network this year by introducing new communities focussed on diversity, future talent and executives, as well as the Summer of Cyber, a roadshow of events which will bring cyber professionals together from the across the country to network, share knowledge and discuss the latest cyber strategy for health and care. Benefits of knowledge sharing The network is something that Martin Price, Royal Cornwall Hospital’s IT security manager knows well, being a member: “There is perhaps no better way to explain the benefits of enhanced knowledge-sharing and professional development than to network with our peers on a slightly more informal basis to get the creative juices flowing. “Being a part of the CAN gives cyber professionals huge advantages. Each individual in the network brings different skills and mindsets to the group, meaning we are constantly evolving with each other
allowing us to advance in our professional development and ultimately protect the NHS.” Tony Cobain, Digital Director at MIAA, is also a member and says networks such as the CAN are crucial for cyber security roles: “For me enhanced knowledge sharing and networking boils down to ‘no provider being an island’. So, from that perspective we have a professional duty to ‘level up’ across care communities and the wider health and care footprint. “The coronavirus pandemic certainly has driven the need for the CAN. It is almost like a self-help group for cyber. For example, someone from an NHS Trust might post about an issue they are having and within minutes another member could provide them with the answer that otherwise could have taken a lot longer to resolve. There is a great sharing of knowledge on the forum, and it stays there, allowing people to pick on current and emerging issues and to enhance their learning and understanding—making us all stronger.” CAN Awards After a challenging two years due to the pandemic, the cyber associates network
introduced the CAN awards to showcase the incredible work being done by individuals, teams and organisations to manage and improve cyber security in health and care. The virtual awards ceremony took place in March this year and shone a light on the innovation and digital expertise that help protect patient care and data across the NHS. This included NHS Informatics Merseyside who won the innovation in cyber award for their ability to creatively solve problems, leading to significant improvements being made to patient care as well as The Pete Rose Outstanding Achievement Award. This was an accolade dedicated to the memory of our Deputy CEO, Pete Rose, who sadly passed away in August 2021. Paul Charnley, Digital Lead at the Health Wirral Programme Office, received this award for his work in developing an innovative integrated system (ICS) wide cyber security group. The awards are a wonderful opportunity to acknowledge the support all members give to one another and really highlight some of the best practice that can be seen across health and care. Crucially, however, networking with cyber peers across health and care increases our ability to defend as one against cyber threats. It is all about making sure that frontline services have the digital infrastructure that they need to give patients the best possible care. The CAN is growing each day and as it evolves, so do the benefits. The network is always on the lookout for new members. If you’re based in the NHS, social care or a local authority, you can find out how to get involved through the link below. L
Being a part of the CAN gives cyber professionals huge advantages. Each individual in the network brings different skills and mindsets to the group, meaning we are constantly evolving with each other allowing us to advance in our professional development and ultimately protect the NHS”
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How digital reporting engaged Shropdoc’s workforce In addition to sharing up-to-date intelligence across multiple departments, Shropdoc’s partnership with Radar Healthcare led to a fully-developed real time reporting solution which encourages staff engagement In 2019, Paul Page was appointed Patient Liaison & Risk Manager at Shropdoc, the provider for out-of-hours urgent primary care in Shropshire, Telford and Wrekin and Powys. He created an incident tracking spreadsheet that provided a link to a specific hard drive containing all relevant documentation. However, the system possessed vulnerabilities such as inconsistencies, delays, incomplete or misplaced forms and consequent risk of GDPR infringements. Such factors were exacerbated by the large geographical area covered by Shropdoc, approximately 3,500 square miles that encompasses ten Primary Care Centres (PCC) with an administrative headquarters in Shrewsbury. Furthermore, the out of hours period, constituting 75 per cent of a normal week, is a challenging and potentially high-risk environment. Ian Tanswell, Associate Medical Director for Quality and Safety, led a group to evaluate a series of systems based upon features, functionality, and cost. Shropdoc wanted a system that could share up-to-date intelligence with multiple people in different departments at various locations. There was a particular need to save time retrieving this data too. Available to everyone, everywhere The largest team in Shropdoc is the Primary Care Assistants, who support clinicians visiting patients at home or seeing them at a PCC. Their tasks include checking kit, equipment, and vehicles as well as undertaking administration duties at the PCC; they are the ‘eyes and the ears’ of Shropdoc. Despite this, their duties were impeded by the inability to record incidents in real-time. Radar Healthcare has given them a place to create an electronic vehicle inspection checklist, removing manual paper trails. Radar Healthcare can be accessed on all mobile devices and be used anywhere with an internet connection, meaning employees and members can record events as soon as they happen. It was imperative to Ian and Paul that everyone had the access to the system and were given an opportunity to provide constructive feedback on the design itself. Therefore, the intention is not only to continually improve patient outcomes but also to encourage staff engagement. Many departments in Shropdoc have been actively involved in the development process, with the Health & Safety Manager taking a leading role. For instance, contemporary guidance from the Health and Safety Executive has been integrated into reporting forms for accidents and incidents, which provide learnings for all.
“By building the forms together, it really gives you an opportunity to engage the workforce and break down organisational silos.” - Ian Tanswell, Associate Medical Director for Quality and Safety, Shropdoc
is for us to tailor the forms, we can develop them for ourselves in the future, so they remain applicable. Plus, we have the ability to teach others.” - Ian Tanswell, Associate Medical Director for Quality and Safety, Shropdoc
Boosting morale through logging data A part of the Radar Healthcare system that will help Shropdoc engage their workforce is developing their compliments processes – the way that they are recorded, analysed, and presented. Ian and Paul highlighted that by presenting and displaying that data meaningfully, it can help drive continuous improvement and improve the wellbeing of both staff and service users. “I believe this system allows us to really create the balance between compliments and complaints and let people know that they are doing a good job. That’s why we chose Radar Healthcare: because it allows us to be more balanced.” - Paul Page, Patient Liaison & Risk Manager, Shropdoc
Radar Healthcare Radar Healthcare’s partnership approach to patient safety enables healthcare organisations to develop custom digital solutions for risk, quality, and compliance management. Our system, which was founded in 2012, is now live in over 10,000 locations worldwide. We were the first supplier to pass LFSPE testing with NHS Improvement and partnered with Milton Keynes University Hospital as the first to integrate the system. With up-to-date insights into performance, risk, and compliance, your organisation can take immediate action, share learnings and ensure continuous improvement when it comes to patient safety and outcomes.
Make the system work for you As Shropdoc goes into the final stages of onboarding Radar Healthcare, they could not praise our Projects team enough. Having dedicated support when needed, a hands-on approach to learning and a gradual development in skills gave Ian the confidence in the product. “It’s a bit like building a car from scratch. If the engine goes wrong; you can identify the fault and know exactly how to fix it. Jack [Forshaw, Project Manager] has shown us how easy it
Click here to see how we work with our partners Free consultation To book a free consultation, click here L FURTHER INFORMATION www.radarhealthcare.com
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Visavvi the workplace technology specialists Audio Visual Consultancy, Design, Installation and Support Trusted to deliver agile and highly effective technology solutions into the NHS for over five decades, Visavvi has guided and supported many organisations and departments to achieve Digital Workplace Transformation. As a Shared Business Services NHS framework supplier, Visavvi has successfully provided a diverse range of audio visual, communication, and collaboration technologies and services to clients. These include central NHS service providers, many trusts and hospitals, and numerous GP surgeries across the UK and Ireland. Highly accredited and trusted by world-leading manufacturers such as Microsoft, Cisco, Poly, and Logitech, our independent consultation, implementation, and support capabilities have led organisations of all sizes through substantial workplace and healthcare transformation. Visavvi’s consultative, client-centric and technology-agnostic approach helps navigate clients through a complex range of technology choices. As part of the Saville Group, Visavvi has a proud heritage and a secure, stable trading history which builds trusted long-term partnerships with clients and suppliers. Accreditations Our commitment in this crucial area is reflected in a comprehensive set of industry accreditations, covering health and safety, quality and process, the environment, and the integrity of digitally-held information. We supplement these with membership to all relevant and leading industry associations. Our impeccable high standards have been recognised
through top awards including the coveted AV Integrator of the Year three times, including in 2021. These accreditations and awards together with the quality of our work have resulted in Visavvi being selected for several public sector and corporate purchasing frameworks, including: Crown Commercial Services; SBS; NEUPC; NWPC; CPC; HEPCW; LUPC; SUPC; and APUC. The Visavvi approach Immediately from the first initial meeting, the experienced Visavvi team deliver a tailored approach specific to each client. Account Managers use their vast knowledge of delivering award-winning projects to work in close partnership with clients to understand their operational challenges and technology objectives. Solution Architects design innovative systems that deliver beyond expectations before comprehensively trained Project Managers and Installation Engineers ensure these systems are installed to exceptional standards. Post-installation, clients are supported by a range of comprehensive, dedicated remote and in-person support services. Audio visual service and maintenance contracts Visavvi offers the industry’s most comprehensive range of ISO accredited service and maintenance contracts available. 24/7 support provides everything an organisation needs to be confident their audio visual and collaboration technology works seamlessly. Proactive in our approach, scheduled preventative maintenance visits combined with the powerful Vantage AV remote monitoring platform ensure workplace environments operate at peak performance, significantly removing the risk of failure and improving operational efficiency for our clients.
firstname.lastname@example.org www.visavvi.com/nhs 0370 606 1100
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Making the case for a clinical satnav Computer-driven support for diagnosis and other clinical decisions must become a mainstream part of the NHS. To achieve this requires accurate, standardised, computable forms of clinical guidance and systems that must be able to talk to each other across the UK. In its latest report, BCS, The Chartered Institute for IT, makes the case for a ‘clinical satnav’ Decision support requires computable AI - a magic bullet? knowledge to improve the excellence and Will artificial intelligence (AI) fix this? AI can efficiency of healthcare and empower patients. help, but it depends on reliable data. Where we Knowledge should be formatted to enable high have good data, AI can produce some kinds quality, computer-driven decision support, so it of knowledge from routine data (such as agesits at clinicians’ fingertips... not in a pile beside specific rates of drug side effects) that is more their desks or in their inbox. persuasive than small research studies. However, “Patients think we know everything about there are other kinds of knowledge (such as them, their problems and where to go next,” the effectiveness of a drug) that challenge AI explains a doctor. “Until something goes wrong, methods used with routine data. This is partly and they recognise that’s a mirage. They realise because of the volume of data, but also because that we’re often flying fairly blind, scrabbling retrospective studies are subject to inherent around for information on them, trying to work limitations. out what their symptoms mean. Widely available healthcare decision support This involves both data about the patient’s is needed and is possible. It already exists to a history and current state, and knowledge about limited extent as a cottage industry. This cottage how to interpret and use that data. Yet, we industry assembles lots of small elements of could have the equivalent of a ‘clinical satnav’ computable knowledge using different tools for practitioners and patients that and standards, limiting the potential suggests next steps (like the for scaling up the industry. knowledge of how to However, in other fields Health calculate optimum routes), beyond healthcare, digital systems h given the available knowledge gathering, of knowle old lots patient health data analysis and support for (the equivalent of personal and expert often ina dge, yet it is location, destination, decision-making c c e ssible at t point of traffic conditions and is commonplace. h e c a re. It’s sitt road works).” Busy healthcare journ ing
als in often in eand guidelines, mail in piles n inboxes or ext t desks o
professionals, increasingly seeking digital-first sources of information, will demand no less. So, healthcare science, regulators and guideline providers need to satisfy that demand if they are to remain relevant to practice. Expectations and realities This yawning - and growing - gulf between the expectations and realities of healthcare contrasts starkly with other sectors. Banking, shopping and travel process information, data and knowledge almost seamlessly. People and their needs are understood so intimately that there’s little difficulty recommending suitable lovers, films, food and holidays for them. Why, then, is healthcare knowledge management so immature? Why, when Britain is a leader in health research do we so rarely produce computable knowledge? Health systems hold lots of knowledge, yet it is often inaccessible at the point of care. It’s sitting in journals and guidelines, often in email inboxes or in piles next to desks. Airline pilots have splitsecond, sophisticated decision support systems to guide their actions. Automated systems will soon manage driverless motorways. We have already seen sophisticated decision support systems land the Perseverance rover on Mars. E
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Elevating the healthcare sector to a new level Philips offers an extensive range of monitors to suit every need - the perfect solution for new requirements that flexible working practices have brought us. power delivery, Windows Hello webcam, and RJ-45 input. Thanks to its 21:9 aspect ratio it can easily replace dual-monitor setups. An additional built-in KVM switch enables users to switch between two devices, such as a desktop and laptop, while using the same keyboard and mouse. With a sleek, futuristic design, it fits perfectly amongst the front desks of doctors’ offices and hospitals.
Over the past two years, the way of working has evolved significantly. From being the exception, work from home (WFH) has become the new normal in many sectors and thus has increased digitalisation in every aspect of our lives. This has also changed the healthcare sector. Not only did the initially unknown virus pose a challenge, but various technological requirements also had to be met. Virtual appointments, seminars, and advisory talks – all kinds of events where it is not crucial to be present physically - were slowly moved to video conference calls and online events. Two years later, we see that the health industry had welcomed the adoption of such changes. In the UK, the NHS has been providing their staff with webcam-equipped displays to accommodate the new Zoom and Microsoft Teams call requirements. And in certain branches and departments, WFH or semi-flexible working environments have become present and will most likely continue indefinitely in some shape or form. Philips Monitors have been successfully supplying displays to the UK healthcare market for years and their innovative line-up offers the perfect solution for the new requirements that the flexible working practices have brought us. One display to rule them all In the extensive Philips monitors portfolio, the Philips 242B1H, a 23.8” display with a colour accurate IPS panel, shines as a great example to cover such new requirements. This monitor is equipped with a pop-up webcam in 2MP, Full HD resolution and also features Windows Hello integration with facial recognition. This enables medical staff to log in to a Windows PC by just looking at the camera, without entering a password, increasing the security and allowing the team
to unlock their PC when their hands are full. To ensure patients’ privacy, the webcam can be tucked behind the panel when not needed. For a sharper display and more screen real estate, the Philips 275B1H offers a step-up with the same webcam, but with a 27” display size and QHD resolution (2560x1440). Both meet the TÜV Rheinland Eye Comfort standard as these models offer an ideal viewing experience, even when used for long hours, thanks to FlickerFree and LowBlue light technologies. Due to the PowerSensor with infrared detection, the display can reduce brightness when the user is away, saving energy costs of up to 70 per cent. One cable to bind them Another feature that emerged as crucially important when healthcare staff are using a work laptop in WFH situations is USB-C docking integration. Philips 243B1JH (Full HD, 23.8”) and the Philips 276B1JH (QHD, 27”) feature the 2MP pop-up webcam of the models above and add a built-in USB-C docking station. With the inclusion of a 4-port USB hub and Gigabit Ethernet port, connecting a laptop via USB-C opens up many opportunities. Via a single USB-C connection, the monitor can charge the laptop (up to 100 W), transfer the video signal (via USB DisplayPort alternate mode), provide a link to the devices connected via the USB hub and connect it to the network (by routing Ethernet via USB-C). Since all staff may not be equipped with recent laptops which feature a USB-C connection, these ‘hybrid’ models also offer DisplayLink technology and a USB-C/ USB-A cable to extend the display via USB-A. Fit for administration purposes, the 34” Philips 346P1CRH features a curved 34” display with 3440x1440 pixels, including also a USB-C docking station with 65W
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Get in touch! In the healthcare sector, users might need to access their computers differently, especially when users are wearing gloves or similar PPE. Philips monitors’ extensive portfolio can also cover such cases thanks to 10-point multitouch displays with the Projected Capacitive (P-Cap) touch technology - SmoothTouch. Responsive to interaction with a stylus, fingers, or with different kinds of glove materials the touchscreen functionality enables medical professionals to use these monitors without interrupting hygiene protocols. The robust, water and dust resistant (IP65 certified – front only) touch displays from the B9T display family offers touchscreen monitors from 15” up to 23.8” with SmoothTouch technology. Currently, Philips touchscreen displays (standalone models 172B9T, 222B9T with Z-shaped stands, or the non-stand versions such as the 222B9TN) are ready to be operated on medical carts with pill dispensing technologies and other mobile workstations to improve patients’ and doctors’ day-to-day tasks. For health institutions that need to take the next step in their IT infrastructure, Philips monitors offer the ideal technology for productivity. L FURTHER INFORMATION www.philips.com/monitors
THIS is key in helping to deliver the NHS Long-Term Plan Digital solutions delivered by The Health Informatics Service (THIS) for Calderdale and Huddersfield NHS Foundation Trust (CHFT) have helped to elevate it to one of the most digitally mature trusts in the UK.
In the last few years alone, CHFT has spent in the region of £16m on digital health solutions to change the healthcare landscape in its hospitals and the services it provides. THIS’s role is to work with its host trust and healthcare sector clients on building capability, and in this case its work is mirroring the vision of the NHS Long Term Plan for technology to play a central role in assisting clinicians. Shirley Haywood, Digital Health Programme Manager, says: “We just don’t land projects; we build capability that iteratively needs to be improved. Yes, it’s important we land them but then we start looking at the next cycle and build on them to make them better and better with maturity. “A lot of the work we do comes about through our relationships with suppliers, and through sharing what we do on LinkedIn and Twitter. Sometimes a supplier will want to land a project so they have a reference site to show other potential customers.” Digital transformation in action Ensure clinicians can access and interact with patient records and care plans wherever they are. CHFT’s Medical Interoperability Gateway (MIG) makes vital GP, social care and community healthcare patient data available to hospitals and other clinicians, increasing efficiency and improving care quality. Designed to connect otherwise incompatible systems, the MIG plugs the gaps when patients admitted to hospital can’t provide medical and other historical details, providing patient data that ranges from demographics and diagnoses to social care plans, allergies, recent procedures, therapies, and tests. This enables Emergency Department (ED) and other acute clinicians can make informed treatment decisions faster, preventing unnecessary hospital admissions and duplicated tests. Use predictive techniques to support local health systems to plan care for populations. THIS has implemented a system of predictive analytics to gauge the survival chances of hospital patients, feeding into near ‘real time’ standardised mortality ratios.
The pioneering work is being done at CHFT’s Huddersfield Royal Infirmary and Calderdale Royal Hospital in Halifax. It means the hospitals have current mortality ratios instead of waiting for the national publication of the Hospital Standardised Mortality Ratio data (HSMR), delivered three months in arrears. The benefits of near real time HSMR enable the trust to pinpoint trends and variations before the national figures are published, as well as improve its ability to improve its clinical review process. Use intuitive tools to capture data as a by-product of care in ways that empower clinicians and reduce the administrative burden. Voice recognition (VR) technology is being used at CHFT hospitals to reduce repetitive tasks surrounding the recording, checking and despatch of patients’ clinical notes and letters. Working in partnership with Nuance Dragon Medical One, a cloud-based solution hosted on Microsoft Azure, THIS is pioneering VR in CHFT’s musculoskeletal and physiotherapy services with an ambition to extend its use further. Encourage a world leading health IT industry in England with a supportive environment for software developers and innovators. THIS collaborated with two major suppliers to create a link between CHFT’s drug prescription system, hosted on EMIS software, and its Electronic Patient Record (EPR), hosted by Cerner Millennium. It is a first-of-type solution across the NHS, which has removed the need for duplicated tasks between two standalone systems. Create straightforward digital access to NHS services and help patients and their carers manage their health. Working with Zebra handheld computers, THIS has developed new uses for the devices that were originally used for scanning patient and medicine bar codes to ensure the right people were receiving the right treatments. They’re now being used for additional purposes such as video calls via Microsoft Teams for patients to connect with relatives – invaluable during the pandemic - and updating records in real time at the bedside. End-user technology also means patients can be monitored at home – blood pressure
Projects landed by THIS address the following specifics of the long-term plan to drive the digital transformation of the NHS Create straightforward digital access to NHS services and help patients and their carers manage their health Ensure that clinicians can access and interact with patient records and care plans wherever they are Use predictive techniques to support local health systems to plan care for populations Use intuitive tools to capture data as a by-product of care in ways that empower clinicians and reduce the administrative burden Encourage a world leading health IT industry in England with a supportive environment for software developers and innovators. monitors are a good example of this. Wearable technology is also coming into use that will continually monitor a patient’s observations and feed the data back to the hospital. L Contact us If you’d like to collaborate and innovate with THIS contact us here. FURTHER INFORMATION www.this.nhs.uk
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Technology But it still seems to be rocket science in the NHS or - to be fair - most health systems. We currently lack the infrastructure for computable knowledge in healthcare. Right now, our situation is like trying to engineer the Industrial Revolution without building the coal mines and railways. In the UK, important initiatives in this field are now underway by NHS England, Health Education England, NHS Scotland and NICE.
We need to format healthcare knowledge into a standard computable form. This translated knowledge needs to be stored in a quality-assured e-library that people and systems can access using open standards
The high cost of poor clinical decisions These costs can be measured. In the US, “Adults and children only receive recommended care about 50 per cent of the time,” the Journal of the American Medical Informatics Association reported in February 2021. “Individual clinician decision-making is commonly associated with mindless, or unwarranted variation (deviations from best practice, not based on evidence or patient preference) and associated with waste, morbidity, and mortality”, reported the journal. This problem, reports the journal, is not confined to generalists, underqualified clinicians or those approaching retirement. “Even specialists claiming to follow best evidence do not consistently do what they say.” This is not the fault of clinicians. They’re typically overwhelme‑d by poorly processed data and knowledge. Scientific advances have outpaced the capacity of the human brain to curate and apply to patients all the amazing insights that are available. Clinicians need, beside them, not a pile of guidelines but the processing speed and interactive capacities of computers. This would keep doctors, nurses, pharmacists and other health professionals in the driving seat of excellent decision- making. And, of course, patients.
to deliver: a dynamic link between scientific learning and what’s known about the person. Where helpful, high quality decision support would guide clinicians through a series of steps: which tests to order, evaluation of the results, possible diagnoses, options for care pathways and treatments. Missing this opportunity carries a high price. Despite everyone’s dedication, the price being paid in health system underperformance and inefficiency, where fatigued clinicians are overburdened both cognitively and bureaucratically. Much more could be achieved, potentially for less, with a better experience for patients and clinicians. Why is this transformation so hard to achieve? Surely computers can read and perform the task? Yes, they can read. But, computers cannot use journals and guidelines to apply knowledge.
Clinical ‘satnav’ to guide practitioners There is an opportunity to develop, at last, what the doctor-patient relationship is designed
Computable knowledge is key There is a solution which is simple to discern though challenging to implement. We need to format healthcare knowledge into a standard computable form. This translated knowledge needs to be stored in a quality-assured e-library that people and systems can access using open standards. There is a growing momentum behind the need for computable knowledge. But there is still a lot more to be done to make sure it’s standardised and properly quality assured. A cottage industry already exists that makes healthcare knowledge computable to underpin
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specific decision support systems. But the standards and quality assurance are proprietary, not open. This means they vary from company to company and cannot form a shared library. It also leads to duplication and potential contradictions. The design of decision support systems is often inadequate to have real value. Often clinicians are so annoyed they switch them off or cancel warning messages without reading them. Coding and regulatory challenges Making knowledge - including NICE guidelines and intricate care pathways - computable means breaking down what is known into small, tightly defined fragments, which are then coded (either ‘tagged’ by condition, or actually translated into an algorithm). These fragments require regular updating, which can be automated once a suitable curation system is in place. And, because healthcare is riskier than other fields, high quality encoding is essential to ensure people get the right computerrecommended diagnosis or treatments and not the wrong ones. Getting all of this right requires leadership, long-term strategy, funding, multi-disciplinary collaboration plus implementation across, and within, all parts of healthcare institutions. These elements are beginning to come together. The goal is attainable. And we can make gradual progress through a series of manageable, safe steps.
Ultimately, a global framework is also required, within which jurisdictional systems can operate. Next steps We need to collaborate, pilot and recognise the opportunities and the challenges – and the dangers of failing to act. It makes sense to start by piloting creation of computable knowledge and decision support in areas where progress will reduce clinical burden and enhance safety. The development of computer-driven decision support will place clinicians in the driving seat of ever-improving, high quality learning healthcare systems. Its wider availability will underpin patient empowerment and self-care. Implementation of computable knowledge and decision support will also be vital if policy makers are to succeed in devolving as much healthcare and resources as possible from secondary to primary care. Machine Learning The infrastructure required for developing such decision-support – translation of knowledge into computable formats – also opens the door to a further major development. Once computers can process healthcare knowledge and connect it to patient data, a truly learning healthcare system becomes much easier. Machine learning - searching for patterns in system-wide records of practice and patient experience – becomes possible. It will provide a new source of knowledge and insights that will sit alongside traditional scientific learning. It
will further improve the excellence of healthcare delivery and enable more personalised patient care, drawn from analysis of so many different patient experiences. It will also help to improve the quality of decision support because it will be possible to examine which types of support are associated with the best outcomes. There are already promising signs that the challenges are increasingly recognised, for example NHS England has identified decision support as a priority for the new Transformation Directorate. NHS Scotland already has a national decision support strategy and service. NICE is actively exploring ways to make its guidelines content computable. Health Education England provides guideline-based decision support to the frontline, both as a point of care tool and a learning resource, and is investigating cultural, behavioural and motivational factors influencing uptake. For the good of the whole UK, indeed the world, these efforts must be coordinated and open to sharing good practice and lessons learned, both within Britain and beyond. L
Business as usual For all these many reasons, healthcare systems have little choice. They need to take advantage of new ways to organise and express their knowledge and connect it to patient data. Health systems, like all organisations, struggle to lead change because they are restricted by their commitment to business as usual. There is no single stakeholder within government with overall responsibility for leading and implementing this complex initiative. Government leadership is required to set out a strategy that defines the goals and the roles of the many different parts of healthcare required to create and implement the strategy. Planning and delivery will not only be interdepartmental (bringing together, for example, those responsible for standards and guidance setting), but also those charged with healthcare digital strategy, regulation, capital infrastructure and clinical delivery in primary, community, social and secondary care. It will also be multidisciplinary, requiring the collaboration of, for example, informaticians and clinicians. Health is a devolved policy in the UK. So, for example, NICE provides national guidance and advice to improve health and social care in England and Wales. But the Scottish Intercollegiate Guidelines Network plays this role north of the border. Some conditions do not have published guidance from an authorised UK body so practitioners rely upon American or European guidelines. We will need to clarify the rules for how Britain’s various guidance standards should be used for decision support.
This report ‘Building a ‘clinical satnav’ for practitioners and patients’ was commissioned by BCS, The Chartered Institute for IT, and based on interviews with members of a working group on computable knowledge that is organised jointly with the Faculty of Clinical Informatics. Authors: Jack O’Sullivan, Jeremy Wyatt and Philip Scott. FURTHER INFORMATION https://tinyurl.com/2p856tst
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. From a completely independent viewpoint, Segmentation Group, with our depth of knowledge in legacy services, can help you gain clarity and remain in control.
Call us on 03300 240480 for a free consultation or email us at email@example.com www.segmentationgroup.com/isdn-/-pstn-switch-off-2025
Issue 22.3 | HEALTH BUSINESS MAGAZINE
A simple solution to a waiting room headache As healthcare services are facing overcrowding, social distancing issues and ultimately more pressure for both staff and patients, have you considered a patient paging solution?
Doors remain open As we’re forced once again to turn our attention to the impact the pandemic is having on some of our key services; hospitals, GP practices, and pharmacies, still have a continual flow of people through their doors every day. Despite being overstretched and under pressure, facilities remain open, meaning that routine services, wherever possible, will be unaffected. This has meant outpatient appointments for the various clinics and services are increasing in numbers, foot flow has increased on sites, all whilst still trying to manage social distancing. A Midlands Trust based Matron advised that they are seeing between 80 - 100 patients per day and are having to continually juggle social distancing, the available space within their waiting areas, and the volume of patients, on top of carrying out their normal duties. Many Trusts have been adopting a patient paging solution to help with these social distancing issues. Providing Patients and Staff with Care and Safety The MediCall™ patient paging solution enables flexibility in where a patient waits for their appointment. All it requires is for the patient to receive a pager upon check-in. The patient then has peace of mind that they are on the waiting list whilst having the freedom to wait in surroundings they feel most comfortable with, whether this is relaxing in their car, grabbing a drink in the café or heading to the on-site restaurant. It also allows for vulnerable or less able-
bodied patients to wait within the normal waiting areas but feel safe within the space, because of minimal people waiting. Trusts adopting the MediCall patient paging solution know that this can improve the waiting experience of their patients. It not only ensures the patient feels safe and at ease whilst on their site, but it helps their staff as well. Their team knows that they can disperse people quickly and easily once patients are checked-in but have the ease of calling them back to the clinic when they are ready to see them. We must not compromise the care and safety of patients and staff during these ever-changing and challenging times. Tools such as MediCall help to solve this. When looking at pharmacies, they’re often places without sufficient waiting space available indoors. The facility of giving people a MediCall pager so they can wait in their vehicle or socially distanced outside again provides the customer peace of mind that they are in a queue, their order is being dealt with, and can socially distance themselves safely. As with the Hospital Trusts, Pharmacy companies provide the best care they can to their customers and staff by utilising the paging solution. A system simple to deploy, easy to use, but provides so much Crucially MediCall is a simple solution to install; it doesn’t require a connection to any IT network and is engineered to give you the site coverage you need. Ensuring nobody misses an alert, MediCall provides an audible tone, flash, and vibration; a sensory combination providing DDA
BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS | www.healthbusinessuk.net
compliance. It also features an ergonomic design for safety hygiene - enabling a fast turnaround at busy times. The simplicity of its function means training and ongoing use are simple to grasp. And therefore, easily integrates with existing on-site processes. Don’t just take our word for it Feedback from those using the patient paging solution have commented about its ease of use, the headache it has removed for them, and quick and easy installation. Sarah Rees of the Surgical Assessment Unit at University Hospital of Wales, Cardiff & Vale said: “The system has been the best investment to improve the patient experience in the hospital during Covid-19. We have proposed your system for our improved patient waiting experience award.” Passionate People. Proven Solutions. Call Systems Technology (CST) has been supplying patient paging solutions for over 25 years to Hospital Trusts up and down the UK. The knowledge and experience built up over this time prove invaluable to customers as they trust that CST will provide them with a solution that works, meets their budgets, and will last. As UK leaders in onsite paging, CST provide customers with the best solution, service, and experience. L FURTHER INFORMATION www.call-systems.com firstname.lastname@example.org 020 8381 1338
Awarding contracts for cutting-edge technology Whether looking to buy technology from an established multinational cloud provider or a small start-up with a cutting-edge machine learning product, procurement law reforms mean awarding the contract isn’t necessarily simple. Jamie Foster, commercial lawyer at Hill Dickinson, explains the rules and how they might change A range of things need to happen for the NHS to adopt and deploy technology, and one of these from a legal perspective is compliance with procurement rules. The long-awaited coming into effect of the Health and Care Act on 1 July 2022 will bring in much discussed changes to procurement and competition law for the NHS, designed to better reflect current policy imperatives around integration as opposed to competition. In due course, these changes will sit alongside changes proposed as a result of the consultation exercise kicked off by the 2020 Green Paper ‘Transforming Public Procurement’ as now contained within the draft Procurement Bill and is likely to herald a new era in the way the NHS procures goods and services. Of course, it is not news to anyone that these changes are coming into force at the same time that the pandemic has dramatically
the case of other bodies such as Clinical Commissioning Groups and Health Education England, £213,477 (inclusive of VAT) or If more). However, for a purcha clinical services, the is more w se Light Touch Regime e ig h t ed towards (LTR) within the clinical services, PCR provides for a The current higher threshold position body wil then the NHS l n (£663,540) At present, the Public o t n e c have to essarily (inclusive of Contract Regulations a market u dvertise to the VAT where 2015 (PCR) require n applicable) before NHS bodies to compete is over thless the value the requirement to contract opportunities e £663,5 tender to the market for the provision of threshold 40 kicks in and when services on the open it does, there is more market where the value of the flexibility as to structuring the contract in question is £138,760 procurement process itself. E (inclusive of VAT) or more (or, in accelerated the adoption of digital technologies by the NHS. It is valid to ask whether the proposed changes to procurement law will make it any easier for the NHS to buy the best of these technologies.
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Leading Change in ICS Implementation When Integrated Care Systems (ICS’s) are launched as statutory bodies in July, NHS leaders will start to implement a major transformation in the delivery of health care at system, ‘Place’ and neighbourhood level, as Philip Watts explains As with any major change process, there are clear steps that leaders should focus on to ensure successful implementation of their plans, and delivery of a meaningful and sustainable outcome. NHS organisations, local authorities and other public sector bodies that will need to work closely together to deliver the agreed strategy could potentially learn from the experiences of similar change programmes both in the public and commercial sector. Whilst NHS and Local Government leaders grapple with how to incorporate subsidiarity of decision making and budgetary management at smaller sized “Place” planning units, experience with large corporate entities would suggest achieving meaningful efficiencies may require a different approach. The move towards centralisation of core functions that can deliver ‘at scale’ and across a broad population is now more common in the commercial environment and closely mirrors those functions that could provide support across the ICS, for all places and neighbourhoods that are delivering services at a local level. Commissioning, funding allocation and other strategic imperatives could be delivered once, and at scale. The cost savings and efficiency that this would drive at a macro level, allowing for greater flexibility and tailoring of strategy to meet the needs of the population at a local level. Similarly, many organisations that have undergone significant change, have started with detailed thinking about the structure and processes needed for the new operating model. While this is always important, any change plans should also consider the behaviours that will be needed for the new organisation to succeed. This step is often overlooked, and this can prove to be a fatal flaw. Successful change agents should carefully consider any changes in behaviours that will be needed to facilitate the desired ‘to be’ Vision. In the case of ICS’s there will need to be a fundamental change in the levels of collaboration that are needed across the whole pathway of care, between all levels of local government, health care and the wider public sector. The formation
of provider collaboratives is likely to be a fundamental part of all ICS plans and represents a huge change from the ‘competition based’ approach that has been central to NHS strategy in the recent past. A clear description of the new behaviours that will be needed at all levels of the ICS is a key success factor for all transformation plans. In addition to this, other key supporting factors include accurate and real-time data. Without the benefit of clear data and metrics it will be extremely difficult to monitor both the pre-ICS situation and the level of impact of the change that ICSs will bring about. Additionally, ensuring that health inequalities are reduced or eliminated will be a key goal. This will require the new organisations to work closely together to ensure that their geographies are offering seamless and accessible care to all citizens within their footprint. Finally, whilst effective presentation by senior leaders of the case for change can help build awareness, understanding and desire for change internally, the success of any change programme is not only dependent on its launch. Sustaining the change, by clear ‘modelling’ and ‘reinforcing’ of desired actions and behaviours is the greatest determinate of eventual success and realisation of expected results. Each leader should develop an individual Change Leadership Action Plan (CLAP),
that describes to their team members in detail, the way that they will communicate, model, and reinforce the change. Leading by example is a key success factor in any change programme, but the specifics of what leaders will do during the first 30, 60 and 90 days after the launch of the change programme is often overlooked. Effective monitoring of the change and encouraging best-practice sharing across ICSs will help inform any necessary post-launch adjustments and interventions to sustain the change and deliver country-wide impact. At Warn and Co, our change philosophy is based on the concept of ‘Launch and Sustain’, as opposed to the ‘Launch and Leave’ approach that has been evident in many failed change programmes in the past. NHS and ICS leaders have a fantastic opportunity ahead of them. The Vision for ICSs is both exciting and compelling and the plans that have been developed by newly appointed ICS leaders are detailed and of high quality. They provide an excellent starting point for the ICS journey. Combined with the simple change leadership principles discussed in this article, the implementation of ICSs should mark a major step forward for the NHS. L FURTHER INFORMATION www.warnandco.com
Philip Watts is Warn + Co’s Head of Customer Excellence and has 30 plus years of experience leading major change in Pharma and Healthcare. Warn + Co is solely focused on business transformation, supporting leaders to turn their visions into the delivery of meaningful results. Transformation services include: • Business strategy and design • Transformation delivery • Culture, change and comms. To discuss ‘Leading the Change in ICS Implementation,’ email email@example.com
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Frameworks However, one option which is becoming increasingly relevant and helpful is the use of frameworks, which are becoming the most common way of buying digital products in the NHS. Where frameworks are established, NHS customers can call off contracts from providers on the frameworks without having to run their own full-blown competitions. Buyers may choose to run mini competitions for providers on the frameworks, to preserve commercial leverage. Historically there have been a range of frameworks which NHS buyers could use as their option for procurement of digital and IT solutions. However, we understand that NHS England and NHS Improvement recently issued guidance recommending which framework agreements could be used – the guidance recommends 36 framework agreements across six category “pillars” including clinical and non-clinical hardware, software/SaaS/Apps, Services, etc. It also summarises the minimum standards for each pillar. The guidance recommends that NHS buyers should use these frameworks for all digital buying and should be able to justify the rationale for not using them, but the guidance is not mandatory, and buyers should always choose the right option for the particular solution they are looking to buy. An example of such a framework is the Clinical Digital Professional Solutions Framework (CDPSF) set up by the London Procurement Partnership (LPP), one of four
Where frameworks are established, NHS customers can call off contracts from providers on the frameworks without having to run their own fullblown competitions. Buyers may choose to run mini competitions for providers on the frameworks, to preserve commercial leverage. national procurement hubs uniquely owned by its members (predominantly NHS bodies). Another is NHSX’s Spark Dynamic Purchasing System for remote monitoring. There is also the government’s G Cloud framework, a digital marketplace for cloud services available to all public sector organisations and currently open to its thirteenth iteration. What’s changing? The Health and Care Act 2022 promises to have a major effect on NHS procurement, with the introduction of the Provider Selection Regime (PSR). The government argues that this new regime will ensure services are procured in the best interests of patients and will remove many of the obligations imposed by the Health and Social Care Act 2012 around competitive tendering. It is worth bearing in mind, however, that at the time of writing, it is expected that the PSR is unlikely to come into force until December 2022 at the earliest rather than being concurrent with the formation of the Integrated Care Boards (ICBs) on 1 July 2022, which will cause some concern immediately since ICB commissioners will have to keep following the LTR for another five months after they are created. Utilising PSR Although not expressly excluded, the rules around the procurement of digital technology by NHS bodies are unlikely to be directly affected by the new regime, as the PSR is focussed on clinical services. The PSR consultation documents recognise the issue of ‘mixed procurements’ but consider these in the context of integral services and social care rather than the procurement of digital technology. However, one potentially significant change which could alter our perspective upon the manner in which digital contracts are procured is in those instances where the determination of whether what is required is a health / social care service or a technology service is not clear cut. Whereas currently, the predominant value answers this question, as noted above, moving forward under the PSR the question becomes one of what the “primary aim” is of the procurement – where this is health/ social care service provision, but the tech side of things is nonetheless of a greater value, it is potentially arguable at least that the PSR could be utilised instead of PCR as the route
However, difficulty arises when awarding contracts for technology services because it is not always clear whether what is being procured is a “pure” technology service or clinical service delivered through technology. The legal answer to that question is that the so-called ‘dominant’ aspect of what is being contracted for takes priority; for instance, if a purchase is more weighted towards clinical services than technology, then the NHS body will not necessarily have to advertise to the market unless the value of the contract is over the £663,540 threshold (though even if the contract value is below that threshold, the NHS body will still have to comply with general procurement law principles of transparency and fairness of treatment). In contrast, where the dominant aspect of the contract is technology, such purchases are subject to the full PCR procurement regime and the lower threshold will apply. It is not always easy to work out what the dominant aspect of a contract is. The PCR does of course offer a range of exemptions for when competitive procurement is not required. Unfortunately, in most cases, the exemptions are unlikely to apply. For example, the ‘extreme urgency’ exemption under Regulation 32 of the PCR, which was used extensively at the start of the pandemic, is unlikely to be available as it can only be relied on in genuinely urgent and unforeseeable circumstances. Equally, the argument that there is only one provider capable of delivering the service is difficult to run in a market as competitive as health technology.
to contract award. Except as described above, procurement rules around digital technology will fall under the new Procurement Bill which has now been published, but which are not likely to come into law until late into 2023 at the earliest, but until the granular detail of both the PSR and the final text of the Procurement Bill are clear, the rules applying to digital technology and mixed procurement remain unclear. For now, the only option for NHS buyers is to continue to consider the ‘dominant’ aspect principle when awarding contracts, and to look to the ever-growing number of frameworks as potentially the easiest way of awarding contracts. L Jamie Foster is a commercial lawyer at Hill Dickinson LLP, specialising in the health and life sciences sectors. Clients include life sciences businesses, NHS organisations, private hospitals and clinics, academic and research institutions, charities and social enterprises, and start-ups. Jamie is a member of Tech London Advocates and frequently presents on life sciences and health topics, including recently to networks such as SEHTA, Medilink, Eagle Labs HealthTech, Health Foundry, Propel YH, the Independent Doctors Federation (IDF),and the NHS Governance Assurance and Risk Network.
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Issue 22.3 | HEALTH BUSINESS MAGAZINE
How do you ensure your Trust gives high quality, consistent services to your patients? One of the key areas where NHS Trusts across the UK have suffered over the past few years is with IT system interruptions impacting the ability for staff to provide the high-quality services that patients have come to expect. How can you minimise this risk going forwards?
Are your IT systems being maintained? Keeping 1000’s of devices (life critical ones at that) up and running, maintaining them, and preparing for the upcoming Windows 11 release in a fast-moving healthcare environment is challenging and traditional, manual, methods are simply not sufficient. Disparate spreadsheets, bespoke databases, teams emailing users, manual surveys and no single source of data can lead to delays and be subject to human error. Using real data and automating many functions can dramatically reduce risk, save money and resources. We all saw the impact that the WannaCry ransomware attack had across the NHS back in 2017. It is estimated to have cost the NHS £92m. It led to 80 out of the UK’s 236 trusts being affected. 603 primary care and other NHS organisations, including 595 GP practices and 19,000 cancelled appointments. The attack led to a scurry of activities to get devices upgraded to the latest version of Windows and protected from future attacks. Some Trusts were more successful than others in doing this and even now there are some Trusts that either have not fully migrated to Windows 10 or are now struggling to keep their estates up to date with the ongoing updates that are required. Running devices with unpatched or outdated operating systems is risky. Most of the NHS devices infected with the ransomware were
found to have been running an unpatched, Microsoft Windows 7 operating system. But keeping 1000’s of devices up to date is not an easy task. Simply turning on ‘auto-update’ is not an option either. This approach could be catastrophic and could bring life-critical devices to a halt at the busiest of times. At ManagementStudio we see these challenges slightly differently. Instead of looking at each of these changes as a big project, we see them as a process. So, whether it is a move to Windows 10, the latest Windows 10 update or even preparing for Windows 11, it can be a seamless process. This can be carried forward into ‘business as usual’ once the devices have been updated and then utilised to keep them up to date at a tempo that suits the Trust, based on a schedule that works for everyone. Data is everything ManagementStudio is an “IT transformation” toolset. It uses data that most organisations already have, to understand existing devices, applications, users, their locations, department and contact information. Once we have all this information, we lock in the relationship between all those data sources. By doing this, we can precisely see the impact that a single application or a device will have on the Trust and its user and start to plan the transformation with the least amount of disruption possible. We can see exactly which applications are used by which devices and users, allowing
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us to rationalise those applications which are not required or map older versions to newer versions. We can the prioritise the application packaging, QA and testing process whilst always communicating with users and stakeholders about the progress of their device and application migration. We can trigger, automatically, user communications as the device or application progresses through its various stages until the user is showing as ‘ready’, upon which we can then send out scheduling information so they know exactly when their device will be updated or replaced. Avoiding Support ‘Bubbles’ We can identify certain devices as ‘VIP’ or ‘Life Critical’ thus allowing organisations to decide precisely when they should be updated and not at times that could prove highly disruptive to the Trust. By updating at a tempo or pace that suits the Trust, you can avoid ‘support bubbles’ by updating devices to a schedule that works for everyone. This approach proved critical when we helped NHS Gloucestershire Trust migrate their users to Windows 10. They had a very small team servicing 1000’s of devices and users. Using automation, they were able to schedule updates at times that avoided critical times during the working day. Take Control of your IT changes Keeping control of the project, seeing predictable outcomes, and preparing for future change is becoming more and more challenging without the correct tools in place. ManagementStudio provides you with that framework that is required to manage change, save money, save resources and get ready for the future. ManagementStudio enables NHS trusts across the UK to deliver new IT systems and maintain existing ones. Check out our 3-minute overview. L FURTHER INFORMATION www.managementstudio.com
NHS Digital launches new GP software framework A new framework designed for the primary care IT market has been launched by NHS Digital. An invitation to tender has been issued for suppliers to join the Tech Innovation Framework, through which, commissioners will be able to buy user-focused GP systems and associated products and services. Prospective suppliers will be required to deliver six core functions in general practice: patient information maintenance; appointments management; recording consultations; prescribing; referral management, and; resource management. Helen Clifton, executive director for product delivery at NHS Digital, said: “The new framework will introduce new solutions into the market to work alongside our current GP offer, providing greater choice and different user
experiences. It will give GPs access to innovative solutions that feature tools they need to make their jobs easier.” Suppliers will also have to meet all the standards on the Digital Care Services Catalogue, including the GP IT Futures Tech Innovation Standard, which is looking for public cloud-hosted, internet-first, browser-based solutions with open APIs that provide a modern user experience. The Tech Innovation Framework will be the fourth framework to launch under the Digital Care Services Buying Catalogue, along with the GP IT Futures and Digital First Online Consultation, Adult Social Care and Video Consultation frameworks. These can help to meet IT requirements set out in the NHS Long Term Plan.
UKHSA licenses UnifAI’s innovative digital reader technology The UK Health Security Agency (UKHSA) has awarded UnifAI Technology a contract to license its AI powered digital reader. The digital reader, developed with Innovate UK funding, uses cloud-based AI to turn a typical smartphone into a medical device for the accurate reading of lateral flow diagnostic tests. Through extensive trials with DHSC, the digital reader does this more accurately than the human eye with an accuracy rate of 99.95 per cent. Following a competitive tender, the UKHSA has selected its digital reader as the
sole solution to help further digitise the NHS Test and Trace programme. Professor Andrew Beggs, Professor of Surgery and Cancer Genetics at the University of Birmingham, said: “The UnifAI technology allows us to further bolster our
Digital Health Rewired returns next year
Radiology replica helps assure young patients
Healthcare IT event Digital Health Rewired returns in 2023 and will continue to connect current and future health IT leaders and teams with the best in disruptive technology and innovation. To be held at London’s Business Design Centre, from 14-15 March, new topics and stages include cyber security, smart medical devices, virtual health, and clinical imaging. Rewired will see high-profile keynotes and digital pioneers share the latest thinking and policy direction. The Digital Nursing Summit will again focus on the latest developments for nursing, midwives and allied health professionals. Also returning is the popular Pitchfest competition which provides a platform for young innovative ventures to scale in the NHS. This year, CardMedic, a website and app designed to improve communication between healthcare staff and patients was crowned the winner. READ MORE
To reassure young patients before they visit radiology, Alder Hey Children’s Hospital is using a fully immersive 3D replica of the department which allows users to explore and familiarise themselves with the surroundings and interact with its specialist devices from the comfort of their own home. In the virtual world, created by Manchesterbased PixelMax, children and young people can collect ‘glowing’ key cards to access different areas of the environment while winning virtual badges for switching on and learning how the equipment including X-Ray machines and MRI scanners work. It is hoped the initiative will reduce delays and cancellations of appointments. Alder Hey Innovation Clinical Director Iain
capability to read lateral flow devices highly accurately and ‘better than the human eye’. With this, we will continue to ensure the highest accuracy we can in reading lateral flow devices for COVID-19, reducing transmission” UnifAI Technology is partnered with Amazon Web Service (AWS) and the solution is hosted in AWS cloud services, giving it virtually limitless scalability automatically and on-demand. READ MORE
Hennessey added: “Our objective is to use the most advanced technologies to solve realworld healthcare challenges. “The quality of the virtual worlds PixelMax develops really stood out to us. It’s been a privilege to work with such a skilled team in creating such an impressive replica of our radiology department, which we hope will engage, educate and provide vital reassurance for visitors.” PixelMax also partnered with The Christie Hospital in Manchester in a similar project to familiarise patients with the proton beam therapy facility. READ MORE
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Cleaning audits made simple with fmfirst Cleaning ®
The National Standards of Healthcare Cleanliness highlight how useful digital auditing systems can be in meeting compliance requirements. Digital audits allow users to identify trends and hot spots, and offers greater transparency when sharing the data within an organisation
This year, the NHS and other healthcare organisations have to show how they plan on becoming compliant with these new standards. The standards highlight how effective digital auditing systems can be in the quest for compliance, however, it’s important to not panic-buy a system. Considerations There are many cleaning audit software providers out there but you must find the right software for your business. The software will essentially do the same job no matter who the provider is, so how do you choose the right provider for you? It comes to a stage where other considerations need to be made over the convenience of using existing providers or cost, such as: ease of use; ability to meet the needs of the facility; one size does not fit all; ability to produce metrics from elements, frequency, and room data to show compliance with the standard; ability to ‘build as you go’ to easily capture room function changes, new rooms, etc; ability to easily export data with simplified reporting functionality; compatibility with NHS building regulation data. Making cleaning audits digital provides users with the opportunity to identify trends and hot spots. It also offers greater transparency and a more effective way to share the data within an organisation. Cleaning audit software shouldn’t be something you purchase just to ‘tick’ a box. The right software, used properly, can be an integral part of your operation, especially when integrated with other tasking modules.
The standards seek to drive improvements while being flexible enough to meet the different and complex requirements of all healthcare organisations. And the software should mirror this principle. Meeting the numbers There are now 6 Functional Risk categories (FR). The expanded scoring categories enables organisations to increase or decrease the risk rating in individual functional areas. However, organisations can choose to adopt these 6 FR categories or the blended approach where target percentages are based on the combined targets for rooms. The standards come with 50 elements, a list of individual items/categories that require cleaning, each one with its own cleaning specification. Scoring from audits can now be displayed using a 5-star-rating, similar to what you find in the hospitality industry. This star rating in healthcare cleanliness aims to be a simple, effective and visual way of providing meaningful information about quality that can be understood by members of the public. Don’t forget the efficacy audits too! As cleaning and infection prevention is a partnership, it’s important to audit the outcome of the cleaning as well as the cleaning process itself. To meet the standards, the efficacy of the cleaning process is just as important as the technical outcomes of the cleaning.
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The NHS is committed to cleanliness, and Asckey is committed to making this as simple as possible for your organisation. Keeping it simple Asckey’s fmfirst® Cleaning has been purposefully built to have minimum clickthrough options and be an easy-to-use application. Its design automates report emails once audits have been completed, and includes any corrective actions that are required. This method of providing instant fault reporting and the options for rectifying, allows users to take action right away. This means time and resources can be proportionately allocated. The software you choose shouldn’t be overcomplicated; the process can be complicated enough! It’s important to choose a digital solution that can help simplify the process and one that can also support the follow-up actions by raising tasks to rectify any faults reported. An application that can be integrated with other programmes will strengthen your auditing, and facilities management, toolkit. By collating the information together, organisations have all the insights they need at their fingertips, highlighting data trends that can then identify opportunities for improvement. Asckey aims to help the right people get the right information at the right time. Contact us to discover more. L FURTHER INFORMATION www.asckey.com
Legrand: We are stronger together Legrand launches Legrand Care, its new global brand specialising in the assisted living, health, and social care sectors Legrand, global specialists in electrical and digital infrastructures launches its new consolidated brand for the Assisted Living and healthcare market called Legrand Care. This new powerful brand allows the company to be stronger in the international market of connected care, taking advantage of synergies and improving the value of products and services for the care sector. Legrand Care was born from the integration of the brands that make up the Assisted Living and Healthcare (AL&HC) business unit of Legrand: Intervox, Tynetec, Aid Call, Jontek and Neat. Chris Dodd, CEO of Legrand Care, states: “The coming together of five highly regarded, customer centric, long established assisted living and healthcare brands into Legrand Care is a significant milestone in our journey.” Likewise, Arturo Pérez Kramer, who has assumed his new role as Deputy CEO of Legrand Care formerly CEO of Neat, explains that ‘this relevant union of forces responds to the objective that Legrand established in 2020: To improve people’s lives’. This great challenge ‘is the essence of our commitment and our consolidated strategy in the new brand, Legrand Care’ Pérez adds. Caroline Mouminoux, Sales Director of Legrand Care and Silver Economy manager in France, formerly Silver Economy representative for Legrand France and Director of Intervox, declares that they are ‘very proud of this announcement’ and that,
with the launch of this new brand, ‘Legrand confirms once again that assisted living and healthcare is a strategic market for the Legrand group, and we see this as a great opportunity to address some of the social and economic challenges this sector faces’. This alliance reinforces Legrand’s strong commitment to ‘the connected care market and the silver economy and opens the doors to accelerate developments and innovation’, Íñigo Ruiz Cossío, Director of Product and Marketing of Legrand Care says. Thanks to the creation of Legrand Care, more than 40 years of knowledge and experience of the members of this division are put into joint value ‘under a common strategic vision, with a coherent image in the market, the five brands will cease to operate as segmented entities and will concentrate their strengths to position Legrand as the leader in connected care worldwide’, Ruiz highlights. In this sense, Mouminoux affirms: “This new Legrand Care division is excellent news for all our customers, partners and stakeholders in the health and social care sector and will give us even more capacity for innovation, to anticipate technological challenges and will allow us to confirm that we are a key player in this market.” All the members of this division feel very motivated by this alliance and share the deep conviction that our shared resources, solutions, interests, and vocation will make them stronger and will allow them to work
together in the development of ‘proactive and preventative agendas, always placing people at the heart of our services. We will be more innovative because we will concentrate our efforts into achieving our shared objectives’, Ruiz remarks. Dodd assures that all members of this new brand firmly believe that ‘this strategic union will facilitate the fulfilment of the mission and vision of this entity’. Mission: A tireless commitment to truly understand customer needs, enabling innovative digitally connected care solutions to be delivered. To be the technological partner of clients, offering comprehensive and fully managed solutions that allow them to efficiently deploy improved care services. Vision: To empower and help people live the healthiest and most fulfilling lives they want in the place of their choice. Dodd concludes: “Together we will be better able to channel our combined resources into new product development and will continue to remain nimble and be proactive to the changing needs of our customers with the strength, resources and quality controls of Legrand, the global specialist in electrical and digital infrastructures in support.” L Legrand is the global specialist in electrical and digital infrastructures, offering high-valueadded products and solutions that improve lives by transforming the spaces where people live, work, and meet. Operating worldwide, Legrand works to enhance electrical and digital infrastructures, embracing the shift to digital technologies while contributing to reduced carbon footprints. Legrand solutions are used in residential and nonresidential buildings, care facilities, as well as in datacentres, industrial spaces, and infrastructure. Its new brand Legrand Care specialises in the innovative development of connected solutions for the health and social care sector. The Group’s technological expertise, its leading positions, the scope of its offering, its international presence and the power of its brands combine to make Legrand a global leader. With a presence in close to 90 countries and a workforce of over 36,700 Legrand generated total sales of €6.1 billion in 2020. FURTHER INFORMATION www.legrandcare.com
Issue 22.3 | HEALTH BUSINESS MAGAZINE
Interoperability success starts with standards Using GS1 standards, data can easily be captured at the point of care for every person, product and place as required - elimiting errors caused by wrong patient, wrong drug, wrong dose and wrong form Late in April 2022, The Faculty of Clinical Informatics (FCI) released a preliminary publication of the new draft Standards and Interoperability Strategy1 commissioned by the NHS England and Improvement Transformation Directorate. Titled ‘How Standards Will Support Interoperability’, the strategy outlines a series of objectives intended to promote the interoperability of data across the NHS. The vision is this: “[To establish] a health and social care system that enables all relevant care information accessible to those who have a legitimate right to do so, at the point of need, wherever it is held”. Achieving system-wide interoperability is the ultimate end goal but, to achieve this, access to standardised data is crucial. As a global standards organisation, this strategy clearly resonates with GS1 UK as its aims reflect our own – to harness the power of standards to transform the way we work and live.
In healthcare our standards – GS1 standards – are used to uniquely identify every person, every product, and every place2 throughout the supply chain and patient pathway. In doing so, this allows greater visibility and traceability from manufacturer to patient by using standardised data to enable interoperability. Where do GS1 standards align? Universal adoption of the NHS number as the unique patient identifier Aligns with GS1’s principles of positive patient identification. At the centre of the architectural approach to interoperability lies the adoption of the NHS number. “Many issues across the NHS have at their root cause the inability for two systems to be able to tell that they want to exchange data for the same patient.”
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Internal-based system identifiers, such as the medical record number (MRN), are frequently still used as the primary identifier for patients. This is not a problem if there is only one system in use, and in a single organisation, but add another system into the equation or consider a transfer of care request to another healthcare provider and traceability unravels. A MRN for a patient in one organisation, can easily be attributed separately to a different patient in another location. It has happened before and still happens, sometimes with detrimental consequences. Recent investigations conducted by The Healthcare Safety Investigation Branch (HSIB) into incorrect patient identification3 provide clear examples of the implications of patient misidentification. In these instances, the recommendation is clear – the consistent use of the NHS number. Noting this as a specific national safety risk, the strategy states: ‘The NHS number is a unique identifier for people living
The widespread adoption of dm+d Aligns with GS1’s principles of unique product identification which spans medicines, medical devices, and assets. The NHS Dictionary of medicines and devices6 (dm+d) is a universal standard for the standardised capture of production information associated with medicinal products. “The standard’s primary purpose is to support interoperability. Therefore, electronic systems that exchange or share information about medicines relating directly to a patient’s care must adhere to the standard by using dm+d identifiers and descriptions when transferring information.” It relies on four key components for standardisation, one of which is the ‘identification of medicines within the supply chain by the inclusion of GS1 GTIN codes where known’. The GS1 Global Trade Item Number (GTIN) provides an accurate and consistent way of identifying products. Encoded into a 2D DataMatrix barcode along with relevant production information (such as batch/ lot number and expiry date), accurate medicines information can be captured and shared across various relevant systems. End-to-end traceability Aligns with GS1’s principles of accurate identification of places for effective location management to enable traceability. The strategy centres on getting the right data, to the right people, in right place, at the right time. The benefits of doing so are significant – not just to clinical staff, but crucially, to patients. Six key advantages are highlighted in the strategy: Improve the quality of care through access to data e.g. reduce the risk that care
in England (and Wales). There is a chance that a patient may be incorrectly identified when the NHS number is not used.’ Additionally, the HSIB makes the following observation: ‘It may be beneficial if further national work is undertaken on the use of the NHS number as a unique identifier, specifically in identifying patients.’ NHS Digital’s standard for automatic identification and data capture (AIDC), DCB10774, already exists for this purpose. In this instance, the NHS number (along with other approved patient identifiers i.e. name, date of birth and sex) is encoded into a 2D DataMatrix. This information is contained alongside a GS1 globally unique identifier to create the GS1 Global Service Relation Number (GSRN). By using the GSRN, this provides a globally unique means of identifying patients – not just from one organisation to another, but also from country to country. This supports interoperability requirements for worldwide patient traceability by way of a global shared care record, the International Patient Summary5.
is provided based on partial or inaccurate information and reduce medicine prescribing errors; release time to care for clinicians by giving them quick and direct access to the information they need; reduce the inefficiencies and safety risks of data entry from paper or different systems; harness the power of clinical decision support and insights to help optimise care ; people who use services will no longer need to remember specific details of their medical history; and staff will be able to move from one care setting to another more easily. Using GS1 standards, data can easily be captured at the point of care for every person, product and place as required. Through point of care barcode scanning, staff gain access to accurate information in real time. The Scan4Safety report’s7 findings provide clear evidence to support this. Headline data from the report include: the release of 140,000 hours of clinical time back to patient care; reduced prevented-error rates by 76 per cent, including elimination of all errors caused by wrong patient, wrong drug, wrong dose and wrong form at Royal Cornwall Hospitals NHS Trust; reduction in the average time taken for product recalls, from 8.33 days to less than 35 minutes at Leeds Teaching Hospitals NHS Trust; non-recurrent inventory reductions of £9m across the six demonstrator sites; and recurrent inventory savings worth nearly £5m across the six trusts. When standardised data is done right System-wide integration in healthcare cannot be achieved without interoperability, and for this, universal open standards need to be in place. This reflects the main principles of the end-to-end model framework outlined in the draft. Not only does it make sense to align data for interoperability across the English health system, it also makes sense to do so with globally unique identifiers, ensuring data is fit for purpose, not just now but also in the future. In doing so, international health systems will be equipped for interoperability, promoting full traceability throughout the world. Make sure the data is unique, accurate, captured once, and shared to many – the
benefits are there for the taking. Now is the time to make the most of the potential of standards to enable interoperability and deliver greater continuity of care for patients. L FURTHER INFORMATION gs1uk.org firstname.lastname@example.org
Website references 1.
https://facultyofclinicalinformatics.org.uk/ blog/faculty-of-clinical-informatics-news-1/ post/how-standards-will-supportinteroperability-90
https://hsib-kqcco125-media. s3.amazonaws.com/assets/documents/ HSIB_Incorrect_patient_identification_ Report_Final.pdf
https://digital.nhs.uk/data-and-information/ information-standards/informationstandards-and-data-collections-includingextractions/publications-and-notifications/ standards-and-collections/dcb1077-aidcfor-patient-identification
https://digital.nhs.uk/data-and-information/ information-standards/informationstandards-and-data-collections-includingextractions/publications-and-notifications/ standards-and-collections/scci0052dictionary-of-medicines-and-devices-dm-d
Issue 22.3 | HEALTH BUSINESS MAGAZINE
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.
FURTHER INFORMATION Tel: 01268 570900 email@example.com www.yewdale.co.uk
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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.
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. FURTHER INFORMATION Tel: 01858 438938 firstname.lastname@example.org www.4c.co.uk
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