LifeStories Magazine 2019

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New technologies and ideas for improving health and wellbeing in Wales NHS Wales innovation and successful collaborations

Welsh Government - Technology, Digital and Transformation

Advances and achievements in the Welsh life science industry



Contents Innovation and collaboration in NHS Wales


Welsh Government Technology, Digital and Transformation

Innovation in the Welsh life science industry

6 Landmark study of smoking and lung cancer

24 The Transformation Programme for ‘A Healthier Wales’

40 Crossing borders for rare disease health awareness

7 World-first virtual assistant in oncology

26 Harnessing the power of AI to improve radiotherapy treatments

40 Addressing the challenge of turf pests

8 Delivering cancer services closer to home 9 Bringing advanced medical therapies to Wales

27 A solution to the issues faced setting up a frequent attender service

10 Hi-tech cabinets improve medicines management

28 Health Technology Exemplars: A true collaboration between industry and health

11 Electronic health record for pregnant women 12 Pharmacy sore throat pilot promotes appropriate antibiotic use 13 New direction for IBS using FODMAP diet 14 Platform collects patient feedback for service improvement

42 Technology facility gains GCLP accreditation

30 Improving quality and value: A new wave of Coordination Hubs for Wales

44 Bring innovation to surgical endoscopy

44 Digitising consent for shared decisions

31 Harnessing the power of deep learning to assess Naso-Gastric tube position

45 A new approach to staff engagement – SPEaC Happy

32 The National Mobilisation Programme

45 Biomarker tracking start-up relocates to Wales

16 Addressing the shortage of diabetes specialist nurses

35 Progress for Choose Pharmacy

46 Top tips for funding and finance

36 Accelerate: the pioneering innovation programme 38 Digital portal for pressure ulcer reporting and recording in Welsh care homes

18 A new network for innovation

42 Significant steps for CRO

43 Innovation at CITER

34 Powys Transformation Project – Delivering a healthy, caring Powys

17 New sharps bin to reduce risks

41 Game changing test for leukaemia

29 ‘Attend Anywhere’ for digital patient care

15 Health Technology Wales makes impact in its first year

17 Bed Block board game informs hospital staff

41 Doors open for BrainBox Initiative winner

47 Shedding new light on medical product design 47 Dopplers win Queen’s Award for Innovation 48 Collaboration to safeguard the lives of care home residents

19 Healthy Thinking podcast series puts forward new perspectives on innovation

48 Making medicines better with novel technologies

19 Welsh Health Hack brings healthcare professionals and technology companies together to innovate

49 MHRA approval for Clinical Services Centre of Excellence 49 Collaboration to explore new ovarian cancer treatment

20 Droplet hydration for the vulnerable in Wales 21 Innovative operational planning tools

50 Empowering patients for digital data input

22 VR distraction therapy for cystic fibrosis patients

50 Going global with maxillofacial prosthetics

LifeStories is produced and published by Teamworks for MediWales.


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Welcome to the 2019 edition of MediWales Lifestories - the publication dedicated to sharing success stories from the Welsh life science sector.

What is MediWales?

This edition of Lifestories has been

between NHS Wales and companies,

published to coincide with MediWales

academic institutions, research

Connects 2019 – the all Wales NHS

organisations and more. Stories

collaboration conference. Now in

include VR distraction therapy for

its fourth year, this conference aims

cystic fibrosis patients, a world-first

to showcase the excellent work

virtual assistant trained in oncology,

being carried out by the health and

hi-tech cabinets improving medicines

care communities in Wales; improve

management, and an initiative to bring

collaborative working between the

advanced medical therapies to Wales.

health boards, industry and research communities; raise the profile of NHS Wales and clinical innovation across the UK; and support closer working relationships with industry, NHS and research groups.

MediWales Lifestories is divided into three sections:

Annual highlights in our calendar include the MediWales Connects conference and the MediWales Innovation Awards.

Digital and Transformation puts a spotlight on innovative Welsh Government initiatives and government-funded projects. Finally, Innovation in the Welsh life


science industry features stories from Welsh companies and universities – including award-winning medical

Wales highlights successful projects

technology, innovations in surgical

undertaken by NHS Health Boards

endoscopy, a new test for leukaemia,

and Trusts across Wales. Many of

and a collaboration to explore ovarian

the projects involved collaboration

cancer treatment.

We encourage collaboration through our publications and a popular programme of events that focus on strategic issues for the life science sector, including regulatory updates, market access, finance and funding, clinical unmet needs, international trade and a range of special interest groups.

Welsh Government - Technology,

Innovation and collaboration in NHS


We support over 180 members from the medical technology, diagnostic and pharmaceutical industries, NHS health boards, university departments and professional services and suppliers.






For further information:


Innovation and collaboration in NHS Wales




Bwrdd Iechyd Prifysgol Innovation and collaboration in NHS Wales Cwm Taf Morgannwg University Health Board


Bwrdd Iechyd Prifysgol Hywel Dda University Health Board


In addition to decreasing treatment complications, increasing survival rates and improving quality of life, the new service is looking to reduce treatment costs for the NHS through a reduction in chemotherapy and radiotherapy complications, fewer and shorter inpatient stays, and fewer clinic appointments dealing with cancer complications and other smoking related illnesses.

Iechyd Cyhoeddus Cymru Public Health Wales

re NHS Trust

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Landmark study of smoking and lung cancer Lung cancer is the leading cause of cancer deaths worldwide, and over 85 per cent of cases are caused by smoking. Initially funded by an international grant from Pfizer, Hywel Dda University Health Board’s realworld study, LungCAST, remains the largest cohort in the world looking at the immediate and longer-term impact of continued smoking or quitting on survival, quality of life and treatment complications for lung cancer patients. Evidence has shown that patients who continued to smoke post-lung cancer diagnosis have poorer survival rates than non-smokers. However, these studies have always been retrospective and smoking status is not validated. Similar findings have also been made in other cancers, with biological reasons why continued exposure to tobacco smoke adversely affects tumour behavior, thereby increasing treatment resistance and complications. The LungCAST study


builds upon this evidence and provides new knowledge of smoking patterns and the effect of cessation on outcomes. Led by Professor Keir Lewis and Dr Rachel Gemine, 32 NHS Health Boards and Trusts across Wales and England have recruited into the LungCAST study over eight years. Results from the first 1,124 patients suggest that around one in three people are smoking at the time of their lung cancer diagnosis and that being a ‘never-smoker’ is independently linked to better one-year survival. Importantly, they have shown that stopping smoking is associated with 25 per cent improvement in survival at one year. The study now has data from over 3,000 patients and is ongoing. As part of this programme of work, a qualitative study has also been conducted to examine barriers and facilitators to cessation following diagnosis of cancer. Patients reported lack of support to

quit, pressure of hospital appointments and fear of failure as reasons that they were unable to stop smoking. From this UK data and with support from the Wales Cancer Network and Public Health Wales, Hywel Dda University Health Board is developing a specialist tailored smoking cessation service for patients with cancer, which aims to maximise quit rates and improve patient outcomes. Both studies have been reviewed by members of Carmarthenshire Lung Cancer Survivorship Group. Swansea University has also collaborated on the project, while the British Lung Foundation and Napp Pharmaceuticals have sponsored attendance to present findings at the European Respiratory Society Annual Conference and American Thoracic Society. At the 2018 MediWales Innovation Awards, the LungCAST study won the ‘Research Excellence in NHS Wales’ award and the early data was published in J Lung Cancer earlier this year. The specialist smoking cessation service is now being evaluated in smokers with breast, head and neck cancer. This lowcost Welsh-initiated service provides a chance for major service redesign, which is immediately applicable and has far reaching implications across different cancers and across health care systems around the world.

Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Ymddiriedolaeth GIG Prifysgol Felindre Velindre University NHS Trust

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

World-first virtual assistant in oncology Good quality information and conversations that patients have about their health are a key but largely underrated and unstudied component that has a impact on health outcomes. Most conversations with patients are conducted in clinical environments, where time and space constraints often do not allow for quality conversations to happen. Using artificial intelligence, as well as machine learning and natural language processing, Velindre University NHS Trust has developed the world’s first virtual assistant trained in oncology, known as RiTTA – Realtime Information Technology Towards Activation. Created in partnership with IBM Watson and Pfizer, it gives patients timely access to quality information through conversation, anytime and anywhere, in order to help them make better choices as they live with cancer. Through extensive discussion with patients, carers and families, it became clear that they valued access to quality

RiTTA is the first AI enabled dialogue agent that will: l Measure and improve health literacy and patient activation l Allow people real-time access to relevant information about living with a diagnosis of cancer that is accessible and can fit in with the way they want to live their lives l Help patients to make better informed treatment decisions

and understandable information, good communication, and the ability to exert control, be independent and prioritise their emotional and psychological wellbeing. Patients have been involved at all stages of RiTTA’s development to date, from design to development. As a cancer centre, Velindre expects patient interaction with RiTTA to transform the way in which clinicians communicate with patients and vice versa. It could significantly change how outpatient and other resources are used, and could even affect the way hospitals are designed in the future. The technology

has already had an impact on the wider health and wealth agenda, and there has been interest from other industry groups who want to know how RiTTA could interact with other digital products, from supporting care in the home to cuttingedge research and development.

“I would lie awake in the early hours of the morning, hundreds of questions racing around my mind. But who was going to answer my questions at 2, 3, 4am? I couldn’t justify calling a helpline for what would be seen as non-emergency enquiries, but it would be at least two weeks before I was due to see any medical professionals. It was frustrating, because my questions were very important to me and I needed answers. If only I had had a communication tool like RiTTA to access information anytime and anyplace. To feel like I was having a conversation with someone when I desperately needed to. To connect with someone, to feel less afraid and less alone.” Debbie Murphey Patient, part of the Patient Leadership Programme


Innovation and collaboration in NHS Wales

Delivering cancer services closer to home

Wales Cancer Research Centre likes to do all they can to make the lives of cancer patients easier. One of the Centre’s principle aims has been to improve access to clinical trials for patients across Wales, giving them access to the latest cutting-edge treatments. To date, they have saved 460 days of travel to research centres in England by opening more trials locally. Currently, all early phase clinical trials (when new treatments are tried for the first time in patients) that open in Wales are managed from Velindre Cancer Centre in Cardiff. Therefore when a patient wishes to explore an early phase trial as an option, it requires a visit to Cardiff. Wales Cancer Research Centre wanted to make this more convenient still by helping to develop a partnership, known as AWaRe (All Wales Early Phase Research Partnership), between Velindre Cancer Centre and the South West Wales Cancer Centre. A new information clinic at Singleton Hospital in Swansea spares patients from


“It’s been good to work with Kay and all the nurses at Velindre Cancer Centre to get this clinic off the ground. Our patients in west Wales can been seen in Swansea to talk about the possibility of entering an early phase trial without traveling to Cardiff for that initial consultation. Before we set up this clinic, some patients would make the trip to Cardiff to be told that there wasn’t a trial available to them. We are updated by Velindre on a weekly basis so we know if there will be a trial available, and we can go through a check list with the patient to look at their trial eligibility here in Swansea. This is just the beginning and we hope the service may be extended in time to provide the treatment locally too.” Sian Whelan Cancer Research Senior Nurse South West Wales Cancer Centre

South West Wales the trip to Cardiff. They can now have an initial consultation in their local hospital, in surroundings more familiar to them. They can learn more about prospective early phase trials and decide if this is something they would like to consider before seeing whether they’re eligible to participate at Velindre Cancer Centre. This is particularly valuable for the handful of patients for whom a clinical trial is not suitable, as it negates the need for an unnecessary, and potentially disappointing, journey.

Kay Willson, Early Phase Team Lead at Velindre Cancer Centre, commented: “The collaboration between the two cancer centres has brought our teams together in a way that has huge benefits to patients and their families. This joint working is a fantastic opportunity for Welsh patients and our research community in Wales. Together we can achieve great things to impact patients’ experience and outcomes.”

Bringing advanced medical therapies to Wales Advanced Therapeutic Medicinal Products (ATMPs) offer significant promise for the long-term treatment of disease, especially in areas of high unmet medical need. Results are proving that ATMPs are highly effective and their potential is being demonstrated by their rapid adoption into health services worldwide, as well as ever increasing multi-billion-pound year-on-year sector investment. A team within the Welsh Blood Service has been working to bring these treatments to patients in Wales by collaborating with ATMP producers to reach the clinics, while building expertise, capability and capacity across NHS Wales to deliver these therapies to patients. Whilst undertaking this work, the Welsh Blood Service continues to hold over 1,700 donation clinics a year across 400 locations in Wales, with 93,818 whole blood donations made in 2018, and a 20 per cent rise in first-time donors. It is also responsible for the Welsh Bone Marrow Donor Registry, currently holding 69,000 volunteers on its panel, which was rated as one of the best in the world for its size.

In 2017, the UK Government recommended that the public sector prepare for the advance of ATMPs. The team accepted the challenge and formed a multiorganisational collaborative group, called the Midlands and Wales Advanced Therapy Treatment Centre (MW-ATTC), to develop the necessary processes to deliver these lifesaving therapies to the people of Wales. Furthermore, the Welsh Government committed to developing an all-Wales strategy to ensure development of ATMP services that are coherent, effective and sustainable.

The 12 partners in the MW-ATTC consortium all have specific expertise in different aspects of the overall production and delivery of advanced therapies. They are NHS Wales, NIHR Birmingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Asymptote Limited, Thermo Electron Limited (as Fisher BioServices), Trakcel Limited, Cellular Therapeutics Limited, Rexgenero Limited, NHS Blood and Transplant, World Courier Logistics (UK) Limited, Miltenyi Biotec Limited and Orbsen Therapeutics UK Limited. The NHS Wales role in the MW-ATTC consortium is led by the Welsh Blood Service, with support from Swansea Bay and Cardiff & Vale University Health Boards, along with the Life Sciences Hub Wales Special Interest Group on Cell and Gene Therapy. The MW-ATTC consortium is currently working with manufacturers to deliver brand new therapies to patients in Wales, with logistics and ATMP storage experts to develop necessary facilities to safely deliver these products, and with informatics partners to provide vital sector infrastructure. The consortium is developing clinical pathways to aid delivery and identifying requirements necessary for future planning and resource allocation.

They are also examining the economic cost and the value of these novel therapies to explore the potential for payer models that may be required to fund them. Simultaneously, the Welsh Government has committed to improving healthcare services in Wales by integrating transformed imaging and pathology services with precision medicine services, which include integrated genetic diagnostics and advanced targeted therapeutics. The Welsh Blood Service has produced a Statement of Intent for Advanced Therapies on behalf of the Welsh Government, outlining the necessary steps for a joined up effort from NHS Wales, Welsh Government, industry and academia to develop an ATMP sector in Wales that will ensure patients safely experience the most effective therapies available. Through the pioneering work of this collaboration and the strategic alignment of ATMP services in Wales, patients will gain access to a number of therapies in the coming years, and developed processes will allow the systematic adoption of new therapies into this model as they become commercially available.


Iechyd Cyhoeddus Cymru

Public collaboration Health Innovation and in NHS Wales Wales

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

HS Trust

Hi-tech cabinets improve medicines management “Installation of the Omnicell cabinets within our Trust has been a fantastic step for us. The new system has greatly improved the safe and secure management of our medicines and offers us a far greater level of control and access. One of the great benefits of the system is the reduction in time it takes to replenish stocks. The reduction in the administrative burden of recording drug withdrawals by hand means our vehicles and crews are more readily available to respond to 999 calls in our communities and spend more time focusing on faceto-face patient care.” The Welsh Ambulance Service NHS Trust has improved its medicines management with hi-tech ‘smart cabinets’ in locations across Wales, ensuring paramedics can respond quickly to call-outs with the right medicines to hand. With funding from the Welsh Government’s Efficiency Through Technology Fund, the Trust has successfully installed 20 automated Omnicell medicine cabinets in 15 hospital emergency departments and 5 ambulance stations across Wales. The cabinets operate using guiding light technology and fingerprint access, providing a more efficient and secure way for ambulance clinicians to access medicines and giving the Trust better control and audit capability of its stock. The new cabinets have replaced a system that was heavily reliant on paper records and required paramedics to physically visit hospital pharmacies to order and pick up certain drugs. Centralised control of medicine supply across Wales now means the Trust can better manage stock so that


clinicians have fast, reliable access to the medicines they need to deliver high quality, pre-hospital care and achieve the best possible patient outcomes.

The Omnicell system provides a national standardised solution across Wales and offers a much greater level of monitoring, control and traceability. For instance, it automatically records which drugs are withdrawn and by whom. By allowing the Trust to better monitor and fine-tune cabinet stock levels, it can also reduce waste. In addition to ensuring drugs are dispensed and managed safely, the system saves valuable time that was previously taken up replenishing stock at hospital-based medicine cupboards in between emergency call-outs.

Chris Moore Health Board Clinical Lead Welsh Ambulance Service NHS Trust

The Omnicell project won the ‘Efficiency through Technology’ award at the 2018 MediWales Innovation Awards. Commenting on the award win, the Trust’s Medical Director, Dr Brendan Lloyd, said: “I’m thrilled that the Omnicell project has been recognised for innovation and patient benefit. This all began with an idea from our Clinical Lead Chris Moore, and now the technology is being adopted by stakeholders across the country. I’m proud that Welsh Ambulance is willing to take a lead in embracing technology and innovative thinking to improve unscheduled care and patient outcomes, and I’m delighted for the Trust and the project team who thoroughly deserve this award.”

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Gwasanaeth Cymru Gwybodeg

Powys Teaching Health Board

Public Health Informatics Service Wales

Electronic health record for pregnant women Ymddiriedolaeth GIG Prifysgol Felindre Velindre University NHS Trust

Wales currently uses an ‘All Wales Maternity’ hand-held record, with some health boards implementing separate hospital in-patient electronic records. Powys Health Board feeds into 11 different District General Hospitals, all using different systems. The effectiveness of the paper document is reliant on the patient remembering to carry it with her and on the healthcare professionals remembering to update it. There is also no back-up copy should the record be lost or damaged. Swansea-based SymlConnect set out to digitally transform the current system by creating an ‘Electronic Community Pregnancy Health Record’. The company initially connected with Powys midwife research leads. Discussions soon identified the need to also involve NHS Wales Informatics Service (NWIS) to ensure clinical standards, security governance and feasibility of integration with the Welsh Clinical Portal. This partnership between SymlConnect and the NHS was supported and sustained with a Bevan Exemplar award.

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Co-designed with midwives, the offline prototype follows clinical standards, triggering prompts to improve data recording. Auto-generated management plans highlight essential information with added safety features. Data completion requirements are displayed and risk factors are flagged up to ensure a superior level of care delivery. Midwives generally have five to seven consultations per day. Achieving NWIS integration with the Welsh Clinical Portal, midwives estimate cutting the admin time for each visit by half. Additionally, a mums’ app, built for Android and Apple devices, allows for a read-only, up-to-date copy of the clinical records to be accessed, for example in emergencies. Personal health questionnaires and information leaflets could also be e-transferred to the mums’ app. A mum-to-be survey was conducted as part of a ‘maternity day assessment changes’ project launched through social

media. Powys midwives also carried out face-to-face discussions during their home-visit consultations to gauge the response to a potential digital version of the hand-held record. SymlConnect obtained a general consensus from partners and stakeholders within NHS Wales and NHS England, where support for the mums’ app concept was overwhelming. The new digital system allows for more streamlined recordkeeping, real-time data sharing and improved security. It also reduces the risk of information being duplicated and enables accessibility anywhere at any time. The collaborative project received the award for ‘Partnership with the NHS’ at the 2018 MediWales Innovation Awards. SymlConnect is currently working closely with Accelerate, a joint project between Welsh universities and the Life Sciences Hub Wales, to initiate live trials of the digital solution.


Bwrdd Iechyd Prifysgol Bae Abertawe Bwrdd Iechyd Prifysgol Swansea University Aneurin Bay Bevan Health Board University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro Bwrdd Iechyd Prifysgol

Bwrdd BwrddIechyd IechydPrifysgol Prifysgol Aneurin Bevan Betsi Cadwaladr University UniversityHealth HealthBoard Board

Bwrdd BwrddIechyd IechydPrifysgol Prifysgol Cwm TafDda Morgannwg Hywel University UniversityHealth HealthBoard Board

Innovation and collaboration in NHS Wales Gwasanaeth Gwybodeg Informatics Service

Cardiff andMorgannwg Vale Cwm Taf University UniversityHealth HealthBoard Board

Pharmacy sore throat pilot promotes appropriate antibiotic use A pilot for an on-the-spot sore throat swab service promotes more efficient use of antibiotics among patients in parts of Wales, according to initial results. The Sore Throat Test & Treat Service (STTT) is being piloted as part of the Common Ailments Service, which encourages patients to visit their community pharmacy instead of their GP for common ailments.

Bwrdd Iechyd Prifysgol Betsi Cadwaladr Bwrdd Iechyd Addysgu Powys University Health Board Powys Teaching Health Board

Bwrdd Iechyd Prifysgol Hywel IechydDda Cyhoeddus Cymru Health Board University Public Health Wales

Bwrdd Iechyd Addysgu Powys Ymddiriedolaeth

Iechyd Cyhoeddus GIG Ymddiriedolaeth Cymru Gwasanaethau Ambiwlans Cymru

Powys Teaching GIG Prifysgol Felindre Health Board Velindre University NHS Trust

“Antibiotics do not work for most sore throats because they Ymddiriedolaeth are caused by viruses. If a sore GIG Prifysgol Felindre

throat is cause by bacteria Velindre University NHS Trust then sometimes antibiotics are needed, but not always. STTT ensures that patients take antibiotics only when they are truly needed, and without putting extra pressure on GP workload for getting a prescription. This is another success of the Choose Pharmacy Platform that we have developed at NHS Wales Informatics Service, and it really shows how technology can support pharmacists to deliver enhanced services.” Cheryl Way Pharmacy and Medicines

The service is accessed through the Choose Pharmacy software developed by NHS Wales Informatics Service. A total of 53 community pharmacies are taking part in the scheme so far – 30 in Betsi Cadwaladr University Health Board and 23 in Cwm Taf University Health Board. The test determines if a sore throat is caused by a virus, meaning antibiotics will not help, or a type of a bacterial infection. Results from a throat swab are provided in minutes, and if a bacterial infection is present and the patient can be helped by antibiotics, they can be supplied by the pharmacist. Education that bacterial infections usually go away without antibiotics is also part of the service, and some patients choose to not take antibiotics even if the throat swab shows positive results. More than 80 per cent of the 1,000 patients who took part in the pilot between November and January were


Management Lead NHS Wales Informatics Service

advised they did not need any antibiotics after taking the swab test.

EmmaPublic Williams, National Clinical Lead for WelshHealth Ambulance Services Wales NHS Trust Choose Pharmacy, commented: “This service is a really good example of how NHS Wales Informatics Service, health Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru boards and community pharmacists have Welsh Ambulance Services worked together to support patient access to NHS Trust appropriate NHS care. Pharmacists working within the pilot have received additional training to deliver the service and see how it supports colleagues in GP practices and out of hours to provide appropriate patient care. Patient feedback has been really positive, with patients considering the service accessible and helpful. The NHS Wales Informatics Service development and implementation teams have worked very hard to deliver a high quality application that supports the delivery of the service within the tight deadline for the project.” Efi Mantzourani, Research and Evaluation Lead in NHS Wales Informatics Service and Senior Lecturer in Pharmacy Practice in Cardiff University, said: “We are pleased that initial evaluation showed such promising results for the new STTT service. We will continue to analyse data for at least one year to see how seasonal variations may affect the service, and we will investigate whether there is a reduction in consultation rates across primary care for sore throat, as the data we have so far is only self-reported.”

Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro Cardiff and Vale University Health Board

New direction for IBS using FODMAP diet Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr Irritable Bowel Syndrome (IBS) has University Health Board

a prevalence in the UK of 15-20 per cent and is thought to affect 1 in 5 people at some stage of their lives, so across Wales 450,000 people may Bwrdd Iechyd Addysgu Powys be suffering. The symptoms of IBS are Powys Teaching characterised by bloating, Health Boardabdominal pain, excessive wind, diarrhoea with ‘urgency’ and constipation. IBS symptoms significantly affect people’s Ymddiriedolaeth daily lives, with many sufferers GIG Prifysgol Felindre NHS Trust reporting absenceVelindre from University work when symptoms are unmanageable.

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda endoscopy investigations, University Health Board

colonoscopy or often concluding a diagnosis of functional gut disorder or IBS. The traditional approach to dietary Iechyd Cyhoeddus management hasCymru concentrated on Public Health regularity of meals, adjustments to fibre Wales intake and the reduction of caffeine, fatty and spicy foods. This advice may be sufficient for aYmddiriedolaeth minority, butGIG many Gwasanaethau Ambiwlans Cymru patients have tried this independently Welsh Ambulance Services NHS Trust

and more recent work has shown that focusing on ‘fermentable carbohydrates’ improves clinical outcomes. Studies show that symptoms improve in over 75 per cent of patients using the low FODMAP diet. The latest NICE Clinical Guidelines (CG61, 2017) and the British Dietetic Association recommend the low FODMAP diet as an effective treatment for IBS if supported by a FODMAPtrained Registered Dietitian.

Traditionally, once red flags have been excluded, medication has been used to ease symptoms, e.g. antispasmodics, laxatives and antidepressants. Pharmacological management is effective in some patients, but can add to the symptoms for others. Some patients are referred to a gastroenterologist for further investigation, such as ultrasound scans,

The low FODMAP diet

Local low FODMAP trial


FODMAP is an acronym for Fermentable Oligo-saccharides, Disaccharides, Mono-saccharides And Polyols. Simply, these are fermentable carbohydrates which are fermented by the bacteria that line the gut, mainly in the large bowel. The fermentation results in gas production and symptoms such as wind and bloating. A concomitant osmotic effect causes an imbalance of water in the large bowel, resulting in either diarrhoea or constipation or in some people both. The low FODMAP diet is an elimination diet, but should only be followed for 4-8 weeks, then the process of food challenges begins. Food challenges form a crucial part of the diet, enabling patients to determine which foods are problematic and helping them to have a more varied diet.

Debbie Thomas, Prescribing Support Dietitian, has been using the low FODMAP approach with IBS patients in some GP surgeries in Bridgend since 2015.

To date, over 300 patients have received low FODMAP advice, with nearly 200 patients completing the programme. All have had a reduction in symptoms, enabling most to reduce or stop their IBS medication.

The aim of the trial has been: to improve symptoms and quality of life for IBS sufferers; to reduce prescribing of IBS-related medication; to reduce the number of IBS-related referrals and consultations; and to potentially reduce the number of invasive diagnostic procedures. In 2017, this primary care project was a finalist in the NHS Wales Awards.

GP IBS appointments have reduced by 82 per cent following this intervention in 132 IBS patients. Analysis shows 354 fewer consultations, comparing the 12-month period before and after low FODMAP advice. Based on a 10-minute GP appointment, this potentially would have resulted in a cost saving of £11,328. In 2017, the trial was extended to staff within ABMU Health Board and to date 98 staff have been advised. At the 2018 MediWales Innovation Awards, this staff IBS project won the ‘Innovation in the NHS’ award.


Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Cardiff and Vale Innovation and collaboration in NHS Wales University Health Board

Platform collects patient feedback for service improvement Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Ymddiriedolaeth GIG Prifysgol Felindre Velindre University NHS Trust

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Findings have already led to service improvements, such as better communication processes with patients and improved booking procedures. An ‘initial patient information document’ was developed as a result of patients’ responses, which suggested that some patients did not fully understand the intervention pathways of the AWMS. Also as a result of WellSaid, clearer information is now provided on the proactive steps that patients can take to help them with weight management while waiting. Finally, follow-up appointments are now made during sessions, so that patients know when they will next be seen, increasing their commitment to attending future appointments. The platform has also had benefits for AWMS staff, as they have received more feedback than previously and worked together to come up with potential solutions to issues.

Aneurin Bevan University Health Board’s Adult Weight Management Service (AWMS) collaborated with a Cardiff-based company to develop an automated web platform, WellSaid, with the aim of discovering patients’ reasons for both attending and dropping out of the AWMS. The platform distributed a brief questionnaire to AWMS patients every six weeks in order to explore user experiences. The questionnaire measured service experience using simple quantitative and qualitative measures, creating an easy and intuitive data collection method of patient experience.


WellSaid sent and collated patients’ text messages and then allowed the AWMS to analyse responses via a downloadable spreadsheet. Developing the platform, the process involved six stages led by the company: Consult, Specify, Design, Prototype, Test, Improve. The project ran from January 2017 to October 2018, generating nearly 2,000 responses from approximately 600 patients. Many initial responses led to further patient engagement via phone calls and face-to-face interviews in a formal research project, to more comprehensively understand patients’ needs from weight management services and consider how technological applications might address such needs in the future.

Once the WellSaid prototype was piloted and initial responses were analysed, the collaboration expanded to include Aneurin Bevan UHB’s Research and Development department and Cardiff Metropolitan University by working with the South East Wales Academic Health Science Partnership (SEWAHSP). The whole collaboration resulted in a £60,000 grant from the Knowledge Economy Skills Scholarship 2 programme, enabling a PhD student to continue working with the WellSaid platform and develop innovative solutions to patient engagement with the AWMS.

Health Technology Wales makes impact in its first year The innovative national body working to improve the quality of care in Wales is making an impact. Set up by ministerial recommendation in 2017, Health Technology Wales achieved substantial success in developing a strategic approach to the identification, appraisal and adoption of new nonmedicine technologies into health and care settings in 2018. Health Technology Wales is funded by Welsh Government and hosted within Velindre University NHS Trust but is independent of both. It also acts as an initial point of contact for technology developers. Vaughan Gething, Cabinet Secretary for Health and Social Services, said: “I welcome the progress made by Health Technology Wales in its first year. They are delivering high quality, evidence-informed advice to our health boards on a range of non-medicine technologies. This is important work that will ensure our health service in Wales is at the forefront of modern technology.” A team of 15 staff has been recruited to respond to the needs of service users and care providers. They draw on the best available evidence and collaborate with partners across health, social care and the technology sectors to ensure an all-Wales approach. In 2019, an Open Topic Call was held to identify relevant topics for appraisal that will be considered as part of the future work programme. 50 topics were proposed to Health Technology Wales from a range of referrers, including NHS organisations and industry. Dr Peter Groves, Chair of Health Technology Wales, said: “We are working with partners across the healthcare sector to ensure that our combined expertise is applied to prompting the adoption of technologies that have the potential to make a real difference to people’s lives. We are excited about the opportunities in the year ahead.”

Health Technology Wales’ achievements and activity in 2018 included: l Responding to 57 topic referrals from a variety of stakeholder groups, including the NHS, Welsh Government and academia. l Producing four pieces of Guidance issued to care providers and 16 Topic Exploration Reports. l Establishing relationships with more than 30 national and international organisations. l Presenting at more than 20 external meetings and conferences. l Holding 15 advisory committee meetings and two multi-stakeholder adoption workshops. l Developing multiple standard operating procedures, an evaluation strategy, a communications strategy and a new website.

Health Technology Wales will research and evaluate the best available clinical and cost-effectiveness evidence about the topics. Based on this evidence, Health Technology Wales will publish Guidance on whether the technology should be adopted for use in Wales. Non-medicine health and care technologies make a real difference to people’s lives in

Wales. Anyone can suggest a topic for Health Technology Wales to appraise on their website.

Visit for more information and updates on upcoming activity.


Innovation and collaboration in NHS Wales Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro Cardiff and Vale University Health Board

Addressing the shortage of diabetes specialist nurses Over three and a half million people in the UK are currently living with diabetes, and as that number continues to increase, the role of the diabetes specialist nurse (DSN) is becoming increasingly important. Swansea University Medical School is responding to this training gap with an innovative new distance learning Master’s course.

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Board theHealth opportunity

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board will help ensure

I am fully equipped to graduate with an to effectively deal with any given MSc Diabetes Practice Postgraduate situation. This course is of particular degree studying full or part-time. The interest to me as it will allow me to course not only includes specialised Bwrdd Iechyd Iechyd Cyhoeddus study in my own time to fit in with my training, diagnostic and assessmentAddysgu Powys Cymru busy family and work life. Another plus Powysbased Teachingknowledge, but also encompasses Public Health Healthpersonal Board and professional development,Wales is that I can choose to do a work-based portfolio, rather than writing another reflective practice and problem-based dissertation.” learning.

Ymddiriedolaeth GIG Ymddiriedolaeth Gwasanaethau Ambiwlans Cymru Nicola Hewer is a DSN at Cwm Taf GIG Prifysgol Felindre Welsh Ambulance Services University Health University NHS Trust Board. Before startingNHS Trust SurveyVelindre

The latest Diabetes UK Workforce (2016) highlighted that DSN workload has increased in volume and complexity since the previous 2012 survey. However, almost one third of DSN posts have been cut or downgraded, or many left unfilled due to recruitment difficulties. The survey also uncovered that 57 per cent of current DSNs will be eligible for retirement within the next 10 years. Currently, training for DSNs is vocational, however, due to a lack of support to attain the qualifications and the experience necessary to progress. Without succession planning, there will be no continuity of training for future DSNs. With the advancements in treatments and technology for diabetes, education for healthcare professionals (HCPs) throughout primary and secondary care is required. Swansea University Medical School’s new Master’s programme is working to close this training gap. The School’s new distance learning programme has been developed jointly by Dr Rebecca Thomas and Dr Sarah Prior at Swansea University Medical School, and is led by leading UK Consultant Diabetologist Professor Stephen Bain from Abertawe Bro Morgannwg University Health Board. The MSc Diabetes Practice has been specifically designed for healthcare professionals – particularly current or future DSNs – wanting to specialise in the field of diabetes. It is a modular distance learning course, offering HCPs


the course, she commented: “As a Community Diabetes Specialist Nurse working for a large Welsh NHS Trust, I face various complex care challenges on a daily basis. My job is very diverse and has both educational and clinical components to it. The number and complexity of people with diabetes is increasing, and I feel that the MSc in Diabetes Practice at Swansea University Medical School

“We have designed the programme to fit around the lives of busy health professionals – as well as being offered as an online distance learning course, we can also offer the option of part-time Master’s, Postgraduate Diplomas and Postgraduate Certificates and individual CPD modules. There are also many funding options including bursaries, postgraduate loans and medical school scholarships.” Dr Sarah Prior Swansea University Medical School

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Bed Block board game informs hospital staff Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Betsi Cadwaladr University Health Board has developed a fun and interactive way toYmddiriedolaeth educate hospital GIG Prifysgol Felindre staff about patient flow.University NHS Trust Velindre

win by finishing the 24 hours with fewer beds occupied than at the start. Levels of Ymddiriedolaeth GIG difficulty are flexible and the game can be Gwasanaethau Ambiwlans Cymru Welsh staff Ambulance Services set up to suit different groups.

Developed at Bangor Hospital, Bed Block is a collaborative educational board game of patient flow for 1-10 players, which lasts around 45-60 mins. The aim of the game is to keep your hospital safe for 24 hours, keep patients moving and avoid disaster. Will a norovirus outbreak, X-ray breakdown, bank holiday, or mandatory training scupper your chances, or will a thankful relative bearing the Bwrdd cake Iechydsave Prifysgol Baestaff Abertawe day? Players manage through four Swansea Bay University shifts and across four hospital Health Board areas by allocating tasks and staff as efficiently as possible. They need to help patients progress from arrival to discharge whilst Bwrdd Iechyd Prifysgol avoiding patient safety incidents, and

The game is now being used as an educational tool for hospital staff, postgraduate and undergraduate healthcare professionals and managers in Bangor Hospital and across North Wales. Many staff had never received any formal education on patient flow before, but most had experienced poor flow in their own professional lives and were able Bwrdd Iechyd Prifysgol to recognise that it negatively affected Caerdydd a’r Fro patient care. With the new game, they Cardiff and Vale are now learning how patient flow can University Health Board be optimised in their daily practice and developing valuable skills that should have a positive impact on the wider hospital Bwrdd Iechyd Prifysgol system. Cwm Taf Morgannwg

Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

NHS Trust

Hospital patient flow is a challenge in many areas of the UK and in developed healthcare around the world, so the game also has the potential to make a difference outside of Wales.

University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

New sharps bin to reduce risks Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Staff in hospitals and other locations who administer injections put used needles and syringes in dedicated bins, Ymddiriedolaeth referred to as sharps boxesFelindre or bins. GIG Prifysgol Velindre University Trust These are commonly little moreNHS than plastic containers with a hole in the top or a lid. Currently these bins can be overloaded by staff, contents can be tipped out if the bin overturns (e.g. while in the boot of a District Nurse’s car), or staff can prick themselves on them while reaching in to dispose of a used syringe. These scenarios can result in ‘needlestick’ injuries for staff or patients, who are then sent to occupational health for blood tests as the used needles can carry HIV, Hepatitis C

and other diseases. This causes significant stress for the people involved, often resulting in staff going on sick Ymddiriedolaeth GIG leave. Gwasanaethau Ambiwlans Cymru

Welsh Ambulance Services A nurse in Betsi Cadwaladr University Health Board NHS Trust has created a new design of sharps bin, which ensures that needles put in the bin cannot come back out again, even if the box is overloaded. The health board funded the creation of a prototype of this new design, and AgorIP then assessed the IP and commissioned a market research report to assess the level of demand in the NHS for a new design of sharps bin. They have explored the viability of selling a new sharps bin within NHS Wales with procurement staff, and the Welsh Health Environment Forum has also discussed the new design with two potential licensees to date.


Innovation and collaboration in NHS Wales

A new network for innovation A new network to identify and scale up best practice in innovative health and wellbeing activity across Wales was launched in March 2019.

The Innovation Network for Health and Social Care in Wales has been established by Life Sciences Hub Wales, together with Welsh Government, to bring together innovation champions, leads and practitioners from across the health and care system, industry and academia.

Launched by the Minister for Health and Social Services, Vaughan Gething AM, and NHS Wales Chief Executive Dr Andrew Goodall, the network reflects the Government’s call for innovation programmes to be complemented by engagement and partnership, set out in its long-term plan for health and social services in Wales, ‘A Healthier Wales’. Leaders and practitioners representing every health board and trust in Wales, along with partners from the social care sector, the third sector, universities across Wales and Welsh Government, have already joined the network.

It is enabling information sharing about programmes and initiatives in Wales which can give advice on turning innovative ideas into practice, products and better ways of working, and is supporting applications for both strategic and local funding opportunities.

The process of building up the current picture of innovation in health and social care across Wales, and identifying opportunities for collaborations, mentoring and joint partner working is now under way.

For more information about the network, visit

Delegates attending the launch of The Innovation Network experience a VR demonstration.


The network is also providing a peer group to support the innovation sections of NHS Wales organisations’ strategic planning of clinical unmet need, and championing the development and implementation of Research, Innovation and Improvement Hubs across Regional Partnership Boards.

Healthy Thinking podcast series puts forward new perspectives on innovation Healthy Thinking is a new series of podcasts from leading thinkers in health and care innovation launched by Life Sciences Hub Wales to bring forward new perspectives on current issues, raising awareness, informing and stimulating debate. The series aims to highlight the barriers to innovation adoption in health and social care and identify the routes to overcome them. Produced for senior leaders and influencers across the health and social care sector, the life sciences industry, academia and government, Healthy Thinking invites key

innovators, leaders and influencers who demonstrate a commitment to transforming services through innovative solutions to share their views and experiences. By showcasing innovation projects that work on a local level, Healthy Thinking aims to inspire others to scale up successful examples on a national level. Recent episodes include one-to-one interviews with First Minister, Mark Drakeford, social prescribing expert, Sir Sam Everington and health inequalities champion, Sir Michael Marmot as well as a panel discussion on the role of APIs in healthcare.

“These new podcasts enable us to share the discussions we are having with senior leaders and innovators, not only in Wales but across the UK and internationally. They are a great opportunity to spark thinking and address innovation adoption in health and social care across Wales.” Professor Sir Mansel Aylward Chair of Life Sciences Hub Wales

To listen to the Healthy Thinking podcasts visit and

Welsh Health Hack brings healthcare professionals and technology companies together to innovate Healthcare professionals across Wales are currently working together with newfound colleagues in digital, technology and data companies to develop innovative solutions to a range of clinical problems faced by the health service. Their collaboration follows the Welsh Health Hack, an annual event orchestrated by Life Sciences Hub Wales and the Bevan Commission with partners Digital Health Ecosystem Wales, Health Education and Improvement Wales, Health Technology Wales, MediWales, NHS Wales Informatics Service and Welsh Government. The highly innovative approach to problemsolving this year saw 16 different challenges “pitched” by health professionals at the event last month. Small, cross-functional teams were then supported to form and work together to create solutions, a product idea, or prototype. The teams presented their responses to a panel of experts from the health service and industry in a bid to secure Welsh Government funding for their projects through its Health Technology

One of this year’s Welsh Health Hack winners pitching to delegates and the Dragon’s Den panel.

Exemplars programme – and the successful ones are now working to turn them into reality. The process’ success is proven - last year a breast surgeon from Cardiff & Vale University Health Board and specialist physios at Velindre Cancer Centre in Cardiff challenged the Hack to find a way of helping patients who were failing to do vital physiotherapy exercises immediately after breast or axilla surgery. The solution proposed was an app, which is now being used by patients at the Centre. The Breast Axilla Postoperative Support app – the BAPS app – uses video

to show patients how to do their exercises, sends them reminders and incentivises them to complete them, and is making a huge difference to their successful recovery. It is also leading to greater efficiencies and generating tens of thousands of pounds in savings. Moves are now underway to encourage its wider take up amongst physiotherapists working in all health areas across the NHS in Wales, which could result in very significant savings. For further details, go to:


Bwrdd Iechyd Prifysgol Caerdydd a’r Fro


Cardiff and Vale Innovation and collaboration in NHS Wales University Health Board



Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board


Droplet hydration for the vulnerable in Wales


Bwrdd Iechyd Prifysgol Hywel Dda University Health Board



e NHS Trust

Iechyd Cyhoeddus Cymru Public Health Wales

Extensive evidence demonstrates the health benefits of good hydration. Dehydration, secondary to inadequate fluid intake, Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru contributes to significant ill health and Welsh Ambulance Services deaths among patients and is therefore a NHS Trust major safety concern. Mild dehydration can contribute to confusion, falls, pressure ulcers and urine infections. Serious dehydrations can cause a person’s condition to deteriorate rapidly, and can lead to acute kidney injury and even result in death. The human cost caused by such harm for patients and carers cannot be underestimated. Through the power of social media, the project lead discovered that a smart hydration system – Droplet – was being

The project Droplet is the world’s first talking hydration aid – a programmable tool consisting of a base and mug (or tumbler) that will talk to patients if they are not drinking enough, and will also alert health and care professionals. The Droplet mug or tumbler is also designed to help people who are coping with tremors or swallowing problems.

tested in Musgrove Park Hospital, Taunton, and that this trial had demonstrated that patients drank more With the use of a Droplet mug or tumbler.

The aim of the project was to undertake a trial using the Droplet Hydration System on four wards in Cwm Taf University Health Board and in one care home. Cwm Taf would be the first Health Board or Trust in Wales to trial this system and would be at the forefront of further developing this innovative idea for the benefit of local communities. Key challenges were securing money to purchase the product and protecting staff time to undertake the testing. The project lead discovered that there was an opportunity for some funding through the Health Board’s Innovation Fund, so they applied and were successful. The lead was excited by the product and very keen to do the testing for herself. However, it soon became apparent that it would never happen unless she engaged her team in the whole process!

Outcomes Initial testing of the Droplet Hydration System has demonstrated an increase of 1000ml in oral fluid intake on average. This equates to approximately four glasses of water/fluid. Improved hydration has been linked to a demonstrable decrease in average length of stay for patients and a decrease in hospitalacquired infections, such as wound and urinary tract infections.

Next steps The next step for this project is to engage with a care home and test the Droplet product there. In addition, the project lead presented the product to a group of individuals looking for a research opportunity linked to frailty, and they collaboratively developed a research bid for a study to test the product with a district nursing team and patients in their own homes. The team applied for funding from the Burdette Foundation and have been awarded £97,000 to take forward the PARCHED study.


Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Cardiff and Vale University Health Board

Innovative operational planning tools Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

When an operation is delayed Powys Teaching or Health Board cancelled, this can have an unintended negative impact on the patient’s health. For this reason, ABCi has developed an easy-to-use, strategic planning tool to Ymddiriedolaeth GIG Prifysgol Felindre help determine Operating Theatre and Velindre University NHS Trust Suites Capacity. Originally built for Aneurin Bevan University Health Board (ABUHB), the tool reports operating theatre requirements categorised by specialty and by elective, emergency and day cases using Mathematical Modelling. Once the user presses the ‘calculate #theatres’ button, sub-models are run in the background, in which the user can specify whether overlapping induction scheduling happens. The expected annual throughput and

surgery durationsPublic can Health also be taken into Wales account. With the opening of the Grange University Hospital, there isYmddiriedolaeth a need to redistribute GIG Ambiwlans Cymru operating theatreGwasanaethau capacity across the whole Welsh Ambulance Services of ABUHB. The new tool helps to test and NHS Trust explore different operating theatre setups

and different annual throughput scenarios for each specialty and subspecialty. For example, the Trauma and Orthopaedics specialty can use it to find out how much operating theatre capacity will be needed to serve the demand for hip fracture in the next five years.

The tool is critically beneficial for both resource efficiency and patient experience. The health board can be reassured that it has sufficient operating theatre capacity available to meet actual patient demand. Decision makers can fully understand and explore the trade-off between waiting times and utilisation, enabling them to make truly informed choices when it comes to theatre capacity planning. This has a direct impact on patient experience by reducing delays and cancellations, which in turn is linked to the expected outcomes for patients. Moreover, resources can be deployed in an efficient way, categorised by specialty and subspecialty. The tool has the potential to be shared and readily used across Wales, in any health board.

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Innovation and collaboration in NHS Wales


Bwrdd Iechyd Prifysgol Caerdydd a’r Fro


Cardiff and Vale University Health Board

VR distraction therapy for cystic fibrosis patients


Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board



Bwrdd Iechyd Prifysgol Hywel Dda

Cystic fibrosis patients are often University Healthtreated Board in isolation due to the threat of infection, where they can experience anxiety, breathlessness and pain. To ease these symptoms, the All Wales Adult Cystic Iechyd Cyhoeddus Cymru Fibrosis Centre partnered with CardiffPublic Health based company Orchard Wales Media and Events Group to develop, introduce and pilot VR distraction therapy for cystic Ymddiriedolaeth GIG fibrosis (CF) patients.


dre NHS Trust

Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services

The team developed aNHS closed Trustsystem in which both the VR headset and the experience were controlled by a tablet. All experiences were held on the device, ensuring they could be used in any location within the CF Centre and hospital, no Wi-Fi required.

Initially, barriers to address included VR inexperience of staff and patients, infection control and a need for data collection. The system was made simple enough for patients and staff to use, with no further training required after an initial demonstration. The headset could be wiped down and disinfected, and VR sanitary masks were provided to meet the strict infection control guidelines. Two apps were developed (one for the tablet and one for the VR device) and connected, so that valuable data about anxiety levels and more could be transferred and accessed in real time by healthcare staff. To ensure maximum patient uptake, it was also necessary to reduce any risks associated with motion sickness or dizziness and to make the experiences as immersive and engaging as possible. Altogether, six experiences were created to cover a wide demographic. Patients were able to travel around cities of the world, swim in the ocean or encounter animals, and some more adventurous experiences included surfing and skydiving. The aim of the project was to help improve care within the CF Centre by reducing the pain, stress and anxiety levels of patients undergoing extensive treatments for their chronic condition. Patients were actively involved in the introduction of the VR therapy and in


The All Wales Adult Cystic Fibrosis Centre is the only specialist adult cystic fibrosis care provider in Wales, with a current patient population of 299.

giving feedback following use. They were also consulted on which were the most and least beneficial experiences and on what kind of further experiences could be introduced for maximum benefit. From patient feedback (age range 17-54 years), results showed that 43 per cent of the patients had symptoms of anxiety pre-VR experience and this went down to just 17 per cent postexperience. The distraction therapy was used on patients with needle phobias, in the hope of allowing bloods to be taken more easily. Anxiety with having bloods taken was shown to be 46 per cent pre-experience and 24 per cent post-experience. Before, only 29 per cent of patients had no symptoms of anxiety when breathless, and post-VR experience this rose to 86 per cent. End-stage disease patients also reported that the distraction therapy reduced their breathlessness and anxiety in dealing with end-of-life decision making. The partnership between the CF Centre and Orchard Media has resulted in direct patient benefit in terms of decreased levels of anxiety, breathlessness and pain. As a consequence, the need for additional medications to relieve symptoms of anxiety in CF patients could potentially be reduced, allowing cost savings. Overall, improved quality of life also has the potential to reduce length of inpatient stay and provide greater patient satisfaction.

Welsh Government Technology, Digital and Transformation


Welsh Government - Technology, Digital and Transformation

The Transformation Programme for ‘A Healthier Wales’ A Healthier Wales ‘A Healthier Wales’ is the Welsh Government response to a parliamentary review, which outlined the strain that the NHS is facing in a modern world where people are living much longer, as well as the need for NHS services to be more seamlessly coordinated to ensure that the quality of service from different providers around the country is kept to a high standard. It is a plan to amalgamate health and social care with an emphasis on individual responsibility for health and wellbeing, moulding them around the needs and preferences of individuals.

The aim of A Healthier Wales is to promote wellbeing by preventing illness and limiting the effects of ill health, rather than focusing on treatment, which has been the approach of previous models of healthcare. The plan aims to ease future strain on health and social care within the NHS from an increasingly ageing population, by keeping services close to people’s homes and encouraging them to remain active and independent for as long as possible


This will be achieved by utilising technology such as social media and digital platforms to engage the public, providing a better understanding of how certain choices can impact on their general health and wellbeing. People will be encouraged to take responsibility for their own health as well as that of their friends and families, while schools and employers will be given information on how to instil healthy life management skills in pupils and employees. In addition, the initiative aims to keep health and social care services in Wales sustainable and to equalise clinical outcomes amongst different health boards. In order to achieve this, transformation will need to be made nationally rather than locally or in individual health boards, with the future service set to move to a ‘whole system’ approach.

The Transformation Programme Since the launch of the A Healthier Wales publication in summer 2018, progress has been good against most of the 40 actions included in the plan, in spite of the impact of Brexit preparations on delivery in some areas. To deliver the 40 shortto-medium term actions set out, the Transformation Programme and the £100 million Transformation Fund have been established, and the key role of Regional Partnership Boards (RPBs) has been cemented. The Transformation Programme is designed to drive the implementation of the 40 specific actions outlined in A Healthier Wales and to kick-start the move to this new system of health and social care over three years, with longer-term progress being made over ten years. As of the end of May 2019, the Minister for Health and Social Services has approved 12 proposals for support worth more than £87.2 million from the Transformation Fund. This means that every regional partnership in Wales is implementing at least one proposal. A rapid review of the initial six proposals showed that they are in line with A Healthier Wales, with good distribution against priority areas, and has informed further proposals.

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In addition to funding for the programme, a further ÂŁ192m of additional funding has been made available to support health boards and local authorities in delivering A Healthier Wales objectives. An Advisory Board, including members from across the health and social care sector in Wales, has been established

to provide strategic advice on the programme. There has been strong engagement with senior leadership, for example through the Health & Social Care Leadership Group. A communications plan has been developed for A Healthier Wales generally, plus programme activity plans against specific actions.

Key challenges for the next twelve month period of delivering the Transformation Programme include further work on engagement, workforce strategy, the National Clinical Plan, joint inspection and digital priorities.


Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Health Board


Welsh Government - Technology, Digital and Transformation Powys Teaching Public Health

Ymddiriedolaeth GIG Prifysgol Felindre Velindre University NHS Trust

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Harnessing the power of AI to improve radiotherapy treatments In 2014, there were more than 19,000 new cases of cancer in Wales, which is expected to rise by at least 2 per cent per year for the next 15 years. Cancer accounts for approximately 7 per cent of NHS expenditure in Wales, amounting to £409 million in 2014-15. This represents the fourth largest spending area for NHS Wales. Radiotherapy is a high-tech, innovative and cost-effective treatment for cancer. However, it is underutilised, in part due to access to resources and the time taken to provide treatment. Currently there are a number of challenges faced by clinician in everyday clinical practice. Such challenges include: 1. Workload – The clinical team faces a huge workload to plan radiotherapy treatments. Complex plans can take up to 2-4 hours of consultant oncology time and the number of hours spent planning could be used for patient benefit elsewhere. 2. Variability – There is evidence that significant inter-observer variability exists when defining the volume to treat with radiation. This is know as the Gross Tumour Volume, or GTV. Variations in GTV could affect the dose distribution between tumour and healthy tissue, potentially causing suboptimal treatments and increasing the risk of side effects. 3. Imaging – Advanced imaging techniques such as Positron Emission Tomography (PET) and Magnetic Resonance Imaging (MRI) can provide functional and molecular information that complements the anatomical data from X-ray imaging and Computer Tomography. Such functional and molecular information can be used for non-invasive characterisation and quantification of disease, and may be used to relate tumour response and survival. However, the management and segmentation of hybrid imaging data adds time to clinical practice and it is not well standardised. Automated processing and outlining of hybrid imaging modalities would help evaluate pathology, measure early treatment response and predict therapeutic efficacy.

The ASPIRE project, funded by Welsh Government, brings together a team of scientists from Velindre University NHS Trust (Prof T Crosby and Dr K Foley) and Cardiff University School of Engineering (Dr E Spezi) with significant experience in cancer imaging and data analytics to improve radiotherapy treatment outcomes. ASPIRE focuses on training Artificial Intelligence (AI) software for the automated identification and delineation of tumour volumes on anatomical and functional scans. It will show how advancements in computing can be used to improve clinical workflow, optimise resources in radiotherapy departments and increase productivity, while improving the quality of service and important patient outcomes. It is expected that ASPIRE will reduce time spent by oncologists outlining tumours. In addition, it will minimise agreement inter-observer variability through AI standardisation, as well as contributing to a reduction in treatment waiting time for patients. This will eventually result in improved outcomes. The integration of AI in the clinical radiotherapy workflow will prepare the ground for future developments related to high throughput medical image analysis. This will help identify non-invasively the best treatment option for each individual patient, opening the door to personalised cancer therapies. ASPIRE is carried out in collaboration with Intel Corporation (UK) Limited. The partnership with Intel allows the Cardiff based team of scientists to access state of the art Intel optimised AI platform and know-how of Intel AI experts, as well as training and support.


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Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro Cardiff and Vale University Health Board

A solution to the issues faced setting up a frequent attender service

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

is fully compliant with the GDPR. The Cardiff and Vale University Health system is currently being used by South Board set up a multi-agency Frequent Wales Police and Housing Associations Attender Bwrdd Iechyd Service in 2013, providingIechyd Cyhoeddus Addysgu Powys Cymru to manage concerns such as anti-social person-centred wrap around care to Powys Teaching Public Health Health Board1500 patients who attended Wales behaviour and domestic violence cases around and has the necessary security levels to the Emergency Department five times a process this data. year or more. Ymddiriedolaeth GIG Ymddiriedolaeth

Gwasanaethau Ambiwlans Cymru

GIG Prifysgol Welsh Ambulance Services The data,Felindre supported by patient evidence, Velindre University NHS Trust NHS Trust showed that the drivers for frequent attendance stemmed from a wide range The following potential of issues, including acute or chronic flare opportunities were identified: up of a known medical condition, acute onset of a new condition, recall by ED l To substantially reduce the for further treatment, palliative care time taken to collate, share and needs escalation, primary care needs, update information, plus the psychosocial needs, social needs and associated printing costs. misuse of services. These wide ranging needs necessitated a response from l To speed up the process, across sectors and highlighted the issue to reduce the meeting time of information sharing across various required, to meet in a virtual platforms, each with their own security environment in order to reduce and information governance requirements. travel or to allow for more It was also highly work intensive, taking preparation time. up significant administrative hours per week simply to collate information, before l To have automated triggers as any supportive work was undertaken. they occur and to auto-notify key agencies as appropriate, Investigations began to look for an enabling a quicker response for IT solution to the issue of agencies patients. communicating on a wide variety of platforms about the same patients. l To have consistency of Neither PARIS, the NWIS file sharing records and potential for more portal nor the incoming Welsh automated system updates. Community Care Information System (WCCIS) cover the range of agencies involved in the Frequent Attender Service, Locality were commissioned by Cardiff which includes the police and criminal and Vale Health Board to develop justice system, amongst others. their core case management platform, Cardiff and Vale University Health ClusterCM, to integrate with existing Board was awarded funding via the patient management systems and deliver Welsh Government Efficiency Through a multi-sector collaboration tool for the Technology Fund to procure a Case prevention and reduction of frequent Management System to help mitigate attendance to hospital Emergency some of these issues. Locality Solutions Departments. offered a case management solution, with The project was successful in delivering user controlled permissions and multia reduction in contacts with Welsh factor authentication login. The software Ambulance Service NHS Trust (WAST) is hosted in certified data centres, and

from frequent callers and attendances at the Emergency Department from frequent attenders. The efficiency of data exchange across all organisations was increased, leading to a faster and more streamlined service. Opportunities to effectively and rapidly deploy a scalable solution across the whole of NHS Wales were also identified as a result of the project and there was an overall increased wellbeing in the lives of frequent attenders. An evaluation of the Cardiff project will enhance plans to offer the system to the regional Frequent Attender Services across the rest of Wales, offering training on the use of the system and on multiagency working. Redesigned processes will also be considered where necessary, and the experiences of staff, agencies and service users will be monitored and recorded. In practical terms, the multi-agency case management software will provide configurable ‘dashboards’ and reporting facilities for real-time and business intelligence reporting, as well as a customisable case management workspace for multi-agency working. Automated alerts and notifications will also enable proactive case monitoring, whilst an automated case flagging and prioritisation tool will lessen staff administrative work.


Welsh Government - Technology, Digital and Transformation

Health Technology Exemplars: A true collaboration between industry and health Put simply, the Bevan Health Technology Exemplar programme is a vehicle for industry to showcase new and innovative technologies, and for healthcare providers to establish whether the new technology works in context and delivers the benefits claimed. The scheme helps translate the concept of prudent healthcare into practice. Since the scheme started in 2015, the Bevan Commission has worked with and supported 50 projects. These projects include mobile apps, Virtual Reality solutions, new medical devices such as the micro-morcellation device Resectr or the Endoscopic Salivary Stone Fragmentation tool ‘StoneBreaker’, the Sterimelt machine (which turns waste plastics into useable materials), and using Artificial Intelligence to deal with queries from the public. Bevan Exemplars are big thinkers from every part of the NHS: surgeons, physiotherapists, nurses, GPs, carers, planning managers and porters. They all have something crucial in common – an innovative and prudent idea that they want to trial and test out in their own communities, hospitals, GP surgeries and care homes. The industry partners want to work with healthcare to improve health outcomes, patient experiences and resource efficiency in NHS Wales. The Health Technology Exemplar programme is a true partnership between the NHS and industry. When demonstrating or creating an evaluation base for new products, neither industry nor the NHS should bear all the risk and cost, so this programme provides a vehicle to share challenges and the rewards. The programme helps industry to connect with health care providers and helps health professionals to connect with industry. Visit:


The Bevan Health Technology Exemplar scheme has gained widespread recognition across the UK as an excellent model of healthcare innovation, as well as making a significant and positive difference to the lives of patients in Wales. Being a Bevan Commission Exemplar and Industry collaborator means you are supported to take your product through to implementation, and will be championed at senior levels within NHS Wales and the Bevan Commission. The Bevan Commission has a strong track record of success, with 80 per cent of projects reaching completion and demonstrating value to the NHS. The scheme also provides NHS staff with a fantastic opportunity to develop their leadership experience, personal knowledge and skills, and to access expert training and mentorship. As a Bevan Exemplar, participants gain greater insight to people and perspectives across the NHS and beyond, and can network with other innovators from a variety of health and care backgrounds.

Contact bevan-commission@ to learn more about how we can make the programme work for you.

Applications are now open for the next call for the Bevan Health Technology Exemplars programme. To learn more, please contact Siôn Charles on 07791 024 021 or email:

What the programme includes: l National Showcase of projects l Network events and peer


l Training and development from

the Bevan Commission’s range of expert masterclasses

l Expert coaching and mentoring

from the Bevan Commission

l Support from Health

Technology Wales to advise on NHS Wales evidence requirements

l Funding contribution from

Welsh Government of £7,500

l Protected time and space

for clinicians to partner with industry

l Potential to access further

Welsh Government funding

“The continued success of the programme demonstrates the value of the scheme to NHS Wales, which receives significant national and international acclaim. It also indicates how the ambitions of ‘A Healthier Wales’ can be made reality at a local and national level.” Professor Nick Rich Swansea University

Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Cardiff and Vale University Health Board

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‘Attend Anywhere’ for digital patient care Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Bwrdd Iechyd

Iechyd Cyhoeddus Cymru

Aneurin Bevan Health Board will be Addysgu Powys Powys Teaching introducing ‘Attend Anywhere’, a Health Board video consulting platform, into several services and care homes in summer 2019. It will enable clinicians to deliver Ymddiriedolaeth patient care closer to home via a secure GIG Prifysgol Felindre Velindre University NHS Trust video link.

Known as telemedicine, it will offer an accessible means to provide clinical advice, support and decision making where health professionals are able to view people online. ‘Attend Anywhere’ provides a video clinic environment that can be accessed by a member of the public using a web browser on their own device, be it a laptop, tablet or smartphone.

Ten care homes from across Gwent have volunteered as early adopters for the Out of Hours project. Emily Williams, team leader at Bethany Residential Home in Chepstow, commented that the project was useful because the current out-ofhours service means staff are spending “too much time on the phone and could be waiting for up to 2-3 hours for a telephone call back from the GP”. The new platform would prevent the need to attend out-of-hours clinics, benefiting the residents who feel “safe and comfortable” in the residential home. Since the project began, the team have engaged with the Airedale’s Digital Care Hub in West Yorkshire, who are delivering a range of telehealth services to over 500 care homes in the surrounding areas. They have found that it offers a viable and effective alternative to supporting care home residents, while demonstrating reduced demand for GP

of interactions between patient and such, the TEC programme acquired the ‘Attend Anywhere’ solution, which is the platform of choice Ymddiriedolaeth GIGScottish Centre for Telehealth for the Gwasanaethau Ambiwlans Cymru and Telecare (SCTT). With 98 per cent Welsh Ambulance Services NHS Trust of users saying that they would use the service again, SCTT have embarked upon a scale-up challenge to spread the expansion of video consultations. Public Health clinicians. As Wales

primary care services by 40 per cent, driving down ED attendances by 33 per cent and reducing non-elective hospital admissions by 25 per cent. In parallel, a project to use video consulting for Speech and Language Therapy services is also underway. This new way of working will involve directing a carer via video link through a swallowing assessment. A difficulty with swallowing (dysphagia) is known to precipitate a reduction in quality of life, malnutrition and poor rehabilitation. However, with prompt access to swallowing assessments, patient deterioration and admissions to hospital could be avoided, whilst reducing waiting times as well as travel and cost implications for staff. These projects form part of the National Technology Enabled Care (TEC) programme, who were funded by the Efficiency through Technology Fund (ETTF). Hosted by Aneurin Bevan Health Board, it has a remit to provide a knowledge management, evidenced based evaluation and best practice centre to facilitate spread of TEC services. Research of the comparable projects and evidence found that traditional video consulting technologies were often not flexible enough to suit the complexity

The TEC Programme is also collaborating with the University of Oxford to develop an evaluation framework to contribute to evidence base and better understand why such projects may succeed or fail. This has opened up opportunities to share the platform, technical support and learning with partner projects. One such example is CWTCH (Connecting with Telehealth to Children in Hospital). Based in Aneurin Bevan University Health Board, this ground breaking new project will support to young people who get admitted to paediatric wards with eating disorders or self-harm.

“We are delighted to receive the funding from the Health Foundation for our tele psychiatry project. The introduction of tele psychiatry has the potential to provide an efficient service that saves time, reduces cost and decreases stress for patients and staff.” Alka Ahuja Visiting Professor Consultant Child and Adolescent Psychiatrist University of South Wales


Welsh Government - Technology, Digital and Transformation

Improving quality and value: A new wave of Coordination Hubs for Wales A Healthier Wales sets out an ambitious plan to bring together all research, innovation and improvement activity within each Regional Partnership Board (RPB) footprint, and is focused on supporting local innovation and partnerships which drive towards new models of care. The aim is to establish a network of hubs that can accelerate and support the drive towards better quality and value as effectively as possible. In doing this, it seeks to build upon existing strengths and established Research Offices, Quality Improvement Hubs and partnerships with universities and industry. The NHS and social care is an essential part of a cross-cutting approach to supporting science, research and innovation. This is why the Research, Innovation & Improvement Coordination Hubs (RI&ICH) is an exciting concept that can help good practice, identified within the RI&I ecosystem in Wales, to scale up in a systematic way and at pace. The Welsh Government is providing funding to support the establishment and initial operation of the Hubs, enabling them to bring people, resources and partners together quickly to deliver benefits. These Hubs will have a specific coordination role, which is intended to complement and add value to existing activity.


As part of their work, they will be seeking out the activity which best improves outcomes for service users by identifying and promoting high-value RI&I. For example through prevention, earlier diagnosis, more accurate intervention, and addressing unwarranted variation and duplication in the system.

RPBs and their partners have been asked to design their proposals against the ten key design principles listed within ‘A Healthier Wales’, with a clear emphasis on: l

Higher value – achieving better outcomes and a better experience for people at reduced cost; care and treatment which is designed to achieve ‘what matters’ and which is delivered by the right person at the right time; less variation and no harm.


Evidence driven – using research, knowledge and information to understand what works; learning from and working with others; using innovation and improvement to develop and evaluate better tools and ways of working.


Scalable – ensuring that good practice scales up from local to regional and national level, and out to other teams and organisations.


Transformative – making sure that new ways of working are affordable and sustainable and that they change and replace existing approaches, rather than add an extra permanent service layer to what we do now.

Welsh Government Transformation Programme Funding has been confirmed for up to two years ending March 2021. A review of the Hubs, including the approach adopted by the three NHS Trusts in engaging with them, will be undertaken during this period.

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Harnessing the power of deep learning to assess Naso-Gastric tube position A project based at the National Imaging Academy of Wales, with support from tech giant Intel, aims to reduce potentially disastrous consequences of feeding through misplaced NasoGastric tubes. Naso-Gastric tubes are commonly used in hospitals and other care environments for a number of reasons, most commonly for feeding. These tubes are generally placed blind and sometimes by inexperienced practitioners. As a result, there is a significant risk of the tube being misplaced into the lungs. This can lead to liquid feed passing inadvertently into a patient’s lungs, which is a situation deemed a ‘never event’ by the NHS.

chance for the team to discuss novel programming approaches and techniques in order to achieve the highest accuracy for the developed software solution. Such a collaboration between Welsh Government, industry and the NHS is exciting, with the project aiming to drive training, innovation and research in the

fast-moving field of Artificial Intelligence in healthcare. The knowledge and skills gained from this project by the team will be carried forward to future developments within the NHS, reducing costs, improving outcomes and ultimately improving the quality of care provided to patients in Wales.

One of the ways in which the tube position can be assessed is by using a simple radiograph – an X-ray image of the chest, which shows the tube and where it lies. The practitioner should look at this image before feeding. The LineSafe project team, led by Radiology Specialty Trainee, Dr Asad Saeed, aim to harness the potential of Artificial Intelligence and Deep Learning to provide an immediate assessment of Naso-Gastric tube position on chest radiographs. This will not only reduce the risk of feeding through a misplaced tube but potentially reduce delays in feeding patients where there is doubt over the siting of the tube. The team is comprised of Consultant and Trainee Radiologists with an interest in Artificial Intelligence, research and innovation, and a diverse skill set including advanced programming and network computing. The two-year project is being supported by Intel, who are providing specialist knowledge and skills in a series of workshops hosted at the Academy in Pencoed. These workshops are a

National Imaging Academy Wales is an organisation focused on training the next generation of diagnostic imaging healthcare professionals including Radiologists and Radiographers supported by NHS Wales and Welsh Government. The Academy is a focal point for collaboration, innovation and research in Wales, creating a dedicated environment for academia, industry and NHS Wales, including new ways of working and exploring applications such as Artificial Intelligence. For more details about National Imaging Academy Wales, please visit:


Welsh Government - Technology, Digital and Transformation

Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro Cardiff and Vale University Health Board

The National Mobilisation Programme

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Bwrdd Iechyd Prifysgol Bwrdd Iechyd Prifysgol Betsi Cadwaladr Hywel Dda University Board Mobilisation Programme University Health Board by Welsh Government The Health National was established

in 2017/18 in order to meet demand for mobile devices in NHS Wales to support the digital transformation of health care services. The main objective of the programme, in its first phase, is to develop a proposal in the form of an investment Bwrdd Iechyd Iechyd Cyhoeddus case that will outline a preferred option for managing the procurement and supply Addysgu Powys Cymru ofTeaching mobile devices to NHS Wales. Powys Public Health Health Board


Abigail Phillips for Welsh Government To support this work, four key areas have and Matt been identified: Ymddiriedolaeth GIG John, Interim Chief Information Ymddiriedolaeth Gwasanaethau Ambiwlans Cymru Officer, ABMUHB. GIG Prifysgol Felindre Welsh Ambulance Services l Mobile Ready – to capture the Velindre University NHS Trust NHS Trust Since the establishment of a formal current state and future infrastructure Programme Board in August 2018, development needs, and understand the following progress has been made associated costs, in order to deliver to meet the objectives of the four key clinical standard Wi-Fi across all NHS programme work streams: primary, community and secondary care facilities in Wales. Mobile Ready: l Mobile Presence – to capture mobile l A reporting tool to allow accurate device use cases and requirements progress monitoring of LHB/Trust across different NHS Wales clinical Wi-Fi delivery against funded plans in ecologies to inform the investment secondary care. case. l Mobile Policy – to support the development and implementation of a ‘Once for Wales’ policy by LHBs, Trusts and NWIS, which will enable mobile service development within an agreed framework of technical standards. l Mobile Procurement & Partnership – to develop an investment case that will identify a preferred option for a vehicle to manage efficient and effective procurement supply, reuse and disposal/recycling of mobile devices within the statutory responsibilities placed on NHS Wales, including the Wellbeing of Future Generations Act. The programme has been managed from July 2018 by the established National ePatient Flow Management Programme team, hosted by Aneurin Bevan University Health Board (ABUHB) working in partnership with ICT colleagues in Abertawe Bro Morgannwg Health Board (ABMUHB). A Programme Board has been established chaired by joint SROs:


l A needs analysis tool, launched in March 2019, to capture the long-term network requirements to deliver clinical grade Wi-Fi across NHS Wales health estate. This will report in 2019/20 and provide the basis for medium to long-term capital planning to ensure NHS Wales develops and maintains a resilient Wi-Fi infrastructure. Mobile Presence – two national workshops were undertaken in July 2018 which have supported the development of: l A mobile persona use case tool that can be used to assess and validate device requirements in NHS Wales. l A mobile maturity matrix tool that will be used to inform mobile requirements and costs for the NMP Investment Case and can be used by LHBs to baseline and monitor their progress in delivering a resilient mobile service to their staff and patients.

Mobile Policy – following a national workshop held in September 2018: l A draft policy has been developed that lays out operational standards for mobilisation that need to be met. The policy will be accompanied by a detailed implementation plan that will identify standard gaps and drive the development of technical and associated quality standards that NHS Wales can use to ensure its mobile services are robust and resilient. Mobile Procurement & Partnership: l A project initiation document has been approved by the Programme Board. This sets out the work plan for development of the investment case for a special purpose vehicle that will manage the procurement and deployment to LHBs of mobile devices and their reuse or disposal as required.

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The main focus for 2019/20 is the completion and presentation of the NMP Business Case. In support of this, the following objectives will be completed: Mobile Ready: a) The completion of the needs analysis tool across all NHS Wales health care environments, including consideration of Public Sector Broadband requirements to ensure detailed requirements are understood, enabling NHS Wales to prioritise its investment against need in 2019/20 and beyond. Mobile Presence: a) Confirmation of device requirements to support the National Nursing E-Documents Programme in order to ensure appropriate funding of this programme. b) Confirmation of National ePatient Flow Management Programme device needs if the Outline Business Case is supported and the programme progresses to procurement and Full Business Case.

c) Analysis of requirement overlap between a) and b) to ensure targeted spending against true need d) Delivery of device requirements to inform the NMP business case. Mobile Policy: a) Final sign off of the National Mobilisation Policy and implementation plan. b) Implementation of the National Mobilisation Policy against the implementation plan. Mobile Procurement & Partnership: Delivery of the main objectives of the Project Initiation Document in order to build an investment case through three main work packages: a) Work Package 1 – Need & Benefit. Analysis of LHB current baseline procurement activity and workshop of requirements to specify the service scope required to meet need and quantify core programme benefits.

b) Work Package 2 - Delivery Options Identification and appraisal of options for a special purpose vehicle including: l Procurement of mobile devices. l Reuse and disposal of mobile devices. l Operational arrangements for the service in terms of organisational structure, funding support, human resource needs, and high level standard operation procedures that will outline how the Special Purpose Vehicle will meet needs at the right standard for its customers. c) Work Package 3 – Implementation Plan for the Special Purpose Vehicle. A timetabled plan for delivery of an operational service, including business change plans and a benefits realisation plan.


Welsh Government - Technology, Digital and Transformation

Powys Transformation Project – Delivering a healthy, caring Powys ‘Delivering a Healthy, Caring Powys’ will support the scale up of new models of seamless health and social care in North Powys. The project will deliver a significant change in the way services are provided and promote wellbeing, early help and support, utilising social and green prescribing opportunities and encouraging people to take greater responsibility for their wellbeing and plan for their future health needs. The project aims to: l Enable citizens, staff and partners to be actively involved in the delivery of the new integrated model and support a new approach to delivery in North Powys. l Achieve wider connectivity across Mid Wales to improve equity of service to a rural population through integrated health and care pathways across counties. l Multi-agency wrap around services with focus on prevention and risk stratification tools to reduce emergency admissions. l Increase uptake of prevention services to reduce smoking, achieve greater participation in physical activities, undertake targeted risk assessments for people with cardiovascular disease and minimise the impact of clinical risk factors (improving adherence to medicines).


l Enable more people to live independently and remain at home safely through technology enabled independence and care. l Enable more integrated working to prevent needs from escalating and provide immediate intervention at time of crisis.

l The environment, as it reduces the requirement for travel across Powys. l Cost and time: reduced travel saves money and time. Practitioners are enabled to undertake reviews with a large number of people in residential care homes without having to leave the office more than once to provide the PadBot.

PadBots PadBots are technology that enables simplified video conferencing between individuals in their own homes and practitioners within social services and health. They are built to make their use as simple and user-friendly as possible. Powys County Council have undertaken a pilot within their own owned residential care homes. This provides support with: l Safeguarding individuals by ensuring that they are safe in their home. l Reviews, by ensuring that all reviews are effectively undertaken in the most efficient manner. l Timescales, by minimising waiting times for regular reviews.

To scale this up and roll out across North Powys, one PadBot will be provided in each care home and in each community hospital. If possible, they will also be placed in Shrewsbury and Telford Hospital and Bronglais Hospital. This would enable care homes to carry out virtual assessments with residents of North Powys who may be in an acute hospital both in and out of Wales. This will also enable virtual consultations for social workers to follow up with patients on hospital wards and could also be used to scale up virtual consultations with GPs in care homes, and it should interface with Skype for ease of access.

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Gwasanaeth Gwybodeg Informatics Service

Progress for Choose Pharmacy Choose Pharmacy is an IT platform which enables better sharing of information between secondary care, GPs and community pharmacists to deliver safer, more seamless patient care. Since we last reported on Choose Pharmacy in March 2017, the system has been rolled out to 702 of the 716 community pharmacies in Wales. At the MediWales Innovation Awards in 2017, the NHS Judges’ Award was awarded to the NHS Wales Informatics Choose Pharmacy Team. At the root of this project is the need for community pharmacists to have improved access to patient information, so that they can provide more beneficial services for patients and alleviate some of the pressures on GPs, out of hours services and A&E departments. Choose Pharmacy has the following capabilities:

Common Ailments Service Community pharmacists can provide treatment and advice, and electronically record a consultation with a patient for minor ailments such as backache, sore throats, diarrhoea and hay fever. This information can be accessed by other pharmacists in Wales through the Choose Pharmacy platform in order to support clinical care. Since the Common Ailments System was launched in September 2013, 83,192 consultations have been completed.

Discharge Medicines Review Community pharmacists can be notified when patients are discharged from hospital through the Choose Pharmacy platform. The electronic discharge medicines information is accessible through the Choose Pharmacy platform. This enables community pharmacists to undertake a medicines review by checking a patient’s medicines at discharge against those prescribed by their GP, which means they can find and resolve any unintended differences.

If a patient is unintentionally prescribed incorrect medication or the wrong dosage, it can lead to harm and readmission to hospital, but this can be avoided through better sharing of information. Since July 2017, 15,562 Discharge Medicines Reviews have been completed and 15,481 medication differences identified and resolved from 148,415 medicines reviewed.

Emergency Medicines Service Community pharmacies across Wales have been participating in the NHS Emergency Medicines Service since 2015. However, a considerable proportion of patients couldn’t have their medication verified by a pharmacist, which meant that they ended up being referred back to other, less appropriate NHS services. Since December 2017, we have been providing community pharmacists access to information on prescribed medicines in their Welsh GP Record. This is now available in all 484 pharmacies commissioned to provide this service across Wales. Since April

2016, 11,895 consultations have been provided and 17,914 items of emergency medication have been supplied. New Services As well as the three services detailed above, the Choose Pharmacy platform has been further developed to record the administration of seasonal flu vaccination, emergency contraception and a sore throat test and treat service. In the 2018/19 flu season, 51,447 flu vaccines were administered in over 400 community pharmacies using Choose Pharmacy and 8,559 emergency contraception consultations have been recorded since 2016. The Sore Throat Test and Treat service, piloted in 53 pharmacies across Cwm Taf and Betsi Cadwaladr Health Boards, has recorded over 1,700 consultations since November 2018. Patient satisfaction with the service is very high and the service has been shortlisted for an Antibiotic Guardian award in 2019. Work is ongoing on sharing appropriate information from Choose Pharmacy with GP practices and hospitals.


Welsh Government - Technology, Digital and Transformation

Accelerate: the pioneering innovation programme Accelerate is a pioneering collaboration between Welsh universities and the Life Sciences Hub Wales. It helps to quickly translate innovative ideas into new technology, products and services for the health and care sector.


Why was Accelerate created? The Accelerate programme was set up to help enterprises in Wales turn their innovative ideas into solutions that can be adopted into health and care. The life sciences sector is big in Wales, employing around 11,000 people in over 350 companies and contributing around £2bn to the Welsh economy every year. For a small country, Wales has lots of innovation to offer. The Accelerate partners recognise that, by supporting the Welsh life sciences industry to push and develop this innovation, they’ll be able to pull it through into the NHS – where it’s most needed – and start making a tangible difference.


It is led by Life Sciences Hub Wales, in collaboration with Cardiff University, Swansea University and the University of Wales Trinity Saint David. Rather than providing funding or grants, the programme offers access to the academic expertise, in-depth understanding of the life sciences eco-system and cuttingedge facilities that innovators and entrepreneurs need to get their idea off the ground.



Who is involved in Accelerate?

Accelerate helps innovators in Wales turn their ideas into solutions that can be adopted into health and care. Whether you’ve got an idea for a healthcare technology but aren’t sure what steps to take next, are in business and looking to expand your product range, or are a health professional who has spotted a smart way to improve a process – Accelerate wants to work with you.

Who can work with Accelerate? Accelerate works with enterprises of all shapes and sizes who are developing healthcare innovations that will benefit patients, improve NHS Wales and boost the Welsh economy. The programme is flexible and applications can be submitted by academics, industry partners, or clinicians. There’s no project minimum or maximum size.

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If you’d like to work with Accelerate, you’ll need to meet the following criteria: A Welsh enterprise must be involved – whether you are one yourself, or you are collaborating with one. The impact of the innovation on the Welsh economy should be clear – whether that’s creating new jobs, introducing new products, or creating new ways of working.

Co-funded by the Welsh European Funding Office European Regional Development Fund, the Welsh Government’s Health and Social Services Group, Universities, Life Sciences Hub Wales, and health boards, Accelerate’s ultimate aim is to create lasting economic value in Wales. To find out more about the Accelerate Programme, please email:



Your innovation must be researchoriented, focusing on benefiting health and care. It could be a new technology, product, process, or service – from diagnostics and medical devices, to therapeutics or enabling technologies, apps and algorithms.



An enterprise must be involved in your project – whether you’re the enterprise yourself, or you’re a governmental body or university that’s collaborating with one.

The work must be a true collaboration. This means your contribution – whether that’s funds, equipment, knowledge, or human resource – must match Accelerate’s.

“Developing innovative new ways to prevent, treat and cure illness and disease is a vital part of the Welsh Government’s vision for the future of the NHS in Wales. The Accelerate programme and new health innovation centres fund will help develop new ideas for health products and services more quickly for use in our NHS and across the world.” Vaughan Gething, AM Cabinet Secretary for Health and Social Services


Welsh Government - Technology, Digital and Transformation Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf Morgannwg University Health Board

Cardiff and Vale University Health Board

Digital portal for pressure ulcer reporting and recording in Welsh care homes Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Dr Margaret Flynn’s seminal report ‘In Search of Accountability’ reviewed theYmddiriedolaeth GIG Prifysgol Felindre circumstances surrounding the Velindre University NHS Trust deaths of a number of residents in a small number of care homes in South East Wales. The report, published in 2015, included 12 recommendations and the Welsh Assembly Government accepted all without redaction. Recommendation 2 centred on the requirements for an open and transparent system for pressure ulcer recording and reporting. Pressure ulcers affect almost 9 per cent of hospital patients in Wales and are commonly found in all care settings. Pressure ulcer development is an important marker for determining the quality of care provided. According to clinical experts, 95 per cent of pressure ulcers may be avoidable. Further to a successful Efficiency Through Technology Fund (ETTF) bid in 2017, a wound registry recording and reporting application was successfully tested in nine care homes – seven in Gwent and two in the Vale of Glamorgan over the October 2017-April 2018 period. The Welsh Wound Innovation Centre (WWIC), in conjunction with a specialist digital company (Arcta Solutions),

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

The web-based system was designed to encompass education, recording and reporting functionality to: 1. Aid the recognition of different categories of pressure ulcers and support treatment in accordance with the All Wales Tissue Viability Nurse Forum (AWTVN) Guidance. 2. Provide a concurrent assessment and treatment record to include wound photography. 3. Deliver a self-populating reporting form to meet the requirements of Regulation 60, Regulation and Inspection Act (Wales).

The idea itself is simple: the development of a pressure ulcer/wound application to improve the practitioner’s ability to assess risk and to achieve guidance on care and treatment. This can also help to maintain a chronological record, which can then provide a seamless record and avoid transitions between services. Turning that idea into a reality, however, requires a collaborative effort, in this case between the care home sector in Aneurin Bevan, the health board, the wound experts at WWIC and a technology partner who invested in the project. Acknowledgement is also given to the Efficiency Through Technology Fund, as this funding enabled the development and first implementation of the tool.


co-produced the bespoke platform, accessible through a web-based application. Although the adopt to scale project is in its infancy, the collaborative believe that there are opportunities to go beyond the care home sector and expand the integrated wound portal into the hospital, primary and community sector so that an ‘individual’ wound record is achieved.

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Innovation in the Welsh life science industry


Innovation in the Welsh life science industry

Crossing borders for rare disease health awareness Ataxia is a Greek word meaning ‘lack of order’. People with ataxia have problems with movement, balance, and speech. It is a rare condition that gradually makes you lose control of your body. Ataxia and Me is a patient group located in South Wales aiming to bring some “order to the lack of order”. As ataxia can happen to at least 1 in 50,000 people, and misdiagnosis is often the case, it is important to make sure people are aware. As part of our new ataxia-aware project, we have created a new website ( which keeps followers up to date on all things Ataxia and Me. From the printing

different events and therefore be on a level playing field within the health and life science arena. Events like the National Ataxia Foundation conference held in Las Vegas have given Ataxia and Me an opportunity to get noticed around the globe. We have invited people to share photos with ‘I am Ataxia Aware’ postcards to add to the awareness project portfolio. At the National Ataxia Foundation conference this year, we were also proud to announce our new Social Media Coordinator, Beth Soden, who established this project. of leaflets, to blog posts of the projects that the patient group is undergoing, the website was created with the aim of informing the public. In its launch month, the new website was seen by 17 countries around the world! MediWales has greatly impacted the patient group by allowing Ataxia and Me to network at lots of

By using digital methods alongside traditional methods, we are moving with the times, making a better future for health, care, research and life sciences. Enabling the patient

Addressing the challenge of turf pests Turf pests are proving to be a significant problem this year. Football and cricket pitches, as well as racecourses and golf courses, are reporting major infestations of leatherjacket and chafer grub. Not only do they damage the turf themselves, but birds and animals wishing to feed on the larvae will destroy

the turf to get to them. The chemicals used for treatment up until 2016 have now been banned or are subject to restricted use, and there is slow uptake of biological alternatives. This is a result of the historically poor reputation and performance of these alternatives, caused by ill-informed application techniques. Seeking to resolve this issue, Bionema has taken to the road!

In April, Bionema hosted over 130 golf course managers and greenkeepers at five breakfast seminars on courses across the country, showing how good education and correct application could help improve success rates. As part of this, a training and case study video was prepared and released, both on YouTube and on the Bionema website.


In May, Bionema invited 100 industry delegates to an Emergency Chafer and Leatherjacket Summit, where the challenges facing the industry were addressed and creative solutions were developed across a wide spectrum of natural solutions. The key recommendation from the expert panel was that Integrated Pest Management solutions were needed, rather than hoping for a ‘silver bullet’ from a single product. When a problem is this big, sitting at home is not the answer. Instead, mobilising the industry to work together in a positive and collaborative way is the solution and Bionema is determined to play its part. There will be a further opportunity to discuss the challenges facing the crop industry, whether turf and amenity or forestry, horticulture and agriculture, when Swansea University plays host to the Biopesticide Summit 2019 on July 2nd and 3rd -

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Doors open for Brainbox Initiative winner BrainBox Initiative is starting to have the impact that its founders at Brainbox Ltd were hoping it would have when they launched the programme to support early career neuroscientists in 2017. The programme aims to offer a significant boost to those looking to make a career in neuroscience by supporting and promoting their research and research ideas. This is achieved through a programme of workshops, awards and an annual conference dedicated specifically to putting early career researchers front and centre. One of the first Research Challenge winners, Dr Helen Nuttall, has subsequently gone on to create her own neuroscience laboratory at Lancaster University. She has recently

been awarded a research grant from the BBSRC of almost half a million pounds in order to investigate the cortical resources required for speech perception in age-related hearing loss, with the view to informing and guiding future interventions. Speaking of Dr Nuttall’s success through the initiative, Andrew Thomas, Managing Director at Brainbox Ltd, commented: “We’re really proud of Helen and what she has achieved and delighted that BrainBox Initiative has had a part to play in that. We’ve always believed in the importance of supporting early career researchers, which was why we created BrainBox Initiative; as a platform to give them opportunities to grow and develop as researchers with promising careers.”

“The BrainBox Initiative played a significant role in how my career progressed after my postdoc. Winning the Research Challenge enabled me to successfully build on an idea and collect pilot data very early on in my lectureship. I was then able to use that pilot data in the BBSRC application and achieve funding for an area of research that I hope will have a beneficial impact on our ageing population.” Dr Helen Nuttall

Game changing test for leukaemia The first test to quickly and accurately predict how people will respond to standard treatment for the most common type of leukaemia has been developed at Cardiff University. The technology could guide doctors’ decisions on which drugs to give to patients. Researchers say that the test could now be a game changer in the treatment of chronic lymphocytic leukaemia (CLL). It also has the potential to change how other cancers, including myeloma and breast cancer, are treated. While previous versions of the test had taken a week to process, results can now be ready in a day. CLL is a slowly developing blood cancer in which patients produce mutated versions of white blood cells that build up in the blood, bone marrow and lymph nodes, and crowd out healthy blood cells. It progresses at different rates in different people and never progresses at all in a third of patients. Until now, there has been no accurate test that can

be used to indicate whether and how fast it will develop in individual patients. Dr Alasdair Rankin, Director of Research at blood cancer research charity Bloodwise, which funded the research, said: “People with CLL can experience great anxiety and uncertainty about how their cancer will

progress. This test could give people the peace of mind that they will receive the most effective treatment possible if it does. It may even allow some people to be told that their cancer is unlikely to progress.”


Innovation in the Welsh life science industry

Significant steps for CRO CatSci is an award-winning contract research organisation (CRO) that provides drug discovery and process chemistry services for innovator pharma organisations. Operating out of Cardiff, CatSci utilises its proven combination of commercially-minded and scientifically-unbiased expertise to deliver exceptional tailored chemistry solutions to a global customer base.

This year has seen CatSci significantly advance its global growth strategy: 94 per cent of its business is exports, with 88 per cent of these coming from the United States. This is a significant rise from 2017, when the number stood at 42 per cent.

The past year has been marked with significant milestones for CatSci; the company has gone from strength to strength as it continues to expand its global reach. September 2018 saw the company triumph at the prestigious CPhI Pharma Awards by winning the Excellence in Pharma: Contract Services and Outsourcing category. The awards are among the most esteemed in the industry, with fellow nominees including Merck, Cambrex and Alcami. CatSci was recognised for its innovative use of biocatalysis, reflecting its premier process R&D services. This also highlights

the substantial interest that biocatalysis has garnered from both industry and academia, with the 2018 Nobel Prize in Chemistry being awarded in this research area. CatSci used biocatalysis to improve the environmental and economical sustainability of an active pharmaceutical ingredient, addressing manufacturing route inefficiencies and an impending patent expiration. The company also continued its ÂŁ1.3 million expansion plan in 2019 as part of its drive to continue to meet the growing and evolving needs of its customers. The company has received ÂŁ125,800 in Welsh Government funding and a further ÂŁ350,000 through the Development Bank of Wales to help to support the delivery of this exciting strategy, which includes the creation of 16 highly skilled jobs. This strategic growth also encompasses an expansion to its existing facilities, allowing CatSci to further enhance its drug discovery and development offerings.

Technology facility gains GCLP accreditation Central Biotechnology Services at Cardiff University has gained Good Clinical Laboratory Practice (GCLP) accreditation following an external audit by Quology in April 2019. This accreditation demonstrates the excellence of the facility to support clinical trials and will be maintained by an annual audit. Central Biotechnology Services already has a track record over the last five years of performing clinical trials to this standard following sponsor audits from a range of clients. This new external accreditation further confirms that it is working to the appropriate high standards and enables the Technology Facility to actively increase its work supporting external clinical trials.


GCLP is an established international quality system for laboratories that analyses samples from clinical trials in accordance with global Good Clinical Practice (GCP) regulations. GCLP ensures the quality and reliability of the clinical trial data generated by a laboratory. By gaining this accreditation, Central Biotechnology Services has demonstrated that it maintains clinical trial data integrity and provides analytical clinical trial results that are consistent, auditable and repeatable. The accreditation is an excellent complement to the ISO 9001 accreditation that Central Biotechnology Services has held since 2009. The current ISO

9001:2015 accreditation, held since 2014, underpins all of the activities and the ethos of the Technology Facility.

Central Biotechnology Services is a Cardiff University Technology Facility providing access to life sciences research equipment and methodologies, with a focus on Cell Analysis/Imaging, Genomics/ Bioinformatics and Proteins/ Diagnostics. It is part of the Clinical Innovation Hub Division of Cardiff University and is based on the Cardiff University Heath Park site.

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Innovation at CITER CITER is internationally recognised for its expertise in basic, translational and clinical research in stem cell science, tissue engineering and repair, and disease translation. CITER supports translational research that is conducive to commercial exploitation and encourages partnership with the industry. CITER fosters networking with workshops, seminars and conferences throughout the year, which in turn supports our members to develop and enhance successful research collaborations and promotes networking with external researchers and stakeholders. Industrial partners are encouraged to attend and showcase collaborative works and solutions tailored for researchers. CITER also actively promotes research excellence with financial support to early researchers promoting research innovation. A key remit of CITER is engagement and we actively deliver educational workshops to primary and secondary school children across Cardiff and to the wider public at public events. Translational research, industrial networking and collaboration are key for CITER researchers to promote and develop innovative solutions. The use of academic knowledge, technology, skills and innovation by industrial partners has been highly successful for improving competitiveness and productivity in Wales and in the UK. CITER is fully supportive of such partnership and aims in promoting academic-industry networking through its activities. Below are examples of projects among many carried out by CITER members.

Cardiff University team has revolutionary drug treatments for eye diseases in sight It is perhaps surprising that in 2019 we still rely heavily on the use of eyedrops as a means of instilling drug doses into the eye. A cross-School Cardiff University collaboration, involving academics from the School of Pharmacy and Pharmaceutical Sciences, the School of

Optometry and Vision Sciences and the School of Healthcare Sciences has secured significant funding from the BBSRC to develop a range of new, advanced products aimed at providing better targeting, thus improving therapeutic outcomes across a range of ocular diseases. Dr Charles Heard and Prof Andrew Quantock demonstrated that significantly enhanced ocular drug delivery can be achieved using a number of advanced drug delivery platforms including thin films, contact lenses and microneedle arrays. With the addition of Prof David Whitaker to the team, a grant of £511K has just been secured from the BBSRC SUPER Follow on Fund. The new award aims to translate laboratory findings into commercially available products and will involve working closely with Cardiff University’s Technology Transfer Officer, Rhian North, and commercial partner Thèa Pharmaceuticals - a company dedicated to developing high-quality products that support ophthalmic care and eye health. Work will initially focus on new products to treat infections of the cornea – keratitis – which presents significant drug delivery challenges for the scientist and morbid prognoses for the patient in cases such as fungal and Acanthamoeba keratitis.

Novel delivery system has the potential to reduce joint replacement infections An interdisciplinary team of researchers at Cardiff University have developed a novel method to increase and prolong the release of antibiotics from bone cement, a material widely used to anchor joint replacements to bone. The innovation has potential to reduce infection rates for cemented hip and knee replacements, a capability of particular importance given there were 2,865 joint replacement infections in the UK in 2017. Infected joint replacements are complicated to treat, requiring longer and more costly surgical and hospital interventions. For patients, this means multiple surgeries, a higher risk of failure and, in severe cases, amputation or death.

When tested in a commercial cement, 22 per cent of the incorporated antibiotic was delivered over 60 days compared with only 9 per cent from the commercial antibiotic cement, increasing post-surgical protection. Unexpectedly, and of great benefit, an increase in the cement’s ability to resist cracking and fracture was also observed. The system uses nano-sized vesicles, known as liposomes, which can encapsulate both hydrophilic and hydrophobic therapeutics. Using a patented technique (WO/2015/004450), these liposomes are uniformly dispersed throughout the cement, resulting in enhanced antibiotic delivery and antimicrobial activity. The interdisciplinary team that developed this technology combined a biomaterials scientist (Dr Wayne Nishio Ayre), an engineer (Prof Sam Evans), a pharmaceutical scientist (Prof James Birchall) and a microbiologist (Prof Stephen Denyer). Its development, optimisation and commercialisation was supported by the Biomechanics and Bioengineering Research Centre Versus Arthritis, Severnside Alliance for Translational Research and Welsh Government Bridging Fund. Having optimised the technology (shelflife, manufacturing, mechanical properties and antimicrobial performance) and demonstrated pre-clinical safety, the team are now seeking support from Health and Care Research Wales, MRC-DPFS or an industrial partner to clinically translate the technology through a single-arm human safety trial with clinical collaborator Mr Rhidian Morgan-Jones at the Cardiff and Vale Orthopaedic Centre. Tangential to this work, funding from the Dunhill Medical Trust and Life Sciences Network Wales has demonstrated the ability of this technology to deliver growth factors (BMP-2) and bisphosphonates to assist more rapid bone healing around the cement.


Innovation in the Welsh life science industry

Digitising consent for shared decisions “Better surgical decisions, better outcomes”: Concentric’s mission is to improve healthcare decisions, with the view that the best healthcare decisions are shared by both patient and clinician. By utilising a digital consent platform, Concentric supports clinicians and patients, together, to make the best decision for each individual. Based at Tramshed Tech in Cardiff and formed following a £350,000 Innovate UK investment, Concentric are the latest health technology startup to choose South Wales as their home. Building upon a successful pilot at Imperial College NHS trust, the team are deploying across three Trusts and Health Boards. With benefits for patients, clinicians and health boards, the company’s clinically-

“We need to support patients and clinicians in the journey towards shared decisions. I wanted to be empowered to take an active role in decisions about my care, and be able to explore my options both in the clinic room and at home. It’s a notable culture change from paternalistic decision making by a clinician for a patient, but I hope this new technology can support that shift.” Sian Phipps Patient Leader, Velindre Cancer Centre led approach aims to tackle a significant challenge in healthcare today. Dr Dafydd Loughran, CEO of Concentric, has a clear vision for the future: patients will be empowered to engage with healthcare decisions, alongside clinicians, as equal partners; clinicians will be supported with data-driven outcome predictions and a digital platform that makes the consent process

easy; and health boards will be assured by a secure, auditable consent platform. By combining great design and data science with a patient-centered approach, Concentric aim to transform how people make decisions about their health.

Bringing innovation to surgical endoscopy Creo Medical is a medical device company focused on the emerging field of surgical endoscopy, which has made strides in addressing the needs of the GI sector – a community that has previously been underserved with regard to innovation and, in particular, advanced energy devices. The company’s CROMA Advanced Energy platform is designed to address the technical challenges associated with delivering advanced energy through the flexible, narrow and miniature devices required of GI practice. Allowing the delivery of microwave energy and bipolar radiofrequency energy through a single accessory port enables the use of a range of novel miniature endoscopic devices with precise and highly controllable cutting, coagulation and ablation capabilities. Speedboat® is the first device developed for use with Creo’s CROMA Advanced Energy platform, allowing the removal of cancerous and pre-cancerous gastrointestinal lesions


using a flexible endoscope. This alternative approach allows the endoscopic removal of lesions in a single large piece (en-bloc), providing a more complete and accurate specimen for analysis. As it is performed endoscopically under sedation, it offers the potential to reduce the number of patients having these lesions removed surgically under general anaesthetic, which in turn can reduce the length of stay in hospital and improve patient outcomes. Having gained CE mark status and 510(k) regulatory clearance, clinicians in several countries internationally have now begun using the CROMA Advanced Energy platform and Speedboat® in their practices, with cases having been performed during 2018 in the UK, the US, South Africa and Spain.

Creo Medical won the Outstanding Achievement award at the 2018 MediWales Innovation Awards.

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A new approach to staff engagement – SPEaC Happy “Happy staff means happy patients” is a well-rehearsed mantra within the NHS and not without reason. A wealth of evidence now exists from the Kings Fund, as well as from the research of Jill Maben and Michael West, all of whom have demonstrated that a happy and engaged workforce results in improved patient outcomes, with reduced mortality and infection rates. Not only is an engaged workforce good for patients, it’s beneficial for organisations too. With the NHS facing a potential staffing deficit of up to 250,000 staff by 2050, a happy workforce is essential to improve recruitment and retention, in addition to reducing costs associated with bank and agency usage.

A real-time staff feedback system, SPEaC Happy, was designed alongside staff at one NHS Trust and has since been rolled out to a number of organisations across the NHS and education sector. This simple system, which is created bespoke for each organisation, allows staff a voice and provides a method of rapid communication between team leaders and staff. By remaining anonymous, staff at all levels of the organisation have the freedom to speak up and have their voice heard. Benefits to organisations can be described in terms of cost savings (£330K in one area of one organisation in a year due to reduction in turnover), but perhaps more importantly in terms of staff engagement and morale, with one NHS Trust seeing its

staff survey improve year on year following implementation. Recognised in the CQC Driving Improvement Report, Deloitte Time to Care and NHS Employers Top Tips, SPEac Happy received praise at the 2016 HSJ Awards:

“The judges were bowled over by this simple approach which demonstrably shifted behaviour and culture in clinical teams. The immediacy of feedback and of action, coupled with clinical ownership, is very powerful.”

Biomarker tracking start-up relocates to Wales Innovative biometric tracking service, Forth, which helps people to navigate their way to better health by tracking their body’s key metrics, has relocated to Wales after securing a six-figure investment from the Development Bank of Wales.

Forth aims to give people greater insight into their body’s internal health, by measuring over 50 key biomarkers for good

health using small blood samples that can be collected by the user at home. Sarah Bolt, the founder of Forth, explained the need for the service, commenting: “We’re bombarded with information about how to improve our health on a daily basis, and many of us are using wearables to track the amount of activity we’re doing or the calories we’re eating. However, we know very little about the state of our internal

health, what areas we need to improve or if indeed our actions are helping at all to improve our wellbeing.” Originally based in Bristol, Forth’s first investment round was secured in Spring 2017 via the crowdfunding platform Crowdcube. Sarah believes the service can not only help to support the Department of Health’s drive towards preventative care, but also those who are monitoring existing conditions such as type 2 diabetes. Elaborating on the company’s aims, Sarah said: “Our aim is to provide a safe, supportive, meaningful and affordable service to help nudge people towards better health behaviours. We believe the first step to positive behaviour change is understanding. By providing people with fast and convenient access to biomarker testing, coupled with an easy-tounderstand results dashboard, we drive a deeper understanding of your own health.”


Innovation in the Welsh life science industry

Top tips for funding and finance At a recent MediWales conference on Funding and Finance, a panel made up of advisers from Brewin Dolphin, Geldards and PwC, together with Mark Bowman from Pulmon IR and Paul Morgan from Biovici, shared their top tips for successfully raising finance.

A summary of the top tips from the panel: Martyn Davies from Geldards l Don’t leave it too late to get advisers on board. It is often a false

economy to bring them in late.

l Speak to several quality advisers and proceed with the one you

have a good rapport with.

l Don’t take more investment than you need. Your valuation should

only increase moving forward; it is therefore better to raise more money later at a higher valuation.

l Don’t be afraid to ask questions. This may be the first time you have

raised investment, so there are no stupid questions.

l Don’t try and do everything yourself. Take advantage of your

advisers and others in the business.

Phil Sampson from PwC l Engage early. The more time you have to fully understand what

will be required from a transaction and have support available, the better chance you will have of getting the deal that is right for you.

l Build up trust and rapport with your advisors. Engage honestly

with them, so that they have all the appropriate knowledge to help.

l Make sure you get the right structure in your business as early

as possible. Leaving it until the last minute could generate unnecessary cost.

l Be ready for an investment, as sorting out any potential stumbling

blocks before an investor looks at the business will help smooth the overall process.

l Be aware that investments can take longer than you expect and

factor this into any requirements you have.

Greg Tait from Brewin Dolphin l Engage early with all advisers. If we can’t help you right now, we

will signpost when we can and recognise when you need a different adviser or service.

l A reputable adviser will provide transparency in terms of service

expectation and fees. When engaging with advisers, the more open you are, the better the advice will be.

l Distinguish between personal and business goals. For example,

if your long-term plan is to retire after selling your business, you need to understand what the business will potentially provide and whether this will be enough to meet your lifestyle aspirations.

l Don’t mistake your business for your pension and never

underestimate the power of compound returns! You might think that you can rely on your business to fund your future, but saving as you go will create a better chance of success. In addition, pension contributions will often be the most tax efficient route to withdrawing cash from your business.

l Safeguard your company’s most precious assets – its key employees.

Protect your business in case of employee loss due to long-term ill health or death. Additionally, employees have the same long-term planning questions that you do, so giving access to advice produces greater loyalty.


Mark Bowman and Paul Morgan l Take advice from your network about suitable advisers that have

worked in the life sciences sector and speak to these advisers.

l Make sure you use suitably experienced advisers. For example, the

lawyer who did your conveyancing might not be the right person to advise you on a fundraising.

l Do not hide anything from your advisers. Due diligence by

investors will discover any issues.

l Do listen to the advice you are give, rather than think that you

know it all.

l Get your “house” in order in terms of IP ownership and contracts,

so that preferably your company owns the IP rather than having a short-term licence from a university.

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Shedding new light on medical product design GX brings brilliant ideas to life as new commercial realities. Since 2004, the company has been applying new light technologies to create cutting edge medical products. From skin treatments and analysis to hair removal and wound healing, GX has actively sought new applications for light to create innovative products for the medical and cosmetics sector.

GX’s business development manager, Claire Banks, says: “We have a strong track record of developing new medical products using emerging light technology. Our team works closely, allowing our range of specialists to each bring a unique perspective to incorporate cutting edge technology into developing new products. This means we can work through technical constraints and find new approaches that make the best use of innovative research, whilst ensuring our designs are cost effective and easy to manufacture. “Over the 30 years we’ve been in business, we’ve built an experienced team with vast knowledge of different applications for light technology. Because light is inexpensive, there’s a high demand for new and varied ways to use it in medical products. What we learn from one project we take with us to the next, so our expertise in ways to use light in product design is always expanding.”

The multi-disciplinary approach of the team at GX means they are well positioned to develop medical products, marrying technology, software and the application of breakthrough research. Since their software and electronics engineers work closely, they easily keep on top of the growing demand for medical products to communicate with other devices, especially through apps. GX’s range of skills and depth of knowledge enables them to continue making an invaluable contribution to developing new medical products for patients and practitioners across the globe.

Dopplers win Queen’s Award for Innovation Huntleigh has been awarded a Queen’s Award for Innovation for its new range of Digital Handheld Dopplers. This award identifies where state of the art design combines with the highest levels of quality and performance.

Opportunity through social mobility. The prize is valid for five years and has shown to increase its recipients’ worldwide recognition and commercial value together with other benefits. The Cardiff facility provides a Global Centre of Excellence for a range of Arjo and Huntleigh products. Employing more than 60 engineering staff, the centre provides a stable platform for further innovations in the future.

Designed to perform when you need it most, the new Dopplers offer reliability that clinicians can depend on, making their jobs easier, safer and more efficient. Innovative features in the new products help clinicians to make quicker and more accurate assessments, providing benefits to both user and patient. Peter Cashin, Huntleigh’s Managing Director, spoke about how good design can improve patient care and clinical effectiveness, saying: “Features we have introduced such as the high resolution colour display represent a first for handheld Dopplers. This allows clinicians to clearly see vascular waveforms as well as hear digital audio sounds. In the Fetal Heart Rate (FHR) version, the FHR data is displayed in high visibility large numbers and recorded digitally as a waveform for archiving and review.”

The Queen’s Awards for Enterprise were instituted in 1965 and are today considered one of the most prestigious awards for UK businesses. The awards acknowledge exceptional achievements within the categories of International Trade, Innovation, Sustainable Development and Promoting

“We are both honoured and proud of this recognition. This marks a significant achievement for our team in Cardiff and confirms that we are developing innovative products that offer our customers an excellent experience, through both performance, functional benefits and a desirable design.” Joacim Lindhoff President & CEO, Arjo AB


Innovation in the Welsh life science industry

Collaboration to safeguard the lives of care home residents In December 2018, an initiative to safeguard the lives of care home residents and reduce the impact on ambulance services, particularly during periods of winter pressure, received the backing of the Welsh Government. This breakthrough project, developed in partnership with the National Collaborative Commissioning Unit, the Welsh Ambulance Service and Mangar Health, is designed to change attitudes towards lifting fallen residents in care homes. Building on recommendations in the Mills, S & Whitehead, R. (2018) Amber Review, the project recognises the pressure that the ambulance service is under to lift residents that fall in care homes, even though 45 per cent are

has been growing, as leaving a resident on the floor for more than an hour is associated with complications such hypothermia, pressure areas and kidney failure.

uninjured. An uninjured fallen resident living in a care home will routinely be allocated as an Amber category by the ambulance service, which can result in long wait times of four hours or more. Concern around this practice

The new Wales Care Home project is designed to create better outcomes for residents through the education of staff and the use of appropriate lifting equipment. This initiative empowers care staff to apply post fall management protocols, including the introduction of health assessment techniques used by paramedics called ISTUMBLE. Care homes across Wales have received a Mangar Camel lifting cushion, specifically selected because it delivers a safe, secure lift for residents and protects the carer performing the lift from injury.

Making medicines better with novel technologies IM and NAZDAQ-listed Midatech Pharma Plc. is using novel technologies to make medicines better. Having recently moved headquarters to Cardiff, the company plans to build on the success of the Q-Sphera™ pharmaceutical manufacturing platform that was developed, designed and built in Wales. The company is focused on the research and development of medicines for rare cancers but also has substantial assets in orphan endocrinology. Having developed three proprietary drug delivery technology platforms, Midatech Pharma’s team of highly specialised scientists across R&D sites in in Cardiff and Bilbao, Spain are developing novel drug products to improve existing therapies and treatments. Midatech Pharma’s lead platform is Q-Sphera™, based on 3D printing of drug-loaded polymer microspheres that enable long-term drug release into the body with high precision. Q-Sphera’s flagship product is MTD201 Q-Octreotide, targeting neuroendocrine tumours and acromegaly. MTD201 delivered positive Phase 1 clinical study results in 2018. This exploratory study


compared MTD201 head-to-head with the existing market leading product in this c. £2.5bn market. The results were very encouraging, with favourable clinical profile, superior usability, and improved patient experience. Midatech R&D has subsequently added further differentiation to the product offering and is now progressing towards a pivotal Phase 3 study. The company is building additional in-house manufacturing capability to meet commercial requirements, prior to filing a submission for marketing authorisation planned for 2021. A second technology platform, MidaSolve, converts otherwise insoluble therapies that can only be given orally as tablets into

liquid medicines that can be injected into the body directly at sites of disease. Through this proprietary nano-drug delivery technology, the company has developed MTX110, which targets a lethal ultra-rare childhood brain cancer (DIPG). Clinical trials in the US are ongoing. MidaCore™, the final Midatech platform, is based on ultra-small gold nanoparticle technology which enables targeting drugs to specific sites of disease. Representing earlier stage opportunities for Midatech, programmes include MTX102, a vaccine for diabetes, and MTD119, which targets solid cancers.

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MHRA approval for Clinical Services Centre of Excellence Sharp, part of UDG Healthcare plc, a global leader in contract packaging and clinical supply services, has received approval from the Medicines and Healthcare Product Regulatory Agency (MHRA) to begin production at its Clinical Services Centre of Excellence in Rhymney. Following a successful inspection by the MHRA, Sharp can now offer a range of clinical trial and commercial services from the £9.5 million facility including primary and secondary packaging with low humidity control, labelling, storage and distribution, QP services as well as controlled drug storage. The Centre also enables Sharp to offer a broader range of integrated services, including

“The Clinical Services Centre of Excellence in Rhymney has tripled Sharp’s clinical service capacity for the pharmaceutical, biotech and clinical research sectors. With the integrated capabilities on offer, the facility also better enables us to offer full-service support and meet the increased global demand for Phase III clinical trials and commercial pharmaceutical services. We are dedicated to supporting our customers for years to come and the Rhymney site is a sign of that commitment.” Frank Lis President, Sharp Clinical Services

serialisation and Interactive Response Technology (IRT) solutions for clinical trial management. The MHRA approval comes as Sharp celebrates its 30th year of clinical operations in the UK. Lis added: “To be able to celebrate two such significant achievements at the same time is testament to the effort and dedication of everyone involved in the success of Sharp.” Sharp has also invested in a solar panel system at the site that will generate approximately 20 per cent of the company’s total annual electricity requirements, further reducing its carbon footprint and increasing environmental performance.

Collaboration to explore new ovarian cancer treatment A new £2.6 million project led by Swansea University aims to dramatically improve the diagnosis and treatment of ovarian cancer – one of the deadliest forms of cancer for women – as incidences of the disease, particularly in younger women, continue to rise.

The Cluster for Epigenomic and Antibody Drug Conjugate Therapeutics (CEAT) project has been awarded £1.2 million from the European Regional Development Fund via the Welsh Government’s SMART Expertise programme and the Welsh European Funding Office. CEAT aims to utilise novel epigenetic drugs to manipulate chemical compounds, creating a new route for the treatment of ovarian cancer.

“Ovarian cancer is often associated with late diagnosis and poor prognosis, meaning new and effective treatment measures are vital. The launch of the CEAT project provides an important step in tackling this problem by developing treatments designed to target ovarian cancer cells specifically, sparing the surrounding tissues and limiting the harsh side-effects often associated with chemotherapy. CEAT development platforms will not only provide novel screening tools for selection of lead therapeutic candidates, but will also aid the identification of patients that will benefit from these targeted treatments.”

The project is being led by Swansea University with partners Porvair Sciences, Bruker UK, GE Healthcare UK, Axis Bioservices and GlaxoSmithKline (GSK). A new Antibody Drug Conjugates company will join the project in its second year.

Dr Deyarina Gonzalez Swansea University Medical School


Innovation in the Welsh life science industry

Empowering patients for digital data input SymlConnect delivers direct patient involvement in digital input, improving accessibility and sharing of secured data on-demand. Wouldn’t it be ideal if patients were empowered to complete digital forms whilst waiting for their consultations? Every day, patients are asked to complete all sorts of paper forms. These include registration and clinical monitoring questions, smoking cessation forms, at-risk assessments, general personal information and national surveys. NHS-published reports demonstrate the significant wastage of valuable resource time in such paper processes and their inherent shortcomings and costs. Human resources are needed to sort, scan and attach the PDF documents with the respective clinical record system. With poor data quality, the progress towards digital NHS aspiration for easy

sharing and on-demand access of information remains a challenge.

Modern technology is capable of balancing the act of data input simplicity for all age groups, while maintaining the information governance, security and standards of the confidential patient data in accordance with strict NHS guidelines.

PatientPlus was created as a direct result of user demand, especially for empowering and involving patients in digital inputs. The process streamlines and modernises the GP practices to communicate better with their patients and allows patients to complete relevant questionnaires digitally, freeing

up the busy reception. Various information, from personal contact details to surveys, health promotions and at-risk assessments of chronic conditions, are digitally collected and saved against the specific patient’s digital record, which the GP can view in real time. Syml has partnered with QRInfo Pod to enable patients to use their own mobile devices, avoiding any technical learning risk barriers. Higher quality data capture is only possible through such digital input, and the seamless integration with multiple GP clinical systems including their clinical codes provides an unrivalled ability for practices to realise true efficiency enhancements. Live assessments are being initiated to ascertain the benefits and demand of such patient involvement.

Going global with maxillofacial prosthetics Technovent Ltd, based in Bridgend is a leading manufacturer and supplier of maxillofacial prosthetic materials, including a magnetic attachment system, supplying to every NHS maxillofacial clinic in the UK and also to patients and clinics worldwide. Until recently, many countries have not had access to prosthetic materials and trained maxillofacial practitioners. This can lead to patients with severe facial disfigurements not being prosthetically restored, often resulting in a poor quality of life. With the help of NHS trained consultant maxillofacial prosthetists, the company runs training courses in the construction of facial prostheses at its centre in Bridgend and has also run training courses in countries worldwide, including Russia, Jordan, UAE, India, Argentina and Brazil. Through these courses, many participants have gone on to become practitioners and/or distributors in their own countries.


By targeting emerging markets through training courses and new collaborations, Technovent has opened up new overseas territories and increased worldwide access to maxillofacial materials and practitioners.

materials and rehabilitation in areas of conflict is vital. The ultimate aim is that every patient with a severe facial disfigurement should be able to receive prosthetic restoration, no matter where they live.

In the last 10 years, the company’s export business has grown dramatically. It now exports products to over 78 countries worldwide, including countries such as Yemen, Iran and Iraq, where the need for patient

Technovent won the Industry Judges’ award at the 2018 MediWales Innovation Awards.

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