LifeStories Magazine

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THE SHOWCASE MAGAZINE FOR WELSH LIFE SCIENCE 2017

Collaboration: sparking innovation in Welsh life science and NHS Wales NHS Wales innovation and successful collaborations

The Efficiency through Technology programme

Advances and achievements in the Welsh life science industry 1

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CELEBRATING CLINICAL PROGRESS AND INNOVATION

The only event of its kind for the health and care community, MediWales Connects is an all Wales NHS collaboration conference NHS colleagues from across Wales, local companies and the wider industry sector will join to share clinical innovation in practice to improve patient outcomes.

The event includes keynote presentations, CPD training seminars, workshops and an exhibition.

The aims of the conference are to: ●

Highlight and showcase the excellent work and research being carried out by the health and care communities in Wales

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Improve collaborative working between the health boards and research communities

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Raise the profile of NHS Wales and clinical innovation across the UK and help promote recruitment for research

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Support closer working relationships between industry, NHS and research groups and clinical trials capabilities

21st June 2017

With the support of Andrew Goodall, Director General of NHS Wales, MediWales Connects will return in 2017.

www.mediwales.com/connects-nhs The Life Science Network for Wales

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Contents

SHOWCASING ADVANCES IN WELSH LIFESCIENCE

Innovation and collaboration in NHS Wales

The Efficiency through Technology programme

Innovation in industry

8 App improves care for patients

22 Efficiency through Technology

38 New technology to improve detection of

with neuromuscular disorders

9 New technology allows non-

invasive sampling of tumour DNA

24 The Bevan Health Technology Exemplars Scheme

25 Sepsis Box equips nurses to start

urgent treatment quicker than ever before

10 New blood-based biomarker to improve diagnosis of colorectal cancer

26 Replacing heart valves without

the need for invasive open-heart surgery

11 Online patient portal enables

better storage and sharing of records prescription medicine through art

13 English or Welsh? New system remembers patients’ preferred language

Time-saving digital tool created for nurses

15 Care home initiative puts patients

paramedics better understand patients

18 Blood donor screening process

to Wales

40 Harnessing microbiology for innovative product design and development

41 Healthcare Centre of Excellence offers 41 Natural compound to tackle chronic lung infections

42 New pocket Doppler and fetal monitor

sensitivity and performance

Swansea University unlocks new innovations

30 Connecting care homes with 31 Outcome-focused industry

partnerships promote better engagement with NHS Wales

32 Lymphoedema Network Wales enables improved treatment solutions for patients

delivers safer, seamless patient care

36 The digital future of mental health

LifeStories is produced and published by MediWales.

Designed by Teamworks. www.teamworksdesign.com

25 YEARS AT THE HEART OF WELSH LIFE SCIENCE

1st Floor, The Bonded Warehouse, Cardiff CF10 4HF Tel: +44 (0)29 2047 3456 Web: www.mediwales.com

43 PET scanning for more Welsh cancer 43 First UK proton beam therapy for cancer to open in Wales

44 Vivi helps clinicians better focus in surgery 44 Significant growth for Sharp Clinical Services

45 Export success for Dynamic Extractions 45 Supporting clinical development around

34 The Choose Pharmacy Platform

services

launched patients

pharmacies: A digital medicines management system

goes digital

19 Novel phase 1 cancer trials come

healthcare sector

29 EU-supported project led by

team deals with non-injury falls

17 Communication app helps

39 Making the most of big data in the

42 Morffi technology improves assay

healthcare providers

first

16 Newly established emergency

life for pregnant women

28 Patient evaluations to inform

14 Video prescriptions support

patients with chronic conditions

38 Pelvic harness provides better quality of

training facilities and 3D printing

27 Less admin, more care:

12 Children learning about wasted

lung conditions

the world

46 Antibodies developed to fight the deadly Ebola virus

46 UK’s first company to manufacture and sterilise medical devices on-site

Editor, Sophie Davies sophie.davies@mediwales.com

Gwyn Tudor, Forum Manager: gwyn.tudor@mediwales.com Debbie Laubach, Operations Manager: debbie.laubach@mediwales.com

Isabelle Perkins, Events and Engagement Manager: isabelle.perkins@mediwales.com Sophie Davies, Marketing and Communications Executive: sophie.davies@mediwales.com

Thank you to our Corporate Sponsors and University Partner

SUPPORTED BY WELSH GOVERNMENT

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Introduction

Welcome to the second edition of MediWales LifeStories - the publication dedicated to sharing success stories from the Welsh life science and health technology sector.

Despite the significant daily challenge to deliver one of the best health services in the world, while managing unprecedented demand driven by both economic conditions and demographic change, it has never been a better time to work with NHS Wales. The health boards and trusts across Wales have embraced the need to adopt new technology and ways of working to meet this challenge.

Throughout this edition of LifeStories, you can find examples of just some of the innovations that are helping to improve patient outcomes and deliver crucial cost savings in our health service.

Collaboration is an overarching theme,

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with most of the projects featured involving collaboration within NHS Wales or between the NHS and Welsh universities or life science companies.

This edition is split into three sections, beginning with innovation and collaboration in NHS Wales.

Staying with the NHS, the second section showcases projects that have been supported by the Efficiency through Technology programme, which is run by the Technology, Innovation and Strategy Team within the Welsh Government’s Health and Social Services Group. This ongoing programme has

provided funding and support for a wide variety of projects to accelerate NHS adoption of new products and services. It has also contributed to the Bevan Commission’s Health Technology Exemplars scheme. The third and final section highlights the diversity and

successes of the Welsh life science industry, with numerous

stories of innovation and achievements from Welsh companies ranging from well-established businesses Renishaw and Huntleigh to new startups such as PulmonIR. Throughout the publication, selected projects and companies have been highlighted as winners at the MediWales Innovation Awards 2016. These annual Awards were delivered in partnership with Health and Care Research Wales as a celebration of innovation and partnership

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across Wales’ life science companies, academia and the NHS. Highlighting examples of innovation and collaboration is an important way of sharing successful practices, learning from each other and inspiring further advances. In addition to LifeStories and the annual Innovation Awards, we are also holding the second MediWales Connects - the all Wales NHS collaboration conference - on 21st June 2017.

This is a unique one-day event that raises the profile of innovation throughout NHS Wales and supports the development of future collaborative partnerships.

Our editorial team would very much like to hear from NHS, academic and industry members who are inspired by the projects highlighted or who would like to see their projects featured in future publications and events.

What is MediWales?

Founded in 1992, MediWales is the life science network and representative body for Wales. MediWales provides advice, support and business opportunities for our members, whilst promoting collaboration within the life science and health technology community in Wales.

With 180 members, our network is largely made up of life science organisations. We actively encourage engagement between companies and the clinical research community and our membership includes NHS health boards and trusts, universities and industry. We are an independent, not-forprofit company.

We innovate healthcare At Roche our aim is to improve the health, quality of life and well-being of people around the world by providing an innovative range of diagnostic solutions and medicines. Roche is a global, research-focused healthcare company with Group Headquarters in Basel, Switzerland.

Our strategy is clear - the patient lies at the heart of everything we do and our focus is fitting the treatment to the patient through prescription pharmaceuticals and in-vitro diagnostics.

What makes Roche distinctive is our pursuit of excellence in science as we deliver the best solutions for healthcare professionals and improve patient outcomes; this is achieved through our unique combination of Pharmaceuticals and Diagnostics.

Everyday, our products help patients and the healthcare professionals who care for them by detecting, preventing, diagnosing, treating and monitoring diseases.

We are proud to have played a pioneering role in UK healthcare since 1908.

Today, we are the leading in-vitro diagnostics company in the UK and the leading provider of pharmaceutical treatments for cancer and viral diseases.

We are also a major supplier of medicines for the treatment of transplantation, virology, bone and rheumatology and renal anaemia. In total, our UK pharmaceutical and diagnostics businesses employ nearly 2,000 people.

Personalised Healthcare We combine our strengths in pharmaceuticals and diagnostics to better fit treatments to patients. When genetic differences can be identified, the efficacy and safety of medicines can be improved enormously. To this end we have a companion diagnostic strategy for every molecule we develop.

Diagnostics As the UK leader in diagnostics solutions, we offer a uniquely broad and innovative portfolio of products to patients, physicians, researchers, hospitals, laboratories and universities.

Our UK Diagnostics business, headquartered in Burgess Hill, West Sussex, employs approximately 500 highly skilled individuals.

Diagnostics is set to play an increasingly important role in the future of healthcare as genetic knowledge presents new and exciting opportunities. Our desire is to provide clinicians and patients with Actionable Health Information - information that reduces the uncertainty in the medical decision making process, enabling them to choose between available alternatives to prevent or treat disease.

Tel: +44 (0)1444 256000 www.roche.co.uk At Roche we focus on developing medicines and diagnostics that will help patients live longer, better lives

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CELEBRATING CLINICAL PROGRESS AND INNOVATION

Cardiff 21st June 2017

300 ●

Why attend?

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Attendees

58%

33%

9%

CLINICAL

INDUSTRY

GOVERNMENT

Types of delegate: Clinicians from:

Senior management

Emergency care

Primary care Social care

Chief executives

Secondary care

Procurement

Welsh Health Board/ Trust Map: Betsi Cadwaladr Hywel Dda Powys Teaching Abertawe Bro Morgannwg Cwm Taf Aneurin Bevan Cardiff and Vale Velindre

Other organisations: Shared services Welsh Ambulance Service NHS Trust

“Impressed by number and range of participants and attendees, well done for organising such a successful conference” Judith Paget, Chief Executive Aneurin Bevan UHB

Social care Public Health Wales Welsh Blood Service

“Really great conference, every single NHS Wales board/trust involved” Ifan Evans, Head of Healthcare Innovation, Welsh Government

For further information email:

connects-nhs@mediwales.com www.mediwales.com/connects-nhs 6

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Cardiff and Vale University Health Board

App improves care for patients with neuromuscular disorders

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Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

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Bwrdd Iechyd Prifysgol Hywel Dda Healthcare technology company University Health Board SymlConnect is working with Cardiff and Vale University Health Board to develop ‘My Care’ - a secure, personalised health information Iechyd Cyhoeddus app to Cymru enable transfer of care for patients with Public Health Wales neuromuscular conditions.

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Standard approaches of dealing with Ymddiriedolaeth GIG acute respiratory illness and emergency Gwasanaethau Ambiwlans Cymru anaesthesia can cause harm to people Welsh Ambulance Services Trust who suffer from rareNHS neuromuscular disorders. Therefore it is vital for clinicians to be aware of a patient’s condition and understand how to treat it, but there is currently no way of quickly communicating these important emergency care needs.

The existing paper-based emergency care document contains information about cardiac, respiratory, anaesthetic and trauma aspects of a patient’s needs.

However, this crucial information is not automatically flagged up at the point of care, so clinical decisions can be delayed or unsuitable ones can be made, resulting in complications and sometimes avoidable deaths.

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‘My Care’ was originally created as a paper-based, patient-held document, giving clinicians quick access in emergency situations to critical, life-saving information about the needs of patients with neuromuscular disorders. Through a collaboration with Cardiff and Vale University Health Board, SymlConnect has developed a ‘My Care’ app in order to further improve efficiency, work towards a paperless NHS and modernise communication between patients and clinicians. The project was supported by the Health Technology Challenge Wales via the South East Wales Academic Health Science Partnership (SEWAHSP).

Patients were involved in the app design phase to ensure that it was user-friendly, and the project also received support from the Neuromuscular Network. Cardiff and Vale University Health Board helped SymlConnect in implementing secured information access across the NHS firewall, which presented a major initial challenge.

Outside of emergency situations, many patients with neuromuscular disorders require routine operations and have interactions with

Better access to clinical information in emergency situations has the potential to dramatically improve outcomes, reducing avoidable deaths and lengthy hospital stays. In addition, allowing patients with neuromuscular disorders to input their own information into the app means they can be more proactive in self-management of their condition and feel safe in the knowledge that information accessed in a critical situation will be accurate.

other healthcare personnel who have little or no knowledge of their condition. Having easy access to a reliable source of information about their diagnosis, possible complications and which professionals to contact will help to improve care, reducing the risk of complications and unnecessary prolonged hospital admissions.

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

M ED IWA LES IN N OVATIO N AWA R DS W IN N ER 2016

New technology allows non-invasive sampling of tumour DNA Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda Cancer patients increasingly need to University Health Board receive personalised medicine tests in order to determine their best course of treatment. However, this requires an invasive biopsyIechyd or sometimes reCyhoeddus Cymru biopsy of their tumour, which is not Public Health always possible because either the Wales tumour is not operable, or the patient is too unwell or simply not willing Ymddiriedolaeth GIG to go through with it. Non-invasive Gwasanaethau Ambiwlans Cymru sampling throughWelsh a simple blood test Ambulance Services NHS Trust is a preferable alternative, particularly when patients are at an advanced stage in the disease.

Circulating tumour DNA (ctDNA) can be found in the bloodstream of cancer patients and is shed from the tumour. It represents an easily accessible source of tumour DNA without the need for an invasive biopsy. The challenge is that the diagnostic analysis of ctDNA requires novel and highly sensitive molecular techniques to be optimised, in association with the development of clinical patient pathways for the handling of these unstable blood samples.

The All Wales Genetics Laboratory has developed and translated new molecular technologies into clinical practice, which enables ctDNA analysis by blood sampling and has now been rolled out across Wales for lung cancer patients. This project has taken several years of work, involving many staff and students, with the help of vital funding from the Wales Cancer Research Centre and Velindre Stepping Stones, as well as the support of AstraZeneca.

Through implementation of the ctDNA technology, more patients will be able to access personalised medicine testing, giving them the opportunity to undergo therapy that is targeted to the biological cause of the cancer and is therefore likely to have a prolonged treatment response. Previously an estimated 3040% of lung cancer patients in Wales did not have the option of targeted treatment, because they did not have tissue available for testing.

The use of ctDNA also reduces the length of the patient pathway to treatment, as analysis times are shortened. ctDNA analysis is rapid and can achieve results within days, compared to 2-3 weeks for the

booking of invasive procedures and then processing of the tissue samples. This has particular benefits in cases where quick diagnosis and treatment could save a life. In the event that a repeat sample is required, a further blood sample can easily be taken and analysed.

Now that the technology is being used for analysis of lung cancer patients across Wales, the team is beginning to develop the service for analysis of patients with colorectal cancer and malignant melanoma. The technology has potential application to many types of cancer. Staff from the All Wales Genetics Laboratory are now in high demand to give seminars about the new service around the UK and in Europe.

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Bwrdd Iechyd Prifysgol Caerdydd a’r Fro

M EDI WAL ES

Cardiff andI NNOVAT Vale I ON AWARDS University Health Board2 0 1 6 WI NNER

New blood-based biomarker to improve diagnosis of colorectal cancer Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Cadwaladr Colorectal cancerBetsi is the third most University Health Board common cancer worldwide and 41,000 cases are diagnosed in the UK each year. Despite screening initiatives, patients continueBwrdd to beIechyd diagnosed Addysgu Powys when the cancer is already at an Powys Teaching advanced stage (55% at Health detected Board stage three or four) or as an emergency (24%) and have weaker chances of survival as a result.

Early diagnosis Ymddiriedolaeth GIG Felindre of colorectal cancer is often difficult Velindre NHS Tust because there are no specific ‘red flag’ symptoms. Resource and manpower constraints can also cause delays in diagnosis and treatment.

To improve early detection of colorectal cancer, there is a pressing need for an alternative screening and diagnostic tool.

The current situation relies on invasive colonoscopy or the use of ionising radiation in CT scans to rule out a malignant process in those at risk. Currently only one in ten patients investigated for urgent suspected symptoms are actually found to have cancer.

An accurate blood based biomarker introduced early into the diagnostic pathway would be able to provide prompt reassurance for symptomatic patients in primary care and permit a more streamlined referral pathway into secondary care. ABMU’s Department of Colorectal Surgery has undertaken a research project in collaboration with the Centre for NanoHealth and the Department of Physics at Swansea University to determine if such a biomarker can be identified.

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Iechyd Cyhoeddus Cymru Public Health Wales

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

The project involved Raman spectroscopy - an established technology based on the spectroscopic analysis of inelastically scattered light for changes that reflect the molecular and structural composition of biological samples under investigation.

ABMU’s innovative study set out to establish if unique Raman spectral signatures can be associated with defined stages of colorectal cancer.

Initial results have shown that there are indeed unique, specific Raman spectral changes in confirmed cancer patients compared to matched controls with sensitivity and specificity of over 90%.

These findings are now being validated with a larger patient cohort, and Swansea Trials Unit are involved in progressing towards a clinical trial of the biomarker in the diagnostic pathway.

The current screening method for colorectal cancer, which involves faecal

testing, has an uptake of only 50%, so blood based Raman spectroscopy may prove to be a more popular alternative. A less unappealing screening method would likely translate into earlier detection and therefore improved survival rates.

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Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg University Health Board

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

Online patient portal enables better storage and sharing of records Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Betsi Cadwaladr Abertawe Bro Morgannwg University Health Board University Health Board has been working with social enterprise company Patients Know Best to Bwrdd Iechyd engage patients inAddysgu an Powys Powys Teaching online portal and measure Health Board its benefits. The portal was piloted in three areas within ABMU; Ymddiriedolaeth Dermatology in Singleton GIG Felindre Hospital, UrologyVelindre in NHS Tust Morriston Hospital and Gastroenterology in Neath Port Talbot Hospital, with funding from Janssen Pharmaceuticals.

The online portal is a tool that brings electronic patient records together, creating one centralised record with all of a patient’s medical information. Patients are able to view and add their own details, and can also use the portal to communicate with their clinical teams. This is particularly useful for patients with long-term conditions, who often require frequent liaison with medical staff.

ABMU, Patients Know Best and Janssen established a working group, which included clinical leads in the health board’s pilot speciality areas. Patients were also involved in this process and asked to give their views on the portal. Meetings were regularly held with all groups to keep track of the pilot’s progress, gather feedback for evaluation and determine the next steps.

Iechyd Cyhoeddus Cymru Public Health Wales

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

During the pilot, the portal was put to good use by the parent of a paediatric patient with a rare skin condition, who inputted their child’s blood results and medications (past and present) and messaged clinical staff, some of whom are based in London, for advice. The parent felt that the portal helped them to deal with their child’s condition more effectively. A clinician also demonstrated how beneficial the pilot had been for several patients, highlighting one particular case where, following an initial face-to-face consultation, they were then able to virtually communicate, treat and discharge a patient entirely through the portal.

Implementation of a digital tool to communicate with patients and store/ share medical records means that healthcare professionals can cut down the time they spend on phone calls and administrative tasks. It also has

the potential to reduce face-to-face appointments, as well as the costs associated with non-attendance rates, and work towards paperless healthcare.

A patient-held record, which they can update themselves and use to contact clinical staff, empowers people to become more involved in their own care and to better manage their wellbeing.

The plan for ABMU is to now roll out the Patients Know Best portal in a scaled up demonstrator, working collaboratively with Velindre Cancer Centre and NHS Wales Informatics Service. In addition to evaluating the portal on a larger scale than in the pilot, this next step will also aim to establish more collaborative ways of working between Velindre and ABMU, so that patients who move between the two organisations can share their records with the clinicians responsible for their care in a more seamless way.

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Bwrdd Iechyd Prifysgol gol Caerdydd a’r Fro 2 0 1 7 S H O W C A S I N G A D VA N C E S I N W E L S H gannwg Cardiff and Vale oard University Health Board

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Children learning about wasted prescription medicine through art

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CymruYour Health’ The ‘Your Medicines, Health campaign is led byPublic Cwm Taf University Wales Health Board’s pharmacy team. The project aims to raise awareness of prescription medicine wastageGIG through Ymddiriedolaeth Ambiwlans Cymru public education, Gwasanaethau with the school art Welsh Ambulance Services initiative targeting children and, in NHS Trust turn, their families.

The World Health Organisation reports that around 40% of prescription medicines do not get taken as directed.

This is a significant waste of resources, but the greatest cause for concern is the impact this has on people’s health.

In the past, health boards have focused advertising on the financial cost of waste. However, it has been found that the public do not respond to this line of messaging, as they link the phrase “millions of pounds lost” to poor NHS management. Such significant sums of money also have little meaning for people from some of the country’s most deprived areas.

Cwm Taf’s pharmacy team sought to find a more effective, engaging way to communicate and spread the message that prescription medicine wastage is a problem.

Through workshops in schools, children have been involved in developing publicity materials that are eye-catching and inform people of what they can do to make the most of medicines, leading to longer, healthier lives.

When designing posters, the children are asked to identify what ‘medicines’ mean to them and why it is a concern that nearly half of our medicines go to waste. They

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think of slogans to help promote safe use, storage and disposal of medicines. The posters are ultimately put on display in schools, local healthcare facilities and at exhibitions in local hospitals.

The pharmacy team studied the reasons why people in the local area tend to waste or stockpile their prescription medicine. Among the reasons were that people forget about it, do not understand its purpose, start to feel better and no longer need it, stop taking it because of perceived side effects, find that it tastes bad or is difficult to swallow, or keep

extra for the future “just in case”. By educating children on the issue, they can learn best practice early in life and go on to share their knowledge with friends and family, so that less prescription medicine is wasted in the future.

The pilot was so successful that a teaching pack has now been developed and the school nurses of Cwm Taf will be rolling this out, accompanied by local artists, to every primary school in the area this year. This includes over 150 schools with around 4,000 pupils altogether.

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

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”

English or Welsh? New system remembers patients’ preferred language Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Ymddiriedolaeth 44% of the population covered by GIG Felindre Betsi Cadwaladr Velindre University Health NHS Tust Board speak Welsh, which is well above the national average of 19%. In 2015-16, BCUHB sent over 600,000 appointment reminder text messages, but the need to send bilingually doubled the output to over 1,200,000 text messages, in turn doubling the cost. In this time, there were also over 43,000 appointment reminders delivered via an agent telephone call, and these calls were always made initially in English, with an option for the patient to then receive a follow-up call in Welsh.

BCUHB is undertaking a project, as part of the Bevan Exemplars scheme, which involves actively asking patients for their preferred language, recording the choice and then using this information for future communications. Patients are now able to state their language of choice for appointment reminders (Welsh, English or bilingual) while at a GP reception desk, on the phone to a hospital booking clerk, on the health board’s website, or in response to a text message specifically asking them for their preference. In the long term, the recorded language choices could be used to manage resources, inform patient booking/clinic management and impact on all patient communications.

The aims of this project are to improve the patient experience by allowing people to choose the language in which they receive communications, and also to make significant cost and efficiency savings for the health board. If just 10% of patients choose to receive their appointment reminders in one language, thousands of pounds will be saved, and if all patients asked to have their reminders in one language, the cost would be reduced by 50%.

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru

Hello, this is your appointment reminder Helo, dyma nodyn i’ch atgoffa am eich apwyntiad

“ Welsh Ambulance Services NHS Trust

In the case of agent telephone calls, the new initiative allows patients to be called in their preferred language from the offset, without the need for a second phone call. Patients are sometimes distressed and concerned during these calls, and communicating with them in their preferred language will put them significantly more at ease.

The language choice intelligence for appointment reminders has been developed by industry partner Healthcare Communications with their Envoy patient communications software.

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Video prescriptions support patients with chronic conditions Iechyd Cyhoeddus Cymru Public Health Wales

Hywel Dda University Health Board Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru has worked with Swansea-based Welsh eHealth Digital Media onAmbulance a digitalServices NHS Trust service that enables clinicians to prescribe information videos to patients suffering from Chronic Obstructive Pulmonary Disease (COPD) or Type 2 diabetes. These two chronic conditions are increasingly common, so there is a need for initiatives that support patients and reduce pressure on the NHS. The video prescriptions tell the real stories of local people who are coping with their conditions, providing peer-topeer education. They also include medical information explained by healthcare professionals and presented through animations. Clinicians co-designed and scripted the videos and then helped eHealth Digital Media to invite patients and their carers to be filmed. The resultant high-quality content is delivered to a patient’s mobile phone, tablet or computer through digital platform ‘PocketMedic’.

In a time when people are increasingly computer literate, video prescriptions offer a more visually engaging alternative to the written information found online or in traditional paper documents. The videos are able to communicate complex ideas in a clear, accessible way, so that patients can better understand their conditions. This empowers them to become more involved in their own care and to more successfully manage their health.

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The desired result of educating patients about COPD and Type 2 diabetes through these videos is to reduce their health problems and risk of complications, thereby reducing the number of appointments and hospital admissions that they require. It is also hoped that hearing the real experiences of other people in the same situation will improve patients’ mental health.

The Wales Diabetes Implementation Group has been so impressed with the initiative that they have bought a license allowing all GPs in Wales to prescribe the diabetes-related videos free of charge to the health board. A donation from Pfizer Inc has also meant that the COPD videos are now available for all GPs in Hywel Dda to prescribe free of charge to as many patients as they want. There are currently negotiations with the Respiratory Health

Implementation Group for an All Wales License beyond Hywel Dda for the COPD videos. Ongoing collaborations with Aberystwyth University are analysing the rate of uptake and impact of the video prescriptions.

In addition to COPD and Type 2 diabetes, eHealth Digital Media has also created videos about Type 1 diabetes, gestational diabetes and people who are at risk of developing Type 2. More series have been made about chronic pain, heart failure, wellbeing (depression and anxiety) and pressure ulcer management. The company has also been developing video prescriptions for patients with lymphoedema in partnership with Lymphoedema Network Wales, which you can read more about on page 33.

Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg University Health Board

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

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

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Care home initiative puts patients first Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

CHAaT is a partnership Bwrddbetween Iechyd Addysgu Health Powys Board Aneurin Bevan University Powys Teaching and the Gwent branch of the Welsh NHS Health Board Retirement Fellowship. Retired NHS staff act as volunteers in nursing homes, offering patients and their relatives an opportunity to talkYmddiriedolaeth in private about GIG Felindre their experiences, with the aim of Velindre NHS Tust identifying good practice as well as any changes that need to be made.

Vulnerable older people often struggle to get their voices heard, and this is particularly the case for those with dementia living in care homes. Through CHAaT, volunteers engage patients in conversations about key themes and values such as maintaining their identity, feeling part of a community and having their needs met. By helping elderly

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Patients and their relatives were heavily The web based feedback system allows Iechyd Cyhoeddus Cymruof CHAaT. involved in the development users of care services to review and rate Health Focus groups were heldPublic to gather their experiences online for the general Wales their views on aspects including the public to see. People can share their model, what support they felt would views on aspects including the quality benefit them and whether they would of care and staff, the surroundings and Ymddiriedolaeth GIG prefer one-to-one or group meetings Ambiwlansvalue Gwasanaethau Cymrufor money. This helps the public Ambulance with volunteers. As the Welsh volunteers are Services to make more informed decisions when NHS Trust former employees of the NHS, they have they are trying to decide on the right relevant skills for the task and a shared care provider for themselves or a family passion for improving care services. member.

Feedback gained through CHAaT indicated that patients and their relatives wished they had been able to learn more about people’s real experiences living in care homes when they were trying to choose a home themselves. As a result of these findings, ‘Think About Me’ was set up to be a Trip Advisor style website for care homes in Gwent. The project was funded

by SEWAHSP’s Health Technology Challenge Wales and produced in collaboration with The Good Care Guide.

A recent development for CHAat is that volunteers are now involved in a pilot where they speak in confidence to patients on mental health wards about their experiences of care. Another new pilot is due to begin in April 2017, in which volunteers will speak to older people on hospital wards who are facing transition to a care home. The volunteers will be using Age Cymru’s guidelines on care homes to advise people and relatives what they should be looking for.

people to speak in confidence about their care experiences, the feedback (positive and negative) can be used to inform future decisions and enable improvements to services.

One outcome of the initiative is that ABUHB has driven forward Advance Care Planning, increasing a patient’s say in what happens as their condition deteriorates. For instance, they now have more opportunities to choose whether or not they wish to be admitted to hospital as they become more unwell and reach the end of their lives. This can prevent hospital admissions that are both unwanted by the patient and costly for the NHS.

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Iechyd Cyhoeddus Cymru S H O W C A S I N G

A D V APublic N C E Health S I N W E L S H

Wales

L I F E S C I E N C E

North Wales Fire and Rescue Service

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Newly established emergency team deals with non-injury falls The Welsh Ambulance Service receives a high volume of low priority calls, where someone has suffered a fall but is not in a serious, life threatening condition. In these cases a ‘blue light’ ambulance is called out to respond, even though it is not essential, because until now there has been no alternative.

The Welsh Ambulance Service recently joined forces with North Wales Fire and Rescue Service (NWFRS) to provide uninjured fallers with more suitable assistance that makes better use of time and resources. A pilot of the new service has been implemented in Conwy and Denbighshire.

The Community Assistance Team comprises of NWFRS staff, specifically trained to deal with non-injury falls. They respond in a vehicle that is fully equipped with specialist equipment, including lifting devices needed to safely help a person back to a seated position. Since the service is mobilised through Welsh Ambulance Service control, the public do not need to do anything different from usual when they report a fall.

The only difference is that, after being medically triaged by Welsh Ambulance Service clinicians, the Community Assistance Team will be sent instead of an ambulance if appropriate. This allows the Welsh Ambulance Service to focus its time and attention on more high priority calls and therefore operate more efficiently.

Deployment of the Community Assistance Team means that uninjured fallers can receive assistance from a team with specialist equipment for responding to falls, so hospital admissions can be avoided wherever possible. They also may get a more timely response than they would from an ambulance, which

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increases the chances of a positive patient outcome. Early intervention is important in dealing with falls, as it can reduce the need for potentially complex

Hip fracture is the most common serious injury related to falls in older people, with an estimated 25% of patients dying within a year of a hip fracture and half of survivors failing to regain their prefracture level of independence.

Through referral to a falls pathway, the new initiative has the potential to reduce the number of people needing ongoing, invasive health treatment and allow continued independence and good quality of life.

and costly medical intervention and hospitalisation in the future.

The Community Assistance Team also undertakes home safety and crime prevention checks to further assist vulnerable people. Through the provision of risk reduction advice about falls, fire and crime and the installation of assistive technology and equipment such as rails and smoke detectors, the service may further prevent admissions to hospital.

Iechyd Cyhoeddus Cymru Public Health Wales

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Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Communication app helps paramedics better understand patients Show Me Where, a joint venture between Cardiff and Vale University Health Board and two members of staff (specialist nurse Irene Hammond and medical artist Jan Sharp), develops tools that enable people with communication difficulties to show where they are experiencing pain by pointing at images. Initially created to help children with autism, as well as the clinicians needing to interact with them, the tool proved so practical that an adult version was produced. It is now being used not just for patients with autism, but also for those with dementia, disabilities affecting speech such as cerebral palsy and more.

The latest step for Show Me Where was a collaboration with the Welsh Ambulance Service to develop an app with funding from SEWAHSP’s Health Technology Challenge Wales. The new app is designed for communication between paramedics or first responders and people who are unable to communicate verbally, including nonEnglish speakers. It is multilingual and has audio in six languages - Welsh, Arabic, Polish, Somali, Urdu and Bengali - and for the hard of hearing. In addition to images showing potential sites of pain (which are a common feature of Show Me Where tools), the app also offers a list of descriptive symptoms such as feeling dizzy, sick or faint.

Show Me Where’s app has been trialled with paramedics and first responders in the Swansea area, along with fan tools which display body part images on connected plastic cards that fold out.

These tools have also been introduced to special schools around Swansea, providing continuity of care if pupils are attended by paramedics. Cardiff and Vale University Health Board has made the tools available in all clinical areas, including on every bed in stroke and intensive care units. By enabling communication in this way, patients can be rapidly examined and treated, potentially saving lives, minimising the need for professional translators and reducing costs to the NHS.

Aneurin Bevan University Health Board’s Learning Disabilities Team is now using Show Me Where with adults who have learning disabilities.

It is also being used in training of Medical Students from Cardiff University and Speech Therapy students from Cardiff Metropolitan University, who attend workshops which explore how to facilitate more effective communication with patients.

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Blood donor screening process goes digital The Welsh Blood Service has now integrated technology that enables more efficient health screening in all of its clinics, including mobile and community clinics.

Blood donors need to be screened in advance to ensure that they do not come to harm from donating and also that their donation is unlikely to harm recipients.

All prospective donors are evaluated for their suitability each time they give blood through a verifiable screening process.

Previously donors completed a paper Health Questionnaire, with multiple questions presented on one densely worded sheet, relying on the donor to focus and interpret the question carefully. Possible errors in this process were questions being misread or misunderstood, question fatigue, and the potential for responses to be missed despite a staff check. Staff had to interpret the complete questionnaire, introducing the possibility of human error.

This paper-based process also had the potential for papers to be misplaced or lost, and if this were to occur, the blood donation would be destroyed for safety reasons.

The Welsh Blood Service’s new screening method involves blood donors using a touch-sensitive tablet computer to complete a health questionnaire. The tablet guides the donor through one question at a time, ensuring that all questions are answered, and performs data verification so that a complete data set is achieved every time. The donor’s responses are downloaded to the local data server and uploaded to the clinic desktop computer simultaneously over a local Wi-Fi network system.

This mechanism reduces the risk of transcription errors and oversights.

Finally, the software selects the

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information that is most pertinent, which reduces human error and removes the burden on clinic staff to interpret high volumes of complex information.

The tablet presents questions tabled in a logical, tailored way (for example, men are not asked pregnancy-related questions), so the donor experience is personalised and the screening process seems less trivial. The touch-screen interface is clear, which improves accessibility for visually impaired donors.

Privacy is also improved, as it immediately displays the next question after receiving a response to the previous one, making it no longer possible for questionnaires to be read ‘over the shoulder’. In trials, the system was found to have a 95% satisfaction rate from donors.

Blood screening parameters are changed and adapted in response to many situations, such as the recent Zika virus outbreak. The tablet’s software can be readily updated and then implemented across multiple geographic locations at one point in time. This single implementation reduces wasted paper and eliminates the chances of using an out-of-date process. As this data is electronically captured, any necessary data recall or extraction is much simpler than working with paper.

The new system has been implemented across Wales, and the proprietary technology only requires an electricity supply, making it reliant in outreach, home or community settings.

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Canolfan Ganser Felindre Velindre Cancer Centre

Novel phase 1 cancer trials come to Wales

Phase 1 Cancer Trials are a key step in the drug development process to generate new cancer treatments. However, they require a highly specialist infrastructure and workforce that was previously not present in Wales. Velindre has recently engaged with several industrial partners, in particular AstraZeneca and Orion, to attract commercial investment, allowing for development of the critical infrastructure needed to run Phase 1 trials in Wales. These collaborations have also resulted in the development of four trial protocols led by Wales-based Chief Investigators.

Velindre and AstraZeneca collaboratively analysed existing pre-clinical and clinical data involving AZ’s drug pipeline.

After an exchange of ideas and data, they generated three Investigator led protocols with Welsh Chief Investigators.

AstraZeneca also awarded three grants amounting to over £1 million in order to fund staff and infrastructure. Orion approached Velindre to run Wales’ first ever First In Human solid tumour study. After becoming the global leading recruiter for this study, Orion asked Velindre to be their only UK site for a follow up First In Human study, allocating a Cardiff Oncologist as UK Chief Investigator.

or London in order to access them. It represented a significant gap in Welsh cancer research expertise, as Welsh Investigators were not able to design and implement Phase 1 trial protocols

and industrial partners were required to engage with English centres. There was also a lack of translational research collaborations between the NHS, industry and universities in Wales.

As a result of Velindre’s rapid expansion of their Phase 1 trial portfolio, Wales has elevated its national and international reputation in the area of cancer research. Welsh patients have more convenient access to First In Human trials, which can offer opportunities beyond conventional NHS treatments. The drug used in the first Orion trial has now progressed to Phase 3 and will potentially become the new standard of care in prostate cancer. These trials are not a cost burden for the NHS; in fact commercial income from the trials has exceeded staff costs, allowing reinvestment into other areas.

Previously, when there was no infrastructure to run these trials in Wales, patients would need to travel to Oxford

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www.teamworksdesign.com

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@teamworksdesign

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Crafting design & communications for science, innovation and technology clients.

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Welsh Government Efficiency through Technology programme 21

E F F I C I E N C Y

T H R O U G H

T E C H N O L O G Y

P R O G R A M M E

Efficiency through Technology The £10 million Efficiency through Technology fund (ETTF) accelerates the adoption of new products and services into practice. Its purpose is to make health and care services in Wales more efficient and to deliver better outcomes and experiences for patients, aligned to the principles of Prudent Healthcare.

The fund encompasses four themes for new and improved ways of working in NHS Wales:

The ETTF takes account of the need for changed ways of working in NHS Wales, particularly in areas where there is a need for better support structures

Technology adoption This area consists of three strands: co-ordinated adoption, rapid evaluation and accelerated scale-up of technologies which demonstrate high impact at an all-Wales level.

and mechanisms that simplify and speed up the introduction of new technology.

Joint working and engagement, which are standard mechanisms

The fund supports two types of projects:

for Efficiency through Technology funding, have been developed to simplify decisionmaking processes. This means that resources can be quickly directed to Welsh Government priorities or scaled up as required. Simple monitoring systems provide rapid feedback on delivery and impact, allowing resources to be reallocated to better performing projects.

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Rapid Evaluation Projects

Scale-up Projects

These test the real world impact

These accelerate the adoption

of new products and services on

of products and services

efficiency and effectiveness. They

which demonstrate significant

are completed within nine months,

improvements in efficiency and

with a funding requirement of

effectiveness, to national or regional

£50k to £200k.

level. They can run for up to three years with a minimum funding requirement of £200k.

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Digital platforms and systems This supports the delivery of priorities in the new Digital Health and Care Strategy. It accelerates the development and implementation of essential digital infrastructure and open connectivity, which will provide a platform for improved practice, products and services.

Practice innovation

Technology development

This enables changes in practice and innovative collaborations. New partnerships between NHS Wales, academia and industry, as well as new models and platforms, will allow NHS Wales to operate more freely.

This involves developing new products and services, particularly in response to unmet needs and as an outcome from applied research in Wales.

S H O W

The four principles of Prudent Healthcare: l Achieve health and wellbeing with the public, patients and professionals as equal partners through coproduction. l Care for those with the greatest health need first, making the most effective use of all skills and resources. l Do only what is needed, no more, no less, and do no harm.

The next call for proposals to the Efficiency through Technology fund will be summer 2017. For more information contact healthtechfund@wales.gsi.gov.uk

l Reduce inappropriate variation using evidence based practices consistently and transparently.

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E F F I C I E N C Y

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M ED IWAL ES IN N OVATION AWARDS W IN N E R 2 0 1 6

The Bevan Health Technology Exemplars Scheme The Bevan Health Technology Exemplars scheme is a collaboration between the Bevan Commission, Welsh Government, NHS Wales and industry, with funding from the Efficiency through Technology programme. NHS Wales organisations have participated in the project, which involves supporting clinicians to rapidly introduce and evaluate an innovative health technology (which is not a drug, vaccine or medicine) into a clinical pathway. Industry partners match clinician time by putting their products, services, time and resources in at risk.

The scheme responds to two clear needs within the sector: Welsh clinicians wanting to implement new innovations at a time of great pressure and demand for NHS Wales services; and industry partners articulating the difficulties in getting new/innovative health technologies trialled, evaluated and procured by NHS Wales. To meet these two needs, the scheme provides funding which supports backfill of clinician time, project delivery costs and practical evaluation of impact. The scheme won the NHS Collaboration with Industry Award

at the 2016 MediWales Innovation Awards, as well as the Value for Money Award at the 2016 Welsh Government Awards.

The scheme aligns well with Prudent Healthcare under the principle of co-production, which provides a more conducive environment for collaboration between NHS Wales and industry where cost and risks are shared. Participating companies have a more streamlined route into the NHS, allowing them to demonstrate and evaluate their products or services in a real world setting with the help of expert clinicians. For high impact technologies, there is potential for accelerated scale-up and widespread adoption. NHS Wales benefits from a more structured way of working with industry, with access to cutting-edge technology to improve pathways and solve health problems. Ultimately, the implementation of new technologies brings benefits to patients, improving both outcomes and experience.

The key strength of the scheme lies in the value for money generated, with all projects leveraging significantly more product, expertise and people resources

The next call for applications will be summer 2017

from industry partners than the seedcorn amount of Efficiency through Technology funding provided to NHS Wales per project. In some cases, the resource match greatly outweighs ETTF contribution.

In one of the flagship Exemplar projects, Bausch & Lomb have deployed a £400,000 cataract laser at the Princess of Wales hospital in Bridgend to optimise cataract surgery pathways. This meets the triple healthcare value strands of improved patient outcomes, resource efficiency and patient experience. This project is especially relevant given that cataract surgery is the most commonly performed operation by NHS Wales, with over 18,000 procedures undertaken per year at an approximate cost of £16 million.

Other projects have so far included: Abertawe Bro Morgannwg University Health Board introducing a novel, lowcost MRI tool which reduces the need for high-cost treatment of complications related to spinal metastases; Velindre piloting a new software program designed to reduce dispensing errors, drug wastage and time spent on manual quality assurance steps; Powys Teaching Board implementing technology which enables the local management of patients with Obstructive Sleep Apnoea; and Cardiff and Vale University Health Board using 3D technology to accurately measure and remotely assess wounds.

Two projects in particular are highlighted on the next two pages – SepsisBox, a collaboration between Cwm Taf University Health Board and Rocialle, and TAVI, a collaboration between Abertawe Bro Morgannwg University Health Board and Edwards Lifesciences.

Vaughan Gething, Cabinet Secretary for Health, Wellbeing & Sport speaking at a recent Bevan Commission Conference

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For more information, contact Sion Charles on 07791 024021 or Sion.Charles@wales.nhs.uk

ifysgol Morgannwg h Board

ifysgol

h Board

ifysgol

h Board

h

st

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

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Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

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MEDI WAL ES I NNOVAT I ON AWARDS WI NNER 2 0 1 6

Sepsis Box equips nurses to start urgent treatment quicker than ever before Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Iechyd Cyhoeddus

Cymru of SepsisBox is the result Public Health collaboration between Wales Cwm Taf University Health Board, procedure pack specialist Rocialle and 1000 Lives Improvement.

Early diagnosis Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru and quick action are vital to the Welsh Ambulance Services successful treatment of sepsis, which NHS Trust occurs when the body’s systemic response to a microbial infection causes damage to its own tissues and organs. This can lead to multiple organ failure and is responsible for an estimated 44,00 deaths in the UK each year. SepsisBox has been designed to provide better care for people suffering from sepsis, improving patient outcomes.

in Wales. By providing these items and clearly showing the procedural pathway, the box equips nurses to start time-critical treatment themselves, without needing to wait for a doctor or specialist. The box is single-use, so there are no concerns about replenishing or date-checking the items.

Within each compartment, items are kept in their own sterile packaging.

NICE has initiated an extensive campaign to have sepsis treated as an emergency, in the same way that a suspected heart attack is addressed, and SepsisBox enables this. A rapid response to sepsis is crucial, as it can save lives and reduce complications for survivors such as limb

Sepsis response bags were introduced

by Cwm Taf University Health Board, working with 1000 Lives Improvement and were seen to improve outcomes.

However nursing staff generally waited for a specialist to arrive and begin the Sepsis Six. The design of SepsisBox encourages and equips nurses to be able to begin treatment as soon as sepsis is suspected. Furthermore, once a sepsis

The Sepsis Six: 1. Give oxygen to maintain saturations >94% 2. Take blood cultures and consider source control 3. Administer empiric intravenous antibiotics 4. Measure serum lactate and send full blood count 5. Start intravenous fluid resuscitation 6. Commence accurate urine output measurement

response bag had been used for the treatment of a patient, it was not always clear whose responsibility it was to replenish it. Sepsis Box eliminates this issue by being single-use and disposable.

Inside the disposable box are six compartments with numbered doors, containing the items needed to deliver each step of the ‘Sepsis Six’ - measures which have been found to reduce the risk of mortality by 46.6% when delivered within an hour of sepsis recognition. The Sepsis Six care bundle is the standard first response to sepsis in acute hospitals

amputation, long-term organ or tissue damage and post-traumatic stress. Better patient outcomes also means less time spent in hospital, and fewer patients being transferred to the Critical Care Unit, cutting costs to the NHS. Typical costs of patient care are £500 per night on a ward and £1700 per night in CCU.

A 12-month trial of SepsisBox began in May 2016 at Prince Charles Hospital in Merthyr Tydfil and Royal Glamorgan Hospital near Llantrisant.

Initial indications are that nurses feel empowered to treat sepsis and provide essential early intervention, suggesting that SepsisBox could potentially offer better patient outcomes.

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E F F I C I E N C Y

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Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg University Health Board

P R O G R A M M E

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

Replacing heart valves without the need for invasive open-heart surgery Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr Patients sufferingUniversity from Heart Valve Health Board

Disease (HVD) often require a heart valve replacement. However, this involves open-heart surgery, which some patients areBwrdd unable to go through Iechyd Powys health because of other Addysgu non-cardiac Powys Teaching problems makingHealth the procedure risky.

Board If HVD is left untreated, the prognosis is poor, with many patients having increasingly frequent and lengthy Ymddiriedolaeth hospital admissions prior to death.

GIG Felindre Velindre NHS Tust

Transcatheter Aortic Valve As part of a commitment to Wales, and to Implantation (TAVI) is a workforce, accommodate its expanding transformational in 2012 Abel & Imray technology moved from its that of to larger previousenables offices inreplacement central Cardiff degenerated heart valves via and more modern offices in 3 Assembly minimally approaches, Square.

It wasinvasive encouraging to see the usually throughHub the femoral artery, Welsh Life Science follow suit and without the need to perform set up one floor below last year and that, open-heart surgery.

Since 2009, along with the firm’s close relationship Morriston Hospital’s Cardiac with MediWales, makes Abel & Imray Centrethat hasitdeveloped a TAVI heart confident will continue to build team consisting of cardiologists, relationships with the exciting and heart surgeons and anaesthetists, innovative companies making up the life who have been using TAVI to treat sciences sector in Wales. patients with aortic stenosis (the most common HVD which involves degenerative narrowing of the aortic valve) who are unable to have conventional open-heart surgery.

TAVI offers treatment options that are tailored to the needs and clinical characteristics of the individual patient.

Furthermore it results in relief of symptoms and quicker recovery than with open surgery. Patients can return to a ward bed after the procedure, avoiding ITU admission and minimising the demands on expensive, limited ITU bed capacity. As the procedure is performed in a cardiac catheter laboratory instead

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Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

Iechyd Cyhoeddus Cymru

The Transcatheter Public Health Aortic Valve Wales Implantation device and an illustration Ymddiriedolaeth GIG showing positioning Gwasanaethau Ambiwlans Cymru within the heart Welsh Ambulance Services NHS Trust

of an operating theatre, it also frees up operating theatre sessions, theatre staff and perfusionists who run the heartlung bypass machines that are no longer needed. This allows more time for other open-heart surgery cases.

The team at Morriston Hospital’s Cardiac Centre has worked with Edwards Lifesciences to plan and develop the service using the company’s TAVI valves.

Edwards has provided training on the use of the valves and ongoing specialist support and assistance. The Sapien S3 valve is the latest TAVI valve which incorporates technical and procedural developments since 2009. It has allowed over 85% of the heart team’s TAVI procedures to be safely performed under local anaesthetic with rapid recovery and discharge from hospital. The average length of hospital stay has decreased by

three days and outcomes show that over 80% of patients are alive at three years post-TAVI. There has been collaboration with patients to produce information for future patients, including a video, explaining the symptoms and natural history of HVD as well as the treatment pathway. The team has also worked with the charity Heart Valve Voice and undertaken a patient survey of HVD in Swansea to improve awareness of the condition and identify key areas to address in terms of support and education.

Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol Betsi Cadwaladr University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University Health Board

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Less admin, more care: Time-saving digital tool created for nurses Bwrdd Iechyd Addysgu Powys

Iechyd Cyhoeddus Cymru

Powys Teaching Health Board

Public Health Wales

Ymddiriedolaeth GIG Felindre Velindre NHSElidir Tust Technology company

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

Health has worked with Betsi Cadwaladr University Health Board to create a digital solution which saves nurses’ time, in response to an SBRI Challenge call. Nurses need to carry out a lot of administrative tasks in order to do their job, but this diverts them from spending time with patients. Elidir Health set out to develop a new system allowing nurses to find 10% more time for patient care, and the resultant CHAI (Connected Healthcare Administrative Interface) exceeded these expectations.

Through the use of CHAI, in comparison to a traditional paper-based system, nurses can have access to all patient information digitally as and when required, whether they are on or off the ward. Inputted data can be instantly in the hands of colleagues, even those who are on other side of the hospital, and can also be accessed from other IT systems to eliminate repeated writing, such as the patient’s address, on multiple forms. The system can store conversation threads about a patient and allows for automatic

calculation of early warning scores and fluid balance charts, all of which improves patient safety.

In the early phase of the development process, Elidir Health spent three months on the paediatric wards of Wrexham Maelor Hospital and Ysbyty Gwynedd Hospital, in order to gain an understanding of the real challenges that nurses face on a daily basis. Later in the project, nurses also provided weekly feedback on the new system.

The simple interface enables nurses to make quick note of tasks and reminders for their shift, and then alerts them when tasks are overdue. For example, they can choose to be notified when a patient’s blood results are ready to be viewed, so that they are able to deliver the correct treatment in a timely manner. This automatic notification of urgent tasks, as an alternative to written notes on scraps of paper, allows nurses to relax a little and spend better quality time with patients.

This enabled Elidir Health to build a solution that is truly ‘by nurses for nurses’, rather than having a product created by software developers with little knowledge of the clinical environment or the cognitive situation of users.

Evaluations have found that CHAI is capable of saving a minimum of 23% of nurses’ time, exceeding the initial challenge target of a 10% saving. It improves not only patient safety but also the patient experience, as it grants nurses more freedom to sit and listen to their patients and address any concerns before they become bigger problems. The solution simplifies critical information flow, providing a more efficient alternative to what is often a complex, time-sapping system.

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E F F I C I E N C Y

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P R O G R A M M E

Bwrdd Iechyd Prifysgol Caerdydd a’r Fro

Bwrdd Iechyd Prifysgol Abertawe Bro Morgannwg University Health Board

Cardiff and Vale University Health Board

Patient evaluations to inform healthcare providers Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

The PROMs, PREMs andIechyd Effectiveness Bwrdd Prifysgol Betsi Cadwaladr Programme provides patients with University Health Board the opportunity to evaluate their care, clinicians and service providers. In the case of PROMs (Patient Recorded Outcome Measures) patients give Bwrdd Iechyd feedback on the outcomes of their Addysgu Powys treatment, while PREMs (Patient Powys Teaching Recorded Experience Measures) Health Board require them to assess their experiences. Healthcare providers can use the information gathered in Ymddiriedolaeth order to evaluate clinical effectiveness, GIG Felindre identify areas for service improvement Velindre NHS Tust and benchmark across organisations, regions and networks. PROMs and PREMs data make it possible to assess the overall value of healthcare services to patients, and will enable Wales to adopt approaches like ICHOM (International Consortium for Healthcare Outcomes Measurement).

The programme has three years of Efficiency through Technology funding (January 2016 – March 2018) and Betsi Cadwaladr University Health Board was the first to go live with PROMs, followed by

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Abertawe Bro Morgannwg and Hywel Bwrdd Iechyd Prifysgol At-home collection Hywel Dda. All are implementing theDda in-clinic University Health Board A unique reference number is generated solution within their Orthopaedic prefor each patient at point of referral. The assessment clinics for hip and knee number and a link to an online portal are patients, with further expansion into foot included in a referral acknowledgement and ankle under consideration. The phase 1 letter, inviting patients to complete the Cyhoeddus Betsi rollout involved anIechyd analytical review Cymru questionnaire online. of completion rates by Cedar Healthcare Public Health Technology Research Centre, Wales so that Discussions are currently ongoing necessary changes could be made to refine with other health boards to identify the questionnaires. The initiative also went opportunities for local rollouts of the atlive in Cardiff and Vale inYmddiriedolaeth December 2016, GIG home solution. Most health boards that Gwasanaethau Ambiwlans Cymru where generic PROMs are being collected use Welsh Patient Administration System Welsh Ambulance from all adult patients referred into a Services should be in a position to deploy at-home NHS Trust Medicine specialty. collection in 2017. An electronic platform So far, 919 PROMs have been collected (as of mid-January 2017) using the following two methods:

In-clinic collection The in-clinic solution allows collection of PROMs in the clinic environment, requiring staff assistance to load each questionnaire onto a tablet for patients to complete.

Patient Recorded Outcome Measures (PROMs)

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is being developed to capture PROMs and PREMs that will interface with existing NHS Wales technology and systems. To facilitate data linkage for more in-depth analysis, Cedar’s HOPE unit (Health Outcomes and Patient Experience) will access nationally held data from all Welsh health boards.

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EU-supported project led by Swansea University unlocks new innovations The AgorIP project is a new openaccess, open-innovation project led by Swansea University and part-funded by the European Regional Development Fund through the Welsh Government.

Led by Project Director Dr Gerry Ronan, AgorIP is worth at least ÂŁ13.5 million over five years. It is open to innovations from Wales and further afield, whether academic or research institutions, NHS bodies or businesses, and to projects at any stage of the development process. The target is for at least 50% of AgorIP initiatives to have originated from the health and life sciences sector, including the NHS. AgorIP seeks to help innovations along their journey from the drawing board to the real world. Through the programme, participants transfer ownership of Intellectual Property to Swansea

University, but they retain rights to the IP so that they will benefit when it is transacted out further down the line.

The university will then work to add value to the initial proposition, for example by funding prototypes or further precommercial research, bringing on board

The AgorIP commercialisation process can be broken down into five phases: l EluciD8 - Discovery Phase l ActiV8 - Launch Phase l TransL8 - Development Phase l InvestorG8 - Maturation Phase l SUIF - Co-investment Phase

specialised technical or commercial expertise and securing patents or other IP. A review board ensures that support is targeted appropriately.

A project can enter the programme at any phase, and support is focused on moving the project towards commercialisation or implementation.

AgorIP follows on from a successful pathfinder project, SHIPP (Swansea Healthcare Innovation Partnership Programme) and benefits from the expertise gained during the previous, highly successful InvestorG8 programme, both of which were funded by the Welsh Government. AgorIP aims to take the successful work started by SHIPP even further, making the most of Welsh ideas and delivering real-world innovation.

The 10-month SHIPP project enabled investment in five initiatives involving collaboration with NHS Wales Health Boards: l ER+ breast cancer diagnostic based on LC-MS tagging technology l Development of an eating disorder app l Graphene based diagnostic for detection of infection l Colorectal cancer diagnostic based on Raman Spectroscopy l Health economics validation of CAREMORE Commissioning

Framework

SHIPP has funded two patent applications in relation to the above, with another expected shortly. Furthermore, the colorectal cancer diagnosis project (which you can read more about on page 10) won the Research Excellence in the NHS award at the 2016 MediWales Innovation Awards.

For more information on AgorIP, contact the Project Manager Ciaran Whyte on 01792 295701.

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

Connecting care homes with pharmacies: A digital medicines management system Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol Healthcare technology company Betsi Cadwaladr Beacon Digital has University been working Health Board with care homes in South Wales to pilot a digital medicines management solution. Abertawe Bro Morgannwg University Health Board provided Bwrdd Iechyd oversight of the work, which received Addysgu Powys funding from the Efficiency through Powys Teaching Health Board Technology programme.

and means that there can be complete Hywel Dda Health Board traceability of individualUniversity medicines in the (rare) event of batch recall. PCS provides access to information on medication, enabling reviews of medicines. As a result of better stock control the care Iechydat Cyhoeddus Cymru ordering home and a better prescription Health or process, there is also lessPublic unwanted Wales returned medication.

The solution is unique because it links care homes and pharmacies, producing a closed Ymddiriedolaeth loop system. It consists of a care home GIG Felindre medicines management system Velindre NHS called Tust the Pro-active Care System (PCS), a secure web portal that stores health records called Invalife, and a pharmacy dispensing system called Consolidated Applications for Pharmacy Administration (CAPA). Data is shared across the applications, giving the user access to a complete medicines record for any individual patient.

Beacon Digital’s system, created with IT partner Invatech Health, ensures a quicker, safer medication administration process in care homes through an automated checking process, as well as improved efficiency through automatic stock control, booking in and prescription ordering. By making use of electronic records instead of paper MAR charts, the system allows for better audit trails. Medication handling also becomes safer for care home staff, and pharmacists no longer need to repackage medicines from the manufacturers’ packaging.

Benefits of the new system for pharmacies include an improved dispensing process due to barcode validation of medicines.

The fact that there is no need to repackage and dispense prescriptions into monitored dosage systems not only saves pharmacy time but also preserves original packaging.

This is favoured by pharmaceutical companies, and by health regulators,

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Bwrdd Iechyd Prifysgol

Part of the Efficiency through Ymddiriedolaeth GIG Ambiwlans Cymru Technology programme Gwasanaethau funding Welsh Ambulance Services allowed the School of Pharmacy and NHS Trust Pharmaceutical Sciences at Cardiff University to evaluate the impact of the electronic medication administration system in care homes. They concluded that post-implementation, the system had eradicated 21 out of 23 types of error. It also recognised that the new system had made several interventions In 2016, the project won that prevented further potential the ‘Improving Care With administration errors. These included Technology’ award at the HSJ attempting to administer medicines to Awards and was also a finalist the wrong resident, trying to administer in the Guardian Public Services the medicine too early or when it had already been administered, and leaving Awards. The system has now an insufficient gap between doses of been successfully commercialised, a product containing paracetamol. On as a major partnership with average, Beacon Digital’s system was WELL pharmacies and a number found to have made 8.7 interventions of independent community per care home resident per month. pharmacies has enabled nationwide distribution. Around 10,000 beds have been signed The evaluation identified that, unlike traditional paper based systems, the up with another 1,000 beds electronic system enabled pharmacists awaiting implementation, to support the care homes in ensuring and work is progressing on that medicines administration was products that support further safe and effective for patients, that capability of the system. Beacon administration records were correct Digital’s relationship with and that new medicines or new Cardiff University’s School of dosages were consistently flagged.

Pharmacy has continued with the Overall, pharmacists made proactive sponsorship of a PhD studentship. interventions on 80% of prescriptions for the care homes that they supplied.

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

Outcome-focused industry partnerships promote better engagement with NHS Wales Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrddhas Iechyd Prifysgol The Welsh Government been Betsi Cadwaladr developing an NHSUniversity Wales framework Health Board for industry engagement through outcome-focused partnerships. This framework will enable NHS Wales to engage and collaborate consistently Bwrdd Iechyd with industry, in a way that drives Addysgu Powys strategic health objectives as well as Powys Teaching Health Board the principles of Prudent Healthcare.

Bwrdd Iechyd Prifysgol Hywel Dda University These partnerships align wellHealth with Board

A number of outcome-focused partnerships with national and Ymddiriedolaeth multinational organisations are being GIG Felindre explored and developed.

For these Velindre NHS Tust partnerships to succeed, it is necessary for clinical need to be aligned with commercial interest and expertise, and for there to be a shared focus on improving patient outcomes, patient experience and resource efficiency. Partnerships must be based on joint commitment, with industry partners putting in their products, knowledge and resources while NHS Wales contributes clinical expertise, data and facilities.

outcomes, data and reimbursement models. The final phase allows contractual commissioning of services, with reimbursement based on the delivery of agreed healthcare outcomes.

the Prudent Healthcare approach and with the global pursuit of value and outcome-focused healthcare.

The first of these outcome-focused Cyhoeddus They are particularlyIechyd of interest to Cymru partnerships was initially developed pharmaceutical companies, who Public Health in 2014 and specifically focused on propose that there isWales shared value redesigning heart failure and lung cancer to be gained through moving from pathways, with the aim of contracting on the current model, based on selling the basis of delivered outcomes, instead drugs, to one which Ymddiriedolaeth is more based GIG Gwasanaethau Ambiwlansof Cymru just purchasing drugs, at its conclusion. on delivering measurable patient Welsh Ambulance Services This work on pathways for heart failure outcomes.

NHS Trust and lung cancer is linked to the Heart Disease and Cancer Implementation groups respectively.

Partnerships go through up to four phases, with check points between each stage. The first stage is initiation, in which potential areas of shared opportunity for both partners are identified and agreed.

Next is the diagnostic and design phase, when a target clinical pathway is analysed in detail, so that a more optimal one can be designed and planned. After this, a ‘dry run’ pilot of the revised clinical pathway is implemented and evaluated, testing

Two further projects have now been initiated through an open call from the Liver Disease Implementation Group, which will be funded principally from the Group’s own resources. The Welsh Government is also supporting Velindre on an Immune Oncology project and finalising a proposal with the Wales Cancer Network to improve treatment pathways and data collection for patients with Haematological Malignancy.

For more information, email: HealthcareTechnologyInnovationandStrategy@wales.gsi.gov.uk

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Lymphoedema Network Wales enables improved treatment solutions for patients Lymphoedema is a chronic condition that causes swelling. It can affect any part of the body, but usually develops in the arms or legs, and is caused by damage to the lymphatic system, which can be genetic or the result of infection, injury or cancer treatment.

In addition to the physical problems associated with lymphoedema, such as swelling and development of skin

The Lymphatic System

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infections called cellulitis, the condition can cause psychological issues due to the impact it has on everyday life and the treatment it requires. Lymphoedema management involves wearing compression garments for up to 24 hours a day, as well as daily exercises and skincare routines. Patients also need regular appointments with healthcare professionals and have a 30% risk of

developing repeated cellulitis episodes, which may cause hospital admissions.

Thanks to the Efficiency through Technology fund, Lymphoedema Network Wales has acquired lymphatic scanning equipment that enables the identification of the lymphatic vessels which are smaller than strands of hair and can become anastomosed into a vein. Lymphatic venous anastomosis (LVA) surgery is a unique form of super microsurgery where the defunct lymphatics are connected to functioning veins, reducing the patient’s need to wear compression garments and significantly lowering their risk of developing cellulitis. Wales has become the first place in the UK to offer this surgery on the NHS. As a result of undergoing LVA surgery, patients have reported less pain and discomfort, and it can relieve 70% of patients of the need to wear compression garments. Through patients undergoing this pioneering surgery, costs are reduced to the NHS, which provides these garments, and patient quality of life is improved.

Lymphoedema sufferers sometimes have to change jobs or give up work entirely due to their condition, so this surgery has the potential to give them access to a wider range of employment opportunities, as well as hobbies and clothes. It can also improve body image and general mood. A 96% decrease in cellulitis is associated with LVA surgery, and patients spend less time feeling unwell and having their daily life disrupted. The fact that they require fewer antibiotics and are admitted to hospital less frequently is also a benefit for the NHS.

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In Wales, 42 patients per year, who meet the eligibility criteria, are now scanned to assess suitability of lymphatics for LVA surgery.

To date, 44 surgeries have been completed in Wales and the benefits are already being reaped.

None of the patients have suffered cellulitis since surgery, saving hospital resources and antibiotics, and six patients have even been able to stop wearing compression garments and be discharged from their lymphoedema service.

All LVA surgery takes place at Neath Port Talbot Hospital in Baglan, with pre and post-operative care provided locally in Health Board Lymphoedema services, Cimla Hospital and on board the Tenovus Cancer Care Mobile Unit.

This unit is the only fully operational facility of its kind in Europe, providing chemotherapy and care for people with lymphoedema. By bringing vital services directly to people with cancer and lymphoedema through a mobile unit in their local area (a familiar environment), less time needs to be spent travelling and waiting.

Through more Welsh Government funding and a partnership with eHealth Digital Media, Lymphoedema Network Wales has recently made even further

advances in lymphoedema care. In an increasingly digital world, where people of all ages are using smartphones and tablets, there are opportunities for new alternatives to traditional information leaflets. Lymphoedema Network Wales has collaborated with eHealth Digital Media to create video prescriptions, in order to support lymphoedema patients in managing their condition.

With valuable input from patients, as well as their families and carers, 16 bespoke films have been made which provide information on various aspects of lymphoedema management. These films are emailed to patients, who can watch them as many times as they want, so that they gain a thorough understanding of managing their condition.

They provide essential information and share the experiences of real patients, so that viewers can gain a deeper insight into the condition through a format that is more engaging and personal than a leaflet or other written content. The purpose of these novel video prescriptions is to help lymphoedema sufferers become experts in self-management of their condition, thereby improving quality of life, decreasing psychological issues such as distress and anxiety, reducing the risk of hospitalisation

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and alleviating pressure on the NHS. These video prescription films will be launched by the Cabinet Secretary in March 2017.

Lymphoedema Network Wales is working in partnership with local health boards across Wales to implement a national Lymphoedema Strategy, aimed at raising awareness of lymphoedema and how simple treatment strategies can improve patients’ quality of life. It is part of the NHS Wales Health Collaborative, an effective resource supporting pan-Wales NHS trust and board chief executives to deliver recommendations to enable more effective joint working in NHS Wales.

Digital media being used for health information

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

The Choose Pharmacy Platform delivers safer, seamless patient care Bwrdd Iechyd Prifysgol Aneurin Bevan University Health Board

Bwrdd Iechyd Prifysgol Choose Pharmacy is an IT platform Betsi Cadwaladr which enables better sharing of University Health Board information between secondary care, GPs and community pharmacists to deliver safer, more seamless patient care. The system is in the process of Bwrdd Iechyd being rolled out across Wales, with the Addysgu Powys aim of making it available in at least Powys Teaching Health Board half of all community pharmacies by the end of March 2018. Development of the system has been funded by the Efficiency through Technology Ymddiriedolaeth programme.

GIG Felindre Velindre NHS Tust

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:

Bwrdd Iechyd Prifysgol Cwm Taf University Health Board

Bwrdd Iechyd Prifysgol Hywel Dda University It is estimated that up to 18%Health of GPBoard

workload and 8% of emergency Research shows that community department consultations are about pharmacists sometimes struggle to minor ailments. Research shows identify discharged patients and that Iechyd Cyhoeddus that GPs are in favour of diverting hospital pharmacists do not routinely refer Cymru the care of minor ailments to other people for the review service, because the Public Health areas of primary care, including manual, paper-based process for doing so Wales community pharmacists, which is inefficient and time-consuming. Choose Pharmacy is able to overcome these issues. would allow them to focus their Ymddiriedolaeth time on more complex cases and GIG Gwasanaethau Ambiwlans Cymru could also reduce patient waiting Welsh Ambulance Services times. An evaluationNHS of the TrustChoose Emergency Medicines Service Pharmacy platform found that it Up to 30% of all calls to NHS 111 services is certainly feasible to transfer the on a Saturday are urgent requests for care of minor ailments from GPs to repeat medication, and a third of these community pharmacists and that calls are referred directly to GP outdoing so is likely to provide a fourof-hours services for an appointment to-one return on investment within to arrange a prescription. This reduces five years. access to out-of-hours appointments for

Common Ailments Service Community pharmacists can provide treatment and advice, and electronically record a consultation with a patient related to 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.

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A&E attendances and hospital admissions, as well as reduced medicines waste.

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. An evaluation of the Discharge Medicines Review Service found that for each £1 invested, £3 was saved by NHS Wales through avoided

symptomatic patients who have a greater clinical need, and also disrupts the usual repeat prescribing and dispensing cycle with the potential for medicines waste.

Some patients even attend A&E with a repeat prescription request, resulting in inefficient use of resources.

Evidence demonstrates that out-ofhours repeat medication requests can be diverted effectively to community pharmacies. Community pharmacies across Wales have been participating in the NHS Emergency Medicines Service since 2015.

However, a considerable proportion of patients cannot have their medication verified by a pharmacist, which means that they end up being referred back to other, less appropriate, NHS services.

Giving community pharmacists access to information on prescribed medicines in their Welsh GP Record would significantly reduce the number of patients needing to be referred and deliver considerable improvements in patient safety.

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Technology exists which would allow this to be shared through the Choose Pharmacy platform. A small number of community pharmacists have been using the Choose Pharmacy platform to record supplies of emergency medicines since September 2016.

As well as these three services, the Choose Pharmacy platform has recently been further developed to record the administration of seasonal flu vaccination and emergency health contraception. These capabilities are also being piloted and will be made available more widely in 2017.

Work is ongoing on sharing appropriate information from Choose Pharmacy with GP practices and hospitals.

Funding has now been committed for up to 2020 to roll out the Choose Pharmacy platform across all community pharmacies in Wales.

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Betsi Cadwaladr University Health Board

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S O IWC CI E AN S IC NY G T AHDRVOAUNGC HE ST EI N H G LYI FPE RS O CG I ERNACM E M E EH F F C HWNEOL LS O

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The digital future of mental health services Ymddiriedolaeth GIG Felindre Velindre NHS Tust

Ymddiriedolaeth GIG Gwasanaethau Ambiwlans Cymru Welsh Ambulance Services NHS Trust

EU funding has enabled Powys Teaching Health Board to provide over 300 patients with computerised Cognitive Behavioural Therapy (cCBT) for depression. Thanks to additional funding from the Efficiency though Technology programme, the health board can now move on from the pilot and upscale the service, making it available to more of the Powys population.

Powys Teaching Health Board estimates that there are over 10,000 people in the Powys region suffering from mild to moderate depression. However, due to the geographical size and rurality of the region, it can be difficult for people to access appropriate services. In an EUfunded project called MasterMind, the health board was one of 24 organisations across Europe selected to implement cCBT, giving depression patients online access to therapy. Powys adopted the NICE recommended ‘Beating the Blues’ system of cCBT, which takes the form of an eight-session treatment programme.

Implementation of cCBT gives patients quicker access to therapy, with no need for waiting lists or physical travel. This brings particular benefits to rural areas, where extensive travel to appointments can be common and provide a barrier to treatment. Making high quality treatment for depression more accessible has the potential to enhance Powys’ mental health service and have a significant impact on the community’s wellbeing.

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As patients complete the online programme, healthcare professionals are provided with updates so they can monitor patients’ progress and identify any warning signs, such as intent of suicide or self-harm. This means that while the system empowers patients to take more control over their own mental health, experts still have an overarching view of their condition and can intervene if needed.

Efficiency through Technology funding has recently been granted to Powys Teaching Health Board, allowing rapid upscaling of the project over the next

three years. The cCBT service will be made more widely available to the estimated 10,000 people in Powys suffering from mild to moderate depression and also extended to include anxiety disorders. Furthermore, there may be opportunities to implement the service in other Welsh public sector organisations, such as job centres and more health boards.

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New technology to improve detection of lung conditions Research undertaken by Professor Paul Lewis from Swansea University’s Medical School has been used to develop a technology for the detection and monitoring of lung conditions such as Chronic Obstructive Pulmonary Disease (COPD).

The technology is now being taken forward commercially by PulmonIR, a medical device spin-out from the university, with an aim to significantly reduce the number of exacerbation-related hospital admissions.

In the UK, an estimated three million people suffer from COPD with an annual cost to

the NHS of over £800 million. Although the condition is irreversible, symptoms including breathlessness, a persistent cough and frequent chest infections can be treated. If left untreated, the condition becomes exacerbated, which can result in hospitalisation, and in 2015, there were 1,920 deaths in Wales as a result of COPD. Professor Lewis discovered that shining beams of infrared light onto a sputum (coughed up mucus) sample allows COPD to be detected from the unique frequency of the light bouncing off it. By speeding up diagnosis and improving monitoring of COPD, the newly developed technology

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has the potential to save lives, lower the number of hospital admissions and reduce treatment costs in the NHS, particularly during the busy winter period.

Having secured significant investment from IP Group, Finance Wales and the Swansea University Innovation Fund, the technology is currently undergoing clinical evaluation through a collaboration with Cwm Taf University Health Board. After these clinical trials are complete, PulmonIR will seek the regulatory approvals needed to launch commercial products.

Pelvic harness provides better quality of life for pregnant women One in five pregnant women experience Pelvic Girdle Pain (PGP), which involves joints in the pelvis becoming irritated and causing discomfort. For some women, this can result in severe pain, making even basic activities difficult and having a significant impact on everyday life. Early induction of labour can be offered to sufferers of PGP, but symptoms do not always subside post-pregnancy.

Despite the prevalence of PGP in pregnancy and its sometimes debilitating effects, there is a lack of evidence based treatments to manage the symptoms. When Dafydd Roberts’ wife Ruth was suffering from such acute PGP that she struggled to walk and became wheelchair bound, the clothing company owner decided to develop a solution. He went straight to his factory and designed a harness that would support all three joints of the pelvis, as well as the weight of a bump, and hold the hip bones in a comfortable position. It provided immediate relief for Ruth, and after refining the harness material (obtaining it from the USA), Dafydd contacted a consultant obstetrician at Wrexham Maelor Hospital for her professional opinion.

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Dr Kalpana Upadhyay helped Dafydd to take his product further with support from a team of researchers, physiotherapists, midwives, and experts from Health & Care Research Wales and Bangor University’s NWORTH clinical trials unit. Funding was gained for a randomised controlled clinical trial across Betsi Cadwaladr University Health Board.

HGR’s harness has the potential to dramatically improve quality of life for pregnant women suffering from PGP. This would in turn reduce the rates of early labour induction due to PGP, leading to savings for the NHS in terms of bed occupancy, operative delivery rates and post-operative complications.

www.maternity-belt.co.uk

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Making the most of big data in the healthcare sector Big data has become recognised as a valuable resource, yet it is often one of the most under-utilised assets within large organisations. Vast amounts of data are captured, but most of it goes unexplored. Swansea-based company We Predict, which already has an established reputation in the manufacturing sector, has the technology and expertise needed to release the potential of big data for the benefit of the NHS.

All outputs can be explored by GP practice, geographic area, age group or gender, so that the NHS can more effectively decide where to allocate resources for treatment and prevention. The predictive analytics help commissioners to visualise and understand the impact of continuing current services or introducing different services and interventions to populations by age, gender or locality. Interventions can be compared in terms of cost savings and health benefits.

The health division of We Predict is led

by Dr Kerry Bailey, a Swansea GP and Epidemiologist.

Emergency admissions

The company is working in partnership with the NHS on several areas, including:

Type 2 diabetes Diabetes is known to cost 10% of the NHS budget and leads to avoidable illness or mortality for millions of people. We Predict provides accurate descriptive analysis of patterns that exist between obesity and Type 2 diabetes such as attributable admissions, length of stay and outcomes.

We Predict provides accurate, automated descriptive and predictive analytics regarding ER, routine and emergency admissions with linkage to external data.

These insights are used to inform planning related to to how cold winters impact frail people and elderly populations and how changes could be made to reduce respiratory admissions.

The data can be explored by GP practice, age group, geographical location, deprivation and frailty score so that

patterns can be identified. Risk stratification helps to identify people who will most benefit at an individual or community level, allowing for informed health service improvements, and predictive analytics give commissioners the opportunity to plan and prevent accordingly.

We Predict is making sense of variable, raw, heterogenous electronic data to provide insights that allow for datadriven decisions. The company can adapt predictive algorithms to suit any questions or priorities, enabling rapid decision making for clinicians and commissioners.

www.wepredict.co.uk

“I could hire two analysts for a year and we couldn’t do this.

What We Predict have achieved in three months is far more than two analysts could manage in a year.”

ABMU Consultant

“Healthcare had been lagging behind other sectors in releasing the potential of their own data.

As an Epidemiologist I am an advocate for data driven decisions, but the NHS does not have the advanced expertise in house to automate big data advanced analytics. We Predict brings the best data scientists, computer scientists with health experts to provide commissioners and analysts in the NHS with valuable insights from routine, administrative data. This is heralding a big change for new operational big data epidemiology, in order to improve health and maximise efficiencies.”

Dr Kerry Bailey Swansea GP and Epidemiologist

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Harnessing microbiology for innovative product design and development Harnessing and even mimicking nature has helped push innovation in product design, especially within the medical sector by utilising biotechnology. GX, a product design engineering company with expertise in this area, has been incorporating life sciences into their products for the past 30 years.

“Looking back over our 30-year history, we have been fortunate to work on some groundbreaking products that use life science technology, many of which are still in development.

Just as technology continues to evolve, so too does the use of life sciences. 30 years ago, I would not have thought to use Plasma to heal wounds or optronics to analyse urine, but today this is commonplace. Who knows where the next 30 years will take us!”

Gary Ross Design Director and one of the founders of GX

Harnessing the power of Luciferin GX’s first project involving bioluminescence was in 1989, when Amersham enlisted GX’s help to develop a portable hygiene monitor. Amersham had discovered a reagent that would emit minute quantities of light when introduced into a sample containing bacteria. The design team were challenged to create a lightweight, handheld monitor to be used to detect bacteria in food preparation areas.

Having successfully developed this easyto-use portable monitor, GX’s next project using bioluminescence came just a few years later, when the Pall Corporation turned to GX for help. Like Amersham, Pall wanted to market a cost-effective device to food manufacturers that would instantly monitor quality control methods and detect harmful bacteria, using bioluminescent technology.

Ground breaking solutions Unlike the Amersham device, Pall’s Luminometer measured the bacteria via a filter, making it a simple device to use with little training required. The team at GX decided to experiment using a vacuum and seal system that would have enough suction to seal the machine onto a surface and exclude all light sources. They created a complete vacuum, which allowed them to use photomultiplier technology to take an accurate reading of bacterial luminescence.

17 years on, thanks to the innovative nature of the vacuum technology and the incredible sensitivity it produced, the product is still in use.

GX developed an innovative way of mixing samples of bacteria with water, and then measuring the amount of light emitted by the plankton to indicate if the water is contaminated.

In house specialists A product team in GX will include engineers with expertise in mechanical, industrial, electronic, software and system design and engineering, all working in tandem. This collaborative approach ensures that GX retains control of the entire project and can often lead to significant breakthroughs. For example, when developing a urine analysis device for Clinitek Status, GX struck upon a novel arrangement of multiplewavelength LEDs to ensure accurate visual analysis of patient records. Whilst this product was designed in the late 1990s, it is still being sold in over 100 countries.

Award winning design Most recently, in 2012, the design engineering team at GX harnessed the power of technology to detect bioluminescence levels in the development of an online analytical toxicity machine, the Microtox CTM, to measure water pollution. The Microtox CTM is a standalone instrument designed to give a continuous indication of water quality. Using bioluminescent plankton,

www.gxgroup.com

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Healthcare Centre of Excellence offers training facilities and 3D printing Renishaw has established a Healthcare Centre of Excellence at its Miskin site.

The Centre, which was formally opened in September 2016, provides a facility for the manufacture of custom medical devices, as well as education and training for the life sciences community.

It houses a mock operating theatre suite and facilities for education, training, workshops and lectures, plus Renishaw’s metal additive manufacturing (3D printing) machines. The mock operating theatre in the Healthcare Centre of Excellence mimics a real-life hospital setting, but without the complication of a sterile environment. In the state-of-the-art suite, neurosurgeons are able to practise using new technology in a familiar environment. The room is lead-lined to enable X-ray use and surgeons can be trained there to perform highly complex

procedures using Renishaw’s range of neurological products. It also has video and audio technology, which allows training to be live-streamed to the adjacent lecture theatre or to the neurosurgeon’s support team, who may be located elsewhere.

Renishaw is a world leader in the design and manufacture of metal 3D printing machines, which are made in a production hall at the Miskin site. 3D printing is changing and improving many traditional industries and processes, and the healthcare sector is no exception, with the technology being put to particularly good use in reconstructive surgery. The company has recently worked with Cardiff and Vale University Health Board to create a CAD/CAM suite at CVUHB for the digital design of dental structures and maxillofacial implants, which will be manufactured using metal 3D printing technologies.

www.renishaw.com

Natural compound to tackle chronic lung infections A key focus for Neem Biotech is developing small molecule alternatives to conventional antibiotics. In practice, this means creating innovative solutions that are accepted by drug development authorities to treat people affected by chronic medical conditions and rare diseases.

Having grown from six staff at the beginning of 2015 to a team of over 25 people in 2016, Neem is now housed in bespoke facilities in Abertillery. The rapidly growing company’s flagship innovation targets the chronic lung infections that rank as the biggest cause of death in people with cystic fibrosis. These infections are particularly difficult to treat, because the

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Pseudomonas aeruginosa bacteria that cause them are often resistant to the antibiotics prescribed.

Neem’s flagship candidate drug substance NX-AS-401 is a small molecule natural compound that builds on 3,000 years of natural product knowledge by adding science to what until today has only been anecdotal or traditional medicine. Success of NX-AS-401 in controlling chronic respiratory infections would create a better quality of life for people with cystic fibrosis, as well as reducing costs to the health and social care systems more broadly.

NX-AS-401 has received Orphan Drug Designation from the United States FDA for use against chronic Pseudomonas aeruginosa-caused lung infections in cystic fibrosis.

Preparations are underway for a firstin-human clinical trial, scheduled to begin in 2018.

www.neembiotech.com

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Morffi technology improves assay sensitivity and performance BBI Solutions is a leading supplier of biological raw materials and finished test platforms to the in-vitro diagnostic market. The Cardiff-based company’s latest innovation is Morffi Signal Enhancement technology – a patent pending novel conjugation technology, which has been developed in-house at BBI by Welsh scientists. Morffi enhances the sensitivity of lateral flow immunoassays (LFIs), opening up opportunities for LFIs to compete with traditional lab testing platforms, which are often complex, lengthy and expensive.

Tested on over 30 conjugates, the technology can provide an up to 10x increase in sensitivity compared to

doctors’ surgeries and home use tests, as diagnosis and screening are made more cost effective and time efficient.

traditional gold conjugates. It works by increasing the availability of antibodies on the label surface, which in turn enhances the opportunity for binding between the antibody and the target analyte in the sample matrix. This method reduces time to result and is advantageous for many

LFIs are simple yet powerful diagnostic tools used for an extensive range of laboratory and point-of-care applications.

The simplicity of these tests allows them to be performed by both skilled laboratory staff and non-medically trained people.

Development of a more sensitive test will help to improve the diagnosis and subsequent treatments of a range of pointof-care tests, such as those for infectious diseases and critical illnesses (e.g. HIV, TB, flu and heart disease) where time to result and accuracy are critically important in determining patient outcome.

www.bbisolutions.com

New pocket Doppler and fetal monitor launched Huntleigh has launched a new handheld pocket Doppler to provide audio representation of the fetal heart and accurate determination of the fetal heart rate (FHR). As well as large number format it can also display a cardiograph.

The device uses state-of-the-art signal processing, which provides crisp definition audio by eliminating noise and hiss caused by electronic thermal effects.

It also makes use of new correlation techniques operating in the frequency domain to offer highly accurate FHR determination.

The pocket Doppler incorporates a timer system to prompt midwives to perform auscultation every 15 minutes, which is a clinical requirement during labour.

Measurements can be stored locally and transferred to a central monitoring software database for convenient permanent records.

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for manual records. The inbuilt ability to record measurements when out in the community or away from the normal clinical setting allows for later download into electronic patient records. Huntleigh’s new Doppler has recently won the prestigious iF Design Award.

Although handheld Dopplers with FHR display have been on the market for many years, first introduced by Huntleigh, the new device helps clinicians to record their activity electronically, reducing the need

Another new innovation from Huntleigh is the Team3 range of advanced fetal and feto-maternal monitors, which has recently been released for sale. The primary purpose of these monitors is to monitor and record FHR and contractions in order to create a cardiotocograph.

This is the first fetal monitor to have technology to measure blood pressure during cuff inflation and to be clinically validated for use in pregnancy. In addition, the TREND function, for use in labour, provides clinicians with clear graphic trend data of key labour trace features, which could save lives and reduce costs to the NHS by minimising negative outcomes.

www.huntleigh-diagnostics.com

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PET scanning for more Welsh cancer patients The Wales Research and Diagnostic PET Imaging Centre (PETIC) is a state-ofthe-art Positron Emission Tomography Centre, providing a clinical service to all the health boards across Wales, as well as a regional paediatric imaging centre for the English NHS. The Centre produces radioactive pharmaceuticals that emit antimatter, which are used to produce diagnostic scans that are critical to the management of certain types of cancer, lymphoma and epilepsy.

PET scanning improves the accuracy of diagnosis and staging in a range of cancers and also reduces the number of

futile surgical interventions and biopsies.

However, prior to the launch of PETIC, Welsh patients had to travel to Cheltenham for PET scans, and as a result, PET scanning was underutilised in Wales. Since the launch of PETIC, demand in Wales has increased from 1,000 to 2,400 scans per year. This has significantly improved the management of patients with lung, anal, colorectal, oesophageal and head/neck cancers as well as lymphoma.

(Belgium) to introduce novel technology to manufacture the radioactive isotope 68Ga using a cyclotron, in order to increase product yields and patient throughput, whilst reducing costs to the Welsh NHS.

Leading on the introduction of 68Gallium DOTA imaging, which will revolutionise the management of neuroendocrine tumors, PETIC has obtained approval for a first national neuroendocrine PET service in the UK. This has the potential to improve diagnostic accuracy and allow the development of a novel theranostic platform. They are partnering with IBA www.cardiff.ac.uk/wales-research-diagnostic-pet-imaging-centre

First UK proton beam therapy for cancer to open in Wales The company has also announced plans to build the first proton beam therapy centre in the United Arab Emirates. The fact that the first UK centre will open in Newport is a coup for the life sciences industry in Wales.

South Wales based Proton Partners International is developing proton beam therapy centres to improve the provision of cancer treatment and transform patient care.

Proton beam therapy is a more targeted form of radiotherapy, which can reduce damage to surrounding tissue and treat hard-to-reach cancers more effectively. It is estimated that around 10% of patients who receive traditional radiotherapy would be better treated with protons. Proton Partners believe that cancer patients deserve the best possible care, without needing to leave the country or spending

huge amounts of money. Therefore the company’s aim is to make proton beam therapy a treatment available on a suitable scale within the UK. Proton Partners intend to build seven proton beam therapy centres in the UK and five internationally. Three are currently being built in Newport, Northumberland and Reading, and two others are in planning.

In addition to proton therapy, each centre built by Proton Partners will offer traditional radiotherapy, chemotherapy, imaging and wellbeing. There are plans for the centres to become cancer research hubs, where patient experience will be used to drive improvements in cancer technology and ensure that the centres’ services are always evolving. Following the opening of their cancer treatment centres in the UK, Proton Partners will undertake a major genomics programme to collate, analyse and distribute data from the centres, demonstrating the capabilities of proton beam therapy.

www.proton-int.com

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Vivi helps clinicians better focus in surgery The first medical device to have been launched by Bay Innovations, a startup founded as a collaboration between Swansea University and two Consultant Anaesthetists at Morriston Hospital, is Vivi – a compact wireless head-mounted display system.

It allows doctors, nurses and paramedics to maintain continuous situational awareness of patient vital signs, such as blood pressure, heart rate and oxygen levels, while they are engaged in clinical procedures or patient transfers. This improves patient safety by enabling clinicians to focus more attention on the patient and also respond more rapidly to any emergencies that may arise during a procedure. It interfaces with existing medical monitoring technologies, and the low cost makes it viable as a disposable device to comply with hospital policies for prevention of cross-infection.

secure Bluetooth connection. Its settings and interface are controlled through an accompanying app, which can be programmed by the clinician to meet their own requirements. The high contrast display is clearly visible in a wide range of ambient lighting conditions, and a head strap ensures that images are stable no matter how much the wearer moves around. Vivi’s simplicity means that it has a longer battery life than other products in its class.

In a clinical environment, monitoring equipment is reliable but not always in a clinician’s line of sight and can sometimes even be obscured by other team members involved in the procedure. This means that a clinician is constantly referring to equipment, which diverts their attention away from the patient. Vivi tackles this problem by enabling healthcare professionals to maintain situational awareness in the clinical environment, without having to look away from the patient.

Vivi can be worn unobtrusively over either eye, or over glasses, and works with a smartphone or computer via a

www.vivi.vision

Significant growth for Sharp Clinical Services Sharp Clinical Services is a leading provider of specialist clinical supply chain services, from drug product development and manufacturing services through to complex clinical supplies packaging, clinical labelling and clinical distribution services.

Their facilities, based in Crickhowell, Powys, are MHRA licensed conforming to the EU clinical trials directive and the company is able to manage the complete manufacturing and distribution needs for all phases of trials. They supply clinical trial supply chain solutions to more than 30 countries over four continents.

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The past year has been a period of sustained growth at Sharp Clinical Services, exceeding their target of 10% profit growth with a figure of 33% ultimately being realised. The company added new key distribution depots in Asia and Eastern Sharp Clinical Services have seen significant growth in both profit and turnover due to the development of commercial packing, in addition to a 50% growth in online quote requests because of increased activity on the company’s website and social media.

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Europe to their audited network and increased their customer base by 20%.

They also took on ten new members of staff and finalised a £9.5 million expansion plan.

This will enable them to move to a bespoke new site with around three times the capacity of their current facility.

They have also focused on developing markets such as Eastern Europe, Israel and South America, as there has been a significant increase in the number of clinical trials being run in these markets.

www.sharpservices.com

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Export success for Dynamic Extractions

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Dynamic Extractions, a Tredegar based spinout of Brunel University, aims to be a global leader in science, engineering and provision of its unique Hydrodynamic Counter Current Chromatography technology. Over the past year, they have increased their exports by 378% as a result of introducing a new range of products.

Historically, the company’s technology was seen as a laboratory based tool, so the route to increasing use and sales was through commercial and industrial applications. This led to the development of a new large scale processor and other enabling products. The market was prepared through strategic new distributorships in the first target industrial markets.

Dynamic Extractions have seen a rise in the number of technical sales enquiries and potential new customers due to forming agreements with key distributors in China and India. With support from the company, these distributors are investing in and setting up customer demonstration and

testing laboratories, as well as service and maintenance capabilities. This is part of a plan for strategic centres of excellence around the world, which customers in these locations require in order to test and validate the technology.

www.dynamicextractions.com

Supporting clinical development around the world As a leading manufacturer of sterile single-use surgical instruments, DTR Medical is involved increasingly in supporting clinicians who are helping in the development of services around the world. In areas such as South East Asia and Africa, health services are still being developed, so the assistance that leading clinicians with the right equipment can give has a tremendous impact.

DTR supports All Ears International in their mission to prevent, mitigate and relieve ear disease and hearing loss in Cambodia and South East Asia. Ear health receives little or no attention in these areas, with chronic ear disease and deafness being common among adults and children alike.

The Swansea-based company has helped by donating Crocodile & Tilley Aural Forceps, Formby & Jobson Probes and Zoellner & Clearway Suction Handles. The Micro Suction range of Verhovens and

Cream Applicators has proved valuable for removing wax and applying creams and ointments.

In addition, DTR has provided single-use instruments for gynaecology (specifically colposcopy) in Ghana, where an improved cervical cancer service is the main objective, for ENT surgeons working in Malawi and for training medical staff in Ethiopia and Africa. DTR has also been involved in the design and development of the LLETZlearn Training Simulator - a device which gives practical help to people learning how to perform cervical biopsies and loop electrode excisions.

LLETZlearn has so far been active in many countries including the UK, Ireland and Iraq, with very successful results.

www.dtrmedical.com

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Antibodies developed to fight the deadly Ebola virus West Wales based MicroPharm has developed promising ovine (sheepderived) polyclonal antibodies in collaboration with Public Health England (PHE) to tackle deadly diseases. The company has also won investment from Flynn Pharma, a specialist pharmaceutical company which has acquired a majority shareholding in the SME. MicroPharm is currently concluding the evaluation of its three lead products.

PolyCAb is in Phase I whilst OraCAb and EBOTAb are at the pre-clinical stage.

PolyCAb is to be administered by injection to treat severe infections by the “hospital superbug” Clostridium difficile. OraCAb is to treat non-severe infections and high-risk patients through the oral route.

The company has won two awards from Innovate UK and two SMART awards from the Welsh Government to complete pre-clinical and Phase I evaluation of these products in collaboration with PHE and the University of Leeds.

EBOTAb was developed by MicroPharm, PHE and the University of Oxford during the Ebola crisis. EBOTAb has been successfully tested in vitro and in vivo and has the potential, if successfully evaluated and approved for human use, to become a therapeutic option similar to ZMapp, but at a lower cost.

MicroPharm’s collaboration with PHE was recently put in the spotlight as an example of best practice in knowledge exchange and commercialisation, and led to PHE winning the latest “Impact Award for Contribution to Society” from the Research Councils UK.

“If found to be safe and effective, it could be a rapid and affordable treatment option for Africa and also globally. PHE and MicroPharm, between them, have filed six families of patents to protect these three products” Professor Seshadri Vasan PHE’s senior business development manager

www.micropharm.co.uk

UK’s first company to manufacture and sterilise medical devices on-site Pelican Feminine Healthcare, part of the Eakin Group, has strengthened its position within the UK women’s health sector thanks to investment in a new Axis AX-10 Series sterilisation unit.

The investment of over £400,000 means Pelican Feminine Healthcare can now not only manufacture medical instruments on its site in Cardiff, but sterilise them as well, making it the only company in the UK capable of doing so.

The sterilisation unit uses Ethylene Oxide (EtO) to ensure products are 100% ready for medical use and can handle a much wider range of materials compared to steam and dry heat processes. This includes heat and non-heat resistant materials, rubber,

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“Having this capability enables us to provide a quicker response to our customer’s requirements and lowers the carbon footprint by eliminating the 450 mile round journey for sterilisation.

It is also planned that the excess capacity of the chambers can be utilised by other Welsh companies assisting medical device business development within Wales.”

Richard Carter Managing Director, Pelican Feminine Healthcare

metal, mechanical and electromechanical materials, surgical materials and laboratory equipment.

Ethylene Oxide destroys microorganisms by alkylating (attaching to) enzymes and DNA and can operate in low temperatures.

Among its many advantages is the fact that it doesn’t deform the sterilised materials and is ideal for biomedical thermosensitive materials. It can penetrate inaccessible places of the materials and is very effective as germicide, fungicide and antivirus. It also provides enhanced safety for the user due to negative pressure in the tank and low gas consumption.

www.pelicanfh.com

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