health business 15.2

SURGICAL ROBOTS MODULAR BUILDINGS

PLUS: ENERGY • MEDICAL FURNITURE • HEALTHCARE IT • MENTAL HEALTH • PARKING

FINANCE

VOLUME 15.2www.healthbusinessuk.net

The importance of clear signage in hospitals

VITAL SIGNSWAYFINDING

How the smarter use of modern technology is transforming patient care

MOBILE TECHNOLOGY

EMPOWERING TECHNOLOGY

Delivering 21st century care and peak-time service: the role of flexible labour in the NHS

THE ROLEOF RETENTION

RECRUITMENT

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entHEALTH BUSINESS MAGAZINE ISSUE 15.2

SURGICAL ROBOTS MODULAR BUILDINGS

PLUS: ENERGY • MEDICAL FURNITURE • HEALTHCARE IT • MENTAL HEALTH • PARKING

FINANCE


The importance of clear signage in hospitals

VITAL SIGNSWAYFINDING

How the smarter use of modern technology is transforming patient care

MOBILE TECHNOLOGY

EMPOWERING TECHNOLOGY

Delivering 21st century care and peak-time service: the role of flexible labour in the NHS

THE ROLEOF RETENTION

RECRUITMENT

© 2015 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541

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PUBLISHED BY PUBLIC SECTOR INFORMATION LIMITED226 High Rd, Loughton, Essex IG10 1ET. Tel: 020 8532 0055 Fax: 020 8532 0066 Web: www.psi-media.co.ukEDITOR Angela Pisanu EDITORIAL ASSISTANT Michael Lyons EDITORIAL DIRECTOR Danny Wright PRODUCTION EDITOR Richard Gooding PRODUCTION CONTROL Jacqueline Lawford, Jo Golding WEBSITE PRODUCTION Reiss Malone ADVERTISEMENT SALES Alexander Baker, Jeremy Cox, Jayne Dula, Patrick Dunne, Ben Plummer ADMINISTRATION Victoria Leftwich, Vickie Hopkins PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

After the election, how will the NHS cope with the next five years?Whatever Government happens to be in control after the next election, it is almost certain to face an uphill struggle against continuing financial problems in the NHS. Some are predicting that three-quarters of trusts will reach the end of this financial year in debt, amounting to an expected £1bn.

Chris Hopson, chief executive of NHS Providers, told the Guardian: “There’s a real danger that the strategic deterioration could speed up and get out of control. The next government will inherit a health service under huge financial pressure, with deficits among hospitals and other providers likely to increase sharply in 2015-16 despite the additional funding for the NHS announced in the Autumn Statement,” he said.

During George Osbourne’s hour-long budget speech on March 18, the NHS was conspicuous by its absence. According to opposition leader Ed Miliband, the Tories are concealing a secret plan to make huge NHS budget cuts. What Osbourne was able to confirm was an additional £1.25bn will be spent on a much needed expansion of mental health services for children and mothers of new babies over the next five years.

In NHS England’s Five Year Forward View, chief executive Simon Stevens predicted a £30bn deficit by the end of the decade, although £22bn of this can be saved by changing the way the NHS works. For acute hospitals, the latest Kings Fund report suggests that closer working with local partners is essential (see page seven for more details of the Kings Fund report Acute hospitals and integrated care: from the hospitals to health systems). Danny Wright

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

3 Volume 15.2 | HEALTH BUSINESS MAGAZINE

Delivering paperless health care

“The right file for the right patient at the right time –

100% guaranteed”

“Patient care and clinical effectiveness

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Contents

LEGIONELLA

PLUS: FACILITIES MANAGEMENT • ASBESTOS • PATIENT SAFETY • SIGNAGE • SECURITY

ENERGYHEALTHCARE IT


A look at healthcare commissioning since the introduction of the Health and

Social Care Act

PROCURING HEALTH SERVICES

FINANCE

Mandatory food standards in the NHS contract for the first time

CATERING

RAISING FOOD QUALITY

Advice for identifying and managing possible Ebola-infected patients

EBOLA VIRUS DISEASE

INFECTION CONTROL

WAYFINDING

PLUS: FINANCE • LEADERSHIP • RECRUITMENT • SECURITY • FLEET MANAGEMENT

INFECTION CONTROL

OCCUPATIONAL HYGIENE

VOLUME 14.5


A look at the NHS post-Francis Report

PATIENT SAFETY

MEASURING THE

FRANCIS EFFECT

The DH’s recently updated guidance

on NHS parking principles sparks

up the debate

TO PAY OR

NOT TO PAYPARKING

How supermarket-style check

out systems can be used in

healthcare to improve safety

TRACKING

TECHNOLOGYHEALTHCARE IT

AMBULANCES

PLUS: DESIGN & BUILD • ENERGY • FLEET MANAGEMENT • HEALTHCARE EVENTS • TRANSLATION

HEALTHCARE IT

LITIGATION


Making sure healthcare waste does not pose a risk to public health or the environment

WASTE MANAGEMENT

BINNING CLINICAL WASTE

Using technology to deliver savings and increase transparency

E-PROCUREMENT STRATEGY

PURCHASING

The first line of defence for infection control

HAND HYGIENE

INFECTION CONTROL

LANDSCAPING

PLUS: HEALTH & SAFETY • ENERGY • FACILITIES MANAGEMENT • FLEET MANAGEMENT

DESIGN & BUILD

ERGONOMICS

VOLUME 14.2


Effective wayfinding is important for

patients, staff and visitors alike

SIGNAGEFINDING YOUR WAY TO

BETTER HEALTH

What issues might a hospital face when

going ‘paperless’ and sharing patient records across

Primary and Secondary Care boundaries?

OVERCOMING PAPERLESS HURDLES

HEALTHCARE IT

PROCUREMENT

PLUS: MARKET RESEARCH • LONE WORKER PROTECTION • FLEET MANAGEMENT & MORE

REFURBISHMENT

ENERGY

VOLUME 14.3


Cost-cutting can put vulnerable patients

at risk, says the Building and Engineering

Services Association

LEGIONELLA

MAKING

WATER SAFE

Harnessing technical innovations to

help keep hospitals bug-free

INFECTION

CONTROL

CLEANING

Bringing together clinicians,

commissioners, providers and social

care teamsHEALTH + CAREEVENT PREVIEW

Health Business www.healthbusinessuk.net

CONTENTS



07 NEWS Partnerships the key to delivering acute care improvements, says Kings Fund; Barts placed in special measures; work on Papworth begins after EIB agrees £46m funding; GPC chair calls on CCGs to take steps to reduce workload 11 FINANCE Peter Shand, director of The Local Improvement Finance Trust explains the impact of the LIFT programme which improves facilities for local primary care and community services 15 RECRUITMENT The NHS is currently battling through a retention crisis. Vicky O’Brien, policy advisor at the Recruitment and Employment Confederation, analyses flexible labour and contingent labour as a method of aiding the NHS at peak times 19 ENERGY Chris Hall, health sector lead at BRE, discusses the new BREEAM products and Mid park Hospital in Dumfries, the BREEAM health awards winner, ensuring that healthcare environments are safe, supportive and user-friendly 25 PARKING Kelvin Reynolds, director of policy and public affairs at the British Parking Association, discusses the latest challenges caused by government guidelines, and analyse the importance of customer experience through hospital car parks 29 NURSING TECHNOLOGY Following a second round of funding allocated from the Nursing Technology Fund, NHS England’s Beverley Bryant looks at how the smarter use of modern technology is transforming patient care

37 E-HEALTH WEEK REVIEW A packed conference of health ministers and the Chief Executive and Medical Director of the NHS made sure that was the message delivered to delegates at the first ever UK e-Health Week

41 SURGICAL ROBOTS Though a fairly new but rapidly evolving interdisciplinary field, robotic systems have already been tested for tele surgery and have been widely explored in almost all surgical disciplines. Geethu Roshan Verghese, research analyst at Frost & Sullivan, reports 45 MENTAL HEALTH With one in ten children needing support or treatment for mental health problems, the government has announced a five year plan to improve services, along with a funding boost from the recent budget

49 FURNITURE When it comes to furniture and mental health, there is more than initially meets the eye, says Dr Evangelia Chrysikou, director of research at the Design In Mental Health Network 53 MODULAR BUILDINGS Hospitals are struggling with high patient demand and a severe lack of bed space. The MPBA’s Jackie Maginnis examines how the modular and portable building industry can help the situation 57 SIGNAGE Jill Joyce from the Institution of Occupational Safety and Health, discusses the importance of clear signage in hospitals – and the many aspects to bear in mind to get it right 60 PRODUCTS & SERVICES Products for the healthcare sector

09

29

41

Delivering paperless health care

“The right file for the right patient at the right time –

100% guaranteed”

“Patient care and clinical effectiveness

enchanced”

“Annual savings of £1.4m with the CCube

scan‑on‑demand solution”

“The system architecture enables easy integration with patient information systems”

Do you want compliance?

Do you want process efficiencies?

Visit www.ccubesolutions.com

Enterprise Software

2013 Winner

Advisory Trade Member

Call us now on 01908 677752 or email [email protected]

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New

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INTEGRATED CARENEWS IN BRIEF

Hitchingbrooke back to NHSHinchingbrooke Health Care Trust, which was formerly managed by private sector firm Circle and placed in special measures in January, is to return to traditional NHS trust legal and governance arrangements from 1 April. Oversight of Circle’s contract was described as “poor and inadequate” in a highly critical report by the Commons public accounts committee, published earlier this week.

Devolution on the menu for LabourLabour says it will back and continue the devolution plan for the NHS in Greater Manchester if they win the general election. Following last month’s announcement for a £6bn health and social care budget by Chancellor George Osborne, Greater Manchester is set to be the first region to gain control of health and spending.However, the declaration doesn’t have the support of all of the party. Andy Burnham, shadow health secretary, claimed that devolution would create a “Swiss cheese NHS where some bits of the system are operating to different rules or have different powers and freedoms.”The Greater Manchester NHS plan is due to come into force in April next year with a shadow Greater Manchester Health and Wellbeing board planned to run from April this year.

NHS Confederation questions NHS finances after budget The NHS Confederation has called for a debate on NHS finances following the pre election Budget on 18th March, in which the Chancellor acknowledged the financial challenges facing the NHS. George Osborne confirmed an additional £2 billion of NHS funding in the Autumn Statement, and announced an additional £1.25 billion investment in mental health services. Rob Webster, head of the NHS Confederation warned that years of “punishing price cuts” for providers are taking their toll on NHS care. There is a good chance the additional money in commissioners’ budgets might only just cover the increase in demand, and be insufficient to cover improvements,” he said.

Partnerships the key to delivering acute care improvements, says Kings FundA new Kings Fund report into Acute hospitals has detailed their achievements and outlines recommendations for government policy makers. Acute hospitals and integrated care: from hospitals to health systems includes five case studies where acute hospitals are working in collaboration with local partners to develop integrated models of care. For acute hospitals, the report suggests that working more closely with local partners will be necessary to achieving the vision set out in NHS England’s Five Year Forward View. It further recommends that creating integrated service models that operate effectively over all organisational boundaries will contribute to acute hospitals playing a fundamentally different role within local health economics. Responding to the King’s Fund report, NHS Confederation director of policy Dr Johnny Marshall said: “This welcome report reinforces what we have been saying for some time – that all NHS bodies, including acute trusts, need to look beyond the boundaries of their own organisation, and work with key partners, including local government, to improve the health and wellbeing of their local communities. “There are many examples of this kind of leadership across the health service but we need Government to support this approach – stability is key to building these local partnerships. The next Government must avoid another top down reorganisation of NHS structures at all costs.” The report outlined three scenarios in which the future of acute hospitals may lie. Firstly, as the worst case scenario, acute hospitals would retreat to a ‘fortress mentality’. Secondly, the situation at presenting the Kings Fund case studies, acute hospitals as integrated care systems, working with local partners to provide coordinated care to those with the greatest need. Lastly, the report outlined a best case scenario, in which acute hospitals went beyond the integration of care services for

patients, to improving the broader health of the local population.The five hospitals featured in the case studies were Northumbria Healthcare NHS Foundation Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Airedale NHS Foundation Trust, Yeovil District Hospital NHS Foundation Trust, and South Warwickshire NHS Foundation Trust. Each site was recognised as having made encouraging progress in developing more integrated models of care. Chris Naylor, senior fellow at the King’s Fund and an author of the report along with Hugh Alderwick and Matthew Honeyman, said: “We are seeing an important shift in thinking in some acute trusts. However, the picture varies across the country, and even in those areas where most progress has been made, there is still a long way to go before the new models of care described in the Forward View can become a reality.” In January, the NHS invited individual organisations to apply to become ‘vanguard’ sites for the New Care Models Programme, one of the first steps towards delivering the Five Year Forward View. More than 260 individual organisations expressed an interest, and on 10 March, the first wave of 29 vanguard sites were chosen. Each site will take a lead on the development new care models. For more details about the vanguard programme, email [email protected]

INSPECTIONS

Barts placed in special measuresThe countries’ largest NHS hospital trust, Barts, has been placed into special measures following an investigation by the Care Quality Commission (CQC). The CQC discovered a culture of bullying and low morale among staff at Leytonstone’s Whipps Cross University Hospital. The CQC report also revealed a failure to meet national waiting time targets, insufficient staffing levels, and high bed occupancy. Under the special measures program, Whipps Cross must develop a stronger leadership team, with a managing director, a director of nursing, and a medical director, responsible for the day to day running of the hospital. Trust chief executive Peter Morris said: “We are very sorry for the failings identified by the

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CQC in some of our services at Whipps Cross and we know the Trust has a big challenge ahead. We will take all the necessary steps to raise quality standards at Whipps Cross.”

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Work on Papworth begins after EIB agrees £46m funding

HOSPITAL BUILDING

£46 million of funding for the new 310-bed Papworth Hospital is to be provided by The European Investment Bank (EIB). The money will be used to fund the Cambridge Biomedical Campus next to Addenbrooke’s Hospital. Construction will start on site immediately and the new hospital will be open to patients in early 2018. The new Papworth Hospital will have 310 beds providing combining inpatient, day case and critical care and almost all inpatient rooms will be single bedroom accommodation with en-suite facilities that will significantly increase both patient privacy and flexibility. The 31 year loan is the third new hospital to be supported by the EIB in UK this year following support for the new Royal Hospital for Sick Children in Edinburgh and the Dumfries and Galloway Royal Infirmary. Jonathan Taylor, European Investment Bank vice-president, said: “Moving Papworth to the new site will improve collaboration on the Cambridge

Biomedical Campus and strengthen a wide range of specialist medical research.” Health Minister Lord Howe said: “Many patients are already benefiting from the role the European Investment Bank has played in important hospital building schemes, such as Alder Hey Children’s Hospital in Liverpool and the new Southmead Hospital in Bristol.” Papworth Hospital is the largest providers of cardiothoracic healthcare in the UK and a leading global centre for development of new heart and lung disease diagnosis and treatment. Many clinicians at Papworth participate in research and the new hospital will build on this. Construction of the new Papworth Hospital on the Cambridge Biomedical Campus will make a contribution to strengthening Cambridge’s role as a world class centre for clinical and biomedical science. The new purpose-built buildings with have state of the art facilities.

The government, major pharmaceutical companies and Alzheimer’s Research UK are due to invest $100 million (£68 million) in the Dementia Discovery Fund.The announcement was made at the World Health Organisation’s (WHO) First Ministerial Conference on Global Action Against Dementia by health secretary Jeremy Hunt. The fund, which will be developed in the coming months, will be invested in by pharmaceutical companies Biogen, GlaxoSmithKline, Johnson & Johnson and Lilly and Pfizer. Prime Minister David Cameron said: “If we are to truly defeat this devastating disease, there must be a bold and determined global effort to invest in medical research. This fund is a major step forward in this effort.”

Dementia Research fund announced

DEMENTIA

HEALTHCARE IT

The chair of the General Practitioners Council has called upon Clinical Commissioning Groups to put measures in pace to stop unfunded work being transferred to primary care. Dr Chaand Nagpaul called on every CCG to create service specifications that included strict measures such as a ban on hospitals asking patients to see their GP for a re-referral after failing to attend an outpatient appointment and mandating every Med 3 discharge to cover a patient’s full recovery. Speaking at a conference organised by Pulse, Dr Nagpaul said he had written to CCG leaders urging them to support practices whose workload was unsustainable.” He told delegates: “Some of this is not just the work, it’s work that is really outside a GP’s competence – GPs are prescribing drugs we shouldn’t and providing treatments we’re not

to competent to because we’re faced with the patient. There are things CCGs can do to put an end to this avalanche of unresourced work.” Dr Nagpaul cautioned GPs over signing up for co-commissioning, expressing concern that they could end up ‘at the mercy’ of local contracts that may allow them to drop the Quality of Outcomes Framework, but could mean working harder for the same pay. He said: “In a local contract, who would GPs turn to? You would have to be very confident in the relationship with your CCG.” Asked about the impact of the 2004 contract on the current loss of partners, Dr Nagpaul also admitted that some of the problems general practice now faces related to ‘the way the 2004 GP contract was implemented’.

Kelsey calls for free wifi across the NHS

LIVER DISEASE

GPC chair calls on CCGs to take steps to reduce workload

NHS England’s National Director for Patients and Information Tim Kelsey has suggested that the NHS should install free wireless internet across its entire estate. Speaking to delegates at an NHS England event run by the Tinder Foundation, Kelsey offered his personal view on the need to roll out free wi-fi access more widely: “What I’m saying is in my view, and something I hope we will all be lobbying the next administration over, is that the NHS has a very important role to play in thinking about how it can use its physical estate better to support people who want to get involved digitally but are currently unable to afford broadband or don’t have access to the internet.” Kelsey revealed that some NHS organisations are already working to implement free wi-fi, which could help to reduce digital inequalities by improving internet access. “The idea that we have got this vast estate and we are not using it itself as an instrument of social transformation seems to be a bit of a lost opportunity, when even the London Underground is capable of installing wi-fi at no marginal cost to it, because of course industry wants to get involved.”

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Written by Peter Shand, director of strategy, the LIFT Council

The Local Improvement Finance Trust (LIFT) initiative is a Government-endorsed finance scheme based on long term joint ventures at national and local level to improve investment in primary and community facilities. It was introduced by the Department of Health in 2000 with the aim of attracting a total of up to £1 billion of private investment by 2010. Already more than £2.3 billion of funding has been injected into GP premises and other community facilities. Over 500 GP practices have been accommodated in new, purpose built premises through the programme and patients have benefited from raised standards, additional capacity and co-location with other service providers. This means that local LIFT companies (LIFTCos) have the relevant experience. NHS England chief executive Simon Stevens set out a vision in a recent interview in the Financial Times, in which he called for an increase in multi-use facilities to help improve public health and control rising costs, as well as leading on integration between health and social care. LIFT is well placed to support this vision.

WORKING FOR LOCAL NEEDSThe success of LIFT as a partnership model was highlighted in a 2012 report by the National Audit Office on the Lessons from PFI and Other Projects, when it was noted that: “Achieving better outcomes for less also requires an ability to work collaboratively with the private sector. NHS Local Improvement Finance Trusts, for example, also act entrepreneurially to build local partnerships between public bodies, such as NHS Trusts and local authorities, and think creatively about the needs of their local area to help bring about the co-location of services.” Furthermore, the LIFT model was also formative in the creation of the Private Finance 2 initiative (the follow-up to PFI) which HM Treasury announced in 2012 and which mirrors LIFT in many crucial ways, including public sector shareholding and representation on project Boards. In a session with the Business, Innovations and Skills Select Committee in 2013 Geoffrey Spence, chief executive of Infrastructure UK, noted that

LIFT companies had a “better sense of partnership” with the public sector than other Public Private Partnerships (PPPs) and that this was something that the government was looking to replicate through PF2. LIFT was also set up with the aim of attracting investment into the most deprived areas of the country, which may otherwise not have had access to high quality healthcare facilities. In total, £891 million has been invested in the 10 per cent most deprived areas of the country, with £1.34 billion invested in the 20 per cent most deprived. Over 30,000 people have been employed by LIFT schemes nationally, and 80 per cent of construction spent has been on local businesses, highlighting LIFT’s significant contribution to local economies.

PUBLIC-PRIVATE PARTNERSHIPOne of the major benefits of

LIFT is that the local LIFTCo recommends and supports

the development a Strategic Services Development Plan (SSDP) from which E

HEALTHCARE ESTATES

FUNDING FOR LOCAL HEALTH INFRASTRUCTUREThe Local Improvement Finance Trust aims to improve facilities for primary care and community services that best meet the needs of local populations. Peter Shand, director of strategy at the LIFT Council explains the impact of the programme and future challenges

Finance

The Integrated

Care Centre in

Oldham is a new

facility incorporating

multi-specialty

services as part of

the local service

strategy


11

it is possible to identify where the current infrastructure provision is constraining the delivery of improved services. Drawing on local population data and the service delivery plans of the local public services providers, the SSDP underpins the estate development and management plan and allows the local NHS to point to areas where investment is required or where shifts in service delivery can be accommodated. From this infrastructure review and reform comes the flexibility to implement new models of care and facilities that can often be used by a large number of providers including secondary care trusts. Plans are then signed off by Strategic Partnering Boards made up of representatives of the local public sector and private sector partners who are also accountable for the success of schemes.

CONTINUITY AND SUPPORTWith a LIFTCo being established and part of the structure within its specific locality for at least 25 years they are part of the community and committed for the long haul of ensuring there is high quality estate in place, no matter which provider is contracted to deliver a service. With full maintenance and life cycle replacement covered under LIFT agreements, for the full term of the lease, the estate will remain in excellent condition even after 25 years with none of the backlog maintenance issues that the majority of the public estate suffers from. Moreover, the corporate and historical knowledge obtained through their work in their localities has placed LIFTCos in an excellent position to provide continuity and support in the future design of service and estate strategies for their local areas. As partnerships have developed over time LIFTCos have also provided more of their ‘Partnering Services’ to the local health sector, including consultancy, business cases, advisory services and extension of facilities management commitments. However much depends on leadership priorities within various localities meaning that there is a mixed picture across the country in how local areas seek to utilise LIFTCo expertise. With the experience and expertise that exists within local LIFTCos we believe that public sector partners should be actively looking to partner with our members to design estates and service strategies fit for their local population.

INTEGRATED CARE CENTRE, OLDHAMAn example of a new facility incorporating multi-specialty services as part of the local overall service strategy is the Integrated Care Centre (ICC) in Oldham, part of the Community 1st Oldham LIFTCo. The ICC is an eight-storey building in the centre of Oldham adjacent to the public transport bus terminal, Greater Manchester tram route and main link road from the M60.

The services provided from this one central location include GP surgeries, unscheduled care, dentistry and primary out of hours services. The ICC also accommodates services for district nursing, pharmacy, radiology, physiotherapy, occupational therapy, minor operations and orthoptics. Audiology and children’s audiology, podiatry, MSK, breast screening, family planning and child health, including children’s mental health services also operate from the ICC.

VALUE FOR MONEYTenants, such as GPs, occupy space in LIFT buildings under Lease Plus Agreements (LPAs), which differ from conventional leases as rents under LPAs cover whole lifecycle costs for the building as the landlord (the LIFTCo) is responsible for maintaining the premises to an operational standard throughout the

asset’s life. Rent increases are also limited to the increase in the Retail Prices Index (RPI) meaning that they are more predictable than under a conventional private sector lease. The Strategic Partnership Agreement, to which all partners in a LIFT scheme are signatories, requires the LIFTCo to demonstrate that it is delivering value for money in relation to new projects by market testing or benchmarking. Market testing is undertaken at minimum five-year intervals and in the first five years the LIFTCo is allowed to demonstrate value for money through the production of benchmarking data.

WHAT NEXT FOR LIFT?What is clear is that the LIFT model has brought about a number of positive changes to local healthcare economies and increased both choice and quality of care for patients with access to a range of services in often deprived communities. Despite this, there exists two key obstacles to further success. Since the passing of the Health and Social Care Act, there has been much confusion surrounding the responsibility for planning and commissioning new estates at a local level, and many CCGs have not looked to frame their service strategies with a view to the needs of the local healthcare estate. Even in areas which have looked to push ahead with plans for the estate, a lack of clear approvals guidance from NHS England has meant commissioners are unable to move forward on even ‘shovel ready’ projects.

The LIFT Council believes that efforts should be made at a local level to develop Local Estates Forums, modelled perhaps on LIFT’s Strategic Partnering Boards, to enable CCGs, Health and Wellbeing Boards, Local Area Teams, Commissioning Support Units, Local Authorities, LIFTCos and the local outposts of NHS Property Services to map estate needs and plan what is necessary to deliver Joint Strategic Needs Assessments and local service strategies. To ensure that these bodies become more than just a ‘talking shop’, we would encourage the government to define their roles in statute with these forums working towards clearing defined Key Performance Indicators. Whilst CHP is leading on a similar strategic grouping in some LIFT areas, more needs to be done to ensure forums are established across all LIFT, and non-LIFT, areas. In developing new premises the LIFT Council

believes that the conclusions of the discussions which take place in Local Estate Forums need quickly taking forward and operating within a streamlined authorisation process.

FUNDINGThe confusion in commissioning processes described above led to a complete freeze in all funding for primary care developments from NHS England early in 2014, whilst it looked to develop what is described as a ‘consistent national process to evaluate bids for funding’. This was finally lifted in the 2014 Autumn Statement as chancellor George Osborne announced a £1 billion fund, spread over four years, to help improve primary care infrastructure. We are pleased that further guidance published by NHS England in a recent letter to GPs has prioritised plans for funding that will extend service provision outside hospital settings, given the inherent experience of LIFTCos in already providing for such a shift in care. However, with much to do to bring the existing NHS backlog maintenance up to scratch (current estimates place the bill at around £4 billion) the £250 million annual fund will only scratch the surface of what is needed. L

The LIFT Council is the trade association for the private sector equity investors in Local Improvement Finance Trusts (LIFT).

FURTHER INFORMATIONwww.theliftcouncil.org.uk

Finance

HEALTHCARE ESTATES

In total, £891 million has been invested in the 10 per cent most deprived areas of the country, with £1.34 billion invested in the 20 per cent most deprived. Over 30,000 people have been employed by LIFT schemes nationally, and 80 per cent of construction spent has been on local businesses



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HEALTH BUSINESS MAGAZINE | Volume 15.214

Written by Vicky O

’Brien, Policy Advisor, Recruitment &

Employm

ent Confederation

Ahead of the general election, all three of the main political parties have committed in some shape or form to the integration of health and social care. However, we are yet to see any real detail or analysis of the workforce that will be needed to deliver this change.

Contingent labour plays an important role, enabling cover for last-minute absences, maternity cover and supplying extra resources during periods of peak demand. Agencies provide a service to ensure that hospitals can maintain safe staffing levels and meet

patient needs. Yet few people are asking what role contingent and flexible labour will need to play in the upcoming integration of health and social care services.

CONTINGENT LABOURAs NHS England’s ‘Five Year Forward View’ acknowledged, care will need to be delivered locally, and organised to support people with multiple, complex and chronic health conditions. A new flexible workforce will be needed – one capable of delivering personalised care across a variety of settings so that patients receive a consistent level of care whether they are on a ward or at home. The NHS will have to manage this flexible workforce. Surely staffing suppliers who are used to delivering workers who provide consistent, high quality care across a variety of settings, used to working hard to secure E

AGENCY STAFF

TACKLING THE NHS RETENTION CRISISVicky O’Brien of the Recruitment & Employment Confederation analyses the role of flexible labour in the NHS, not only in propping up the health service during peak times, but also tackling the retention crisis and delivering 21st century care

Recruitment

AGENCY STAFF



Case

Stu

dy

She can pay a bill, order a meal, or book a flight.

She lives online. But she can’t tell her GP that her

husband noticed frequent changes in mood, and

she’s worried. But frankly she doesn’t have time.

Until now.

With askmyGP she can connect with her own

GP practice, and choose a named GP she trusts.

Entering her concern, she answers a series of

questions which let her explain the problem in

detail. It’s confidential, and crucially it’s convenient,

so she can do it any time, and send it to the GP.

Within minutes, the practice is in touch, the GP

has taken a look and offered her a telephone call or

an appointment later today.

Just as they would for all their patients. And with

80% of us now owning a smartphone, more and

more are going to find askmyGP is the future.

Faster, easier access to your own GP.

Contact askmyGP. Visit online: askmygp.uk | Email: [email protected] | Tel: 01509 816 293

The ‘new’ thing sounds ever so like a new model of car. Everyone loves the sparkling finish, that factory fresh smell, and when you sit inside the mileometer still showing only two digits. What are the new gadgets this time? Electric windows and cd players are so twentieth century. The latest model is roomier, longer range, more economical, and presumably has wifi. But it’s still a car, and will get us from A to B in about the same time. This is my fear about new models of care – they are new structures, within which about the same care will be delivered by more or less the same people. I daren’t say the word reorganisation, because of course it can’t be one of those, whether visible from space or only from across the road. A new mode of transport would be a jet pack. We could leap with ease across lakes and over tall buildings. All the old assumptions and limitations would go, but it would matter little whether the jet pack came in red, white or blue, with or without adjustable armrests. Now, will the new models of care enable and encourage new modes? New ways of

delivering healthcare are certainly available, and new systems of organizing around patient demand rather than provider supply have shown spectacular outcomes. Yesterday I was at a north London GP practice who have consistently delivered a median response time of 11, between the new patient demand and speaking to a GP. Minutes that is. And it’s more efficient, ie less work per patient, meaning no one is turned away. That is with a system in which they understand demand, know how many GPs they need, when, and what to do. Anyone can do it, in any structure or model. We can now go further, get out of the jet pack and into the rocket. Online access for patients can further multiply GP productivity, and enhance patient empowerment and convenience. Some of the technology is new, but the GP-patient relationship remains at the heart of the NHS and we lose this at our peril. New models of care need to encourage new modes, with the same goals of better access and continuity of care which we’ve had before, and the will to measure and persevere in improvement.

FURTHER INFORMATIONTel: 01509 816293Email: [email protected]: askmyGP.uk

Online access can increace GP productivity and enhance the patient experience

Harry

Lon

gman



access to CPD, vetting and performance feedback for such a peripatetic, flexible workforce can offer some key insights. A lot of the debate so far with regards to contingent labour in the NHS has focused on the increasing use of and spend on agency staff, and how this reflects the current retention crisis hitting the NHS. The REC/KPMG Report on Jobs, featuring original survey data which provides a picture of recruitment, employment, staff availability and employee earnings trends, has shown an increase in the amount of health and social care vacancies being passed to recruiters for permanent roles. But we know that advertising for more permanent roles doesn’t mean that there will be enough candidates willing to fill them; hence the recent overseas recruitment drives. Demand for agency workers is stronger than ever. Our members tell us that they took lots of calls after Christmas from nurses who had got to the end of their tether and wanted to move into temporary work instead. Indeed, a majority of agency nurses have either had long careers as permanent employees in the NHS, or are combining temporary assignments with permanent roles as a means to develop experience in specialisms that they wish to transfer into full time. However, because of dissatisfaction with management, inflexible shifts and long hours, many of these highly skilled, experienced, caring people have made a decision to quit permanent NHS jobs completely. Last year we surveyed nurses who had made this switch and they said they preferred to work that way as it meant they can exert more personal choice over what wards they work in and how often they have to

switch between day and night shifts. Perhaps, therefore, the transfer away from ward politics and set institutional settings, as promised in the ‘Five Year Forward View’, will help ameliorate the current recruitment and retention crisis hitting the NHS. In the interim however, we are missing out if we do not reach out to agencies and their candidates to learn more about what motivates and guarantees the delivery of good quality compassionate care.

A GOOD STAFF EXPERIENCE The NHS National Quality Board recently released its framework ‘Improving experiences of care: Our shared understanding and ambition’, published in collaboration with NHS Improving Quality and the Health and Social Care Information Centre. It is one of a few initiatives that has emphasised how critical a focus on workforce leadership, management and wellbeing is to the delivery of compassionate care. Evidence included in the framework shows that organisations which deliver good experiences of care have workforces with higher levels of wellbeing as well as more satisfied patients and service users. One of its many recommendations is that organisations should “use the potential of their staff and focus on supporting staff to deliver a good experience”. So why are we not inviting the one section of the workforce – contingent labour – that has attracted so much attention in the press to the table? The use of flexible labour in the NHS looks set to stay, be it the continuing need for agency workers to cover gaps and fluctuations in demand or, more fundamentally, the

likelihood that this way of working is the only solution to tackling the retention crisis and delivering personalised 21st century care throughout a variety of community settings.

LEARNING LESSONSThe immediate lessons for now? A focus on HR processes such as induction, appraisal, prioritising staff engagement and morale, have all been strongly linked to improving people’s experiences of care. In terms of specific lessons to be learnt from the contingent labour workforce, take a lesson from the REC’s Chain Reaction report published in association with CIPS and the CIPD, which examined the effect supply chains have on recruitment and how HR, procurement and recruitment professionals develop more strategic working relationships to improve efficiency and quality in recruitment. The research revealed the organisational benefits of prioritising candidate experience and satisfaction – and indeed recommended that it is positioned as a contractual obligation between clients and their staffing suppliers. HR departments across the NHS should certainly be encouraged to be more assertive about the quality of the hire, the induction and integration processes they institute rather than seeing agency workers as merely cost units on a spreadsheet to be managed and ultimately minimised. There is also still a need for those using managed service providers to really extend their line of sight and scrutiny beyond the first tier to SME specialist suppliers. This is to benefit from their frontline knowledge and insights on recruitment and retention challenges and trends within each labour market, as well as the likely capacity of the local talent pipeline to deliver the new visions of integration and compassionate care. Part of this will necessarily involve NHS Trusts and suppliers collaborating to manage contingent staffing spend. The challenge is to guarantee that procurement agreements are an attractive and financially viable option for specialist SMEs. Therefore, the Department of Health needs to step up its investment in training for HR and procurement professionals beyond self-help toolkits to ensure effective, efficient and equitable contract management.

RECOGNISING THE STAFFThe NHS is its staff. As clichéd as its sounds, it bears repeating. Not only do staffing costs make up over 70 per cent of the NHS’ £110 billion annual budget, raising standards across health and social care in the future will depend on so much more than safe staff to patient ratios, or the creation of thousands of new training places. While there is certainly an urgent need for investment in national workforce planning, NHS trusts need to start recognising the role of contingent labour as an invaluable resource in building a sustainable NHS labour market. L

FURTHER INFORMATIONwww.rec.uk.com

Recruitment

AGENCY STAFF

Because of dissatisfaction with management, inflexible shifts and long hours, many highly skilled, experienced, caring people have made a decision to quit permanent NHS jobs completely



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Possible energy savings of 80% compared

to fluorescent• Fast return on investment, low energy

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• 50,000 hour life with consistent light output for the duration

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t: (01952) 238100e: [email protected]

Energy saving LED LuxPanelsIdeal replacement for fluorescent tubes

5GUARANTEE

year extended

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year on site

Ideal for use in: wards, corridors, offices, theatres,

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Written by Chris Hall, Health Sector Lead, BRE

BREEAM is the leading and most widely used environmental assessment method for buildings. It provides a methodology which delivers better environmental results, value, comfort and healthy outcomes for building users. It sets a standard against which the performance of buildings can be measured and independently certified, becoming the de facto measure used to describe a building’s environmental performance. For the NHS it is also a sign off requirement that capital projects over £2m in value (and all non-primary care buildings in Wales) are required to meet BREEAM minimum standards.

BREEAM AWARDS AND NOMINATIONS Some of the best performing buildings assessed under BREEAM’s sustainable buildings standard were recognised at the annual BREEAM awards celebration hosted by TV architect Charlie Luxton in London earlier this month. A panel of independent judges including architect Bill Gething, Claudine Blamey of the Crown Estate, Alan Cole of the Home Office, Mike Smith of BSRIA, Louise Sunderland of the UK Green Building Council and Thomas Lane of Building magazine selected the winners from a shortlist of the highest scoring buildings in each category. Their decision was based on the specific circumstances,

challenges and achievements of each development as well as the very

high BREEAM scores achieved.Over 50 ground-breaking

projects were shortlisted from across Europe with eight awards going to UK-based projects and four others shared equally between France and Norway. Five health facilities were shortlisted

under the BREEAM Healthcare category:

Cloughmore Medical Centre in Cardiff, Dumfries and Galloway

Acute Mental Health Unit, Lees Medical Practice in Oldham, Peterborough Primary Care Centre, Urgent and Emergency Care Centre, and New Cross Hospital in Wolverhampton. Dumfries and Galloway Acute Mental Health were named as the winner. Judges said they found this a difficult category to reach a decision on. The submitted projects were all well balanced projects with similar BREEAM scores although they covered a range of health sector buildings. In many ways there was little to choose between the projects but the judges felt that the Award should go to the Dumfries and Galloway Acute Mental Health Unit. This design focused on finding sustainability that successfully reduced impacts and created a supportive and high quality internal environment in a difficult context. E

BREEAM AWARDS

SUSTAINABILITY IN HEALTH FACILITIES CELEBRATEDChris Hall, health sector lead at BRE, discusses the new BREEAM products and the BREEAM health awards winner, ensuring that healthcare environments are safe, supportive and user-friendly

Energy

The BREEAM

award-winning

Midpark Hospital

achieved the BREEAM

Excellent Rating at

Design Stage thanks

to sustainable

objectives



and wellbeing of all patients and staff and reducing patients’ sense of isolation from nature and their surroundings. The quality and quantity of daylight have major impacts on health and wellbeing particularly for mental health care patients. To minimise water and energy consumption, low water use appliances and energy and water sub-metering have been installed. This will also aid future energy management and allow for carbon reporting as part of the trust’s CSR.

LESSONS LEARNED AND FUTURE PLANS The innovative pre-fabricated structure designed for this building and the original design of all windows for security and natural ventilation are both fully replicable for future projects. The approach to providing high levels E

Energy

BREEAM AWARDS

Further useful BREEAM linksMore information on the BREEAM awards and BREEAM schemes can be found on: www.breeam.org The BREEAM team will also be on BRE stand in the Sustainability area at the Healthcare Estates Conference and Exhibition in October and we would be happy to speak to you or give advice. Find out more at www.healthcare-estates.com

Our BIU brochure provides more information and can be found here:http://www.breeam.org/filelibrary/BREEAM%20In%20Use/KN5016_BREEAM_In_Use_Brochure_2013.pdf

The key features noted were the careful use of prefabrication techniques and the efforts taken to design windows which allowed for the provision of good and controllable natural ventilation whilst meeting the strenuous anti-ligature requirements required in this facility.

ABOUT THE AWARD-WINNING BUILDINGDumfries and Galloway Acute Mental Health Unit, now known as Midpark Hospital, is NHS Dumfries and Galloway’s mental health facility for in-patient care. Opened in 2012 it replaced the accommodation previously provided by Crichton Royal Hospital. It now provides a modern, stable and secure environment for patients requiring specialist care. The hospital has six wards and 85 beds.

GREEN STRATEGYThis new mental healthcare facility is being procured using the NEC form of contract as part of the NHS Framework for the client NHS Dumfries and Galloway. Arup are a preferred supply chain partner for the Laing O’Rourke team. With the early involvement of a contractor, the project team has been able to explore suitable pre-fabrication applications. This approach will reduce on-site activities and drive quality. The project has achieved the BREEAM Excellent Rating at Design Stage. Arup is the BREEAM assessor for the project and have been able to take a pro-active approach to the assessment process.

In order to achieve the project’s sustainable objectives, Arup has developed natural ventilation and daylighting strategies. Their expertise in modelling has enabled these approaches to be successfully delivered. The project uses a district energy system, fuelled by biomass, for heating and domestic hot water production. This is produced via the in-site buffer vessels fed by plate heating heat exchangers in the plant room which significantly reduces carbon emissions. As a result the project has achieved an Energy Performance Certificate A rating, placing it in the top one per cent of NHS Scotland properties for energy performance.

MAJOR ENVIRONMENTAL FEATURESThe innovative pre-fabricated structure designed specifically for this building played a major part in reducing the construction waste produced on the project. A unique anti-ligature window included in the naturally ventilated windows – specified and installed by Laing O’Rourke with wind catchers installed for providing natural ventilation to internal areas – allowed all patient areas to be naturally ventilated. This provides the best internal environment for healing and recuperation and reduces carbon emissions too. The design maximises daylighting and provides views out into the gardens and landscape, helping to optimise the health

To minimise water and energy consumption, low water use appliances and energy and water sub-metering have been installed at Midpark Hospital. This will also aid future energy management and allow for carbon reporting

Dumfries and Galloway Acute Mental Health Unit, now known as Midpark Hospital, uses a district energy system, fuelled by biomass


21

Adve

rtise

men

t Fea

ture BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net


Currently spending more than £750 million on energy costs each year, the NHS is being encouraged to update and improve energy management systems after adopting a target to cut greenhouse gas emissions by 10 per cent for 2015. ARI-Armaturen UK has been working with hospitals around the UK to assist the NHS in meeting these demanding targets. They seek to help secure a more economical estate for the future by showing new ways to become more energy efficient and therefore. ARI-Armaturen’s ENCOsys has been a major solution for sites looking for a proficient heating system and offers considerable savings in energy and cost when compared to traditional systems such as shell and tube calorifiers. ENCOsys is a compact, low maintenance steam-to-water plate heat exchange system designed to provide hot water instantaneously up to 2100kW. Suitable for various applications including domestic hot water and low temperature hot water; ENCOsys systems are currently in operation in many NHS hospitals across the UK.

ALTERNATIVE OPTIONSThe Green Investment Bank (GIB) suggested that the NHS could potentially slash its energy bills by up to 20 per cent, saving £150 million each year. Solutions such as LED lighting, enhanced heating and smarter control systems could help to cut greenhouse gas emissions quickly and investing in better energy savings should more than compensate the costs of any new technology or systems required. With so much pressure from the media and encouragement from the government, now is the time to be making changes and looking for alternatives in order to cope with budget cuts and rising energy costs. Sites that have installed ENCOsys units benefit from improvements to operating efficiency with reduced heat loss from equipment, improved temperature control as well as better thermal efficiency, all resulting in vast improvements to operation efficiency and energy savings. The system is designed to provide hot water instantaneously whatever the load conditions

so there is no need for a water storage vessel. Having no water storage vessel also helps to eliminate a potential breeding place for legionella and other bacteria, therefore reducing the need for regular inspections. ENCOsys is more responsive to changes in secondary operating conditions which results in far tighter temperature control. Generally, the water temperature leaving shell and tube heat exchangers tend to cycle in a pattern similar to a sine wave which means the temperature set point may have to be set higher to ensure the unit meets the required load at all times. By using the ARI-ENCOsys, temperature control is considerably improved, typically providing an estimated three per cent energy saving. Based on these factors, the ARI-ENCOsys can be approximately seven per cent more energy efficient when compared to a basic shell and tube heat exchanger.

SAVINGSOne of the most significant savings however, is that unlike shell and tube heat exchangers, ENCOsys does not need to be stripped down for insurance inspections. This results in further cost savings and dramatically reduced health and safety risks associated with this work. ARI-Armaturen UK Ltd Sales Director, Nicholas Davies commented: “By heating the secondary water and sub-cooling the condensate in the same plate heat exchanger, substantial energy savings can be achieved and cost of ownership is further reduced

because improved energy efficiency means lower fuel bills and lower CO2 emissions.” Another benefit of the ENCOsys heating system is that the physical design is extremely compact, with the largest unit occupying less than 3m³ and the smallest unit occupying less than 1.5m³ resulting in a smaller footprint.The Department of Health are encouraging better procurement by ensuring that NHS Estate and Project Managers are choosing the right suppliers, getting value for money and the quality products needed in order to secure a more economical future. QUALITY SERVICEARI-Armaturen boast a wealth of knowledge and technical experience in energy management systems so from assessing your initial requirements, through conduction of surveys to final commissioning, the installation process can be completed in a short timeframe, leaving you assured that you have been provided with a quality product and quality service. ENCOsys is a well-engineered packaged solution from valve specialists ARI-Armaturen UK Ltd, which is delivered fully assembled and tested ready for connection. L

FURTHER INFORMATIONTel: 01684 275 752 [email protected] www.ari-armaturen.com

ENERGY

NHS LOOKS TO EFFICIENT HEATING TO CUT BILLS In response to recent reports putting the NHS under pressure to reduce spending and improve energy efficiency, ARI-Armaturen UK has been increasing its affiliation with the NHS in order to help achieve more efficient energy management of estates and facilities

Energy

BREEAM AWARDS

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of daylighting and views out to the landscape and the gardens are also fully replicable. Three years development work in conjunction with window manufacturers and Laing O’Rourke has resulted in a unique window system being specified and installed. The specially-designed AA 3110 Healthcare Solution window maximises natural light and natural ventilation while minimising the risk of self-harming for patients.

Its features include a versatile horizontal sliding window which can provide three security levels to meet the security requirements of individual patient areas.

WHAT BENEFITS DOES BREEAM CERTIFICATION OFFER? Sarah Jane Stewart, the Arup BREEAM assessor who worked on the project, said: “Using BREEAM ensured that the development was designed from the onset to provide high levels of daylighting and natural ventilation and delivered a low carbon energy solution.

“This was to meet the design objectives which were firstly to maximise the health, wellbeing and treatment of the patients and secondly keeping utility and maintenance costs and carbon emissions low for the client or owner occupier.”

LATEST DEVELOPMENTS AND USAGETo complement the BREEAM New Construction a new non-domestic refurbishment BREEAM scheme was launched in November 2014. Additionally, a health specific BREEAM In-Use scheme for the existing estate was launched with Bart’s Healthcare in May 2014. BREEAM In-Use (BIU), focuses upon the operational efficiency, cost-effectiveness and occupant comfort of buildings in use. It is different to other schemes as it drives continuous improvement in operation, delivering Opex budget savings to Estate Managers. The scheme can also be applied across an estate of buildings managed using consistent policies with a new volume sampling approach to maximise cost-benefit. Recently BRE has also piloted a new Occupier Management (Part 3) section to the scheme with Bart’s Healthcare and Great Ormond Street hospitals, particularly aimed at healthcare campuses. The fees are considerably lower than for other BREEAM schemes and the scheme could be used before, during and after a strategic planning programme to assist the transformation process. BRE is interested to hear from any NHS organisation that would be interested to partner with us to further develop the new BIU Part 3. This would allow us to refine the requirements further in order to match with your needs and would help us define the tone,

language and focus of the method further based on the needs of the NHS in general.

BREEAM REFURBISHMENT The great thing about the new standards is that they are really flexible which works really well for refurbishment. Its emphasis is looking at what you can influence and opportunities to make improvements. It has four modules that you can select depending on the scope of works, allowing you to tailor the assessment more to the project. It also works alongside new construction so you can assess mixed new build/refurbishment projects. The modules include: fabric and structure (part one), core services (part two), local services (part three) and interior design (part four). You can get a rating for work to the M&E services (part 2 and 3) or just for an internal fit-out using parts 3 and/or 4 e.g. refit of a ward or department. You can also choose to use all parts for a major refurbishment project. The scope of the scheme, detailing the work that may warrant the assessment of an individual part can be found at the links below. L

FURTHER INFORMATION A new online system for BREEAM can be found at: www.breeam.com/projects where you can test out the new standard using the pre-assessment estimator. Further information is also online at: www.breeam.com/ndrefurb



IS THIS THE ONLY TIME YOU PUT YOURSELF INMY PLACE?

UKPC recognise the importance of protecting disabled bays and we have already developed strategies with Hospitals around the country in conjunction with DMUK.

A non-disabled motorist parking in a bay reserved for authorised blue badge holders is misusing that space and this can have a detrimental impact on the perception, image and efficiency of your hospital. We employ courteous staff and utilise cutting edge technology to provide you with effective and reliable parking services.

In an environment when visiting a hospital starts with car parking, UKPC can provide a service that adds value to healthcare.

© 2014 UK Parking Control Ltd*Source Parking Matters 2013 Survey


A non-disabled motorist parking in a bay reserved for authorised blue badge holders is misusing that space and this can have a detrimental impact on the perception, image and efficiency of your hospital. edge technology to provide you with effective and reliable parking services.


*Source Parking Matters 2013 Survey

OF BLUE BADGE HOLDERS SURVEYEDAGREED WITH THE STATEMENT ‘NONBLUE BADGE HOLDERS OFTEN PARK INDESIGNATED DISABLED PARKING BAYS’79%*

To fi nd out more and to talk to us about Parking Solutions that will really fi t your needs call us on...

0333 220 1030 [email protected]

The Parking Professionals

The problem is an old one. The solution is a simple one! Make a change and protect your disabled bays and ensure that ALL your patients can park with confi dence and their hospital visit to be of ease.

Working in partnership withDisabled Motoring UK

www.disabledmotoring.org

UKPC A4 Disabled Ad Februay 2015.indd 1 03/03/2015 16:30

Written by Kelvin Reynolds, director of policy and public affairs, BPA

In August 2014 the Department for Health published its Guidance document – NHS patient, visitor and staff car parking principles. At the outset it says: “NHS organisations should work with their patients and staff, local authorities and public transport providers to make sure that users can get to the site (and park if necessary) as safely, conveniently and economically as possible.” In principle, what can there be to disagree with in that laudable aim? As ever the devil is in the detail. The detailed Guidance is likely to be the metaphorical ‘swan song’ from the coalition government so far as parking at healthcare sites is concerned. Therefore it becomes important to question what the Parking Professionals’ view on this guidance

is and how can we ensure that the most laudable objectives are actually delivered?

THE BPA CHARTERThe British Parking Association (BPA) and its Healthcare Special Interest Group has been working closely with the Department of Health as it develops the detailed Guidance. It has been providing professional knowledge, practical experience and detailed comment on the emerging proposals. We recommended that the Guidance make reference to the BPA’s Healthcare Parking

Charter. First published in 2010, long before the government

initiative, the Charter provides a set of guidelines for

NHS Trusts and car park operators to help deliver effective and efficient

parking for everybody, including those with particular or special needs. The Charter very much aligns with the ‘Parking Principles’ published last summer. In 2015, the BPA Charter is to be fundamentally reviewed to ensure that it continues to promote best practice in healthcare parking. Plans are also being made to introduce robust auditing of the Charter signatories to measure their performance against the Charter – thus raising its value even further. Actions speak louder than words as they say. Signing up to a Charter is one thing – delivering it on the ground is another and we aim to raise standards by demonstrating that Charter signatories mean what they say. The Charter commits NHS Trusts and their contractors to recognise the importance of car parking policy as part of a wider transport strategy and the need to manage traffic and parking in line with demand and environmental needs. It also encourages best practice in providing good lighting, simple-to-use payment equipment, clear signage and clearly marked parking bays: all commensurate with achieving the Safer Parking Award or the Park Mark. Concessionary parking (including qualifying for the NHS Healthcare Travel Costs Scheme) is supported by the Charter. This is particularly for patients with long-term illnesses or serious conditions that require ongoing treatment, and for those who need to visit patients regularly in hospital. By becoming E

HOSPITAL CAR PARKS

HEALTHCARE PARKING – A DOSE OF COMMON SENSEThe British Parking Association’s Kelvin Reynolds shares his views on the latest government guidelines on hospital parking, examining what could be done to achieve its main aims

Parking

Car parks

are for people.

Remember that

people do not park a

vehicle for the

sake of it – they

park in order to do

something

else

IS THIS THE ONLY TIME YOU PUT YOURSELF INMY PLACE?


A non-disabled motorist parking in a bay reserved for authorised blue badge holders is misusing that space and this can have a detrimental impact on the perception, image and efficiency of your hospital. We employ courteous staff and utilise cutting edge technology to provide you with effective and reliable parking services.


© 2014 UK Parking Control Ltd*Source Parking Matters 2013 Survey


A non-disabled motorist parking in a bay reserved for authorised blue badge holders is misusing that space and this can have a detrimental impact on the perception, image and efficiency of your hospital. edge technology to provide you with effective and reliable parking services.


*Source Parking Matters 2013 Survey

OF BLUE BADGE HOLDERS SURVEYEDAGREED WITH THE STATEMENT ‘NONBLUE BADGE HOLDERS OFTEN PARK INDESIGNATED DISABLED PARKING BAYS’79%*

To fi nd out more and to talk to us about Parking Solutions that will really fi t your needs call us on...

0333 220 1030 [email protected]

The Parking Professionals

The problem is an old one. The solution is a simple one! Make a change and protect your disabled bays and ensure that ALL your patients can park with confi dence and their hospital visit to be of ease.

Working in partnership withDisabled Motoring UK

www.disabledmotoring.org

UKPC A4 Disabled Ad Februay 2015.indd 1 03/03/2015 16:30



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a signatory to the Charter, the Trust is committing to abide by its requirements.

THE BPA STANCESo what did the BPA say about the emerging Department for Health Guidance? Firstly, we said it should restate the Parking Principles that were published last summer. Secondly, we said it should ask the fundamental question: What should be the most important consideration when designing and managing parking at healthcare facilities in the UK? The answer? We believe it should be the patient/customer experience. Earlier Department for Health Guidance seems to have had a heavy emphasis on travel plans and, while these are necessary, it is important to recognise that these mostly serve the needs of staff. Whilst it is staff that provide the volume of regular travellers that enable Trusts to implement these schemes, visitors and patients can benefit from them too. It is important to realise that most schemes comprise components which are not suitable for everybody. Trusts need to be thinking about this when implementing an overall strategy to make hospitals and clinics accessible for all who need to travel there be they patients, visitors or staff. It is also important to remember that a motorist who is leaving is likely to be in a completely different frame of mind to when they arrived. Information gathered on the way in may have been forgotten, and they may have other things on their mind to contend with when leaving. Any requirements

to make payment for the parking and the whole departure experience should recognise this. Reputations for all destinations, be they shopping, leisure or healthcare venues can all depend on the journey experience; do your best to make it a good one.

CAR PARKS FOR PEOPLEAdditionally, we wanted to mention how important it is to choose carefully when employing a parking contractor to manage NHS sites. If Trusts are clear on what they want to achieve (i.e. their strategy) they can bring in a parking contractor to implement the measures that will best deliver this outcome. In these circumstances, it is important that an approved operator is sought to carry out this work such as those that are part of the BPA’s Approved Operator Scheme (AOS). When advice is needed to develop the strategy in the first place, consultants and contractors with appropriate experience should be sought. Many BPA members have this expertise. Expensive mistakes abound because of inexperienced advice being provided in the first place. Equally, NHS Trusts that are outsourcing need to recognise that the nature of their contractual arrangement with the service

provider can have a significant influence on the management and enforcement model or regime used. A management contract with a fee paying arrangement between the Trust and the contractor is very different to an arrangement where the service provider earns their income from parking management and enforcement activity. Finally, the lesson I learned a long time ago is that car parks are for people. Remember that people do not park a vehicle for the sake of it – they park a vehicle in order to do something else. Perhaps to shop, to work, to take leisure time or in some cases to access healthcare facilities. Parking is a means to an end not an end in itself. The quality of the parking is the first and last impression of that experience. It’s an old cliche but the old ones are the best: ‘You only get one chance to make a good first impression.’ Lasting impressions do just that – they last a lifetime and making sure your customers and clients have a good experience in your parking facility says a lot about you and what you think of them. L

FURTHER INFORMATION www.britishparking.co.uk

Parking

Parking is a means to an end not an end in itself. The quality of the parking is the first and last impression of that experience

HOSPITAL CAR PARKS



Nervecentre Software uniquely provides a whole hospital platform that can deliver

electronic observations, handover, task management and clinical assessments; and allows

governance and escalation management to be added to any hospital process.

Our solutions are platform independent and integrate into a hospital’s existing IT and PAS

systems. The innovative handset independent applications function with all mobile devices.

For more information or to arrange a demo please contact us.

Using Nervecentre Software on electronic devices has

enabled University Hospitals of Leicester NHS Trust

to signifi cantly improve communications and enabled

improvements in the care and management of patients.JULIA BALL, Assistant Chief Nurse, University Hospitals of Leicester NHS Trust

[email protected] 0118 974 0128 www.nervecentresoftware.com

electronic observations

mobile handover

clinical assesments

task management

hospital at night

messaging applications

bed management

MOBILE HANDOVER

CLINICAL ASSESSMENTS

TASK MANAGEMENT

HOSPITAL AT NIGHT

INSTANTMESSAGING

BED MANAGEMENT

ELECTRONIC OBSERVATIONS

Nervecentre helps support clinical processes to improve patient safety and outcomes

A4_Advert_Chosen.indd 1 14/01/2015 11:03

Written by Beverley Bryant, director of strategic system

s and technology, NHS England

The National Health Service (NHS) has a distinguished history of innovation. Since its beginning in 1948, the NHS has delivered some of the world’s most ground breaking developments, including the first test tube baby born in 1978, the first heart, liver and lung transplants carried out in 1987 and the introduction of MRI scanners in hospitals which have made the detection of tumours and other cancers possible. The recent launch of the 100,000 Genome Project, a £300million investment to support ground-breaking genetic research into cancer and rare diseases, is a paradigm shift in modern medicine and will transform how diseases are diagnosed and treated. However, the NHS is yet to harness the

true potential of the information revolution. While other industries have become digital by default, health has yet to fully grasp the opportunities presented by advances in technology, and delivered them at scale.

A FUTURE OF CHANGEIn October last year, the Five Year Forward View revealed a shared desire amongst patient groups, clinicians, local communities, frontline NHS leaders and national organisations to lead and support change,

committing the NHS to further use of technology to achieve this aim.

Less than a month later, the National Information Board

(NIB) released Personalised Health and Care 2020. This is a framework for action which provides the first blueprint that all national bodies, clinical and civil society leaders have agreed

on, suggesting how the NHS

should push itself into the digital age. Its proposals are ambitious. It targets real time digital records for all health and care services by 2020 at the latest; patient access to all their records online by 2018; a new kite marking service for health apps and giving all people at their end of their life the opportunity of a mobile digital record which will record their preferences for treatment. Our hope is that the commitments on the use of technology and information, outlined in the Five Year Forward View and Personalised Health and Care 2020, will create the right conditions for locally-led transformational change to occur. There has been some fantastic work happening at both a national and local level which, taken together, has helped to quietly ensure the kind of far reaching adoption of modern technological services that has eluded us in the past.

NURSING TECHNOLOGY FUND As the Director of Strategic Systems and Technology at NHS England, my job is to create the vision and strategy for use of technology in the NHS. It’s not all about technology of course, but it is an enabler that helps us to deliver improved outcomes for individuals and allow greater access to health and care services. We want to encourage and empower our dedicated care professionals to engage with technology in a way that is both meaningful and helpful to them, which is why we are delighted there was such a positive response to the Nursing Technology Fund. In October 2012, the Prime Minister announced dedicated capital investment, E

MOBILE TECHNOLOGY

TECHNOLOGY TO EMPOWER NURSESFollowing a second round of funding allocated from the Nursing Technology Fund, NHS England’s Beverley Bryant looks at how the smarter use of modern technology is transforming patient care

Nursing Technology

The Five

Year Forward

View revealed last

year aims to lead

and support change,

committing the

NHS to further use

of technology

Nervecentre Software uniquely provides a whole hospital platform that can deliver

electronic observations, handover, task management and clinical assessments; and allows

governance and escalation management to be added to any hospital process.

Our solutions are platform independent and integrate into a hospital’s existing IT and PAS

systems. The innovative handset independent applications function with all mobile devices.

For more information or to arrange a demo please contact us.

Using Nervecentre Software on electronic devices has

enabled University Hospitals of Leicester NHS Trust

to signifi cantly improve communications and enabled

improvements in the care and management of patients.JULIA BALL, Assistant Chief Nurse, University Hospitals of Leicester NHS Trust

[email protected] 0118 974 0128 www.nervecentresoftware.com

electronic observations

mobile handover

clinical assesments

task management

hospital at night

messaging applications

bed management

MOBILE HANDOVER

CLINICAL ASSESSMENTS

TASK MANAGEMENT

HOSPITAL AT NIGHT

INSTANTMESSAGING

BED MANAGEMENT

ELECTRONIC OBSERVATIONS

Nervecentre helps support clinical processes to improve patient safety and outcomes

A4_Advert_Chosen.indd 1 14/01/2015 11:03



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The UK’s healthcare industry is, on the whole, failing to keep pace with the rate at which consumers are adopting mobile technology. That’s amongst the findings of a new study conducted by Digital Healthcare Agency, Integrated Change.

MOBILE RESEARCH METHODOLOGYIntegrated Change set out to discover how UK individuals are accessing information from NHS foundation trusts. A Freedom of Information Request was sent to a number of NHS trusts to ascertain the number of visits to their website, proportion of traffic coming from mobile devices and the bounce rates of users from those devices. This was followed by a robust manual assessment of some 900+ websites carried out to identify if hospitals have branded apps. The agency interviewed 100 private orthopaedic patients aged between 15 and 65 to find out their views on using mobile devices to book appointments and access information pertinent to their ongoing treatment.

MOBILE-DRIVEN MARKETData from the Freedom of Information Requests revealed the amount of traffic visiting NHS websites from mobile devices has increased by 118 per cent over a 12 month period. Despite this, 57 per cent of NHS websites are not mobile optimised, which means the design and content does not dynamically adapt to the many different screen sizes that exist for a smartphone and tablet device. Failing to optimise valuable website content is damaging; many NHS websites are missing an opportunity to present their services in a mobile-friendly bite size way. Without doubt, optimising a site for both mobile and tablets does help healthcare organisations become more efficient and effective in delivering their multi-disciplinary services online.

BRANDED HEALTH APPS The study revealed that only 15 per cent of 159 NHS trusts have invested in branded apps for their audiences. Interestingly, with the exception of London, the Southern trusts have been slower to respond to the mobile shift than the Northern trusts. Types of healthcare mobile apps include staff communications, weight loss programs and dosage calculators for practitioners.

MOBILE PATIENT FEEDBACKWhen 100 private orthopaedic

patients were interviewed, half of them said they

would make and amend appointments via a mobile app. It’s self-evident that patients are receptive to mobile technology and are keen to access certain

information specific to their care and treatment

using a smartphone. The study found that 27

per cent of UK senior citizens are already self-tracking some aspect

of health. Patients and those who make decisions for their care are becoming ever more mobile savvy. They expect the healthcare information they require to be readily available on any device. Engagement with patients outside hospitals and clinics is becoming increasingly important as the requirements of the ‘digital’ patient become more complex. Resisting change could be a barrier to growing website traffic and hindering an enhanced e-patient experience.

MOBILE TECH IN THE NHSThe NHS has some innovative web resources for users and plenty of content for those looking for accurate healthcare information. The sheer volume and quality of what’s available freely to users is something the NHS should be proud of. However, the agency’s findings indicate that the NHS is failing to ensure that this wealth of information is available to users

in a digital format that is easily accessible via mobile. The healthcare industry isn’t keeping pace with mobile technology; it’s at a crossroads where it really can play a pioneering role in digital health.

MOBILE MIND-SETHealthcare in the UK needs to be more agile and respond to the mobile market faster. Let’s not forget healthcare professionals and NHS staff alike who are sophisticated ‘internal’ consumers. They too expect the NHS to adopt mobile technology, primarily to improve their daily work tasks, roles and duties. In the highly competitive retail environment, the use of mobile as a delivery channel is mainstream. This sector in particular has stepped up to consumers who have a mobile mind-set. Lessons can be learnt from retail to help stop UK digital health falling behind the curve. The introduction of plans launched in November 2014 by the Department of Health to improve health outcomes and the quality of patient care through digital technology by 2020 could be the starting point for change. There is an opportunity now for the NHS to enhance the patient experience through mobile.

COLLABORATIVE PARTNERINGIn collaborative partnerships with digital organisations, healthcare providers can embrace new technologies so they don’t continue to lag behind in mobile adoption. There are creative and innovative suppliers in the industry that will help UK hospitals leverage opportunities to deliver a well thought out mobile strategy and improve the overall digital patient experience in the future. These research findings can help healthcare organisations plan their next moves in the e-patient journey towards digitisation across all services. L

FURTHER INFORMATIONTel: 0203 [email protected]

MOBILE TECHNOLOGY

KEEPING PACE WITH MOBILE SAVVY PATIENTSNew study conducted by Digital Healthcare Agency, Integrated Change finds that the NHS is falling behind when it comes to serving increasingly mobile savvy patients

The amount of

traffic visiting NHS

websites from mobile

devices has increased

by 118 per cent

over a 12 month

period



or, the ‘Nursing Technology Fund’ to support nurses, midwives and health visitors to make better use of digital technology in all care settings. This will help deliver safer, more effective and more efficient care. The fund was first launched in December 2013 and invited NHS organisations to bid for money to buy technology to facilitate staff in providing compassionate and personalised care. The first round of applications saw 74 Trusts awarded funding totaling almost £30m. This funding has enabled them to put in place some really exciting and innovative initiatives. This includes voice recognition technology for a Paediatric Intensive Care Unit; an Electronic Observation System that allows nurses and clinicians to record clinical data at the bedside on electronic devices in real time and the deployment of digital pens to community and district nurses and midwives – which allow for captured data to

be integrated into back office patient systems. Buckinghamshire Healthcare NHS Trust won the largest amount of funding, £1 million, to allow them to buy mobile devices and a supporting software solution to integrate directly to the EPR. This will allow community nurses and community midwives to work more efficiently. Approximately half of the successful applicants from the first round have reported that they are at least 80 per cent of the way through implementing their projects which have delivered £3 million of benefits to date. This is a brilliant achievement in a short space of time and we expect the benefits to continue to roll out as these new ways of working become fully embedded.

THE SECOND ROUNDThe focus of the second round of the Nursing Technology Fund applications shifted from

Nursing Technology

MOBILE TECHNOLOGY

The Nursing Technology Fund

In October 2012 the Prime Minister announced the establishment of a Nursing Technology Fund to support nurses, midwives and health visitors to make better use of digital technology in all care settings, in order to deliver safer, more effective and more efficient care.

The funding was to be allocated to providers following an application and evaluation process. The first round, for £30M, was for funding to be spent in FY13/14. In the second round launched in November 2014, £35M of capital funding has been awarded to be spent across FY14/15 and FY15/16. The funded projects represent the full range of geographies and care settings, and beneficiaries include nurses, midwives, health visitors and healthcare assistants. The range of projects covers the following technology-enabled capabilities (in order of popularity):

Digitally-enabled observations managementMobile access to digital care records across the communityDigital capture of clinical data at point-of-careSafer clinical interventionsReal-time digital nursing dashboardsSmart workforce deploymentRemote face-to-face interactionDigital images for nursing care

technical solutions to technology-enabled capabilities. Eligibility for the second round of applications was also expanded and 62 organisations including Local Authorities (LAs) and Voluntary, Community and Social Enterprises (VCSEs), as well as NHS Trusts and Foundation Trusts, have been awarded funding totaling almost £35 million to be spent across 2014/15 and 2015/16. Successful applicants of the second tranche of funding include Marie Curie Cancer Care who were awarded £1million for their Connected Nursing project. The project enables mobile access to digital care records, digital capture of clinical data at point-of-care and resource scheduling software. Also benefiting from the second round of funding was Milton Keynes Hospital NHS Foundation Trust who were awarded £646,000 for their project to enable the monitoring of vital signs and Early Warning Scores at E



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Health Secretary Jeremy Hunt wants the NHS to be paperless by 2018. In a directive issued earlier this year, Mr Hunt outlined desires for patients to have digital records so that their information can follow them. But unlike previous large scale, top-down directives, he wants this driven bottom up and by 2018 any crucial health information should be available to staff at the touch of a button. Most NHS sites hold patient related data on a variety of different media, such as paper, microfilm and digital. It is currently very difficult to identify exactly what information may be held on a given patient. This has resulted in falling standards for maintaining the patient’s acute medical record, therefore increasing risk and leaving patients and clinicians at a disadvantage. To address this, established Electronic Document and Records Management (EDRM) technologies provide relevant cost effective solutions. This offers the chance for Trusts to embrace a culture of compliant information management practice to deliver paper lite health care, if not a paper less health care. There is no magic bullet solution – just a common sense approach which focuses the available technologies on specific processes to ensure that the solution delivers what is expected of it.

EDRM TECHNOLOGIESThe core technology has been around for over 35 years, and is in use across many industry sectors. Lessons have been learnt through careful application of EDRM technologies. Systems have become more affordable and are delivering real and measurable benefits. The first key point to keep in mind is how vital it is to understand that simply digitising paper records is not enough. The solution must offer facilities to stop producing new paper through generation, management, and integration of electronic records. Additionally, interoperability is important. Patient information resides on many disparate systems within Trusts. The electronic medical record cannot sit in a document management system that remains un-connected with other hospital systems and processes. Information must be exchangeable and shareable amongst all practioners. Furthermore, delivery remains a critical key point. To be optimally effective the electronic record has to be delivered to key users when and where they need it. A solution which offers a standard interface for all users will provide limited functionality to most users.

ACHIEVEMENTSA number of Trusts took the bold step towards paperless healthcare some years

ago. These Trusts achieved paper lite health care using EDRM, by paying great attention to the underlying processes. So, what have they achieved? Savings gained through process efficiencies are achieved by minimising dependencies on paper and delivering the electronic patient record to those who provide care, at the right time, every time. This is managed by guaranteeing the accuracy and quality of information delivered. St Helens and Knowsley NHS Trust already has all of its patient records accessible online for doctors, nurses, GPs, and community services. Savings gained through realisation of real estate provides more treatment facilities and a better quality of care. The recently launched e-LGs managed service is a great example of how a very ‘low-tech’ service is helping GP practices to release much needed space in the surgery for clinical activities without breaking the bank. Access and control is integral to efficiency. Digitising patient records makes it easier to control access and sharing. The Hunt directive of ‘information following the patient’ is both practical and readily manageable. One step leads to the next - innovation is within reach instead of being unreachable. Advances in IT and the consumerisation of IT mean that rapid progress towards the wider digital revolution can be made within the NHS to help deliver timely and accurate information. Use of electronic forms to capture, store, manage, and deliver information electronically is a way in which this can be attained. Similarly, the vast amount of information locked in paper records is now being transformed into actionable data – systems that can understand content and deliver it to those who need it, when and where they need it. These are no longer predictions. We have access to real data complied over the last few years – data that makes the case for going digital compelling. So, the question is: why isn’t everyone doing it?

VALUABLE LESSONSGiven the bad press about large scale IT implementations, two valuable lessons must be learnt. Firstly, not all Trusts are ready for the top end solutions. Each must accommodate the technology and its implementation gradually to suit a number of local conditions. Secondly, a core application cannot be driven top-down without involving the people who will actually use it and who will be held accountable. The bottom-up approach means that the digital revolution in the NHS is achievable - gradually and over time rather than committing astronomical sums on large scale IT projects. L

FURTHER INFORMATIONwww.ccubesolutions.com

NURSING TECHNOLOGY

IS A PAPERLESS HEALTHCARE MYTH OR REALITY?CCube, content management solutions specialists, focus upon the possibility of the NHS becoming paperless, and the technologies available for Trusts looking to make the next step to digitisation



Nursing Technology

MOBILE TECHNOLOGY

Connected nurses for Marie Curie

The Marie Curie Nursing Service (MCNS) has around 2,000 nurses in the UK, delivering palliative care to 31,800 (2013) patients in their homes.

Currently 70 per cent of this care are visits delivered by one or two nurses overnight with one patient and is co-ordinated by The Marie Curie Referral Centre using a Customer Relationship / Patient Information system called Patient Connect. The remaining (and quickly growing) 30 per cent of the care is for visits involving one or two nurses caring for multiple patients, day and night, in one shift and is co-ordinated by local regional teams using white-boards, spread-sheets and other manual methods. Information about patients and visits is communicated to all nurses via telephone. This is recorded on paper by the nurse. The Connected Nursing project will deliver, for the MCNS for the first time: mobile access to digital care records; digital capture of clinical data at point of care; capture digital images for nursing care; and, enable smarter workforce deployment through the use of resource scheduling software.

the bedside in real-time. Also recognised was the Devon Partnership NHS Trust, who were awarded £204,000 for their Video Consultations for Nursing Staff project to equip patients and develop proper therapeutic environments for remote consultations in a community mental health care setting. Croydon Health Services NHS Trust (CHS) received £967,000 to invest in mobile technology to enhance clinical care in community and community maternity settings. This included digital pens, laptops and tablets which will improve the timeliness and quality of data capture and provide visibility of the whole patient record enabling greater coordination of care.

SAFER DRUG DISPENSING Also benefiting from the second round of funding was Homerton University Hospital NHS Foundation Trust, who received £512,000 for powered clinical trolleys for drug rounds.This project will deliver a versatile powered clinical trolley solution which will enable nurses in the acute setting to document clinical information about medicines they have or have not administered to patients during drug rounds, data that will be stored in the patients’ electronic medical record (EPR). The solution will store medicines securely in a highly portable trolley with a PC (and power supply) connected to the Trust wireless network to

enable direct recording in the EPR system. Northumberland, Tyne and Wear NHS FT meanwhile was awarded £640,000 to implement a state of the art ward-based automated medicines management system.The overarching effect will be the delivery of safer clinical interventions and a reduction in patient safety incidents involving medicines administration and medicines management. The combination of automated storage

cabinets and intelligent trolleys will minimise the risk of mis-selection

and mis-administration of medicines as well as

releasing significant nursing resource to deliver more direct patient care.

SMART TECHNOLOGY CHOICES

With more technology available now than ever

before, the NHS must make the smart choices. Nationally,

we are focusing on IT systems to provide the ‘electronic glue’ to enable

different parts of our health and care service to work together. Locally, commissioners will look for systems that solve their problems, but it is key that all these technologies meet with the nationally specified security, interoperability and data standards. Having a digitally enabled workforce and getting away from paper will allow our clinicians to have constant access to meaningful information – such as medications, allergies and medical history – available immediately across all care settings. E

Nationally

NHS England

is focusing on IT

systems to provide

the ‘electronic’ glue

to enable parts of

the health and care

service to work

together



Hospital at Night is a patient focused NHS change programme dedicated to patient safety. A multi-professional and multi-speciality approach to out of hours care should improve service and patient experience. Providing the best possible care at night is one of the fundamental principles of the programme, and with the development of Mobile Medic from Hospedia, technology that is already in use across the NHS can be utilised to deliver further improvements in this area.

PRIORITISING SERVICE DELIVERYNationally recognised for the high quality of its services, Bedford Hospital NHS Trust has been named one of the top 40 hospitals for eight successive years by the independent data analysts CHKS. The arrival of new Medical Director Colette Marshall sparked an impetus to build on this excellent reputation, creating an effective Hospital at Night team, supported by the best available technology, to deliver an efficient and clinically safe service at night.

FINDING THE RIGHT SOLUTIONAs existing users of the ExtraMed Patient Flow Management solutions from Hospedia, the Trust were already experiencing the operational efficiencies and communication improvements offered by the eWhiteboards during the day. By working closely with the development team behind the solution, they were able to create a system that matched their Hospital at Night needs. Mobile Medic is the next generation of paging and bleep systems, providing real-time, effective communication between wards, site management, and doctors on call. Between the eWhiteboard technology and a smartphone app, the solution enables staff to raise, receive, manage and allocate calls to the most appropriate person.

Non-emergency calls are now entirely handled through the Mobile Medic solution, releasing the bleep system to be solely used for emergency communications. The powerful technology allows staff to raise a call once; from there the team coordinator allocates the call to the most appropriate person.

REALISING THE BENEFITSWith Mobile Medic, hospital staff now have fast access to a real-time view of all calls raised overnight. This increased transparency has led to increased understanding of the

profile of the hospital during out of hours periods, identifying operational

improvements that could be made to further support service

delivery during these times. Increasing the communication between teams has led to increased collaboration – a key part of the Hospital at Night change programme’s

mission. Ward staff are able to direct referrals to

the Hospital at Night team in the most effective way, without

the time and effort that used to be spent phoning around for a consultation

– ultimately releasing time to care. One of the issues with Hospital at Night models is often the allocation of workload, and the lack of visibility around whether a clinician is in the middle of patient care and therefore not able to respond to their pages. Mobile Medic provides visibility of who is out of range, as well as the calls that have already been allocated to the team and any team members who have advised that they are unavailable. All of which means that the team coordinator can rapidly assess where to allocate each call, significantly reducing delays in responding. Workforce reconfiguration and performance management opportunities also arise from the implementation of Mobile Medic. Analysts can review a full audit trail within the solution, identifying information on a global and individual level. Globally,

hospital management can see trends and handover arrangements to identify where staffing and workload are aligned, or not. On an individual and team level, it is possible to highlight information such as time of call raised, when the call was accepted, and when it was completed, allowing management to accurately identify blockages, highlight performance issues, and recognise best practices.

FURTHER APPLICATION‘At Night’ working is only one of the primary off peak periods within healthcare, and Mobile Medic is equally as effective during weekend shifts, or any other time when a reduced staffing level is standard. With the power of the solution already in action, there are further developments and benefits that are expected over the coming months at Bedford. From implementing NICE G50 clinical guidelines, to improving communications in handover, to leveraging the statistical power of the data collected by the solution, there is plenty more to come. L

FURTHER INFORMATIONFurther information can be found at www.hospedia.com or contact [email protected]

MOBILE TECHNOLOGY

HARNESSING TECHNOLOGY TO TRANSFORM HOSPITAL AT NIGHT WORKINGUsing innovative technology solutions can help hospitals to manage the different resourcing and requirements that occur during out of hours periods. The Mobile Medic solution from Hospedia allows hospitals access to real-time views of ‘at-night’ calls, driving improved communication, better workforce allocation, and better task allocation

Mobile

Medic is equally

as effective during

weekend shifts,

or any other time

when a reduced

staffing level is

standard



Nursing Technology

MOBILE TECHNOLOGY

Aspire / Wireless solution

Codem / Ward upgrade solution

Optima / Fully structuredwired solution

Ultima / The ultimatebedside IP solution

Fusion-IP Nurse Call Solutions

Intelligent Communication

Heath Mill Road, Wombourne, Staffordshire, WV5 8AN, UK. Tel: +44 (0) 1902 895 551 www.staticsystems.co.uk

Personalised Health and Care 2020

On 13 November 2014, the Department of Health and the National Information Board released its Personalised Health and Care 2020 framework. It’s a bold vision for how technology should work harder and better for patients and citizens by 2020. The

vision commits to giving

everybody online access

to their GP records, viewed through

approved apps and digital

platforms, by 2015. GP practices are well on their

way to achieving this but national leaders want to go one step further by offering people access to all of their health records – held by hospitals, community, mental health and social care services – by 2018. In just four years, every citizen will be able to access their health records at the click of a button, detailing every visit to the GP and hospital, every prescription, test results, and adverse reactions and allergies to drugs. Patients will also be able to record their preferences and thoughts alongside official medical notes. The alliance will establish a national digital standard for people at the end of life – building on the success of Co-ordinate My Care in London – so their care preferences are respected. The digitisation of the Personal Child Health Record (the red book) will offer new mothers personalised mobile care records for their child.

View the framework at: tinyurl.com/o7sffan

While the NHS is a world leader in primary care computing, progress on hospital systems has been slow and the NHS is not yet fully exploiting its comparative advantage as a population-focused national service. The bringing together of patient data and enabling comprehensive transparency of performance data will help patients make informed choices and help the NHS commission better quality care. LOOKING TO THE FUTUREThe NHS is not one monolithic organisation. It is made of thousands of caring, clever and committed individuals, many of whom have an insatiable appetite for new technology. This is not just the IT staff – we’re talking about nurses, GPs, admin staff. Everyone is becoming more adept at using IT on a day to day basis and more aware of the potential for technology to transform services and help the NHS evolve in order to meet the changing needs of the patients we serve. Looking to the future, we know that globally the population is living longer yet have more complex health conditions. As a nation we remain committed to providing a high quality healthcare system for all our citizens and have recognised the need to take advantage of the opportunities technology has to offer in order to support the care delivered by esteemed care professionals. L

FURTHER INFORMATIONwww.england.nhs.uk



Patient Partner in its simplest form enables patients to ring their practice 24/7 and book a GP or nurse appointment through an automated system. The system communicates live with the practice’s clinical database and will only allow the patient to book the appointments the practice wants to make available. More commonly, the practice will want to implement some of the more advanced features of Patient Partner, such as repeat prescription ordering, populating triage lists, and specialist clinic campaigns. The latter is often used in conjunction with Medical Messenger, Voice Connect’s texting, emailing and postal solution.The effects of implementing the system are many. PATIENT ACCESS24/7 patient access is improved by offering patients the ability to make appointments at any time and from anywhere. The frustrations of having to wait for the surgery to open and join the queue are removed. By spreading these calls through the night and morning, the reception team receive less calls, relieving the pressures on a surgery in the mornings. This pressure release can also allow practices to review their staff deployment. Many practices struggle to cover their extended opening hours without increasing staff costs: by taking the pressure off the mornings, some practices can then deploy their staff more evenly across the day. DNA rates improve, with patients not only being able to choose the appointment times that suit them, but they can amend or cancel appointments 24/7, freeing appointments slots that can then be booked by other users. A&E ATTENDANCE RATESA number of CCGs believe it can help reduce Accident & Emergency (A&E) attendance. A proportion of patients attend A&E simply due to growing levels of anxiety regarding an ongoing condition. They feel unwell during the evening or over the weekend and because they don’t know when they will next have access to a GP their concerns grow and they attend A&E. Patients that can book an

appointment over the phone 24/7 know when they can next speak to their doctor. Knowing when you’re going to see a GP reduces anxiety, empowers the patient and makes the patient less likely to attend A&E.

HOW TO GET THE BEST OUT OF YOUR PATIENT PARTNER SYSTEMFor seasoned users the key to getting the best from Patient Partner is to take the time to review the system. It’s very easy to let Patient Partner take the calls and book the appointments silently in the background and forget that it’s there. Review the monthly reports to make sure your call count and appointment rates are where you want them and give the system a call to make sure you’re offering the appointments and clinicians you

should be. Are you still running you practice appointment book in the same way and are you using Patient Partner for campaigns? In the flu season use Medical Messenger to send out your invitations by the cheapest media (text, email or post) time the send for the evening and let the patient’s book themselves in for their inoculations. You can PIN protect any specific clinics to make sure only the patients with need book the slots.

NEW USERSFor new users the key is appointment availability and promotion. Voice Connect staff will guide you, but plan to make as many appointments available through the system as you can, and make sure that they are available overnight not just on the day. Patients are happy to use the system 24/7, so encourage them to do so by making appointments

available at any time. Before you know it, morning call counts will be lower, taking pressure off your reception. Promote the system. It will self-promote

when patients ring the surgery, but make a big noise about it. Send all your patients a text or email telling them about the service. Have a reminder on your prescriptions. Make sure all your staff are aware of the system and its benefits and ask them to suggest to the patients they should try the system. Many practices are amazed at how quickly patients start to use the system and how quickly they see the benefits. If you aren’t already planning to implement Patient Partner have a chat with one of Voice Connect’s Account Management team; they would be happy to come and see you and explain how it could work for your practice. L

FURTHER INFORMATIONTel: 0116 232 [email protected]

PATIENT ACCESS

CCG’S CHOOSE PATIENT BOOKING SERVICE TO IMPROVE PATIENT ACCESS

Patient access is improved by offering patients the ability to make appointments at any time and from anywhere. The frustrations of having to wait for the surgery to open and join the queue are removed

With over 10 per cent of UK practices having Voice Connect’s Patient Partner system installed and with Barnsley CCG, Camden CCG and BEMS+(Bath and North East Somerset Enhanced Medical Services) CCG all at different stages of rolling out the system, the company looks at why it is proving so popular and how to get the best out of the system

Adve

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Written by the Healthcare Inform

ation and Managem

ent Systems Society

UK e-Health Week at Olympia, London on the 3-4 March was the first e-Health Conference and Exhibition created in partnership with the Healthcare Information Management Systems Society (HIMSS) UK, the British Computer Society (BCS) and NHS England, a much needed testament to the importance of eHealth in the wider healthcare economy. The Open Stage featured virtually every NHS big hitter including an opening pre-election debate between two former health ministers, Rt Hon Alan Milburn MP and Rt Hon Stephen Dorrell MP, who admitted that despite their differences they did have some shared objectives. Dorrell said: “It’s inconceivable in the modern world that you can deliver the objectives of best quality care for patients and fair access to that care without fully employing information technology.”

LARGE CROWDSDue to the looming election, the event drew in large crowds eager to see what might be in store if a new government were to come into office. Despite this, NHS ceo, Simon Stevens said he was confident that the plans in the Five Year Forward View, published last autumn to improve public health and introduce new, efficient service models, would go ahead no matter what party comes into power. He said: “Getting technology and information right over the next five years is going to be essential for the transformation that we need.” He added that the

transformation required included the need to do more to improve hospital

infrastructure, in particular with regards to electronic

medical records and tackling interoperability in a systematic way.

Outside of the Open Stage, and also getting its own share of attention, was the Nursing Plenary, a unique conference stream dedicated to nurses with an interest in improving patient care using information and technology. More specifically, the sessions looked at examples of best practice and drew comparisons from healthcare organisations across the UK, whilst looking at the opportunities for IT in the future of nursing.

ELIMINATE THE JARGONAs part of her session, keynote speaker and WeNurses founder Teresa Chinn MBE issued a word of warning for technology suppliers wanting to engage with nurses, by saying: “Just don’t call it eHealth. The e-word strikes fear into the hearts of many clinicians. ‘What does the ‘e’ stand for?’ they say. By using some of the jargon we use in this industry, we’re not doing ourselves any favours – just creating a division that doesn’t need to be there.” Luckily, the name UK e-Health Week did not deter too many nurses, with the plenary remaining full for the entirety of the day. Another well received session was that of the National Information Board (NIB). The Board, following the release of its long-awaited IT strategy, ‘Personalised Health and Care 2020’, held its board meeting in public at the conference. The NIB outlined the strategy which has several short-term aims for 2015, including providing online access to GP records for all citizens and establishing a ‘kitemarking’ process to assess apps for NHS approval. Noel Gordon, non-executive director of NHS England, said: “We need to demonstrate our ability to deliver, earn the credibility that we can take this society E

E-HEALTH WEEK REVIEW

UNLEASHING THE POWER OF E-HEALTHHealthcare IT is no longer for back office staff and techies. A packed conference of health ministers and the chief executive and medical director of the NHS made sure that was the message delivered to delegates at the first ever UK e-Health Week

Healthcare IT

UK e-Health

Week was the

first e-Health

Conferemce and

Exhibition created

with HIMSS, the

BCS and NHS

England


37

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Deontics is an Artificial Intelligence (AI) company whose technology is developed from first principles for clinical use incorporating concepts from cognitive psychology and computer science. Deontics pathway and decision products render relevant, personalised evidence items from clinical guidelines and protocols at a highly granular level at the point of care and have been shown to increase compliance with clinical guidelines in practice. These products have the potential to substantially increase clinical performance standardisation and patient safety both at unit level and across sites or regions effectively combating the ‘postcode lottery’. Because decision data is captured alongside outcomes and other clinical data, Deontics

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Each year there are around 100,000 hip fractures due to falls affecting the elderly in the UK and the number is rising by 5.3 per cent per annum according to the National Hip Fracture Database. This is much faster than the aged population increase. The causes of a fall are often unknown, and only 20 per cent of all falls are recorded. A hip fracture operation and the rehabilitation costs £15,000, and requires a long stay in hospital. British company Hip Impact Protection Ltd has responded to this ‘unmet clinical need’ bylaunching Fall-Safe Assist. This is a new, patented device embedded within a comfortable and effective hipprotector. This chip technology accurately identifies every fall, recording the time, date, location, the direction and force of the fall, and passes that information to a linked mobile every six hours.

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on a journey toward a technology-based health system, and also earn the right to invest huge sums of public money.”

PRESS ATTENDANCEAnother sure sign that e-Health continues to climb the political and public agenda were the number of press walking the exhibition floor. More than 70 journalists registered for the event including three national camera crews who arrived on the day. Twitter was also buzzing, in no small part down to @wenurses who generated topical Tweetchats throughout the day and health commentator Roy Lilley, who had his own Twitter Lounge – Roy’s Noise complete with fireplace, slippers and sofa – where he tweeted interviews with some of the most influential speakers. Feedback from delegates was equally well-heard. Colin Jervis, independent healthcare consultant and interim director of IM&T at Kettering NHS Foundation Trust, said: “The plenary sessions on the first day of e-Health Week 2015 was the best I have attended in 20 years of working in healthcare ICT. The speakers and their presentations were excellent and it’s good to see ICT attaining the prominence it deserves in the transformation of the NHS.”

HEALTH SECRETARY ON STAGEWrapping up the second day and left with standing space only, something which is largely unheard of at the end of two long days of conferencing, Health Secretary, Jeremy Hunt took to the stage. He grabbed everyone’s attention by holding up a USB stick and asking the audience what might be on it. Highlighting the vast potential for data to shape our health and care, Hunt announced: “It is my entire genome sequence.” During the question and answers session, the Health Secretary was asked to explain why £200 million had been slashed from NHS England’s £240 million technology fund. Much to the surprise of the audience he said that the money may be reinstated: “What we’ve actually done is staged a roll-out of the tech fund, rather than cut it in absolute terms,” he said. Hunt added: “My view is that it is really important to increase the investment in IT because in terms of long-term efficiency, and long term sustainability, there is nothing more important than investing in IT.” He then took to the lively exhibition floor to talk to exhibitors and see demonstrations of innovations already in use within the NHS.

BIGGER AND BETTERSteve Bryant, managing director of HIMSS Europe, who organised the event, summarised: “HIMSS felt there was a strong demand for an eHealth event in the spring which really aligned the bigger healthcare picture together with the eHealth agenda and UK e-Health Week has done just that. “The feedback from delegates has been fantastic and next year’s show will be bigger and better, with a new format to ensure delegates, exhibitors and thought

leaders are brought even closer together and new streams that will draw in a wider audience that work on the front line.” Tim Kelsey, national director for patients and information at NHS England, added: “e-Health Week is a really important festival of how we can transform services for patients, give people much more control over their health and well-being and ultimately become more financially sustainable. We have to spread the message, and e-Health Week brings entrepreneurs, thought leaders and healthcare professionals together and in the mix of those conversations come some very important insights in how we can move with speed in the digital revolution.” L

Next year’s event will take place on 9-20 April at London Olympia.

FURTHER INFORMATION www.ukehealthweek.com

Healthcare IT

E-HEALTH WEEK REVIEW

“It’s inconceivable in the modern world that you can deliver the objectives of best quality care for patients and fair access to that care without fully employing information technology.” Rt Hon Stephen Dorrell MP

NHS ceo Simon Stevens spoke of his confidence about the plans in the Five Year Forward View, published last

autumn to improve public health and introduce new, efficient service models



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Direct Telecom Services are an award‑winning provider of two‑way radio solutions. Established in 1988, Direct Telecom Services supplies, integrates, hires and maintains two‑way radio solutions throughout the UK.

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Direct Telecom Services_HB15.2 - FP.indd 1 20/03/2015 09:39

The United States Food and Drug Administration (FDA) have approved voice activated robotic arms and master slave robotic systems that has the potential to impact most areas of surgery. From their inception, surgical robots has been designed and developed to enhance surgeon’s abilities in terms of vision, sensing and instrument manipulation. New robotically-assisted surgery methods and systems are pushing the boundaries of medicine.

ROBOT-ASSISTED SURGERYSurgical Robotics is one of the most intensely researched areas in the medical devices industry that is primarily market-driven. They have been developed to automate the process of imaging, navigation and communication for surgeries. Robotic automation of surgical systems is offering crucial improvements in terms of accuracy and repeatability of the surgical procedure. The demand for faster recovery, reduced hospital stay and better aesthetics post-surgery is also advancing the surgical robotics field. Robotic systems are being developed for fewer incisions, increased precision and versatility to make surgery safer and more efficient for patient. Operative procedures carried out with the assistance of robotic technology are termed as robot-assisted surgery (RAS). Robotic technology is used for surgical imaging to obtain images for planning, navigating and confirming the position of surgical instruments and implants. They are used for interventional surgical strategy, real time intra-operative imaging, and articulation of the surgical instruments beyond normal manipulation and for navigating the instruments for the procedure. Robotics surgery uses computer assisted systems between the surgeon and the surgical tools which mean that there is no complete elimination of the surgeons but the incorporation of the latest advances in robotics, computing, imaging and navigation for assisting the surgical procedure. The E

MEDICAL DEVICES

ROBOTS REVOLUTIONISING PATIENT SURGERYThough a fairly new but rapidly evolving interdisciplinary field, robotic systems have already been tested for tele surgery and have been widely explored in almost all surgical disciplines. Geethu Roshan Verghese, research analyst at Frost & Sullivan, reports

Surgical RobotsW

ritten by Geethu Roshan Verghese, Research Analyst, Technical Insights, Frost &

Sullivan

Surgical

Robotics is

one of the most

intensely researched

areas in the medical

devices industry

that is primarily

market-driven

The da Vinci Robotic Surgery System from Intuitive Surgical

(Sunnyvale, California) was the first surgical robot approved by FDA for

assisting laparoscopic surgery



EB 17.6 Pages 1-108.indd 28 01/11/2012 16:37

EB 17.6 Pages 1-108.indd 28 01/11/2012 16:37

therapy to the surface of a beating heart. They are called snake robots that will be used to access difficult anatomical spaces of the heart through small ports when large body openings are unavailable or inconvenient. The da Vinci system is also currently being studied for endoscopic cardiac surgeries. Another use for robotic technology being investigated is for pediatric laparoscopic surgery. Robotic systems appeal to various specialists and hospitals because of its application in various clinical areas. The da Vinci system has been approved for urological, general laparoscopic, non-cardiovascular thoracosopic and thoracoscopically-assisted cardiotomy procedures. The system has been adopted by more than 2,025 academic and community hospitals for approximately 1.5 million for various surgical procedures as of 2013.

INDUSTRY CHALLENGESThe biggest challenge within the surgical robotics industry is the extremely high initial cost of acquiring and maintaining the robotic systems that has been restraining

adoption. The substantial cost disadvantage for using the surgical robots has prompted companies to develop systems with low cost. This has led established market players to work on offering significantly low-cost solutions for maintenance and disposable instruments of the systems that will provide a positive attribute when catering to a highly priced surgical robotics industry. Despite many studies evaluating the feasibility of robotic surgery, there is still much to be desired. More high-quality clinical trials needs to conducted to assess the efficacy of robotic surgery. The level of clinical evidence to support the economic efficiency, improved ergonomics and reduced surgeon fatigue has to be increased before full potential of these systems can be realised. Even with the lack of robust clinical data supporting the efficacy and safety, robotic surgery has proven itself to be of great value, particularly for performing conventional laparoscopic procedures in inaccessible anatomical locations. Next generation surgical robotic technology, focusing on ultra-minimally invasive surgery, haptics feedback and augmented reality will improve and expand the use of surgical robots as well as bring surgery into the digital age. L

FURTHER INFORMATIONwww.frost.com

Surgical Robots

MEDICAL DEVICES

da Vinci Robotic Surgery System from Intuitive Surgical (Sunnyvale, California) was the first surgical robot approved by FDA for assisting laparoscopic surgery. With its first mover advantage, the company is recognised as the global leader in robot assisted minimally invasive surgery.

ROBOTIC SURGICAL MACHINESRobotic surgical machines have a number of other advantages. Surgical robots can provide higher magnification with an immersive view of the surgical operative field. They offer unsurpassed visual clarity for precisely visualising target anatomy within the surgical space and improve depth perception. Companies are working on additional visual enhancements for the surgeon’s vision that will enable even real-time molecular imaging and microscopy. The supposed increased efficiency and reliability of imaging from robot assisted surgeries will promote the use of robotic technology for almost all types of surgical procedures, such as transplanting organs, shrinking stomachs, fixing heart valves and so on. Current robotic systems provide miniaturised endo wrist instruments that can mimic surgeons’ natural hand and wrist motions intuitively similar to an open surgery. Development initiatives in this direction are looking into imparting higher degrees of freedom for the instruments that can rival surgeon capabilities. Motion scaling and tremor reduction are other features of surgical robots that enables seamless adjustments of hand to instrument movement ratios in tight surgical spaces.

GETTING INTERACTIVESurgical robots can offer interactive interfaces which is a much sought-after aspect in robot assisted surgery. A multitude of technology developers within this space are researching on natural visual interaction, holograms and augmented reality for better human machine interfaces. Robotic systems are being developed with simulator environments that can import patient specific data and for rehearsal of patient specific surgical procedures. This is used for training surgeons, reducing complication rates and also for maintaining robotic surgery skills. Surgical simulators are offering surgical learning experience to lower the learning curve for surgeons to adopt surgical robots. They remain adjunct in the training of surgeons and it is seen that leading and upcoming companies are looking into capturing the data regarding surgeons’ performance which can even be used to train the surgical robots to perform similar independent tasks. These advantages will translate into better adoption of surgical robots by hospitals and healthcare facilities to overcome the limitations of higher patient and shortage of trained professional staff. More

organisations and surgeons will be investing in robot assisted surgery for overcoming surgeon fatigue, improving ergonomics and communicating clinical excellence.

A RANGE OF SURGICAL DISCIPLINESThe growth of the surgical robotics since the latter half of the 1980s has been striking. From a few initial efforts for laparoscopic surgery, endoscopic surgery and stereo tactical surgery, the field has expanded to various disease states. In the realm of surgery, robotic technology is at the cutting edge of precision and miniaturisation; this transverses to wide application areas of minimally invasive procedures for neurosurgery, urology, gynecology, cardiothoracic, orthopedic, laparoscopic and even oncology. A number of robotic systems are currently approved by the FDA for specific surgical procedures. Neurosurgery was one of the first surgical disciplines for robotic technology, due to the need for high precision to localise and manipulate instruments within the brain and the cranial anatomy. Neuromate System from Renishaw PLC (London, UK) and Rosa

Robotic System from Medtech Innovative Surgical Technology (MontPellier, France) have been clinically approved for neurological procedures such as deep brain stimulation (DBS), stereotactic surgery, brain tumor, epilepsy surgery and craniotomy surgery. Urologists have found applications for surgical robots in laparoscopical nephrectomy, pyeloplasty, adrenalectomy and radical prostatectomy. Cholecystectomy, Nissen fundoplication, Heller myotomy, pancreatectomy, gastric banding and distal gastrectomy are some of the laparoscopic gastrointestinal procedures performed using surgical robots. Laparoscopic surgeries have been revolutionised with surgical robot technology and the da Vinci system is the widely used surgical robot within this discipline. Emerging opportunities for this discipline includes surgical robots that makes of natural orifices or ultra-small incisions. Robotic surgery is also widely accepted in the orthopedics sector as it is well suited for operating on bones, offering increased accuracy for knee, hip and spinal procedures. Minimally invasive cardiac surgery is an area where robotic surgery is transforming medicine. Several research groups are developing robotic procedures that will expand laparoscopic techniques for cardiac surgery which was previously unexplored. Heart Lander is a mobile miniature robot currently in development at The Robotics Institute of Carnegie Mellon University (Pittsburgh, PA) for delivering minimally-invasive

Current robotic systems provide miniaturised endo wrist instruments that can mimic surgeons’ natural hand and wrist motions intuitively, similar to an open surgery



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A review of mental health services by the government’s Children and Young People’s Mental Health Taskforce has found that too many young people are not getting the help they need and has prompted the government to put into action a five-year plan to improve services. The Taskforce identified significant challenges facing Child and Adolescent Mental Health Services (CAMHS) including funding cuts, gaps in data, increasing difficulties in accessing treatment and a lack of clear leadership and accountability arrangements. The taskforce’s report, Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing, makes a number of proposals that the government wishes to see implemented by 2020. This includes tackling stigma and improving attitudes to mental illness and improving access for children and young people who are particularly vulnerable. To help implement the measures, the government’s recent budget allowed for £1.25bn to improve mental health services,

with a significant proportion directed towards children and young people.

THE PROBLEMExplaining the issue, the report says: “One in ten children needs support or treatment for mental health problems. These range from short spells of depression or anxiety through to severe and persistent conditions that can

isolate, disrupt and frighten those who experience them.”

Mental health problems in young people can result

in lower educational attainment (for example, children with conduct disorder are twice as likely as other children to leave school with no qualifications) and

are strongly associated with behaviours that pose

a risk to their health, such as smoking, drug and alcohol

abuse and risky sexual behaviour. The report also goes into the

economic case for investment. It says that “75 per cent of mental health problems in adult life (excluding dementia) start by the age of 18. Failure to support children and young people with mental health needs costs lives and money. Early intervention avoids young people falling into crisis and avoids

expensive and longer term interventions in adulthood. There is a compelling moral, social and economic case for change.”

THE MEASURESTo tackle the problems, the report recommends a series of measures. This includes the introduction of a ‘one-stop shop’ service in the community, to direct young people to places that can help them. It also stresses the need for a comprehensive set of waiting-time targets for services and the launch of a hard-hitting anti-stigma campaign. It also urges that support is continued throughout teenage years and into the early 20s to avoid a loss of support at age 18. Greater use of online tools and apps to encourage self-help is also outlined, as is improved care as close to home as possible and extra training for GPs and other who work with children, such as staff in schools.

The taskforce’s review, which is part of the Department of Health’s report ‘Making mental health services more effective and accessible’, sets out how much of this can be achieved through better working between the NHS, local authorities, voluntary and community services, schools and other local services. It also makes it clear that many of these changes can be achieved by working differently, rather than needing significant investment. E

With one in ten children needing support or treatment for mental health problems, the government has announced a five year plan to improve services, along with a funding boost from the recent budget announcement

Mental Health

WORKING TO HELP YOUNG MINDS

BUDGET FUNDING

A review of

mental health

services has found

that too many young

people are not getting

the help the need

and improvements

are necessary


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Mental Health

BUDGET FUNDING

One in ten children needs support or treatment for mental health problems. These range from short spells of depression or anxiety through to severe and persistent conditions that can isolate, disrupt and frighten those who experience them

Commenting on the report, the Mental Health Network’s director of policy, Rebecca Cotton, said: “This report on the future of mental health services for children and young people is particularly timely. We all know that intervening early is vitally important. Around one in ten children aged between 5 and 16 years of age will have a mental health problem, and all too often those children do not currently access the help and support they need.”

EXTRA FUNDINGIn the recent budget, the government announced £1.25bn funding for mental health to help implement the key proposals within the taskforce’s report. Training in Child and Adolescent Mental Health Services (CAMHS) and schools to improve access to mental health services for children and young people will receive £1.5 million. £75 million will be spent on improving care for women who experience mental ill

health during pregnancy or after giving birth, as maternal mental illness is identified as a common reason why young people develop mental health problems. Deputy Prime Minister Nick Clegg said: “I have heard, time and again, harrowing stories from young people and their families about how they suffered and their condition deteriorated waiting to get the right treatment for serious mental health problems. “That’s why I am determined to start a seismic shift to revolutionise children’s mental healthcare and end this unacceptable injustice.

“By introducing access and waiting time standards and committing to talking therapies for children in every region, we are helping to build a fairer society where young people can get the right treatment and support they deserve to live a better life.” The money is expected to help treat 110,000 more children over a five-year period. L

FURTHER INFORMATIONFuture in mind report: tinyurl.com/lej6pej



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The furniture used in institutions could be very much indicative of their regime and values. It demonstrates how a system regards the individual and gives clear hints about the expected behaviours of service users. Nowadays, more than sixty years from the psychiatric reform, the messages tend to be mixed. In the UK, after the innovative yet risky period of normalisation where safety was compromised in understaffed facilities, we witness a return towards more conservative approaches. This, however, does not necessarily constitute the case in many European countries such as the Netherlands, where more integrated approaches enable the country to tackle dangerousness in a more systemic way. To some extent, these approaches provide the potential to reduce some anti-ligature specs in psychiatric environments. In the rest of the world, there is discussion on where mental health goes, with eminent reforms in many countries from New Zealand, to Eastern Europe or Israel to name but a few.

LOOKING BACKAn interesting element of this variety of approaches is that there has not yet been a linear path of progress when it comes to mental health. It is important, therefore, to have some knowledge of the past. This will enable us to be aware of what is truly innovative or what is an institutional element that finds its way back into the system. This is not only our way to avoid design being used to create new ‘modernised’ institutions

but also our way to create products that constitute true innovations that

are applicable to more than the limited geographical context of the UK. In

other words, true innovation can be very much welcomed across the borders. Even if mental health services present distinct differences from place to place, mental health pathology is universal, and clever solutions that respond to the actual problem will be very much appreciated in several contexts. DESIGN FOR DE-INSTITUTIONALISATIONBack in the 1960s, architects Baker, Davies and psychiatrist Sivadon revolutionised the concept of designing for the entire spectrum of mental health environments. Their elaborate and comprehensive recommendations in the WHO publication ‘Psychiatric services and architecture’, they deal with furniture. They developed a pioneering concept advocating the shift from prison-like to home-like forms for psychiatric hospitals and campaigned for the introduction of atmospheres and styles that were as domestic as possible. This innovative approach was backed by social theories, related to the therapeutic qualities of space as these were perceived at the time and was named ‘psychiatric architecture’. The team’s recommendations for the WHO publication received limited appreciation in practice, and the reality in psychiatric hospitals remained that of the old institutional regime. With regard to furniture, this translated to the continuing use of immobile or very heavy pieces that have been associated with total institutions (Marcus 1993, Vavyli 1992). Yet, the idea of a haven for mental health was too good for psychiatrists to abandon. So it was reintroduced by Professor Amiel, in his concept

of topotherapy, a new paradigm emphasising the therapeutic qualities of three dimensional space (Cole 1980, Amiel 1976). The design features that he introduced were closer to a hotel typology, with emphasis on bi-polar pairs that used antitheses for therapeutic purposes.Soon after, H. Goodman, chief architect of the British Ministry of Health came with a new approach. He advocated the need for mental health facilities to get rid of any institutional references that reflected incarceration. Instead, he insisted on normal furniture and carpeting, prioritising a normal environment as higher than security. During that period in Britain there was a growing body of specialists that considered many of the anti-ligature devices as ‘unnecessary and self-defeating’ (Goodman 1976). This was a period where a strong criticism of the hospital environment, the anti-psychiatry movement and experiments such as the one by Rosenham, which proved the inability of clinicians to distinguish between real and pseudo patients in psychiatric admissions, cast considerable doubt over psychiatric institutions. Yet, despite the several approaches that sprang during this period one common factor rose and has not been questioned since: environment mattered and interior design including furniture has been an element to be considered seriously. More research justified this further. Poor environments that showed neglect as well as frightening places have been connected to absconding (Sainsbury Centre 1998). In addition, the environment conveys messages to staff and service users as far as it concerns expected behaviours (Griffin et al 1969; Malkin 1992). Finally, staff and service users were aware of their environments and the value that these environments had towards the therapeutic procedure (Chrysikou 2014).

SO, WHAT’S NEXT?Comfortable quality furniture that is durable, safe and light, domestic looking bathroom fittings and fixtures that are of good quality and windows without bars that can be opened for ventilation by the user, are but some of the details that are available nowadays to the designer. Modern materials could be used for increased durability and lightness. These are actually much safer and offer unlimited options to creativity. On the contrary, the heavy furniture offers only a fake sense of safety that professionals back in the 1950s knew very well. What appears as a heavy, unliftable object in the eyes of an inexperienced mental health designer could be a dangerous object in the hands of a service user in crisis. The frustration can arm the individual with force and willpower that enables lifting the heavy object and throwing it or using it as a barrier. We should not allow neglect, tough budgets for mental health, or a sense of ignorance on the effect that space can have on the wellbeing of service users and staff and therefore in the quality of care. Around the world, health professionals and architects are not necessarily aware of the true implications and stakes

FURNITURE AND MENTAL HEALTHWhen it comes to furniture and mental health, there is more than initially meets the eye, says Dr Evangelia Chrysikou, director of research at the Design In Mental Health Network

Comfortable

furniture

that is durable,

safe and light, and

domestic-looking

bathroom fittings are

details available

to the

designer



Furniture

when they still position themselves between the two opposing poles of mental health frameworks. This constitutes from one side, those who advocate that architecture could assist staff in the task of preventing service users to harm themselves or others. This tends to become more and more demanding as a result of increasingly tough budgets, especially on skilled staff. As far as it concerns design, this translates to design for anti-ligature and places emphasis on the security of the facilities. The remaining aspects of the mental health professionals’ job description, such as engaging with clients in conversations and activities, are not directly addressed by this approach. In more detail, the anti-ligature considerations tend to be met either by creating sacrificial layers that cannot stand pressure (such as Velcro curtains or collapsible curtain rails) or by objects that can be designed and built to withstand violence (such as fixed or built furniture, unbreakable containers for audiovisual equipment such as TVs, use of toughened glass), or fabrics that are easy to clean (such as vinyl). In short, maintenance and durability are key to this approach.

THE ALTERNATIVEThe other approach is opposed to this framework and considers that heavy, fixed furniture and padded cells have been, in design terms, linked to the definition of

institutional space. The gradual progress in the medical and pharmaceutical domain, as well as the techniques of complimentary to psychiatry professions such as therapists and psychologists, questioned the need to include all these restrictive elements. To them, these restrictions had to be imposed at times that both society and medicine did not provide the options available today. This trend is proposing good quality, durable furniture that demonstrates to service users that they are taken care of in an environment that shows them respect and trust and that caters for their needs and wellbeing. Such examples could include gigantic interactive touch screens fitted into the walls of rooms, even in seclusion. From these, service users can communicate with staff, write, draw, watch videos or listen to music defining the degree and type of communication or stimuli they are willing to have. However, even less hi-tech solutions can have an impact in service users’ wellbeing, by increasing their personalisation and choice in the environment. This can be achieved through their ability to interact with the configuration of furniture in their rooms, which dictates for mobile objects that are flexible to manoeuvre. Therapeutically, this can be an excellent tool for therapists to access behaviours and progress, as passivity is often linked to ill health. Similarly, in common areas, pieces of furniture that clients can lift

and re-arrange to form social groups are indicative of social progress. Even aggression can be communicated through service users’ use of furniture allowing staff the opportunity to interact according to the messages they receive. Of course the type and specifications of furniture is only an aspect of it. Other aspects can be the arrangement of the furniture in place according to how sociofugal or sociopetal it is, the amount of furniture according to parameters such as function, territoriality, ambience, sense of crowding and space blockage, accessibility etc. However, these very important issues are a whole new topic that is beyond the scope of this article. Within the Design In Mental Health Network, we are very much aware of the value of the environment for mental health. We are even more aware of the benefit from the dialogue and the continuous learning process on all aspects of mental health design. For that reason, we are open to all specialties involved in the process, including the service users to actively join us. The exchange of ideas and the grounds for discussion is the core of many of our initiatives, such as the Better Bedroom initiative or our conference and exhibition that put mental health design where it should be: on the spotlight of innovation. L

FURTHER INFORMATIONwww.dimhn.org



Case

Stu

dy

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Food waste is a very expensive issue for hospital kitchens. The amount of food waste being sent to landfill has risen steeply, while at the same time, legislation concerning waste management is tightening and the costs for bagging and binning are increasing. A recent Wrap report highlighted that the sector wastes 121,000 tonnes of food every year or 18 per cent of food purchased while bagging and binning waste costs the sector around £230m each year. What’s more, maceration is being outlawed across most of the British Isles, including Ireland (2013) and Scotland (2014), and shortly in Wales (under consultation fpr 2016/17) and Northern Ireland (2016), which means new solutions must be sought. Any solution to the problem has to start with an attempt at reducing the amount of waste in the first place. While some surplus is unavoidable (e.g. in food preparation), other waste might be reducible, for example perishable stored food or food leftovers on plates. A tweak in management and buying procedures might help with both issues, especially if there are particular foods or meals which are routinely binned, where

an alternative may be more popular. For all unavoidable waste, there are new, environmentally friendly and cost effective alternatives to binning or macerating. Kingspan’s Waste2-O product is a tried and tested, efficient and easy-to-use way to dispose of food waste. Food is loaded into the top of the unit and a powerful formulation of naturally occurring bacteria rapidly digests it, producing a totally neutral, greywater solution that can be

disposed of down your sewage drain. Suited to any busy hospital or healthcare kitchen serving at least 300-400 meals per day, the Waste2-O typically costs 4p per kilo to dispose of waste food and is a sustainable alternative to bin collection and transportation of waste off-site. It’s totally compliant with all relevant waste management legislation including the EU Waste Framework Directive 2012 and Food Waste Regulations 2013, giving complete peace of mind. Waste2-0 is an affordable, low carbon, on site system that’s fully managed by Kingspan Environmental Services, the experts in intelligent environmental compliance solutions. Allied to Waste2-O is the new intelligent

‘iFOG’ system that uses naturally occurring micro-organisms to eat the fat, oil and grease (FOG) which builds up in kitchen drains. iFOG was highly commended in the Sustainable Catering Equipment Award category at the recent CESA Awards 2014.

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Kingspan Environmental: Intelligent food waste management that cuts the cost of waste for hospitals



The crisis of NHS finances means hospital bosses constantly have to think of innovative ideas to save money and drastically cut costs. The modular and portable building industry has been around for many years and is available to provide low cost, sustainable solutions to hospitals as well as the wider healthcare industry. Modular buildings can be manufactured with ultra quick lead times and supplied as an extension or an ‘add on’ to meet peaks in demand. Structures are available as either a permanent or temporary option at cost to suit the needs of the client. Modular also presents other fundamental benefits, making modular a healthy choice for hospitals that require an expansion or an upgrade. Other major benefits include energy compliance, meeting the latest regulations and the ability to create complete bespoke design solutions.

FLEXIBILITY, DESIGN AND BUILDGiven the limited amount of space available in the majority of existing hospitals, modular buildings provide an instant advantage to those who desperately need a cost-effective and bespoke solution to utilise all the space available. Healthcare modules can also be used as a temporary or permanent measure. This provides the option for fully functional hospital buildings

to be removed and reused if required. Modular units are thoroughly planned and designed to suit specific user requirements. Buildings are also created offsite in a factory, which enables urgent clinical services to be delivered faster, resulting in minimum disruption in a hospital. Modular buildings are constructed to the latest healthcare standards fully compliant to all building regulations, encompass Part L energy efficiency; this means modular build also presents lower carbon emissions. Members of the MPBA produce the required Energy Performance Certificates, so a customer can be certain of the energy rating for a building.

NORWICH COMMUNITY HOSPITALAn MPBA member provided two 24-bed and general rehabilitation wards including specialist bariatric treatment areas for Norwich Community Hospital in just 12 weeks. The building was designed to provide a zero carbon rating as well as being designed to meet BREEAM excellent standards. The ground floor ward houses much-required

space for stroke rehabilitation patients whilst the upper floor space was carefully designed for general rehabilitation patients, which replaced an out-dated existing ward. In order to create a hospital building that is green, clean and safe carefully designed ecological features were manufactured including a rainwater harvester for toilet flushing and an air to water heat pump. The pump is self-contained on the roof of the building and provides domestic hot water for the under floor heating system.

DAISY HILL HOSPITAL Daisy Hill Hospital had an

urgent requirement for more space due to the

unprecedented patient surge. Two additional operating theatres including associated anaesthetic rooms, a five-bed general surgery stage one recovery

ward, an eight-bed day surgery unit recovery

ward and an endoscopy decontamination suite

were added. The new buildings were required as soon as possible

as to not disturb existing patients. Modular build was selected as the perfect option for the hospital owing to the emphasis on reduced timescales, a high degree of cost certainty and contemporary design structure. Offsite production resulted in hassle-free building and minimum E

HOUSING THE PATIENT SURGE

Hospitals are struggling with high patient demand and a severe lack of bed space. The MPBA’s Jackie Maginnis examines how the modular and portable building industry can help the situation

The crisis of

NHS finances

means hospital

bosses constantly

have to think of

innovative ideas to

save money and

cut costs

MODULAR HOSPITALS



Modular Buildings

The new Wilo-Stratos, Wilo-Stratos GIGA and Wilo-CronoLine-IL-E for building automation are already compatible with all communi-cation system worlds thanks to the IF-Module. Do you want to know how you can exploit future potential for effi ciency in the building technology of today and save energy costs? Wilo makes it easy!

*when compared to an old uncontrolled pumpGo to www.wilo.co.uk/consultant for the full story.T:01283 523000 E:[email protected]

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thanks to optionally integrable interface modules ƒ High Effi ciency Drive, the drive of the future

Just scan the code andwalk into the world of Wilo!

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0000001470.indd 1 28.01.2015 16:49:30

disruption onsite whilst essential new healthcare facilities were delivered. The design and build specification of Daisy Hill Hospital is now in full compliance with all current Health Technical Memorandums (HTMs) and Health Building Notes (HBNs). The hospital is also equipped with cutting edge technology, enabling medical professionals to deliver modern and effective healthcare that patients deserve. PETERBOROUGH CITY HOSPITALInnovative offsite manufacturing techniques and modular construction expertise provided by an MPBA member offered Peterborough City Hospital flexibility of bespoke design and advanced quality controlled factory manufacture. The hospital also benefited from a major reduced onsite installation programme compared to traditional build. Peterborough City Hospital’s new modular accommodation block was installed in just 16 weeks on site. The building also has a 60-year structural design life with a 25-year structural warranty. The new build incorporates a comprehensive and cost effect range of sustainable and eco-friendly features including increased levels of insulation, low-energy lighting, energy efficient heating systems and water saving technology.Allowing natural light in the accommodation block was a key requirement for the hospital. Modular design flexibility permitted features such as the inclusion of full height glazed walls within communal areas to maximise natural daylight, this met the precise specification of the hospital. Dr Peter Reading, interim chief executive at Peterborough and Stamford Hospitals NHS Foundation Trust, said: “The building has

been created in a modular design which means it will be more straightforward to extend it in the future, if necessary”.

WORCESTERSHIRE ROYAL HOSPITALIn order to help ease pressure on the Accident and Emergency department at Worcestershire Royal Hospital, a member of the MPBA successfully delivered a complex interim health building for urgent emergency care in just six weeks – two weeks ahead of the agreed schedule. The new Surgical Clinical Decisions Unit (SCDU) built for Worcestershire Acute Hospitals NHS Trust provides 24-beds in two wards and ancillary facilities including dirty and clean utilities, nurses’ base, consulting rooms and two en-suite isolation rooms, to reduce the waiting time for patients arriving at A&E. The temporary building will remain in use for around five years. Other features installed in the new unit include a nurse call system, fire alarms, medical gases, bed-head trunking and access control. The new build is linked to the hospital’s existing building and there is a full climate control and an air change ventilation system.The entire internal fitting was completed as part of a turnkey solution, which improved co-ordination and dramatically reduced the programme time. The modular building system used for this project was specified

largely because of its superior energy efficiency, with air tightness

performance that significantly exceeds Building

Regulations requirements. The new SCDU facility at Worcestershire Royal Hospital is a specialist unit, which allows A&E patients to be assessed fully

Modular Buildings

MODULAR HOSPITALS About the MPBAFounded in 1938, the MPBA is the UK’s only not for profit trade association for the modular and portable building industry.

The MPBA is highly-recognised as the central voice representing and promoting the use of temporary and permanent modular buildings. What makes the MPBA unique is the extensive knowledge offered about the industry. All member applications to the MPBA are carefully assessed before being accepted. The MPBA has developed an enforceable code of ethics and practices, which has been approved by industry regulatory bodies and designed to support the passion of professionals within the modular/offsite industry.

before being transferred to relevant parts of the hospital or even discharged. HIGH QUALITY AND FAST TRACK SOLUTIONGiven the critical nature of the healthcare industry, the ability to have a low cost, modern and fully functional building that can fit into small and unique spaces, without causing day-to-day disruption onsite is a benefit not to be overlooked. If you do decide to go the modular route, make sure that you talk to industry direct. This will without doubt save money. The Modular and Portable Building Association has members who have been fully vetted before joining, MPBA members will provide the highest quality structures and meet the needs of any healthcare project. L

FURTHER INFORMATIONwww.mpba.biz

The ability

to have a low

cost, modern and

functional building

that can fit into

unique spaces is a

benefit not to be

overlooked

The new Wilo-Stratos, Wilo-Stratos GIGA and Wilo-CronoLine-IL-E for building automation are already compatible with all communi-cation system worlds thanks to the IF-Module. Do you want to know how you can exploit future potential for effi ciency in the building technology of today and save energy costs? Wilo makes it easy!

*when compared to an old uncontrolled pumpGo to www.wilo.co.uk/consultant for the full story.T:01283 523000 E:[email protected]

Wilo-Stratos GIGA, the powerful one:

ƒ For use in heating, cooling and air-conditioning systems ƒ High-effi ciency EC motor ƒ Very high overall effi ciency ƒ Communication-capable for building automation in all system environments

thanks to optionally integrable interface modules ƒ High Effi ciency Drive, the drive of the future

Just scan the code andwalk into the world of Wilo!

Save upto 70% on energy costs with the Wilo Stratos Giga*

0000001470.indd 1 28.01.2015 16:49:30


55

TURisNICE recommends the TURis system as the new gold standard for Transurethral Resection of the Prostate

• TURis system is of equivalent efficacy to the monopolar system for transurethral resection of the prostate (TURP)

• Estimated saving of £285 - £375 per patient when moving from monopolar to TURis

• TURis could provide cost savings by: - Fewer re-admissions - Reduced risk of blood transfusion - Reduces TUR syndrome

• TURis could reduce length of hospital stay

• TURis is likely to generate cost savings compared to the monopolar TURP system

Reference: NICE medical technology guidance 23 guidance.nice.org.uk/mtg23

OLYMPUS MEDICALKeyMed House, Stock Road, Southend-on-Sea, Essex SS2 5QH, UK

Follow us on Twitter @OlympusMedUIMEAwww.olympus.co.uk

TURisNICE recommends the TURis system as the new gold standard for Transurethral Resection of the Prostate

• TURis system is of equivalent efficacy to the monopolar system for transurethral resection of the prostate (TURP)

• Estimated saving of £285 - £375 per patient when moving from monopolar to TURis

• TURis could provide cost savings by: - Fewer re-admissions - Reduced risk of blood transfusion - Reduces TUR syndrome

• TURis could reduce length of hospital stay

• TURis is likely to generate cost savings compared to the monopolar TURP system

Reference: NICE medical technology guidance 23 guidance.nice.org.uk/mtg23

OLYMPUS MEDICALKeyMed House, Stock Road, Southend-on-Sea, Essex SS2 5QH, UK

Follow us on Twitter @OlympusMedUIMEAwww.olympus.co.uk

Written by Jill Joyce, senior policy and research advisor at IO

SH

Imagine a frosty February morning. It is -8°C and you arrive in shock at an unfamiliar hospital complex. The ambulance you tried to follow has long disappeared with your partner who has just suffered a heart attack at home. This is just one occasion, when you need clear, easy to read, informative hospital signage. Where can you park the car and when you have, how do you find the patient? I was lucky, a passing nurse on their way to work, realised my dilemma and helped me. But with good hospital signage you don’t need to be in the right place

at the right time – you should be able to see at a quick glance exactly where to go. Outside the hospital you need signs that are well lit and can be seen clearly from the main road. It’s essential that directions to the Emergency Department are eye catching – some hospitals paint the road outside it red, indicating where ambulances can park but not the general public. Good traffic management

should ensure that patients and relatives approaching the

Emergency Department by car are guided to an

appropriate car park. Areas such as accident

and emergency can benefit from signage that helps to keep patients and their relatives calm. For example, one of the frustrations in accident and emergency is wondering how long you have to wait. A large diagram on the wall showing a patient’s journey through the Emergency Department can be useful.

LEAD THE WAYInside the hospital, it is also useful to have different coloured paths painted on walls or floors so that patients and visitors do not get confused by corridors, which look similar. Signage also has to be suitable for the patient. For example, Great Ormond Street Hospital has been designed to be appealing to children. Animal characters are used to designate areas within the hospital, show visitors the way and at the same time entertain the children. For hospitals within the National Health Service there are guidelines available at www.nhsidentity.nhs.uk/all-guidelines. These specify the corporate typeface (Frutiger or Arial), use of the NHS logo and tips such as the fact that using all upper case letters makes signs more difficult to read. When deciding what size the letters should be, it’s important to take into account how far away they need to be in order to be read and also the fact that they need to be accessible to everyone – including wheelchair users. Braille signs will be needed for those with E

WAYFINDING

PROVIDING VITAL INFORMATION TO PATIENTS & STAFFJill Joyce from the Institution of Occupational Safety and Health, discusses the importance of clear signage in hospitals – and the many aspects to bear in mind to get it right

Signage

It’s essential

that directions

to the Emergency

Department are

eye catching – some

hospitals paint the

road outside

it red



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impaired vision and are normally positioned underneath the standard text. There is also advice on where signs should be mounted and how high from the floor they should be (normally 60 inches/152 cm from the floor to the centre of the sign). It’s also important to ensure that letters and symbols contrast well with their background to improve legibility.

WHAT LANGUAGE?If services are to be truly accessible to everyone, then depending on the region, it may be important for signs to be in more than one language. If so, it is important to take into account the degree that the signage reflects the population, which parts of the hospital need to have bilingual signs and the degree to which the translated text in each language is equivalent to the source text. An example of hospital signage in a Jerusalem hospital where there had been wrong lexical choices led to slight variations such as ‘premature baby clinic’ being signed as the ‘new born clinic’. This highlights the need for good quality control in translation and the acknowledgment that sometimes it is not possible to provide a true equivalent translation. An alternative is to provide pictograms. Pictograms are symbols illustrating what is located in the area identified on the sign. There is usually a written description directly below the symbol. Pictograms can also be used to communicate health and safety information. IOSH-sponsored research found that pictorial materials improved understanding in migrant workers in the construction sector.

CATEGORISING SIGNAGE Health and safety signage at the hospital will be required if there is a significant risk that can’t be avoided or controlled in any other way, such as through safe systems of work or engineering controls. These signs are divided into five categories. The first of these categories is prohibitory

signs, which are round and have red edging, for example ‘No Smoking’ signs. Additionally, warning signs, which are yellow outlined in black, for example ‘Radioactive material’, form a second category. Mandatory signs, which are round with a blue background, for example ‘Pedestrians must use this route’, are categorised accordingly. Emergency escape and first aid signs are rectangular or square and have a green background. An example of this sign is one with a white arrow indicating the way to take in an emergency. Finally, fire-fighting signs, which are also rectangular or square but have a red background, are categorised separately. Other signs can also be used to indicate unsafe conditions – such as wet floors. These and trailing cables are a cause of many slip and trip accidents. General housekeeping is important and planning cleaning work to avoid times when corridors are busiest is sensible. It is not sufficient to rely on a sign to make an area safe. When staff and visitors are preoccupied or in a hurry, they may not notice signs indicating a wet floor or may ignore them or even remove them. Another area of accident prevention is to keep pedestrians and traffic well segregated and this is where clear road traffic signs and mandatory signs for pedestrians are paramount.

DIGITAL SIGNAGETraditionally hospital signs were made of plastic and the advantage of this material is that it is hard wearing and can be in many colours. However, one sign always displays the same information. The advantage of new digital signage is that it can provide up to

date relevant information. In practice most hospitals use a combination of both. Digital signage can be used to let patients know how long they will have to wait in a clinic, how many car parking spaces are left but can also be used to broadcast messages about healthy behaviours or even show calming landscape pictures. There are now products available that can be uploaded with information and a schedule of what to play at different times. This information can be sent to the digital displays over the computer network, although this needs to be scheduled at a time, when it will not slow the network down.

SIGNIFICANT SIGNAGESo to summarise – remember why we need signage. Good signage ideally incorporates colour coding. It provides information about the services and facilities of the hospital and enables people to easily identify where they are currently and in what direction they need to go. It provides identification of wards, rooms and also areas, which are not accessible to the general public. It also has to meet statutory requirements. For example, there needs to be appropriate safety and warning signs, indicating fire exits and slip and trip hazards. Digital signage is a good flexible format to provide up to date messages. Finally, it is important to carry out regular checks to ensure that your signage is working and if any signs need replacing. Good management of signage will improve the experience of a hospital visit for patients and visitors and make it a more pleasant environment for staff. L

FURTHER INFORMATIONwww.iosh.co.uk

Signage

WAYFINDING

Pictograms are symbols illustrating what is located in the area identified on the sign and can be used to impart health and safety information



Prod

ucts

& S

ervic

es

Toshiba understands the pressure healthcare organisations are under to manage costs and improve efficiencies, with customer care as the primary objective. Toshiba’s range of printing products offers solutions to directly improve measurable objectives, such as service levels and patient care outcomes. Designed to specifically enhance patient experience and improve patient safety, the company ensures that its products integrate easily into existing systems, protect data, and ultimately optimise workflow and the accuracy of information. From portable through to industrial and from high resolution desktop printers through to multifunction devices, Toshiba products are used for a wide range of applications throughout the healthcare sector. The company provides wristband printing for monitoring patients, which is critical to improving patient safety and minimising potential medical

risks. Its mobile pharmacy enables high quality, accurate labels, of differing sizes ready for use. Desktop dispensary printing is low-cost, with a small footprint, multiple interfaces and high quality print. Large capacity label rolls, for industrial labelling applications require high speed batch printing. Office printing- including copy, scan and fax solutions- enhance office efficiency, where high speed, quality document output is essential for improved productivity.

FURTHER INFORMATIONTel: 0843 2244944www.toshibatec.co.uk

Innovative technology for the healthcare sector

ICT

The NHS has been asked by the government to make further savings in addition to those currently outlined for this year. Hospital Mart, an online health sector listing site that assists medical organisations sell any equipment, aims to generate this much needed income and reduce costs in what is a difficult financial environment. This includes used, pre-owned, refurbished, redundant or slow moving equipment that is no longer wanted. The company provides an easy to navigate, five step, low cost method of disposal and its site can be viewed on both smartphone and tablet. By using Hospital Mart, both public and private healthcare services can sell their items throughout the UK and other parts of the world, realise their assets and generate much needed income.

Calculations on the sale of equipment enables a reduction in overhead costs. Administration, insurance costs, depreciation, disposal costs and storage can be vastly reduced. Hospital Mart recognise that the cost benefit ratio indicates major gains for the NHS. By using Hospital Mart, buyer and seller are simply brought together for mutual benefit. Its service offers value for money whilst adhering to current safety regulations and provides a clear and simple method of disposal. By generating valuable income, the solution to difficult financial conditions may just be a click away.


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Solar Advanced Systems Ltd is a multi award winning designer, installer and funders of solar PV for all types of domestic and commercial buildings. The company is committed to providing the most affordable, efficient and sustainable solutions to the forever rising energy costs. Forward- thinking companies are investing in solar PV to take advantage of this clean and reliable energy source. Solar Advanced Systems offers bespoke finance or lease packages that are tailored to specific site requirements. Its unique finance scheme, ‘RIOS’, allows high energy users to install a maintained and operated solar PV installation with zero capital investment. These schemes are typically cash positive from year one, yet allow the client to benefit from

reduced utility costs and the government backed feed-in tariff as these are retained by the client. With extensive experience in designing, managing and installing solar PV systems from 3kW to well over 1.3MW, you can rest assured that your installation will be carefully quoted, professionally installed and fully guaranteed with all the documentation and advice you require along the way. If you’re considering solar then call today and see how Solar Advanced Systems can start to help your organisation win the battle of ever increasing energy costs.

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FIRE SAFETY

Under the Regulatory Reform [Fire Safety] Order 2005, all healthcare premises need to have an up to date fire risk assessment document which demonstrates that their healthcare premises meet the fire safety requirements of the current law. FIRE-STAT International is an award winning specialist fire safety consultancy with 25 years business experience staffed by highly experienced ex-senior fire officers who are both accredited fire risk assessors and qualified fire consultants. FIRE-STAT International is also fully insured for professional indemnity, public liability and employers liability and is a

member of the Association of Fire Consultants and the UK fire protection industry. A fire risk assessment from FIRE-STAT International will extend to 40 pages, include plans, photographs and an action plan of essential fire safety precautions. The managing director of FIRE-STAT International is Gary Whitworth, former chief fire officer – Kent Fire and Rescue Service and former government fire advisor.

FURTHER INFORMATIONTel: 01293 823044Tel: 01293 823921Mob: 07949638071www.Fire-Stat.co.uk



Products & Services

Secure Furniture Solutions has developed a unique anti ligature wardrobe. The product is the only one of its kind worldwide, and is now the answer to the problem of self harm ligature attempts on wardrobe doors. Utilising an innovative hinge mechanism with an optional electromagnetic lock, the ligature warning system gives back privacy dignity and security of possessions. It provides basic human rights for all service users, rights that cannot be maintained using open faced wardrobes. The door looks and operates as a standard wardrobe door, but in the event of forces of over 13kg being exerted on any part of the door, this would allow the movement needed within the mechanism to engage the alarm. Any continued downward force on the door would then result in the door leaf continuing to slide down the hinge mechanism to its end point. This results in the door being at an angle that can no

longer support a ligature attempt. Secure Furniture Solutions’ ligature warning system can be interfaced with existing nurse call systems, or supplied as a standalone system. There are additional management system security features available. For further information please contact Secure Furniture Solutions on the details below.


Opening the doorway for safer, secure furniture

FURNITURE

George M Zintilis, PhD, BSc (UCL), Chartered Engineer (MICE, MIMechE), specialises in real estate, projects and facility activities in relation to performance, opportunity and risk management. His experience includes ten years in risk management on the client side – at Deutsche Bank as director and at Barclays Bank – and over 20 years as a consultant. Zintilis is on the Risk and Business Continuity Committee of the British Institute of Facilities Management, providing good practice guides, training and events to its worldwide membership. Zintilis has over 30 years of experience in the public and private sectors, in areas such as defence, counter-terrorism measures, bank RE and facilities, oil and gas, nuclear power and airports. Zintilis & Associates Consulting Engineers (ZACE) has helped organisations benefit through lower risks, lower costs and higher performance when managing their activities and

vendors in RE portfolio, capital projects, facilities services and transformation programmes. This is best achieved via an enterprise risk system to the ISO31000 standard, which considers the risks for each business objective via a framework of policy, strategy, governance, resiliency, oversight, compliance, controls and delivery. Using the Three-Lines-of-Defence model for delivery, operational oversight and audit, an organisation or department can meet or exceed its business objectives.

FURTHER [email protected]

ZACE: Risk and performance management

RISK MANAGEMENT

Cynergy is made up of a team of engagement specialists who have helped hundreds of organisations achieve lasting transformation. Applying its knowledge and creativity to the NHS and UK public sector only, whose organisations each have their own distinct objectives and needs, Cynergy has a proven track record of working with clients large and small on successful and innovative communications projects. Cynergy’s award winning team - a talented mix of creatives, strategists and facilitators - provides inspirational and cost-effective solutions for clients in event management; branding & design; strategic communications; staff engagement; web, digital & motion; and development programmes. The company prides itself on

having a genuine understanding of the challenges facing the sector, being outcome-focused and values-driven, and taking a uniquely interactive approach. With particular expertise in engaging hard-to-reach audiences, Cynergy’s people-centered communications tackle real issues with real people. In short, Cynergy engage hearts and minds. Whatever communications platform support is needed in, the company ensures that key messages are clear, consistent and meaningful for your target audience – Cynergy would love to help.


Creative solutions for health and social care clients

EVENTS



Deontics is an Artificial Intelligence (AI) company whose technology is developed from first principles for clinical use incorporating concepts from cognitive psychology and computer science. Deontics pathway and decision products render relevant, personalised evidence items from clinical guidelines and protocols at a highly granular level at the point of care and have been shown to increase compliance with clinical guidelines in practice. These products have the potential to substantially increase clinical performance standardisation and patient safety both at unit level and across sites or regions effectively combating the ‘postcode lottery’. Because decision data is captured alongside outcomes and other clinical data, Deontics

provides the capability to fully ‘measure’ practice and provide a benchmark for improvement. All data items flowing through a system are captured real-time and time-stamped and are available for audit and research purposes and can be analysed individually or at population level. Deontics can also enable patients to have access to relevant personalised evidence and so can encourage shared decision making.

FURTHER INFORMATIONTel: +44 (0) 20 3567 [email protected]

Deontics – Leading clinical pathway and decision support technologies

HEALTHCARE

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

Andrew Sykes Hire 20ARI-Armaturen UK 22Asckey Data Services 62BG Products 38Bosse Interspice 6BTS Biogas 20Care Check 14Ccube Solutions 4, 32CFH Docmail 50, 51Cynergy 61Decorative Panels Lamination 8Deontics 38Direct Signs UK 58Direct Telecom Services 40Epson UK 12FIAT 10Fibre Technologies 42

Fire Stat International 60GP-Access 16Highland Marketing IBCHIMSS 37, 39Hip Impact Protection 38Hospedia 34Hospitalmart 60HP cover

wrapIntegrated Change 30JRA Gadgets 38Kamstrup 23Kingspan 52Melia Whitehouse Hotel 58Nervecentre Software 28Nexus Industries 18Olympus Medical 56PHS Group IFC

Ring Automotive 14RMJPI London Business 44Secure Furniture Solutions 61Solar Advanced Systems 60Static Systems Group 35Technomek BCThermohouse UK 23Toshiba Tec UK 60UK Parking Control 24Voice Connect 36Wilo UK 54Wiltshire Enterprise Training 44World Of Benches 49Worth Learning 44Yeoman Shield 46YPO 26Zace Risk Management 61

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health business 15.2

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