Health Business 13.2

HEALTHCARE IT

VOLUME 13.2www.healthbusinessuk.net

SECURITY

Benefits for patients, carers, staff, and the wider

healthcare industry

STAYING AWAY FROM HOSPITAL

TELEHEALTH

PLUS ENERGY | FIRE SAFETY | FLEET MANAGEMENT | DESIGN & BUILD | SIGNAGE

INFECTION CONTROL

Fat tax, cooking lessons, banned adverts – can preventative measures really work?

A HEAVY NHS BURDEN

OBESITY

Comm

entHEALTH BUSINESS MAGAZINE ISSUE 13.2

Hospital Hotel HappeningsHEALTHCARE IT

VOLUME 13.2www.healthbusinessuk.net

SECURITY

Benefits for patients, carers, staff, and the wider

healthcare industry

STAYING AWAY FROM HOSPITAL

TELEHEALTH

PLUS ENERGY | FIRE SAFETY | FLEET MANAGEMENT | DESIGN & BUILD | SIGNAGE

INFECTION CONTROL

Fat tax, cooking lessons, banned adverts – can preventative measures really work?

A HEAVY NHS BURDEN

OBESITY

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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.ukEDITORIAL DIRECTOR Danny Wright ASSISTANT EDITOR Angela Pisanu PRODUCTION EDITOR Richard Gooding PRODUCTION CONTROLLER Jacqueline Lawford PRODUCTION ASSISTANT Jo Golding WEBSITE PRODUCTION Reiss Malone ADVERTISEMENT SALES Kylie Glover, Jeremy Cox, Lorena Ward, AJ Baker ADMINISTRATION Victoria Leftwich, Lucy Carter PUBLISHER Karen Hopps REPRODUCTION & PRINT Argent Media

Elderly patients who no longer need round-the-clock care could soon be packing their bags for ‘hospital hotels’. NHS England is currently reviewing the proposals, which are based on a system widely used in Scandinavia 32with large hotel chains running the service on hospital sites. Visiting hours for family members would be far more flexible; relatives would be able to stay in a nearby room, and the system would certainly save the NHS money – according to figures from 2010, the cost of keeping a patient in a hospital bed overnight is more than £300 compared with around half that for a hotel room.

Commenting on the proposals, Candace Imison, King’s Fund’s deputy director of policy, said: “The patient hotel concept offers advantages to some types of patient, such as those who receive cancer treatment a long distance from home.” Health minister Earl Howe added that local commissioning groups had ‘freedom and responsibility’ to develop their own ‘innovative’ ways to deal with problems.

Speaking of CCGs, health secretary Jeremy Hunt pledged to review Payment by Results while addressing a delegation of over 150 CCG leaders in London recently. It is widely believed that PBR is seen to reward activity rather than outcomes. Johnny Marshall, GP and director of policy at the NHS Confederation, said: “Payment by Results doesn’t separate results from activity. We are not in the business of maintaining business as usual. We don’t have the flexibility to bring about the change we need.”

Finally, in another innovation at Falkirk’s Forth Valley Hospital, sufferers of insomnia and tinnitus will soon be given access to audio therapy – the hospital radio service plans to broadcast soothing sounds, including birdsong and snoring! Read more on page 9.

Danny Wright

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

3 Volume 13.2 | HEALTH BUSINESS MAGAZINE

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Contents


SPECIFIERS INDEX 2011/12

sponsored by

ASBESTOS MANAGEMENT – keeping the hidden killer at bay

INFECTION CONTROL

Vaccinating the NHS

front line against flu

LEGIONELLA

CATERING HB AWARDS

VOLuME 11.9


CLEANING – PAS 5748: Blueprint for cleanliness or yet more bureaucracy?

VoLumE 11.8

HEALTHCARE ITHow can open source software benefit the NHS?

SECuRITYProtecting healthcare facilities from both common and not so common security threats

FuRNITuRE

ENERGY CoNFLICT mANAGEmENT


RECRUITMENT – Defending the vital role of locum staff PLUS MORE

BARIATRICS

FIRE SAFETYENERGY

VOLUME 11.10


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EMERGENCY PLANNING

Ensuring service continuity during major incidents

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VoLumE 11.6

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Health Business www.healthbusinessuk.net

CONTENTS

49

11

07 NEWS Monitor wants ‘risk pool’ for new NHS providers; BMA calls for action on pensions; doctors to train on robot patients 11 OBESITY With obesity costing the NHS an estimated £49.9 billion per year, Dr Matthew S Capehorn, from the National Obesity Forum, examines the problem

19 INFECTION CONTROL Julie Storr, Annette Jeanes, Helen Forrest, and Claire Kilpatrick look at the history of hand hygiene in relation infection control

27 SECURITY James Kelly, chief executive of the British Security Industry Association discusses the value of CCTV in securing hospitals 31 FIRE SAFETY A preview of FIREX International, taking place on 13-16 May 2013

33 HEALTH & SAFETYSafety and Health Expo is Europe’s leading annual exhibition for the occupational safety and health industry 35 FACILITIES MANAGEMENT The BIFM has announced a new category for its 2013 Awards

37 DESIGN & BUILD What can resin flooring offer the healthcare sector? Helen McGachie, CEO of the Resin Flooring Association, explains

41 ENERGY The severity and length of the cold weather will have driven up energy bills in hospitals, which may require a policy re-assessment, writes ESTA’s Richard Hipkiss 43 SIGNAGE David Catanach takes a look at wayfinding signage in hospital buildings

45 FLEET MANAGEMENT The Energy Saving Trust’s Bob Saynor dishes out top tips for fuel-efficient driving

49 HEALTHCARE IT Dr Paul Shannon examines how IT systems can help address the key findings of the Francis Report

55 TELEHEALTH How is telehealth benefiting patients, carers, hospital staff, and the wider healthcare industry?

63 CONFERENCES & EVENTS A look at this year’s healthcare events

41

19

09



HB New

s

NEWS IN BRIEFBMA’s GP support plansThe BMA is to launch an initiative to support GPs and patients through the challenges facing general practice. The drive, led by the BMA GPs committee, aims to provide GPs with resources to communicate with patients about pressures caused by contractual changes imposed on the profession in England. It will also seek to help GPs with patients’ concerns about the impact of the Health and Social Care Act implementation.

Vitamin D guidance from National Osteoporosis Society New guidance from the National Osteoporosis Society suggests that GPs should test vitamin D levels in patients who display symptoms of deficiency and those with underlying bone disease who may benefit from having their levels corrected. The guidance is the UK’s first on identifying and treating vitamin D deficiency. It sets out recommended groups for testing for the first time and specifies the levels that require treatment. Dr Neil Gittoes, a consultant endocrinologist at Queen Elizabeth Hospital in Birmingham and co-author of the guidance, told Pulse: “A key idea behind the guideline is that in some parts of the country virtually everybody who walks through the door is getting vitamin D tests done, but in others patients who clearly have features compatible with vitamin D deficiency, or who have bone conditions where it would be helpful to work out whether they are deficient or not.”

Health secretary Jeremy Hunt has asked smaller businesses to ‘hang on in there’ for NHS contracts, after admitting that the NHS procurement process for IT is weighted towards large technology providers, but

When the Coalition government assumed power in 2010, it pledged that at least 25 per cent of public sector contracts would go to small and medium-sized enterprises (SMEs). However, speaking at a Digital Life Sciences event in the Houses of Parliament, the health secretary said current procurement processes damaged the companies they were trying to protect.

Hunt said: “I think the NHS has got a long way to go before we are a truly level playing field for SMEs.

“I think that one of the great ironies, or the great mistakes really, is that even procurement law, which is designed to create that level playing field, actually creates procurement processes of such bureaucracy that it puts off SMEs. It favours incumbents who tend to be the bigger companies who have the resources to invest into six-or nine-month procurement processes. I think we need to do better, opening ourselves up to SMEs.”

EU law was to blame for some things, said the Minister: “We are going to do what we can to break down those barriers to procurement, though some of them I am afraid are constrained by EU procurement law.”

However, he claimed the new Health and

Social Care Act which came into force in April would go some way to even things out.

“Hang on in there and remember that the approach we are going to be taking is very much at a level of individual trusts,” said Hunt.

“I think there is quite a lot of evidence that where we have made the fastest progress is place, where small is beautiful and you have teams that are nimble enough to deliver stuff really quickly.”

“That is the way we have got to go. Don’t give up. The NHS needs you. I think it is really worth hanging on in there. This is a market that is going to grow and I think it could do with lexible people who have brilliant new ideas.”

Hunt has previously committed the NHS to going paperless by 2018, with electronic records available online by 2015.

RCN’s competition concernsThe Royal College of Nursing has raised concerns ahead of a House of Lords motion to annul new competition regulations being introduced in the NHS. RCN general Secretary Dr Peter Carter said: “The RCN remains concerned that new Clinical Commissioning Groups could be forced into using competition as a result of these revised regulations. Members have voted overwhelmingly in favour of a resolution calling for the removal of Section 75 regulations. Competition in the NHS should only be applied where it helps to deliver high quality patient care, not on the basis of price alone.”

PROCUREMENT

Hunt tells SMEs: “Don’t give up – the NHS needs you”

READ MORE: tinyurl.com/d4sts9x

READ MORE: tinyurl.com/byv86oa

READ NOS GUIDANCE: tinyurl.com/cskz9ea

Despite improvements being made to the way in which the NHS is managing its property, there is still £2.3bn worth of annual savings available if better facilities management and procurement practices were adopted, according to the latest annual report by built asset consultancy EC Harris.

The report reveals wasted space in the NHS estate is equivalent to 157 hectares – larger than London’s Hyde Park. Progress has been made through the better use of property and disposal of surplus land, which has seen the wasted space fall by 53 per cent since 2009.

The report acknowledges further

opportunities to improve efficiency via removing much of the 12.8 per cent of the NHS Estate that is ‘functionally unsuitable’ and which hampers efforts to deliver high quality, lower cost facilities.

Conor Ellis, author of the report, comments: “Everyone accepts that health is facing a more-for-less agenda over the next five years plus. Trusts must look at benchmarking to first quartile in all asset forms, from hospital throughput and clinical safety to hard and soft fm alongside management performance to ensure effective delivery – the so called whole life/ holistic model.

READ THE REPORT tinyurl.com/ccj5ohm

£2.3 billion to be saved through better FM says EC Harris report

NHS ESTATES



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HB New

s

NEWS IN BRIEFCCG handover causes payment ‘chaos’According to Pulse, GP practices are reporting the 1 April transfer of responsibility has caused ‘chaos’ with payments that used to come from PCTs, resulting in severe cashflow problems. Practice managers have complained of irregular payments and problems claiming for business rates and water bills, while elsewhere GPs have identified issues with PMS payments and DES reimbursement. NHS England told Pulse that its local area teams were experiencing some ‘transitional’ problems with payments.

Survey reveals the majority of doctors think NHS 111 should be scrappedA poll by Doctors.net.uk shows that 70 per cent of doctors think the NHS 111 service should be scrapped. A poll of 748 primary and secondary care doctors found that 70 per cent wanted the 111 service withdrawn permanently, 16 per cent of them thought it should remain temporarily withdrawn until fixed; 12 per cent thought it should be live, but put right. Two per cent thought it did not need to be changed. NHS 111 roll out across England has been delayed due to safety concerns. MPs will investigate the role of the NHS 111 service as part of a review of emergency services and emergency care.

A quarter of nurses have been ‘discouraged’ to blow the whistle on concerns over patient care, a poll has suggested. Royal College of Nursing leader Dr Peter Carter said many nurses faced a culture of fear and intimidation at work and this was placing patient safety at risk.

The poll, conducted on more than 8,200 nurses, found that 44 per cent would think twice about whistle blowing because of worries about victimisation or reprisals.

One of the key recommendations made by the Mid Staffordshire NHS Foundation Trust public inquiry chairman, Robert Francis QC, was that concerns and complaints should be able to be raised “freely without fear”.

But Dr Carter told the RCN’s annual Congress in Liverpool: “These responses illustrate that despite the recent attention which has been drawn to the importance

of whistle blowing, many nurses are still experiencing a culture of fear and intimidation if they try to speak out. This is putting patient safety at risk.

“One of the key lessons from the Francis report was that frontline staff must feel confident that they can raise concerns about patient safety without fear of reprisals.

A third of nurses questioned said they didn’t know whether their organisation had a whistle blowing policy, and of the 64 per cent who had raised concerns, nearly one in ten said they had raised concerns as little as a week ago. Nearly half of the concerns raised were about staffing levels; 21 per cent were about patient safety. Meanwhile, 45 per cent of nurses who had raised concerns said their employer took no action.

Parliamentary inquiry into pancreatic cancer launchedThe All Party Parliamentary Group on pancreatic cancer (APPG) has announced the launch of a special inquiry which look at pancreatic cancer survival rates and investigate why rates of survival from the disease, at around 4 per cent, remain the lowest of all the 21 most common cancers in the UK. The APPG will consider a number of issues, including early diagnosis. The inquiry will also seek evidence as to why UK survival rates lag behind many other EU countries as well as the US, Canada and Australia. The inquiry’s first session takes place on 16th May.

MEDICAL RECORDS

New body launched to promote common standards in record keepingThe Professional Records Standards Body (PRSB) has been launched to promote the development of health and care records based on common record keeping standards.

The PRSB, which is intended to become the primary source of knowledge and expertise on health and social care record keeping standards, is backed by nearly all the royal medical colleges. A central aim of the PRSB will be to make sure that the requirements of those who provide and receive care can be fully expressed in health and social care records. It will also provide guidance for those working on technical implementation of the standards, and on their maintenance. Professor

Iain Carpenter, chair of the new body, said: “The creation of PRSB will help organise the structure and content of health and social care records around the needs of patients and the health and social care sectors.”

The PRSB was launched in March. Founding members include: the Royal College of Physicians, the Allied Health Professions Federation, Royal College of Nursing, Royal College of General Practitioners, BCS, the Academy of Royal Medical Colleges, Royal College of Pathologists of Pathologists, the the Royal College of Surgeons of England.

NHS WHISTLEBLOWING

A quarter of nurses discouraged from whistleblowing, says RCN

READ MORE: tinyurl.com/blkeep6

READ MORE: tinyurl.com/bxf7l32

READ MORE: www.doctors.net.uk

Hospital Radio Therapy planned at Forth ValleyInsomniacs and tinnitus sufferers are to be given the opportunity to tune into an alternative form of therapy whilst in Forth Valley Royal Hospital. The treatment will be delivered via bedside radio and will feature soothing sounds including rain, waves, birdsong and snoring. Future programmes will include a soundscape of the hospital, featuring the noise of the mail and pharmacy robots, patients exercising in the physiotherapy gym, and snippets from the neonatal ward, the renal department and the laboratories. There will also be an episode about dreams and their interpretation. As well as being available at the hospital bedside, the new series can also be listened to through an i-player type service on www.channel604.org



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Written by M

atthew S Capehorn, clinical director, N

ational Obesity Forum

The Health Survey for England Report published in 2012, showed that in 2010, obesity rates rose again to 26 per cent of women and 26 per cent of men aged 16 or over classified as obese (BMI > 30kg/m2). In total 58 per cent of women and 68 per cent of men were classified as either overweight (BMI 25-30kg/m2) or obese. This suggests that the majority of the population are more likely to have a weight problem than be of a healthy weight. The National Child Measurement Programme (NCMP) for 2010/11 showed 1 in 4 (23.1 per cent) children aged 4-5 years, and over 1 in 3 (33.4 per cent) children aged 10-11 years, are overweight. This is of concern, not just because of the immediate risks to health for these children, but also because evidence suggests that obese children have a high risk of becoming obese adults. The NCMP should begin at an earlier age, and measurements taken every year.

CAUSES OF OBESITYForesight highlights over 100 different factors involved in why we, as individuals or as a society, may be obese and getting bigger. Therefore, unless we tackle all of these different factors, we will not solve this problem, and this will require planning and resources. Critics often suggest that treating obesity, especially in an obesogenic environment, is a waste of time, as any weight loss will return. However, obesity is a chronic relapsing condition, and whether it is due to genetics, learned behaviour, our society, or a mix, we have to accept some people may have a predisposition to weight regain. However, morbidity and mortality is dependant on weight at any given time, and those who have undertaken weight loss programmes will be at a lower weight at any given time than those who have not, even if their weight slowly creeps back on, and therefore at lower risks of comorbidities. Obesity is associated with

causing, or aggravating, over 50 common medical conditions, including important life-threatening conditions such as diabetes and

cardiovascular disease, obstructive

sleep apnoea and other respiratory conditions,

and many cancers. Rather than treat the consequences

of these conditions we should focus our attention on dealing with the cause.Prevention or Treatment.

Common sense would suggest a need to focus on prevention; however the evidence base for effective preventative measures just does not exist. The discussion as to whether we need a ‘nanny state’ or ‘nudge’ tactics is a good one. A ‘nudge’ towards healthy behaviour can be very effective, eg, an attractive staircase in your field of view may entice you away from seeking a lift or escalator. Our obesogenic environment can be changed but requires the will, suitable planning, and sufficient resources.

THE FAT TAXA proposed 20 per cent fat tax will not cure the obesity problem. It makes no sense to tax fat in isolation, ignoring other food groups such as sugar. There is no such thing as a bad food is true in this context, as you can eat high fat/sugar foods on occasion as part of a nutritionally balanced calorie controlled

diet. Any tax on food will therefore penalise the poor and discriminate against those of normal weight. It may not even have the desired effect of changing eating patterns, eg, if craving a chocolate bar, a patient would pay a subsidy possibly greater than 20 per cent at a vending machine. Ultimately it does not educate the patient on healthy eating or lifestyle change. Because there is no such thing as a bad food, manay weight management clinics do not propose a specific ‘diet’ that many patient find it difficult to adhere to. Instead they focus on small, achievable, and more importantly sustainable changes in the existing diet that has the overall effect of reducing calorie consumption and overall health improvements. Healthy food subsidies: A subsidy on healthy foods, such as fruit and vegetables, may help promote ‘5-a-day’. However, without education this could result in additional calorie consumption. Studies, eg, Interheart, show that abdominal obesity is a more important modifiable risk factor for myocardial infarction that diet, and so over-consumption of even ‘healthy’ foods may be harmful. Limiting take-aways: A meal from a take-away, or Quick Service Restaurant (QSR) can be eaten as part of a nutritionally balanced calorie controlled diet. The important factor for local authorities will be to ensure that sufficient choice is available, to allow the consumer a ‘healthy’ alternative, and not, for example, place a row of QSRs outside a school. Portion size limits and calorie information: A sensible proposal would be to restrict E

ADULT OBESITY

OBESITY: A WEIGHTYPROBLEM FOR THE NHSAs the prevalence of obesity increases, the associated medical problems will increase also. If current trends continue then projections made by the Foresight Report suggest that by 2050, 50 per cent of adults will be classified as obese by BMI, with direct and indirect costs of obesity costing the NHS an estimated £49.9 billion per year. Dr Matthew S Capehorn, clinical director of the National Obesity Forum, examines the problem facing the NHS

Obesity

The Health

Survey for

England Report

shows that in 2010,

58 per cent of women

and 68 per cent

of men were

overweight



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portion sizes served by QSRs (Quick Service Restaurants) as recently proposed in New York, and to further encourage calorie information on menus.Advertising: This could be limited to avoid any unnecessary and inappropriate targeting of children, and used for health promotion education.

Food labels: The controversy over different food labelling system is unhelpful. For weight management, the calorie content is most important. We should ensure that calorie content is displayed in large print on the front of labels, and perhaps a combination of GDA/traffic light nutritional information available, wherever possible, elsewhere on packaging. Cooking skills: As Jamie Oliver demonstrated in Rotherham, in his ‘Ministry of Food’ television programme, there are many people that do not have basic cooking skills, such as being able to boil an egg. It is futile for weight management service providers to educate on the benefits of cooking from raw ingredients if patients then go home without the skills. It is important that all weight management services work in partnership with teams that can deliver cooking skills. Education in schools: The core curriculum should have lessons on health and wellbeing that include education on obesity, its importance, effects on the body and consequences, social impact etc as well as teaching of correct portion sizes, knowledge about calories and the Eat Well plate, cooking, benefits of physical activity and knowledge of local services available etc This should form part of weight management programmes despite the body of evidence suggesting that it has little effectiveness as a weight loss intervention. There is evidence for physical activity being beneficial for weight maintenance. Furthermore, we want to aim for a healthy weight in order to improve health, and as part of that we should encourage physical activity as part of the lifelong behaviour change to promote the cardiovascular benefits. Previous and on-going studies by The Early Bird Diabetes organisation have cast doubt on whether additional compulsory physical activity in the school setting will result in increased physical levels.

USE OF THE WORD OBESITYRecent debate has surrounded the use of the word obesity. It is true that in certain circumstances, referring to a patient ‘not being at a healthy weight’ may be preferable, we must not lose sight of the fact that the word obesity carries important beneficial connotations, eg, one of my own clinic patients insisted they did not have to worry about their child’s weight because their NCMP letter said he was only ‘very overweight’ and not ‘obese’. She understood the importance of obesity, and would ask for help if ‘Little Johnny’ was obese but he was not. It took some time to explain that very overweight’ was a politically correct way of saying that he was in fact obese.

THE HEALTH-ECONOMIC ARGUMENTHealth-economic data suggests that focussing all of our resources on prevention may not be the most cost-effective. There is no evidence currently available to suggest that preventative measures work, and Foresight proposed that the cost of a preventative intervention may be as costly as doing nothing. However, we do have evidence that treatment interventions work, and that this does convey health-economic benefits. Furthermore, we should consider obesity management as secondary prevention, as we do with cardiovascular disease. In this sense the management of the obese prevents further obesity, morbid obesity, and the super-obese, and so on. This management should be done in the primary care setting. Incentivising GPs to focus attention on obesity is achievable through the existing Quality and Outcome Framework (QOF), which represents the performance related pay element to a GP’s

income. At present the only QOF indicator that directly targets obesity rewards GPs for registering the number of obese people that they see. Merely drawing a register will not prevent a single overweight person from developing type-2 diabetes or a single obese person from having a heart attack. In addition to QOF incentives in primary care, there needs to be investment in structured frameworks, to help provide local areas with integrated interventions at all levels, such as the award-winning NHS Rotherham Healthy Weights Framework. This investment needs to be long-term (10 years+) rather than in the form of short-term commissions to providers, which currently inhibits service development. Albeit based on crude extrapolation of costs for the NHS Rotherham framework, similar services could be developed to cover the UK for an estimated £240m per year (considerably less than the anticipated direct and indirect costs of obesity).

THE NHS ROTHERHAM OBESITY STRATEGYIn 2008, NHS Rotherham made £3.5m available to fund their obesity strategy for a 3 year period. NHS Rotherham’s Healthy Weight Framework proceeded to win the 2009 NHS Health and Social Care Award. Since this time, and despite financial pressures on the NHS, funding has been made available to continue the services, based on proven success and the health-economic argument that it will save more money in the long-run. Total cost for all interventions is currently £1m per year for the population of Rotherham which is approximately 253K.

The NHS Rotherham Obesity Strategy for the management of healthy weight in adults and children involves 4 tiers of intervention. The initial level of intervention is the activity most often done in the primary care setting, which involves identifying those patients that have weight problems, and who are motivated to change, especially those with medical conditions that are likely to worsen with increased weight. It is important to clarify that this primary activity, and any associated health promotion advice, can be delivered by any healthcare professional from primary or secondary care, or in the pharmacy, council, leisure services, or private sector. The 2nd tier of intervention is a community based, time limited, weight management programme of diet, nutrition, lifestyle and exercise advice delivered by trained staff. For adults this is the Reshape Rotherham programme delivered by the Rotherham dietetics department, and for children this

is the More Life (formerly Carnegie) Clubs programme delivered by DC Leisure. Patients can be referred, or self-refer, to these services. Those patients who do not meet their healthy weight targets in this level of intervention, or those who are considered to be more at risk of comorbidities and/or require more specialist intervention, are referred into the 3rd tier, which is the specialist service delivered by the Rotherham Institute for Obesity (RIO). The Rotherham Institute for Obesity (RIO)RIO is the specialist tier of intervention for adults and children with weight management problems, as part of the overall NHS Rotherham Healthy Weights Framework. It has a multidisciplinary team approach to managing weight problems by providing specialists that can provide different approaches. This includes Health Trainers, dedicated Obesity Specialist Nurses (OSNs), Healthcare Assistants (HCAs), Dietetics input for complex dietary needs, “Rotherham Cook & Eat” skills education, Talking Therapies including psychological input, Exercise Therapists, group work for exercise, therapies and nutritional advice, and a General Practitioner with a Specialist Interest in Obesity (GPwSI) for any medication issues. Patients’ referrals are initially triaged to assess which, if not all, of the services offered by RIO are required. In all cases, blood pressure, weight, height, BMI, and fat composition using bio-impedence scales, are recorded. Increased risk associated with South Asian origin is taken into account. If no recent blood tests have been performed these are requested in order to exclude previously undiagnosed metabolic conditions, eg, diabetes and E

Obesity

ADULT OBESITY

Incentivising GPs to focus attention on obesity is achievable through the existing Quality and Outcome Framework, which represents the performance related pay element to a GP’s income



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PROTECTION & MANAGEMENT Week

13-16 MAy 2013 NEC BIRMINGhAM

IFSEC13 Lightbulb 297x210mm Psig.indd 1 18/03/2013 16:44

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IFSEC International 2013 celebrates 40 years of successfully promoting security excellence to the international security market

Bright ideas for security innovation

IFSEC is part of the Protection & Management week uniting

business professionals across security, fire, facilities and safety.

PROTECTION & MANAGEMENT Week

13-16 MAy 2013 NEC BIRMINGhAM

IFSEC13 Lightbulb 297x210mm Psig.indd 1 18/03/2013 16:44

pre-diabetic states, hypothyroidism etc.All patients receive further basic dietary and nutritional advice as well as lifestyle and exercise therapy and education throughout the length of time they are in the service. This may include further explanation of the specific roles of calories, portion sizes and nights off the diet, or education on basic cooking skills in order to complement nutritional advice given (provided in on-site kitchen facilities). Talking Therapists are proficient in techniques such as Cognitive Behavioural Therapy (CBT), Neuro Linguistic Programming (NLP), Emotional Freedom Techniques (EFT), and Hypnotherapy. Patients are seen by the GPwSI (GP with Specialist Interest) if there is need for a review of current medications that may have more weight-friendly alternatives, or for the prescribing of weight loss pharmacotherapy. Consultations are performed on a one-to-one basis in dedicated consulting rooms, although group work is available. Meal Replacement Systems and Very Low Calorie Diets (VLCDs) are not funded by NHS Rotherham, but RIO does educate

individuals on their benefits and when appropriate they are recommended. RIO patients benefit from a subsidy offered

directly by commercial sector providers. Appointments can be made with

one of two exercise therapists, who provide tailored

programmes in on-site gym facilities. Patients are offered a minimum of six sessions with one of the exercise therapists, during which time the aim is to educate and motivate

the individuals. Patients are then encouraged

to engage with free and subsidised local leisure

facilities that have been arranged through partnerships with RIO. Further facilities within the Institute include a dedicated meeting room which allows for educational meetings, for patients and/or healthcare professionals. This room provides a resource library with computer terminals, books/journals and educational tools, as well as additional “exer-gaming” facilities (ie, gaming systems that encourage physical activity, such as the Wii-Fit). RIO is already very well established as a centre for education and research, with links

to several academic institutions, and is currently conducting several studies. All NHS Rotherham patients meeting local Specialist Commissioning Group criteria for NHS funding of (tier 4) bariatric surgery are encouraged to come through the RIO service. RIO has demonstrated a reduction in inappropriate referrals to surgical centres, and a 50 per cent reduction in the numbers needing referral for bariatric surgery (compared to anticipated numbers), suggesting considerable financial savings. Similarly, RIO works with the morbidly obese children (and parents) who may request attendance at the (tier 4) residential weight management camps. RIO has recently become the first centre in the UK, based in primary care, which is routinely screening for Obstructive Sleep Apnoea (OSA) in high risk populations, incorporating the use of overnight oximetry. It is the long-term plan for this centre to offer a more cost-effective, and primary care based, sleep service. RIO is currently developing facilities to become the first centre in the UK, to offer endoscopic surgical procedures, such as the bariatric intra-gastric balloons (and possibly endobarriers), in the primary care setting. L

FURTHER INFORMATIONwww.rotherhaminstituteforobesity.co.uk

Obesity

ADULT OBESITY

Referring

to a patient

as ‘not being at a

healthy weight’ may

be preferable, but we

must not lose sight of

the fact that ‘obesity’

carries beneficial

connotations

Understanding correct body composition is key when developing the fitness and health of individuals. Not only far more accurate than BMI in children and adolescents, but by monitoring changes in fat, lean mass and fluid, it also creates a healthy understanding of what is happening inside the body and how the body works, motivating children and young people to maintain a healthy lifestyle. Data is available on children from the age of six. Results can be downloaded via Bluetooth directly into Windows software or a portable printer for instant analysis. The portable printer allows results to be printed quickly and is something tangible for your students to keep and show. The test works play laying the subject down and applying two electrodes

to the hand and the foot. Then a small electrical frequency is passed through the body and measurements of the resistance and reactance to the flow of the current made. Based on feedback from its large customer base, not only is Bodystat quick to use, but also non-invasive with good reproducible qualities that don’t require any degree of skill or training. Established in 1990, Bodystat Ltd is a British company and are the developers of one of the World’s leading bio-impedance systems. A proud partner of UK Active.

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Becoming educated on body composition is key

Freeward Thinking... offers a range of accessible online e-courses for all your needs. Assert Yourself: Learning to be Assertive is a fabulous example of the selection on offer. Learn from the ground up watching famous faces Kris Marshall and Pippa Haywood as they ‘demonstrate’ the subtle differences between assertive, aggressive and passive. The website’s home page has an entertaining sneak preview of this course. From overcoming the fear of being honest to being able to say ‘no’, Assert Yourself will build assertiveness skills to enable you to become more positive and effectively creative. If you are unsure where to start with being assertive, or find that you need to learn the differences yourself, this course is ideal for you. It lasts for two hours online and is appropriate to anyone.

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Nedap’s AEOS security management platform has been designed for security managers. Our long experience in the security business, combined with our knowledge and understanding of what our clients need, has resulted in a tried and tested security solution. AEOS now secures access, people flow and building management for 37 million people, daily. In the UK for example, two major banks and the largest police organisation selected AEOS as their security management solution. They chose AEOS because of its flexible, user-friendly software and its ease of management. An important factor was the AEOS implementation model and customer support solution: they know that the Nedap team will be there for them, when they need us. Drop by our stand at IFSEC and meet the Nedap team to find out for yourself or visit www.nedap-securitymanagement.com

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Visit us!

IFSEC 2013

Monday 13 May -

Thursday 16 May

NEC Birmingham

Hall 4/B60

20130424 health business print.indd 1 24-04-13 15:04:28

We only have you in mind.

Nedap’s AEOS security management platform has been designed for security managers. Our long experience in the security business, combined with our knowledge and understanding of what our clients need, has resulted in a tried and tested security solution. AEOS now secures access, people flow and building management for 37 million people, daily. In the UK for example, two major banks and the largest police organisation selected AEOS as their security management solution. They chose AEOS because of its flexible, user-friendly software and its ease of management. An important factor was the AEOS implementation model and customer support solution: they know that the Nedap team will be there for them, when they need us. Drop by our stand at IFSEC and meet the Nedap team to find out for yourself or visit www.nedap-securitymanagement.com

Security Redefined

Visit us!

IFSEC 2013

Monday 13 May -

Thursday 16 May

NEC Birmingham

Hall 4/B60

20130424 health business print.indd 1 24-04-13 15:04:28

The Protestant hospital in Mülheim an der Ruhr has 602 beds and around 1,250 staff and is also an academic college hospital of the University of Düsseldorf. The clinic uses the AEOS security management platform from Nedap and the offline lock system from Salto.

When the quick-response emergency team internally known as ‘Christoph 7‘ after the most famous rescue helicopter in Germany rushes to an emergency such as a heart attack or a stroke somewhere within the hospital, there is no time to be lost: in the most serious case it can be a matter of life or death. Saving lives has absolute priority of course and requires unhindered access. The access control management system must therefore be

prepared for this eventuality. So the Team has its own special ‘Christoph 7’ cards: held in front of any card reader they initiate elevator priority control. The elevator that is specially reserved for the emergency team is ordered to the appropriate floor. Only when a Christoph 7 card is used in the elevator will it then go with priority to the selected floor. The elevator is

released for normal operation again by the Team by card. This is just one of many features that the new access control system provides.

PAVING THE WAY FOR FLEXIBILITYThe foundation of the system goes back to an investment decision made in 2008. As well as access control, this includes the identity and authorisation management, IP video management and intrusion alarms. Add to that the supervision and reporting with web-based alarm administration via a web-based, operating system independent graphic interface. The Salto off-line system has been fully integrated into the AEOS security management platform

and thereby enables the homogeneous administration of all components, people and functions. AEOS manages a total of 1,580 off-line lock systems. It manages all online doors and online functions, the access doors, the off-line lock system, room doors, patient cabinets and containers, employee cupboards as well as mobile care and food trolleys.

EMERGENCY DOOR MONITORING AND CANTEEN TROLLEYSApplications of the security management system can be found everywhere. For example, all escape doors, i.e. those doors that are on escape and rescue routes within the hospital, are connected to AEOS. Whereas alarms could only be raised before by pressing an emergency button, they can now also be alerted at a central point and forwarded. The connection also serves to prevent doors being opened without permission. If this happens anyway an alarm is raised in AEOS so that the door can be closed again. An additional connection to the video surveillance system is also planned.

The scope of the Nedap software reaches even as far as the catering service: the central food supply service functions in this Mülheim hospital in that the food is delivered to the kitchen deep frozen, divided into portions and stacked in the canteen trolleys. It is then thawed and carefully warmed up on the ward so that it doesn‘t arrive on the plates lukewarm or even cold, because of the long transport distances.

Each of these canteen trolleys has a transponder that automatically opens the door in front as it passes over the inductive loop in the floor directly below. In this way it is not necessary for a member of staff to manually open a door with their card each time and the kitchen remains accessible to authorised persons.

CENTRAL LOCATION – PREFERRED PARKINGFor shopping-lovers, it is very practical to use the car park of the centrally located hospital, and so some employees had the idea of using their ID cards outside normal working hours.

This is now prevented by a connection to the AEOS software, as Dietmar Vetten of GST explains: “The installation specialist has fitted a card reader to the parking lot barrier that is connected to the AEOS system. This has saved having three separate proprietary parking management systems.”

The parking spaces can be of ‘mixed’ use according to an algorithm – that is, by the public (by visitors) and by staff. The software shows the current occupancy status of each.

If one of the staff park there too long an email is sent to the facility management personnel. Parking authorisation for the various stand-by services is organised so that just the one person from each stand-by team that actually has stand-by duty can park there during the appropriate shift, even though all the staff that provide stand-by cover have authorisation for the various parking lots.

FURTHER INFORMATIONwww.nedapsecurity.com

AEOS manages a total of 1,580 off-line lock systems. It manages all online doors and online functions, the access doors, the off-line lock system, room doors, patient cabinets and containers, employee cupboards as well as mobile care and food trolleys

SECURITY MANAGEMENT

NO HURDLES FOR THE ‘SPEED TEAM’Modern Access Control for the Protestant Hospital in Mülheim

Advettisement Feature



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Trim Size - 210 x 297 mm (W x H)Contact - 01223 307000

Miele Professional instrument washer-disinfectors provide outstanding infection prevention. And with their sophisticated engineering, they’ll repeat the results time after time – all to EN ISO 15883 standards. They’re engineered to perform for years to come, meaning less downtime, longer replacement intervals and ultimately less cost. Which is bad news for contamination but great news for your budget.

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Client - Miele ProfessionalPublication - Health Business Insertion Date - February 2013

Trim Size - 210 x 297 mm (W x H)Contact - 01223 307000

Miele Professional instrument washer-disinfectors provide outstanding infection prevention. And with their sophisticated engineering, they’ll repeat the results time after time – all to EN ISO 15883 standards. They’re engineered to perform for years to come, meaning less downtime, longer replacement intervals and ultimately less cost. Which is bad news for contamination but great news for your budget.

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Written by Julie Storr, Annette Jeanes, Helen Forrest, Claire Kilpatrick

HAND HYGIENE

HAND HYGIENE ON A GLOBAL SCALEHand hygiene is the topic of two annual, global days of action, the subject of major campaigns, and hits the headlines frequently. But it is still not occurring enough to ensure patient safety. Julie Storr, Annette Jeanes, Helen Forrest and Claire Kilpatrick look at the history of hand hygiene in relation to infection control

Infection Control

It’s 2013, and most of us spend our time keeping up with the myriad of mandates and directives that, in the name of patient safety and standards, aim to prevent as many infections as is humanly possible during care delivery. Ensuring the hands of healthcare workers are clean, when having contact with the patients and service users who put their trust in healthcare every day, is a big part of this. How did we get here? How did we get to the point that hand hygiene is the topic of two annual, global days of action and the feature of an editorial and edition of the Journal of Infection Prevention?

TALK OF THE TOWNThe topic is still being talked about in this year, this decade, still hitting the headlines; and still not occurring enough to ensure patient safety, as well as the patient confidence in healthcare that we want to see. At the time of writing this, it took Google 0.26 seconds to retrieve 15 million entries on the term hand hygiene. There are almost 50,000 videos on YouTube and as well as hand hygiene now being a MeSH term in its own right – quite an achievement, it is also a well-used hashtag on Twitter. If “what gets talked about gets done” (Fraser 2002) is really true, then we have nothing to fear and this problem is sorted. But we know, due to many underlying reasons, that this is not the case. So do we know where to go next?

An annual

global day

focused on hand

hygiene is facilitated

by WHO. For 2013 this

will be 5 May, and

is a patient safety

intervention

An annual global day, which is facilitated by WHO occurs every 5 May focused on hand hygiene in healthcare. However, this year has seen the topic talked about from many different angles at a national and international level. It is being talked about as a true patient safety intervention that protects patients from harm. The Agency for Healthcare Research and Quality (AHRQ) in the US (AHRQ 2013), the Chief Medical Officer’s (England) annual report volume two (Chief Medical Officer 2013) and the final Report of the Mid Staffordshire NHS Foundation Trust Public Enquiry (Francis 2013) mention hand hygiene so many times that it’s hard to count, so why would we think we have ‘done hand hygiene’ or that it’s old news? It is clear that there continues to

be an urgent need for renewed action to make hand hygiene happen more reliably. To not do this, should another incident happen, could be seen as neglectful. Therefore it is the time to be responsible and accountable for this call to action to make sure no person receives sub-optimal care due to the omission of hand hygiene.

BEHAVIOUR CHANGESome say it started with Semmelweiss, but where most of us are today more or less started with Pittet et al (2000). In the first year of a new century, those who were around were inspired by this culmination of a revolutionary account of how a straightforward, multimodal behaviour change strategy could change the way we looked at a fundamental action: cleaning our hands at key times when delivering care. It injected new life into a recalcitrant problem that formed the staple diet of infection preventionists’ day-to-day activity. It re-energised and reinvigorated the issue. For some of us it changed everything. And today, to celebrate 5 May, across the UK and Ireland we should not underestimate the role we have played in influencing the global agenda on hand hygiene and therefore

ultimately influencing the safety of patients at home and around the world.

Before the cleanyourhands™

campaign for England and Wales was conceived, the work of Roa et al (2002) was published and disseminated, highlighting the application of social marketing and bedside alcohol-based handrub to

impact on healthcare associated infection. It is worth remembering

that it was under the strong influence of the senior ICN involved at the time

that led to this groundbreaking work. E



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Infection Control

of care’. Point of care wasn’t a new term overall, but it was in relation to thinking about vulnerable patients in their beds in particular, and the times when they most needed our protection – when they were being touched or while critical items were being inserted into them. What a great idea! A clear focus on a few critical times when this lifesaving action is vital; not an endless list of times at which a basic hygiene measure we should all expect, should happen. Unfortunately people fail to remember and acknowledge this in healthcare, still, and in turn patients get harmed: fact.

COMMITTED TO HAND HYGIENEIn the early part of the last decade came the launch of other campaigns tying in with the start of WHO’s Clean Care is Safer Care programme, which at inauguration had nine leading countries, including all UK countries, pledge their commitment to take action through national hand hygiene campaigns. Scotland then became a leader in their field, launching the Washyourhandsofthem campaign which incorporated different elements to suit the population’s needs – a methodological protocol, national public auditing and reporting and a public marketing aspect including evaluation through market

Between 2002 and 2005, the first nationally funded campaign on hand hygiene improvement in healthcare was then developed, tested, evaluated and implemented across England and Wales and became a model illustration of a multimodal approach to improvement that has been cited in the World Health Organisation’s (WHO) Guidelines on Hand Hygiene in Healthcare (2009). This, and the work of Pittet and his team in Geneva (2000) was also influenced by the work of the Oxford Radcliffe Hospitals local hand hygiene campaign that incorporated patient empowerment (McGuckin et al, 2000). Part of the scoping of the cleanyourhands™

campaign also saw the influence of a senior Infection Control Nurse in Swindon in catalysing the adoption of the term ‘point

research, among other things (Kilpatrick 2007).The cleanyourhands™ campaign from England and Wales was then launched in Northern Ireland in 2008 to add to our countries’ efforts, and the Republic of Ireland is still being innovative in their national approach, working hard to spread the word of the WHO 5 Moments.

THE DOMINO EFFECTSo, what has really happened during this time? We have seen a domino effect, starting with individuals, then organisations, then countries, and now we have over 15,000 healthcare facilities across the world signed up to the WHO 5 May campaign, SAVE LIVES: Clean Your Hands, including many on our doorstep. What we don’t realise during this time is how much of the change management and human factors fields we have influenced over these years – terms that are used today and are synonymous with innovation and future thinking. We are not good enough at celebrating success in healthcare, but perhaps on 5 May each year, while we take stock and reflect on the pressing need to maintain a strong focus on hand hygiene improvement, we should also recognise that, over the last E

About the authors

Julie Storr is President of the Infection Prevention Society and formerly cleanyourhands™ director and WHO programme manager. Annette Jeanes is nurse consultant, infection prevention and control at the University College London NHS Foundation Trust. Helen Forrest is lead nurse for Infection Prevention & Control, SEQOL, Swindon. Claire Kilpatrick is communications director at the Infection Prevention Society, and formerly WHO programme manager and nurse consultant at Health Protection Scotland.

At the time of writing, it took Google 0.26 seconds to retrieve 15 million entries on the term hand hygiene. There are almost 50,000 videos on YouTube. As well as hand hygiene now being a MeSH term in its own right, it is also a well-used hashtag on Twitter


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At Optimus Conferences we are committed to providing you with outstanding events to assist you in your professional development and aid whole school improvement.

Our diverse portfolio of one-day national conferences are designed to meet the needs of senior School and Academy leaders across the country. Our upcoming events will provide the latest statutory advice and practical strategies to help you stay up to date and efficient in your role.

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Dussmann Service UK Ltd prides itself on providing the customer with a professional cleaning and security service with an option to provide facilities management if required. The company prides itself on being a corporate member of BICSc and approved contractors with the SIA. Dussmann understands that every building and every company has different requirements so it looks to develop an individual concept for every client. This involves combining services to produce a package which is adapted to your needs. The scope of Dussman’s services are varied; it can provide basic office cleaning through to highly specialised clinical work as well as a range of security services.

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A cleaning service is essential in maintaining your facility but can sometimes be a costly overhead. Dustbox Cleaning Services provides a wide range of cleaning and maintenance services from ongoing cleaning services and contracts, one off deep cleans, to hard floor cleaning, servicing and repair. The company’s aim is to be the number one cleaning company in the south west. It is working towards its aim of being the best cleaning company by ensuring that it works to the highest cleaning standards and provide its clients with a service, which cannot be rivalled. Dustbox Cleaning Services specialises in providing CRB checked staff and services to the care industry and fully understand the practices and standards required in this sector.

The company provides cleaning services to all types companies whether you are based in health facilities, care homes, shops, retail and industrial units. The company offers full commercial cleaning tailor made to suit your needs and can organise and implement

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HEALTH BUSINESS MAGAZINE | Volume 13.222

HAND HYGIENE

Infection Control

decade, gains have been made and infections averted because we got better at hand hygiene. It is inherently difficult to determine the precise impact of single interventions like hand hygiene that take place within complex sociotechnical systems. However, it is highly likely that a significant part of the work we have all done over the last 10 years has saved lives. It’s never enough and there is always more to be done. The bottom line is that if we continue to accept defects in compliance with hand hygiene then our patients will be harmed. Such an acceptance undoubtedly flies in the face of the IPS’s vision that no person will be harmed by a preventable infection. No infection preventionist, manager, leader or CEO should tolerate this. As the Agency for Healthcare Research and Quality said a couple of months ago – hand hygiene works as a patient safety intervention. Let us focus on it around

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The My 5 Moments for Hand Hygiene approach defines the key moments when health-care workers should perform hand hygiene. This evidence-based, field-tested, user-centred approach is designed to be easy to learn, logical and applicable in a wide range of settings. This approach recommends health-care workers to clean their hands:

Before touching a patient

After body fluid exposure/risk

After touching a patient, and

After touching patient surroundings. For more information visit www.who.int

this time of 5 May, as well as every day. In addition let us commit to continuously revisiting, developing and designing monitoring techniques and interventions that will help to maintain and improve the behaviour of those we urgently need to influence. Let us never tolerate complacency and dismissiveness. Hand hygiene is actually a technology that works for patient safety and some of our IPS members are working hard right now to forge the right future in this regard for our patients and service users. What will be next in hand hygiene improvement and how can we continue to contribute to this? Can you be the catalyst for the next phase of the hand hygiene improvement conundrum? L

FURTHER INFORMATIONTo view the original article, visit www.bji.sagepub.com/content/14/3/84.full

The bottom line is that if defects in compliance with hand hygiene continue to be accepted, patients will be harmed. According to the Agency for Health Care Research states, hand hygiene works as patient safety intervention

My 5 Moments for hand hygiene: Guidelines from the World Health Organisation



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Pall’s QPoint Tap Water Filter Assembly, the latest addition in the company’s line of advanced point-of-use (POU) filters for protection against waterborne pathogens, offers enhanced features, improved performance and a longer capsule life of up to 2 months. With a fixed, chrome docking station and exchangeable filter capsule, the filter assembly reduces waste and costs while simplifying the installation and exchange process. The filter capsule is designed and validated for retention of a broad spectrum of waterborne pathogens frequently found in drinking water such as Legionella spp., Pseudomonas aeruginosa, non-tuberculous mycobacteria, Escherichia coli, Aspergillus fumigatus and Cryptosporidium parvum. These pathogens are known to cause infections in immunocompromised and vulnerable people.

QPoint offers an immediate, protective barrier of double layer 0.2 micron sterilizing grade filtration without restriction on the volume of water used. The high technology pre-filtration membrane maintains good flow rates despite variable water qualities. Retrograde contamination control is enhanced through the combination of a proven non-leaching bacteriostatic additive molded within the housing and an inner protective shield against backsplash within the filter capsule.

The QPoint assembly has been validated under laboratory and multi-center field site conditions, received drinking water approvals at various national levels and complies with Regulation EU 10/2011 for food contact. Emergency hotlines are available for many countries, enabling rapid response and deliveries in case of critical contamination with Legionella spp. and other waterborne pathogens.

ARE THERE RECOMMENDATIONS FOR POINT-OF-USE WATER FILTRATION?World Health Organisation (WHO) recommendations are generally followed throughout the world for drinking water quality requirements and point-of-use water filtration is listed in those recommendations as one measure in hospital risk areas. In addition there are numerous national and regional drinking water guidelines, and several have integrated POU filtration as one option to prevent transmission of water

pathogens to patients and users. Since 2002, a guideline from the French Ministry of Health has advised that healthcare facilities install 0.2 µm micro-filtration at point-of-use in high risk areas. The Robert Koch Institute (RKI) recommends water filtration during the last rinsing step of endoscopic reprocessing protocols. In 2010 the German Committee for Hospital Hygiene & Infection Prevention at the RKI recommended point-of-use water filters for specific applications in the care of highly immune-compromised patients. In the UK, the Yorkshire Cancer Network states that point-of-use filtered water is the most appropriate option for the provision of potable water for immuno-compromised cancer patients. In the WHO publication Legionella and the prevention of Legionellosis (2007) POU filters are recommended for high risk areas such as transplant units and ICUs when Legionella free water (0 CFU/1000 mL) is not achievable. Health Technical Memorandum 04-01 has recently been updated to include advice for augmented care units with regard to

Pseudomonas aeruginosa and recommends POU filtration as one of the choices for protection of augmented care patients.

WHICH ECONOMICAL ADVANTAGES ARE GIVEN BY POU FILTRATION?Cost comparisons between sterile bottled water, commercially available mineral water and POU filtered water provided as drinking water for highly immuno-compromised patients in hospitals revealed significant cost advantages of disposable POU filters. For example hospital acquired waterborne infection results in higher morbidity, mortality and adds costs to healthcare facilities. The value of POU filtration must therefore also be assessed from a preventive perspective. P. aeruginosa for example is known to cause hospital acquired infections in intensive care units such as bloodstream infections, urinary tract infections, surgical wound infections and pneumonia. Additional costs for bloodstream infections or pneumonia in ICU patients can easily exceed 15,000 USD per patient. Installation of POU water filters in one ICU with 10 water taps may reveal cost savings if only one single infection is avoided. Indeed, in a large clinical study significant cost savings of about 64,000 USD per year were

calculated after installation of disposable water filters on 7 ICU taps per year based on the reduction of Pseudomonas infections. In another study, net cost savings of 231,000 USD due to the reduction of total patient care cost after filter installation have been reported in a subacute care unit in the US (2010). One additional way to save cost using Pall’s POU water filters has been demonstrated by installing filters in the laboratory setting to avoid false positive Tuberculosis fast acid staining results deriving from Non-Tuberculous Mycobacteria in the rinse water. The cost saving per avoided false positive result was approximately 2,250 USD. L

FURTHER INFORMATIONFor more information on QPoint filters, please visit www/Pall.com/QPoint or follow us on Twitter @PallSaferWater

Pall’s new QPoint Tap Water Filter Assembly offers protection against waterborne pathogens, longer capsule life and improved performance

INFECTION CONTROL

QPOINT TAP WATER FILTER: IMPROVED PERFORMANCE AND REDUCED WASTELatest addition to point-of-use filter line offers validated protection against waterborne pathogens for up to 62 days




Protecting people, property and assets

www.ingersollrand.co.uktel: 01922 707400

email: [email protected]

Protecting people, property and assets is an ongoing, ever changing and vital responsibility. It is what underpins the

product development process at Ingersoll Rand Security Technologies and delivers innovative access and security

solutions for a wide range of differing market requirements.

Our design and manufacturing expertise means we are well placed to tailor integrated solutions incorporating

products from our wide portfolio of products and services - door controls - exit hardware - mechanical locking - steel

doors - automatic doors - blast resistant doors - electronic locking - time & attendance and portable security.

To discover how we can help you, please contact us or go to:

www.ingersollrand.co.uk

You can also see us at IFSEC International - Hall 5 Stand E60

Protecting people, property and assets

www.ingersollrand.co.uktel: 01922 707400

email: [email protected]

Protecting people, property and assets is an ongoing, ever changing and vital responsibility. It is what underpins the

product development process at Ingersoll Rand Security Technologies and delivers innovative access and security

solutions for a wide range of differing market requirements.

Our design and manufacturing expertise means we are well placed to tailor integrated solutions incorporating

products from our wide portfolio of products and services - door controls - exit hardware - mechanical locking - steel

doors - automatic doors - blast resistant doors - electronic locking - time & attendance and portable security.

To discover how we can help you, please contact us or go to:

www.ingersollrand.co.uk

You can also see us at IFSEC International - Hall 5 Stand E60

Written by Jam

es Kelly, chief executive, BSIA

Hospital buildings can face a number of threats, one of which is the risk of intruders. Naturally, hospitals see a large number of people through their doors every day and it can be difficult to monitor the intentions of each individual. Hospitals can be considered attractive to thieves because they are home to expensive equipment and machinery, along with an abundance of different medications. To add to this, they are also rife with confidential patient data; if this kind of information falls into the wrong hands, the consequences could be detrimental to both the patient and the reputation of the hospital. Therefore, it is essential that effective security measures are implemented to minimise the risk of such threats.

CCTV: KEEPING A WATCHFUL EYE In terms of hospital security, CCTV is particularly effective. Such security can stem beyond the four walls of the hospital – cameras can also be strategically installed around the hospital perimeter, particularly around car parking areas. Many of those who visit a hospital tend to stay there for a long period of time, particularly if their loved ones are undergoing extensive treatments. Therefore, thieves may see these unattended vehicles as easy targets. CCTV can deter thieves from damaging or stealing this property and maintaining a safe environment for those passing through. As previously mentioned, hospitals may be attractive to thieves due to the kinds of medication that are kept on site. While these kinds of supplies are usually kept in secured areas, experienced thieves may still be able to breach the security in place. By placing CCTV cameras around these high-risk areas, hospital staff can be reassured that these vital resources do not go missing. One particular element of CCTV that is being increasingly employed is Video Content Analysis (VCA), the name given to the automatic analysis of CCTV images, which is then used to create meaningful information regarding the content. For example, VCA can be used to automatically detect an intruder, or to count the number of people entering or leaving an area – beneficial for keeping track of how many people have entered or left an emergency room during a given period of time.

If the area that needs protecting is particularly extensive – such as the multiple floors and rooms of a hospital building – then multiple screens are often required to be monitored at once. VCA can offer solutions to make this monitoring process as efficient as possible, particularly during the night when less staff may be on duty. Advances in technology mean that this process can be streamlined through the employment of either motion sensors for the CCTV – where the cameras only start rolling when movement is detected – or by using fence-mounted vibration detectors that trigger an alert in the security control room. Naturally, a hospital environment is often very busy with only small periods of quietness within the day, therefore some areas will need closely monitoring at all times. However, other areas may not need such close supervision and this type of detection can be time effective,

ensuring that footage is picked up when movement is detected but

avoiding the hassle of closely watching an empty hallway.

Another element of CCTV that can prove invaluable for the health sector is BS8418, the British Standard for remotely monitored, detector-activated CCTV systems. When deployed, BS8418

compliant solutions consist of cameras and detectors

placed strategically around a site, linked together by specialised

transmission equipment to a Remote Video Response Centre (RVRC). Here, operators can visually confirm what is happening, call up on-screen plans of the hospital and even issue verbal warnings to intruders via on-site speakers. If necessary, the RVRC operators can also alert the police who, as the incident is confirmed visually and is associated with a URN (Unique Reference Number), should

provide a rapid response. The ability to provide a prompt response when incidents occur is a priceless feature within the health sector, allowing situations to be managed effectively and for hospital staff to continue their own vital tasks without being called away.

THE BENEFITS OF INTEGRATION While CCTV is an extremely effective tool on its own, it can be even more effective when integrated with other systems. The developments in technology and the scope of CCTV systems mean that they are being used in a range of applications that stem beyond their traditional uses. One such application is that of detection and visual verification of smoke and fire. CCTV can be utilised in this sense to protect hospitals from the dangers that a fire would inflict on the large amounts of people occupying the building, and the unwelcome damage to vital equipment that would no doubt transpire. Despite its hugely beneficial use, a BSIA survey has shown that disappointingly, few organisations are taking advantage of these capabilities. While fire and smoke would cause a huge disruption to any organisation, within a hospital setting it would be even more destructive. Obviously, a large percentage of a hospital’s population is people with illnesses, and if exposed to smoke, their condition could be rapidly worsened. This is not to mention the explosive nature of some of the chemicals kept on site, which, if exposed to fire, could cause a magnitude of damage. If a fire were to occur, patients would also need to be evacuated extremely quickly and reallocated to a safe environment, and hospital staff may not have the time, resources or manpower to achieve this. CCTV can help to minimise these risks. Although still effective, traditional fire alarms cannot always guarantee the immediate identification and response to fire incidents, especially when large premises, like hospital buildings, are involved. In fact, according to some statistics released in 2010, 75 per cent E

CCTV IN HOSPITALS

EFFECTIVE PROTECTIONAlong with ensuring the safety of patients, hospitals have large numbers of staff working varied shift patterns to consider, not to mention valuable equipment stored on site and the footfall of visitors. James Kelly, chief executive of the British Security Industry Association (BSIA), discusses the value of CCTV

Security

One

element of

CCTV that is being

increasingly employed

is Video Content

Analysis – automatic

analysis of CCTV

images



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Combine panoramic, 360˚ security cameras with a Wavestore video recording system and the result is a highly effective video surveillance system which will play a valuable part in helping healthcare facilities implement a zero tolerance policy in respect of any aggressive behaviour towards staff, as well as provide security managers with a powerful tool to deter and detect the theft or malicious damage of valuable medical equipment and other assets.

The use of 360˚ technology can significantly reduce the number of cameras needed to monitor, without any blind spots, a large area such as an A&E entrance or hospital reception. Wavestore video management software is able to de-warp the panoramic/fisheye images captured by a 360⁰ camera and simultaneously display them alongside images from other analogue or IP security cameras in a user configurable multi-image display. Unique to

Wavestore, operators can view de-warped images created from the recorded image and control a ‘virtual’ PTZ function to track activity and save video clips of an unlimited number of individual events captured in the camera’s entire field of view. The process can be repeated as often as is required in order to extract and save evidence.

Wavestore’s open platform software supports video analytic functions including motion and intruder detection, license plate recognition, people counting and biometrics such as facial recognition.

FURTHER INFORMATIONwww.wavestore.com

Panoramic recording success in the fight against crime



of the fires that happened in 2008 occurred when fire detectors were in place but did not operate due to the fact that the fire in question had not reached the detectors. VCA can offer a solution to this concern. Unlike conventional smoke detectors, which react only once the smoke reaches the device. VCA systems can actually identify smoke at any distance, as long as it is within the cameras’ visual reach. This fast detection of smoke and fire is absolutely essential in ensuring speedy emergency service response and evacuation. The fire service have become increasingly reliant upon visual verification when responding to emergency calls, so CCTV can also help to ensure a fast response time. Another benefit of this type of visual verification means that it can take place at a distance, without compromising the safety of individuals. Moreover, once the emergency response has been guaranteed, CCTV systems can prove invaluable in guiding the fire service to the location of the fire without putting lives at risk.

ACCESS CONTROL SOLUTIONSCCTV systems can also integrate well with access control software. As expected, in a hospital environment there are many areas that can only be accessed by authorised personnel, and if breached by an intruder, could have potentially damaging consequences. Often these areas are controlled through access control systems, such as swipe cards or fingerprint readers, and when coupled

with CCTV systems, can provide very efficient and usable solutions for staff and visitors. One major benefit of this is pre and post-event video recordings initiated by the access control. Video recordings can be linked with event information, which makes searching for a particular event on the recording much more efficient. For example, if an intruder has entered the building and attempted to breach an access controlled area by forcing a door, operators can search for ‘Door forced – laboratory 4’ allowing them to easily look at images of the intruder and react accordingly.

INTEGRATIONThis kind of integration can also be beneficial in terms of human resource management. CCTV can be combined with Time and Attendance systems to detect the occurrence of ‘buddy-clocking’ – when employees are clocking each other on and off work – thus making sure that everyone is working their appropriate hours and no one is treated unfairly. BSIA members have had direct experience in securing the health sector. For example, Derbyshire Mental Health Service NHS Trust had been experiencing difficulties with repeat offences such as theft, robbery and motor vehicle burglaries at its sites and called upon a BSIA member to install an access control and CCTV solution. The BSIA member subsequently installed CCTV systems across a network of 11 Derbyshire

NHS sites, which all linked back to a monitoring station. A variety of 37 CCTV units, infrared detectors and tannoy solutions were installed across the 11 sites, along with 17 access control installations, 24 proximity readers, break glass and infrared detectors. Each member of Derbyshire NHS staff was also issued with an access key. Upon using the key, the action is bookmarked along with the footage from the nearest CCTV unit. This means that if an access card is stolen, and an intruder gains access fraudulently, CCTV footage of when and where the incident took place can be brought up on the integrated recording timeline. This is achieved almost instantaneously without having to sort through hours of footage. In addition, if one of the break-glass detectors or infrared alarms is activated, the incident is also logged on the CCTV footage for operators to examine immediately. Since the installation of this extensive integrated security solution, crime rates across Derbyshire Mental Health Services NHS Trust have been said to have reduced to zero. The most important factor to consider when sourcing a security system is that you choose from a trusted supplier. BSIA members offer a reputable service, are committed to best practice and have been inspected to quality European and British standards. L

FURTHER INFORMATIONwww.bsia.co.uk/find-a-local-security-company

Security

The number of violent incidents at work shows a downward trend over the last decade, with incidents remaining fairly constant over the last four years. Findings from the Crime Survey for England and Wales (CSEW) show that in 2011/12. There were 643 000 incidents of work related violence estimated in England and Wales in the 2011/12.Of these 324 000 were classified as assaults and 319 000 classified as threats. This was broadly similar to the number estimated for the previous year at 654 000 incidents (2010/11 CSEW) The risks of being a victim of work related violence are there – 41 per cent of victims were assaulted or threatened twice or more in 2011/12 The occupations with the highest risks of experiencing work related violence were those involved in protective services, health and education A substantial proportion (40 per cent) of offenders were known to victims of violence in the workplace. Alcohol and drug use remain a factor in many incidents and whilst in the majority of

cases no injuries are sustained, in 12 per cent of cases physical trauma is indicated with possibly serious physical and psychological consequences.Also, in 2011/12 5493 cases of violence at work were reported under RIDDOR.

When violence is happening it affects your business growth and the entire staff morale. A new employee typically receives training for specific job functions; i.e. Conflict training however, it is important to consider continuing to train an employee throughout his career. A profitable company invests energy in training employees. By learning more skills, an employee can be more productive and assume additional responsibilities that will benefit both employee and you as an employer.To boost their productivity and safety, employees should be equipped with skills to do their work more efficiently, thus improving their productivity and safety, which results into more profits and revenue for your business.

Pass Training identifies the nature and scale of problems of conflict and violence

experienced by staff at work place, and shows the know-how communication what is more body language can be used to solve problems and reduce the likelihood of conflicts, and how to reduce the risks.

We train our applicants to know good practices to follow after an incident occurs.

Let’s move forward and ensure that your team is confident to prevent conflict situations from arising and Pass Training Constancy Limited is here to help you out.

FURTHER INFORMATIONFor more Information on our courses and how we can help professionalise the workforce, contact us on 08432 895581 or [email protected]

Professionalise the workforce and ensure that your team is confident to prevent conflict situations



Fire

Saf

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We have an in-depth knowledge of fire safety management within some of the most challenging working environments, some of which and most predominately being health-care premises, places of entertainment, leisure, and assembly.

All of our services are tailored to your needs, whether it be fire training, or fire risk assessment. We also provide the appropriate documentation so that you can record all of your fire safety information and checks within a professional folder which is in-line with legislation.

Simon Riddell is a well-respected and fully certified trainer / fire risk assessor. He has a Fire Service background and also spent three and a half years working for NHS Highland as their Fire Training Officer. NHS Highland stretches out to 43 per cent of Scotland, and in his role Simon developed building/department/ward specific procedures to ensure

that staff were appropriately trained to deal with fire and evacuation incidents within their own environments.

S.R.FIRE use the HAAGEN ‘Bullseye’ fire training equipment – a safe and effective method to train your staff on the practical use of extinguishers.

Ensure you receive the best! Testimonials online.

FURTHER INFORMATIONTel: 07801 579 277 Email: [email protected]

S. R. FIRE (INVERNESS) Ltd: skilled at saving lives

Fire Risk Assessments Limited specialises in helping businesses to ensure that they are meeting their obligations under the Regulatory Reform (Fire Safety) Order 2005. The company’s unique blend of experience is tailored to provide an integrated total fire safety management service, and its aim is to deliver a cost-effective yet high-quality service. Fire Risk Assessments Limited endeavours to draw upon its experience and knowledge to guide and advise practical and professional solutions to solve its clients’ fire safety problems. Having a fire risk assessment in place is a legal requirement.

Finding out what the law says and what it means in practice can be extremely time-consuming and that’s where the company can help. The company offers fire risk assessments carried out by fully qualified assessors, covering the whole of the UK. Fire Risk Assessments Limited also provides fire safety training, which can be carried out on-site, online or supplied in a DVD format, starting from as little as £9.99 per person.

FURTHER INFORMATIONTel: 0208 763 [email protected] www.firera.co.uk

Professional fire safety management solutions tailored to your needs



Across the health industry, facilities management is becoming more essential to the smooth-running of a business; with what feels like an ever-increasing focus on health and safety not just in your own products and services, but on your premises and for your employees. With legislation placing the responsibility with the business owner, it is imperative that you’re in the know about the latest advancements in protection and management.

FIRE INSIGHTSA well structured fire protection, safety and health, as well as security strategy can be more than a burden, however. As part of a wider business case, investing in the latest technologies and hearing about the latest insight can also help to reduce your insurance costs. FIREX International, one of the world’s largest dedicated fire safety events, is returning to the Birmingham NEC in May with its strongest ever proposition for 2013 as it becomes an annual event. This definitive international fire prevention and protection event will provide a superior overall offering this year including new layout changes with seamless cross over points between FIREX International, IFSEC International and the Facilities Show. Whilst more than 150 exhibitors will showcase the latest innovative and cost-effective products and services, attracting key decision makers and qualified fire protection professionals from over 70 countries across the globe, the FIREX International educational offering will focus on live, industry driven, issues.

THE ACADEMYThe FIREX Academy will be the epicenter of education at FIREX International 2013. Sponsored by Hochiki Europe and in association with the FIA, the Academy will offer knowledge from key industry figures and hold debates based on the entire safety system in a building. Seminar topics have now been confirmed, focusing on how end users approach the interaction between active and passive fire protection systems. The full programme can be found at www.firex.co.uk. The Intelligent Buildings Seminar Theatre will take place in the dedicated Intelligent Buildings area, which aims to create a combined fire and security area for both FIREX and IFSEC, focusing on the common area of systems integration and convergence. Unlike other features, it is not a showcase of new products, it’s about holistic solutions. In a nutshell, Intelligent Buildings – Fire & Security opens up opportunities for inter-operability and information sharing between fire, security, IT, data and building management systems.

DETAILSFIREX International will take place at Birmingham NEC, UK, from 13-16 May 2013 Expo as part of Protection & Management Week. Meet like-minded decision makers from security, safety and health, and facilities management industries at the co-located events; IFSEC International (www.ifsec.co.uk), Facilities Show (www.facilitiesshow.com) and Safety & Health Expo (www.safety-health-expo.co.uk). For further information on FIREX International, Protection & Management Week, or to register for free entry into the 2013 event and its co-located shows, please visit www.firex.co.uk. L

FURTHER INFORMATIONwww.firex.co.uk

FIRE PREVENTION AND PROTECTIONFIREX International is the leading event for professional involved in fire protection, prevention and detection, offering a comprehensive seminar programme with thought-leadership and a chance to see the latest fire safety products and services

Fire SafetyEVENT PREVIEW

The Academy

will be the

epicenter of

education at FIREX

International and will

offer knowledge

from key industry

figures



Adve

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At least 1 in 30 UK employees has drugs in their systemat any point in time*. How are you managing the risk?

* Research is based on the results of 1,668,330 drug tests conducted by Concateno’s laboratories on behalf of 856 UK employers over a five year period (2007 to 2011) to measure the incidence of drug use amongst employees | MES0118 Ed.1b

[email protected]+44 (0)1235 861 483

Concateno, a subsidiary of Alere™ Inc., brings together Europe’s strongest and most experienced drug and alcohol testing organisations and with over 60 years of collected expertise. It offers an unparalleled breadth of advisory services and testing capabilities – spanning laboratory, point of care tests and all sample types for any biological specimen including urine, oral fluids, and hair. It manufactures diagnostics tests and reagents and has three world-class laboratories accredited to ISO/IEC 17025:2005 for hair, oral fluid and urine testing. Concateno’s 400+ employees perform and deliver more than 10 million tests annually, supported by a global network of 500 sample collection officers, trained in-house on strict chain-of-custody procedures. Together, Concateno conducts testing for

over 8,000 companies in 130 countries around the world across all industries, healthcare and government bodies. Concateno’s white paper ‘High Society’ has provoked many key opinion leaders to both comment on the findings that 1 in 30 people have alcohol or drugs in their system and to revise their companies drug and alcohol policy. Concateno is very proud of the work it does to support all areas of industry and health care both in the UK and globally.

FURTHER INFORMATIONwww.concateno.com

Concateno: global drug testing services for healthcare professionals

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In order to deliver a relevant and forward thinking show in 2013, the teams at Safety & Health Expo recently hosted a series of focus groups to find out exactly how the role of today’s health & safety and facilities management professional is evolving. The results found that alongside day-to-day responsibilities the top challenges within health & safety was the safety culture within the workplace and managing employee health and wellbeing. This research and industry insight has helped to shape the event this year, which returns to Birmingham’s NEC from the 14-16 May 2013. The event these year will not only provide the latest information on products and legislation, industry case studies, seminars from the leading voices from across the sector whilst also offering access to top associations and CPD opportunities, Safety and Health Expo will offer practical solutions for every practitioner that they can take back with them to implement within their workspace.

INDUSTRY SUPPORTSafety and Health Expo is Europe’s leading annual exhibition for the occupational safety and health industry and the only health and safety show to have exclusive support of key industry partners including the Institute of Occupational Safety & Health (IOSH), the Royal Society for the Prevention of Accidents (RoSPA) and the British Safety Industry Federation (BSIF). Safety & Health Expo 2013 will welcome over 300 exhibitors, with everything from fire safety management to environmental control, PPE and training covered. New exhibitors to the show this year include HB Protective Clothing, Rocky Brands and Superior Glove Works alongside returning favourites Draeger Safety, Portwest Clothing, Scott Safety and ATG Gloves. Safety & Health Expo provides unrivalled opportunities to discover the latest products and services for the industry, take part in informative and interactive educational session whilst networking with peers across three days, making this an essential date in the

calendar for the safety and health industry. The Arco Academy returns with more interactive sessions than ever before; encouraging visitors to take part in live demonstrations and discussions that centre on education through innovation, and the growing role behavioural safety is playing in transforming safety cultures across the globe. The IOSH Networks Arena will host a series of events focusing on specific IOSH Industry Groups including the IOSH Retail and Distribution Group, IOSH Construction Group

and the IOSH Sports Ground and Events Group. Amongst others, these

exclusive events will allow both members and non-members

of IOSH to meet with other health and safety professionals working within their sector. Taking one of the sessions, Tim Roberts, head of health and safety at Glastonbury

Festival will discuss the issues of maintaining safety

at major public events.Dr Ioannis Toutoungi,

health and safety manager for construction at Gatwick Airport will take a session on organisational culture and safety at Gatwick Airport. Also in the IOSH Arena, Steve Manchester, business group manager for fire safety for BRE Global will look at handling flammable gases, liquids and dusts, and ensuring DSEAR compliance. The Barbour Directors Club will offer an unmissable opportunity for networking with top tier management working within health and safety, whilst also providing essential, commercially driven debates on the issues faced by leaders across the globe.

WELLBEINGThe introduction of the Health & Wellbeing Theatre will address issues around boosting productivity within the workplace through a variety of initiatives, including stress management, ergonomics, behavioural safety, equality and diversity. The sessions will cover employer obligations, how to promote health and wellbeing throughout the workplace and the impact this has on the bottom line.

With one in ten workers reporting a work-related health problem this is a huge challenge for all employers. However, combating wwork-related illness and injury doesn’t need to cost your company a fortune, in fact changing the culture within your business could save your organisation a tidy sum. So what could you be doing to more effectively tackle the absence and injury culture within your workplace? Confirmed sessions so far include the importance of hand hygiene, managing conflict in the workplace, cognitive behavioural therapy, technology to reduce stress.

A DRIVE FOR BETTER HEALTH & SAFETYAlso new this year at Safety and Health Expo 2013 is the Business Driver Safety Zone, launching in partnership with Fleet21 and Honda UK. With so much misunderstanding surrounding certain areas of business driver safety and compliance, this new feature promises to be an informative and valuable addition to the show exploring key areas of health and safety legislation, different types of training available and their effectiveness in combating road risk. Safety and Health Expo 2013 also returns with its most popular features including the SHP Legal Arena will bring together a ‘dream team’ of legal experts including regular SHP columnist Kevin Bridges from Pinsent Masons; Jon Cooper from Bond Pearce; Peter Forshaw of Weightmans; and Ron Reid from Shoosmiths. Joining them will be many other leading solicitors, presenting the most significant health and safety cases and topics, offering vital advice on how to avoid costly workplace incidents and prosecutions. L

EVENT PREVIEW

HEALTH, SAFETY AND WELLBEINGSafety & Health Expo, the annual exhibition for the occupational safety and health industry, has support from key industry partners IOSH, ROSPA, and the BSIF, to give visitors authoritative content from the leading voices across the industry

Health & Safety

The

introduction

of the Health &

Wellbeing Theatre will

address issues

around boosting

productivity

within the

workplaceProtection & Management shows

Safety & Health Expo is co-located with the Facilities Show, the annual event solely dedicated to one of the fastest growing professions in the UK and Europe. What’s more, attendees to the Safety & Health Expo and Facilities Show will also be able to attend both IFSEC International, the security industry event that annually brings together the entire security buying chain in one place, and FIREX International, the leading event for every professional involved in fire protection, prevention and detection. All four shows offer a broad range of information, including the latest products and services plus a host of seminars and presentations from across all sectors.

FURTHER INFORMATION www.safety-health-expo.co.uk



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The UK’s pest control experts for the healthcare industry working to help you prevent avoidable

secondary infection.

Flowcrete UK GREEN Floorzone offers a single source flooring package solution for the healthcare sector. Representing years of research and development, the GREEN Floorzone covers every aspect of flooring installation within the health and care sector, from substrate through to final floor finish, with the option of underfloor heating and sound-proofing built in. It features a number of performance flooring options, such as choices in resin floor finishes, including anti-microbial surfaces that harness the natural power of silver, along with self-levelling screeds, an energy-saving underfloor heating system and noise-reducing acoustic layer. The sustainable resin floor finishes has options designed to cope with the rigours of health and care environments. Including the seamless terrazzo Mondéco Mirrazzo, which is made of 60 per cent recycled material and Mondéco Crystal

Ice, and contains recycled glass and mirrors, reducing the need for lighting. An optional element of the GREEN Floorzone involves installing an Isowarm underfloor heating system, which offers energy efficient savings of up to 30 per cent compared to conventional heating systems. Engineered to support staff, patient and visitor comfort alike, Isowarm offers targeted, zoned heat, which is located underfoot, eliminating the risk of burning. Finally, another optional feature, is Isocrete Acoustic Foam, which reduces sound transfer between floors.

FURTHER INFORMATIONTel: 01538 308685 www.flowcrete.co.uk

The future in flooring for the healthcare sector



The great strides being made by facilities professionals in the healthcare sector were recognised at the 2012 BIFM Awards, which champion best practice in the facilities management profession. Healthcare projects and initiatives triumphed in three of the 15 categories and were highly commended in one other. Running since 2001, the BIFM Awards have recognise the best individuals, teams and projects from across the facilities management sector. For 2013, the BIFM Awards are proud to announce a new category. Individuals, projects or organisations who have made a ‘Profound Impact on the Industry Over the Last Five Years’ will be recognised in this year’s honours. The category’s judges are open to entries where a sustained and profound impact has been created, delivered and evolved for the benefit of the FM industry. This is expected to be a hotly-contested category – which is testament to the advances made in the FM profession over recent years. The 2013 BIFM Awards are open to all in the industry, including non-BIFM members. The Awards ceremony will take place on Monday 14 October 2013 at The Grosvenor House Hotel in London. The BIFM Awards entry deadline has been extended by one week to Friday 3 May (FM of the Year closes 28 June).

FM INNOVATIONAt last year’s BIFM Awards, Birmingham Children’s Hospital scooped the award for Innovation in the use of Technology and Systems. The hospital uses portable tablets that operate off the 3g mobile phone system to be transported to wards to allow the children to order food directly by using the interactive tablet technology. The tablets connect directly through to the hospital kitchen and provides integrated stock ordering and menu ordering whilst also providing

bespoke dietary choices to patients based upon dietician input into

the integrated system. The interactive and

integrated nature of the system impressed the judges and the scalability of the system to other hospital uses, such as drug dispensing and patients notes was thought to offer

a huge opportunity for advancement. The system

was the first of its type in the UK being used for menu ordering

and the use of tablet technology coupled with software development to release nursing time, improve data collection and reporting was impressive. The tablet was demonstrated and found to be intuitive and fun to use – specifically designed for children.

ACKNOWLEDGEMENT FROM INDUSTRYOliver Jones, chairman of the judges for the BIFM Awards, told FM World

that the awards are now seen as the pinnacle within the industry: “After an extraordinary number of entries in 2012, the BIFM Awards have unquestionably now become the ‘gold standard’ for an objective assessment of the best in FM. “To win an award – whether as a team member, a client representative, or member of the leadership team – is extremely tough and, consequently, a very worthy achievement.

“An award win is a true demonstration of independently evaluated differentiation in a highly competitive marketplace. “As always, we wish to keep abreast of market sentiment and feedback received. Our new award for 2013 (Profound Impact on the Industry Over the Last Five Years) is focused on finding and recognising the individual, organisation or project that has had a profound impact on the FM industry over the last five years.

“The judges are open to all entries where a sustained, profound impact has been created, delivered and evolved to the benefit of the FM industry. “I would urge all FM business and team leaders to be bold enough to enter the BIFM Awards and test themselves against the best of the rest, helping the Awards – and the recognised value of facilities management – go from strength to strength.”

FURTHER INFORMATIONEnter at www.bifm.org.uk/awards2013

BIFM AWARDS 2013

APPLAUSE FOR SHINING EXAMPLES OF FMThe BIFM has announced a new category for its 2013 Awards – individuals, projects or organisations who have made a ‘Profound Impact on the Industry Over the Last Five Years’ will be recognised at this year’s event taking place in October and is expected to be a hotly-contested category

Facilities Managem

ent

The 2013 BIFM

Awards are open

to all in the industry,

including non-BIFM

members. The entry

deadline has been

extended to

3 May

Swish announces the addition of three NEW designs to its Marbrex wall and ceiling panel range. The new designs have a modern, matt stone finish which enhances the existing range of marble and wood effects.

Marbrex panels are suitable for any room in the home, office or in food preparation areas. They can be fitted to both walls and ceilings which provides a hygienic surface that is easy to clean and is ideal for clinical adaptations.

Waterproof and boasting some insulation value to a oom, they help to reduce

condensation and combat the issue of mould and damp which can have a detrimental effect on the health of the resident.

Durable and simple to install, Marbrex can be affixed to existing tiles, plaster or brickwork joining together easily for a neat finish. A PVC-U alternative to tiles, paint and wallpaper, it can be installed in around half the time required for tiling.

Marbrex gives 100% performance, without compromising on style, finish or quality.

FURTHER INFORMATIONwww.marbrexpanels.co.uk

Marbrex panels – ideal for adaptations



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To cope with the demands of the industry many projects require fast turnarounds that minimise downtime and disruption, and allow fast track installations that facilitate the early laying of floorcoverings. In hospital refurbishments closing off wards and corridors that are in use 24-hours a day is impractical, and there may be limitations on carrying out preparatory work and installing dust extraction equipment. Strict requirements surrounding work associated noise, dust and indeed vibration, particularly when in close proximity to operating theatres or neonatal departments are also a consideration. ARDITEX NA is a rapid setting levelling and smoothing compound that has the ability to adhere to surfaces which would have previously been viewed as problematic or not ready to receive floorcoverings, without intensive preparation.

These include rough and poor concrete surfaces, old adhesive residues and flooring grade asphalt. ARDITEX NA can be applied to create a sound, level and smooth surface that is ready to receive floorcoverings and ceramic tiling after only four hours, with no priming necessary on most surfaces. With a range of high performance flooring and tiling products, ARDEX have an excellent track record in the healthcare sector and have completed many successful new build and refurbishment projects in recent years.

FURTHER INFORMATIONwww.ardexcpdacademy.com

Fast track flooring solutions for health and care environments

With more than 80 years of heritage and a determination to provide solutions that meet the needs of today’s healthcare environment, Rada is leading the way in hand washing and showering solutions. Part of the global Kohler Co., Rada designs and manufactures a wide range of commercial showering and washroom control products from its centre in Cheltenham and services a wide range of hospitals, clinics and NHS trusts across the UK. The Rada product portfolio offers a wealth of TMV3 approved products that meet the specific challenges posed by hospitals. From taps with innovative InsutechTM safe-to-touch technology to intelligent, digital non-touch controls, important in the fight against HCAIs. Rada has also been a key advocate in the fight for improved infection control and a holistic approach to fighting

HCAIs. Last year the company introduced Rada Recommends, a guidance document which sets out four key steps for NHS facilities, estates, infection control and nursing staff to consider to help achieve compliant hygiene levels, and ultimately, safe environments for patient care. All Rada products offer end users the very highest standards in safety, water and energy savings, reliability, precision and control.

FOR MORE INFORMATIONTel: 0844 571 1777www.radacontrols.com

Rada: providing practical solutions for infection control in healthcare



Written by Helen M

cGachie, CEO

of the Resin Flooring Association

The Healthcare environment requires a variety of performance criteria from its chosen flooring. Due to the complexity of trafficking and use of the areas involved, differing types of flooring should be selected to suit specific environments within a hospital building. However, the most important factor is the hygienic properties of the flooring and its ability to be cleaned and maintained. Seamless resin floors have a proven track record of over 40 years in the strictest of hygiene environments, namely the food industry.

WHAT IS SEAMLESS RESIN FLOORING?Resin flooring is applied in situ to a prepared concrete surface either as a flowing or trowelled mortar or as a surface coating. A polymerisation or curing process then takes place to produce the final synthetic resin finish. Large areas of seamless flooring can thus be installed without the need for any joints other than where there are movement joints in the base concrete. The lack of joints is beneficial since such recesses are more difficult to clean and risk harbouring harmful bacteria. The fully cured Resin flooring is impervious, non-absorbent, washable and non-toxic. Typical floor areas in the healthcare sector could be split into public and private, or more likely to be front of house and back of house such as reception areas, waiting rooms and corridors; wards, staff rooms, stock rooms; theatres, X-ray rooms, intensive care units; laboratories, mortuaries and kitchens, canteens, plant rooms. With the wide range of conditions to be encountered, it is important to identify the specific environment in each case to choose a suitable flooring material. To give good service, the flooring material must satisfy all the mechanical, chemical, physical, biological, and practical requirements of the user: Mechanical – to support machinery and to withstand impact and abrasion; Chemical – to be resistant to (and protect the substrate from) chemicals to be encountered; Physical – to withstand temperature changes (thermal shock) and prevent ingress of contaminants; Biological – not to support biological growth; E

FLOORING

WHAT’S THE SCORE WITH A RESIN FLOOR?Seamless resin flooring provides a high performance, durable finish to suit many hospital and healthcare applications. With specialist hygienic, slip resistant, chemical resistant and anti-static systems available, resin flooring satisfies the demanding requirements of today’s industrial environments, writes Helen McGachie, CEO of FeRFA – the Resin Flooring Association

Design & Build

Resin

flooring is

applied in situ to

a prepared concrete

surface, either as a

flowing or trowelled

mortar, or as

a surface

coating



Desig

n &

Build

Dixon Flooring was originally established in 1966. Dixon Flooring Contractors Ltd is a commercial flooring company carrying out installations throughout the U.K. The company supplies and installs all types of floor finishes from impervious carpets to non-slip safety vinyl which comply with hospital regulations, from all the major manufacturers. All its installation teams are fully employed by the company and are uniformed, CSCS card holders. Dixon is a member of the Contract Flooring Association and holds Safe Contractor accreditation. The company specialises in carrying out installations in

occupied work spaces and outside normal working hours to minimise any impact to the business. The company carries out installations and removals of flooring in a safe and eco-friendly manner to a number of different healthcare sectors, government agencies as well as major public and private organisations. Dixon Flooring Contractors Ltd adheres to a very strict recycling programme in partnership with Green Box recycling to minimise its impact on the environment.


Flooring which complies with hospital regulations

Beauflor, a brand of Beaulieu Flooring Solutions, Europe’s largest floor covering manufacturing group, is one of the leading producers of vinyl flooring and the only company in the world to manufacture vinyl flooring up to 5m wide. Beauflor has an extensive range of products for residential and commercial applications in 2m, 3m, 4m and 5m widths. Beauflor not only focuses on the technical qualities of the product, but also offers a wide-ranging design portfolio in woods, tiles and plain all-over options to present the perfect answer to every flooring need. The brand new Beauflor ‘Ultragrip Contract’ range demonstrates the company ethos of combining strength, beauty and low maintenance in one cost effective flooring solution. Beauflor, using state-of-the-art production methods for its vinyl flooring, has invested heavily in the technical aspects

of the process to improve product benefits such as low maintenance and greater sound absorption, along with an antibacterial top coat which ensures long-lasting antibacterial protection for your floor. One of Beauflors major concerns has been to control the sources of volatile organic compounds (VOCs) for which it has obtained the highly regarded American Floorscore certificate, together with the German AgBB label and the French CSTB A+. Furthermore, all products are REACH conform.

FURTHER INFORMATIONwww.beauflor.com

The only company to manufacture vinyl flooring up to 5m wide

Lees Flooring were established as a family-run business in 1949. It is one of the oldest and best-known flooring companies in East Anglia, specialising in commercial and residential flooring. Directly employing operatives, who are all CSCS registered and CRB checked, Lees Flooring are proud to have built a reputation for the quality and professionalism of their work.

The company offers a complete supply and fit service to all commercial businesses, local authorities, health authorities, insurance companies, banks, building societies, backed by friendly, professional staff and over sixty years’ experience in the business. A no obligation survey and quotation service

is offered in conjunction with an extensive showroom facility complete with a wide range of commercial and residential flooring options.

The company is member of the Contract Flooring Association, has CHAS membership and, with on-going training, is compliant with all Health and Safety regulations.

The company’s extensive knowledge of preparation and fitting techniques enable us to provide our clients with a quality installation service.

FURTHER INFORMATIONTel: 01603 425371 Fax: 01603 [email protected] www.lees-flooring.co.uk

Lees Flooring: quality and professionalism



Practical – to be easy to clean, to be hygienic, to be slip resistant, to be aesthetically pleasing, and to be durable.

RESIN FLOOR FINISHESThe types of resin flooring systems available and their area of use are described in detail in FeRFA’s RIBA CPD Approved Guide to the Specification and Application of Synthetic Resin Flooring (freely downloadable from www.ferfa.org.uk) Innovation in product manufacture has led to the introduction of a new range of decorative resin flooring systems. Colour, texture, flexibility and design are now key considerations, with products available to suit every design concept, from attractive terrazzo to contemporary creations. Slip resistant or anti-static/conductive versions of all these categories may also be available for use in sensitive areas such as operating theatres, X-ray suites and laboratories. Comfort flooring or liquid vinyl resin systems have been growing in popularity in recent years. These types of resin floors are generally a modified FeRFA Type 5 flow applied system, comprising a primer, a flow applied ‘body coat’, optional surface sealer and may include a rubber underlay and associated adhesive and pore filler. This type of resin flooring aims to offer the user the comfort properties typically provided by cushion vinyl, with the additional benefit of providing a seamless hygienic floor. Comfort flooring is monolithically bonded to the substrate and therefore removes the need for welded joints. Resin flooring can also be overlaid at the end of its life span unlike vinyl which needs to be removed and disposed of.

COMFORT FLOORING AT YORK A comfort flooring system proved to be the ideal choice at York Hospital where it was used in an operating theatre as well as in the wards. The comfort floor resin system provided a seamless, hygienic and noise suppressing floor which is easy to clean and maintain. Resin flooring and coving was installed at the Morgan Stanley Clinical Building, part of the Great Ormond Street £250M redevelopment project. On this project, the functional and decorative elements of resin flooring were required, where a hygienic and durable resin floor was installed in the new kitchen areas, and decorative seamless resin terrazzo was chosen for the play area and restaurant. As with all floors, good housekeeping and the correct cleaning regimes are important, but a dense, seamless, resin flooring will facilitate easier cleaning, and many manufacturers offer systems with antimicrobial properties based on nanotechnology, specifically for use within the healthcare environment. Joints are a point of weakness on any floor, not only from a design point of view, but also

from a hygiene and maintenance point of view. Seamless resin floorings therefore have an edge over other types of flooring since joints can be kept to a minimum. By contrast, ceramic tiled floors may have more than 10m of joints

per m2 of area. The minimum requirement for joints in resin flooring reduces

the possibility of mechanical breakdown and facilitates

maintenance. As a consequence, there are resin floors in arduous environments still giving good service after 15 to 20 years.

CONCLUSIONThe healthcare

environment presents a very wide range of

diverse requirements for any flooring system. Often

regulated under tight budgetary controls, it is important that the correct selection is made to provide a cost effective and practical solution. The high cost of reinstalling a floor, in terms of disruption, inconvenience, and loss of practical use of a sensitive area such as an operating theatre, makes it important to get the floor right the first time. This requires a thorough understanding of the environment, the best possible design, and the choice of the most suitable product for the job. Resin flooring has demonstrated over many

years its capability to satisfy the most demanding requirements, and makes the ideal choice for any healthcare environment.The installation of resin floors is also a specialist skill area, and for this reason FeRFA fully endorses a qualified workforce through the achievement of NVQ Level 2, leading to a FeRFA ID Badge and the CSCS Blue Skilled Card and above. Details of skilled and experienced contractors can be found on the FeRFA website www.ferfa.org.uk

FERFAFeRFA, the Resin Flooring Association represents resin flooring product manufacturers and specialist contractors, and allied trades. Established in 1969, FeRFA currently represents over 60 UK based companies, and has established Codes of Practice for each of its member categories. It takes an active role in promoting resin flooring and in developing both national and international standards, and has recently received an award for two of its technical guidance documents.Presented by the CITB (Construction Industry Training Board) the Growth Fund Recognition Award was given for FeRFA’s best practice guidance on Measuring and Managing the Level of Slip Resistance provided by Resin Floors and Static Controlled Flooring.

FURTHER INFORMATIONTel: 01252 714250 E-mail: [email protected]

Design & Build

FLOORING

With the

wide range of

conditions to be

encountered, it is

important to identify the

specific environment in

each case to choose

a suitable flooring

material

Resin floors must meet the mechanical, chemical, physical, biological, and practical requirements of the end user

and its surroundings, and therefore the installation of is a specialist skill area



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Health Business Mag__Planner_Half_Page_Advert_125_x_178.Wilo_X3_2002_print

Friday, March 8, 2013 9:59:34 AM



Richard Hipkiss, chairman, Energy Services and Technology Association

Hospitals and other residential centres will have been particularly impacted by the heat requirement over the past few months. Both the severity and length of the cold weather will have driven up energy bills. Now there is no certainty that next year will be as bad, but energy managers will have to factor the possibility into their calculations. We have had several cold winters recently. While that may be ‘natural variation’ rather than anything to do with climate change, it should make managers focus much more closely on ways to reduce those bills. For larger units, the case for on-site Combined Heat & Power (CHP) may be well worth revisiting. Traditionally, the case for such technology has been made according to heat requirement – this is the basis for sizing the boilers. The rationale is that excess electricity can be sold to the grid but there is nowhere for waste heat to go except into the local environment. So the heat load forms the baseline.

CHANGING ECONOMICSWhile that is still true, the economics are changing slightly. Most major NHS units – and a number in the private sector – are required to take part in the CRC Energy Efficiency Scheme. That means that they have to pay a penalty for all the fossil fuels they use. Investment in CHP can mitigate the exposure in several ways. First, if one therm of gas or one kilogram of solid fuel produces a certain amount of heat, in a CHP unit there is also a specific amount of power produced as well. That reduces the amount of grid electricity that must be purchased. So there is a reduction in the overall cost but also a saving on the number of emissions allowance that have to be purchased. Furthermore, if the CHP unit can run alternative fuels then there is the possibility of introducing some combustible wastestreams in the co-firing mix. There are a number of Energy Services Companies (ESCOs) and Contract Energy Management (CEM) providers who will be prepared to help determine the business plan and, if viable, install and operate the system for you. Large public sector organisations like hospitals have a very good credit rating and these providers will generally regard the health service as a good credit risk. So you may not have to find upfront funds in order to upgrade.

These ESCOs can help much more widely too. Take a look at the CRC league table to see where health service providers came. The NHS Blood and Transplant service came sixth overall, but they don’t have residential sites using a great deal of heat. The next health service entry is at number 33 – Nottinghamshire Healthcare NHS Trust. At 46 comes Bradford Teaching Hospitals NHS Trust. With the University Hospital of South Manchester NHS Foundation Trust at 79, that concludes the Health Service’s presence in the top 100. And with Mid-Yorkshire NHS Trust at 190 and the NHS Business Services Authority at 199, that makes a total of six NHS organisations in the top 200 of the CRC league table for energy efficiency. It is a striking statistic. One of the ways of achieving a good position in the league table was to take ‘early action’. The relevant actions were to install automatic Monitoring & Targeting (aM&T) or to become a member of the Carbon Trust Standard (originally an ESTA scheme before being taken over by the Trust). In the first league table – and almost certainly the last under new Government plans – it is instructive to look at who adopted one or both of these measures. The top 100 entries on the table installed one or both of these. Then the figures start tailing off although it is not until position 427 that the first entry comes which has no allowance for either technology. That having been said there are almost 2,100 organisations included in the table and a large number of them had done nothing about aM&T or the Carbon Standard when the list was compiled.

A COST EFFECTIVE INVESTMENTYet aM&T is one of the most cost-effective investments a Trust can make. It automatically collects and analyses the metered data. Current products can also automatically produce the Display Energy Certificates (DECs) required for many health service premises. The early action metrics provided an ‘easy win’ for health service Trusts.. The installation of aM&T really ought to be high on the list of energy efficiency initiatives being considered by senior managers.The original vision of the CRC never made it to the start line of course. It was supposed to be a scheme that was largely revenue neutral and those high in the league table could have expected to receive more money

back than they had laid out on the purchase of emissions allowances. But that was before the Financial Crash and the CRC has effectively become a carbon tax. Funds are not recycled to participants: they go straight to the Exchequer. With the architecture and philosophy changed, there was some criticism that the scheme was now over-complicated for what it was (now) designed to achieve. In its review of the CRC, the Government acknowledged the scheme’s role in focusing attention on energy saving technologies such as aM&T and energy-efficient lighting systems. However, it did also propose a significant simplification of the CRC and its conclusions were published last December. The ‘new style’ CRC will no longer be a ‘cap-and-trade’ scheme where participants can buy and sell allowances

on the market. In future there will be two fixed price sales of allowances

per year. Only gas and electricity consumption will

be included (electricity only through settled half-hourly metering). The revised scheme will also incentivise CHP through the way it treats input fuels, so

that is another reason for hospitals to reconsider

their options on this technology (oh, and the league

table is to be abolished!).So, ‘CRC-lite’ will still require

organisations bear down on energy consumption if they are not to find themselves open to a significant penalty in terms of the cost of emissions allowances they have to buy each year. But it is worth putting these costs in context. An allowance to emit one tonne of carbon dioxide currently costs £12 under the scheme. But to emit one tonne of carbon dioxide, you need to consume 1,850 kWh of grid electricity, using official Government carbon conversion factors. For gas, the figure is 5,450 kWh. The savings to be made just from cutting consumption dwarf any reduction in emissions allowances costs. The real challenge for Health Service organisations is to focus on cutting consumption while maintaining services. L

FURTHER INFORMATIONRichard Hipkiss is chairman of the Energy Services and Technology Association (ESTA), which represents over 100 major providers of energy management equipment and services across the UK. For more details visit the website at www.esta.org.uk

ENERGY POLICY

POLICY MATTERSThe effects of a cold and long winter may remain with the Health Service for some time. Regardless of how well medical budgets are protected there will certainly be a re-assessment of policy following this prolonged cold spell, writes Richard Hipkiss, chairman of the Energy Services and Technology Association

Energy

Most

major NHS

units are required

to take part in the

CRC Energy Efficiency

Scheme, meaning they

have to pay a penalty

for all the fossil

fuels they use



C

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Health A4 full April 2013.pdf 1 09/04/2013 09:17:26

David Catanach, director, British Sign & G

raphic Association

When you need something to work and you find out at exactly the time you need it most that it’s not designed at all for what you had in mind, it can become infuriating – especially when the deficient subject is a wayfinding signage scheme, which should guide you effortlessly to your destination, but often doesn’t because it’s been badly designed, poorly located or is just plain wrong. There’s nothing worse than wandering round a building looking for a particular location, only to miss it because the sign that tells you that you’ve arrived had been sited on a door (and somebody has left the door wide open) or to save money, the sign was made out of a thin rigid material that has now snapped away from its fixings. You will want the signing to be of a robust material, probably tamperproof, durable, definitely graffiti proof and vandal resistant, but easy to change when needed, easily read, complies with DDA legislation, incorporates the ‘corporate colours’ and won’t deteriorate or look cheap and tatty after a while. Wayfinding is a specialisation within the scope of signing overall. It’s a specialisation that’s really dangerous to dabble in whether you’re the manufacturer of the components comprising a wayfinding system, or the practitioner who installs them. There are so many factors the end product needs to satisfy – letting any one of them dominate at the expense of another leaves you with the ruin of a wayfinding scheme to deal with. Signs that relate to generally static chunks of infrastructure, such as Inverness or Penzance, have a life span that’s largely a function of the materials they’re made from. When the weather has done its work, the sign will be replaced, in all likelihood with something pretty much identical. That’s because unless something really unusual happens, Inverness and Penzance will always be where they are now. Most wayfinding schemes though usually point the way to something that is anything but static. People get promoted. Radiology gets a new machine and moves to a bigger room three floors down. A new chief executive is installed and he’s a medical practice driven animal, so management consultancy is consigned to a new home in a temporary building by the bins. A wayfinding scheme has to be ‘updatable’ to reflect these changes.

SHADES OF GREYSeriously, just how many shades of grey are there? Try telling that to whoever

was responsible for the directory in a London department store I visited. Every little component in the system has been stove enamelled, or painted, in a shade of grey close, but not close enough, to its

neighbour. Every time a change was made, a new shade of grey would find its way into the directory. Eventually, it lost its way completely. As a template for colour variation it worked well. As a wayfinding directory it resembled a thick layer of the Earth’s crust that had been stuck up on the wall. It was further made to look as if the seagulls had been at work as the white

text ran into half a dozen typefaces and letter heights. Reading it took twice as long as your eyes had to adjust at every level. How about the provincial theatre that signed up for wayfinding ‘in character’?

No room here for the crisply rendered, get-it-at-a-glance quality of a sharply contrasting sans-serif face and unmistakeable din-standard arrows. Try brown lettering on gold anodised aluminium and, as if that’s not enough, make sure the letter is Olde English and forget that it has a lower case too. Oh and by the way, let’s put the signs next to the doors to the auditorium so that when the door is open you can only ‘see’ half the sign. Old scheme NHS – acres of brown Darvic but at least you could read the text quickly. Thankfully, wayfinding done well is an absolute joy to behold and there’s quite a bit of it around. Airports and railway stations, on the whole, get it right. They spend a small fortune on signing because they’re in the business of herding people from one place to another and – their system would simply grind to an excruciating halt if they didn’t do it well. The British road traffic signing scheme is just about the best in the world and, let’s face it, we get plenty of time to admire it at close quarters! Wayfinding done well is a deep design specialisation. It draws upon knowledge of how type works and how things distilled to the barest essence actually function. The very fact that it’s not a discretionary involvement of the user with the sign, but something closer to necessity confers upon it a responsibility to do its job and to do it well. No one goal in wayfinding is seconded to another. Whether the scheme sets out to counterpoint the architecture that is its host, or to work with it, it must do so in a manner that sits comfortably with its need to direct and inform. Give legibility its head though, and you may have won in the functional stakes, but you’ll also have blighted the venue with the aesthetics of a car crash. L

FURTHER INFORMATIONwww.bsga.co.uk

WAYFINDING

LOSING YOUR WAY?David Catanach, director at the British Sign and Graphics Association, takes a look at wayfinding signage in hospital buildings

Signage

“...Signs that relate to static chunks of infrastructure have a life span that’s largely a function of the materials they’re made from...”



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Insurers provide protection but with accident claims rising all the time you have to look after your own costs and FLS (First Legal Support) is here to help. FLS and its parent company Plantec Holdings provide innovative and flexible independent accident investigation and accident management services. It has established excellent reputations for delivering high quality solutions to the motor insurance industry. Its services are designed to help save time and money in the event of a road traffic accident by managing and investigating the accident pro-actively and effectively. Driven by understanding customers’ needs and requirements enables FLS to deliver outstanding bespoke services underpinned by its professional approach and excellent customer service. The company’s record of delivering high quality services to the motor insurance industry is enhanced by

its range of insurance products which provide a comprehensive solution for fleet operators. Fleet operators have a considerable amount of their time consumed by having to deal with the administration and investigations themselves following such accidents. Outsourcing such services to a specialist company can save a considerable amount of time and money as well as taking away the stress of dealing with such matters.

FURTHER INFORMATION Contact: Andrew Drewary, DirectorTel: 07817 043 [email protected]

Driving down fleet costs following an accident



users as far ahead as possible to avoid unnecessary braking and acceleration. Maintain a greater distance from the vehicle in front so that you can regulate your speed when necessary without using the brakes. When slowing down or driving downhill, remain in gear but take your foot off the accelerator as early as possible. In most situations and for most vehicles this will reduce fuel flow to virtually zero. When accelerating, shift to higher gear early, usually by around 2,000-2,500rpm High speeds greatly increase fuel consumption so avoid excessive speed. Other tips for better fuel efficiency include keeping tyres correctly inflated. Underinflated tyres are not only dangerous but also increase fuel consumption. All ancillary loads, but particularly air conditioning, add to fuel consumption so use it sparingly.Turn off your engine if you expect to be stationary for more than a minute or so. Remove racks, roof boxes and bike carriers when not in use as they significantly increase air resistance and fuel consumption at higher speeds. Keep windows shut at high speed and avoid carrying unnecessary weight as this will increase fuel consumption. L FURTHER INFORMATIONwww.energysavingtrust.org.uk/ smarterdrivingwww.ecodrive.org

Written by Bob Saynor, the Energy Saving Trust

Fleet Managem

ent

The dramatic improvements in vehicle efficiencies seen in recent years are very welcome, but there is also evidence of a widening gap between manufacturers’ official fuel consumption figures and what’s achieved in real life. A report from the International Council on Clean Transport published last year showed that on average this gap had grown from eight per cent in 2001 to 21 per cent today. This surely means there’s a stronger case than ever for training to help drivers achieve – or at least get closer to – the official figures. THE BENEFITSReduced fuel consumption and CO2 emissions are the biggest benefits with an average improvement of just under 15 per cent on the day of training. As with any training – driving or otherwise – this will decrease over time, but we believe five per cent is a realistic long term saving. This is supported by evidence from German research of between 3.7 and 6.2 per cent fuel savings.

Because of the focus on greater anticipation, efficient driving also reduces accident rates. Arriva North West is a good example: The bus company ran eco-driving training for their drivers in 2007 and the following year it recorded a 29.6 per cent reduction in ‘at fault’ collisions involving other vehicles and an 18.3 per cent reduction in non-fault collisions. Eco-driving also reduces vehicle wear and tear which, in turn, reduces maintenance costs. Our experience shows that there’s no substitute for one-to-one training. And the training doesn’t need to be lengthy. Just under an hour per driver can go a long way. Short-duration eco-driving training is the basis of government subsidised eco-driving programmes in England and Scotland. In-car technologies, especially those giving drivers instant feedback on their driving can be effective in providing

on-going feedback, encouraging drivers to use and develop their skills.

THE TECHNIQUESFor most drivers, the biggest benefits come from greater anticipation, better use of gears and by slowing down on the motorway. In more detail, drivers should drive smoothly, and anticipate

situations and other road

DRIVING THE GREEN WAYThe Energy Saving Trust’s Bob Saynor dishes out top tips for fuel-efficient driving

Fuel-efficient driving tipsAnticipate situations to avoid unnecessary braking and acceleration.

When accelerating shift to higher gears early, usually by around 2,000-2,500rpm.

Avoid high speeds as they greatly increase fuel consumption.

Keep tyres correctly inflated as underinflation increases fuel consumption.

Use air conditioning and other ancillary loads sparingly.

Turn off your engine if you expect to be stationary for more than a minute or so.

Reduce drag by removing racks, roof boxes and bike carriers, and keep windows shut at high speed.

Avoid carrying unnecessary weight as this will increase fuel consumption.

Reduced fuel

consumption and

CO2 are the biggest

benefits with an

average improvement

of just under 15 per

cent on training

day

FLEET MANAGEMENT



At Alphabet we’re always developing new, more eco-efficient ways of moving employees from A to B. It’s all part of our vision for the future of sustainable mobility.

Existing forms of fleet management underpin this vision. But there’s certainly more to come.

Take GreenCARE for example. A clever way to help you identify your fleet’s CO2 emissions, benchmark your carbon footprint against our best performing customer, and reshape your fleet to minimise future costs.

AlphaCity, our ground-breaking car sharing scheme, offers eco-efficiencies too. With fewer cars serving more staff it’s good for your pocket and the planet.

Both are just yet another step forward in clever green thinking from Alphabet.

Eco-Efficient Mobility is on the Move.

Find out more:

Tel: 0870 50 50 100Email: [email protected]

1996 Health Business Advert A4.indd 1 19/03/2013 17:00

At Alphabet we’re always developing new, more eco-efficient ways of moving employees from A to B. It’s all part of our vision for the future of sustainable mobility.

Existing forms of fleet management underpin this vision. But there’s certainly more to come.

Take GreenCARE for example. A clever way to help you identify your fleet’s CO2 emissions, benchmark your carbon footprint against our best performing customer, and reshape your fleet to minimise future costs.

AlphaCity, our ground-breaking car sharing scheme, offers eco-efficiencies too. With fewer cars serving more staff it’s good for your pocket and the planet.

Both are just yet another step forward in clever green thinking from Alphabet.

Eco-Efficient Mobility is on the Move.

Find out more:

Tel: 0870 50 50 100Email: [email protected]

1996 Health Business Advert A4.indd 1 19/03/2013 17:00

The 2012 Alphabet Fleet Managment Report highlighted a remarkable fact; 79 per cent of businesses have embraced ‘sustainability’ by setting green fleet targets as part of their fleet strategy. However companies are still concerned about the apparent cost of going green, especially as cost control remains a priority for most fleets both in the private and public sectors. What does this mean to fleet managers faced with meeting their organisations’ increasing desire to fulfil the environmental agenda? With so much pressure on internal departments, it is often difficult to ring fence the time to deliver on the environmental targets which are increasingly a key part of the CSR deliverable. Another consideration is the knowledge and skill required to establish and implement a sustainable strategy, let alone the cost element.

MEETING SUSTAINABLE OBJECTIVESPursuing green fleet policies will deliver cost savings in a number of areas for companies, especially fuel. Around half of fleets see the cost of changing vehicles as the main barrier to attaining these goals however. The suggestion is that many would like to bring forward the replacement of existing vehicles with lower-CO2 models but have not done so because of the additional up-front costs for the early termination of contracts. That’s why so many organisations are employing experienced fleet advisers like Alphabet to help them to achieve their sustainable objectives. One of the proven tools that Alphabet employs to help businesses to measure and manage their fleet’s carbon footprint is GreenCARE. GreenCARE was the industry’s first comprehensive online analysis tool allowing companies online access to the environmental performance of their fleet. Using detailed information on CO2 emissions, vehicle manufacturers, fuel type and engine size Alphabet customers can benchmark their fleet performance and work out where savings can be made with the click of a mouse. The system also allows them to compare their fleet against Alphabet’s ‘average’ and ‘best in class’ performers.

SCENARIO PLANNINGGreenCARE has been enhanced, adding sophisticated scenario planning. This allows

fleets to plot how changes to their vehicles, such as adjusting manufacturer and model, engine size and fuel type affect the fleet’s performance in terms of CO2 emissions and MPG. Using the results fleet managers can build a realistic fleet policy and plan how to phase out certain vehicles over a set period to reduce CO2 emissions, improve MPG and therefore reduce business cost. In turn this supports users in complying with company goals and CSR requirements – an increasing requirement for many fleet managers. Significantly, GreenCARE also saves managers time. Their fleet data is pre-loaded into the system, enabling them to quickly analyse their fleets using a series of graphs or data exported into excel spreadsheets. Nigel Trotman, strategic fleet consultant at Alphabet, commented: “GreenCARE is a really exciting proposition for managers as it helps them to understand and manage their fleet’s carbon footprint. The predictive modelling function is really attractive to

users as it allows fleet managers to remodel their fleet online and understand what would happen if they changed their vehicle mix. This is very unique in the industry and available to all Alphabet customers.” Recently GreenCARE has undergone further upgrades, and now offers light commercial vehicle (LCV) operators access to the same reporting and analysis capabilities, helping them make better-informed decisions when it comes to the management of their fleet. In summary GreenCARE was developed to enable our customers to review the environmental impact of their fleet both historically and currently. GreenCARE provides proactive support and guidance to Alphabet’s customers in order for them to meet their corporate environmental responsibilities and potentially reshape the future of their fleet. L

FURTHER [email protected]

GreenCARE has undergone further upgrades, and now offers light commercial vehicle operators access to the same reporting and analysis capabilities, helping them make better-informed decisions when it comes to fleet management

FLEET MANAGEMENT

HELPING YOU MEET THE SUSTAINABLE AGENDAGreenCARE’s Sophisticated scenario planning allows fleets to plot how changes to their vehicles, such as adjusting manufacturer and model, engine size and fuel type, could affect the fleet’s performance in terms of CO2 emissions and MPG, explains Alphabet’s Nigel Trotman

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Written by Dr Paul Shannon M

BChB FRCA MBA

It’s the individuals within the organisation that make up the culture. In short, it’s ‘the way we do things around here’. But, the way we do things can be greatly influenced for the better by IT systems. Somewhere along the line, according to Francis, the NHS seems to have lost its way. The causes are no doubt manifold, but I believe that new technology can be used to help re-establish these principles, and should certainly be part of the solution.

SECRECYA key finding of the Francis report was ‘Secrecy’ – IT systems can show you what’s going on. Some of the shocking and callous treatment that patients were subjected to at Mid Staffs would be impossible if only we could ‘see’ what was happening. A good example is the recording of clinical observations. Most inpatients will have their vital signs recorded regularly. Parameters such as blood pressure, heart rate, respiratory rate, oxygen saturation, temperature, pain scores, etc, are noted on charts so that a longitudinal picture can be seen, which indicates whether the patient is deteriorating, improving or staying the same. Early Warning Scores (EWS) exist that can detect when patients need more intervention.

LACK OF OPENNESSAnother key finding of Francis was a perceived ‘lack of openness to criticism’. At present, bedside observations are done manually and are most often paper-based. There is audit evidence that only about 70 per cent of observations are actually done and/or recorded. When electronic systems are introduced recording increases to nearly 100 per cent. Partly, this is due to the fact that it is obvious where the gaps are and, perhaps more importantly, who is responsible. Steps in tasks can be made compulsory, no ‘corner-cutting’ or skipping items. (Think of buying an airline ticket online; you must follow the prescribed sequence else you can’t complete the task). More sophisticated IT systems can proactively assimilate automatically information from disparate sources to predict which patients are most at risk. Regulators, commissioners of healthcare and the public also need information to make meaningful comparisons

between organisations. Sharing and comparing the outcomes of different hospitals can drive up standards.

ACCEPTANCE OF POOR STANDARDS Another key finding was the ‘Acceptance of poor standards’. With the best will in the world no doctor or nurse can know everything. Health IT can help direct care and ensure that the patient stays on the right track, i.e. receives all the appropriate care that they should in a timely manner: right thing, right way, right time. For instance, when teams hand-over care using electronic systems, communication

is improved. This helps to overcome the fragmentation of care delivery, where the left hand doesn’t know what the right hand has done. Similarly, electronic prescribing systems contain decision-support software that can automatically alert clinicians about potentially harmful drug-drug interactions.

MISPLACED ASSUMPTIONS ABOUT THE JUDGEMENTS AND ACTIONS OF OTHERS

According to Francis, the quality of care should be described in

standards. IT systems can be used to monitor how

closely these standards are adhered to and E

FRANCIS REPORT

CULTURAL CHANGE THROUGH NHS IT: A TALL ORDER?Many of the issues identified at the Mid Staffordshire NHS Foundation Trust could be seen at any NHS hospital. The overwhelming message of the Francis Report was the need for ‘cultural change’ in the NHS. However, this is a tall order since the NHS doesn’t so much have a culture, writes Dr Paul Shannon

Healthcare IT

Some of

the shocking and

callous treatment

that patients were

subjected to at Mid

Staffs would be

impossible if we could

‘see’ what was

happening



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Working with partners in the NHS, local government and the private sector, Advanced delivers IT solutions in support of safe, efficient care with integrated management information. Advanced has a range of integrated care solutions offering visibility of information for both the commissioner and care provider.

to guide practitioners in what to do in given situations. At present, in the UK, very little use is made of such electronic, standard-based applications. Where they can replace tedious, repetitive, high-speed and complex tasks currently performed manually, they can improve safety. Electronic systems are logical and operate to high standards. CLINICAL INTELLIGENCEIT systems collect huge amounts of data. If all the data currently held on paper were available for easy analysis, we would be able to produce reports in ‘near real-time’. In other industries, great use is made of such data and is called ‘Business Intelligence’. To make this concept culturally acceptable to the NHS, I would suggest calling it ‘Clinical Intelligence’. There are three main applications: Direct patient care: what’s happening to this particular patient? How well is this doctor/team/hospital performing? There is huge variation in the performance of different individuals and teams, yet rarely is this made known. Wide-scale issues: with good population data, we can track large-scale changes, such as the obesity ‘epidemic’, ‘flu outbreaks, and the uptake of public health measures.

DEFENSIVENESSElectronic systems permit the automatic capture of data. This can be structured, semi-structured and unstructured. Coding systems, such as SNOMED CT and ICD10, aim to overcome ambiguity in language by providing terms that have defined meaning. If information is captured it can be investigated, analysed and presented in meaningful ways providing the possibility for remembering and learning from mistakes as well as providing a real-time picture of how things are (current status, dashboards), and how things are likely

to be in the future (prediction).Key finding: ‘A failure to put the patient first in everything that is done’ Having the necessary information about a patient is essential to good clinical care. Having that information at your fingertips, when you need it, helps avoid pitfalls and promotes personalised decisions. The patient feels valued, listened to and at the centre of your attention. In my experience, patients love to read their medical notes! It helps with shared decision-making and simple errors can often be detected. But, in reality, it rarely happens and the NHS makes it pretty difficult to do. It is technically quite easy to provide the same information to the patient that the clinician has, in a secure and safe way. For a number of reasons though, clinicians are often the biggest barrier preventing patient access to records. Feedback from patients and carers is a great idea, but only means something when it impacts on individuals and teams in some way. For the first time, doctors have to collect patient feedback in order to revalidate their licence to practise. Moreover, financial penalties for 30-day readmission rates could reduce NHS hospital income by as much as 3 per cent. Quality will count. CONCLUSIONThere will be much soul-searching and analysis following the Francis report. For me, the key is better information leading to better care. Francis states: “If the culture of those engaged in and with the NHS is to change, information must be made available

about the performance and outcomes of the service provided to enable patients to make treatment choices and have a proper understanding of the outcomes for them”. As we have seen, electronic systems can help reduce risk through a variety of mechanisms. I believe that the time is now ripe to exploit health IT fully in the NHS in order to reap the patient safety benefits. These systems, properly implemented, can provide the step-change in patient safety that everyone knows we need. L

ABOUT THE AUTHORDr Paul Shannon MBChB FRCA MBA is a practising NHS anaesthetist with an extensive clinical leadership record in the NHS at local, regional and national level. His passion is to improve patient care. Paul was National Clinical Lead for ‘Choose and Book’ (the electronic booking service within the NHS) at NHS Connecting for Health, where he chaired the National Clinical Reference Panel. He has also served on the Medical Managers’ Committee of the British Medical Association (BMA), and as a council member of the UK Council for Health Informatics Professionals (UKCHIP). In 1998, he became a Consultant Anaesthetist with a special interest in obstetric anaesthesia, at Doncaster Royal Infirmary (UK). He still works part-time for the NHS providing anaesthesia services for Orthopaedic surgery and Obstetrics/Gynaecology.

Healthcare IT

FRANCIS REPORT

Feedback from patients and carers is a great idea, but only means something when it impacts on individuals and teams in some way

Dr Paul Shannon offers top tips to meet the Digital ChallengeFollowing heath secretary Jeremy Hunt’s recent challenge to the NHS to ‘go paperless’ by 2018, doctors and hospitals are going to need IT tools to coordinate care electronically. Care coordination is essential to avoid duplicate treatment and to prevent medical errors. Whether it is a GP, hospital, other healthcare provider or local authority, they are all at different levels of implementing IT. In fact, many are still manually posting or transporting health records to other members of care teams, which can take days. Even if a patient moves from one doctor to another down the corridor in a medical building, the patient may have to carry records in a paper folder rather than their being accessed or transmitted digitally. For healthcare providers to properly exchange information and coordinate care,

it should be in ‘near-real time. A phone or fax machine may not be good enough, but there are numerous ways that the NHS can rise to the health secretary’s challenge by making more use of existing, national tools that are already up and running:

NHSmail is a secure, encrypted email service that can be used instead of ‘inhouse’ email systems. It means that secure emails containing patient-identifiable data (PID) can be safely sent anywhere within the NHS. NHSmail 2 is coming soon, which will have even more functionality. There’s really no need to send letters and faxes to colleagues anymore.

Choose and Book (CAB). About 60 per cent of all first outpatient referrals are now done through CAB. E



Heal

thca

re IT

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Do you need to change the way you think?The Industrial Revolution was driven by standardisation and mass manufacture of components. In the 18th and 19th centuries it was mechanical components like nuts and bolts; now in the 21st century the same is happening with software. Powerful, tailored and above all flexible business solutions can be built and configured using inexpensive standard software components. Leaders need to change the way they think about IT; they need to see it as a service, take control of it as a business too, and spend their limited budgets in smarter ways. Facing constant change, business managers need tools that allow them to respond quickly and inexpensively, using strategic solutions. Using ‘enAct’, enCircle’s business process automation platform, one public-sector organisation realised returns

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Healthcare IT

NHS IT

Make it 100 per cent to get the most benefit. Consider the other functionality within the application such as the ‘Advice and Guidance’ section to avoid inappropriate referrals.

Summary Care Record. A surprising amount of useful clinical information can be found here. The more it’s used, the more useful it becomes.

Automate the discharge summary. It’s virtually impossible to attain the NHS standard of discharge summaries to GPs within 24 hours without using electronic systems. A good electronic patient record system should permit electronic discharge summaries to be sent to GP systems easily.

ePrescribing. This is a high-impact patient safety issue; no more problems with doctors’ notorious handwriting. ePrescribing can be ‘standalone’ or integrated into an EPR. It may be best to start with a gradual roll-out in enthusiastic areas, rather than a ‘big bang’ approach.

View results electronically instead of printing out paper. Get into the habit of accessing pathology and radiology results

without printing out paper and consider using a Single Sign On tool so that you don’t have to remember multiple passwords.

Exploit ‘departmental’ systems to the maximum. For example, if your trust has a theatre management system, see if you can use it to record the clinical record. A relatively easy start is the surgical operation note. But, make sure that any ‘bespoke’ systems can talk to others using Health Level 7 standards.

Don’t duplicate. Paper records are not more valid than electronic ones, so you don’t have to do both. If you’re told to write paper records and create electronic ones, someone’s missed the point. One Consultant I heard of confiscated all the pens of her trainees when they came to her clinic.

Know your ‘business continuity’ policy. Inevitably there will be times when electronic systems are not available, so you need to have robust alternatives in place just in case.

Develop a ‘portal’ mentality. This means automatically pulling information from multiple sources into a single area.

There are various ways of achieving this, but make sure the patient is the ‘context’, that is, you only view information about one patient at a time. This is an important patient safety factor in order to avoid confusion.

Find out about your trust’s IT strategy. Your IT department needs your input. Do you have a clinical lead for IT, or even a chief clinical information officer (CCIO)? Could you do it? You don’t need to be a ‘techy’ or have a Master’s in Informatics; this is about improving patient care, it’s not an IT project.

Enjoy the digital revolution. The NHS is ‘data rich but information poor’. In the era of ‘big data’, find out ways of exploiting data for patient benefit and/or professional development. For example, how do you compare against your colleagues, other trusts, international best practice? Annual appraisal and revalidation requires individual, practitioner-level information, and nobody wants to bottom of the league table.

By Dr Paul Shannon, consultant anaesthetist in the NHS and medical director at CSC

Top tips to meet the Digital Challenge (continued)

Providing security for hospitals, clinics and other medical institutions involves more than the best choice of products and features. Learn how security systems such as access control, intrusion detection, and digital video surveillance can be deployed to protect patients, staff, property, and information. Health authorities and hospital staff are especially challenged to provide safe environments for employees, patients and visitors. Hospitals, by their nature, are designed to be open and accessible to the public, which means street crime and other dangers can easily enter through doors if not properly protected. In this financial environment, it is essential that healthcare institutions seek to proactively and continually reduce operating costs and limit liabilities. Many hospitals are turning to technology to help make the security staff more productive and effective. New

solutions for security, facility and data management enable healthcare institutions to both reduce costs and improve the safety at their facilities. Hosted by IP UserGroup International, an Independent Security Technology Forum, IP-in-Action LIVE Manchester, comprises a table-top EXPO, workshops and product demonstrations, a series of focused seminars covering many aspects of today’s security and safety technologies and a ‘Quiz the Guru’ session – your opportunity to ask the experts. Free to delegates and guests, the day includes a complimentary buffet lunch

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Implemented effectively as part of a whole system redesign of care, telehealth and telecare can alleviate pressure on long term NHS costs and improve people’s quality of life through better self-care in the home setting. Typically, it involves electronic sensors or equipment that monitors vital health signs remotely from home or while on the move. Readings are automatically transmitted to an appropriately trained person who can monitor the health vital signs and make decisions about potential interventions in real time, without the patient needing to attend a clinic.

Telecare is a service that enables people, especially older and more vulnerable individuals, to live independently and securely in their own home. It includes services that incorporate personal and environmental sensors in the home, and remotely, that enable people to remain safe and independent in their own home for longer. 24 hour monitoring ensures that should an event occur, the information is acted upon immediately and the most appropriate response put in train.

WHY TELEHEALTH?Telehealth and telecare has the potential to make significant health improvements and quality of life impacts for people with a high dependency on the NHS, local GPs, social services and local hospitals. It provides a means to increase the availability of NHS clinical support by allowing local practitioners to be in permanent contact with those people less able to look after themselves.Telehealth and telecare can help improve the reach of the services that the NHS provides and can help keep people out of hospital, avoiding the pressures this puts on them

and their families. Individuals benefit too. Telehealth and telecare allows for more effective self care, improved quality of life for carers, less travel and disruption for routine check-ups, retained dignity, increased confidence to manage own health, and fewer stressful, unplanned hospital admissions.

There are numerous benefits for health and social care professionals. Through risk stratification, professionals can identify those people in their practice who have Long Term Conditions (LTCs) and could be better supported if telehealth were adopted. Professionals can be better informed of the status of these people and see less demand on services, with fewer A&E events and unscheduled inpatient episodes. Professionals may also see less impact on family members/carers of people with (LTCs) as they start to take more control of their own health.

More regular data means professionals can be better informed of a person’s health status which leads to early intervention and proactive care. What’s more, deploying telehealth-enabled services modernises the way by which large numbers of people with LTCs are treated improving their care, quality of life and the life of their carers, and makes more efficient and effective use of available clinical teams by reducing unnecessary home visits. The healthcare industry should also see significantly less A&E usage and unplanned admissions.

In May 2008, the Whole System

Demonstrator (WSD) programme was launched, which has been one of the most complex and comprehensive studies the Department of Health has ever undertaken on the subject of telehealth, and has yielded a wide range of very rich data.The WSD programme is the largest randomised control trial of telehealth and telecare in the world, involving 6191 patients and 238 GP practices across three sites, Newham, Kent and Cornwall. Three thousand and thirty people with one of three conditions (diabetes, heart failure and COPD) were included in the telehealth trial. There are many different types of telehealth and telecare but each of the three sites made their own decisions on the equipment they would use in their health and social care economies. According to the result findings, when used effectively, telehealth and telecare can reduce death rates by as much as 45 per cent. The programme also found a 20 per cent reduction in emergency admissions; 15 per cent reduction in A&E visits; 14 per cent reduction in elective admissions; 14 per cent reduction in bed days, and an eight per cent reduction in tariff costs.

3MILLION LIVESThe Department of Health (DH) believes that at least three million people with long term conditions and/or social care needs could benefit from the use of telehealth and telecare services. Following on from the WSD programme results, Paul Burstow, Minister for Care Services launched 3millionlives, a campaign to support the NHS, social care and professional partners to deliver telecare and telehealth to millions of people.A key aim of the 3millionlives programme is for the Department for Health and industry to work together over the next five years to develop the market and remove barriers to delivery.

Care services Minister Paul Burstow said: “This paper shows that

telehealth can help to reduce emergency hospital

admissions by 20 per cent and mortality by 45 per cent for patients with long-term conditions. To realise these benefits we need service transformation – and

telehealth can help deliver that change.

“We are working closely with industry, the NHS and

social care organisations to make progress through the

3millionlives initiative to develop flexible funding models with a reduced price point, which will achieve the economies of scale needed to make telehealth a success.”

REAL PEOPLE BENEFITTelehealth is helping individuals across the UK to gain better control of their long term conditions and improve their quality of life. 67-year-old Emelie, for example, suffers from E

CCTV IN HOSPITALS

Telehealth and telecare services have been shown to reduce mortality rates by as much as 45 per cent, according research, as well as significantly benefit individuals, their families, carers, and the wider healthcare industry

Telehealth

Implemented

effectively,

telehealth can

alleviate pressure on

long-term NHS costs

and improve people’s

quality of life through

better self-care

at home

HEALTHCARE OUTSIDE HOSPITAL WALLS

Ascom (UK) LtdT: 0121 353 6151E: [email protected]

MAKE TELEHEALTH A REALITY FOR THEMI am over 65 and have worked hard all of my life.I wish to live in the comfort of my own home.I don’t want to be in and out of doctors’ surgeries and hospitals.I want to keep my independence.I want to be in control.I want to manage my health at home.Please give me the tools I need to do this.

Make their experience your reason for investing in the future of Telehealth.Ascom - specialists in Independent Living solutions.


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a condition called Congestive Cardiac Failure (CCF), which is a heart condition where the heart loses the ability to pump blood efficiently. The result is that the body doesn’t get as much oxygen and nutrients as it needs, leading to problems like fatigue and shortness of breath.

Emelie was diagnosed with CCF in 1995. All though in the past few years her condition has improved somewhat, the concern for Emilie is that her blood pressure could go up very quickly without warning. “If I eat something with more salt than my body needs, my blood pressure goes up. All the symptoms flare up.”

Emelie, who lives alone, has been trialling the TeleHealth system in her home since July 2009. The system is aimed at giving her the tools she needs to help manage her own health at home with the supervision of health professionals. Using TeleHealth, Emelie is able to take her own blood pressure, weight, pulse and oxygen levels each day. The readings are taken with special equipment which is linked to a set-top box connected to her television. The results are automatically uploaded to a team of healthcare professionals who view them daily and can contact Emelie if anything is out of the ordinary.

Emelie, a retired nurse, is enjoying the part she now plays in managing her own health and she is more conscious of changes in her readings.

“I can see how my readings are related to my diet and how much physical activity I do. If they change, it makes you think ‘What have I done? What did I eat?’ and when you remember, you say to yourself ‘no

wonder my readings have gone up!’ One day I took my BP after my exercise and the nursing team sent me through a message straight away to say it was extremely high and if I knew of a reason for the sudden change. Of course I realised right away that I should have waited before I did my readings after I exercised. But I definitely now know someone is looking out for me!”

DIABETES MANAGEMENT Terry Munro, 65, suffers from insulin controlled Diabetes. Living alone with diabetes has always been a concern in case he ever fell into a diabetic coma with no one around.

Terry is now being assisted to live in his own home, thanks to the help of TeleHealth technology. With the TeleHealth system Terry can see for himself what his readings are and take necessary steps to avoid an emergency situation. Each day, Terry – who has been trialling the TeleHealth system in his home since December 2008 – takes his blood pressure, weight, and blood sugar levels. The readings are taken with special equipment which is linked to a set-top box connected to his television. The results, shown to Terry on his television, are then automatically uploaded to a team of healthcare professionals who view them daily. If any abnormalities are highlighted, immediate action can be taken.

“I have much greater peace of mind about my condition now. As soon as anything changes I know I’ll be contacted by someone

in my care team to check up on me.” Terry is now more conscious of his lifestyle habits. He has increased confidence because help and advice is just a remote control button or phone call away.

COUNCILS PLAY THEIR ROLESTrafford Council has launched a Telecare Pledge Scheme, providing people over the age of 80 with a one year free trial of using the products in their home. Executive councillor Michael Young said Trafford’s telecare scheme has proved extremely popular with local people who want to remain living at home..

“This pledge will provide more people with the opportunity to experience the huge benefits of Telecare equipment for themselves. This further investment is an important element of our continuing focus on providing personalised, quality care at a time and in a way local people need and deserve.”

Corporate director of communities and wellbeing, Deborah Brownlee, reinforced the importance of the Telecare pledge. She said: “It is encouraging to see so many people already benefiting from Telecare equipment and services within their home. However it’s important to us that anyone over 80, or their families, who think this free year trial may be of interest to them take time to find out more.” L

FURTHER INFORMATIONwww.3millionlives.co.uk

TelehealthTELEHEALTH

Wireless nurse call systems like Aid Call’s provide all the functionality and reliability of a hard wired system, but with the added benefit of greater flexibility, with more powerful features and functionality.

The flexible system is modular and can be moved around and added to as required. Wireless nurse call systems are quick and easy to install, the systems are infinitely changeable and expandable allowing for the constant ability to deal quickly with ever changing clinical priorities and demands.

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If you are looking for an effective, cost efficient monitoring system for your residents, Aid Call’s wireless system could revolutionise the way you manage your Nurse Call communications.

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All the benefits of a hard wired system at a fraction of the cost Vision360 (UK) is a new and

independent entrant to the healthcare market in the UK, building on its experience in delivering low-cost, high-quality consumer-focussed solutions in the private sector for network operators and others on smartphones, tablet devices, PCs and set top boxes.The Vision360 Telehealth Toolkit is a market-ready solution that is based on open standards and standard-based technology. It has been designed with clinical input from inception and can be used with a variety of medical devices and readily integrated with existing primary and acute clinical care records and triage systems. Patients receive a touch screen tablet device which connects wirelessly to both medical devices and our own secure servers. The user experience is, above all, simple, with audio cues, multi-language support

and personalised educational and instructional videos.The Telehealth Portal enables healthcare professionals across the care spectrum to enrol, manage and responds to patients from PCs and portable devices.The solution has recently been deployed in a joint initiative by an NHS Trust and CCG in London and will be rolled out more widely in the coming months. The company’s aim is to enable rapid deployment at low cost, with measurable outcomes, working alongside existing community healthcare teams.


Introducing the V360 Telehealth Toolkit



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As I write this article, Google returns 4,730 results for the search “QALY 92000” – a mere seven days from the publication of this research, based on the Whole Systems Demonstrator (“WSD”). It is certainly an attention-grabbing headline and on the face of it, raises a serious question mark around telehealth, when set against a NICE threshold of £30,000 per QALY gained.

This is of critical importance given that the potential positive impact on patients’ health, satisfaction and mortality, which has been confirmed once again by the WSD study, including an actual fall in mortality rate of 45 per cent (even with the relatively clunky technology of the day).

As the MD of a company that now offers cost-effective telehealth solutions, with over 10 years’ prior experience in media and technology and a professional finance background, I hope that I can provide a little insight into why this headline is, in fact, largely meaningless for those now considering investing in telehealth. For a more in-depth view, check out our blog at http://www.vis360.co.uk.

There are some points that I would like to touch on briefly here, which have the potential to create wide-ranging variances between the study results and real-world deployments.

The WSD was a randomised control trial (RCT) with all of the attendant restrictions. The patient selection was relatively wide (within the broad qualifying criteria) and a range of telehealth interventions were used. No adaption to usual care was made for telehealth participants. Telehealth participants would not have been encouraged through active promotion of the benefits of telehealth – self-confidence, reassurance, anxiety-reduction and so on. All of this is sub-optimal from a telehealth perspective (though necessary for an RCT).

There were no non-English speaking patients. Nowadays, we can provide multi-lingual telehealth services and non-English speaking patients, in my view, are one of the groups who stand to gain the most from this technology.

Only 30 per cent of WSD participants are included in the data for the cost

effectiveness research – 969 of 3,230 participants, with just 538 telehealth patients. This is reflected in the potentially wide variation between sample and population means in some of the key data. For example, at 95 per cent confidence level, average annualised inpatient days for the telehealth population could be as low as 2.20 days (versus reported sample mean of 3.92 days).

Costs (including care costs) are measured over a 3 month period only based on patient’s own reported care usage data. This is a short period particularly given that a high proportion of patients suffered from COPD (40 per cent of the telehealth group), for which exacerbations are impacted by cold weather and hence subject to seasonal trends.

I want to focus particularly on costs. The WSD trial took place five years ago –

this is a huge amount of time in technology terms. The total average annualised costs

per patient (including care costs) for this study were £5,559 for the control group and £6,384 for the telehealth group. Before telehealth equipment and intervention costs, the average annualised costs were £5521 and £4554 respectively, reflecting telehealth savings from reduced care costs.

My view is that, given the many other uncertainties presented by this research, a ‘neutral cost position’ when comparing telehealth and non-telehealth care would be a great starting point. For this to be the case, annualised telehealth costs would need to be not higher than £967 rather than the £1,830 reported in this research.

EQUIPMENT COSTSReported annualised average telehealth equipment costs were £674 and total equipment costs were spread over 5 years – an average total cost per patient of £3,370! In some cases equipment costs were as high as £4,260 per patient. These prices are an order of magnitude higher than those achievable today (certainly compared to our own solutions).

TELEHEALTH INTERVENTION COSTSThese costs include centralised tele-monitoring staff, home installation costs, project management costs and so on. The average annualised cost for this was £1,156 per patient (£96/month). From the data provided, we estimate one member of staff per 26 telehealth patients (at worse) and one per 42 patients (at best). We would expect this ratio to be a multiple higher. Total installation costs per patient were as high as £480! Staff and installation costs appear to account for about 68 per cent of total telehealth intervention costs.

CONCLUSIONThe research is interesting but the headline figure is not relevant for decision-making in 2013 given all the factors above. Within the research, however, sensitivity analysis was carried out, reducing telehealth equipment costs by 80 per cent and intervention costs by c. 43 per cent to reflect changes in technology prices and monitoring effectiveness, resulting in a drop in total annualised cost for telehealth

patients from £6,344 to £5,370 – slightly less than the non-telehealth group – and so comfortably inside the “neutral cost” position. On this basis the cost per QALY gained falls from £92,000 to just £12,000. My view is that the real life benefit would be much greater.

At Vision360 (UK) Ltd , we are interested in engaging with CCGs, Trusts, CSUs and other parties who would like to deploy low-risk, integrated, cost-effective and measurable telehealth solutions. L

FURTHER INFORMATIONRead more about our V360 Telehealth Toolkit on page 59 and see http://www.vis360.co.uk

The WSD was a randomised control trial with restrictions, with only 30 per cent of participants included in the cost-effectiveness research

TELEHEALTH

WHY WSD FIGURES FOR THE COST EFFECTIVENESS OF TELEHEALTH ARE MISLEADINGEddie Abrams of Vision360(UK) Ltd presents an alternative perspective on this important, recently published research




Medvivo

Telehealth is an increasingly commissioned service due to the recognition of the benefits in managing long term conditions with remote monitoring. The purpose of telehealth services is to improve clinical outcomes for patients and increasing productivity in health services, which will result in significant long-term cost savings. Telehealth has been specifically mentioned in the NHS Mandate published in November 2012 and is acknowledged as a vehicle for delivering QIPP.

Medvivo (formally Telehealth Solutions) believe that telehealth is the game changer that will ensure a sustainable NHS. To help add to the pool of evidence Medvivo are working with Imperial College London on a case study that looks at the cost and efficiency benefits of telehealth as well as quality of life for the patients.

Study

Donal Markey, Clinical Director for telehealth at Medvivo and responsible for service design and delivery explains “The Case Study is assessing the effectiveness of a telehealth intervention from a quantitative and qualitative perspective and cost effectiveness from a GP Practice perspective.

The cohort characteristic is similar to the Whole Systems Demonstrator (WSD) in that we have focused on patients with Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and diabetes at various stages of disease progression. It was mutually agreed to start with COPD patients and then to progress to CHF patients and finally to diabetes patients due to the complexity of these conditions and the subsequent complexity of developing an

“It gives me security because it’s there so I know that somebody else, other people are on the outside listening in and looking after me, so it’s good. I’m quite comfortable with my illness now.” Rose COPD Patient in Portsmouth

The Portsdown Case Study:What a fully-managed service can accomplish

effective and cost effective intervention.

Rather than add to research with another randomised controlled trial we have chosen a case study research format to explore the practical aspects of how a GP Practice implements a telehealth intervention with centralised triage, how best to implement this intervention into established care pathways, the impact of the intervention on clinicians within the GP Practice and the impact on the patients that access the service.

The WSD set out to measure the effectiveness of telehealth and also the cost of delivery but it did not attempt to establish the cost effectiveness of telehealth as an intervention therefore we have specifically looked at measuring the cost effectiveness of telehealth from a GP Practice perspective as part of our study.”

This research is being conducted by Imperial College London, led by Professor Nick Bosanquet with initial top line findings released in 2013.

Professor Nick Bosanquet

Introduction to Portsdown Group Practice

The Portsdown Group Practice operates across 4 surgeries and covers Portsmouth and the surrounding areas. Of the 30,000 patients, 14.5% of the practice population is aged over 65.

Dr Julian Neal, Senior Partner at the

Fully-managed telehealth service model

There is a wealth of experience in the UK and elsewhere concerning telehealth deployment and the elements listed below have been identified as those that are often the hardest for existing services to offer:

Portsdown Practice explains, “Long-term conditions are becoming an increasing problem in general practice, and these patients will inevitably need extra attention after the initial diagnosis and during more challenging periods of their diseases. This means that a significant proportion of our patients will benefit from telehealth at one time or another. Having patients record their vital signs and answer pertinent questions about their health gives us a greater insight into their disease and enables us to optimize their treatment and Medvivo Specialist Nurses to support them during difficult times, empowering them to take greater control over their condition”.

Visit – www.medvivo.com Call – 0800 8600 768 Email – [email protected] Tweet - @medvivonews

Medvivo

Telehealth is an increasingly commissioned service due to the recognition of the benefits in managing long term conditions with remote monitoring. The purpose of telehealth services is to improve clinical outcomes for patients and increasing productivity in health services, which will result in significant long-term cost savings. Telehealth has been specifically mentioned in the NHS Mandate published in November 2012 and is acknowledged as a vehicle for delivering QIPP.

Medvivo (formally Telehealth Solutions) believe that telehealth is the game changer that will ensure a sustainable NHS. To help add to the pool of evidence Medvivo are working with Imperial College London on a case study that looks at the cost and efficiency benefits of telehealth as well as quality of life for the patients.

Study

Donal Markey, Clinical Director for telehealth at Medvivo and responsible for service design and delivery explains “The Case Study is assessing the effectiveness of a telehealth intervention from a quantitative and qualitative perspective and cost effectiveness from a GP Practice perspective.

The cohort characteristic is similar to the Whole Systems Demonstrator (WSD) in that we have focused on patients with Chronic Obstructive Pulmonary Disease (COPD), Chronic Heart Failure (CHF) and diabetes at various stages of disease progression. It was mutually agreed to start with COPD patients and then to progress to CHF patients and finally to diabetes patients due to the complexity of these conditions and the subsequent complexity of developing an


The Portsdown Case Study:What a fully-managed service can accomplish

effective and cost effective intervention.

Rather than add to research with another randomised controlled trial we have chosen a case study research format to explore the practical aspects of how a GP Practice implements a telehealth intervention with centralised triage, how best to implement this intervention into established care pathways, the impact of the intervention on clinicians within the GP Practice and the impact on the patients that access the service.

The WSD set out to measure the effectiveness of telehealth and also the cost of delivery but it did not attempt to establish the cost effectiveness of telehealth as an intervention therefore we have specifically looked at measuring the cost effectiveness of telehealth from a GP Practice perspective as part of our study.”

This research is being conducted by Imperial College London, led by Professor Nick Bosanquet with initial top line findings released in 2013.


Introduction to Portsdown Group Practice

The Portsdown Group Practice operates across 4 surgeries and covers Portsmouth and the surrounding areas. Of the 30,000 patients, 14.5% of the practice population is aged over 65.

Dr Julian Neal, Senior Partner at the










• Composition of clinical protocols reflecting the input and approval of senior specialists• Support in patient recruitment• Scheduling & performing installations• Training the patient in how to use the equipment• Nurse-led Clinical triaging• De-installation and cleaning of equipment to pass onto the next patient• Support of data analysis – both quantitative and qualitative

These can be offered by a specialist organisation that manages all aspects of the implementation of telehealth services. This is the most cost-effective and efficient method as staff are utilised for specific tasks. Robust project management should be in place to support the initiation and expansion of telehealth services, supporting the NHS teams to deliver the service they want for their patients. On-going performance analysis should also feature from the start of any service to recognise the benefits of the service, which can be particularly difficult to measure (in terms of admissions avoidance and projected savings).

In particular, clinical triaging should feature as a component of a commissioned service as it is key to the scalability of telehealth envisaged by the Department of Health in the 3millionlives campaign, which aims to make telehealth and telecare available to 3 million people over the next 4 years to 2017.The aim of this service is to reduce hospital admissions for patients with conditions such as COPD and CHF thus reducing the acute care costs for these patient cohorts.

“Working in partnership with Medvivo has given us the opportunity to support our patients whilst enabling our clinicians to focus on the most complex cases. The fully managed service is the only viable option to ensure high standards of care are met and maintained during this time of efficiencies, and actually represents improved care pathways for Long Term Conditions through self-management. It is clear that telehealth is good for patients; clinical outcomes are improved, lives are saved and admissions are prevented. Patient engagement with their long term conditions also increases. My own experience of telehealth suggests that significant cost savings can only be generated if a central nurse-led triage service is at the heart of any telehealth service” says Dr Julian Neal.

“I love it. It makes me feel as though I’m more superior to the disease. I’ve got it, but you are not going to kill me I’m going to beat you and I’m going to push you down. That’s the only way I can describe it”

Patricia COPD Patient in Portsmouth

Benefits

““In November alone Medvivo’s Fully Man-aged Service produced savings of £31,141 and 89 bed days were saved from 19 hospital avoidances. Since the research began in June (until the end of November) 696 bed days and £249,128 have been saved. (Fig 1).

These are impressive figures and only represent a cohort of COPD patients. We are currently recruiting CHF patients and will then progress to diabetes patients. We believe that the results will continue to show that the Fully Managed Service can keep patients healthier for longer, reduce unplanned hospital admissions and save the NHS money.” Explains Clinical Director for telehealth Donal Markey.

Dr Julian Neal agrees adding, “Telehealth is about doing things differently. At the moment the NHS is facing a deluge of work, most of which is actually to do with ageing population with long term conditions. You simply cannot allow the triaging of every individual patient who has a telehealth system in their home to be done by people who are currently working in the community, all that does is it adds to their current workload rather than detract from it. So central triaging is the way that you get the financial and the efficiency gain.

“For example we see diabetic patients 3 times a year on average, so we are getting 3 snapshots a year of how they really are. With telehealth we can measure their blood pressure, their pulse, their blood glucose levels, how they are feeling on a daily basis without involving any of the current partners or practice staff by monitoring this remotely by a specialist nurse that we trust, who can, by him or herself look after between 2 and 300 patients quite easily every day. And that is a revolutionary new way of delivering healthcare to people living with long term conditions”.

“I have had a lot of positive comments from patients who feel that the service has made a big difference for them. They no longer go to the GP as much as they used to because they keep antibiotics as a rescue pack at home and there is someone always checking on their progress and advising them. The early intervention through Telehealth helps to treat patients in their own homes and therefore avoid unplanned hospital admission and A & E attendance. For some patients by the time we call them they would have taken the right action according to what we advised them previously. So Telehealth promotes patient education which in turn helps in self-management. “ Lawrence Gora

Telehealth Specialist Nurse

What products were used?

The Fully Managed Service utilises the user friendly HomePod, which is a touchscreen tablet loaded with approved clinical protocols, that patients interact with to identify how they are feeling that day. This information is sent, securely, to Medvivo Specialist Nurses who are based in a central triage centre. These nurses monitor the results using Medvivo Clinical User Interface (CUI) which collates the patient’s data and allows them to identify trends and communicate with the patient. Additionally we offer asset management and supportive infrastructure services.


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MEDTEC UK1-2 May – Olympia, LondonMEDTEC UK exhibition and Conference 2013 brings together the medical device manufacturing community. The conference aims to understand some of the challenges surrounding R&D, design and regulation. It will be packed full of case studies, innovative start-ups and industry guru discussion. It will discuss how regulatory and healthcare reforms will effect device development in the future. The event will feature key educational content on leading innovations and new technologies; live demonstrations of next-generation technologies, as well as live networking opportunities. medtecukshow.com

PHARMACY SHOW29-30 September - NEC, BirminghamPharmacists are facing a host of challenges in these tough times, from medicine shortages to declining NHS margins, whilst on the other end of the scale, a variety of opportunities including Medicine User Reviews and the New Medicine Service, which if understood properly, can considerably benefit pharmacy businesses. As the biggest show for the pharmacy industry, created for the industry and now led by the industry, the Pharmacy Show allows delegates to get the very latest information on all of the changes taking place in the sector, as well as advice from leading experts on how they can adapt to take advantage of the opportunities. thepharmacyshow.co.uk

INFECTION PREVENTION 201330 September-2 October – Excel, LondonInfection Prevention 2013 is the UK’s largest infection prevention and control event. It brings together the healthcare community to discuss the latest thinking around infection control such as

the global threat of infection spread, antimicrobial prescribing and stewardship, behaviour change, cleaning, disinfection and Sterilisation, and outbreak investigation and management. Delegates benefit from an exhibition of the latest products and services to combat infection as well as an informative conference programme with a line up of expert speakers.www.infectionpreventionconference.org.uk

HEALTHCARE EFFICIENCY THROUGH TECHNOLOGY EXPO8 October – Olympia 2, London The Healthcare Efficiency Through Technology Expo brings together healthcare leaders to discuss how to deliver better patient care and outcomes through technology. As well as being a showcase for innovation, technology and best practice, the Expo also brings together senior executives, clinicians and GPs, patient facing organisations, regulatory bodies and local authorities with senior government officials and healthcare specialists from not-for-profit organisations and private sector businesses. healthcareefficiencythroughtechnologyexpo.co.uk

EHI LIVE5-6 November – NEC, Birmingham EHI Live brings together everyone involved in healthcare IT – suppliers, healthcare IT professionals and clinicians – for lively and productive discussions and debates about how to use IT to improve the efficiency and quality of health services. Anyone who has an interest in healthcare IT and the use of information in healthcare systems and clinical practice should attend EHI Live 2013. www.ehi.co.uk

CONFERENCES, EXHIBITIONS & EVENTS

EventsBUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net


E X P E R I E N C E

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If you are looking for bright lights and a vibrant city atmosphere then the Bristol Marriott Hotel City Centre is the ideal location. The hotel is situated on the doorstep of Cabot Circus shopping centre home to over 120 stores, bars and restaurants. Whilst at this luxury modern contemporary hotel why not visit one of the many local attractions Bristol has to offer. The hotel is Easily located just off of the M32, five minutes drive from Temple Meads train station and 25 minutes from Bristol International Airport. With over 1,300 sq m of flexible meeting space the hotel holds the largest hotel conference space in the South West. The largest suite holds a maximum capacity of 600 theatre style or 450 banqueting style which makes the ideal venue for large conventions and exhibitions. The hotel has direct loading access to meeting rooms and is equipped with onsite Marriott technical support.

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Established in 1888 Sharp and Nickless is an undisputed specialist in the production of Brandy Snaps and traditional biscuits. Baked the old fashioned way, using traditional ingredients, its products are to be found in delicatessens, gift shops, tourist centres, hotels and restaurants throughout the country. The Brandy Snap range includes baskets, cones and rolls, the ideal base for delicious desserts. They are also available in catering packs. Olde English Brandy Snaps and Honey Snaps are favourite items in many hamper selections. Classic Brandy Snaps make the perfect holiday souvenir and can be supplied to retailers complete with postcards of the local attraction. For the Christmas trade, there is a festival spiced

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Glamox Luxo Lighting is a market leader in medical and commercial lighting, with a proud corporate history of over 75 years experience. The range of medical lighting products are designed to be ergonomic, efficient and resilient, and have been tried and tested in healthcare environments for many years. Specifically designed with the latest LED technology to ensure optimum performance, low CO2, energy-saving, reduced running and maintenance costs. This, combined with Glamox Luxo’s superior arm technology, makes it today’s market leader. The latest designs are engineered to retro-fit into previously installed Luxo brackets. Luminaires are designed and photometered to ensure the correct light levels, colour index and distribution for the appropriate tasks. This can range from examination and

minor surgery with the LHH and AIM ranges to dimmable CARELITE luminaires for bed-head patient reading. Simple installation on wall, ceiling brackets and trolley mounting keeps costs down. Glamox Luxo aims to provide medical teams with quality designed tools, so the highest level of care can be given to the individual needs of the patient.

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designer, manufacturer and installer of food service and kitchen production areas using, where necessary, equipment from leading food service equipment manufacturers. Holmes Group utilises in house design skills to the benefit of its clients by converting initial conceptual ideas into practical and exciting operational facilities. Throughout the process, highly skilled and knowledgeable designers provide advice and recommendations to its client’s team, working closely with them to achieve their objectives. With a highly skilled R&D team, Holmes Group has a number of products which are unique to the industry, including

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One of my main concerns is that care homes may not have the necessary type of cover in place to ensure that in the event of any unforeseen circumstance that their care business is adequately protected. If you manage a care business, you need to be sure that the reputation and financial success of your business, which you have worked hard for, are insured. This has prompted me to write the easy to understand guide below to help you understand what each insurance covers and why you might need them.

KEY INSURANCESSo what are the key insurances and what they are designed to cover? Here are the typical types of insurance you would expect to be offered alongside an easy to understand statement describing the cover.

When you see ‘property’, this generally means building and contents insurance, similar to the type you would purchase on your own property. ‘Legal liabilities’ would typically include employers’ and public liability insurance, potentially including care and treatment. ‘Employers’ liability’ is protection for you as an employer in the eventuality of a claim against you from a member of staff for issues such as negligence in the event of an accident. The same would be the case for public liability but obviously for visiting members of public. ‘Business interruption’ covers you in the event that your business can no longer function, ensuring that your business does not miss out financially and in turn help to avoid closure of your care home. Engineering insurance – the main purpose

of this part of the policy is to carry out the statutory inspections of the homes twice yearly. The insurance element is for all risks including breakdown (as long as not down to wear & tear) as part of these inspections. ‘Legal expenses’, as you would expect, covers legal costs incurred when defending actions against your business such as employment disputes.

OPTIONAL COVER Alongside the above typical insurances you may also be offered optional cover options such as private and commercial motor – this would provide cover for any motor vehicles associated with the care business including minibuses. Optional cover could also include employee dishonesty which can be costly for any business and this cover provides insurance for loss of money/stock as a result of theft or dishonesty by an employee. The option of directors & officer cover protects the directors & officers of the company in relation to allegations of wrongful acts in their capacity. What’s more, charity & charity trustees cover protects the charity & its directors & officers against alleged wrongful acts committed by the charity and directors & officers. I hope that the information I have provided above has helped you with the maze of jargon and information that exists in the world of insurance but if it hasn’t then please do not hesitate to contact me. L

FURTHER INFORMATIONTel: 0845 485 3222Fax: 020 7621 1511www.aon.com

Employers’ liability is protection for you as an employer in the eventuality of a claim against you from a member of staff for issues such as negligence in the event of an accident

INSURANCE

PROTECTING YOUR CARE BUSINESSChris Mallett, client manager at Aon UK writes an easy to understand guide on care home insurance to help you understand what each insurance covers and why you might need it

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The health service holds some of the most sensitive personal information on record, so it’s vital that that both patient and staff information is kept secure. But, in recent years, the loss of data has become an all too common scenario. According to figures compiled from reports of Data Protection Act breaches filed by the Information Commissioner’s Office (ICO) over the 12 months from July 2011 in England, Wales and Northern Ireland, the NHS lost track of 1.8 million patient records, with sensitive information found in public places and made readily available on the internet.

With this in mind, the ICO has warned that more data breach fines will be issued to NHS bodies if they continue to fail in meeting their legal obligations. It is critically important that health organisations ensure they do everything in their power to ensure similar situations don’t happen again. It is vital to learn from and move forward from the events of the past and one way to improve data security is to introduce more secure printing practices. Working with the right tools and an expert print vendor such as OKI, a global business-to-business brand, dedicated to creating, secure, affordable, professional in-house printing solutions can dramatically improve processes.

SECURITY MATTERS Before the data reaches print, it will have gone through a range of security firewalls and barriers. However, the question is how safe is the data once it reaches the printer? It is critical that the security of this data is not overlooked at the last stage, as every day, employee’s print, fax, copy, scan and electronically send sensitive information, so printing has to be closely monitored and protected.

All NHS organisations have to adhere to a safe haven policy to ensure the privacy and confidentiality of information. In order to meet this requirement, NHS organisations have to comply with a detailed code of practice. Already, many have designated safe haven fax machines; devices that are located in a secure area and are used to receive documents of a private and confidential nature.

And while there is no requirement for safe haven printers, Trusts that have printers with ‘secure print’ functions that are used by multiple teams, must use this feature to print confidential documents. Where this is not possible, users should instantly collect their documents from the printer so that they are not left lying around and any uncollected documents must be reported.

TIP-TOP TECHNOLOGY Working with OKI there is no need to take the unnecessary risk that sensitive documents will be left on the printer. OKI prides itself on its product development and today, many of its devices have built-in encryption and secure printing capabilities.

OKI offers Secure Print, which enables the user to store documents prior to printing on the printer’s Hard Disk Drive (HDD) or Secure Data (SD) card. It only becomes possible to access this content once a four digit, user-defined pin or secure password is entered on the printer’s front panel. Only with the right credentials will the document then be printed. Once printed the document is automatically deleted from the system.

Many multifunction printers feature scan to email which convert the scanned image to a PDF and send to email recipients. This is a convenient way to send hard copy documents directly to a person’s email inbox. However, documents can still fall in the wrong hands so the OKI MB491 and MC562 multifunction printers also feature encrypted scan to PDF. Encrypted PDF files are more secure than standard PDF files requiring the recipient to have a password in order to open the file. Passwords can be either globally set or designated for one user when the email is sent. OKI Network IP Security (IP Address

Filtering) Support also enables access to a printer (for changing configurations and for printing) to be limited to a specific PC or range of PCs as such, it becomes possible to control who has access to each device. This reduces the chance of unauthorised users either printing any unnecessary documents or changing a printer’s settings.

All OKI solutions also support the disablement of unused protocols and network ports, which prevents unauthorised access to printer and print servers and in turn, reduces the likelihood of external hacking attacks.

PICK THE RIGHT PARTNER In order to ensure print is managed as securely as possible, it can be a wise move to work with a print vendor that has established experience. With detailed knowledge and involvement

across the complex health services print landscape, OKI can help guide any health organisation through its print environment in order to improve security and drive efficiency.

OKI has a dedicated team of 25,000 specialists across 120 countries. Drawing on its expert resource, OKI can tailor a solution to meet the needs of a specific customer.

TIME TO TAKE ACTION Given the spate of recent data breeches, it is vital that health organisations learn from the past. Health organisations also need to act fast to avoid the increasing ICO data breach fines and restore confidence in the public sector’s ability to secure sensitive information. It is simply not good enough for confidential information to be lost in public places or made readily available on the internet. The time has come to improve all aspects of data security, print included.

With the right data breech policies in place, alongside the right print vendor and devices it is easy to improve print security and minimise the risk of a data breech. Today is the day to take action and improve print security, because tomorrow it might be your Trust splashed all over the front page of the nationals. L

FURTHER INFORMATIONwww.oki.co.uk

Don’t take the unecessary risk that sensitive documents will be left on the printer – OKI’s Secure Print stores documents prior to printing

DATA MANAGEMENT

TAKE CONTROL OF PRINT AND SECURE SENSITIVE DATAGraham Lowes, marketing director, Oki Systems UK, discusses why it is important for health organisations to protect sensitive data at the point of print and how this can be achieved




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The importance of good clinical and operational governance for NHS Trusts has never been more crucial, with Foundation Trusts such as Mid Staffs and Morecambe Bay being under scrutiny due to catastrophic failings.The Public Inquiry into Mid Staffordshire NHS FT examined the commissioning, supervisory and regulatory bodies, and the final report sets out 290 recommendations for changing the culture across the NHS. The final investigation report, published by the Care Quality Commission, into the University Hospitals of Morecambe Bay found that the Trust needed firm leadership and robust governance systems, and highlighted the importance for clinicians and managers to work together.There have also been recent reports regarding the NHS in Lincolnshire, where a former hospital Trust boss claimed he was breaching a “gagging order” to reveal how he was told to prioritise meeting targets over patient safety.

In response to failings such as these, Tim Kelsey, Director for Patients and Information at the NHS Commissioning Board, and Health Secretary Jeremy Hunt, both acknowledge the need to modernise healthcare and to improve transparency across the NHS; and they recognise that

technology is the solution to deliver this.At both Mid Staffs and Morecambe Bay, the Trusts were found to have major issues with management. They did not have systems in place to effectively manage and oversee the operation of the hospitals within the Trust. With the use of specifically developed software for managing operational governance, Trust Boards can be efficient, transparent and productive.

The use of risk management software at board and managerial level ensures

that risks are reported consistently and efficiently, creating living risk registers and making sure all risks are mitigated. All authorised parties can contribute to the identification of risk, ensuring patient care remains the top priority. Once a risk has been reported, there is a full audit trail to aid transparency and provides assurance that any significant risks are resolved.

The introduction of technology can also ensure that important decisions are not left until the next board meeting and historic precedents are available for effective

and consistent decision making. Implementing good governance practices leads to better patient care and enables the Trust Board to demonstrate accountability to local people that their health service is being safely run. Technology is the key to improving governance cost effectively.

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Milliken’s thriving financial and operational performance is a direct result of its heightened emphasis on safety and performance. In fact, Milliken is one of the last major American textile manufacturers to survive the off shoring of the industry. After a two-decade long journey that culminated in winning both the Malcolm Baldrige Award and the Japanese TPM (Total Productive Maintenance) Excellence Award, Milliken now applies its best practices in client organizations using its robust consulting group. Performance Solutions by Milliken™ helps companies compress their learning curve to drive rapid results in the area of safety and operational performance.

CULTURE OF WORKPLACE SAFETYThe Milliken Safety Way™ process is a systematic 20-step approach designed to engage your complete organization in owning the safety process. Performance Solutions by Milliken clients break through their safety performance plateaus and achieve Total Illness and Incident Rates (TIIR) closer to the goal of zero with Milliken’s Safety Way™ system. Performance Solutions by Milliken practitioners guide their clients toward improved manufacturing safety practices while creating a culture of workplace safety that is effective, scalable and sustainable. The Milliken Safety Way™ system helps reduce costs associated with accidents, boosting productivity and morale while improving all-round performance.

Milliken Performance Solutions’ Practitioners are seasoned Milliken operational leaders averaging over two decades of hands on experience of building and supporting the safety process in their own locations. Many of their plants have gone many years without a lost accident. They support clients in their journey to build a stronger safety process, tailoring the

approach to suit the local needs and culture, with a strong emphasis on leadership coaching, first line supervisor mentoring alongside a significant focus on developing employee confidence in ownership for the safety process.

One such client using who has engaged with Performance Solutions by Milliken is ConAgra Foods. VP of ConAgra Performance System, David Alvarado states, “ConAgra Foods is committed to continuous improvement, especially in areas like employee safety and overall equipment effectiveness. Our partnership with Milliken has strengthened our performance in these areas and reinforced the power of our overall performance system.”Another firm concerned with its employees’ safety was Tilcon Connecticut, Inc. “Our Milliken Safety journey has been invaluable in terms of helping us establish an employee based safety program that is designed by our employees for our employees,” says

Ciaran Brennan, Tilcon Connecticut’s former President and CEO. “The vast majority of people who work for us possess far more talent, capability, creativity and intelligence than their present jobs require or even allow them to use on a daily basis.” He adds that through his company’s safety engagement with Performance Solutions by Milliken, Tilcon Connecticut was able to “create the right set of conditions for these behaviours to emerge.”

Performance Solutions by Milliken clients typically report a 65% reduction in injuries after the first year of engagement. Also, clients also experience a 60-85% increase in involvement of their employees in the safety journey. Needless to say, this precipitates an increase in motivation and morale among client employees. In terms of consequence costs, a reduction of 30% is typical in the first year. Performance Solutions by Milliken’s Safety Way™ system typically uncovers safety opportunities two to four times greater than a client’s leadership team will quantify across the company.

Chris Poole, European Business Development Manager for Performance Solutions reflects on the progress that Milliken clients have seen: “The biggest challenge we see in the organisations that ask for help, is a disconnection between those employees who are exposed to the hazards in the workplace and those who own the decision making process for managing those hazards. Very

often, leaders do not understand the details needed to make the right decisions, and the employees on the floor feel that safety is ‘done to them’, rather than something they feel they own, can improve and sustain.

RESOURCES, SAFETY AND PROBLEM-SOLVING EDUCATION“We design the process with the floor employees at its heart and work with leaders to provide resources, safety and problem-solving education, and most importantly time to engage in safety every day. We call this time, ‘sacred time’, and it is the single most important aspect for leaders to commit to so that they can realize the full potential of their employees. A business that effectively supports their people in these ways always sees significant reduction in risks, hazards, incidents and true ownership for safety.” L

FURTHER INFORMATIONChris Poole, European Business Development [email protected]: 07834 608255

A business that engages every employee in ownership for safety problem-solving, always sees significant reduction in risks, hazards, incidents and true ownership for safety

HEALTH AND SAFETY

OWN THE SAFETY PROCESSWorld-class companies adopt a safety-first approach to operational performance that places a healthy work force at the top of all corporate objectives. Milliken & Company is one such firm. This 145+ year-old multinational chemical and performance materials company has been on a continuous improvement journey with a particular focus on complete employee ownership for safety




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Recognition by the MSc Health Informatics at Swansea University“The College of Medicine in Swansea University welcomes non-graduates

to apply for its Masters in Health Informatics course. Those who have undertaken at least two years experience in any branch of health informatics and have

completed the HIC diploma level course would stand an excellent chance of being made an offer of a place. The HIC course is excellent preparation for studying

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The purposes of investment in EHR systems can be summarised as: 1 Patient care: rapid access to up-to-date records by any authorised care service provider sharing in the care of that patient

a Internal to the institution (ie within the same organisation).

b External to the institution (ie between care organisations and all levels of care – community, primary, secondary, tertiary)

2 Institutional Management: organising data for better summarising and reporting, as well as for business and financial management.3 Audit: quick retrieval of ‘outliers’ and abnormals; ready reporting of activity summaries (eg outcomes by treatment choice; check-ups by diagnostic category).4 Research and Evidence: export of data to warehouses for generating evidence as to best quality practices, cost-effective therapies, service planning and development5 Risk reduction: Incorporation of evidence-based care guidelines as well as clinical decision support and artificially intelligent (knowledge-based) systems to monitor, guide and critique decisions, and minimise adverse events.

Whilst 1a, 2 and 3 are readily achievable without very much effort or forethought (eg purchased off-the-shelf), the remainder require considerable preparation and must be addressed by formulation of regional (national) standards for data as well as for communications. A recent report from North America, where there has been a large push into investment in EHR systems has revealed that this has not achieved the results that

had been anticipated in large part because of the problems in exchanging data between one system and another. This should come as no big surprise since proprietary electronic records systems are not designed with ease of interaction with competitor systems in mind, nor can they readily be modified for

this: this functionality has to be included in the original design specification.

EVIDENCE-BASED GUIDELINESEssentially the same issue will shortly be recognised in relation to incorporation of evidence-based guidelines and systems (5, above), when the incompatibility of the data collection and storage systems of different proprietary EHRs will again prevent ready deployment of such advanced care systems. We need to specify standards.

STANDARDSStandards – for what? The solution to these issues lies in the specification of standards, but the issue is which standards? There are three sets of vital standards that need to be agreed upon at a regional/national level:

Standards for internal interfaces between modules – these are of importance but only as regards future-proofing the investment made in systems, proprietary or otherwise such that a new module can be plugged in to replace an outdated module in keeping with a ‘best-of-breed’ system development.

Standards for data – there need to be agreements on:

Data elements, and their meanings, classification and coding – we have to all talk the same language.

Data sets – that is the groups of data elements that are collected in the context of specific signs, symptoms and presentations. These are vital for enabling inter-institutional comparisons, assembly of evidence, and implementation of knowledge-based systems.

Data exports – that is the configuration of data contained in records for export

(incorporating privacy issues) to research and analytical facilities, as well as for data migration to new systems when these replace older systems.

Care-related communications – where again there are two issues: ‘pushed’ communications, such as where a clinician

sends a test request to a laboratory and receives the result from them (broadly covered by HL7); ‘pulled’ communications, such as where a clinician seeks to retrieve data about a patient (after authorisation) from another location/institution where it is stored.

JOINED-UP HEALTHCARE SYSTEMEach of these issues is of vital importance for a ‘joined-up’ healthcare system to emerge – and we are a considerable way from that at the present time. Of course there will be a continuing process of evolution in systems and care, and this will necessitate that various lists and tables can readily be updated – for example classification systems; data sets; communications messaging etc. In addition there will need to be facilities to guide (using a protocol) data collections and sets based on the evidence and driven by a knowledge base, which will also be regularly updated.

This brief article raises a number of important issues: those dealing with acquisition of healthcare information systems need to be familiar with these. They include: electronic information systems, best-of-breed versus single vendor systems, communications, data exchanges, structured messages and push vs pull, classification and coding of data, preferred terminologies, data elements, sets and file structures, data import and export, privacy, risk and audit, research and data warehousing, medical expert and knowledge-based systems, data gathering and best practice protocols, and standards in bioinformatics. L

FURTHER INFORMATION+44 (0)20 8133 2376 www.health-informatics.co For a more detailed version of this article visit www.hidotco.org

Incorporation of evidence-based guidelines and systems, where the incompatibility of the data collection and storage systems of different proprietary EHRs will again prevent ready deployment of such advanced care systems

ELECTRONIC HEALTH RECORDS

MAKING INVESTMENTS IN EHR WORKThe purposes of investment in Electronic Health Records systems are several, and each has to be fulfilled through the investment




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As an exhibitor at the Healthcare Innovation Expo 2013 in March (Europe’s largest in healthcare innovation), Idox Information Solutions participated in the conversation surrounding the current changes, potential challenges and the future direction of the health sector. Engaging with students, staff and organisations from across the UK health landscape over the course of the event, the company undertook a healthcare survey exercise in order to obtain insight into the present issues being faced by the sector in the areas of funding, skills and training. The findings of the healthcare survey highlighted attitudes towards funding, skills and training in healthcare workplaces: A total of 41 per cent of the respondents rated ‘lack of funding for projects’ as the most critical threat facing their organisation at the current time. Over half of all survey respondents (51 per cent) recognised ‘soft skills’, such as communication and teamworking, as the biggest skills gap within their organisation. A total of 35 per cent also noted that ‘management skills’ represented a major organisational skills gap. Over one-quarter of survey respondents had not received any legal or ethical

compliance training from their employer. Of the respondents that noted that they had undertaken training courses, there was an even 50/50 split between face-to-face training and training provided by e-learning software. A total of 25 per cent of the respondents that had undertaken training recently, had not been provided with a certificate or record of attendance following such courses. Some 34 per cent of respondents rated their organisation’s track record in securing grant funding as ‘requiring improvement’, with a further one-quarter unable to comment as

they didn’t know enough information about their organisation’s funding strategy. Over half of all survey respondents indicated that they thought that ‘finding eligible funds quicker’ would improve their chances of securing funding. 45 per cent of respondents also noted that relevant training in areas such as putting together funding applications would help. Idox Information Solutions also used the Healthcare Innovation Expo as a platform from which to launch its latest funding website, GRANTfinder 4 Health. This is Europe’s only funding information service dedicated to the specific needs of healthcare organisations. Backed by 30 years of funding experience,

GRANTfinder 4 Health offers access to over 5,000 health-related funding programmes: from modest local health initiatives to major, multi-national European programmes.Alongside a number of intuitive new features, the site also invites submissions for its expert blog section, which outlines the latest trends affecting the health sector. FURTHER INFORMATIONTel: 0844 874 [email protected]/health

Healthcare survey obtains much-needed insight into the present issues faced in funding, skills and training

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

Access Security 28Advanced Health & Care 50Aidcall 57Alphabet Car Lease 46, 47AON 67Ardex UK 36Asckey Data Services 68Ascom UK 54B.I.G Floorcoverings N.V. 38Biocote 20Bodystat 15Bolle-Safety 68CCT Venues 62Commercial Garage Equipment 12Concateno 32CP Training Services 68Debenhams IBCDixon Flooring Contractors 38DSDM Consortium 58Dussmann Service UK 22Dustbox Cleaning Services 22enCircle Solutions 52Ergolet 32eShare UK 70ESP 28Eurosite Power 53Evac Chair International 24FIC UK 66

Fire Risk Assessments 30First Data Bank Europe 56First Legal Support 44Flowcrete UK 34Freeward Thinking 15Glamox Luxo Lighting 65Grace Care Personnel 22H Kemp & Son 62Hamilton Rentals 6Health Information Consulting 72, 73Holmes Group 65Idox Information Solutions 74Infranor 4Ingersoll Rand Security 26IP User Group 53IT Kiosks 52Julian Ellis Chartered 62Kirktec Systems 44Kohler Mira 36Language Line 63LEE’s Flooring 38Light Rabbit 38Magic Internet Technologies 44Marriott Bristol City Centre 65Medical Gas Services 44Miele Professional 18Milliken Industries 71Mitsubishi Electric 48

Multitone IFCNBC Bird and Pest Solutions 34Nedap Security Management 16, 17Nicholls and Clarke 34OFTEC 40OKI Systems UK Limited 69Optimus Education 22Pall Europe 25Pass Training Consultancy 29Quantum Profile Systems 36Rhodia UK 36S.R Fire (Inverness) 30SETS 66Sharp and Nickless 65Shawbrook Bank 64Sidhil 64Signs Express 42Sound Leisure 8Speedliner Europe 23Swallow Evacuation & Mobility 10Swish Building Products 35Tastecard BCTelehealth Solutions 55, 57UBM Information 14Vision360 (UK) 57, 59Wavestore 28Wendy Fisher Consulting 66Wilo UK 40



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Health Business 13.2