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In another side to commerciality, a whistleblower has submitted evidence to the Office of Fair Trading about suspected price fixing in private patient services run by some eight NHS trusts, which have avoided a formal investigation. Deborah Jones, director in the OFT’s services, infrastructure and public markets group, said: “We welcome the assurances given by these Trusts which have enabled us to bring our preliminary investigation to a close”. Ensuring that staff are protected and safe is paramount in gaining their trust. Lone workers with close contact to members of the public, where they may be threatened by abuse or attack, are particularly vulnerable. Methods to combat this can be digested on P27. Matthew Swindells of the BCS Health Group reminds us of the words of Malcolm Grant, chair of the NHS Commission Board, who said: “The best clinical commissioning groups will be

those with the best information systems.” As Matthew points out, the challenge will be for IT to enable the whole system, not just the ‘silos’. More on Page 67. Finally, it emerges that NHS Direct is leading the race to provide NHS 111 services. It is the preferred provider in nine areas, covering some 30 per cent of the population. Most of the remaining contracts are to be awarded by mid-September, but the British Medical Association has warned about a hasty rollout of the service, which it said risked patients being sent to the wrong place, waiting longer, blocking A&E and using ambulances needlessly. Read more on Page 73.

In the next issue, we plan to cover recruitment, fire safety and barcoding.

Until then......

Danny Wright

ENERGYOpportunities

for improvement

need assessing

says ESTA

VOLUME 12.6www.healthbusinessuk.net

DESIGN & BUILD | LEGIONELLA TESTING | HB NEWS | PLUS MORE INSIDE

STAFF PROTECTION HEALTH & SAFETY CALL CENTRES

HEALTHCARE IT

Population Health Management

© 2012 Public Sector Information Limited. No part of this publication can be reproduced, stored in a retrieval system or transmitted in any form or by any other means (electronic, mechanical, photocopying, recording or otherwise) without the prior written permission of the publisher. Whilst every care has been taken to ensure the accuracy of the editorial content the publisher cannot be held responsible for errors or omissions. The views expressed are not necessarily those of the publisher. ISSN 1362 - 2541

If you would like to receive all issues of Health Business magazine for £95 a year, please contact Public Sector Information Limited, 226 High Road, Loughton, Essex IG10 1ET. Tel: 020 8532 0055, Fax: 020 8532 0066, or visit the Health Business website at:

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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 Karl O’Sullivan PRODUCTION CONTROL Jacqueline Lawford WEBSITE PRODUCTION Reiss Malone ADVERTISEMENT SALES Kylie Glover, Jeremy Cox, Lorena Ward, Grace Banks, AJ Baker, Josephine Martha ADMINISTRATION Victoria Leftwich, Lucy Carter PUBLISHER Karen Hopps GROUP PUBLISHER Barry Doyle REPRODUCTION & PRINT Argent Media

Under new UK Trade and Investment plans, hospitals will be encouraged to set up profit-making branches abroad to raise funds for patients at home, and to heighten the international profile of the health service. The NHS Confederation has backed the move. Tim Smart, chief executive of King’s College Hospital, said that it could provide valuable income at a time when central budgets are being constrained. However, the Patients’ Association said the plans could be a ‘distraction’ at a time of upheaval in the health service at home. More on page 7.

BUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net

03 Volume 12.6 | HEALTH BUSINESS MAGAZINE

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Contents

07 HB NEWSNHS expansion abroad; Price fixing concerns; Increased statisfaction with cancer services

13 FINANCE NEWSThe heads of the NHS Confederation respond to Monitor’s report into the finances of Foundation Trusts

17 STAFF TRAINING / HEALTH & SAFETYRoger Bibbings, occupational safety adviser at RoSPA, examines right the right policies and procedures to make Health & Safety work in hospitals, plus David Halicki of the IOSH Healthcare Group explains why hospitals are unique sites and looks at the issues they face in safeguarding patients, visitors and employees

27 STAFF PROTECTION More than six million people in the UK work either in isolation or without direct supervision. IOSH looks at steps to be taken in order to make them safe, plus Alex Carmichael, technical director, British Security Industry Association, explains how security technology is helping.

33 DESIGN & BUILDThe UK continues to set the pace for healthcare architecture, with several projects singled out for praise at the 2012 Design & Health International Academy Awards, held in Kuala Lumpar in June

37 ENERGYWith huge efficiency savings expected from the health sector over the coming years, all opportunities for improvement need to be systematically assessed, says Alan Aldridge, executive director of the Energy Services and Technology Association (ESTA). Plus a look at the Energy Event exhibition and conference, which features keynotes from Professor Brian Cox and former government spin doctor Alastair Campbell

43 LEGIONELLA TESTING John Murthy, UKAS, explains how procurers in healthcare can help discharge their legal obligations through accreditation.

47 INFECTION CONTROLThe UK’s largest infection prevention and control event takes place at the ACC, Liverpool On 1-3 October and promises to offer more infection control information under one roof than ever before

53 PARKING A current diagnosis of the parking sector from Dave Smith of the British Parking Association, which has recently published a new five year strategy outlining its desire to raise standards

59 CATERING The future emphasis on nutrition and hydration for effective patient wellbeing and clinical care was highlighted at The Hospital Caterers Association 2012 Conference

63 HEALTHCARE ITMatthew Swindells, chair, BCS Health, recently discussed using IT to improve population health management plus Neil Darvill, director of health informatics at St. Helens and Knowsley Teaching Hospitals NHS Trust explains the benefits of a wholesale digitisation of patient records.

73 CALL CENTRESNHS 111 - with more to be awarded in mid-September, NHS Direct has won contracts to cover thirty per cent of the population, but concerns about hasty rollout remain

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ING Car Lease have joined forces with Alphabet and are now known as Alphabet. The good news is, the combined strength of Alphabet and ING Car Lease means you benefit from even more experience, knowledge and know-how. With over 20 years experience in providing fleet solutions to the Public Sector, we understand the diverse challenges that running a vehicle fleet in the Public Sector can present. Our specialist Public Sector team are dedicated to ensuring the running of your fleet is as efficient and effortless for you as possible. Our commitment to innovation, and focus on what your business needs, both today and in the future, means a range of exciting ground-breaking products are on the horizon. To find out about our latest product, AlphaCity, visit www.alphabet.co.uk/alphacity

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NHS SERVICESNEWS IN BRIEF

Health worker flu vaccine uptake increasesHealthcare worker uptake of flu vaccine has increased from 35 per cent to 45 per cent in 2011/12. The figures released this week by NHS Employers and the Social Partnership Forum follow an external evaluation of last year’s Flu Fighter Campaign. Flu leads and other NHS Staff were interviewed to establish which elements of the campaign had worked best. The results have been fed into this year’s campaign with a strong focus on the importance of training vaccinators and the development of new campaign materials.

NICE guidance recommends fast assessment for spasticityChildren who are diagnosed with spasticity must be referred for specialist assessment without delay, says the latest guidance from NICE. It says standardised care could improve the lives of thousands of children. According to NICE, there is currently “considerable variation in practice in managing spasticity, including in the availability of treatments and the intensity of their use. “

NHS Expansion abroad to be financed by private patient profitsOfficials from the Department of Health and UK Trade and Industry will launch a joint scheme this autumn which will aim to build links between hospitals wishing to expand abroad. Under the programme, hospitals including Great Ormond Street, the Royal Marsden and Guy’s and St Thomas’ could create new branches. According to reports in the Independent, up-front investment could only be drawn from income received from private patients and any profits made abroad would be channelled back to the UK. The proposal was reportedly inspired by hospitals in America, including Baltimore’s John Hopkins, opening similar branches abroad. Health Minister Anne Milton said: “This is good news for NHS patients who will get better services at their local hospital as a result of the work the NHS is doing abroad and the extra investment that will generate.” NHS Confederation chief executive David Stout insists it was “absolutely right” to generate income and dismissed concerns about a shift away from local services. He said: “If this initiative diverted attention significantly away from running local health services into work internationally, I agree that would be a problem. But I really don’t think that’s what’s going to happen. “This is a real opportunity - the NHS has

always been very well regarded internationally. We’ve often had international companies, organisations and countries come in to talk about the NHS, about how we could help, but we have never been very systematic about how we respond to those opportunities.” However, the move has been criticised in some quarters for moving the NHS away from its traditional ethos. Patients Association chief executive Katherine Murphy told the Independent: “The guiding principle of the NHS must be to ensure that outcomes and care for patients comes before profits. “At a time of huge upheaval in the health service, when waiting times are rising and trusts are being asked to make £20bn of efficiency savings, this is another concerning distraction. The priority of the Government, hospital trusts and clinicians should be NHS patients.” Jamie Reed MP, Labour’s Shadow Health Minister, added: “At a time when staff are losing their jobs and waiting times are rising, the Government’s priority should be sorting out the mess it has created in our NHS. Under David Cameron we’re seeing a rampant commercialisation of the NHS. He needs to get a grip and start focusing on patients, not profits.”

Electronic tracking system wins RPS awardEast Lancashire Hospital’s lead pharmacist has won a national prize for ensuring fewer errors are made about patients’ medicines when they move between home, hospitals and care homes. Alistair Gray has worked at the Royal Blackburn Hospital for 10 years. He won the Royal Pharmaceutical Society’s Medicines Safety Award 2012 after developing an electronic tracking system for the East Lancashire Hospitals NHS Trust. Alistair, from Chorley, said: “I am delighted to win the RPS award and it has been great to see more joined-up working about patients’ medicines in hospitals within the trust. “Nobody should experience ill-health, or readmission to hospital, because their medicines are not right, and our systems are now much improved.”

PHARMACY

The reorganisation of NHS primary care must not be allowed to jeopardise the developments in safeguarding patients that have been made over the past five years in controlled drugs management, insists the Care Quality Commission. The CQC’s latest report ‘The safer management of controlled drugs’ found that over the past year, good progress was made in maintaining controlled drugs local intelligence networks (CD LINs) and there have been further improvements in sharing information. However, the report’s authors warn: “CD LINs need to continue to function effectively through the changes to the structure of primary care and make adequate preparations to ensure that their existing arrangements are sufficiently robust to store intelligence securely.” The CQC also found that there was little change in CD prescription in NHS primary care over the past year, with just a one per cent increase in overall volume between 2010 and 2011 – and a three per cent decrease in cost.

The number of privately prescribed items decreased by six per cent over the same period. However, the report’s authors say they noticed an unexplained upward trend in privately prescribed dexamfetamine, and in both privately and NHS-prescribed methylphenidate. They advise that the use of controlled drugs should be carefully monitored, to ensure that they are prescribed appropriately in all sectors, and that there should be more active encouragement for the use of a standard Controlled Drug Requisition Form (FP10 CDF).

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HEALTH BUSINESS MAGAZINE | Volume 12.608

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Neal DeansNeal Deans has been appointed to the role of joint director of estates and facilities for St George’s Healthcare NHS Trust and St George’s, University of London. The joint appointment is part of a partnership programme focusing on closer working between the two organisations to achieve a shared goal of providing the highest quality education, training, research and clinical care.

Anna BradleyAnna Bradley has been appointed as chair of Healthwatch England. She is also being appointed as a member of the board of the Care Quality Commission (CQC). Bradley stated: “Healthwatch England will act as a champion for those who sometimes struggle to be heard. I am privileged to be determining the future shape of the organisation – and determined that it will make a genuine difference where it matters most. My immediate focus will be to identify strategic priorities for action, and then to ensure that these inform real change to the future of service delivery.”

Peter FranzenPeter Franzen is to become the vice chair at James Paget University Hospitals Foundation Trust. Franzen was appointed interim chairman of the hospital in November last year as the JPH went through the most turbulent time in the hospital’s history following poor reports from the Care Quality Commission. He helped steer the trust through a difficult seven months and oversaw the appointments of interim chief executive David Hill and substantive chairman David Wright.

Tracy CannellTracy Cannell has been appointed permanent chief executive of East Coast Community Healthcare, which provides community services in the Great Yarmouth and Waveney area. Paul Steward, chair, said “Tracy has made a huge contribution to the development leadership of East Coast Community Healthcare and we would not be where we are today without her knowledge and skills. She helped get the organisation through a very difficult authorisation process and has helped us positively overcome many challenges since then.”

Mid Yorkshire Hospitals Mid Yorkshire Hospitals NHS Trust has announced the appointment of three new directors to its board. The non-executive directors are Wakefield councillor Patricia Garbutt, Trevor Lake, a member of the West Yorkshire Police Authority, and Rosie Valerio, an employment consultant to the voluntary sector.

www.healthbusinessuk.net/news

The government’s plans to include hospital doctors on clinical commissioning groups (CCGs) may not work and could exclude these doctors under present rules, according to the British Medical Association (BMA). The Association has written a letter to health minister Lord Howe pointing out a basic problem with the regulations as they stand, and how it believes it may be necessary for the government to change the current stipulation that the secondary care clinicians on CCG boards must not be employed by providers from which the CCGs commission services. The government said the rules, laid in Parliament in June, were intended to avoid conflicts of interest. However, in their letter to Lord Howe, several BMA branch of practice committee leaders argue that this rule will prevent the effective local interface between primary and secondary care that was supposed to happen in CCGs. The letter says: “The regulations prevent CCGs from benefiting from local expertise and formalising valuable relationships with secondary care colleagues. They may also cause practical problems by making it difficult for the CCGs to recruit secondary care physicians to these positions. “For example, there would be little incentive for medical directors elsewhere to release doctors for this work if it would

not benefit their local area.”The BMA argued strongly for the inclusion of secondary care clinicians on CCG boards during the parliamentary passage of the Health and Social Care Bill. The letter, signed by BMA GPs committee chair Dr Laurence Buckman, BMA consultants committee joint deputy chair Dr Tom Kane, BMA staff, associate specialists and specialty doctors committee chair Dr Radhakrishna Shanbhag, and BMA public health medicine committee co-chair Dr Keith Reid, welcomes hints that the regulations could be relaxed. NHS Commissioning Board chief executive and NHS chief executive Sir David Nicholson recently told Pulse magazine that there might be a need to take stock of the regulations if not enough consultants were recruited to CCG boards. The BMA letter adds: “It is necessary for the NHS Commissioning Board to assess how CCGs are fulfilling the requirements of the regulations as they enter the authorisation process. Longer term, we feel that the board should commit to regularly review the impact of the geographical restriction on secondary care appointments in order to ensure that [it] does not limit the value of the secondary care presence on the CCG board.”

Plans to include hospital doctors on CCG boards may not work, says BMA

HEALTHCARE REFORM

bma.org.uk

Association (SRPHA), but have avoided a formal OFT investigation and gave assurances they would stop sharing pricing information. The OFT is writing to all NHS hospitals with private units to warn they must abide by competition law.Dartford and Gravesham NHS Trust has been warned about anti-competitive behaviour over the way it runs private patient units. The Trust was reported by a whistleblower.

NHS Price fixing concerns PRIVATE TREATMENTS

Patients paying for private treatment in some National Health Service (NHS) hospitals may be overcharged because they are sharing pricing information, according to The Daily Telegraph. The newspaper has reported that a whistleblower has disclosed evidence to the Office of Fair Trading (OFT) that eight NHS hospital trusts had been exchanging ‘commercially sensitive information’ about treatment charges at private patient units. According to the report, the hospitals are part of the Southern Region Private Healthcare

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Increased satisfaction with cancer services reportedCANCER CARE

More cancer patients are reporting that they are treated with respect, given treatment choices and are benefitting from better services than a year ago, according to survey results released by the Department of Health. The second national cancer patient experience survey shows 98 trusts have improved on their results from last year and overall 88 per cent of patients surveyed rated their overall care as excellent or very good. Results on speed of treatment, choice of treatment and dignity all increased slightly. The proportion of patients who felt they were seen as soon as necessary by a hospital doctor rose to 83 per cent from 81 per cent

in 2010, and the proportion given a choice of treatment before their treatment started rose to 84 per cent from 83 per cent. A total of 94 per cent of patients, compared to 93 per cent in 2010, said that they were always given enough privacy when being examined or treated. Receiving clear answers to their questions and being treated with respect remained steady at 91 per cent and 83 per cent respectively. Health Secretary Lansley said: “We want an NHS which puts patients at the heart of everything, with a focus on the care given and results which matter most to people. This survey shows we are heading in the right direction.

Where Trusts are doing less well, I would urge them to look at what patients are telling them and take action so that cancer care best practice is adopted across the whole of the NHS.” Juliet Bouverie, director of services, Macmillan Cancer Support, said: “It is fantastic news that so many Trusts have improved in the experience they provide cancer patients in one year. However it is essential that this is the case across all cancer types. People who have rarer cancers should not be treated any worse than those with a common cancer.”

Hospitals are putting diabetic patients at risk of amputation by not having specialist diabetes footcare teams. Diabetes UK has today published the names of over 80 hospitals in England and Wales that have not set up multidisciplinary footcare teams (MDTs), despite this being recommended by the National Institute for Health and Clinical Excellence (NICE). The data was taken from the National Diabetes Inpatient Audit. There are approximately 100 diabetes-related amputations every week in the UK, but up to 80 per cent of these could be prevented, says Diabetes UK. Barbara Young, chief executive of Diabetes UK, said: “Everyone agrees that specialist hospital footcare teams are important for preventing amputations and can save the NHS money. It is appalling that so many hospitals are letting down people with diabetes by still not having one of these teams in place. It is a tragic example of the short-termist approach of some hospitals that they are failing to invest in an MDT, despite the fact that the financial savings from doing fewer amputations is likely to outweigh the cost of setting up one of these teams.” Establishing these teams would help reduce the amputation rate in people with diabetes, which is more than 20 times higher than in the rest of the population. There are approximately 100 diabetes-related amputations

every week in the UK, but up to 80 per cent of these could be prevented, says Diabetes UK. One of the reasons for the high levels of preventable amputations is that diabetic foot problems can deteriorate very quickly – this is why people with diabetes who have foot ulcers should be referred to an MDT within 24 hours. There is evidence that MDTs are effective at preventing diabetic amputations; because amputations are so expensive to treat, MDTs can also save the NHS money. A report by the charity in March 2012 showed that one hospital spent £33,000 a year on specialist services but saved £250,000 a year by reducing the number of amputations. Diabetes UK is calling for the 84 hospitals without an MDT to establish one, and is writing to the chief executives of these hospitals’ trusts to make the case. The number of prescriptions given for diabetes drugs in primary care in England has increased by 50 per cent in six years, according to official figures.Diabetes prescription numbers have exceeded 40 million for the first time last year, according to data from the Health and Social Care Information Centre (HSCIC), which looked at prescriptions from GPs, nurses and pharmacists medicines.

Specialist care teams could avoid amputation says Diabetes UK

DIABETES

The Government may consider forcing GP practices to hold a licence from the regulator Monitor in the future, and practices could be fined up to 10 per cent of their turnover if they fail to hold one or breach its terms. A new Department of Health consultation on which NHS organisations should hold a licence showed that GP practices could join foundation trusts in the future in needing to hold a licence from Monitor. Monitor will bring the licensing regime into force for NHS foundation trusts from April next year and for other providers of NHS services from April 2014. This will give Monitor power to regulate prices, address anti-competitive behaviour and promote better integration of services. The Department’s consultation ‘Protecting and promoting patients’ interests – licensing providers of NHS service’ proposes that Monitor will have powers to take action if a provider breaches a licence condition, fails to hold a licence or fails to provide Monitor with information it has requested. The document says that it ‘may’ be unnecessary for Monitor to license all providers because there are alternative bodies, such as the NHS Commissioning Board, that could, using contractual levers, enforce on GPs any requirements to protect patient choice, prevent anti-competitive conduct and enable integration. It says: “Where Monitor could work with other bodies in the system to secure equivalent

standards, particular types of provider would initially be exempt from the requirement to hold a licence. “We are recommending that providers of primary medical and dental services should initially be exempt from the requirement to hold a licence.” However, it adds: “During the next Parliament, the government intends to carry out a full review of how the licensing regime is operating. It may well be that in the light of experience, providers who were initially exempt would then be brought within the scope of licensing. It may be that, in the light of that review, it would be appropriate to license providers of primary medical and dental services in future.” Health secretary Andrew Lansley said: “We need to ensure that patient’s interests are protected and that the health service is doing everything it can to help them, whilst not over burdening the NHS with unnecessary bureaucracy. Commissioning, led by doctors and nurses, can use these priniciples to secure effective provision of services for their patients. “That’s why we’ve published this consultation on strengthening sector regulation in the NHS – to seek views on our proposals and whether we need to consider other issues.” The consultation closes on October 22.

GP practices may need a Monitor licence and could face fines

REGULATION

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MONITOR REVIEWUnison lashes out at South West Trust consortiums’ regional pay plansA group of NHS Trusts has been accused of undermining staff morale and patient care after details emerged of plans to introduce regional pay and conditions. Unison said 20 Trusts in the South West which have formed a consortium to fix the pay, terms and conditions of health workers in the region were considering making changes such as cutting pay and holiday entitlement.Proposals put forward included reducing sick pay, cutting the working week, equivalent to 250 jobs, and a 10 per cent reduction in unsocial hours pay, said the union. Tanya Palmer of Unison’s South West region said: “Rogue employers involved in the consortium are risking the chance of reaching a national agreement. They are also undermining staff morale, stable industrial relations, staff recruitment and retention and, ultimately, patient care. The 20 NHS Trusts include Foundations from acute, teaching, mental health and community health care.” Ms Palmer said the consortium did not have the mandate, authority and responsibility to engage in negotiations: “Many Trusts in the South West are already struggling to recruit trained nurses, for instance Gloucester Foundation Trust and Royal Devon & Exeter Trust. “Why should a nurse working for the NHS in Taunton earn less than a nurse in Birmingham? This will lead to a detrimental impact on patient care as staff move to better paid regions and morale plummets.” Unison said the proposals would be “extremely damaging” and would take staff in the South West out of the nationally negotiated Agenda for Change terms and conditions which cover 1.5 million health workers in England and Wales. A Health Department spokesman said: “The NHS already has the freedom to determine pay terms and conditions, but most employers prefer national pay frameworks such as Agenda for Change. However, some NHS organisations are frustrated that trade unions have failed to reach agreement on proposals that NHS employers have put forward over the last 18 months to ensure it remains affordable and fit for purpose. The need for local negotiations could be reduced if the NHS Staff Council were able to bring negotiations to a successful conclusion.”

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Radical action needed to ensure long term NHS stability, says StoutMonitor’s Review of NHS Foundation Trust plans (2012/13) shows that the sector still faces challenges in meeting greater demand and more stretching health care targets while delivering significant savings each year. Commenting on the findings of the report, Monitor’s chief operating officer, Stephen Hay said: “In the short term, the sector’s balance sheet is in good shape overall and trusts have planned sufficient cost savings in the year ahead. However, Monitor’s review suggests that an increasing number of individual trusts will face financial difficulties by the end of this period, with different issues affecting different trusts. Our experience of reviewing these plans tells us there are indications that the sector’s finances will be weaker by the end of 2015. We expect an increasing number of trusts could be placed in significant breach for financial reasons. “Particular challenges come from the need to improve the quality of care while delivering considerable savings each year. Foundation trusts are planning to do this without planning to treat fewer patients or reduce the level and quality of care they provide. To achieve this, they will need to look at making significant changes in the way services are delivered to meet patients’ changing needs.” There is no single issue affecting trusts’ resilience and the report highlights that financial risk is distributed unevenly across the sector. Each trust will face its own combination of challenges and require its own approach to dealing with them. The challenges include: pressures in the local health economy; specific cost structures, such as large or expensive PFIs; and questions about the sustainability of the District General Hospital model if it remains unchanged. Some key points identified in this year’s plans include: Trusts are forecasting a more challenging 2012/13, with the aggregate Financial Risk Rating (FRR) declining from 3.4 to 3.2, reflecting increased risk. Significantly, 43 trusts (30 per cent of the sector) are forecasting a lower FRR in 2012/13 than they achieved in 2011/12 and only ten trusts (7 per cent of the sector) are forecasting a higher FRR in 2012/13 than they achieved in 2011/12. The pattern of risk is spread unevenly across the sector: of the 20 small acute trusts. Six are in significant breach, and of the 41 mental health foundation trusts, 14 are regarded as low risk (FRR 4/5). Foundation trusts are forecasting CIPs to remain greater than 4.1 per cent of operating costs each year from 2012/13 (peaking at 4.3 per cent in 2013/14). Income is forecast to increase by only 1 per cent in 2012/13 and then decline by 1 per cent per year thereafter. There is a small planned improvement in Governance Risk Ratings (GRRs) in 2012/13 compared to actual performance in quarter 4 2011/12. Also, 77 per cent of foundation trusts are forecasting green or amber-green GRRs throughout 2012/13

Responding to Monitor’s findings, NHS Confederation deputy chief executive David Stout said that radical change would be necessary for the long term, even though most foundation trusts are managing immediate financial challenges. Stout said: “The figures in this report accurately reflect what we have been saying on behalf of our members for some time. NHS leaders are expressing some confidence in meeting the immediate financial challenge. But pressures are continuing to grow across the NHS, with increasing numbers of NHS organisations starting to experience significant financial pressures. To maintain quality in light of these pressures, the report rightly highlights the need for significant changes in the way services are delivered.” Stout continued: “NHS leaders know the real challenge is to tackle a flat budget while managing the increased costs of treating an ageing population, advanced technology and the growing rates of lifestyle diseases such as obesity. And they know that doing this will require more radical action, further integration of services and expanding community-based care. “This is necessary to avoid the financial pressures harming patient care, and to ensure the NHS keeps up with the needs of local populations. To tackle these challenges successfully, NHS leaders need to get the public on board with some very difficult decisions.” “We need to get communities fully involved in discussions about how we shape services. Local NHS organisations, with political support, need to be clear that it is possible to change the way staff work and where services are offered so patients get better care.” The results of the NHS Confederation’s recent survey of NHS leaders highlighted growing fears about the impact of financial pressures on the quality of care. Speaking in June, NHS Confederation chief executive Mike Farrar said: “Our survey shows that many NHS leaders see finances getting worse. In response, they are cutting costs in the short-term but they know that much more radical solutions are the only answer in the long run.”

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HealthBusiness 125Hx178W.indd 1 20/08/2012 21:11:01

How?We create a total

learning experience using synchronous

learning

The International Institute of Risk and Safety Management (IIRSM), accredited online training www.iirsmtraining.com/training provides the health and social care industries with a simple to use online training system, to make it easier for employers to deliver a detailed awareness of the hazards that face workers (including temporary workers) day to day.

This IIRSM accredited online Hospital Induction training http://www.iirsmtraining.com/training/hospital-induction/ focuses not only on the basic principles of health and safety, but specifically those issues within in a hospital or similar environment such as Safeguarding Children, Violence and aggression, Lone Working, Risk/Incident reporting, Complaints, Fitness to Practice, Infection Control, Work at Height, Basic Life Support, DSE and People Handling, protecting not only staff but also those they affect such as patients and colleagues.

International Institute of Risk and Safety ManagementSuite 7a, 77 Fulham Palace Road, London W6 8JAEnquiries: +44 (0)20 8741 9100Email: [email protected]

Written by Roger Bibbings, RoSPA

Hospitals are potentially dangerous workplaces with employees facing a multitude of hazards on a daily basis, ranging from an outbreak of Legionella bacteria to falls and musculoskeletal disorders. And it is worth noting in this context, that the vast majority of people employed in the care sector often show more concern for those they care for than they do for themselves, often putting their own health at risk in the process. There are obvious legal and moral reasons for effectively managing health and safety, and there is also a strong business case. Prosecutions for health and safety breaches have resulted in some sizeable financial penalties, and court proceedings can also severely damage the reputation of public and private sector organisations. The duties in the Health and Safety at Work etc Act 1974 (HSWA) require employers to ensure the health and safety of all employees and anyone who may be affected by their work - something which The Management of Health and Safety at Work Regulations 1999 also builds on by requiring suitable and sufficient risk assessment.

MAINTAINING GOOD HEALTH & SAFETY Good health and safety management is not just about legal compliance. During tough economic times, it pays to maintain a good health and safety record, not least because an accident or work-related ill health incident can disrupt service delivery and can also be very costly. In their daily work, healthcare workers can face a very wide range of threats to their safety, health and wellbeing, not just slips and trips, manual handling, microbiological tasks and so on, but issues associated with shift work, violence and aggression, not to mention work related driving. But it is also important to remember that hospitals deliver important services to some of the most vulnerable members of society, which means risk assessments need to be undertaken in order to ensure the necessary preventive measures are put in place for everyone affected. Essentially, employers have to ensure, “so far as is reasonably practicable”, the absence of risk to the safety and health of employees and others who are affected

by their undertakings, such as patients. There are certain basic principles which, if implemented effectively, enable organisations, such as hospitals, to achieve this. Essentially, these include: having a robust system in place to manage health and safety, rather than relying on one-off interventions; identifying principal hazards and the organisation and assessing the associated risks to establish if sensible and balanced safety measures are in place. And, of course, the right policies, people and procedures to make this work, include informing, training and supervising employees; reporting, recording and investigating accidents and near-misses; and periodically reviewing performance and feeding back lessons learned. Working in a hospital environment means employees have a responsibility of care to many vulnerable patients, with moving and handling making up a large part of the day’s activities.

MOVING & HANDLINGAccording to the Health and Safety Executive, around 5,000 moving and handling injuries are reported each year in health services and around 50 per cent of reported accidents in the sector are incurred when helping to move patients of reduced mobility. Slips and trips are also one of the most common accidents and make up over a third of all major injuries. In 2010/11, there were 11,390 reported injuries

to employees in the health sector and 6,453 in social care. According to RIDDOR, the majority of reported injuries were handling injuries (making up 39 per cent in the health sector) and a quarter were attributed to slips and trips. Preventing handling injuries is a major challenge. How people are moved and handled is essential in promoting recovery, maintaining independence and providing a feeling of wellbeing. It is not only a basic human right for people to be treated with dignity and respect during the handling process, but also a legal requirement. It is therefore vital for staff to understand how to minimise the risk to their backs and limbs and thus it is advisable for residential homes and authorities to purchase appropriate handling aids. Some ways of minimising risk are: avoiding lifting patients manually; encouraging patients to assist in their own transfers; and thoroughly evaluating equipment and furniture before it is purchased.

SUPPORTING WORKERSA commitment to support - and if possible, rehabilitate - those who have been injured in connection with their work is also important. Whether you are in primary care or any other sector, a ‘suitable and sufficient’ risk assessment is obviously the place to start and, again, whether you are in primary care or any other sector, assessment should be used to help define the correct handling process E

STAFF TRAINING: HEALTH & SAFETY

HEALTH AND SAFETY - NOT JUST ABOUT COMPLIANCERoger Bibbings, occupational safety adviser at the Royal Society for the Prevention of Accidents (RoSPA), examines right the right policies and procedures to make Health & Safety work in hospitals

Staff TrainingBUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net


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E to be adopted. For example, some staff, such as nurses, may have to adopt and hold awkward postures as part of their work, so it is paramount that any stresses and strains arising when caring for and treating people are addressed. Training may help to prevent injury arising in such circumstances and reduce the number of days taken off work as a result. Planning, informed by risk assessment, and setting goals for improvement are also central to reducing slips and trips, as is the day-to-day spotting of hazards such as spills, trailing cables, poor lighting and unsuitable footwear. It is a collective responsibility and one that should be taken seriously by everyone. This is why it is important for all managers to work with employees to minimise risks, for example, by identifying possible hazards and selecting, for example, anti-slip floorings in areas which cannot be kept dry. Planning means there needs to be a record of who is responsible; for example, for getting spillages and objects cleaned up quickly and making these details clear to everyone in the workplace. And the same approach to planning needs to be adopted for any cleaning and maintenance work undertaken in order to encourage good health and safety. Then by monitoring and reviewing management arrangements, any areas in need of improvement can be highlighted and agreed actions put in place. It is important to involve employees in this process, as they are often best placed to assess the effectiveness of the management system in its ability to deal with the risks.

LEGIONNAIRESLegionnaire’s disease has been in the news again. Healthcare providers should ensure that a full risk assessment is carried out of their hot and cold water systems, as Legionella bacteria, a potentially fatal type of pneumonia, can multiply where temperatures are between 20-45°C and nutrients are available. Temperature control is the best method to help combat an outbreak and these systems should be routinely checked, inspected and cleaned. The presence of sludge, scale and fouling can also increase the risk of Legionella, which is contracted by inhaling infected airborne water droplets. And, with the pressure on hospitals to keep up with hot water demands, increased water temperatures mean there is also a scalding risk to the vulnerable people who use their services. Where there is a risk, water temperatures must not exceed 44°C, as those with reduced mobility, for example, often cannot react appropriately, or quickly enough, to prevent the injury from arising. Another hazard to be aware of is asbestos, a naturally occurring fibrous material that was extensively used in the UK from the 1950s through to the mid-1980s. Lives continue to be lost to it as the dangerous fibres when inhaled can cause a string of diseases, some of which are fatal. These conditions, which include fibrosis of the lung, lung cancer and mesothelioma, a deadly cancer of the lining

of the lung, will not affect you until later on in life, so it is necessary and sensible to take action now. Any building built before the year 2000 (including hospitals) is likely to contain asbestos, so it is a legal duty for employers to identify whether asbestos is present and to maintain a register so that a risk assessment can be carried out before any work such as repair, modification or demolition can be undertaken. According to the Health and Safety Executive, approximately 20 tradesmen die from asbestos-related diseases every week and so it is important to know how to handle it safely and be aware of the risks. To find out more, visit www.hse.gov.uk/hiddenkiller.

TRAINING Covering all of the issues above, training and competence are essential skills to help contribute to the smooth running of the workplace and in a hospital environment a lack of either could prove to be a costly mistake. Training can also give each member

of the team the safety knowledge and skills necessary for them to play their part effectively. And this is not just the case on traditional “health and safety” issues. A recent Care Quality Commission (CQC) report, which looked at care issues including dignity, identified 12 UK hospitals as a “moderate” concern, after they were found not have met the required standard in “respecting and involving” those who used the services. A key finding from the CQC’s 2011 dignity and nutrition inspection programme revealed that both staff and patients felt there were not always enough staff with the right training on duty to spend enough time giving care. Half of

the 12 hospitals were also found to be failing in standards of staff training. Examples of the findings included: “None of the staff we spoke to were able to recall having specific training in how to ensure people’s privacy and dignity was supported,” and “Staff told us they had very little training on dysphasia, rehabilitation, privacy, dignity or dementia”.

CONCLUSIONFirst off, while patient care is a top priority, we must not turn our back on ensuring good health and safety for staff, patients, contractors and visitors. Quite simply we can’t afford to. As in any undertaking, the keys to managing successfully in health and social care for good health and safety outcomes are senior management commitment and leadership, workforce involvement, competence and access to specialist advice. Staff training in particular is of the upmost importance; for example, safer people handling training can prevent musculoskeletal disorders, meaning the number of working

days lost will go down as will the associated costs which otherwise put a significant strain on health and safety budgets. But, as outlined earlier, a systematic approach to health and safety management is required, not a disjointed series of one-off interventions. The important thing to remember is that good health and safety is no accident. It has to be planned for and worked at. Indeed, a positive safety culture is a key performance indicator in today’s busy and challenging healthcare sector. L

FURTHER INFORMATIONwww.rospa.org

Staff Training

STAFF TRAINING: HEALTH & SAFETY

Some ways of minimising risk are: avoiding lifting patients manually; encouraging patients to assist in their own transfers; and thoroughly evaluating equipment and furniture before it is purchased.





If you are responsible for a businesspremises, the law requires that youhave a fire risk assessment. To findcompetent providers, you need BAFE. Under the provisions of the Regulatory Reform(Fire Safety) Order 2005, the Duty Holder orResponsible Person for a building is requiredto make a Fire Risk assessment to clarify thefire precautions necessary to ensure the safetyof staff, customers and property.

At present there are no adequate means toensure the competence and reliability of acompany commissioned to carry this out.

BAFE scheme SP205 has been developedspecifically to address this situation, and willprovide reassurance to the Responsible Personthat they are doing everything possible tomeet their obligations.

So don’t leave everything to chance.Make sure that your suppliers areregistered with BAFE.

Don’t gamble with your fire risk assessment!

www.bafe.org.ukT: 0844 3350897

E: [email protected] 2, Fire Service College,

London Road, Moreton-in-Marsh, Gloucestershire GL56 0RH

One Call Training provides a range of construction and building training solutions to facilities staff at many government and privately funded institutions including hospitals, schools and universities as well as the private sector including building, maintenance, electrical, painters & decorators, glazing trades etc. In addition to being members of Independent Asbestos Training Providers (IATP) as well as a long standing Prefabricated Aluminium Suppliers & Manufacturers Association (PASMA) Approved Training Provider for Portable Scaffold Tower Training, other courses provided throughout the UK include IPAF Powered Access, Safety Harnesses, Ladders & Steps, Working at Height, Asbestos Awareness, Manual Handling and Abrasive Wheel Safety. Manage Buildings? Then you have a duty to manage Asbestos. The role of the duty holder is

to manage the maintenance of Asbestos. The HSE has made available specific guidance and a step by step guide to aid Duty Holders fulfil their obligations. One Call Training, a member of the Midland Construction Safety Association & The Newcastle Construction Safety Group, can guide you through the process to ensure that staff are armed with the information they require to minimise the risk.

FOR MORE INFORMATIONTel: 07814 [email protected]

One Call Training supports HSE Hidden Killer campaign

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training

Specialists in behavioural safety and industrial machine safety, SpringBoard Safety Services offers a comprehensive range of sensible health & safety solutions and a variety of safety training to industry and the healthcare sector ‘Train the Trainer’ courses are accredited through the OCN at level 3 for the trainer. Delivered by experienced trainers, these provide ongoing support and advice after the course for two years, with updates as and when they occur. The company keeps train-the-trainer course numbers low in order to deliver the best possible training aimed squarely at the delegates’ requirements. Once a course is booked, SpringBoard Safety never cancels due to lack of numbers. Each trainer receives premium training materials including a trainer’s manual (written by

trainers for trainers), a delegate workbook, trainer guide, test papers, case studies, lesson plans, exercises, a course CD and Video/DVD on some courses. Current courses include: Health & Safety/Risk Assessment, Challenging Behaviour & Dementia, Emergency First Aid at Work, People Moving and Handling, Medication, Infection Control, Food Hygiene, Safe Guarding of Vulnerable Adults, Deprivation of Liberty and Fire.

FOR MORE INFORMATIONTel: 07718 898510mail@springboardsafetyservices.comwww.springboardsafetyservices.com

Accredited Healthcare Training from SpringBoard

Written by David Halicki, IO

SH Healthcare Group

The employer has a legal duty to protect the health, safety and welfare of their employees, but also anyone who might be affected by its daily business activities, premises and facilities. That means patients, visitors, contractors and any employees of other healthcare organisations who might be visiting the hospital or working on-site.

Hospitals exist to look after people’s health, so why is health and safety so necessary?By the very nature of their conditions, patients are classed as ‘vulnerable’ people, so it’s essential that their healthcare is provided in the right environment. The facilities - including medical devices and non-medical equipment - must be ‘safe and suitable’, cleaned and well maintained. And all of this must be operated by people who are trained and competent to do so, which is why health and safety is so vital in a hospital environment. What’s more, in a safe, healthy environment, staff feel looked after, experience a morale boost and are more motivated, which promotes higher standards of care. The more employees are off sick because of work related injury or ill health, the more chance there is that the quality of service to the patient may be affected due to a number of factors including inconsistency, poor communication and lack of investment in

individuals’ situations. Good health and safety in hospitals increases efficiency and reduces lost time through reduced sickness absence.

What areas of health and safety does a hospital have to cover?A hospital must utilise everything in the health and safety toolkit. It has to consider safe access and exit, moving and handling, slips, trips and falls, management of sharps and management of waste. It also needs to make sure it controls contractors, looks out for and prevents violence and aggression, cleans and maintains all of its buildings and equipment and provides proper training and information on health and safety issues. Many of the activities of a hospital will also fall under the jurisdiction of the Control of Substances Hazardous to Health (COSHH) Regulations 2002, and they must provide proper infection control, legionella prevention and management of other harmful bacteria and microorganisms. It also includes chemicals, ionising and non-ionising radiation and a host of other substances.

What are the most prolific health and safety issues that a hospital might face? The issues will vary from hospital to hospital, but they should all be identified by risk assessments and dealt with in a way that best controls the risks to patients, staff

and other visitors or employees within the premises. Experience shows that maintenance of equipment, facilities and grounds can be areas for concern as they aren’t in the spotlight and can be the first area to suffer budget cuts in times of austerity. Back log maintenance is an area where things can be missed due to lack of funding and investment. We often find that the management and control of contractors can be overlooked as they fall between the gaps of hospital visitors, employees and patients. But health and safety managers and hospital bosses should be just as diligent, making sure that the work of contractors meets the same standards, as it’ll be their responsibility if things go wrong and injury and ill-health incidents creep up.

How do you look after staff experiencing stress/mental health issues/depression? Many hospitals are trying to be proactive, even in these austere times, to reduce the risk of stress to protect its staff, especially as high sickness and absence levels can affect service delivery. Almost across the board there have been wellbeing groups set up and health and fitness sessions made available, with flexible working catered for where possible. If staff feel the effects of stress, many hospitals have confidential counsellors for them to discuss problems with. To help reduce the source E

HEALTH & SAFETY

HOSPITALS: USING THE FULL HEALTH AND SAFETY TOOKIT

Health & Safety

Health and safety in a hospital environment means exactly the same as in any other business or organisation. David Halicki of the IOSH Healthcare Group explains why hospitals are unique sites and looks at the issues they face in safeguarding patients, visitors and employees.



adv_EMCdruk_stef.indd 1 26-07-12 10:22

E of stress it’s now common for the hospital’s occupational health department, human resources department and the staff member’s manager to work together to find a solution.

What are the areas that require most vigilance in a healthcare setting?The main risks to staff tend to be violence and aggression, moving and handling, slips, trips and falls and sharps injuries, so it’s vital that they are properly trained in those areas and understand where they can get information and support. In terms of patients, the areas I often see posing a risk are slips, trips and falls and infection control.

What kinds of tasks does a health and safety manager of an average-sized hospital meet in his day-to-day work?There may well be some routine in their job, such as delivering induction training, attending committee meetings, dealing with correspondence and email - but it can vary from day-to-day. Policies will need to be written or revised, departments might need assistance with their risk assessments and specialist training might need to be delivered. On occasions, there may be incidents to investigate or contractors to monitor. A health and safety manager has a great deal of liaison with other departments, such as facilities, or estates, and even pathology when the need arises. It’s also important for them to get out from behind the desk to walk the patch and carry out safety tours when they can. After all, they need to be known by everyone and accessible by all managers and staff.

How far up a hospital’s priorities should health and safety rank?Health and safety is about being sensible. Hospitals are there to provide safe, quality services to patients and be a good employer to the employees who provide those services on their behalf – good health and safety should be an important part of enabling them to succeed in that mission. A hospital should be managing the risks that could prevent it from achieving its aims - health and safety is a part of that. This said, compliance with health and safety legislation, such as the Health and Safety at Work Act 1974, should be treated with as much seriousness as compliance with any other law that governs how a hospital manages its business. This includes the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and the Care Quality Commission (CQC) Essential Standards.

Are there any risks to current hospital health and safety posed by budget cuts to the NHS?Without a shadow of a doubt. A properly resourced hospital is a safe and healthy hospital. After all, if equipment and facilities are not properly maintained, this poses a risk to the safety and welfare of patients, staff and visitors. It’s somewhat ironic if a place

which is supposed to promote and improve health is also risking it. Adequate funding enables the delivery of safe and quality services, but also makes sure the workforce providing the service are properly resourced, healthy, safe and happy – it allows them to provide a good level of care. A hospital with poor health and safety can suffer legal sanctions, prosecution, court costs, fines, legal fees and compensation claims, which are all hugely costly. Sickness absence and injury from inadequate health and safety can also mean a hospital becomes inefficient, while experiencing more down time and higher personnel turnover, which all adds to the cost. In the long run, it makes far more financial sense to properly resource a hospital so it can maintain facilities, equipment and buildings, keep staff healthy and safe and look after contractors, patients and visitors.

Do people appreciate the importance of good health and safety in hospitals?Managers and staff who work in a hospital where health and safety is a priority will understand the innate value it brings. But all staff and patients unknowingly appreciate the benefits of good health and safety, as quite often, it goes unnoticed when everything is working properly. Senior managers need to realise that health and safety is not an additional burden, but an integral and essential part of their delivering a safe,

quality service to patients and purchasers of healthcare services from the hospital.

Is the role of health and safety in a hospital different to a factory or a public space? Why? A hospital has a greater risk portfolio than any individual factory. Factor in the patients and visitors and it makes it a very complex place to manage health and safety. It has so many high risk areas and activities going on at the same time, such as construction or refurbishment activities, hazardous waste, laboratories, radiation and a need for complete sanitation. It’s a very high risk industry.

ABOUT IOSHFounded in 1945, IOSH is the biggest health and safety membership organisation in the world. The IOSH Healthcare Group meets the professional development needs of 1,800 members working in public and independent healthcare, including primary care, acute services, mental health, ambulance services, social services and learning disabilities. Every year, IOSH organises four networking events in locations across Britain and Ireland, choosing topics that are identified as areas of interest through the feedback received from members. L

FURTHER INFORMATIONwww.iosh.co.uk

Health & Safety

HEALTH & SAFETY



Trai

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


Polyflor, the UK’s leading manufacturer of commercial and residential vinyl floorcoverings has launched a new product in the Polysafe range. Polysafe Modena PUR features a high-clarity, micro-granite appearance across 14 different shades and is available with the manufacturer’s groundbreaking Polysafe PUR (polyurethane reinforcement). The development of Polysafe Modena PUR follows increased demand for more aesthetic floorings that can be used throughout a building but that still retain sustainable slip resistant properties. Customer demand is now for high quality designs with built-in safety, containing safety particles that are virtually invisible and do not detract from the good looks demanded in the more showcase areas of a facility. The inclusion of clear aluminium oxide within the vinyl ensures that Polysafe Modena PUR is fully compliant with HSE and UK Slip Resistance Group Guidelines, achieving 36+ in the Pendulum wet test and a surface roughness of 20 microns and above. The appeal of all 14 shades is protected by Polysafe’s class-leading cross-linked and UV cured PUR maintenance enhancement, to enable optimum appearance

levels and maintenance cost savings of up to 60 per cent. “Polysafe Modena PUR is a fantastic product that combines all the tried and tested qualities of Polysafe with the look of a smooth, decorative flooring range” explains marketing manager Simon James. “This is a supreme option for front of house and high circulation areas, but can also be used in traditional safety flooring locations”, he adds. Polysafe Modena PUR fully meets the requirements of EN 13845, the European standard for safety flooring and achieves a BRE Global Generic A+ environmental rating. It is also suitable for recycling through the Recofloor Vinyl take back scheme. Download a copy of the Polysafe Modena PUR brochure from the website or contact Polyflor Samples Direct via the number below.

FOR MORE INFORMATIONTel: 0161 767 2551www.polyflor.com

Polyflor treads new ground with Modena PUR - slip resistant properties for use throughout the building

Utilising innovative sonar technology, the Dyteqta-System is a preventative monitoring system which ensures that there is an adequate seal between the population of a building and the contents of the drainage and sewer system. In a hospital, for example, the drainage system links every area, from general medical and isolation wards to operating theatres, mortuaries and public waiting spaces. The extensive pipe network is sealed from building occupants, in the main, by a small volume of water in a water trap or U-bend. If these seals are lost, harmful pathogens, including hospital superbugs such as C. diff and MRSA, may pass into the occupied space and spread infection. DYTEQTA™ monitors the state of the seal between the building drainage and sewer system and the healthcare

building population, reports anomalies, and so prevents cross-contamination from one part of the building to another. Dyteqta’s product remotely monitors a building’s drainage network to identify any defective water trap seals for timely maintenance. With this innovative system, the company’s expert team is ready and able to help healthcare professionals take a proactive approach to reducing the risk of cross-contamination with an affordable and non-disruptive solution that is easy to install in new or existing facilities.

FOR MORE INFORMATIONTel: 0845 604 4953Email: [email protected]

Dyteqta – a new hospital infection control strategy

Alan Gardner is a Fellow Member of International Institute of Risk and Safety Management, and has experience in managing health and safety services and setting up governance structures and safety management systems in the NHS and social housing sectors.This includes the implementation health and safety and risk assessment systems, governance arrangements, writing policies and procedures and carrying out risk assessments related to a wide range of activities as part of risk management structures. Alan Gardner has experience in serious accident and incident investigations in the NHS and Social housing sector, and has developed

emergency planning and business continuity procedures along with the coordination of major incident exercises. Alan also has operational experience in applying food safety and fire safety legislation. A variety of health and safety training courses, including manual handling, display screen risk assessor and personal safety training, can be delivered.

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A wealth of experience in risk management and safety from Alan Gardner

Medical school teaching about the importance of physical activity is “sparse or non-existent,” according to new research from the the British Journal of Sports Medicine. Only four (15.5 per cent) medical schools of all 31 in the UK included physical activity in each year of the undergraduate course. Five (16 per cent) did not include any specific teaching on it in their undergraduate courses. Only half (15) schools included the current CMO guidance on physical activity in their course, despite it being endorsed by all four UK departments of health. This knowledge gap will leave tomorrow’s doctors ill equipped to promote physical activity effectively to their patients and stem the rising tide of serious disease associated with lack of exercise, say the authors, writing online in the British Journal of Sports Medicine.The findings are based on a survey sent to the curriculum lead or director for medical studies for each of the UK’s 31 medical schools. This asked about the form and content of key aspects of education on the promotion of physical activity, in accordance with national guidelines, and the total amount of time given over to teaching the basic science and health benefits of physical activity across the undergraduate course.

The education leads were asked to name the specific teaching modules in which physical activity education appeared. And they were asked if the Chief Medical Officer’s (CMO’s) guidance on physical activity - which spans all age groups, and which was published last July - appeared anywhere in the curriculum. The responses uncovered some ‘alarming’ findings, showing that there is widespread omission of basic teaching elements, according to the authors. The absence of physical education teaching points to ‘a major disconnect’ between undergraduate medical education, evidence based clinical guidelines for the treatment and management of many long term conditions, and national policy, with its emphasis on good health and disease prevention, say the authors. The total amount of time spent on teaching physical activity was “minimal”, the responses showed, averaging just four hours compared with an average of 109 hours for pharmacology, say the authors. The specific modules in which physical activity featured varied widely, but it was most often included in public health, cardiology, respiratory medicine and endocrinology. Only two schools said it was included in health promotion and in community and general practice.

The authors point to 39 different clinical guidelines for specific diseases and conditions in which physical activity features as a method of treatment, and highlight the fact that most of the population lives largely sedentary lives. “A basic understanding of the benefits of physical activity, how to effectively promote it (with behaviour change techniques), and combat sedentary behaviour for different age groups underpin the ability of future doctors to manage modern non-communicable chronic diseases and follow clinical guidelines,” conclude the authors. They call for dedicated teaching time on physical activity for all medical students, as a matter of urgency.

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SH Lone workers are those who work by themselves without close or direct contact with colleagues. The number of job roles which involve lone working can be vast.Jane White, research and information services manager for the Institution of Occupational Safety and Health (IOSH), said: “On the whole, people classed as lone workers either work on their own within an establishment or are mobile, working on the road or from home. “However, some employees may be working alone because they work outside of normal hours or because their circumstances dictate that they need to.” Employees subject to the most risk are those who have close contact with members of the public, where they may be threatened by abuse or attack. Steve Sumner, chair of the IOSH Public Service Group, said: “More often than not staff who work alone but interface with service users and the public generally face an increased risk of abuse or actual violence because they don’t have the immediate support of colleagues or others, such as security staff if an incident occurs.” It is often perfectly safe to work alone. The law requires employers to think about and deal with any health and safety risks before people are allowed to work alone. Under the 1974 Health and Safety at Work Act, employers have a responsibility for the health safety and welfare of all their employees. They are also responsible for the health and safety of all those affected by their work activities, for example any self-employed people they engage with and visitors such as contractors. Steve added: “The risks associated with lone working vary depending on a job role. They can be minimal or significant, predictable or unpredictable. Whatever the activity, it’s essential the risks are adequately and appropriately assessed before the it commences.

DELIVERING BAD NEWS“Workers can be particularly at risk when they are delivering bad news for example, regarding the removal of a service previously provided. Clients and their family may get upset and angry and become abusive. Regulatory staff such as environmental health officers and trading standards officers may also be at significant risk especially when visiting premises in the evening. However, other roles such as cleaners

working out of hours may be very safe but simply need some way of summoning help should something happen.” Employers need to investigate significant hazards faced by the lone worker and assess the risks involved both to them and those affected by their work. However, when the situation escalates and the risks change rapidly the staff at risk should be skilled in using a dynamic risk assessment to enable them to recognise the need to remove themselves from the situation. Any risk assessment for an employer working alone in an office or in any location should assess whether the conditions they’ll be working in are normal or abnormal, and whether they are hazardous - both in terms of the type of people they face, and the physical conditions of the area such as lighting and office location. Lone workers in local government may have to refuse appointments, reject applications for benefits or generally give bad news that may change a person’s life - all of which can spark emotional reactions that they need to be trained to deal with and diffuse. Staff should also be trained in how to deliver bad news to reduce the risk of angry reactions.

KEPT UNDER REVIEWJane White said: “It’s vital that the steps any government authority puts in place to safeguard their workforce are kept under constant review. This will involve changing and improving risk assessments to reflect the experiences of the individual, their needs and additional intelligence which may require the assessment to be changed.

“Lone workers need to be provided with extra support to alleviate risks to their health or safety. Employers need to ensure that they’re empowered through training, to equip them with the knowledge of how to deal with hazardous situations should they arise.” “Group training is an ideal way to share and learn from experiences of this type of work, helping people pool suggestions on the measures that can help to overcome problems. After all, good communication is the most important aspect of looking after lone workers.” Learning from experience is one of the best ways of avoiding problems in the future, so organisations should not just report incidents and file them away – they should be used to

improve lone working policy to avoid similar problems in the future. Encouraging a risk and incident reporting culture is important, and collecting information from other stakeholders who witnessed or dealt with incidents should provide key information for strategy in future. Communication plays a key role in protecting lone workers. Steve said: “Managers and colleagues of lone workers must have systems to enable them to know where a lone worker is, what they are doing and if they are working remotely, when they are expected back. If staff are working late in the office then mechanisms should be in place to ensure that the duty building manager is aware they are on site and when they have left the building. ‘Buddy’ systems can be useful as they enable a lone worker to keep in regular touch with another employee. This ‘buddy’ will know the places, times and people that their colleague is coming into contact with and will be able to raise the alarm if an expected call or form of contact is missed.”

SENSIBLE MEASURESJane said: “IOSH urges organisations to adopt sensible control measures that don’t unnecessarily alarm – they must be practical and proportionate. However, employers must remember that technology shouldn’t be used in isolation, or as a substitute for proper training and techniques. It’s an added layer of protection that adds value and can make the difference in a worst case scenario.” There are a large number of new technologies available on the market to assist in reducing risks to lone workers. These devices include smart name badges that operate using mobile phone and GPS technology which some employees might find intrusive and computer systems where people regularly log in to show they are safe, starting a chain reaction of emergency

procedures if they don’t. Simple things such as speed dial buttons on mobile or desk phones, panic buttons that link to a base or the police or sharing electronic calendars can help reduce risks or summon help more quickly. A panic alarm which sets off a loud noise can also be effective. However, it is essential to understand that these devices must be considered in addition to robust procedures and not relied upon as the sole solution to the risks posed. Staff may also find training in diffusion techniques useful but they must recognise when it is time to leave or summon assistance. L

FURTHER INFORMATIONtinyurl.com/c58qv5z

“..The risks associated with lone working vary depending on a job role. They can be minimal or significant, predictable or unpredictable..”

LONE WORKERS

ALONE, BUT SAFE? Thousands of lone workers in the UK are at risk each year of falling victim to verbal abuse, a physical assault or an accident during work hours. IOSH reports.

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Almost by definition, lone working can be both intimidating and at times dangerous, so the protection of lone workers involves a twofold approach; not only to provide safeguards but also to offer reassurance to the people involved. The nature of their work means that many are required to travel alone, both in isolated rural and busy city-centre locations, and often after dark, leaving them particularly at risk. To address these important issues, the security industry has worked with the police and end-users to develop a combination of practice, technology and standards capable of providing an effective – and cost-effective - solution to the risks. The development of technology and practice in the field has focused on encouraging and enabling lone workers to assess the risks they might be facing and provide them with the means both to summon aid in an emergency and collect information that can be used in evidence, if necessary. This has led to the creation of lone worker devices equipped with mobile phone technology that connect employees quickly and discreetly with an emergency response system that has direct links to the police. A number of products are commercially available from BSIA member companies, including miniature devices that resemble ID holders.

ENSURING AN EFFICIENT POLICE ESCALATION PROCESS In the United Kingdom, the most efficient way to raise a lone worker alarm is through a lone worker solution that is audited and approved against BS8484, the first British Standard for the provision of lone worker device services, introduced in 2009. The ability to elicit a police response is clearly a crucial factor and credible lone worker solutions have been developed to maximise effectiveness through the reduction of false alarms (often achieved through the capture of valuable audio evidence informing a process of discernment during an emergency situation involving a lone worker). This is achieved through a combination of 24/7 remote monitoring and two-tier alert facilities, classified as pre-activation (aka amber alert or pre-alert) and activation (red alert). All approved devices

are monitored by an Alarm Receiving Centre (ARC), accredited to British Standard 5979 (Category II). An ARC should also be audited and approved against the relevant section of BS8484 along with BS5979 Category II in order to apply for a Unique Reference Number (URN). Once issued by the local Police Force the URN allows the ARC to raise an alert one level above a 999 call, which aids the user in receiving a timely response. Sending a pre-activation message from a device allows users to dynamically assess risk whilst informing the ARC when they are entering an area with a potential

risk – e.g. before walking across a dark car park. If the user then experiences a problem or encounters a situation that seems likely to escalate into something more serious the lone worker device can be activated to summon help quickly. Typically, activating the lone worker device automatically triggers a voice call to the ARC. No further action is required by the user, as the device effectively functions as an open microphone, enabling the ARC to capture an audio recording of the incident for future action such as police investigation of legal proceedings. Operators at the E

LONE WORKERS

THE FUNDAMENTALS OF LONE WORKER SAFETYMore than six million people in the UK work either in isolation or without direct supervision, often in places or circumstances that put them at potential risk. A wide variety of organisations employ people whose jobs require them to work or operate alone, either regularly or occasionally. Alex Carmichael, technical director, British Security Industry Association, explains how security technology is helping to keep such lone workers safe in healthcare and other settings.

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E ARC also monitor the audio channel in real time, enabling them to assess the situation and alert the police if the user needs help or protection. This procedure allows the police to optimise their response to genuine emergencies by providing a ‘moving picture’ of the incident, including an increase or decrease in risk as it happens. The very knowledge that this is taking place is, of course, a major boost to the user’s confidence.

DUTY OF CAREWorking alongside their clients, many BSIA members have developed similar, highly effective lone worker solutions to protect a wide range of personnel, including truancy officers, community nurses, transport workers and victims of domestic abuse. Meeting their obligations under duty of care legislation is a key concern for many customers, and one of the main reasons why lone worker devices are introduced. In fact, acknowledging its responsibilities under Health & Safety legislation and duty of care and by identifying and understanding specific risks encountered by its wone workers were the primary reasons behind The Capita Group PLC’s decision to invest in a lone worker security solution provided by BSIA member, Argyll. The Capita Group PLC is the UK’s leading business process outsourcing (BPO) and professional services company. Among the many roles performed by Capita is

providing the majority of customer service, administration and enforcement of TV Licensing throughout the UK. Visiting addresses throughout the UK, sometimes in crime-hit urban areas, carries with it an inherent risk of confrontation, which can escalate to verbal and physical abuse.

Fundamentally, should one of Capita’s front-line enquiry officers experience jeopardy, they are a single button-press away from summoning assistance - quickly and discreetly. Using a preconfigured button on their mobile phone, they can issue a duress signal, which instantly alerts Argyll’s 24/7 manned control room and simultaneously opens a voice channel enabling operators to listen in. Trained operators then put into effect an agreed incident management procedure and, if required, use existing links with the Police to ensure a swift response. Sophisticated voice recording ensures that every incident is captured and can be produced as evidence if required.

EXPERT GUIDANCEThe development of British Standard BS8484, a Code of Practice for the provision of Lone Worker Services, has been a key element of the security industry’s work to create such solutions. BS8484 is employed by most members of the BSIA’s Lone Worker Steering Group and forms the basis for police response to lone worker systems. The BSIA has also published two associated

guides, which provide both employers and lone workers themselves with easy-to-follow advice. ‘Lone Workers – An Employer’s Guide’ informs employers about and what to look for when sourcing a supplier. The guide covers the employers’ responsibilities to its lone workers, as well as specific criteria for

selecting technology, monitoring services and providers, including the possession of quality management systems such as

ISO 9001 and the delivery of appropriate training. It can be downloaded free

by visiting http://www.bsia.co.uk/publications and searching

for form number 288.

GUIDESFor employees whose role requires them to work alone, the BSIA has produced a separate guide, ‘Lone Workers – An

Employee’s Guide’, which can be downloaded by

visiting the BSIA’s website and searching for form number 284.

James Kelly, chief executive of the BSIA, comments: “These guides recognise the importance of keeping lone workers safe and secure. Responsible employers will consider the health and safety of their lone workers as a top priority, and the use of lone worker devices can help by connecting such employees with an emergency response system that has direct links to the Police. BS8484 is the basis on which Police respond to lone worker systems, so it’s important for employers to choose a supplier who works to these standards.” L

ABOUT THE AUTHORAlex Carmichael is technical director of the British Security Industry Association, the trade association covering all aspects of the professional security industry in the UK. BSIA members provide over 70 per cent of UK security products and services and adhere to strict quality standards. For more information see www.bsia.co.uk, email [email protected] or telephone 0845 389 3889. To find out more about the BSIA and the work of its members (including the case studies mentioned in this article), or to find a reputable suppliers of lone worker devices, visit the Association’s website at www.bsia.co.uk/lone-workers

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The development of British Standard BS8484, a Code of Practice for the provision of Lone Worker Services, has been a key element of the security industry’s work to create such solutions.



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The annual Design & Health International Academy Awards programme has a significant influence on the global design of humanistic environments that support health, wellbeing and quality of life, reflecting important aspects of the exceptional work undertaken by researchers and practitioners at the forefront of the field of design and health. The Dyson Centre for Neonatal Care at Bath’s Royal United Hospital scooped a commendation in the Health Project (under 40,000 sq m) category. The development was designed by Feilden Clegg Bradley Studios and also won a second commendation in the International Sustainable Design class. The Centre opened its doors on the 23rd July 2011 to its first babies. The project, funded as a 50/50 partnership by NHS budgets and fundraising by The Forever Friends Appeal, has resulted in a dramatically different and improved environment in which the RUH can care for the 500 premature and sick babies that

it looks after each year. A pioneering holistic and therapeutic approach towards the new building has created a new low carbon unit allowing the staff to practice new methods of care for premature and sick babies. The building consists of a single storey new‐build extension, and the refurbishment of the space occupied by the existing NICU facility. The new‐build element accommodates the clinical, support and reception functions as a discreet but contemporary intervention. The refurbished element comprises staff and parents’ facilities. The two elements are linked by a new ‘umbilicus’ which also provides an access point for emergency vehicles. The new building encloses an external courtyard space which provides both vista and breakout from reception and parents areas. The grouping of the care rooms forms a route around the staff base which is the heart of the unit. The clockwise circuit of cot rooms forms a diagram of intensity of care, beginning with

intensive care, then on to high dependency, then special care, on to the parents’ rooms, then finally home. From parents’ feedback progress along this ‘route’ is very important psychologically – it is important that the ever‐decreasing intensity of care is legible to parents. The consulting examination and treatment spaces are carefully daylit. Parents and staff can now perceive changing external conditions through day and night, increasing well‐being. The heart of the clinical area is generously roof lit providing daylight to all the central spaces within. Sunlight is allowed to enter the building in certain controlled areas to add sparkle and delight without disturbing the working of the unit. Within the care areas light is carefully controlled to ensure that babies gain an awareness of day and night as they develop. Sustainability in construction and use has been central to the design. The team were adamant that the new NICU should not be a one‐off showcase for sustainability, but should serve as a template and catalyst for sustainable healthcare design by challenging existing standards, defining new targets and developing strategies replicable elsewhere in the health sector. E

UK HEALTHCARE PROJECTS SHINE AT ACADEMY AWARDSThe UK continues to set the pace for healthcare architecture, with several projects singled out for praise at the 2012 Design & Health International Academy Awards, held in Kuala Lumpar in June during the 8th Design & Health World Congress & Exhibition.

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Dyson Centre for Neonatal Care at Bath’s Royal United Hospital. Photo by Craig Auckland/ Fotohaus.

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E The unit is constructed entirely in cross laminated timber. This construction has benefits in terms of embodied energy, and is quick and clean to construct within a healthcare environment. The timber is exposed internally, creating a more calm and domestic environment within an acute clinical setting. The project has achieved Breeam ‘Excellent’, and incorporates a sedum roof for rainwater attenuation, and to increase biodiversity on the site. These measures will combine to make the Unit a beacon for sustainability across the health sector.

DESIGNING OUT MEDICAL ERROR Winner of the International Research Project category was Designing out Medical Error, authored by Johnathan West and Grace Davey of Helen Hamlyn Centre, Royal College of Art and Oliver Anderson of Imperial College London. One in ten hospital patients in the UK suffers unintended harm as a result of medical error - a key contributing factor is that clinical processes continue to evolve but the design of much ward-based equipment remains largely unchanged. The Designing Out Medical Error (DOME) project aimed to better understand and map healthcare processes on surgical wards, establishing an evidence base to design equipment and products which better supports these processes and therefore reduce instances of medical error. This three-year multidisciplinary project was set up with the aim to reduce medical error by creating a better fit between healthcare processes on surgical wards and the equipment and products that support them. The research team mapped surgical processes with NHS staff and patients; investigated how safety is managed in analogous industries; and used novel research techniques to identify and prioritise the five most error-prone processes on surgical wards - hand washing, information handover, vital signs monitoring, isolation of infection and medication delivery. Interventions were designed for each process and tested in a simulated ward environment. These include the Carecentre, an all-in-one unit for the equipment needed for patient care in the bed space, a communication campaign for hand hygiene, and a new trolley to monitor vital signs that is easier to clean and use. Some of the design interventions are undergoing clinical trials and have been taken forward by manufacturers to production.

ENDEAVOUR UNITAlso commended in the Health Project (under 40,000 sq m) category was The Endeavour Unit at James Cook University Hospital in Middlesbrough, designed by NBBJ. The project is central to the vision of South Tees Hospitals NHS Trust for major expansion and modernisation of cancer services at James Cook University Hospital with a focus on radically improving the patient environment and associated recovery. Separation of

clinical functions frequented by inpatients from those that serve outpatients enabled construction of a new £13m satellite facility for radiation therapy, the Endeavour Unit. The ambulatory oncology centre allows patients to experience optimum cancer treatment in a holistic environment that is comfortable, efficient, non-clinical and, importantly, where they do not feel fear whilst undergoing the highly stressful procedures of radiation therapy. Simultaneously the BREEAM Excellent project regenerates and defines the hospital’s north-entrance square, enhancing way-finding and creating a sense of place. The patients’ journey is at the heart of the design. Clinical spaces, including an outpatient’s clinic, three linear accelerator treatment bunkers (with flexibility for a forth) and a CT-scanner suite, are placed in individual blocks around a single double-height reception space. Wide gaps between the brick clad volumes open this waiting-space towards landscaped ground, creating a ‘pavilion in a garden’ with daylight streaming in. Innovative integration of the historically often intimidating linear accelerator treatment bunkers greatly improves patient access and experience, eliminating the traditional maze like approach featuring 90 degree turns to dissipate radiation. The result is an easy to read environment, a place that promotes healing through views of nature, natural light & ventilation, and by instilling a feeling of privacy and of being in control. A reduced sophisticated range of finishes including warm large tiles, oak ceilings & privacy-screens, combined with artwork and low-level lighting generate the opposite of a harsh, clinical environment. Back-lit images of local countryside incorporated within ceilings above treatment tables encourage patients to feel relaxed. A ‘floating roof’ clad in reconstituted stone covers the central waiting-space while the CT-suite roof projects to form a covered colonnade, leading patients towards / into the building. These overlapping roof planes generate a welcoming transition from outside to inside,

providing shelter for arriving patients and add striking shadow play to the overall composition. Construction commenced in March 2010 and was completed to programme in September 2011. Delivered below budget, the project returned savings of over £500k to the Trust. The Ferndene Children and Young People’s Centre in Northumberland won the top prize in the International Mental Health Design class. Designed by Medical Architecture, Ferndene opened in autumn 2011 and is a purpose built £27 million inpatient centre which provides inpatient assessment and treatment for young people with complex health, behavioural and emotional needs including those with a learning disability. Ferndene is the first such integrated service of its kind in the country. The modern facilities provide accommodation for children and young people from the north-east of England and Cumbria and some of the specialist services also receive referrals from across the United Kingdom. All the young people have their own bedroom, most of which have en-suite facilities. There is also a wide range of therapy, educational, social and recreational facilities; a flat for visiting families; and office accommodation for staff.

INTERIOR DESIGNExcellence in interior design and use of the arts was also highlighted, with two nods to UK projects. Central Manchester University Hospitals NHS Trust was highly commended in the International Use of Art in the Patient Environment category for its hydrotherapy project created by LIME Art). In the International Interior Design Project category, Northwick Park Mental Health Centre in north west London, designed by Broadway Malyan, was also commended. L

FULL LIST OF WINNERSThe award attracted almost 100 submissions. For a full list of the winners and commendations visit tinyurl.com/7ntro7n

Design & Build

DESIGN AND HEALTH INTERNATIONAL AWARDS

The Endeavour Unit at James Cook University Hospital in Middlesbrough, designed by NBBJ.



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Written by Alan Aldridge, executive director, ESTA

The health sector uses huge amounts of energy and makes great efforts to ensure that it is used efficiently. However, energy is one of those areas where continual technological development means there are always opportunities to save even more. Structural and policy changes affecting the sector also open up new ways of saving more money and reducing emissions still further. Perhaps because of the rapidly changing policy and compliance landscape, the health sector finds itself in the unenviable position of ‘bucking the trend’ and recording an increase in energy intensity. How can hospitals turn this negative performance indicator into a positive one? One of the issues occupying the larger Trusts over the last few years has been the introduction of the Carbon Reduction Commitment Energy Efficiency Scheme (CRCEES). In its original form, this was a revenue-neutral way of encouraging greater energy efficiency. Indeed, the best performers under this scheme would have made a net gain on their payments to the Treasury. That form of the CRCEES, unfortunately, never made it to the light of day. Instead, the scheme has become a straight carbon tax and the aim of all the participants is simply to reduce exposure by cutting back on emissions. The Government has recently held a further consultation on ‘simplifying’ the CRC which only adds to the current uncertainty. Its response to the consultation is not now due till October, but whatever happens, it will not go away. One obvious reaction to this carbon tax is to attempt to decarbonise the energy supply, switching to renewable energy wherever possible in order to minimise emissions and, consequently, the need to purchase emissions allowances. Unfortunately, that is not likely to be the most cost-effective way of addressing the challenge. Renewable energy is not likely to be any cheaper than any other form of energy to buy – and certainly not if onsite installation is being considered. And while there

may be some saving from a reduction in carbon allowances, it must always be remembered that the cheapest option is the one where you do not need to buy the energy in the first place. And that means improving energy efficiency. Over recent years, there has been much talk about a ‘waste hierarchy’ which determines how the issue of waste should be approached – it is now a formal part of the Waste Directive. The first step is to minimise the amount of waste produced. Recycling comes next and at the end of the process ‘disposal’. In energy there is a similar process. Here the first step is efficiency, cutting out any excess consumption and wastage.

STAGE 1So for Stage 1, switch off plant and equipment that does not need to be on overnight, early morning or late evening – such as compressors, chillers, boilers and, importantly, lights. In Stage 2, make sure that whatever you use is energy efficient – both the fundamental efficiency of the equipment (such as motors and lights) as well as the

way it is controlled; for example, make sure heating and cooling are not on at the same time. The return on investment on these stages is likely to be 30-50 per cent – far, far higher than the 5-12 per cent achievable on renewable energy installations. Only after this stage, when the aggregate energy demand has been reduced to a minimum, should decarbonisation and onsite renewables be considered. By tackling the issue in this way, the residual carbon footprint is kept as small

as possible, which cuts down the cost of final decarbonisation. And this final stage is likely to involve the biggest budget items anyway.

OUTSOURCINGAn increasing number of hospital trusts are outsourcing their energy management requirements, along with other activities, in order to concentrate on their core responsibilities of providing healthcare to the community. After all, it makes sense to entrust specialist tasks to experts. However, that does not absolve the trust from all responsibility or influence in this area. In the long term, it is the customer that pays for the service one way or another and it is important to ensure that the contract provides good value for money. We have come a long way from the accounting rules of the 1980s where the capital investment involved in outsourced services such as energy was included in a hospital’s own budget, making contract energy management (CEM) or energy performance contracts unattractive. This delayed the introduction of public sector outsourcing in areas like energy, while in other parts of the world – and particularly the USA – it became the norm. Today, outsourcing is an accepted practice within the public sector and a number of the larger hospital trusts have opted for this route. The energy contractor will normally replace old and inefficient equipment with new, highly efficient alternatives following a thorough review of the requirements – both current and likely – of the hospital. New technologies like Combined Heat & Power (CHP) and photovoltaics might make up part of this programme of refurbishment and upgrade, as well as new control systems for the internal environment. In this way the client gets brand new equipment without the need for a large upfront investment. The contract is for a fixed period of time, with the whole programme being financed either through a fixed price per unit of energy or through sharing the savings achieved under the new regime. The idea is similar to that proposed in the

Green Deal where energy efficiency measures will be financed through the savings achieved over their lifetime. The benefit to the energy user is that, again, there is no upfront injection of funds and in addition energy bills start dropping from the time the measures are installed. For smaller hospitals, the Green Deal, when it arrives, should enable them to make a step-change in their energy performance too. Outsourcing energy services does not mean that the customer should just walk E

Energy management is not a ‘black art’ and should not be perceived as such by colleagues.At its simplest, it is using a scarce and increasingly expensive resource as wisely as possible.

ENERGY MANAGEMENT

THE SMARTER USE OF ENERGY IS NOT A BLACK ARTWith huge efficiency savings expected from the health sector over the coming years, all opportunities for improvement need to be systematically assessed. Savings can almost always be made through greater energy efficiency, even where programmes are already in place, argues Alan Aldridge, executive director of the Energy Services and Technology Association (ESTA).

EnergyBUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net




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E away and let the contract run its course. For a start there are some areas where it is not entirely clear who should take the initiative. If a trust has a contract with a performance contractor that allows it to buy energy for a fixed price, that may not be a sufficient incentive to encourage the service provider to actually cut energy consumption. After all, that will ultimately reduce revenue. The initial contract negotiations need to address this potential ‘hole’ in the strategy. Equally, if the contract is framed purely in terms of the efficient operation (and replacement) of the energy equipment on site, then the whole area of occupant behaviour is left unaddressed. Now, the evidence suggests that behavioural change can make a major difference to the savings achieved. There is a (perhaps apocryphal) story about a hospital in the south west of England that, some years ago, introduced tamper-proof thermostats to the wards and administration areas in an attempt to take the ‘human factor’ out of internal environmental control. It did not take too long before staff worked out that by placing a cold pack on the thermostat they could switch the heating on and likewise a heat pack would trigger cooling. Needless to say, this ‘automatically controlled’ building saw its energy bill rocket. This may be an extreme example but every energy manager knows the potential reductions in consumption to be gained from engaging staff in energy savings campaigns (rather than antagonising them). Yet who has responsibility here? In a shared savings scheme there would be a clear incentive for the services provider but the employer (i.e. the trust) would still have control over staff training and the time they spend away from their paid jobs. Ideally, the two partners will work together to encourage ‘responsible’ behaviour amongst the workforce. The energy services provider would have the expertise and systems-specific knowledge to develop and deliver the training. For the hospital trust, engaging the staff more closely with environmental goals like energy efficiency can help add to its attractiveness as an employer as well as its green credentials with other stakeholders.

DOING IT YOURSELFWhen the size of the facility does not justify a full energy performance contract and energy management remains an in-house function, the energy manager will have to address most of these issues themselves. It may still be useful to hire energy specialists for particular tasks such as energy audits and dealing with CRC returns, etc. While the Carbon Trust register of energy consultants has now been closed, ESTA – in cooperation with the Energy Institute – is launching a Register of Professional Energy Consultants which should make the selection process easier. The Register will provide a search function for energy users to find

people with the particular skills they are looking for. It will also provide a forum where energy users can invite qualified consultants to tender for contracts.

AUTOMATIC MONITORINGOne of the most effective pieces of equipment for in-house energy managers is an automatic Monitoring & Targeting (aM&T) system. This takes away the repetitive aspects of data collection and analysis. The system can be interfaced with other office processes like billing and reporting. Importantly, many of these systems will automatically produce the Display Energy Certificates (DECs) now required annually for most hospital buildings.

Monitoring & Targeting will help energy managers identify anomalies as soon as they occur and deal with them – machinery breaking down or controls sticking in the ‘on’ position, as well as the gradual performance ‘drift’ seen in nearly all equipment (see fig 1). Another area to consider is the introduction of formal energy management strategies and programmes. Globally, energy management is assessed under the ISO 50001 Energy Management Systems procedure, which is largely based on the European Standard BS EN16001, which many energy managers will know and love.

A number of ESTA members were closely involved in its development.Because it mirrors many of the basic elements of ISO 14001 and the ISO 9000 series, its structure is readily understandable by managers from most disciplines and this brings energy management into the more general framework of management reporting. This enables performance to more easily reported to senior managers and funding requests made in a way that is more accessible to CFOs. Its systematic structure also makes the task of energy management itself more pragmatic and logical. Energy management is not a ‘black art’ and should not be perceived as such by colleagues.

At its simplest, it is concerned with using a scarce – and increasingly expensive – resource as wisely as possible. Whether the programme is driven in-house or externally, the challenge is to keep up with the latest developments and implement them appropriately. L

FURTHER INFORMATIONThe Energy Services and Technology Association (ESTA) 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

While the Carbon Trust register of energy consultants has now been closed, ESTA, in cooperation with the Energy Institute, is launching a Register of Professional Energy Consultants which should make the selection process easier.

Energy

ENERGY MANAGEMENT

Figure 1. Performance drift. As the days get colder, more heating is required. Without proper monitoring and effective controls, settings tend to ‘drift’ away from the optimum, resulting in higher standing losses (horizontal dotted line) and day-by-day fuel use.





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Energy efficiency and costs are firmly in the spotlight for the public sector. The Energy Event, taking place on 11-12 September 2012 at the NEC Birmingham aims to help public sector professionals to optimise their organisation’s energy use, comply with legislation and put in place sustainable energy efficiency and procurement solutions. Headline speakers include Philip Lowe, director general of energy at The European Commission, ITV News correspondent Daisy McAndrew, Professor Brian Cox, Alastair Campbell and professor James Woudhuysen. The exhibition will sit alongside two other events - The Renewables Event, which focuses on renewable energy technologies, and RWM in partnership with Chartered Institute of Wastes Management.

ASSOCIATION INPUTThis year’s show has been put together with valuable input from key industry associations including ESTA, Major Energy Users’ Council, Energy Institute, Waterwise, GAMBICA, BCAS, BCIA and WTL - a line-up that ensures that the event remains innovative, inspirational and essential. The conference programme is spread over four dedicated theatres, and the conferences will examine the issues and concerns facing the energy

sector and the challenges of reducing costs and risks now and in the future. The Energy Information Theatre will feature expert advice on energy efficiency and energy management; industry experts will be presenting case studies on how organisations can benefit from energy monitoring and energy management. One presentation focuses on designing out energy inefficiency in buildings, with another looking at changing user behaviour, and the resulting energy savings. Keynote speakers will offer some compelling guidance on current thinking and some frank views:

James Woudhuysen, professor of forecasting and innovation at De Montford University, will explain why he predicts that power cuts are coming, the fallacy of smart meters, and green jobs – why the subsidies don’t work. Visitors also have the chance to hear from Professor Brian Cox and Alastair Campbell – both there to answer the fundamental or most challenging questions about the universe and politics, spin, and communications strategy. The afternoon sessions are curated by the Major Energy Users’ Council and

will include discussions about Britain’s decarbonisation and the role and effect of bureaucracy on energy efficiency. The Energy Insight Conference will debate the issues that are crucial those responsible for energy purchasing, and the carbon reduction policies and practices within their organisations. It will be chaired on the first day by Daisy McAndrew, ITV News special correspondent. Speaker highlights include Philip Lowe, director general of energy at the European Commission, talking about the investment needed to meet European electricity demand; Volker Beckers, CEO of

RWE npower, covering the future of energy use in the UK and Chris Train of the National Grid, who will be discussing low carbon energy sources. There will also be a compelling panel discussion on how the UK will cope with demand, and current thinking on low carbon energy sources. The presentation on creating renewable energy strategy will give public sector organisations looking at renewable energy an in-depth insight. The ESTA Theatre is curated by the Energy Services and Technology Association (ESTA), whose seminars are designed with energy managers in mind to offer a comprehensive understanding of principles, awareness of policy issues and

effective implementation to produce savings. It also focuses on maintenance and management costs, which will help manufacturers to understand how to bring energy costs down. The Hosted Content Theatre will feature presentations by a mixture of associations and exhibitors including Waterwise and npower. The seminars will cover water efficiency, energy procurement and a live energy debate.

FURTHER INFORMATIONwww.theenergyevent.com

THE ENERGY EVENT

OPTIMISING ENERGY USETaking place in September, The Energy Event features an impressive speaker lineup that includes professor Brian Cox, former government spin doctor Alastair Campbell and James Woudhuysen, professor of forecasting and innovation at De Montford University

Energy

Ian Hargreaves established HCS Consulting in 2000 after 18 years’ experience in Estates in the NHS, 13 of which included overall responsibility for energy management and capital projects. Since then, HCS has carried out energy consultancy services extensively within the NHS and the public sector, including Carbon Trust funded surveys, and currently provides tailored energy management services (particularly useful where the Trust no longer has a full-time energy manager), air conditioning reports, Carbon Trust Standard accreditation and advice, and Display Energy Certificates. HCS Consulting is a member of ESTA, and

is listed on the new ESTA/Energy Institute Register of Independent Energy Consultants. Ian has recently qualified as a Certified

Measurement and Verification Professional, which enables him to independently verify savings claimed for energy efficiency schemes (of any size) that repay the capital cost through annual savings – particularly important when increasing energy costs or changing practices obscure the savings. HCS Consulting can also offer validation of your Trust’s carbon emission footprint to the WRI/WBCSD GHG emissions Protocol or for CRC, EU ETS or ERIC annual returns.

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Although Legionella bacteria are common in natural water courses such as rivers and ponds, they rarely pose a significant danger to the population when in their natural environment. However, within engineered water systems, Legionella can readily grow, with cooling towers, evaporative condensers and domestic water systems most commonly associated with outbreaks of the disease. With approximately 500 cases reported in the UK each year, around 35 of which are fatal, preventing incidents of Legionnaires’ Disease is a priority for anyone who is responsible for managing premises that utilise wet cooling systems, process water systems and domestic hot/cold services. For the healthcare sector, the naturally compromised immune systems of many patients in hospitals increases the risk posed by the Legionella bacteria.

RISK MANAGEMENTHealth and Safety legislation in the UK requires all employers to consider the risks from Legionella and to take the appropriate precautions. The majority of organisations do not have the in-house resources to assess and tackle the threat of Legionella sufficiently, so will utilise the services of specialist risk assessment companies such as the RPS Group. Amongst its 5000 staff across the world, the RPS Group employs highly qualified and experienced Legionella consultants, who conduct risk assessments, independent audits and microbiological sampling within the Healthcare sector. Whilst identifying companies to assist with assessing the risk of Legionella is relatively straightforward, how can procurers in the healthcare sector be sure that the services are fit for purpose and will help them to discharge their legal obligations? The answer, increasingly, is accreditation. Accredited Legionella Risk AssessmentTogether with industry and other relevant stakeholders, UKAS has helped to develop a framework for accrediting Legionella risk assessments under both ISO/IEC 17020 (General criteria for the operation of various types of bodies performing inspection) and British Standard BS 8580:2010 (Water Quality – Risk assessments for Legionella control

– Code of Practice). The British Standard has been produced in order to underpin The Health and Safety Executive (HSE) Approved Code of Practice and guidance document L8 (Legionnaires’ Disease: The control of Legionella bacteria in water systems).

CONTINUING PROCESSAchieving UKAS-accredited status is a rigorous and continuing process that does not end with the initial assessment visit. The organisation applying will undergo a four year assessment cycle, consisting of two thorough visiting assessments and two further surveillance visits. During each of the visits the organisation will

have to demonstrate that it is technically competent, that its staff is suitably qualified, its working practices are fit for purpose, and the appropriate equipment is being used. The Health Protection Agency has stated that “UKAS accreditation assists clients in their selection of assessors and leads to greater consistency of Legionella risk assessments, with consequent improvements in protection of the public health.” As one of the first companies to achieve accreditation under the new BS 8580 standard, RPS is ideally placed to assess the impact that accreditation has on customer confidence. Mike Rose, commercial director at RPS said. “UKAS accreditation E

Whilst identifying companies to assess the risk of Legionella is relatively straightforward, how can procurers in healthcare be sure that the services will help them to discharge their legal obligations? The answer, increasingly, is accreditation

LEGIONELLA

ACCREDITATION: DELIVERING CONFIDENCE IN LEGIONELLA RISK ASSESSMENTSNHS Lothian is still investigating the cause of an outbreak in which three men died and around 100 people had confirmed or suspected cases of Legionnaires Disease. John Murthy, UKAS, explains how procurers in healthcare can help discharge their legal obligations through accreditation.

LegionellaBUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net


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Quality Through PartnershipILS is a market leader in the provision of contract laboratory food and pharmaceutical testing services in the UK, providing a wide range of UKAS accredited, GMP compliant chemical and microbiological testing to both the food and pharmaceutical industries.

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new and emerging companies all producing pharmaceutical ingredients, products and medical devices. The extensive scope of testing, conducted within the pharmaceutical division at ILS is carried out within our two pharmaceutical testing departments: Pharmaceutical Microbiology and pharmaceutical Chemistry. Our laboratories are fully equipped to respond to the increased demand for out-sourced pharmaceutical testing. Continual expansion and investment in new technologies, instrumentation and laboratory personnel ensures our customers continue to receive a ‘Total Quality Service’. Food testing has been conducted by ILS for almost 40 years and during this time ILS has gained a vast knowledge, technical expertise and experience within the fields of food microbiology and food chemistry testing. As such there hardly be a food product or raw material that we have not

tested or analysed. Our purpose built food testing laboratories are amongst the most impressive, fully equipped facilities in Europe, catering for a wide range of food analysis. Continual expansion and investment in new technologies, instrumentation and laboratory personnel has led to our scope of UKAS accreditation to be one of the most extensive in the UK. It is the policy of ILS to incorporate good professional practice and quality into all aspects of its services. Some of our current accreditations and approvals include UKAS, Tesco, DEFRA and FDA.

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E helps us to demonstrate that our services are of the highest quality, providing the necessary comfort to procurers that we are competent to deliver on promises.”

TECHNICAL COMPETENCEConducting Legionella risk assessments with impartiality and integrity are key components of the new BS8580 standard. In addition to establishing the technical competence of staff and appropriateness of resources and facilities, UKAS accreditation also demonstrates that the services are impartial. This is becoming increasingly important to procurers of Legionella risk assessment services, as Mike Rose explains.“In the past procurers have had very little guidance over what constitutes a suitable and sufficient Legionella risk assessment. They may have had a suspicion that some companies providing the full package of assessment and remediation services have been offering assessment services at below cost price, safe in the knowledge that they will profit from any remedial works that their assessment identifies. UKAS accreditation assures clients of our integrity and that the assessment report provided will be an unbiased appraisal of the Legionella risk in that particular building.” Beyond giving organisations confidence in the quality and integrity of services they are procuring, using UKAS accredited services can provide them with other more tangible benefits, as Mike Rose outlines. “Nearly all outbreaks of Legionnaires’ disease can be attributed to a failing in management control of some kind. It goes without saying that

the main motivation for assessing Legionella risk is the health of employees, patients and others. However, there are also sound financial reasons for preventing outbreaks of Legionnaires’ Disease. Firstly there are the financial costs of being successfully prosecuted such as legal fees and fines to consider. But perhaps more importantly,

the negative impact on an organisation’s reputation can be very damaging in the long run, especially within the healthcare sector.”

ABOUT UKASThe United Kingdom Accreditation Service is the sole national accreditation body recognised by government to assess, against internationally agreed standards, organisations that provide certification, testing, inspection and calibration services. Accreditation by UKAS demonstrates the competence, impartiality and performance capability of these evaluators. UKAS is a non-profit-distributing private company, limited by guarantee. It is independent of Government but is appointed as the national accreditation body by the Accreditation Regulations 2009 (SI No 3155/2009) and operates under a

Memorandum of Understanding with the Government through the Secretary of State for Business, Innovation and Skills. UKAS is licensed by BIS to use and confer the national accreditation symbols (formerly national accreditation marks) which symbolise Government recognition of the accreditation process. UKAS accreditation provides an

assurance of the competence, impartiality and integrity of conformity assessment bodies. Accredited certification, testing and calibration and inspection reduces the need for suppliers to be assessed by each of their customers. UKAS’ involvement in international groups provides for mutual recognition which further reduces the need for multiple assessments of suppliers and as a consequence helps to reduce barriers to trade. It is therefore BIS policy to recommend the use of UKAS accredited conformity assessment services whenever this is an option. L

FOR MORE INFORMATIONFurther information about the accreditation of Legionella risk assessment activities can be found on the at www.ukas.com

LegionellaLEGIONELLA

In addition to establishing the technical competence of staff and appropriateness of resources and facilities, UKAS accreditation also demonstrates that the services are impartial.

The UK market is now becoming more stringent on what type of vessels are installed - whether static or flow through - depending on the installation and system requirements, but specific ‘flow through’ design is likely to become a standard requirement for booster set installations. Reflex manufactures a large extensive range of expansion vessels for different application in heating, chilled water, and drinking water in 3, 6, 10, 16 and 25 bar, and in 2 to 5000ltr sizes. The Type DD integrated internal circulation anti-legionella expansion vessels have just been WRAS tested and approved suitable for drinking water applications to the UK standards. The DD vessels range from 8 to 33ltr, and are 10 bar pressure rated with a butyl bladder in accordance to KTW–C norms. All vessels have a pre charge pressure of 4 bar nitrogen from the factory and are manufactured to EC norms for pressure vessels 97/23/EC. The complete range

of the flow through vessels are from 8 ltr to 3000ltr 10 bar and 16bar from 60 ltr to 3000ltr. The larger vessels are undergoing WRAS approval expcted to be approved later in 2012. The DD vessels can be supplied with special flowjet valves so the vessel can be isolated and/or media drained for replacement or modification. A ¾” T piece is included with all vessels supplied from 8 to 33ltr and can also be installed with flowjet as a packaged unit. The smaller DD WRAS approved range can be supplied with wall mounting

straps, whereas the 33ltr has its own lugs for wall mounting.The design of this unique expansion vessel is essential to the the prevention of legionella, as this is not a static media vessel and there is circulation through the vessel as all times when installed in the system flow. Reflex’s vessels are manufactured to high standard, but are priced in order to retain its market share in

the UK. Linked with similar system type products encompassing vacuum degassing, pressurisation pump and compressor systems (+/- 0.1 to 0.2 bar maintenance) etc. and with its technical expertise in these fields, Reflex is quickly becoming a useful partner to many installers and consultants in the heating and chilled water market.

FOR MORE INFORMATIONContact: Dan [email protected]

Reflex quickly becoming a useful partner to many consultants in the heating and chilled water market



LEGIONELLALegi

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Second Legionella outbreak: Cost cutting to blame?The second outbreak of legionella in two months has highlighted that cost cutting may be impacting on the maintenance of cooling towers. Nine people were confirmed with legionnaires’ disease in Stoke-on-Trent, following an outbreak in Edinburgh at the end of May in which three people died. Greg Davies, head of service development at Assurity Consulting, said that the failure to conduct proper and appropriate risk assessments, and implement and independently review the effectiveness of controls, is leaving systems open to contamination.

BAD PRACTICEDavies said: “In my experience, bad practice and poor performance are directly attributable to the majority of legionella outbreaks involving cooling towers. A contributory factor to this can be a reduction in the levels of service on systems – maintenance, water treatment or health and safety – in an attempt to try and cut or manage cost”. “Furthermore, duty holders can wrongly assume that the responsibility for managing and monitoring cooling towers becomes the sole domain of the contractor when it forms part of an outsourced contract. It does not. This issue is particularly problematic

as it leaves owners and building managers unaware of how their systems are performing and of any potential risks.”Davies identified the recent variable weather as a possible additional issue:“When there is variable demand for heating or cooling, periods of inactivity/low load can turn quickly to high load/continuous use. In these instances, if the towers are poorly maintained, treated and managed, the chance of a legionella outbreak could increase significantly.”

INTERPRETATIONAdrian Aylett, Hydrotec technical manager, said that there was a lack of correct interpretation of elements of the Health and Safety Executive Approved Code of Practice document L8 (the ACOP), which is leading to cutbacks in scale-control measures, which can lead to contamination. “Some choose to interpret ‘Some form of scale control is desirable’ as a reason for not employing scale-control measures in hard-water areas. This term ‘desirable’ has led to many projects having the scale-control measures deleted due to cost considerations.” Hydrotec (UK) has been in discussions with Dr Paul McDermott of the HSE to get clarification on their understanding of the L8 document as it stands in terms of scale-control measures. Dr McDermott stated that

cost considerations should play no part in the limiting of risk, and that all reasonable methods should be implemented to protect the system, should a water analysis identify that the water is of a “scale-forming consistency”. Davies added: “A company or operator needs to have in place measures, including a risk assessment, effective management control procedures and good processes of review, which in turn will act as an early warning system and flag up any potential dangers. Interpreting the term ‘desirable’ as a reason to opt out, with no realistic and substantive supporting information, is not a reasoned defence.”

MANAGING THE RISK“If L8 is adopted, interpreted and implemented in an appropriate and site-specific manner, you have a very good basis for managing the risk. It is usually failures in properly implementing the requirements that lead to problems occurring.” Davies continued: “Factors that have led to historic outbreaks of legionnaires’ disease include: poor installation, commissioning and maintenance; failure to adequately assess risk; roles and responsibilities not being clearly understood or abdicated; poor communication; a lack of specific training; and poorly introduced and managed schemes of management and control.”



Kingfisher Environmental Services (KES) specialises in the management of water quality in commercial and industrial buildings throughout the UK. Approved by the Legionella Control Association and to ISO 9001 quality standard, KES advises customers on all types of water management issues whether on an individual project basis or as part of a continual management programme. In the last 10 years KES has also become one of the UK’s leading testers of swimming pools and spas, helping both private and public swimming pool operators achieve good water quality within their sites. The strength and depth of technical expertise within the company is a reflection of the emphasis on staff training, and as such its customers have access to advice whenever they need it – whether on site or in the office. Wherever there are regulations or guidelines, KES will advise on how best

to achieve compliance whilst bearing in mind commercial issues. Areas of expertise include: Legionella risk assessment and Preventative maintenance programmes; Water sampling and analysis; Disinfection of domestic water systems; Cooling tower management; Swimming pool and spa sampling, and Pool plant maintenance and servicing. If you would like to discuss any of the services please contact Ian Lamaison via the details below.


Water management expertise from Kingfisher

If you are an employer or person in control of premises, you must organise a Legionella risk assessment, therefore a reliable thermometer kit is essential. ETI’s Legionnaires’ Temperature Monitoring Kit has been specifically designed to monitor the temperature of both standing water and the surface temperature of pipes and tanks that form part of the water system. Each kit contains a Therma 1 thermometer, three probes - penetration, precision ribbon surface and PTFE exposed junction wire, a tub of probe-wipes and a waterproof countdown timer, all housed in an carrying case. Legionella, like many bacteria, thrive at certain water temperatures and therefore a wide range of workplaces are at risk where artificial water systems exist, e.g. local authorities, large businesses, universities, hospitals, nursing and care

homes, schools, children’s nurseries, housing associations, charities, hostels, landlords, managing agents, hoteliers, guest houses and caravan and camping site owners. In fact, anywhere where water is stored and circulated around a building. ETI supplies the Legionnaires’ Temperature Monitoring Kit at £122.50 plus carriage and VAT.

FOR MORE INFORMATIONTel: 01903 202151www.etiltd.com

Legionnaires’ Temperature Monitoring Kit from ETI

Following the success in Bournemouth over the last two years, Infection Prevention 2012 continues to offer delegates an educational, informative and inspiring conference that is value for money, with access to more infection prevention companies under one roof than any other event in the UK. Organised by the Infection Prevention Society, this event is the major infection prevention conference and exhibition of the year. The conference has been awarded 15 CPD Credits, attracting over 600 delegates and more than 100 exhibitors with an array of renowned speakers covering all your infection prevention needs.

THE PROGRAMMEThe programme incorporates a cross section of infection prevention and control topics that will update, educate and enthuse both those new to this important area of clinical practice and those looking to expand their existing and extensive knowledge. Highlights of the programme are listed below. These lectures provide the latest information on clinical and professional topics that are essential for any professional working in infection prevention and control. The conference opens with a session from Dr Benedetta Allegranzi, Technical Lead, World Health Organisation (WHO) entitled “Global burden of healthcare associated infections”. Dr Allegranzi will provide delegates with an understanding of the worldwide burden of HCAIs, discuss the differing worldwide challenges and explore opportunities for improvement. Later on Monday morning will be an informative lecture on ventilation: “Which way does the wind blow?” from Craig Macintosh, principal clinical scientist, Wirral University Teaching Hospital NHS Foundation Trust. In this session Mr Macintosh will put ventilation and air hygiene into context in terms of overall causes of HCAIs, identify the basic principles of ventilation systems, and suggest a role for the audience as users of the systems. Monday morning concludes with The EM Cottrell Lecture, dedicated to the first Infection Control Nurse appointed in the UK, and given by Professor Judith Tanner, professor of clinical nursing research, De Montfort University. Entitled “Think; Plan; Do”, in this

session Professor Tanner will aim to show how a ‘can do’ attitude can be developed, while demystifying research and discussing how research can be implemented into practice. The final Monday session is an exciting, interactive courtroom enactment, “Infection prevention in the dock” by 7 Solicitors LLP. The objectives of this session are to take the mystery and fear out of courtroom appearances while providing an insight into how to conduct oneself if summoned to appear in court.

TUESDAYThe highlights of the second day of conference include a session from Professor Ian Cumming OBE, national director for quality during transition, National Quality Team entitled “Improving quality during times of transition”. Professor Cumming will explain the importance of continual quality improvement and the challenges faced improving quality during times of transition, and examine the processes and systems required to ensure high quality care is delivered during transition to a new healthcare system. Concurrently, Dr Julie Hughes, nurse consultant/senior lecturer, 5 Boroughs Partnership NHS Foundation Trust/University of Chester, will deliver an insightful session called “An ethnographic study of infection prevention and control in a mental health trust”. The objectives are to gain an in depth study of the challenges involved in complying with infection prevention in a mental health trust, gain an insight into the role of leadership, role models and organisational structure within infection prevention and control, and identify the educational/training preparation and the needs of healthcare workers in relation to infection prevention and control, making recommendations for practice.

WEDNESDAYDay three starts with the second eponymous lecture, The Ayliffe Lecture, which will be given by the renowned Professor Andreas Voss, professor of Infection Control, Canisius-Wilhelmina Hospital, Radboud University Nijmegen Medical Centre, The Netherlands. The morning features two additional concurrent highlights, the first of which is “Surface coatings – a review of the evidence” from Christopher Gush, head of clinical innovation and research, Royal College of General Practitioners. In this session, Gush will consider the rationale for antimicrobial surfaces in healthcare, and will provide an overview of available antimicrobial surfaces, illustrating gaps in the evidence for their use. The second of these concurrent sessions is on “E-coli - Management of an international wide e-coli outbreak” from Professor Dilys Morgan, head, Gastrointestinal, Emerging and Zoonotic Infections, Health Protection Agency. The objectives for this session are to understand the complexities and challenges of dealing with an international outbreak, identify the mechanisms for case finding on an international scale, and understand international surveillance systems and control measures. These are just some of the highlights of Infection Prevention 2012 and there are numerous other sessions to keep delegates interested. For the full programme visit www.ips.uk.net and follow the link to Infection Prevention 2012.

ORAL PRESENTATIONS AND POSTERSA highlight of the annual IPS Conference is always the oral presentations and posters. The 2011 event featured over 100 posters and 12 oral presentations which covered a huge range of subjects and provided an invaluable resource during conference. 2012 promises to offer a similar array of quality information. The closing date for abstract submissions for 2012 was the 2nd July 2012. The Exhibition at Infection Prevention 2012 will feature products and services from over 100 companies working within infection prevention and control. Some of these will be long term supporters of IPS, but the exhibition will also feature some new faces, new products and recent innovations. The exhibition offers the ideal opportunity to discuss particular infection prevention and control requirements with a huge range of specialist companies. E

A highlight of the annual IPS Conference is always the oral presentations and posters. The 2011 event featured over 100 posters and 12 oral presentations which covered a huge range of subjects and provided an invaluable resource.

INFECTION PREVENTION 2012

INFECTION PREVENTION 2012 BETTER THAN CUREThe UK’s largest infection prevention and control event takes place at the ACC, Liverpool On 1-3 October and promises to offer more infection control information under one roof than ever before

Infection ControlBUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net


Prescribing Information ChloraPrep® (PL31760/0002) & ChloraPrep with Tint (PL31760-0001) 2% chlorhexidine gluconate w/v / 70% isopropyl alcohol v/v cutaneous solution. Indication: Disinfection of skin prior to invasive medical procedures. Dosage & administration: ChloraPrep – 0.67ml, 1.5ml, 3ml, 10.5ml, 26ml; ChloraPrep with Tint – 3ml, 10.5ml, 26ml. Volume dependent on invasive procedure being undertaken. Applicator squeezed to break ampoule and release antiseptic solution onto sponge. Solution applied by gently pressing sponge against skin and moving back and forth for 30 seconds. The area covered should be allowed to air dry. Side effects, precautions & contra-indications: Very rarely allergic or skin reactions reported with chlorhexidine, isopropyl alcohol and Sunset Yellow. Contra-indicated for patients with known hypersensitivity to these constituents. For external use only on intact skin. Avoid contact with eyes, mucous membranes, middle ear and neural tissue. Should not be used in children under 2 months of age. Solution is flammable. Do not use with ignition sources until dry, do not allow to pool, and remove soaked materials before use. Over-vigorous use on fragile or sensitive skin or repeated use may lead to local skin reactions. At the first sign of local skin reaction, application should be

stopped. Per applicator costs (ex VAT): ChloraPrep: 0.67ml (SEPP) - 30p; 1.5ml (FREPP) - 55p; 1.5ml - 78p; 3ml - 85p; 10.5ml - £2.92; 26ml - £6.50. ChloraPrep with Tint: 3ml – 89p; 10.5ml – £3.07; 26ml - £6.83. Legal category: GSL. Marketing Authorisation Holder: CareFusion UK 244 Ltd, 43 London Road, Reigate, Surrey RH2 9PW, UK. Date of preparation: October 2011.

Adverse events should be reported. Reporting forms and information can be found at www.yellowcard.mhra.gov.uk. Adverse events should also be reported to CareFusion Tel. +44 (0)1235 867 967

References:1. Darouiche R et al. N Engl J Med 2010; 362: 18-26. 2. Department of Health (2011) High Impact Intervention: Care bundle to prevent surgical site infection. Available at: http://hcai.dh.gov.uk/files/2011/03/2011-03-14-HII-Prevent-Surgical-Site-infection-FINAL.pdf. Date accessed: 12.04.11. 3. UK PL 31760/0001 CHL158a Date of preparation: February 2012

Based on evidence from a recent study reported in The New England Journal of Medicine conducted using ChloraPrep,2 pre-operative skin preparation has been included in the High Impact Intervention for the prevention of surgical site infection for the first time.1

CareFusion offers advice on meeting infection prevention requirements as well as support and training in skin preparation techniques.

The and only

New GuidanceNew GuidanceNew GuidanceNew GuidanceNew Guidance New Guidance

New GuidanceNew Guidance New GuidanceNew Guidance New Guidance New Guidance

New GuidanceNew GuidanceNew Guidance



New GuidanceNew Guidance New GuidanceNew Guidance New Guidance New GuidanceNew GuidanceNew Guidance New GuidanceNew Guidance New Guidance New Guidance




The Department of Health has recently updated its high impact intervention care bundle for the prevention of surgical site infection to include pre-operative skin preparation with 2% chlorhexidine in 70% isopropyl alcohol1

licensed and evidence-based skin preparation system that allows you to meet these new guidelines3

To find out more, please visit www.chloraprep.co.uk

Prep the skin. Protect the patient.

E THE SOCIAL EVENTSThe exceptional educational programme at Infection Prevention 2012 is enhanced by the social events, which allow valuable time for building up relationships with fellow infection prevention and control colleagues. For those who would like to explore Liverpool, there is a tour of the host city the Sunday afternoon before conference begins, which will take in the city’s historical sights and will include a trip on the Mersey ferry. The Monday morning of conference starts with the annual “Run, Walk or Crawl for IFIC”, where delegates are encouraged to pull on their running shoes and be part of this year’s 5K route in Liverpool to raise money for the International Federation of Infection Control (IFIC). Monday evening’s entertainment is an indoor cirque extravaganza at the Circo Bar on Albert Docks, which will feature acrobatics, fun and games. The social programme finale is the annual Gala Dinner, which will be held on the Tuesday evening at the prestigious St George’s Hall. The Conference provides the ideal opportunity for continual professional development for all healthcare professionals. All delegates will receive a certificate of attendance after the event which will record the sessions that they have attended. In addition the programme has been awarded 15 Continuing Profession Development (CPD) credits for medical staff from the Royal College of Pathologists. All sessions will be mapped against the IPS competences - this information will also be on the certificates of attendance and full information will be available online. The mapped chart will help delegates decide which sessions they should attend as part of their professional development. L

FURTHER INFORMATIONDelegates can register at www.ips.uk.net Follow the conference on Twitter: @IPSConf

Infection Control

INFECTION PREVENTION 2012

Highlights from Infection Control 2011

To provide a taster of this important educational event, each month a speaker presentation and slides from the 2011 conference is uploaded to the IPS website, a link to which can be found on the IPS hompage at www.ips.uk.net. Presentations include the following 2011 sessions, which are currently available online for viewing:

EM Cottrell Lecture - Stronger Together: Anne Bialachowski, Immediate Past President, Community and Hospital Infection Control Association, Canada (CHICA)

Dare to soar - Your attitude determines your altitude: Tricia Hart, Deputy CEO, Director of Nursing and Patient Safety and DIPC, South Tees Hospitals NHS Foundation

The Hepatitis ‘C’hallenge – the national picture” Koye Balogun, Epidemiology Scientist, Centre for Infections, Health Protection Agency.

Reducing urinary catheter associated infections in care homes: Dr Cliodna McNulty, Head, Primary Care Unit, Health Protection Agency.

DDC Dolphin has expanded its HTM testing service to NHS hospitals with an increasing number of hospitals now committed to comply with the recommendations in HTM 20/30-01/01. With Hospital Acquired infections (HAIC) continuing to be a serious problem, infection control departments are seeing the benefit of a professional programme of testing. HTM 20/30-01/01 validation is the core of the washer disinfector service and maintenance programme that DDC Dolphin provides to hospitals, helping to reduce the possibility of HAIC. A nationwide team of 28 validation engineers is the largest in the UK, dedicated to Dirty Utility equipment. They are trained and accredited by Eastwood Park (NHS Training Centre), subject to regular

re-certification, and are equipped with the very latest testing equipment to carry out testing on all manufacturer’s machines. DDC Dolphin’s specialist engineers are trained to interpret test results correctly, and to produce HTM reports to a high standard. The excellent training validation engineers receive is reinforced through regular commissioning stage validations, weekly and quarterly testing, and annual revalidation to HTM standards. DDC Dolphin also provides breakdown and repair services and a range of preventative maintenance contracts.


DDC Dolphin expands HTM testing services for NHS





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Non-wetting, atmospheric and surface active dry mist disinfectant dispersal device that provides:-• Reliable,repeatableperformancewitheveryapplication• Fullyautomaticcontrolswithonebuttoncycleselectorforverysimpleoperation• Non-damagingtomostsurfaces,electronicdevicesequipmentandfabrics• Economicalinuseaspartofaroutinecleaningandhygieneprogramme• Incredibleeconomywithamaximumof80mldisinfectantusedper50m3room.• Simpleandsafetouse.Theportabledevicemeansmulti-roomapplications madeveryeasy,thedeviceevenautomaticallyemptiesattheendofeachcycle minimizingliquidspillage.• Effectivecoveragesupportedbyclinicalindependenttestingofmachine.• Independenttestsprove4,5&6logreductionsofenvironmentalcontamination inlessthan2hours(equivalentof99.99%-99.9999%)*• TestedworldwideincludingbutnotlimitedtoUSA,UAE,Germany,Ireland&UK• Minimaldowntimecomparedtoothersimilartechnologies.• ProbablytheonlytrueDryMistdisinfectingmachineavailable• Treatmentdoesnotleaveanystickyresidues• IntegratedaspartofnewuniquemuchlargerDryMistsystemoffering unequalledflexibledecontamination–availablesoon• Patentsappliedforworldwide

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Infection Prevention SolutionsInfection Prevention Solutions (IPS) is a leading Independent Infection Prevention and Control Company providing services across the UK

The Company provides a unique pro-active specialist service incorporating consultancy, audits, training programmes (some accredited by the RCN), staff support, development and publication of policies and procedures and strategic services inc. gap analysis and strategy review. We also provide a range of environmental microbiology services inc. assessment of Legionella management and specialist ventilation services together with guidance on new build and refurbishment work. We own a unique software system iCAT which is widely used within the NHS and independent sectors and provides access to over 1000 different audit tools. These comprise questions, answers, descriptive rationales and corrective actions. All questions are fully referenced. The tools are modified from DOH endorsed tools and are designed for use by non-specialist staff such as Practice Nurses or Practice Managers to undertake their own audits using our unique software as a web-based self audit. All reports are generated instantly and consist of a full colour coded report with corrective actions (fully referenced) and accompanied by an action plan for each audit.

This software is fully managed by IPS and tools are updated regularly to ensure content is consistent with current legislation, expert guidance and evidence-based practice.

If you would like to know more about our comprehensive Infection Prevention services and our very cost effective audit solutions which could benefit your Organisation please contact us on: 020 8906 2777 and we would be happy to discuss the different options available.

Alternatively, please visit our newly launched e-commerce website which lists all the services we offer including our full range of audit tools.

Find us at: www.infectionpreventionsolutions.co.ukOur offices are at: Gordon House, 1-6 Station Road, Mill Hill, London NW7 2JUTel: 020 8906 2777 Fax: 020 8906 2233 or email [email protected] Certificate No. GB2001573 Registration No. 0044/1

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Pull cords in toilet areas have long been identified as a potential source of skin and faecal bacteria. On contact, these germs can be transferred to hands, putting the carrier at risk of acquiring an infection. Effective cleaning of standard pull cords is hampered by the multifilament braid design which enables dirt and germs to become embedded. Now Actif Hygiene Ltd has developed the Biomaster Clean PullCord (www.cleanpullcord.co.uk), which has a durable, smooth, wipe clean coating impregnated with Biomaster Antimicrobial Technology. The non-PVC polymer coating can be wiped with standard cleaning products or disinfectants and the Biomaster additive provides protection 24 hrs a day from bugs such as E.coli and MRSA. The new pull cord has the appearance and characteristics

of a standard pull cord and can be easily retrofitted using the components already present. Available in white or translucent blue for bathroom pull cord, red for disabled toilet alarms or orange for nurse assistance alarms.


Who last pulled your cord?

Infection Control

Health Protection Agency reports high rate of surgical site infections following caesarean section operationResearch from the Health Protection Agency (HPA) identified 394 surgical site infections among 4,107 women followed up after a caesarean section operation (9.6 per cent). The majority of these infections were minor (88 per cent) and the risk was found to be higher in overweight or obese women, according to findings published in the British Journal of Obstetrics & Gynaecology. The study looked at data from 4,107 caesarean operations from 14 acute hospitals across England which were carried out in 2009. This rate of infection is higher than would be expected for what is considered to be a relatively ‘clean’ operation i.e. not in an area of the body with high bacterial levels such as the large bowel. Using similar methods to identify infection risk, the rate of infection following a hysterectomy is 6.6 per cent and for operations in the large bowel it is 14.7 per cent. Of the 394 women who developed an infection, 348 (88.3 per cent) were superficial incisional infections. These will clear up in a few days but will probably require antibiotic treatment. 19 (4.8 per cent) were deep incisional surgical infections affecting deeper tissues under the skin. These will require a course of antibiotics, along with possible hospitalisation and additional surgery on the wound in more serious cases. 27 (6.9 per cent)

were organ/space infections, 25 of which were classed as endometritis (infection of the lining of the womb) and two were other reproductive tract infections. These are infections which affect an internal body cavity, and can be debilitating to the patient; requiring a course of intravenous antibiotics, and hospitalisation in many cases. 23 (5.8 per cent) had to be readmitted to hospital for treatment of their infection (0.6 per cent of all the women). There were a number of factors that were associated with the development of an infection; the strongest association was with BMI (Body Mass Index), with a weaker association to the age of the woman. Obesity was strongly associated with development of a surgical site infection, with the risk of developing an infection, whether superficial, deep or organ/space, increasing the more overweight the woman was. Those who were overweight (BMI 25-30) were 1.6 times more likely to develop an infection, obese women (BMI 30-35) were 2.4 times more likely and those with a BMI over 35, 3.7 times more likely. The research also found that younger women (those under 20, compared to those 25-30) were 1.9 times more likely to develop an infection. Reasons for this are not clear and more research is needed in this area. Dr Elizabeth Sheridan, head of healthcare

associated infections at the HPA, said: “Reducing rates of surgical site infections following a caesarean should be made a priority. Given that one in four women deliver their baby by caesarean section, these infections represent a substantial burden. They will impact not only directly on the mother and her family but also are a significant cost in terms of antibiotic use, GP time and midwife care and every effort should be made to avoid them. Women choosing to have caesarean section for non-medical reasons should be aware of the risk of infection, particularly if they are overweight.” “As has been seen in both this study and several others, there is an established link between BMI and an increase in the risk of developing a surgical site infection. Monitoring infections in women having a caesarean section is important as a means to drive down infection rates. As levels of obesity are rising, optimising surgical techniques and identifying the most appropriate dosing of antibiotics could provide a means for reducing wound infections in obese women.” John Thorp from the British Journal of Obstetrics & Gynaecology added:“With the rise in numbers of women having a caesarean section and the rise in obesity rates, this issue is an important one. More needs to be done to address ways of reducing infection.”

Advanced Sterilization Products has a proven track record of designing and delivering innovative infection prevention solutions that dramatically raise the level of healthcare and safety for those who matter most. Its pioneering technology, global distribution and established leadership position enables the company to simplify the process of buying and operating infection prevention products and services every day, for thousands of medical facilities around the world. This in turn enables customers to focus on what they do best - preventing infection and saving lives. GLOSAIR™ 400 Area Decontamination Solution consistently protects your

environment against pathogens. ASP’s mist technology offers uniform diffusion of 5-6 per cent hydrogen peroxide solution, even in hard-to-reach areas. It’s mobile and simple to use, making it ideal for use throughout the NHS. Designed for small and large spaces particularly for use within a hospital setting, the GLOSAIR™ Area Decontamination Solution provides the right balance of safety, efficacy and convenience.

FOR MORE INFORMATIONTel: 01344 871081Email: [email protected]/emea

ASP - helping to protect lives against infection in hard-to-reach areas

Kärcher is the world’s leading provider of cleaning systems, cleaning products and services for recreation, household, trade and industry. Its products enable customers to solve their cleaning tasks in an economical and environmentally-friendly manner. Kärcher supplies the healthcare industry with a range of products including steam cleaners, scrubber driers, sweepers and high-pressure cleaners, as well as specialist detergents and accessories. Kärcher’s range of healthcare cleaning products can improve hygiene and

cleaning efficiency in a range of critical and non-critical healthcare environments. With on-site consultation, including demonstrations and trials, Kärcher helps its customers choose the right equipment for their needs. Kärcher also offers its customers comprehensive service contracts ensuring the long life and trouble-free use of their machines.

FOR MORE INFORMATIONTel: 01295 752142www.karcher.co.uk

Kärcher’s environmentally friendly cleaning systems



CLAMPING BAN COMMENCES 1ST OCTOBER 2012!

Covering the UK and Ireland

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For a FREE appraisalcontact Simon Mabbutton 020 8747 3466or 077 3076 6469

For more information on either of theseservices please contact Simon Mabbutton 020 8747 3466 or 077 3076 6469

Parkbytext allows parties to maximize revenue and reduce costs. Please visit www.parkbytext.com for further details

PEA also offersa cashless parking payment system called

Are Your Parking Bays BeingAttacked by Space Invaders?

Protect Them With The New Automatic SAFEGUARD Barrier

The SPACEGUARD barrier provides the perfect way to ensure your parking space is reserved for you alone! From October 2012 the enforcement of parking regulations on private land in England & Wales will be dependent on ticket issuing only and with the ban on clamping the incidence of unauthorised parking is likely to increase.

The SPACEGUARD is operated via a remote control key fob. Pressing the button on arrival will cause the barrier to drop and on departure simply repeat the procedure.

The SPACEGUARD takes about 5 minutes to install and is �tted with a battery that only needs to be recharged every 3 months for normal operation.

There is no longer a need to get out of the vehicle and insert a key to a drop post, you can do it all from the comfort and security of your car.

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Written by Dave Sm

ith, British Parking Association

There is no doubt that parking is something that permeates all of our lives. As a car driver - a shopper, commuter, a visitor to or a user of services such as healthcare, libraries, schools, colleges and universities. Or perhaps simply as a resident, whether living in a block of flats, a town centre housing estate or a detached property with a private driveway. Parking and where we choose or need to park our vehicles is often a daily consideration, and one that we increasingly have to give more thought to. At the British Parking Association we have recently published a new Five Year Strategy outlining our core objectives. In it, we outline our desire to raise standards in the parking profession and enable our members to provide better services for the motorist. New technology in the sector - including software and apps that help motorists identify and pay for parking, and energy efficient vehicles that are kind to the environment - is becoming more widespread and we hope that by promoting innovation, technology and sustainability we can assist in developing, challenging and moving our sector forward.

MASTER PLANOur annual Master Plan for Parking sets out what we think we must do together to achieve success for the parking profession. The issues outlined within this document are by no means exhaustive and we continue to develop our Master Plan each year as our profession matures. By continuing to work in a consultative and constructive manner, we aim to achieve the best outcome for the motorist and the wider parking profession. In early July, we launched our 3rd annual Master Plan for Parking coinciding with a reception to welcome our new President. The Master Plan supports our more formal approach of influencing government policy and we are well positioned to work closely with government both at Minister and Officer level. In addition, we want to work more closely with stakeholders to achieve our vision of excellence in parking for all. We have already forged links with the healthcare sector by developing a Charter for Hospital Parking, a new version of which is shortly to be published, which calls for fair and reasonable parking charges to ensure effective management and provision of service for

visitors, staff and patients. We encourage all those who manage parking at sites that provide healthcare to sign up to the Charter and over 75 organisations have already done so. More information can be found on our website at www.britishparking.co.uk/ Charter-for-Hospital-Parking.

AGING CAR PARKSOne of the BPA’s major concerns is the numerous aging car parks which are not properly serviced and maintained. Many are prematurely reaching the end of their useful life and being closed for safety reasons. Ideally, we would like to see owners and operators preparing and implementing a life-care plan and under taking regular structural safety inspections which will identify defects and prompt repairs to minimise the risk of structural failure. The closure of a multi-storey car park can have a detrimental effect on the community which the car park serves and works against the regeneration of town centres. Clearly, there should be a much greater emphasis on the need to ensure that parking structures are properly inspected and maintained. To facilitate this, proper servicing and maintenance should be seen as a priority cost

of the operation and not a call on so-called ‘surplus’ funds generated at the car park. Of course there is no point in having a structurally sound car park if it does not feel safe. Reducing crime and the fear of crime is another key initiative of the BPA and The Safer Parking Scheme does just that. It is owned by the Association of Chief Police Officers (ACPO), but operated and managed by the BPA on their behalf; all UK Government’s recognise the benefits of the Scheme.

PARK MARKSafer parking status, or Park Mark® as it

is known by the public, is awarded to parking facilities that have met

the requirements of a risk assessment conducted

by the Police. These requirements mean the parking operator has put in place measures that help to deter criminal activity and anti-social behaviour, thereby doing everything

they can to prevent crime and reduce the fear of

crime in their parking facility. For customers, using a Park

Mark® Safer Parking facility means that the area has been vetted by the Police and has measures in place to create a safe environment. Through the planning processes, our aim is for all new car parks to E

PARKING

PARKING IN RUDE HEALTH?A current diagnosis of the parking sector by Dave Smith of the British Parking Association, which has recently published a new five year strategy outlining its desires to raise standards

Parking

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at parking enforcement IT specialist, Imperial Civil Enforcement Solutions (ICES), has used the company’s trainers. “The quality of the training that ICES notice processing staff receive is very important to us,” says Ellis. “We entered into a contract in 2009 with South Thames College who put us onto one of their training provider, Pass Training Consultancy. We discussed our training needs with Pass, who agreed to provide an industry leading qualification in the form of the NVQ Business Administraion, which specialises in notice processing. The course was delivered in a timely and professional manner and has improved beyond doubt the professionalism of all the staff who have so far undertaken the NVQ. “Being an accredited City & Guilds NVQ, the qualification further enhances each individual staff member’s qualifications and is of value to them of the equivalent academic standard as five GCSE’s.”

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E be required to achieve a Park Mark® award. The BPA would like to see wider public awareness of Park Mark® and are asking Government, police organisations and other agencies involved in the regeneration and creation of safer communities and to become more proactive in promoting the benefits of the Scheme. Better promotion and public awareness will increase its popularity.

CLAMPING BAN And whilst we strive to promote safer parking for all, we are also embarking on a major awareness campaign of a different kind. On October 1st this year the landscape for parking on private land in England and Wales will change considerably as a ban on clamping and towing away on private land is introduced. When the clamping ban comes into effect on October 1st, all forms of vehicle immobilisation and removal will be prohibited in England and Wales unless there is some form of lawful authority to do so. It will be unlawful to take any action that might be considered to be immobilising a vehicle – including the simple action of closing and locking a gate. Vehicles causing an obstruction on private land can be relocated by landowner at his own expense but otherwise will be immune from any kind of action to remove the obstruction; the new law does empower the police to deal with them however and yet at the same time, it is reducing police resources. We don’t see Police putting a high priority on removing obstructions on private land. The positive news for landowners and operators is that, following lobbying by the BPA, the Act introduces a duty on the keeper to identify the driver when enquiries are made by the landowner or his agent. Failing this, the keeper becomes liable for any parking charges due as a result of the breach of contract or trespass. This will make it easier for parking operators to more effectively manage parking on private land and is fairer to the landowner; The Government indicated that it would not introduce these provisions relating to keeper responsibility until the BPA had established an independent appeals service. This appeals service, to be called ‘Parking on Private Land Appeals’ (or POPLA) is in development and will be established and managed by London Councils, who also provide the adjudication service for local authorities in London.

DVLA ACCESSFor the last few years, access to the DVLA’s database – which enables operators to follow up unpaid charges arising from enforcement action on private land - has only been available to members of an accredited trade association (ATA). The BPA provides this through its Approved Operator Scheme (AOS) which has been in place since 2007 and currently has around 160 members. The Scheme has in place a Code of Practice that sets standards of fairness for methods of parking enforcement on private land, including

vehicle immobilisation (clamping), ticketing and ANPR technologies. As part of their lobbying in response to the Protection of Freedoms Act, the BPA called for all organisations involved in parking management and enforcement to be a member of an ATA, such as the AOS. Unfortunately, as the Act stands, this is not part of the legislation and could result in some of the rogue clampers becoming rogue ticketers; giving out tickets, and relying on the motorist to pay the ticket without appeal. Time will tell whether this fear is justified. The new Act applies to all private land regardless of who owns it which means, as well as retail parks, supermarkets, leisure facilities and the like, so will it affect local authorities and other public organisations who manage parking on their own private land. There are important implications for local authorities and public bodies here and the BPA is working with the UK’s Driver & Vehicle Licensing Agency (DVLA) to better understand their requirements with regard to accessing the DVLA registers in these circumstances. Because the Protection of Freedoms Act provides for such significant change to the way landowners and their operators/agents carry out that management, the BPA’s Code

of Practice for Parking on Private Land is undergoing a significant revision and Code 2102 was published at the end of July to come into effect on 1st October. The Code will set out the key issues around levels of charging and signage, the two issues which motorists and consumers are most concerned about. As the Act only applies in England and Wales, the BPA is continuing to lobby the Scottish Government for the introduction of keeper liability provisions but this will not happen by October. This means that current law and practice will continue in Scotland. Additionally, in Northern Ireland, immobilisation and towing away will continue to be lawful as the Northern Ireland Assembly decided not to adopt the powers contained in the Protection of Freedoms Act. Working across the borders with our partner organisations and members

from each of these

nations is crucial to our understanding of the issues that are faced nationwide. There is much we can learn as well as being able to inform through shared experience and knowledge. BPA members are able to tap into a vast array of this knowledge through a variety of events and resources. A variety of special interest groups helps bring together members from specific fields of expertise to discuss and debate the latest topics and

our regional network, covering England, Scotland, Wales and Ireland, enabled the BPA and its members to come together to impart and garner information that is helpful and often vital to their organisations.

HEALTHCARE SPECIAL INTEREST GROUPThe next meeting of the BPA Healthcare Special Interest Group will take place on November 28th. Check the BPA website for further details on venue, timings and agenda. If you are interested in attending or would like to find out more about the work of the BPA, contact Alison Tooze, events and membership manager. L

FURTHER INFORMATION For more information visit www.britishparking.co.uk

When the clamping ban comes into effect, all forms of vehicle immobilisation and removal will be prohibited in England and Wales unless there is some form of lawful authority to do so.

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Coventry UH lifts parking charge cap

Patients with chronic conditions could be paying more for parking after Coventry University Hospital lifted the £150 a year cap on charges. The cap meant that those who visited the hospital regularly wouldn’t have to pay an unlimited amount in parking charges. In a statement, the hospital blamed the tough financial climate and said that there was a concession scheme in place for patients coming to hospital for regular treatment. Given the financial climate, the Trust Board made the decision in January this year to focus efforts on creating extra spaces for visitors and easing congestion, which it knows are issues which affecting the majority of patients and visitors. The Taxpayer’s Alliance gave a robust response to the changes: “This is a tax on being sick and totally unacceptable, particularly as it targets the most vunerable and those who can probably least afford it. It shows again that the PFI deals were poorly negotiated at the time,” said Robert Oxley, campaign manager. The hospital currently charges £7.70 for parking for 24 hours but cancer and renal patients can park for free as can parents of sick children who accompany them on an overnight stay. At City hospital in Birmingham parking for 24 hours costs £5.00. There is also no official cap on how much visitors have to pay in a year but there is a three month season ticket available costing £35. In Stafford, visitors to the hospital pay £6.00 for 24 hours but long-stay patients can apply for a discounted rate of £8.00 for seven days. Regular patients are considered for free permits. At the Leicester Royal Infirmary, the official parking charge for 24 hours is £12 with special reduced rate for patients and prime carers of £5.50.

Staff asked to pay back missed parking charges from two years agoMore than 500 staff at Cheltenham General and Gloucestershire Royal Hospitals have been asked to put their hands in their pockets after hospital management realised they had failed to collect £80,000 in parking permit payments from them as long as two year ago. Staff who park at Cheltenham General and Gloucestershire Royal Hospitals pay a fee for a permit. The cost, taken out of their salary over 12 months, depends on their income. Gloucestershire Hospitals NHS Foundation Trust declined to say how the error had occurred, but a spokesperson told This is Gloucester that it had ‘recently come to light’ that in the financial year 2010/11 the trust did not collect car parking permit payments from 796 staff, meaning it had failed to recover around £80,000 of income. The trust has apologised to hundreds of workers for the error. It has written off the debt from lower earners but is still asking 572 of its 7,500 staff to pay the remaining money owed. As the trust attempts to save £22 million this year, the move has been heavily criticised. Tracey Roberts, spokeswoman for the Royal College of Nursing in the South West, said: “It’s financial mismanagement. They are asking staff to trust that they are making the right decisions about cutting costs and they can’t even make basic accounting procedures work.”

She continued: “Health staff are already feeling the pinch of a pay freeze for the last two years, changes to pensions and the increased cost of living. Whilst the trust is offering to spread payments over a year, staff will also have to be paying this year’s parking fees as well. So it’s a double hit with many staff already feeling overstretched in the current climate.” Those who earn up to £15,000 annually pay £35 per year for a parking permit, while staff taking home more than £75,000 cough up £190 per year. Following discussions with the trust’s audit committee, it was agreed any staff member who owed less than £40 as a result of non-payment during 2010/11 should not have to pay with £30,738 written off. It has now sent a letter to the 572 individuals remaining asking them to agree to a 12-month repayment plan. Some members of staff have since left and will not be asked for the money. Ian Tait, director of estates and facilities, said: “We understand that this will be an unexpected cost for the members of staff affected and have apologised to each individual for the inconvenience it will inevitably cause. He continued: “The decision to recoup this money was not taken lightly. However we do have a duty to reclaim these costs and have tried to be as fair as possible in our approach.”

Staff car park handed over to visitorsWarwick Hospital is hoping to relieve pressure on parking by creating almost 100 more spaces for patients and visitors. Feedback from patients has led the South Warwickshire NHS Foundation Trust to turn one of its staff car parks into a second patient and visitor car park. Staff will be moved to a larger site off Millers Road, which the hospital is hiring for an undisclosed amount. With 277 spaces and a further 18 for disabled drivers, parking at the Lakin Road site is often difficult during visiting hours, and traders in nearby Millers Road have complained about visitors parking in the street.Describing parking as a ‘pressure point’, Matthew Statham, a governor who represents the public of Warwick and Leamington on the

trust’s board, believes paying for off-site land for staff is a ‘novel’ approach to a seemingly unsolvable problem. He said: “Car parking has come up at public meetings and governors’ meetings for as long as I’ve been a governor. “We need to make sure the staff can get to work and we need to make sure the patients and their visitors can get there.” Chief executive Glen Burley said: “The trust has decided to add an additional patient and visitor car park in order to alleviate some of the pressure that we have been seeing on our existing car park. We always try to take into consideration the best interest of our patients and visitors and this solution offers our local community easier accessibility to our hospital site.”

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The 2012 Annual National Conference of the Hospital Caterers Association (HCA) which this year was entitled “Accept The Challenge – Feed The Future” welcomed the appointment of Fionnuala Cook OBE as the HCA’s new president who was formally elected at the Association’s Annual General Meeting. The conference focused on the primary issues facing the NHS and hospital catering in 2012 with the emphasis on innovation, inspiration and recovery. The programme of speakers challenged delegates to work together to help create a better healthcare system that is modern, dynamic and can react to a changing environment. With the NHS facing the biggest cuts since its inception, hospital catering will be subjected to significant financial challenges and extremely tough operating circumstances in the years ahead. As a consequence, hospital caterers will be expected do more for less without compromising quality and find ways to work together to ‘feed the future’.

EDWINA’S EXPERIENCESThe conference opened with ex-Health Minister and politician Edwina Currie as keynote speaker. She gave a stirring account of her experiences of the health service from a visitor and patient perspective. She believed hospital caterers should take the lead on catering in hospitals and not government or managers. She also urged them to keep checking perceptions of the food with patients at all times. She stressed the need for them to identify ‘friends’ and not ‘enemies’ within the system and to work with them. She also said that NHS Trust board members should eat in the hospital restaurants in order to have closer affinity with the needs of the catering system, patients, staff and visitors. In her presentation about the development of new criteria for “Outcome 5 – Meeting Nutritional Needs”, Karen Oliver, national chair for the NACC and operations manager, Nottingham City Council said that its key aims was to provide personalised care for patients through adequate nutrition and hydration based on the requirements of Regulation 14 of the Health & Social Care Act.. The Care Quality Commission (CQC) has launched a toolkit entitled “Observation prompts and guidance for monitoring compliance”, as

a guidance for CQC inspectors as well as Food Facts Sheets with which the personal needs and tastes of individual patients can be taken into account and catered for.

PEAT REVIEWGraham Jacob, section head – workforce and facilities, NHS Information Centre explained how PEAT audits will be reviewed to meet the new Outcome 5 criteria. This will involve the inclusion of checks to see how services are being provided to meet the change in public expectations for food services. It was felt that the existing PEAT audit format was too focused on meeting the needs of the system rather than the patient and that the NHS had changed dramatically since PEAT first

started back in 2000. He also stressed that just meeting the minimum standards should not be regarded as good enough. Whilst remaining as an annual self assessment format, the new process is likely to provide motivation for improvement whilst also being a recognition of true excellence. It will also look at how to enhance the engagement with patients, assess a greater number of wards, not just one and it will review problems within the system such as caterers being held accountable for issues outside of their control. The aim is to pilot the new PEAT process in October 2012 with a launch target of April 2013. Outlining the content of a new British Dietetic Association (BDA) document to help dietitians, caterers and all those working E

Edwina Currie believes hospital caterers should take the lead on catering, and not government or managers. She urged them to keep checking perceptions of the food with patients at all times

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ACCEPTING THE CHALLENGE AND FEEDING THE FUTUREThe HCA 2012 Conference, highlighted the future emphasis on nutrition and hydration for effective patient wellbeing and clinical care

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E in food and beverage services achieve Outcome 5, Maxine Cartz, registered dietitian, Compass Group said that the aim was to provide a framework of standards with consistent methodology and language. The newly name “Nutrition and Hydration Digest: Improving Outcomes through Food and Beverage Services” brings all tools and evidence up to date as well as detailing new approaches to ensuring nutritional adequacy of menus regardless of the type of diet (e.g. vegetarian, cultural) and across all eating events of the day. The new Digest has been produced by the BDA Food Counts team and is endorsed by the Royal College of Nursing, the HCA and the Patients Association.

PHYSICAL & EMOTIONAL COMFORTDr Jocelyn Cornwall, director of the Point of Care Programme, The King’s Fund raised the question of “Food Quality and Assurance – Do We Care for Patients?” “Seeing the person in the patient” she said, was the focus of the Point of Care Programme. Within the NHS Patient Experience Framework, one of the key points is physical comfort as well as emotional comfort. Under NICE Standards for inpatient experience, providers will be held to account for delivering adequate nutrition and hydration for patients at all times. Dr Cornwall said that whilst patients are saying hospital food is improving but over the timeframe of 2002-2010 it is still, in reality, progressing very slowly. She stressed that with the changing demographics of the population and the profile of patients, training and the physical design of hospitals have not kept pace with the changing face of patients. 65 per cent of admissions are over 65, one in four are over 85 and 10 per cent are over 90. She pointed out that a fundamental change was needed from setting policy to the frontline of services with a need for a complete re-think of care provided. Food also need to be thought about differently. “Food was not only about nutrition and nutrients” she said “but also a source of pleasure, comfort and familiarity”.

PROTECTING THE KEY ASSETUnleashing the potential of employees as champions of public health was the focus of the session by Professor Heather Hartwell, associate professor of health and social care at Bournemouth University. Highlighting the connection between work and the health of the nation, Heather explained that the cost of employees not in work because of sickness cost the country £100bn per year. She stressed that it was the duty of employers to protect their key asset – their workforce. As a significant employer, the NHS together with the food service industry, should work towards helping employees make healthier food selections through measures such as food labelling, availability of healthier options in vending machines etc. She mentioned the availability of the Workplace Wellbeing Charter for England (2011) which as a self

assessment document, enables organisations to assess where they stand on their healthy eating commitment. Duncan Burton, deputy chief nurse at University College London Hospitals started his address with some startling statistics namely that 30 per cent of patients on admission to hospitals are malnourished and that malnutrition costs the NHS £13bn per year. He also said that with the NHS needing a 20 per cent efficiency improvement equivalent to £20bn on the NHS annual budget, saving money whilst driving up quality of care was a real challenge for nurses but he added, good nutritional care could help deal with this.

PRESSURE ULCERS Another startling statistic quoted by Duncan was that over 50,000 patients per year in England suffer from hospital acquired pressure ulcers, equating to £1.4–2.1bn to treat each year and 4 per cent of total NHS expenditure. He pointed out the role of good nutrition in reducing the incidence or severity of pressure ulcers and the obvious saving that could be made on treatment, if food and eating were given higher priority. He highlighted the important role of Protected Mealtimes, staggered across different wards at different times to allow clinical work to continue. Duncan also pointed out the need to focus on the Patient Recovery Pathway in order to set pre and post operative nutritional targets that could help improve recovery and reduce patients’ length of stay in hospital. With the ageing of the population and dementia on the increase, Duncan stressed the need to improve care for the elderly with eating. He also felt that there was a need to increase the focus on training for nurses to improve their awareness of the role of nutrition in the prevention of certain health problems, instead of the concentration on their treatment and cure. The conference culminated in a lively debate panel session which assessed the

arguments for and against topics ranging from how to simplify the supply chain and more effectively purchase ingredients; the possibility of outsourcing main

meal production to allow caterers to

concentrate on food services at ward level and

using fresh, locally sourced produce cooked in kitchens on all

hospital sites to the viability of creating one single national NHS menu. The panel included Kevin Goldfinch, buyer (Fresh Produce), NHS Supply Chain; Brian Young, director-general, British Frozen Food Federation; Martin Cantor, catering project manager, Royal Wolverhampton Hospitals NHS Trust and Mike Duckett MBE, catering services manager, Royal Brompton Hospital. The general consensus of was that caterers could produce the best food in the world but if it is not eaten by the patients then it is inconsequential where it comes from or how it is presented. It was agreed that caterers had to do more to ‘make friends with nurses’, to improve communication, to support better food service and to ensure assistance is available for all patients that need help with eating.

TURBULENT TIMES“We are working through some of the most turbulent times ever to face the NHS. The challenge to us all, regardless of outcome, is to rise above the maelstrom and to continue to provide the best possible patient feeding service we can without compromising on quality. This year’s speakers provided enlightening glimpses of how the future for hospital catering and the expectation for food provision in the hospital environment and the workplace in general is likely to change,” said Janice Gillan, national chairman, Hospital Caterers Association. L

FURTHER INFORMATION www.hospitalcaterers.org

CateringCATERING

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Written by M

atthew Sw

indells, chair, BCS Health

I chose to talk to the PHCSG regarding the changes that have been brought in by the recent Health and Social Care Act 2012, handing commissioning over to ‘clinical commissioning groups’, largely run by GPs. As the chair of the NHS Commission Board, Malcolm Grant recently said, the best clinical commissioning groups will be those with the best information systems. There is, therefore, an obligation on those who work in the area of primary care informatics, to step up to this challenge. Traditionally healthcare has stood out as the one industry where the perceived wisdom is that spending and quality are inextricably linked. It is held by many to be self-evident that if you reduce cost, you must, by default, increase how long people wait for care and reduce the quality of the service. No other industry can get away with this simplistic view, and the evidence shows that in healthcare the received wisdom isn’t true either. There are innumerable studies around the world to show that variations in quality are frequently nothing to do with the amount of money spent. Whether you look at the Darmouth Health Atlas showing the failure of higher spending to correlate with better outcomes in the US, or at the fact that many of England’s hospitals with the best clinical outcomes also have the lowest reference costs; you see that money can be spent wisely to get great outcomes at lower costs or badly to get poor outcomes at high cost.

CHALLENGEThe challenge for informaticians is to show that we can break the received wisdom, that we can we reliably and repeatably reduce cost whilst improving access, quality and outcomes through the application of information and technology. There are only two ways to drive cost reductions and quality improvement. Firstly,make individual healthcare institutions and services such as hospitals, community clinics and home nursing more productive. Secondly, make the whole health and care system more productive The former is critically important and the NHS should not be distracted from the important task of driving waste and inefficiency out of its services. I have previously written a number of papers and given several talks on the potential for productivity improvement in hospitals through process redesign and the application of

evidence-based care, supported by information and technology. In my talk I focused on the whole system and the opportunity to transform the economics of health and care by placing the patient at the centre of system design and using information and technology to improve their health and reduce their cost demand on the healthcare system. The challenge is for IT to enable the whole system, not just the silos – stepping out of our narrow institutional interests and finding a way to deliver benefits for the population, the patient, the NHS and its staff. This needs to be based upon five pillars: 1. Strong electronic health record (EHR) foundations in hospital care, primary care, community care and homecare – because without good, real-time clinical information, very little else is possible. There is a question about whether the purchaser or commissioner of care should worry about the EHR systems being used by their providers, or even whether they have a right to have an opinion. I would argue that if they are serious about managing quality and developing benefits through system integration they should insist that their providers have a digitised health record and are able to share this data in real time. The next generation of healthcare

information technology will apply knowledge algorithms such as prompts on the appropriateness of admission or the identification of patients at risk of being readmitted as an emergency, as the data is collected so that, for instance, preparation for managing their discharge can start as they come into hospital. These, and the hundreds of other intelligent support algorithms that it would be possible to build and run to support staff and protect patients, are dependent on comprehensive EHR gathering data on patients as it is known, not two days after discharge. Furthermore, commissioners should insist of the digitisation of the whole care pathway because it will support the elimination of ‘memory based care’ and the distribution of clinical decision support to propagate the application of best practice. It is well known that one of the keys to better, safer, lower cost care is the application of evidence, but it is also understood that the adoption of new knowledge into routine practice is painfully slow - one study showing that it takes 17 years for new knowledge to be adopted into practice by half the physicians. This is not because doctors are difficult and refuse to use the evidence in front of them. E

Einstein did not clutter his mind with ‘facts’ he could find in a book - he devoted his efforts to interpretation. The average clinic appointment doesn’t provide the time to refer to text books

HEALTHCARE IT

IMPROVING POPULATION HEALTH MANAGEMENTMatthew Swindells, chair, BCS Health, recently discussed using IT to improve population health management. This article elaborates on his discussions.

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E It reflects the fact that the volume of new evidence being produced, the complexity of care pathways and the number of professionals involved in providing care makes ‘memory based’ care a defunct approach to modern medicine. Einstein did not clutter his mind with ‘facts’ he could find in a book, he devoted his efforts to interpretation. The average clinic appointment doesn’t provide the time for a doctor to refer to a pile of clinical text books, so we expect them to provide care based on what they can remember.

PRESCRIBING ERRORSThe consequences are seen in the waste and harm that is caused by prescribing errors - three to five per cent of all hospital admissions, £500M of unnecessary costs; and the myriad examples of where best practice care can deliver low cost, higher quality, but is patchily adopted. That is why, when commissioners think about redesigning a health system, they need to require their providers to use EHR technology effectively and then apply the ‘closed loop’ principle to quality management beyond the hospital and integrated care pathway processes. 2. Using a health information exchange to link the care system together – so that we don’t have silos of information, but clinicians can have access to all the relevant information at the moment of decision. Digitising the silos is not enough to transform healthcare as a whole. Health information exchanges allow organisations to connect and exchange information across an entire health system. In Oklahoma, for example, a publicly managed Health information exchange called Secure Medical Records Transfer Network (SMRTNET) captures data on more than 2.6 million people or 72 per cent of the state’s population. There are a growing number of published studies that support the clinical and economic benefits of this integration. One recent study showed that HIE access achieved a 230 per cent return on investment by reducing admissions through A&E; another showed efficiency saving in primary care from improved access to test results and less staff time handling referrals; and a third showed that 70 per cent of outpatient doctors forecast that a HIE would reduce costs, 86 per cent that it would improve quality and 76 per cent that it would save time. The technology now exists to allow hospital doctors to see relevant patient data directly from the GP system and the GP to see data directly from the hospital EMR, allowing clinicians to share their knowledge about a patient in real time. 3. Gathering data together, outside of individual systems and organisations, to give a comprehensive view of the health of a population. Clinical integration through a HIE will improve quality and productivity in operational practice, but designing the health system of the future requires more than this.

Advances in technology now mean that system-wide information design, which is the legitimate interest of commissioners, can move beyond retrospective reporting, into real-time patient and quality management. This requires us to lift data out of the institutions and bring it together at a higher level, in the cloud, to enable pain free health system reporting and benchmarking to drive process improvement, reduce bureaucracy and insurance income retrieval, real-time patient and system tracking to optimise the patient experience, predictive modelling to plan future interventions, and whole pathway decision support that is not encumbered by organisational boundaries. This liberation of data allows the health system to maximise value by focusing on addressing the needs of the whole population and within that: stratify to identify patients with long-term conditions and ensure that they received locally agreed pathways of care, personalised to their own needs; ensure that episodic care is applied according to best practice evidence and that quality and cost are monitored; and that specialist care is supported by the appropriate experts and advanced decision support tools. 4. Support the direct management of patient care, so that community services address the right patients, in a timely way, supported by the information and evidence that they need. In an EHR enabled health system, population level information analysis isn’t simply for information and reporting. To drive changes in population health it needs to be integrated directly into frontline patient care. The data from risk stratification and by tracking the clinical data collected in hospital, community, primary and home care, as well as by the patient themselves, can be used to prioritise cases for a case manager, telephone based health coach or home nurse’s schedule. It can then guide the conversation that they have and the vital signs that they need to collect, applying decision support algorithms in the background to prompt advice to the patient or decisions to refer to another professional. It can alert the hospital or primary care clinician if a patient is deviating from their expected recovery or disease management pathway and therefore provoke an intervention. And it can ensure that patients, their carers and the clinical team are kept informed about decisions made in other parts of the care pathways.5. Use technology to support the patient in

being a partner in maintaining their own health.There is considerable experience around the world to suggest that simply giving patients access to their clinical record adds little value. Some highly motivated patients are interested and access it frequently, but most look once and then very rarely. To make a personal health record compelling it needs to be interactive and supportive. The PHR should provide a simple and user friendly record of the patient’s notes in different organisations for them to view. Most patients have GP records and several hospital records. The PHR should bring these together in one place, and not be tethered to a single institution or software vendor. It should prompt the health maintenance activities that patient should be undertaking,

such as exercise or taking their own measurements. It should integrate

with home monitoring devices such as scales, pedometers and blood pressure cuffs. Through its interface to the cloud-based population health platform it should link with data captured at home and with data captured in

primary care or at the hospital and provide real-time alerts with advice

on what to do next – such an online evisit questionnaire, and share this data

with their GP, case manager or practice nurse.

WHAT IS NEEDEDPopulation health improvement requires more than retrospective public health analysis. It requires a platform of electronic health records in all parts of the health system so that data can be accurately captured, shared and used to provide decision support prompts that encourage the application of best practice. These platforms need to be integrated through an HIE to allow clinicians to share information and gather the data to support analytical tools. An information infrastructure is required that allows automated retrospective reporting and submissions; real-time patient tracking; predictive modelling, risk assessment and population segmentation; patient prioritisation, and; the application of evidence based decision support algorithms. Care management tools need to support the management of patients across all settings and the proactive intervention to support health. Patient tools need to assist them in managing their own health and to engage them in decision making. The NHS will not deliver 20 per cent productivity savings without this investment in information and technology. The challenge is whether we have the skills and the courage to change the way medicine is practiced, with the help of IT. L

FURTHER INFORMATIONMatthew Swindells is chair of BCS Health. For further information, visit www.bcs.org/category/6044

Healthcare IT

HEALTHCARE IT

Traditionally

healthcare has

stood out as the

one industry where

the perceived wisdom

is that spending

and quality are

inextricably

linked



Impact the efficacy of diagnosis and treatment with Wireless Networks The healthcare industry’s need for staff mobility, transfer of digitised records, standardised administration of medication, and improved asset management are the primary reasons that wireless networks flourish in healthcare environments. Companies in the Healthcare sector are using wireless LANs (WLANs) creatively to improve patient care and to achieve much-needed cost efficiencies.

The business of healthcare is both mission-critical and life-critical. Putting accurate, up-to-date medical information into a caregiver’s hands at a patient’s bedside can greatly impact the efficacy of an individual’s diagnosis and treatment while also reducing the cost of care.

Given the inherently mobile nature of doctors, nurses and orderlies who move from bed to bed or examining room to examining room, ministering to patients, Consultants are using smart phones and tablets to communicate, manage workflows and access medical information to improve care and make important medical decisions quickly. Accessibility to current patient data from mobile devices at the point of care reduces the overall cost of health care delivery by alleviating much of the duplication of effort and inefficiency associated with hard copy patient charts. Next generation wireless 802.11n solution brings speed, throughput, reliability and performance without increased costs and complexity. The sophisticated policy and security control that’s inherent in 802.11 standards is another enhanced component of the new Wi-Fi technology, along with the secure, fast roaming functionality. This allows mobile clinicians and others to stay connected securely while moving across coverage areas of different access points (APs) – without noticeable signal latency, which is mandatory for supporting deterministic, real-time communications such as voice over WLAN.

As an Aerohive Platinum partner, LAN2LAN has experience and expertise of the most sophisticated wireless infrastructures in the Healthcare sector, our team has developed a well–tested methodology, which will take you effortlessly from initial planning through to final delivery, supported by our N3 Connecting Healthcare compliance.

Customer Testimonial “Over the last two years LAN2LAN has worked closely with Chesterfield Royal Hospital - from the initial WLAN configuration and installation; and later transferring skills and knowledge to our IT team.” Equipping staff with this expertise allowed them to take on the maintenance of our own wireless network, improving the quality of our IT infrastructure; and making a positive contribution to the trust’s cost efficiency programme.”

David Linacre, ICT Manager Chesterfield Royal Hospital NHS Trust

If you would like to know more about how next generation wireless can improve your patient care and cost efficiencies, please call LAN2LAN Wireless Specialist, Simon Hawes, on 01483 594114 or email [email protected]

Improve patient care at home, avoid unnecessary hospital visits and improve efficiency No need for caregivers to spend hours trying to find out information about the patient, keep separate (inaccessible) paper records for recording patient information and use antiquated mobile phones for communicating when out in the community anymore. With a proven digital pen solution, carers can fill out the relevant patient forms using their digital pen. Once completed, an electronic copy of the form is sent to the back-end patient system as encrypted data via Bluetooth through a smartphone. Due to the real-time stamps applied through the process, the co-ordinators back at base are able to track the arrival and completion of the assessment to ensure all referrals are assessed. All data captured is secure and confidential; the data-capture device is discreet and does not disturb the interaction between carer and patient. A copy of the record remains in the patient’s home enabling the family and voluntary sector equal access. Any information previously collected by the pen is instantly available to other authorised healthcare professionals to view patient records, such as after-hours GP surgeries or even unscheduled care areas such as A&E (Accident and Emergency). This increases efficiency on several levels, such as eliminating the duplication of data entry, reducing travel time and increasing the amount of time the carer spends with the patient, while at the same time enabling the carer to see more patients daily. LAN2LAN’s long-standing customer, Aneurin Bevan Health Board (ABHB) is using the digital pen solution as part of a healthcare initiative in Wales called the Gwent Frailty Programme. Their aim is to improve home care for the frail and elderly, thereby significantly preventing admissions and reducing hospital stays. Aneurin Bevan Health Board (ABHB) works in partnership with five unitary authorities to deliver services to 600,000 people around Gwent, so the solution has been developed to ensure it meets patient safety and information governance standards. Aneurin Bevan Health Board has improved quality of home care, potentially saving over £600,000, with the electronic data entry created through this combined Wi-Fi, Mobility and smartphone solution. Customer Testimonial “The biggest benefit is the fact that the solution enables information sharing to prevent unnecessary (hospital) admissions and keeps the patient in their own home as much as possible.”

Jon Holmes, Head of Informatics Aneurin Bevan Health Board

If you would like to know more about how the digital pen can improve patient care at home, avoid unnecessary hospital visits

and improve efficiency, please call Gary Duke at LAN2LAN on 01483 594100 or email [email protected]

www.LAN2LAN.com

Written by N

eil Darvill, director of health informatics, St. Helens and Know

sley Teaching Hospitals NHS Trust

Setting the NHS free from paper-based systems is essential for improving healthcare. At St. Helens and Knowsley Hospitals that goal is in sight. A huge digitisation project has already allowed us to consign paper hospital medical records to the bin. In terms of speed and efficiency it’s like reaching the open motorway after being stuck behind a tractor on the B roads. And we have even more ambitious plans in store. Within months I hope that most of our patient services will be run entirely electronically. The main foundations are already in place, as clinicians have instant and easy electronic access to patient records. Our computerised bed management system is being upgraded and we will shortly complete the rollout of electronic order communications (OCS) and e-discharge. Next, we will ensure that the notes clinicians take during each patient consultation go straight onto the computer – eliminating the last widely used paper-based process.

BREAKING THE PAPER CHAINSPaper shackles your potential – it can only ever be in one place. Files can take time to locate, access and move. Physical notes can be hard to care for, and can be illegible, incomplete or untraceable. The basic task of making sure the clinician has the correct file when it’s needed becomes a major logistical feat when it has to be done hundreds of thousands of times a year. Going electronic significantly improves our ability to deliver the best possible patient care in a safe and timely manner. It required three years of change management, working closely with the 14,000 IT users that the Health Informatics Service looks after. This shift was only possible because we had already done all the deeply unglamorous work of creating good-quality infrastructures (these reach beyond the Trust throughout the local primary, community and mental health sectors). We also ensured that there were sufficient computers, that were fast enough, and that there was support to deal with any problems. This allowed us to create an environment where staff no longer worried about whether the IT would work – it was a given.

BENEFITS ALREADY ACHIEVEDThe digitisation of medical histories combined with the fact that most of the transactional and diagnostic matters are computerised is producing a transformation. The benefits are speed, efficiency, accuracy, reduced administration and enhanced patient safety. These are rather abstract terms when the

aim is to change lives – a couple of examples show the gains in more human terms. Our old patient discharge form was five sheets of self-carbonating paper and the transfer of information could be imperfect. Now an e-form is completed as the patient is discharged. The system is linked both to the patient record and to pharmacy. Take-home drugs are ordered from our formulary list, corroborated and sorted. Patients are handed a printout before they leave. By summer the rollout will be complete and full details of any episode, diagnosis, treatment, drugs and follow up will be emailed to local GPs in an instant. The bed management system is also a major advance. If patients are transferred within the hospital, the system removes the possibility of urgent information being sent to an incorrect location. There is no delay in transferring information with the patient and notes and test results are instantly available to the clinicians taking over their care. Previously patient locations were identified at the end

of each day. One gain, in some ways modest, makes a real difference to the experience of patients and families. When relatives arrive at the hospital after learning that their husband, wife or parent has been admitted, by typing in a name receptionists can immediately give directions to the right ward, reducing any stress or delay in reaching their loved one. OCS, again, transforms and simplifies. When numerous tests are ordered, once rollout is complete, we will be able to track each order and be sure it is acted upon. There is no possibility of results being missed or delays in information being received by the clinicians.

AN EVEN BOLDER FUTUREOur achievements to date, especially the shift to electronic patient records, have put us in an enviable position – right at the forefront of NHS informatics. Just as important is that they pave the way for new developments that will mobilise the full potential of our IT to enable clinicians to improve patient E

Our old patient discharge form was five sheets of self-carbonating paper and the transfer of information could be imperfect. Now an e-form is completed as the patient is discharged.

PATIENT RECORDS

PAPER-LITE AND BEYONDNeil Darvill, director of health informatics at St. Helens and Knowsley Teaching Hospitals NHS Trust, explains the benefits of a wholesale digitisation of patient records. He now hopes to create a computerised toolkit to support clinicians in delivering better patient care.

Healthcare ITBUSINESS INFORMATION FOR HEALTHCARE PROFESSIONALS – www.healthbusinessuk.net


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Advanced Technologies Support Anticoagulation Management SolutionINRstar is the UK’s leading ClinicalDecision Support Software foranticoagulation management. Oursoftware currently underpins over 2,000anticoagulation clinics in both primaryand secondary care, providing advancedsupport for anticoagulation clinics andenhancing patient safety. When usedwith point-of-care testing, our clinicaldecision-support is proven to help cutcosts and free up clinician time,representing impressive savings to theNHS and service providers.

INRstar enables health professionals tonavigate safely through the increasinglycomplex decisions brought about by theemergence of new anticoagulationtreatment options. Within bothsecondary and primary care settingsINRstar’s flexible approach isconsistently praised for enablingefficient management of patients onoral anticoagulants and supportingnurse-led clinics.

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With an experienced and dedicatedteam of developers and cliniciansbehind the scenes, INRstar is constantlyenhanced to meet nationalrequirements. Our development teamfollows the Lean and Agiledevelopment methodology, whichtogether with our rigorous ISO13485and ISO90001 processes allow us toupdate our software at regular intervalssafely and securely, ensuring that allusers are kept up-to-date at all timeswithout the need for complex on-siteupgrade procedures.

Major national developments toanticoagulation management have ledto extensive enhancements to thesystem, which the team has worked toincorporate quickly and efficiently.Recently published NICE guidelines onthe use of new oral anticoagulants(NOACs) for the prevention of stroke in

patients with AF are being reflected inthe system as well as improvements tothe system that make it ideal for use byAQPs (Any Qualified Providers).Furthermore, INRstar complies with theEuropean Medical Device Directive(93/42/EEC) and complies with allConnecting for Health informationsecurity requirements.

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New Technologies for ImprovedPatient Care

Recent developments include the newINRstar N3, which is centrally hostedwithin the secure N3 network, makingINRstar accessible from multiplelocations facilitating the sharing of dataand resources.

Advanced benefits include:

• Comprehensive reporting and audit trails facilitating clinical audit so that the effectiveness and safety of the service can be monitored, as well as providing opportunities for national benchmarking, trend monitoring andquality management.

• Approved and published Algorithms and Diagnoses promoting treatment consistency across multiple users and improving patient safety and the management of clinical risk.

• E-learning package providing entry level training suitable for all users, (with advanced face-to-face and group training also available).

• Intuitive user interface with comprehensive on-line help system and user warning messages.

• Secure role-based access aligned withstaff training and function enabling greater control of user access and efficient allocation of workload between staff of different skill levels.

• Certified and proven interfaces to popular GP clinical systems eliminating the possibility of data entry errors and saving valuable time.Interfaces to laboratory and hospital patient administration systems available on request.

• Interface to the Roche CoaguChek XSPlus point-of-care testing device allowing users to import the patient’sINR result automatically into the corresponding patient record in INRstar.

Moving to INRstar

Once you’ve made the decision to moveto INRstar, we have a dedicated teamon hand to ensure the entire process isas streamlined and painless as possible.If you are moving from an existinganticoagulation management system,we may be able to migrate yourexisting data as we have developedroutines for all the major anticoagulationmanagement systems - installation isquick and easy, requiring little or no on-site disruption. Deployment andupdates across any number ofworkstations is via a straightforwarddownload and does not requireadministrative rights, thus reducing ITsupport costs. We would be happy todiscuss any additional IT requirementsthat you may have.

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Health Business Ad 8.12 7/8/12 11:55 am Page 1

E outcomes. Conceptual work is underway on an innovation that will combine the power of our clinical IT, our huge quantity of patient data and the wealth of knowledge held by our most senior clinicians. The vision is for a highly structured data capture system which not only records and provides all the relevant information for every encounter, but offers decision support at every point along the patient pathway. While our most senior doctors cannot be present all the time, their expertise can. So, for example, when a junior doctor enters a patient’s details they would see a list of questions to ask. The answers would trigger onward events by indicating an appropriate course of action. If the doctor wished to prescribe something to which the patient is allergic, the system would flag it up. Or if a patient is having drugs for chest pains and new height and weight measurements show their BMI might be of concern, suggestions would be made on how to proceed. What we are aiming for is a system that provides a default position, based on specific

information about each patient. This in no way reduces the role of the clinician. It’s not a matter of right and wrong, it’s about saying ‘most patients who had this test had this one as well’, or ‘if A and B turn out to be the case, it might be beneficial to do more

tests’. The decision would always remain with the clinician.

AN EMPOWERING TOOLKITAt present we have clinicians mapping out what they believe a new, empowering system could and should do. The result would be

a toolkit rather than a prescriptive off-the-shelf

product. This is important because we want clinicians

to determine exactly how any process works, and I want us to be

able to evolve and change it ourselves, without having to go back to the supplier constantly or wait for generic updates which may not fulfil our specific needs. While some specialist IT systems will always be needed, I hope the new project will be largely centralised around the electronic patient record, to maximise accessibility. I also believe that the interface

should embrace more than just the mouse and keyboard. Desktops are fine for many uses, such as an outpatient clinic where the clinician is in a room and patients pass through. But it does not suit a ward round where it’s the patients who are static and the doctors are on the move. Everything needs to be equally functional on mobile devices.

BACK TO THE FUTUREWhat we hope to develop is an e-forms orientated system with decision-tree software that links back into the EPR. It’s not rocket science; it’s about the innovative application of technologies which already exist. I hope to initially get something up and running in outpatients, then spread it through the acute sector and out into the whole of our local healthcare economy. Oddly enough, the whole idea owes something to the paper-based case notes model we have worked so hard to eliminate. Although the medium itself was flawed, it was successful in terms of having a single repository for each patient’s information and storing it in a way anybody could use. This is something that we want to replicate, but in a way that means clinicians have every relevant piece of information, expertise and support at their fingertips no matter what the time, place or situation. And that means better, safer patient care. L

Healthcare IT

PATIENT RECORDS

What we

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At Airwave, we fully understand the technology as well as the level of service required to meet the requirements of a busy hospital. Our fl exible multi-brand approach allows us to offer the very best solution for both you and your patients. We’re brimming with smart solutions for bedside entertainment and information, and our latest healthcare televisions provide the very best in TV choice and picture quality.

Complement your patients’ bedside TV with video calling, internet, meal ordering, secure EMR/EPR access and X-rays. Improve hospital effi ciency with Airwave’s bespoke hospital red button services, allowing staff to broadcast information quickly and directly to patients bedside televisions.

Innovative designs include: TV on arms, ceiling poles, TV on trolleys for perfect viewing positions, as well as Airwave’s infection-approved, wipe-down, multi-coded remote controls.

So for your ‘picture of health’, friendly professional advice and competitive prices please call us on 0845 555 1212 or email [email protected]

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AIRWAVE NEWS

THE IDEAS FACTORYAirwave Europe offers some smart advice on how to make the most out of your Healthcare TVs

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Whether starting from scratch, upgrading orreplacing your existing patient or residentialTV entertainment system, it is important to remember that today’s technologies also provide simple integration of communication tools for patients, staff and visitors, delivering efficiencies across single and multiple sites.When scoping out your plans:

AVOID DOMESTIC SETSEnsure you purchase dedicated Hospitality TV screens. Hospital screens from the top manufacturers including Samsung, Philips, LG, Sharp and Barco have dedicated hospital features such as menu locking, channel list control, multi bed & wipe down remote controls, headphone connections and easy network interfacing providing you flexible and maximum control over your TV system on a bed by bed, room by room or individual ward basis. Products include Freeview LCD/LED TV in black or white models, touchscreens, PC-TV, IPTV and the latest in Smart systems for both coax and data networks.

UTILISE PATIENT TVS To inform and educate your audience. Patient TVs are the perfect media to enlighten patients of hospital services and local amenities as well as offering advice on a healthy lifestyle. Airwave has developed their revolutionary AirCAST and AirMEDIA range of information screen and interactive packages enabling greater communication to and from the patient making a more comfortable stay. Airwaves AirCAST system incorporates the familiar red button services on your TV allowing patients or residents to quickly and easily navigate different sections and pages of hospital or care home information. Sites can instantly update the system via a web interface keeping information fresh and up to date. AirCAST allows any site or group to broadcast its own local content such as information about special hospital incentives or charity projects.

GET PATIENTS CONNECTEDIf you want to secure top patient satisfactionrecords, today’s patient will be expecting toseamlessly connect with the world from theirbeds. Airwave’s AirMEDIA can enhance your existing patient TVs with the internet, transforming your existing sets into today’s

modern Smart TVs via a compact receiver. AirMEDIA smart hospital TV technology allows hospitals to even upgrade existing sets if implementing a new system is outside of your budget. So should you have an entertainment system in situ but simply wish to improve the services on it then there is a solution available. With AirMEDIA and its innovative remote control, patients can browse the web, access and complete patient feedback forms, view specific healthcare and well-being sites and interact with a huge range of information

and entertainment services. Chatting, surfing, games and shopping

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hospital room TV! With an intuitive interface patients can simply access journey planners, events, television guides, news magazines, maps, and navigation

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For your patients. Airwave’s innovative designs include 1.5m and extended 1.8m TV on arms, TV on ceiling poles and the latest in TV on trolleys, for perfect viewing positions from all bed types. Whatever you need Airwave has an answer giving comprehensive manoeuvrability in any ward or residential requirement.

GO DIGITALPaper notices and billboards are soon to become a thing of the past as hospitals are entering the digital age. Digital signage in waiting rooms, corridors and reception areas is a cleaner, low cost method of connecting with patients, guests and visitors. Airwave provides a range of digital signage where content is instantly and easily updatable, and can be broadcast to multiple screens from a central point. With touchscreens and TVs now over 100 inches is size complimented by simple software management and administration tools communicating has never been easier. L

FURTHER INFORMATION If you have been inspired by Airwave’s top tips, further information on the latest hospital AV products and services can be found at www.hospitaltv.co.uk. Alternatively you can contact the Airwave team directly on 0845 555 12 12 or at [email protected]

Airwave’s innovative AirCAST

Just one of Airwave’s TV on arm solutions

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Written by Paul Cham

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ave Europe

Patient TVs are the perfect

media to enlighten patients of hospital services and local

amenities as well as offering advice on a

healthy lifestyle





Pagers are a prescription for happier patients A busy outpatients’ clinic at Frimley Park Hospital, Camberley, Surrey, means the Pharmacy processes up to 200 prescriptions a day. “We target a maximum 20-minute turnaround for our customers, but this is a long time, especially in a relatively small waiting area. Some have to stand

while they wait for their prescriptions, which is clearly far from ideal,” says Sue Horne, Dispensary Manager.

To alleviate the problem, the Pharmacy Department invested in a MediCall™ pager system from Call Systems Technology (CST). Now, when patients hand in their prescriptions they receive a pager, so they are free to leave and go where they choose, maybe for a co�ee, a walk or into the hospital grounds, whilst their prescriptions are prepared. When they are ready, a sta� member activates

the patients’ pagers so that they alert them to return to collect their prescriptions.

“We conduct regular surveys on ‘customer satisfaction’. Since we’ve had the pagers for a few years we decided that one of our questions would be to see if our patients �nd them useful. The feedback from this survey has been 100% positive,” says Sue Horne.

The main motivation behind this implementation was improving the

customer experience. One of the issues for the pharmacy is that very often it is “the end of the line”. The patient may already have had a long wait for the original consultation in outpatients, they may then need blood tests or x-rays too.

“The pagers allow patients to leave the department, attend other areas for treatment, or simply to relax while they wait for their prescriptions.”

“The MediCall system is simply a really useful tool - so much so, that I’ve recommended it to other outpatient departments in the hospital.”

Call Systems Technology 0800 389 5642 / 020 8381 [email protected] www.call-systems.com

call systemstechnology

The pagers allow patients to leave the department, attend

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After being selected by NHS South East London, NHS Direct is now the preferred provider for NHS 111 in nine areas of England, covering 30 per cent of the population, and will provide call handling, clinical assessment and referral to an appropriate service. It has been awarded preferred provider status in the West Midlands; Greater Manchester; Cheshire and Mersey; Cumbria and Lancashire; Cornwall and the Isles of Scilly; Somerset; North Essex, and; Sutton and Merton. For the most recent South East London contract, NHS Direct will partner with Bromley Healthcare and GRABADOC. The majority of contracts are due to be awarded by mid-September. Health Secretary Andrew Lansley had ordered a rollout of NHS 111 by April 2013. But in June, the deadline was extended by up to six months for parts of the country which could prove they needed longer. This came after plans faced extensive criticism. GP leaders said they were worried there would not be adequate clinical engagement and that the rushed rollout would undermine the safety and reliability of the new service. Eight Clinical Commissioning Groups (CCGs) applied for the delay. The British Medical Association had also warned about a hasty rollout of the service, which it said risked patients being sent to the wrong place, waiting longer, blocking A&E and using ambulances needlessly. Its lead on NHS 111, Peter Holden told Health Service Journal: “Every CCG should have applyied for an extension. We are trying to make [NHS 111] run before it can stand, let alone walk.” The Royal College of Nursing said at the time it still had “deep reservations” because the service meant patients only speaking to clinically qualified professionals “around a third of the time”. Not-for-profit GP-led organisations have won just five of the 26 NHS 111 contracts awarded so far. Dr Nigel Watson, chief

executive of Wessex LMC and a GP in the New Forest, said the low numbers did not reflect the concern on the ground about the speed of the rollout. He said: “There are quite a number of people who are concerned about how 111 will work, what the pilots have shown and whether it provides value for money. For a lot of the CCGs going through authorisation it is not the number one thing on their agenda. In some areas, there are concerns but they will make the best job of it. It does not show that everyone supports it.” NHS Direct chief executive Nick Chapman said: ‘We are delighted to have been selected as the preferred provider for the NHS 111 service in a number of areas so far. We are looking forward to working with those commissioners and local NHS organisations to provide the

NHS 111 service for their patients.”“The national coverage provided by

NHS Direct’s 0845 4647 service will no longer be required when NHS 111 is

rolled out across the country, and the future NHS Direct will be

focused on meeting the needs of the local commissioners

and their communities.”Official figures show an

eight per cent rise in ambulance attendances in areas of the country that piloted the new urgent care number

over the past year. This compares with three per cent in ambulance attendances from January 2011 to February 2012 across the rest of the country, and comes after warnings from the GPC that the rollout is processing too quickly. The figures also show visits to A&E have increased by three per cent in the areas where NHS 111 has been rolled out, compared with two per cent in non-pilot areas in the 12 months preceding February 2012. GP out-of-hours, urgent care and walk-in centre visits were lower in areas with pilot NHS 111 schemes across the same period, with a six per cent rise compared with 17 per cent across England. Speaking at the NHS Confederation annual conference, Lansley stated: “The essence of it is the ability not only to put a directory of services behind the call, but joined up, responsive services that mean we have a more effective urgent care system in the right place at the right time.” L

CALL CENTRES - NHS 111

NHS DIRECT AWARDED LIONS SHARE OF 111With more to be awarded in mid-September, NHS Direct has won contracts to cover thirty per cent of the population, but concerns about ‘hasty’ rollout remain

Call Centres

NHS 111 contractsNHS County Durham And Darlington - North East Ambulance Service (NEAS)

NHS Isle of Wight - Isle of Wight Ambulance service (IOWAS)

NHS Derbyshire pilot phase 2 - Derbyshire Health United (DHU)

NHS South West London Croydon - Harmoni Wandsworth - Harmoni Sutton and Merton - NHS Direct

NHS North West London Hillingdon - Harmoni

NHS Oxfordshire - South Central Ambulance Service (SCAS)

NHS Great Yarmouth & Waverley South East Health

NHS East & North Herts - Herts Urgent Care

NHS Leicestershire & Rutland - East Midlands Ambulance Service/LMC

NHS South of Tyne & Wear - North East Ambulance Service (NEAS)

NHS West Herts - Herts Urgent Care

NHS Norfolk - East of England Ambulance service (EEAST)

NHS Berkshire - Berkshire Healthcare Foundation Trust

NHS Cambridgeshire & Peterborough - NHS Direct

NHS North Tyne and Wear - North East Ambulance Service (NEAS)

NHS Suffolk - Harmoni

NHS Inner North West London - London Central West Unscheduled Care Collaborative

NHS Somerset - NHS Direct

Hampshire, Southampton and Portsmouth (SHIP) cluster - South Central Ambulance Service

NHS Newcastle - North East Ambulance Service (NEAS)

NHS Yorkshire and Humber - Partnership of Yorkshire Ambulance Service NHS Trust and Local Care Direct

NHS South East London - Partnership of NHS Direct, Bromley Healthcare and GRABADOC

NHS Cornwall and Isles of Scilly - NHS Direct

NHS North Essex - NHS Direct

NHS West Midlands - NHS Direct

NHS North West - NHS Direct covering three contracts: Greater Manchester; Cheshire and Mersey; Cumbria and Lancashire



chairAalborg chair is ideal for a wide range of applicationsincluding waiting areas, nursing stations, receptionand admin use, and as bedside seating.

• Encourages an alert and upright posture, easyto get up from.

• Available in several heights, including versions withdetachable upholstery and arms.

• Supplied on rails, gas lift or fixed bases.• Strong and damage resistant.• Moulded in antimicrobial plastics, the seat provides

comfort and wipe-clean hygiene.• Compact storage.

saddleThe benefits of saddles have been recognised overmany years and include:

• Comfort both during and after long periods of use.• Promotes a balanced and upright posture.• Reduces back pain.• Can be mounted on fixed height (with or without

footrests), or to gas lift bases.• Stores usefully under a desk or table.

The Aalborg saddle can be used by young or old, bylarge or small as a single component for simplicity,durability, low cost and hygiene.

Good posture,hygiene, comfort,practicality anddurability whereit’s required most.

Affordable seatingfor office, bedside,consulting andwaiting roomapplications...

For news and details... www.aalborgdk.comThe Aalborg range of furniture is available worldwide. Please contact us • To arrange a productdemonstration • For detailed product information • For details of your nearest approved stockist.T: +44 (0)7768 931016 or +44 (0)7800 912426 E: [email protected]

Health Business_v3_LHP:Layout 1 13/07/2012 16:37 Page 1

Hospitals are places we attend hoping to see an improvement to the well-being of either ourselves or of others. Our perceptions of the environment, the furniture and the equipment, must make a positive contribution to an encouraging atmosphere. Cleanliness is essential. The interior and contents must be easy to clean, so the choice of colours, of materials and of surface textures have to make this evident, to inspire confidence. New hospital buildings are designed to have smooth surfaces without nooks and crannies to harbour germs, a feature not always possible with complicated equipment although this should be an aim. Furniture in waiting rooms is just as important as ward furniture. Upholstery, armrests and especially surfaces contacted by hands must be easy to clean. Upholstery and many fabrics have an unhelpful propensity for the storage of germs and be either avoided whenever possible or able to be simply replaced if not. Most applied surfaces can be obtained with anti bacterial qualities, and chairs need not have absorbent upholstery or be upholstered at all provided the seat shape promotes comfort and good posture. Clearly tall and heavy persons need higher seats than do smaller persons and children. The elderly or infirm find a higher seat with armrests more easy to get out of. Since waiting times can be long, the importance of good seating increases and catering for special individuals is less easy but still needs to be tackled. Seating for patients can be tailored to individual need, but as space is often constricted, saddle stools or seat perches for visitors can save space and be adequately comfortable. The design of hospital beds has come a very long way and today there are many fine designs with electric lifts to make life easier for the nurses and more comfortable for a range of patients and disability. With huge improvements to battery technology and of control systems, economies of time are likely in the future from the design of bed routing systems along pre-destined routes.

STAFF FURNITUREWe’ve discussed the ‘visitor’s’ furniture but staff also need consideration. A workstation or desk which occupies a small space and can be shunted or wheeled away to relieve

clutter is helpful for nursing staff or doctors. Frequently there is no need for seating provision for visiting doctors or surgeons to write up patient notes, and a high desk with a folding top might be all that’s needed. Wherever we go, there are times we just need to sit down or to lie down and the reason should determine the shape of chair or repose. When we eat the ability to digest is important and so we should avoid sitting too low down since this reduces stomach capacity and hinders the digestive process. But often the height of a dining chair is the determinant of not only how high but indeed how we sit. The average adult is taller now than 50 years ago so both the chair and the table should

also be higher. When we relax the focus of our eyes determine a more reposed posture. The elderly and those who are continually getting up and down need to be seated higher and the shape of the seat will determine whether we are encouraged to be upright by inducing lordosis or sit in a damaging slumped fashion. The working relationship with a desk or keyboard is one many of us have for several hours each day. Nurses write notes, use keyboards, need to stay alert and frequently need to spring into action. Do nurses suffer from back pain or strained neck muscles? Do you? The reason often results from sitting too low at desks equally too low. The ‘chair’ is just too familiar an everyday object. But we all need to sit down for many reasons. The choice of chair may be unrelated to an objective understanding of either the need or the consequence of its use. We should do better, spend more wisely, and understand the consequences of poor posture. Not back the neck pain of the desk bound, not discomfort in breast feeding through provision of ill chosen chairs. British designers have produced some of the very best (and some of the most aesthetically pleasing) designs and continue so to do together with a growing

understanding of the importance of posture. We need to ask a very few basic questions before choosing a chair, or a desk, or bed or just about anything for your hospital or yourself. And be sure to ask specialists, those used to results. The term ‘ergonomic furniture’ is a term widely misused and many ergonomists used to unrelated issues, have very little understanding of posture.

GETTING WHAT YOU NEEDIf you are a doctor, a nurse or an administrator you will have a good idea of the sort of equipment you would like to see in a hospital. Each is likely to place a range of sometimes conflicting values on the selection, and reading catalogues from suppliers might just confuse. Better to ask questions or even form a committee - all those likely to have use or contact with it - and each make a list of needs for an experienced industrial designer to see and to rank in order of benefit. Best to ask opinions of all user sectors and not assume one person knows it all. Furniture need not be hugely expensive - but mistakes are. There might well be items which tick most boxes. However so many new and improved materials and objectives develop and doing things as always might place developments in the slow lane. Better to

return to fundamentals like ‘what are we doing here?’, ‘how can we keep track of our patients and the best specialists to advise them?’, ‘how can we prevent transference of germs?’, ‘with a ‘can do’ approach could we encourage our patients and staff to be positive and enjoy their experience?’ Children’s wards especially need to be places both happy and positive in attitude, could we do the same for the rest of us? Perhaps by ensuring comfort, by enabling patients to communicate more easily with staff and helping them to know they are being listened to. The seat might be a chair, a stool or a chaise longue, each might have a specific purpose so you might need three, or perhaps a multi-purpose solution might remove the need for a table or a book holder and clip to the bed economising on space. Assessments of price, value, guarantee, of what could go wrong, needs to be made before ordering. Does the choice look good? Appearance can be the ‘feel good factor’. L

FURTHER INFORMATIONTel: 07768 [email protected]

Seating for patients can be tailored to individual need, but as space is often constricted, saddle stools or seat perches for visitors can save space and be adequately comfortable.

HOSPITAL FURNITURE

CHOOSING THE RIGHT FURNITUREHospital furniture needs to be special for the benefit of both visitors and staff. It’s better to ask opinions of all user sectors and not assume one person knows it all






MEDICINES MANAGEMENT

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McKinsey’s 20091 report to the previous government identified changes in drug spending could deliver 10 to 15 per cent of the overall savings and indicated this might be achieved by reducing variation in prescribing practice and increasing the use of generics over branded products. In 2011 The King’s Fund ‘The quality of GP prescribing’2 report highlighted the need to address variation in prescribing practice and encourage adherence to best practice. Earlier in 2012 the GMC PRACtICe3 study into the prevalence and causes of prescribing errors in UK general practice revealed prescription drug errors for one in six people, with the elderly and young being almost twice as likely to experience an error. Bruce Guthrie’s recently published study in The Lancet4 found that the number of morbidities and the proportion of people with multi-morbidity increased substantially with age so that by age 50 years, half of the population had at least one morbidity, and by age 65 years most were multi-morbid with physical and mental health comorbidities. In 2011 First Databank (FDB™) undertook extensive independent research to drill deeper into the current suite of clinical decision support available to understand: why GPs reject the clinical decision support alerts available; why GPs don’t always adhere to best practice, and; what extra support is required to assist the new CCGs and their component GP practices to achieve their saving targets? The research showed that existing technology and tools did not specifically address the issue of deviation from best practice and most

importantly none were clinically sensitive at a patient level – making recommendations without reference to current ‘problem’ and comorbidities or polypharmacy issues.

THE SOLUTIONFDB has developed its new Medicines Optimisation solution specifically to help CCGs and GP practices manage their medications budgets and improve patient outcomes through better quality prescribing and adherence to best practice guidelines such as NICE. FDB’s Medicines Optimisation at the point of prescribing helps GPs and patients by providing: patient specific drug recommendations (with polypharmacy and comorbidities taken into account); timely, evidence based best practice (prompts to follow relevant guidelines, with links to source documents), and; price

comparisons for the drugs that are safe, in line with best practice for a specific patient. FDB’s Medicines Optimisation analytics provides a current view on prescribing behaviour across CCGs providing access to population level analytics, which can be drilled down into the individual patient record to allow interventions, best practice guidance (reducing prescribing variations) and the information required to build condition specific formularies. These tools will free up medicines management team’s time for direct clinical care or local initiatives. The next generation of medicines related active clinical decision support is here now, complemented by unique patient level analytics capabilities.

FURTHER INFORMATIONFor more details on FDB’s Medicines Optimisation solutions email [email protected] or visit fdbhealth.co.uk

REFERENCES1. ‘Achieving World Class Productivity in the NHS 2009/10 – 2013/14: Detailing the Size of the Opportunity’, McKinsey & Co, March 2009.2. The Kings Fund – ‘The Quality of GP Prescribing’ - Dr Martin Duerden, Professor David Millson, Prof. Anthony Avery and Dr Sharon Smart, 20093. ’Epidemiology of multi-morbidity and implications for healthcare, research, and medical education: a cross-sectional study’ Karen Barnett, Stewart W Mercer, Michael Norbury, Graham Watt, Sally Wyke, Bruce Guthrie, www.thelancet.com - published May 20124. ‘Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study’, May 2012

FDB HELPS FREE UP MEDICINES MANAGEMENTFDB has developed its new Medicines Optimisation solution to help Clinical Commissioning Groups and GP practices manage their medications budgets and improve patient outcomes

Recent NHS cuts have driven many practices to reassess every aspect of their spending to ensure they are as efficient as possible. One key aspect to assess, to make sure that operation costs are as efficient as possible is printing. In fact, most practices do not have a clear understanding of the amount they spend on printing or how to streamline the process to make it more cost effective – and that’s where OKI fits in. Working with a global business-to-business brand such as OKI, which is dedicated to creating cost effective, professional in-house printing solutions, a range of strategies and products can be implemented to meet all practice requirements. However, before any services can be deployed, practices need to understand their current printing environment so the right solution for the job can be selected. The first step to taking control of printing costs is to evaluate current practices and this is exactly what OKI excels at. OKI’s comprehensive managed print services (MPS) programme starts with a print assessment that uses state-of-the-art techniques to provide a complete analysis of an organisation’s print environment. The next stage is a consultation between OKI and the practice. Then an audit of existing output volumes, types of printing and paper sizes takes places so the best printing recommendations and implementation plan can be devised based on each practice’s specific needs. The overall analysis process is designed to optimise print device usage to enable a more efficient strategy, providing a total long-term solution for the practice. In fact, the audit will also point out the unseen overheads of printing, such as the need for storage space and the cost of man-hours spent supporting disparate systems. In addition, OKI will highlighting the further savings and efficiencies that can be made through simple, but sometimes overlooked tasks such as ensuring printers are set up and used appropriately.

BE EFFICIENT Many practices don’t realise how much money they waste powering printing equipment when it is not in use; a problem which OKI has addressed. Two years ago OKI implemented ‘Deep Sleep’ mode – a setting that reduces power consumption to the barest minimum (often less than 1 watt) yet the machine is still able to ‘wake up’ quickly when a new job is needed – and today this is standard on all new

ranges such as the compact B401 mono laser through to the A3 C800 series colour device. In fact, many practice devices spend long periods of time not being used so it is important to ensure they consume the minimum amount of energy when they are in standby to maximise efficiency and reduce power costs.

INNOVATIVE PRODUCTSOKI is consistently creating innovative products to meet its clients’ needs to ease and eliminate industry challenges and its latest range is no exception. Today, OKI has added ‘Auto-Power Off’ technology into the latest range of products, saving hundreds of watts of power. The setting automatically turns off the printer after extended periods of non-usage and as a result, this can create big savings in power usage over the product’s life. Many of the latest OKI devices can also be set to print in mono as standard, allowing practices to reduce unnecessary colour printing, while enabling them to use colour when required, such as when they may want to print eye-catching information leaflets or signage on demand. In addition, by implementing an OKI print device, practices can also set up their printers to print double-sided, as a default option, which enables further cost savings as less paper is used across the practice. In addition to controlling the amount of energy printer’s use, practices should consider implementing multifunction printers (MFPs). Choosing an MFP enables a practice to implement a single device rather than having

to install a separate copier, fax machine and printer. Working in this manner it becomes possible to receive faxes onto a PC, which helps reduce the cost of consumable usage and documents can be received and distributed electronically via email without ever needing to be printed. OKI’s colour-capable MFP may also be a better option than a single function colour printer device in terms of providing the practice with optimal levels of flexibility. Colour MFPs can do everything a mono device does with the added benefit of colour for the occasions when it is required. Generally practices use A4 devices for daily printing tasks. However, each practice does require the capability to print prescriptions. To work in the most efficient manner possible, OKI’s new B401 printer now enables practices to print on a range of sizes from A6 to A4 including custom size in a range of media. As a result, practices only need to buy one printer to handle its range of printing needs – far more cost effective.

BUSINESS-WIDE BENEFITS A MPS approach that combines a comprehensive print assessment such as that from OKI can bring a range of benefits to almost every practice, helping them monitor, control and cut printing costs, whilst driving business efficiencies – key benefits for any practice in these times of austerity.

FURTHER INFORMATIONwww.oki.co.uk

PRINTING SOLUTIONS

OKI’S CONTROLLED APPROACH TO PRINTINGRob Brown, managed print services manager, OKI, discusses how practices can keep a lid on printing costs by deploying managed printing services




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

A1 Window Cleaning 40

Aalborg 74, 75

Actif Hygiene 50

Air Quality Assurance 40

Airwave Europe 70, 71

Alphabet 6

Audax Global Solutions 28

Bafe 20

BDB Law 12

Business Furniture Online 40

C3 Headsets 72

Call Systems Technology 72

Carefusion 48

Cetas Kinetic 16

Clarity Informatics 62

DB Motion 34

DDC Dolphin 49

Dyteqta 24

Eco Cooling 69

Eco Lab 40

Elgy Safety 24

Eradic8 50

Escape Mobility 22

ESP Micro Sensor Switch 38

ETI 46

First Data Bank 76

Franklins Fire and Safety 25

G2L – Unity 64

Gerflor 32

Gilgern Doors 34

Hamilton Rentals 14, 15

HCS Consulting 41

HD Services 34

Healthy Buildings 42

IBIS Solutions 16

ILS 44

Infection Control Solutions 50

Infection Prevention Show 47, 49

Infranor 60

Johnson & Johnson Medical 51

Karcher UK 51

Kingfisher 46

Kosnic UK 36

Lan2Lan 66

Landrover 54

Lexacom OBC

Medica 8

Mercury Security Management 26

Metric Group 57

Muller Dairy 58

Multitone IFC

OKI Printing Solutions 77

One Call Training 20

Parking & Enforcement Agency 52

Pass Training 54

Pedecall Podiatry 8

PFU Imaging Solutions IBC

Phoenix Private Ambulance 8

Polyflor 24

Reflex 38, 45

RTR Services 31

SB Payroll 18

Selectamark 30

Service FM 34

Singers Healthcare Finance 56

Springboard Safety Services 20

Sullivan Cuff Software 68

Surrey Energy Ratings 38

Tallaght Cross Medical Village 16

The Interactive Health & Safety Company 25

The Parking Shop 54

Tristel 78

Voice Connext 28

Wiggly-Amps 10

Zurich 4



Leading high level disinfectant Trigene Advance has been renamed Distel by Tristel Solutions and coincides with a change of distribution channel for the product range within the NHS. As the manufacturer and owner of the formulation since July 2009, Tristel had previously used a third party distributor to market the Trigene family direct to the end user but this will now be done directly through the company’s 14 strong field sales team and through specially selected medical wholesale suppliers. Distel provides everything you need in a high level disinfectant; excellent efficacy, easy to use, safe to handle, versatile in use and does not corrode. There are two fragrances and two simple dilutions which cover all applications; 1:10 for high risk

areas and 1:100 for general use. Distel comes in one and five litre containers in concentrate form and is also available as a 500ml trigger spray pre-diluted at 1:10. The Distel formulation is also available in two sizes of high level disinfectant wipe drums. With a wealth of experience supplying the NHS and private healthcare institutions, the Tristel team are best placed to assist you with your infection control requirements.


Distel - the new name for Trigene Advance disinfectant for the NHS A nursing home that prides itself

on providing quality care with dignity has taken its ethos to a new level, by becoming the first in Ireland to install ‘state of the art’ inclusive toilets. Glenashling Nursing Home’s 25 bedroom extension is the first of its type in Ireland to be built to PassivHaus standards. The facilities encompass a Clos-o-Mat Lima Lift height adjustable ‘wash and dry’ toilet and another toilet with a Clos-o-Mat Palma ‘wash and dry’ toilet with Aerolet toilet lift, all supplied by Total Hygiene. The Clos-o-Mat Lima Lift can be used as a conventional WC but can be raised or lowered to suit the user, and features built-in douching and drying. If the user remains seated after toileting, pressure on the flush pad triggers simultaneous flushing and douching, followed by warm air drying. As a result, people with issues affecting manual dexterity, balance or mobility can toilet unaided, without needing a carer to assist

them with personal hygiene. The Clos-o-Mat Palma offers the benefits of the Lima Lift, but is set at a fixed height. Today, over 40,000 Clos-o-Mats are installed in domestic and commercial environments, some of which are still in daily use some 30 years after first being fitted.


Clos-a-mat’s state-of-the art inclusive toilets

All names, manufacturer names, brand and product designations are subject to special trademark rights and are manufacturer‘s trademarks and/or registered brands of their respective owners. All indications are non-binding. Technical data is subject to change without prior notifi cation.

“Thanks to ScanSnap I save time and money!”

What can ScanSnap do?

Speedy and compact scanners for business card to A3 documents

• Scan to Folder: Store scans to a folder, network folder, or to SharePoint (PC) or iDisk (Mac)

• Scan to Email: Eliminate faxing and share electronic documents over email

• Scan Business Cards: Scan business cards and automatically extract contact information

• Scan to Print: Use ScanSnap with your printer to create copies

• Scan to Word (.doc): Scan directly to an editable Word fi le

• Scan to Excel (.xls): Scan directly to an editable Excel fi le

• Scan to PowerPoint (.ppt): Scan directly to an editable PowerPoint fi le (Win only)

• Scan to Microsoft SharePoint, Scan to SalesForce chatter

• Scan to iPhone®/iPad® or Android devices

• Scan to Cloud: Scan to Dropbox, Evernote®, Google® DocsTM and / or SugarSync

Adam Claridge-Chang, Wellcome Trust Centre for Human Genetics Simply amazing machine. Makes handling documents almost effortless. Now I have gone nearly paperless in almost everything I do.

Dr. Osman Bhatti, National Health Service, UKThe ScanSnap certainly makes scanning literally a snap and not only does it scan fast and accurately, it is so versatile and portable.

Jonathan Jones, Consultant Neuroradiologist, Plymouth Hospitals NHS TrustThe good thing about ScanSnap are that they’re quick & reliable so it doesn’t matter if it’s unobtrusively scanning a request form at work whilst I’m discussing the case with the referring clinician or scanning the hefty proceedings a conference.

Martin Pendry, Osteopath, London The three main things thatI love my scanner for are: Keeping notes from courses that I attend for my professional development, keeping a record of those statements the utility companies send and keeping receipts of things bought.

Rainer Wolf, Surgeon, Kreiskrankenhaus Grünstadt, GermanyA year ago I decided to scan all my documents and store them on my PC to reduce paper and to find them quickly, wherever I am with my Notebook or to save them in the cloud.

Steve Keay, Field Engineer, HealthcareI use my ScanSnap after each visit in my car to email my paperwork whilst out and about which allows me to be more efficient and keep my paperwork up to date.

Tim Husband, Owner, Tim Husband Hearing HealthcareWith ScanSnap I can be in a remote location with my mobile audiology suite, testing kit and ScanSnap and not only can I produce an instantaneous digital copy of any documents on my hard drive but with 3G I can store in the cloud using an encrypted service.

The ScanSnap is incredible for the money and I’d happily recommend it to anyone with similar needs.

Please visit www.ScanSnapit.com for further information

+44 (0)1295 738 011www.lexacom.co.uk [email protected]

Lexacom Digital Dictation was originally designed by doctors, for doctors, and is now relied upon by thousands of professionals to produce accurate documents, easily and efficiently. Our latest software enables immediate and secure dictation, anytime, anywhere and features:

• Widespread integration with leading clinical systems • Live, snapshot and detailed reporting• Complete transparency/visibility of all work practices and workloads• Cloud system meaning authors can dictate whenever and wherever they like• The highest levels of security to ensure confidentiality• Suitable for use with PC, laptop, iPad, iPhone and Blackberry• Free 30-day trial to give complete confidence before purchase

In a recent customer audit, Lexacom’s digital dictation software was shown todeliver improvements in efficiency of up to 50%.

IMPROVE PATIENT CARE WITH DIGITAL DICTATION

I have noticed a significant increase in general efficiency. Documents are processed mush faster and the typists and doctors are much happier with the system they’re using.Debbie Howarth, Practice Manager, Tudor Surgery in Nantwich

To find out how Lexacom can help improve your patient care, contact us on 01295 738011

LXM100-HBMAdvert-v2.indd 1 09/08/2012 10:32