Luke Rutterford, Technical Manager at Rentokil Specialist Hygiene, outlines why he believes care homes should outsource hygiene and waste management services
Care homes across the UK are rightly scrutinised to ensure their service standards are up to scratch.
However findings from NHS watchdog, the Care Quality Commission, reveal there have been a record number of official warnings issued to care homes over the past year. With the government cutting back on budgets and staff resources stretched, it is clear public sector social care is taking a big hit. With the possibility of hygiene standards slipping, care home managers should consider outsourcing deep cleaning tasks to trained professionals, to enable them to focus on delivering exceptional care to their residents.
The pressures imposed on care homes by shrinking budgets and stretched resources could feel like an intolerable burden. Juggling front line services and back room duties can cause hygiene levels to slip - leaving grime and bacteria to build up - that can go unseen by staff. Bodily fluids such as blood, urine and vomit - which are a common occurrence in care homes - can seep into porous materials and not be visible to the untrained eye. This makes clean-up extremely difficult and the risk of exposure to infectious organisms much greater.
A professional specialist hygiene company can work around staff and residents to clean and decontaminate the premises in a safe and legal way. There can be a tendency for staff to rush through the cleaning of a room in order to get it back into service and this could mean that some vital areas are missed altogether.
The benefit of using external, specially-trained professionals is that they have experience of a broader range of different establishments and cleaning challenges. They can offer alternative ways of achieving the highest standard of hygiene possible - often not available to the care home worker - whilst minimising disruption to operational activities, using the latest technologies to deliver quick effective hygiene within a care home.
Another area staff should not have to deal with is waste management. Care homes can produce a large amount of waste each week, which can often contain hazardous materials like needles and syringes. These materials require an efficient collection and disposal service to ensure they are taken offsite promptly and disposed of in a responsible manner. It’s important to remember that when it comes to hazardous and infectious waste, the cradle-to-grave rule applies. This means the producer of waste will always be held responsible for the safe and legal disposal of it, even after it has been passed onto the waste carrier collecting it. This is why it’s important to work with comprehensively-trained waste disposal experts who will safely and securely dispose of waste and advise on the correct products and procedures to ensure compliance with both UK and EU legislation.
With the winter months fast approaching and the inevitable onset of the Norovirus (which can shut down a care home in 24 hours), as well as other infectious diseases just around the corner, managers need to make sure they have systems and processes in place to manage and limit possible outbreaks. At such crucial times, employing a professional service to extensively deep clean and rapidly decontaminate premises in a safe, legal and discreet way is vital.
Mark O’Herlihy, EMEA Director of Healthcare, Perceptive Software
The NHS recently announced an unprecedented number of applications to its ‘Safer Hospitals, Safer Wards Technology Fund’. Over 760 expressions of interest from NHS Trusts were registered to get a share of the £260m pot of funding. This was all in aid of achieving the government’s dream of having an ‘integrated digital care record’ (IDCR) for all patients.
Since Jeremy Hunt first announced his plans in February for a paperless NHS by 2018, NHS Trusts have been under mounting pressure to perform and ensure they have the solutions in place that will enable them to reach this goal. But is the government’s plan really realistic? How can NHS Trusts get hold of the right data, at the right place and the right time, to deliver efficient patient-centric care?
A ‘paperless’ environment would be the utopia but ‘paper-light’ may be a more realistic goal for hospitals to strive towards. There seems to be a lack of education in the market around which technologies are available. This, combined with already overstretched IT expertise within hospitals to support long term roll outs of new technology, means hospitals have major hurdles for NHS trusts to overcome.
In order to ease the decision making and implementation processes for digital records, however, it’s critical to have clinicians at the heart of this as they’re ultimately the ones who will be working with this technology. NHS Trusts need to better understand the digital technologies available to them to improve clinical effectiveness, which will in turn reduce the administrative burden placed on frontline staff. With manual processes, time wasted on finding misplaced, lost or damaged documents is considerable and a major hassle for patients who are already likely to be under stress. Implementing an IDCR provides numerous benefits, ranging from essential cost savings to improved operational efficiency and effectiveness. Records can be created, updated, amended, stored, shared and accessed much more quickly than a paper alternative.
Some are turning to Electronic Medical Records (EMRs) to address this but in reality this cannot be used as a standalone system. EMR actually leaves hospitals and clinicians with an incomplete patient history thanks to the extensive collection of unstructured content that it cannot manage, such as clinical images, scanned documents and video files. This amount of unstructured data is growing as we speak, demonstrating a critical need for a more complete solution.
Currently, this content is stored in Picture Archiving and Communication Systems (PACS) or medical imaging systems. Maintaining these unrelated, siloed systems is a significant drain on both hardware and IT resources. What’s more, these disparate systems often cannot communicate with each other, making it difficult to share content across NHS departments.
It’s essential to integrate Enterprise Content Management (ECM) with Vendor Neutral Archive (VNA) technologies to deliver a unified content platform and a more comprehensive, reliable patient record. This facilitates staff in accessing all forms of content from one single enterprise content repository and enables enhanced collaboration and sharing of patient information. This will help reach the goal of more patient-centric care where patients could even access their records online – another objective the government wants to meet by 2015.
Ultimately the government’s goal is attainable but first it is key for NHS Trusts to fully understand their available options. This will put them in a far better position to meet these targets and achieve greater efficiency and quality of care, positioning patients at the very heart of this process.
As the NHS focuses more heavily on community-based care, tele-medicine is taking centre stage. Effective use of tools to enable patient conditions, such as diabetes, to be remotely monitored will be key to enabling more patients to be treated at home and support the community-based care model. As Holger Felgner, General Manager at TeamViewer explains, the role of remote access software in delivering high quality care, irrespective of location, will become increasingly important. This is a real chance for clinicians to both collaborate and remotely deliver truly innovative patient services.
In the wake of the report into the failures at Stafford Hospital, decision makers across the NHS are immersed in debates about the most cost-effective and efficient way to structure an overburdened health care service without compromising the quality of care. Facing year-on-year requirements to cut costs, it is becoming increasingly important to streamline processes, reduce duplication of effort and, where possible, improve collaboration between cross-discipline teams.
Clinicians within hospitals need a better way to share knowledge and expertise irrespective of geographical location. They need to be able to deliver remote advice and services to patients at home and create a secure, effective way of working with the growing numbers of private care providers to ensure consistency of care.
Given these pressures, it is no surprise that a number of tele-care models and ideas are being evaluated across the NHS today. Many, however, are focused on patient control – asking the patient to upload information such as insulin readings or blood pressure results into a portal. Not only are these developments time consuming, they also place the onus on the patient to update information.
Furthermore, this approach does not support the multi-discipline, multi-location collaboration model that will be essential to cost effectively maximise expertise, minimise costs and improve patient care. A growing number of institutions achieve this model via remote access software. The technology can be immediately deployed both in the hospital environment and patient home with no fuss or IT overhead and allows connecting to a remote computing system within seconds.
Indeed, there are many examples today that demonstrate the way tele-care enables secure collaboration between clinicians irrespective of location.
For example, a doctor in one hospital may take an x-ray of a broken bone. Though he has dealt with many similar injuries, this specific case is something he has never seen before. However, he does know someone in another hospital that could help. On the basis that the x-ray is a high-resolution image, rather than reduce the file size and email the photo to his colleague, the other doctor can remotely access his computer and view the x-ray in high resolution. At no point is the patient’s data transferred between clinicians: the advising clinician is securely accessing data held at the hospital, avoiding any risk of breach in patient confidentiality.
In addition, tele-medicine has a role to play in reducing out-patient appointments, which is a key consideration for those with chronic conditions or disabilities. For example, in Israel, a company called MediTouch that manufactures innovative, wearable motion capture devices for rehabilitation, uses remote access software to assist patients in different countries. The patient’s aid sets up the physical device between the patient and the computer while the doctor accesses their computer and controls all functions for the rehab process. Taking this approach not only minimises the complicated and costly process of getting the patient to a hospital for rehab but also avoids the alternative of having multiple clinicians spending time travelling between patients, enabling a single clinician to efficiently and effectively support multiple patients from a single location.
The potential benefits within the hospital environment are significant. Specialists can provide care from a distant location, minimising overtime payments and improving the speed to response to a patient. Hospital rounds can be transformed by replacing the traditional patient chart on a clipboard system that still dominates the ward round with remote access enabled tablets. Instead of having a nurse prepare all the necessary documents which the doctor then carries, makes notes on and then asks a nurse or intern to update the system, the doctor could simply carry a tablet. From the tablet, the doctor can connect to the system on this PC, get all data for the patient on screen and make the necessary changes. In other words, it is only one person doing the work, and there is no need to buy, print and then throw away an enormous amount of patient charts.
The key to facilitating this collaboration is secure remote access technology that allows individuals to share their screen or access a database, use the web cam to check physical symptoms and share analyses with colleagues. Critically, there is no data transfer, reinforcing security and avoiding the risk of patient records becoming dispersed across multiple locations. Combined with a full audit trail – including recording of clinician conversations if required – the hospital can ensure every patient- related interaction and discussion is recorded.
Given the massive changes currently underway across the NHS, it is essential to grasp every opportunity to reduce costs through collaboration whilst also improving patient care. The key to good patient care is speed and relevance of communication and that must be the key for tele-care. Successful deployments can provide the real-time collaboration required to cut down on wasted travel time, excessive paperwork and extended overtime payments. Critically, patients will also receive a faster, more relevant response and better service.
Without a doubt, tele-medicine can transform lives. The challenge will be to ensure that tele-medicine is not perceived solely as a way of monitoring patients at home but a real chance for clinicians to both collaborate and remotely deliver truly innovative patient services.
By Sharon Kemp, Consultant Health Director at Corporate Culture
The Health and Social Care Act 2012 officially came into existence on April 1st this year, clearly setting out the case for change in the NHS in England and Wales. It arrived against a troubled backdrop. Barely a day goes by without headlines about one section or other of the service being added to the critical list. Demand for services and the costs of providing them continue to rise due to an ageing population and increases in the numbers of people suffering long-term illness. Meanwhile, we’re falling behind other European countries in major public health markers such as cancer survival rates. As if those challenges weren’t enough, the parlous state of public finances means there is greater pressure than ever to make future healthcare provision more affordable.
While the NHS creaks and groans, the Act seeks to resolve these issues by modernising a service that itself is in its pension years. Legislation focuses on preventive health, aiming to simplify the system by putting clinicians at the centre of commissioning, meaning decisions are made by those closer to the patient.
The Act marks a significant change to the NHS as we know it. Some 152 Primary care trusts, along with strategic health authorities, have been replaced with Clinical Commissioning Groups (CCGs). These CCGs now control a £65bn slice of the total NHS budget. Private sector companies and third sector organisations are eligible to tender for healthcare contracts; in short, anyone can be a provider and competition is already fierce.
CCGs are doubtless primed to meet all the challenges head-on, but can they succeed? Introducing the Health & Social Care Act is one thing but implementation is another. Firstly there is huge reorganisation under way, meaning skills transfer and employee engagement are key as local authorities and newly appointed health and wellbeing boards take up the gauntlet of providing integrated and patient-centred services for their local communities. They will be supported by 19 Commissioning Support Units and 27 NHS England area teams respectively. A lot of change!
But even when the reorganisation settles down, health commissioners and providers face the unenviable task of making the system work. I believe they can only succeed if they provoke a wholesale change in attitudes and behaviours amongst the communities they are delivering services to. The fact is unhealthy behaviours must no longer be viewed in isolation; one risky behaviour does not happen in a vacuum, it’s not a realistic view of the way people live their lives.
The system needs to treat each person who comes into contact with the health service as an individual and look at their lifestyle in the round. If we want people to live longer, healthier lives then we need to motivate them to change their behaviour, ideally before illness takes hold. The new system requires a real move towards a ‘predict and prevent’ model, as opposed to traditional ‘diagnose and treat’. Directors of Public Health will need to look at the current way of working and determine how they can be more productive and create a sustainable solution. A long-term strategy of true behaviour change is imperative if we are to repair our health system.
This means understanding the triggers that make people act in a certain way – and determining what would motivate them to make choices that will help them live healthier lives. The focus should be less about individual issues like obesity or smoking cessation and more on helping patients to understand what their future looks like. This ‘probable versus preferred futures’ approach should give the patient a compelling reason to act but often it’s not enough. At the same time we need to demonstrate the benefits of adopting healthier behaviours in the here and now. Health professionals will need to meet patients and put their lives under the microscope: what life stage are they at, what are the specific barriers preventing healthy choices? And how can these be tackled? The more we understand the person and their lifestyle, the better chance there is of tapping into the right motivations and interventions they can benefit from and ideally then manage themselves.
There is some evidence that those in a position to tackle the public health challenge are looking to sustainable behaviour change thinking for more of the answers. Public Health England recently published their annual Marketing Plan 2013-2014. In it they describe a ‘relentless focus on behaviour’ and enabling ‘new ways for people to understand and monitor their own behaviour’. This begins to filter through in 1 or 2 of the key programmes they have committed to deliver on a national scale. For example the healthy older adults (50+) programme talks about encouraging people to ‘present and prosper’, an approach designed to communicate the benefits of earlier diagnosis. Typically associated with cancer, we will now see campaigns tackling several diseases that this age group are at risk of with stroke and dementia also being included. They talk about driving greater integration by bringing these conversations together in a co-ordinated way.
Similarly the programme targeting young people (11-16 year olds) finally acknowledges the criticality of this stage of life when most young people begin to be exposed to risky behaviours and may choose to smoke, drink, take drugs and have sex for the first time. Their ‘audience first’ approach aims to stop treating issues in isolation as well as meet this audience where they are. It looks to use tools and techniques that fit into a young person’s life and trigger positive conversations about health. With the proliferation of Smartphones, wireless technology and the growing digital landscape that these teenagers inhabit we may now see behaviour change campaigns that look to catalyse and even co-create these important conversations about health delivered through much more appropriate channels.
These are just two examples; this type of integrated approach and co-ordinated thinking need to become the norm. In cash-strapped times cost savings are paramount. Fewer people demanding services should help ease the burden faced by an overloaded NHS system. Closer examination of lifestyles, empowering people to take more responsibility for their own health and giving people compelling reasons to change their behaviour and make better choices is the first step to a brighter, more sustainable future for individuals and the health service alike.
Data sharing between NHS organisations will help drive clinical efficiency and enable better decision-making as fiscal and demographic pressures come to bear, says Peter Osborne of LOC Consulting.
The introduction of the new NHS structures in April this year transformed the way patient health services in England are commissioned. Replacing Primary Care Trusts (PCTs) with Clinical Commissioning Groups (CCGs), they place clinicians at the centre of the commissioning process, base payments on quality of care, and give GPs more responsibility for managing budgets.
CCGs are tasked with using their knowledge of patient pathways to drive efficiency and eliminate functions that fail to meet patients’ needs. They are now responsible for commissioning the majority of secondary healthcare services – about 60% of the annual budget. They also have the freedom to ‘buy, build or share services’ via any provider meeting NHS standards.
The priority now is to drive further savings and improve clinical efficiency, arguably the greatest challenge facing the NHS. With budgets ring-fenced and allocated on a ‘flat-cash’ basis, rising patient demand means annual cost savings of some £5bn must be found. At the same time, standards of care are under intense scrutiny following publication of the Cavendish, Francis, and Keogh reports, while A&E is said to be reaching breaking point.
Given that pay accounts for approximately 70% of NHS trusts’ costs, the obvious saving is to cut staffing levels. But with the political debate ramping up, the NHS can ill afford further negative headlines around failings in care or cuts to front-line staff. A much better approach is to deploy this cost in a more effective way. This can be achieved by identifying instances where there is duplication or inefficiency at primary and secondary care level, and by optimising the flow of patients between them.
Lack of visibility
CCGs have already identified the benefit of working together with commissioning services across boundaries. Providers are also working more closely to attract as many patients as possible to ‘choose’ their services. However, competition between providers based on quality and not price has created barriers to commissioning integrated services. With CCGs, clinical support units (CSUs), and secondary care providers each operating as separate entities, managing their own budgets and costs, the result is a non-joined up approach.
For example, a patient arrives at a primary care facility; a clinician examines them and, if required, sends them to a secondary care facility where they are re-examined and provided specific treatment if needed. The patient is then discharged, but if they have to make a repeat visit, the whole process is replicated – with all the associated costs. Looking at this scenario as a cost driver would suggest that the patient in question should be treated differently.
Ironically, restructuring itself has driven operational inefficiency into the commissioning system, due to the complexity of the buy, build, or share model, and the fact that doctors and clinicians tend not to be experienced in forecasting, management, and co-ordinating budgets or resources. The separation of commissioning and provisioning also makes it harder to allocate cost on a per-patient basis, since there is no end-to-end view of the necessary data. Without visibility across the two, it is much harder to drive further cash releasing or operational efficiency savings.
Identifying the real costs
Managing data on an incident-by-incident basis gives cost per outcome. But without the ability to look at a range of cost drivers, it is not possible to identify efficient or inefficient interactions in the front end or back end. Handoff’s between services is particularly vital to understand. For example, where one service is using another as a front-end facility, changing the behaviour of the services involved could reduce cost for both in the longer term.
At a macro level, it is relatively simple to identify cost drivers. The difficulty is in breaking them down to a level that allows organisations to understand the drivers of cost and then to implement change. Many medical consumables such as bandages and syringes for example, are purchased in bulk using agreed payment scales, but although the trust benefits from a discount, there is the potential for wastage if they are not used before their ‘use-by’ date.
Without the right data, it is difficult for trusts to employ logic over procurement protocol without wastage becoming a cost driver. Inflation has been another key challenge, with clinical supplies and service costs reported to have risen by 8.7% in 2011-12. One of the impacts of this was highlighted in recent HSJ research, which revealed acute trusts were disproportionately targeting non-pay budgets in this year’s savings plans in the wake of the Francis report, while the Department of Health has announced that the NHS is looking for a saving in procurement of £1.5bn by the end of 2015-16.
Lessons can be learnt from the manufacturing supply-chain, where there is a need to assess the cost to produce, aligned wastage, the cost to expedite and the desire to achieve a just-in-time delivery. Much of this thinking could be transferred to the health sector, with pathways seen as an integrated process. Information on the costs of treating individual patients provides a much more detailed understanding of the real costs of care incurred, enabling more informed management decisions. It also has the potential to engage clinicians by making clearer the link between clinical decisions and aspects of efficiency cost-drivers and cost-effectiveness.
Time for action
Adopting a more joined-up approach to healthcare data across NHS organisations could provide nurses, doctors and clinicians with greater insight, as well as improving the quality of care and optimising capacity and consumables. Core to the requirement of CCGs is the understanding and manipulation of national datasets, trust datasets and the commencement of data capture to fully understand the costs of services.
Today, many trusts consider data collection a burden imposed on them by external parties, and are often unwilling to collect data to support their own decision-making process. In other words, they tend to collect it to meet the measure rather than seeing it as a potential value-add. The vast majority of trusts are going to have to raise their game, recognise the value of disciplined data collection and consolidation, and then use thorough analysis to make better decisions.
Although there is no single solution to achieving benchmarking and cost apportionment, both commissioners and providers have the opportunity to realise further operational efficiencies through the data and information available to them. There are also opportunities to achieve dramatic improvements in the quality of data and information they collect, and the way in which it is collected.
Following the warning from NHS England’s chief data officer that “only a handful of trusts” are likely to meet the new data requirements from April 2014, it is certainly time for action. Only with the necessary data at their disposal can NHS organisations cast off the mistakes of the past decade, where budget has been spent in the wrong areas, to target those where real value can be added instead.