Should healthcare companies spend money on occupational health services? Judith Howard-Rees of the Commercial Occupational Health Providers Association (COHPA) explains why it pays to be proactive in keeping your workforce well.

Fit for work means fit for business. The need for a drive to reduce sickness absence and incapacity, and to retain people in work who are recovering from a health problem, is clear to most employers. The Institute of Directors has said that it regards the use by companies of occupational health services to help them look after their workforce as “part of good employment practice”. This is especially true during the economic downturn, when efficiency and effectiveness are going to be key factors in riding through a difficult time.

Last year, 172 million days of work were lost due to absence from work for health reasons, many of which were linked to work-related ill health. The cost to industry in the UK is estimated at £13bn, in addition to the cost of the 2.6 million people who claim incapacity benefit. Proactive intervention, before the employee stays away from work due to poor health, makes good business sense.

Human capital

In 2003, an extensive research programme into the link between employee health and productivity found that the business case for occupational health was sound: looking after the workforce was a reliable way for companies to keep their health costs down. The report, written by Dr John Cooper, Head of Corporate Occupational Health at Unilever, and published in Personnel Today, 2003, concluded that “Human capital is one of the few remaining differentiators for competitive advantage.”

Poor nutrition, sleep problems, medical conditions, high stress levels and sedentary lifestyle were identified as risk factors for health. Those who addressed these risk factors showed 50% improvement of performance at work, while 60% felt better motivated, 75% said their overall health had improved, 80% were sleeping better and 90% had more energy. It appeared that the higher the number of risk factors, the greater the absenteeism and the lower the productivity. The study showed that employees being at work but consistently underperforming (‘presenteeism’) was as a big a problem as absenteeism.

The Department of Work and Pensions (DWP) endorses such findings, and is actively promoting the importance of nutrition, exercise and sleep in the effort to combat obesity, musculoskeletal malfunction and poor mental wellbeing. Its November 2008 publication Improving Health and Work: Changing Lives is intended to enhance the health of the work-age population.

Face under pressure

Few SMEs have access to occupational health services, and mainstream healthcare providers often have little understanding of what goes on in workplaces and what management can (and cannot) do to make adjustments. However, the involvement of OH specialists can make all the difference when it comes to retaining valuable employees who are experiencing health issues at work.

Take the case of Karen (not her real name), who left school and joined the health services – then decided that was not for her, and obtained a job as a sales representative in the healthcare industry. She undertook additional training and in a short space of time was promoted to area supervisor.

Karen enjoyed travelling around the country and meeting lots of different people. Her sales targets were always met and sometimes exceeded. Her weekends were busy with socialising and life was good. Then she and her partner began to have some challenges in their relationship. She worked harder to be home on Friday night and tried not to look at her e-mails over the weekend. But eventually she and her partner split up. Now her weekends were free to catch up with work, write reports and supposedly relax. A glass of wine with supporting friends became a regular occurrence.

Worry over finances and the anxiety of being single spurred her on to exceed targets. She began to find sleep difficult, and fast food on the road led to indigestion. She noticed that she was more disappointed if she did not meet her personal targets (which exceeded the company’s). Her colleagues noticed that she was becoming irritable, and on one occasion she was found crying in the ladies’ toilets. She tried going to bed early, only to find herself getting up in the night to tackle her e-mails. One morning she left a hotel late and, in a rush, hit another car as she joined the main road. Although her injuries were relatively minor, causing musculoskeletal discomfort in the neck and shoulders, she was signed off work for three weeks. Her Med 3 said “workrelated stress”. She simply could not face going back to work.

Fortunately, her company had an occupational health advisor, who worked closely with the safety and HR departments and knew her manager well. An occupational health assessment was arranged.

Back to the light

At the assessment, which was completely confidential, Karen was able to give an account of her professional role, her mental and physical health concerns, and her social circumstances and lifestyle. This enabled the OH advisor to make some personal recommendations and to advise the company on the steps it could take to support Karen and restore her confidence in her professional ability.

Karen reduced her alcohol consumption and made sure that she arrived at her hotel in time to take a walk or use the gym facilities. The planning of her week took into account her busy schedule, and ensured that there was plenty of time for administration. The safety officer contributed to a travel risk assessment that took into account driving, car maintenance, personal security and the use of road maps and SatNav facilities. Karen’s HR manager, in conjunction with her line manager, re-evaluated her achievements and expected performance, and agreed realistic targets for both her and the company.

Karen began to sleep better, she improved her exercise and diet, and the musculoskeletal discomfort subsided. Her confidence was restored and her team saw the difference.

At her OH review six weeks later, Karen was able to confirm that she was feeling much better. She realised that through talking with someone who understood her job role and her personal ambitions, she was able to focus on the issues that mattered. As a result, the company regained the dynamic sales representative whom they had first employed. It also ensured that other team members had the opportunity to address the wider occupational health and safety issues within their roles, preventing the need to go off sick.

Working together

Occupational health services work with employers and employees to manage the interface between health, work and wellbeing. They link together health, safety and performance. They work with managers to select and recruit the right people; they manage risks to health and promote wellness, finding appropriate ways to manage both short-term and long-term difficulties. They help companies and staff alike to overcome health-based hurdles or perceived barriers that may prevent the successful holding down of a job.

Like safety professionals, OH professionals are engaged directly by the employer and work within DWP and HSE guidelines. They allow the company to focus on its core business, confident that this often problem-ridden aspect of their business is being effectively dealt with. By diagnosing and treating problems when they first arise, rather than when the system has broken down, they save both the company and the employee trouble and cost. A stitch in time saves nine – whether for a corporation or an SME.

Activa ranked best small healthcare company

Activa Healthcare has achieved the medtech sector’s only ranking in this year’s Sunday Times ‘100 Best Small Companies to Work For’ nationwide workplace survey.

The Lohmann & Rauscher compression therapy and wound care company, which specialises in providing solutions for venous and lymphatic disease needs, came fourth overall – up two places from last year.

Rob Holder, Activa Healthcare’s Marketing Director, noted the areas of the survey in which Activa excelled: 96% of employees reported that they feel proud to work for the company and 94% that they “love working for the firm”, a category in which Activa came top overall.

He said: “Dealing with people who enjoy their work will always add to the experience for those on the receiving end, including pharmacists and pharmacy assistants. Couple this enthusiasm with groundbreaking product developments, which are consistently customers’ first choice, and Activa is in a strong position to help improve sales.”

Over 90% of employees at Activa find it “an inspiring place to work” and feel it “makes a positive difference to the world”. Activa’s Managing Director, Marc Courtney, has again been awarded second place overall for his leadership.

The Best Companies awards system is a recognised authority on the UK’s best employers, judging key workplace issues such as leadership, personal development and inspiration. Awards are decided through confidential employee surveys, focusing primarily on job satisfaction as a means of judging the overall work atmosphere. Small companies are defined as those with fewer than 250 employees.

Two healthcare companies featured in the overall Sunday Times ‘100 Best Companies to Work For’ list: Medtronic in 25th place and Stryker UK in 51st place. Medtronic ranked 20th and Stryker 48th for leadership. The companies’ highest ranking was in the personal growth category (to what extent staff feel they are stretched by their job), where Medtronic ranked 14th and Stryker 19th.

B. Braun supports World Kidney Day

A Sheffield-based healthcare company reinforced its commitment to the treatment of kidney disease with special events to mark World Kidney Day.

B. Braun Medical Ltd helped to support a mobile health clinic held at Barker’s Pool in Sheffield, allowing members of the public to be tested for high blood pressure – a key symptom and cause of kidney disease.

Staff at the company’s Thorncliffe Park site had a visit from the Sheffield Kidney Research Foundation mascot, Billy the Kidney, and hosted a dress-down day to raise funds for the local charity.

B. Braun Avitum UK, part of the B. Braun group, has recently opened a number of dialysis units across the country as part of a major investment in the renal care sector. The new units offer patients improved access to individual facilities and modern dialysis equipment with ultra-pure water.

Hans Hux, Group Chief Executive of B. Braun in the UK, said: “Anyone, anytime, can be struck with kidney disease. More than three million people face chronic kidney disease in the UK today; and this number is expected to rise over the next ten years. Meanwhile, an estimated 13,000 people are killed by the disease annually in this country.

“The purpose of World Kidney Day, which we are delighted to support, is to raise awareness about the importance of our kidneys – an amazing organ that plays a crucial role in keeping us alive and well – and to spread the message that kidney disease is common, harmful and treatable.”

Gerry New from Sheffield Kidney Research Foundation said: “We are extremely grateful for the involvement of a company like B. Braun Medical Ltd. It is brilliant that they are so keen to help us raise awareness of kidney disease, and their ongoing help and support is invaluable.”

London, 16 March 2009

Technologies to keep patients warm in acute care, diagnose and monitor bone marrow cancer, alert carers to elderly people at risk, enable remote monitoring of long-term conditions and protect babies from choking – the companies recognised by this year’s Medilink UK Awards are responsible for developing and commercialising healthcare technologies that can benefit the very young, the elderly and the medically vulnerable.

The Medilink UK annual awards, sponsored by Xiros plc, recognise outstanding achievement in the UK healthcare sector: cutting-edge medical technologies, outstanding business achievements, international success and collaboration.

Held at the Haberdasher’s Hall, London on Monday 16 March, the awards ceremony glowed with the energy of technological and commercial innovation in a sector recently noted by Lord Drayson as one in which the UK can lead the world. The nominees for the five awards – Export Achievement, Innovation, Growth in Sector, Partnership with the NHS and Start Up – were the winners of the regional Medilink Awards, selected by a panel of sector specialists from the 12 UK regions.

Technologies and talents

• The UK Trade & Investment (UKTI) Export Achievement Award was won by Yorkshire-based Inditherm Medical for its performance in international trade. In 2008 the company, which designs and manufactures heating and warming products for use in operating theatres, recovery rooms, A&E departments, delivery suites and veterinary surgeries, has increased its export sales by 338% – 80% of this generated by accessing new markets.
• The Health Technologies KTN Innovation Award went to The Binding Site Ltd – the Birmingham-based immunodiagnostics company responsible for developing Freelite, an immunoassay used to diagnose and monitor multiple myeloma cancer cells found in bone marrow. This diagnostic solution has made such an impact on healthcare that national and international guidelines on the treatment of multiple myeloma now make Freelite results a requirement for monitoring the treatment of patients.
• The BERR (Department for Business Enterprise and Regulatory Reform) Growth in Sector Award was presented to Tynetec Ltd. In 2008 this North Eastbased company, which designs and manufactures social alarms, telecare sensors and access control systems, increased its turnover by 29.9% – thus demonstrating strong business strategy, product innovation and customer partnership. Tynetec’s entire product range is designed and manufactured in the UK.
• The NHS National Innovation Centre (NIC) Partnership with the NHS Award went to Home Telehealth Ltd. This Cardiff-based company provides UK-wide telehealth services, products and solutions for patients with longterm conditions, enabling them to be cared for in a setting of their choice. In collaboration with the South East NHS Trust, the company has delivered a new telehealth care model that has led to a reduction in the numbers of hospital admissions and hospital beds used, as well as the length of time patients stay in hospital and the number of GP visits.
• The NIHR (National Institute for Health) Research Start Up Award was won by Nottingham-based 4FX Healthcare Ltd, whose baby healthcare product range includes an award-winning baby nasal aspirator designed to safely clear congestion from babies’ noses. Since 2006, 4FX has doubled its turnover and increased profit by 217%; in 2008, it won the Queen’s Award for Enterprise.

White heat

Inditherm’s Chief Executive, Nick Bettles, commented: “We were delighted to have been selected as the winner of the prestigious Medilink UK Export Achievement Award. Inditherm’s innovative technology is helping to deliver better patient care, in addition to significantly reducing the costs of preventing intraoperative hypothermia. Our strong overseas performance reflects the efforts of our international distributors and the support they receive from our dedicated team here in the UK.

“To be recognised with this award, after winning the regional heat with Medilink Yorkshire and Humber, is a real achievement for Inditherm’s medical business. We would like to thank Medilink for the help they have given us over the years, and UKTI for their support in our export activities.”

Paul Duncan, CEO of The Binding Site, said: “We are extremely proud that The Binding Site’s technology has been honoured with such a prestigious national award. This is a true testament to the achievements of our dedicated team, and to the exceptional impact that Freelite is having on the diagnosis and treatment of multiple myeloma and other related plasma cell disorders worldwide.”

In the 13th of our series of interviews with healthcare industry professionals, Fiona Wiseman, Consumer Marketing Manager for Mobilis Healthcare, talks to On Target about her working life.

What happens in your typical working week? What challenges do you face?

My biggest challenge at the moment is trying to balance my work and home life. I have a one-year-old child, and my journey to work takes 75 minutes, so it can be quite hectic.

One of the first things I do when I get into the office is review the sales performance. In particular, I’m looking at the web performance: that’s quite a new element of our business, and I’m keen to see how the websites are performing. I’m looking at online sales and evaluating the analytics behind them and looking at how well we’re performing in the search engines.

The big challenge, obviously, is the economic climate. I’m constantly looking at ways in which we can add value to help our customers, so there’s lots of promotional activity at present (offline as well as online). We try to talk to customers daily; but one of the biggest challenges I find in customer relations is actually getting hold of the right people, especially within the NHS.

I’m looking at web development: talking to customers effectively online is crucial for us, and because we talk to various markets it’s important that we get the right message to the right audience. We often use direct mail as one method, but talking to them via e-mail is something we can do more costeffectively. In the current climate, reaching the right people in a cost-effective manner is quite a big challenge.

Who are your target customers and how do you reach them?

We supply healthcare equipment for physiotherapy, podiatry and orthotic solutions, from large capital items to wound dressings. Our customers include the NHS and private practitioners. Another key market for us is professional sports clubs, especially football and rugby clubs. We also sell products through sports retail outlets and pharmacies.

The NHS is a huge target market, and the best way for us to access NHS customers is through sales people. It is important that we help them serve their patients better and provide the right level of care. Talking to them face to face is most effective, and we do this through conferences, study days and training days. Other methods include direct mail and e-mail if appropriate.

The sports clubs are very personal operations: they rely quite heavily on our sales people to provide them with the right advice and products. Retailers obviously want to make sure they can bring customers into the store, so we need to ensure they have the right point of sale to attract customers.

Recently we supplied the TV series Gladiators with supports and medical equipment – which we did initially when the show first came on TV, years ago. When we heard it was coming back, we got in touch and offered to provide them with the relevant supports, which have been tried and tested by professional sports people for years. You could say we were supplying them with all the support they needed! From the feedback we got, the Gladiators themselves were very impressed – and our new Vulkan Si black and silver supports were more in keeping with their outfits.

Occupational health is another major area for us. We have a wide range of products in posture and back care, so we’re talking to OH professionals about solutions to address back problems at work. We’ve supplied Sorbothane insoles for corporations such as Asda and Toyota – and for the military and emergency services, where the insoles are recommended by the employer but purchased by individuals.

How is the market for assistive technologies in the UK changing?

The market is changing because traditional technology companies are recognising that this area represents a market for them to develop – supplying, for example, telephones for the visually impaired or alarm clocks for the hearing impaired. As a result, it’s becoming a lot easier for specialist companies like us to provide people with aids to daily living.

In the current economic climate, we all face challenges. We need to maintain our customer base and make sure we are actively listening to them – because whether they are in retail or in healthcare, the economic crisis means they are struggling. We have to do all we can to help them continue to provide an effective service to their customers.

On Target recently looked at how the ABHI Code of Business Practice establishes recognised standards for medical device sales and marketing. Here, Doris-Ann Williams explains how the BIVDA Code of Conduct provides a hallmark of best practice for the diagnostics sector.

All industries are increasingly being required to recognise and follow regulations concerning ethical behaviour. An industry code of conduct, which may also be known as a code of practice, is a demonstrable and enforceable way of doing this. Hence, in common with most industry associations, the British In Vitro Diagnostics Association (BIVDA) has a code of conduct to which all member companies must adhere.

Around the world

BIVDA’s code was established early in the Association’s lifetime, but has more recently been updated to mirror the code governing members of the European Diagnostics Manufacturers Association (EDMA). In turn, EDMA’s code was infl uenced by that of the Advanced Medical Technology Association (Advamed) in the USA. Laws governing corporate behaviour are much tougher in the USA than they have been in Europe, so it was imperative that concerns from American parent organisations were recognised.

BIVDA is currently undergoing another review of the code, this time to ensure that we are broadly in line with the Association of British Healthcare Industries (ABHI) in order to minimise confusion among NHS stakeholders and to benefit those company members, such as Johnson & Johnson, who have businesses in both the medical devices and IVD sectors.

The BIVDA code is provided to its member companies both in printed form and electronically. It can also be downloaded by any interested party from the BIVDA website (www.bivda.co.uk).

Walk the line

The code addresses many forms of interaction between BIVDA members and health professionals. The four sections address different activities:

• Part A governs interactions with health professionals. It spells out dos and don’ts for company-sponsored product training; supporting educational conferences; running sales and promotional meetings; arrangements with consultants; gifts; and charitable donations.
• Part B provides guidance on adherence to competition law. The guidance has been drawn up for BIVDA by a firm of competition lawyers, and is periodically reviewed and updated. Members are bound by these laws at any time when two or more individuals from more than one company in the same industry sector have any conversation, formal or informal – even a chat over a pint in the local pub! Infringement of EU competition law is taken very seriously, and both companies and trade associations can be heavily fined (up to 10% of annual global sales).
• Part C covers the direct commercial activities of companies, including the promotion of products and how representatives behave. Unlike the pharmaceutical industry, the IVD sector does not have a formal examination for sales reps – but they need to be adequately trained, with the technical knowledge to provide information on products accurately and responsibly. The code assumes that a company representative is any employee representing the organisation in the public arena, so the guidelines are not limited to sales executives.
• Part D explains the framework for managing compliance with the code and how complaints are dealt with. BIVDA encourages its members to resolve issues by communication when possible. If this fails, the next step is to raise a complaint against the company seen to be at fault. The ultimate sanction against a member company is expulsion from membership. There have been three complaints raised in the past seven years, and only one of these proceeded to the formal arbitration procedure. No complaints have been raised outside of the industry sector by customers or other stakeholders.

Code of Conduct FAQs

The following FAQs illustrate how the code may be applied in some circumstances. However, they are not intended to be fully comprehensive, and it is recommended that the Code of Conduct is read in its entirety.

How do I meet the code’s requirements when providing product training?
Product training may be necessary to ensure the safe and effective use of certain products. The training should take place at appropriate locations, taking into account the convenience of the attendees and the nature of the training. So probably not in the Bahamas. Reasonable expenses may be paid and meals and accommodation provided. Any hospitality or entertainment should be modest in value and subordinate in time to the training.

What about sponsoring conferences?
Companies can sponsor individual attendance of a healthcare professional at an educational conference, provide financial support to the conference organiser, purchase advertising space and lease exhibition stand space at the event.

What is meant by sales or promotional meetings?
These are individual meetings with one or more customers from one establishment to demonstrate new products, discuss contracts etc. Modest hospitality may be provided during these meetings.

Can I use a customer as a consultant?
Yes, provided that there is written agreement, any compensation is commensurate with the service provided, there is a legitimate purpose, selection has been based on qualifications and expertise, and any meetings take place at an appropriate location with modest hospitality.

Can I still give away free pens?
Promotional items of minimal value, such as pens, are allowed. Where possible, these should be related to the professional’s work or for the benefit of patients.

What would constitute a charitable donation?
This could be a grant for advancement of medical science, patient education or public education, or sponsorship of an event for charitable purposes.

What is competition law?
Article 81(1) of the EC Treaty prohibits agreements between companies and decisions of associations of companies to restrict or distort competition within the EU. This includes tacit agreements or passive acceptance of anti-competitive behaviour.

What can’t I do when promoting my products?
Member companies should not disparage competing products or services unless by quoting data from an independent publication already in the public domain. Clinical or scientific opinions from the medical or allied professions should also be treated with respect. Companies should not bring the industry into disrepute or cause a loss of public confidence in the IVD sector.

How should an industry representative behave?
Taking into account the principles guiding promotion, the individual should also avoid offering inducements to set up meetings, and ensure that that all meetings are held in a reasonable manner, taking into account the wishes of the individual customer (regarding frequency, timing and duration only) or any arrangements in force at a particular establishment.

What do I do if I feel a competitor has breached the Code of Conduct?
If the complaint cannot be discussed with the competitor directly, or they will not listen to you, then contact the Director General of BIVDA. The complaint will be investigated by the Executive Committee, and if their decision is not accepted it will be escalated to an independent council – which will consist of an independent chairman (such as the BIVDA President), a representative from another trade association, a representative from a professional association and two nominees from the BIVDA Executive Committee – who will hear the complaint and decide on the action to be taken.

The British In Vitro Diagnostics Association (BIVDA) is the national trade association for companies with major involvement and interest in the In Vitro Diagnostics (IVD) industry. BIVDA represents both manufacturers and distributors who are active in the UK. All IVD companies, irrespective of their national origin, are eligible to become members of BIVDA. As well as providing a range of support services for its members, BIVDA pursues a strategy of raising the awareness of the clinical and cost utility of diagnostics in the provision of effective healthcare in the UK.

Ocelus delivers without pain

A new needle-free injection device will be brought to market as a result of £100,000 investment from Finance Wales plc and the Welsh Assembly Government.

Ocelus Ltd, based in Cardiff, has developed a device that can be placed on the skin to deliver drugs via microscopic particles.

Many drugs, including insulin and vaccines, cannot be given orally or by patches. The new device could make it much easier to take these drugs, creating substantial savings for drug companies and health services.

Finance Wales plc, which provides commercial funding to SMEs, has taken a £50,000 equity stake in Ocelus Ltd. The Welsh Assembly Government is providing £50,000 through its Single Investment Fund to support the development and commercialisation of the product.

Dr Andrew Kirby of Ocelus Ltd said that the micro-implant device “allows the functionality of an injection with the convenience and lack of pain of a patch”. He described it as “the next generation” on from technologies such as microneedles, which have proved “difficult to commercialise”.

Ocelus Ltd aims to work with major pharmaceutical companies and pursue licensing opportunities to develop revenue.

Leanna Davies, Early Stage Investment Manager at Finance Wales plc, said: “Ocelus Ltd has devised an ingenious method for delivering drugs into the body. The potential for this product is huge in terms of savings to the health sector, pharmaceutical industry and in reducing the problems associated with conventional injections, such as pain and inconvenience.”

For more information, visit www.financewales.co.uk

While the DH declares progress in the war against hospital infections, a disturbing Healthcare Commission report into deaths at Stafford Hospital shows that infection control is not the only aspect of patient safety in the NHS to require attention. Among the new steps the NHS is taking is the adoption of a surgical safety checklist – and some UK healthcare companies are developing products to support its use. On Target looks at how medtech is advancing the patient safety agenda.

Losing control

The war against MRSA and other healthcare-associated infections is slowly but surely being won, as regular DH reports inform us. However, there are signs that the focus of concern over patient safety in the NHS is shifting to other areas: gaps or mistakes in patient care caused by a shortage of time, resources, staff and training. These are all areas in which the medical technologies industry can make a difference by providing solutions that are designed to help clinicians bring together safety and efficiency.

In the March issue of On Target, Stephen Ramsden, Chief Executive of Luton and Dunstable Hospital NHS Foundation Trust and a leading member of the National Patient Safety Agency (NPSA), drew attention to such aspects of patient safety as rescue failure (linked to failure to monitor the vital signs of acutely ill patients), pressure sores and surgery errors. All of these involve some level of neglect, with healthcare technologies being used incorrectly or not at all.

The Healthcare Commission’s report on preventable deaths at Stafford Hospital has brought these issues to national attention. About 400 more people died at Stafford Hospital between 2005 and 2008 than would be expected, the report said. It identified deficiencies at “virtually every stage” of emergency care, with the underlying cause that managers prioritised financial and efficiency targets with the goal of achieving foundation trust status, to the detriment of patient care.

The investigation began in April 2008, after local complaints were backed up by statistics showing a high death rate. The report cited low staffing levels, lack of equipment, poor training and ineffective systems for identifying failure. It noted, for example, that there were not enough nurses to provide adequate care; that heart monitors were turned off in the emergency assessment unit because nurses did not know how to use them; and that patients were moved from A&E to a ward without nursing care so that the four-hour A&E waiting time target could be met.

The Commission said that Stafford Hospital’s “strategic focus was on financial and business matters at a time when the quality of care of its patients admitted as emergencies was well below acceptable standards.” It warned trusts nationally to ensure that a preoccupation with finances and strategic objectives did not compromise patient care. It also called for all NHS hospitals to be able to access reliable information on comparative mortality and other outcomes.

Ian Kennedy, the Commission’s Chairman, said: “This is a story of appalling standards of care and chaotic systems for looking after patients. There were inadequacies at almost every stage in the care of emergency patients.” He added: “Targets or an application for foundation trust status do not lessen a board’s responsibility to its patients’ safety.”

With the Government pushing for all NHS hospital trusts to become foundation trusts by the end of 2010, the conflict between financial performance and patient safety is likely to recur. But with the legal costs of patient harm spiralling and organisational survival at stake, there is no margin for error. While targeted intervention, supported by new medical technologies, is reducing the incidence of ‘superbugs’, other problems driven by lack of time, staff and training are in urgent need of solutions.

Keeping track

In January of this year, a pilot study by the World Health Organisation (WHO) stated that millions of lives could be saved on the operating table through the use of a Surgical Safety Checklist. The NPSA has now issued an alert that requires NHS organisations in England and Wales to implement the WHO Surgical Safety Checklist for every surgical patient by February 2010.

The WHO pilot study ran in eight hospitals around the world, and collected data from non-cardiac patients. It concluded that the use of a checklist can cut the death rate from surgery by 47% (from 1.5% to 0.8%) and the complication rate by 36% (from 11% to 7%). Hence, for the estimated 8 million operations performed every year in England and Wales, the checklist could prevent over 50,000 fatalities each year.

The WHO checklist specifies 19 steps of checking and recording to be completed before, during and after surgery. A similar system is used in aircraft cockpits before take-off to ensure that the whole team checks everything before the plane leaves the ground. With its capacity to drive improvements in teamwork and communications, the checklist is an important step forward.

Supporting safety

However, as Tony Davis, CEO of Medilink West Midlands, points out, the checklist alone will not solve the problems that trigger surgical errors. “At the moment, it’s just a piece of paper, another piece of administration for our overworked NHS teams. But by using technology to prompt and record the process, keeping patients safe from error can become a transparent, fast and monitored process.

“By using technology as a safety net, the NHS can ensure that the Surgery Safety Checklist works, that patient safety improves, while enhancing the efficiency of NHS staff and communication. Such innovative technology ensures the checklist approach and ethos can be applied across all areas of the hospital, not just within the operating theatre.” –Tony Davis, CEO, MedilinkWM

“With so many lives at risk because of individuals’ mistakes, it’s essential that hospitals across the UK follow the lead of those surgeons and staff who have already introduced checking systems into their operating theatres and wards, with similar reductions in fatalities and complications.”

Tony Davis points to two examples in the West Midlands of companies that have been working with hospitals to develop innovative medical devices to help the NHS implement the checklist more effectively, assisting the work of surgeons and perioperative teams:

• Birmingham’s Heartlands Hospital has piloted an effective and error-proof way of replicating the checklist using technology. The new electronic wristband from Safe Patient Systems uses passive radio frequency identification (RFID) to improve identification processes, patient safety and staff efficiency, saving money and reducing the risk of lawsuits. The company is in discussion with the NPSA to combine this technology with the Surgical Safety Checklist, making it easier for surgeons and staff to adopt and use.
• A new wireless technology, Near Field Communication from Sero Solutions, allows the user to touch their mobile phone against an electronic tag in order to initiate a task or receive data. The company is looking at ways in which this technology could help all members of a team record their feedback or patient interactions. By sending the URL of a mobile Internet session on a PDA device, each user could contribute their own feedback on the checklist to be viewed before each stage of the surgical procedure.

Wider patient safety issues are being addressed by the Institute for Digital Healthcare at Warwick University’s digital laboratory, which brings together technology experts from the Warwick Manufacturing Group, researchers from Warwick Medical School and key NHS staff to translate scientific advances into improved patient care.

Letting in the light

“By using technology as a safety net,” Tony Davis says, “the NHS can ensure that the Surgery Safety Checklist works, that patient safety improves, while enhancing the efficiency of NHS staff and communication. It will also make the effects of the checklist easier to measure.

“Such innovative technology ensures the checklist approach and ethos can be applied across all areas of the hospital, not just within the operating theatre,” he concludes. “A patient’s entire journey through the hospital, including every interaction, can be checked and recorded.”

By supporting good practice and teamwork, providing cost-effective solutions that bridge clinical and administrative priorities, medtech enables health providers to reconcile the goals of patient safety and organisational efficiency. These solutions can help to make sure that disasters such as the failure of emergency care at Stafford Hospital become a thing of the past.

Medilink West Midlands is an independent organisation working to raise the profile of the medical and healthcare sectors in the UK. For more information, visit www.medilinkwm.co.uk To contact Tony Davis, CEO of MedilinkWM, e-mail tony@medilinkwm.co.uk.

News

Medtech joins the Office for Life Sciences table

The Government is to create a new cabinet committee that will co-ordinate policy across departments to develop and promote the ‘life sciences’ in the UK: medical devices and diagnostics as well as biotech and pharma.

The new Office for Life Sciences (OLS) was announced by Lord Drayson, Minister for Science and Innovation, as a body intended “to implement a strategic plan of action to ensure we fully realise our leadership position in this area”. Health Minister and surgeon Lord Darzi is a member of the committee.

After consulting initially with leaders of the pharma and biotech industries, the Minister has now brought in the medtech industry and confirmed that medical devices and diagnostics are a crucial part of the UK life sciences industry.

The OLS aims to co-ordinate Government policy on the life sciences across relevant departments: Business, Health, Innovation and Treasury, with a small staff drawn from those departments reporting to Lord Drayson.

The industry representatives were asked what they would like to see happen in the next three months, six months and two years. The ABHI is working with its biotech and pharma counterparts to put together a list of priorities for the ‘life science’ industry, and working with the OLS team to clarify the issues faced by the medtech sector.

The ABHI commented: “It is explicit and perhaps helpful that the Government is casting around to support whatever high-growth activity can partially replace the financial sector, looking ahead.”

More than a ‘credit crunch’, the blight of economic trauma is spreading across the world. Does this mean the European medical device industry should scale down its ambitions? Not according to Sreevidhya Praveenkumar of growth consultants Frost & Sullivan, who argues that the situation calls for proactive strategies rather than fear.

The economic downfall around the world is now a stark reality, and is expected to continue its onslaught for an indefinite period. The medical devices industry, which has many small segments operating within it, is not insulated from the rough weather outside. The major concern among medical device manufacturers is whether the global economic downturn will blunt the rapid current growth of their industry.

Alive and well

The medical devices sector is one of the most vital and dynamic sectors of the European economy. The industry is constantly driven by innovative research and development, which needs to keep pace with the increasing demand from health providers (reflecting increasing patient demand for these solutions). There are reportedly more than 6,000 medical device suppliers in Europe, employing around 300,000 people.

The European medical devices market is highly fragmented, with numerous niche product lines aimed at modest-sized markets. Companies involved in medical device manufacturing range from large corporations producing a broad range of devices and pursuing a global marketing strategy on a worldwide scale to SMEs concentrating on a single product line in a specific geographical region.

The bigger picture

The worldwide medical devices market comprises three main regions: the USA, Europe and Japan. The USA represents the largest share with approximately 45%, followed by the European Union (EU) countries with 30% and the rest of the world with 25% (see Figure 1). The global market for medical devices is currently estimated at US $314.6 billion. Of this, US $94.39 billion can be attributed to the European market.

Short-term prospects

Over the last five decades, the healthcare industry has experienced rapid escalation in healthcare costs and medical expenditure. Today, in most western European nations, healthcare is one of the fastest-growing segments of government spending. One of the main underlying factors driving healthcare expenditure across Europe is the ageing population, which has caused increases in particular sectors of healthcare needs. These age-related diseases fall mostly into the cardiovascular and musculoskeletal categories.

The ageing population will substantially affect social, political and economic conditions in Europe, and this will tend to reinforce its impact on the healthcare market. Since healthcare expenditure and age are strongly related, it can be predicted that the future ageing population will result in a continued surge in healthcare expenditure. The medical devices market is steadily growing at a rate well above the growth rate of the world economy.

The traditional healthcare markets in the USA, Europe and Japan are showing lower growth than the overall global market, and this is caused mainly by cost-containment policies. Nevertheless, health services are typically viewed as necessities that consumers are very reluctant to forego during difficult economic times.

The ongoing recession is placing pressure on firms that provide health insurance, and also reducing consumers’ discretionary spending for purely elective medical care. None the less, the immediate outlook for medical devices is promising – especially for assisted living facilities, which will benefit from the rapid growth in the numbers of people aged over 85. A number of EU countries, such as Belgium, France, the Netherlands and the UK, have found that healthcare expenses multiply between the ages of 65 and 75 in comparison with the younger and middle-aged groups.

'Hot segments'

Figure 2 provides a rough market segmentation of the medical devices industry, with the key growth areas starred. This list refl ects the impact not only of the ageing population but also of the obesity crisis, the infection control agenda, the migration of healthcare services from the hospital to the community, and the impact of technological innovation (for example, in minimally invasive surgery) on healthcare. The growth of each medical device market segment is affected by its own specific market dynamics. Segments such as cardiology, gynaecology, wound care and orthopaedics are unlikely to be badly affected by the economic downturn in the short term. However, the industry may not achieve phenomenal growth under these conditions.

Trouble ahead

The financial downturn, being a countercyclic trend, will not spare any industry in the long run. Medical devices are no exception. Though the medical devices industry will flourish in the short term due to continued high demand and its own resources, it cannot withstand the recession indefinitely.

The industry is highly dependent on its end users, mainly the hospital sectors. In recent months, hospitals have reported a 20–30% reduction in the volume of elective procedures such as hip and knee replacement surgeries. The combination of the hospitals’ financial environment and the recession will reduce their purchasing volume and the average sales price for the devices they purchase. This will certainly affect the revenue and growth of the medical devices industry.

The accelerated pace of the recession is expected to peter out from the third quarter of 2009. The device manufacturers most likely to suffer lasting effects are those in the orthopaedic, spinal, cardiac cath, endoscopy and other non-urgent specialties.

Seize the day

To conclude: the medical device industry can be optimistic about 2009, despite the global economic gloom, due to the fact that imperative healthcare needs are not going away. However, the longerterm prospects will be difficult for some segments of the healthcare market as the balance of healthcare spending and provision shifts to adapt to what will clearly be lasting damage to the economic health of European society.

Increasing market share and launching new products efficiently is thus a crucial priority for European medical device companies. From strategies for launching new products and increasing their market share to identifying and infl uencing decision-makers, the list of sales and marketing activities to be undertaken urgently is long and demanding. In particular, marketing is a major challenge for medical device manufacturers in the current climate: delivering the right marketing message to the right audience, with the right educational mix, will be essential for future success.

This is not a time to stand still and wait: it’s a time for planning and focused action. The next decade will be a tough one for many medical device suppliers. They may need to switch to lower-cost manufacturing sites in order to stabilise their revenue, or merge in order to increase their turnover and thus be protected from the lengthy economic winter. But those who plant seeds now will reap a harvest in the years ahead.

Sreevidhya Praveenkumar is a Research Associate, Healthcare for growth consultants Frost & Sullivan. For more information, visit www.frost.com