In the medical technologies industry, a truly effective sales and marketing team is hard to find - or to replace. Sam Meakin, Director at the Recruitment Management Group, offers a guide to cultivating and harnessing talent.

More than ever, the medical technologies sector needs its highest performers to be fully engaged and actively participating in organisational development - but not enough time is spent on retaining and developing existing talent. Cultivating talent in the workforce is necessary to ensure high levels of sales and marketing achievement while implementing efficient business delivery; but it is also important that individual professional developments are built upon, personalised and recognised.

The new healthcare market

Healthcare is an increasingly complex market, and both NHS and private sector health providers are becoming a great deal more commercially minded. As such, they need to be managed with a much greater degree of sophistication. Most are now looking for solutions-based partnerships rather than just a product - and this has a real impact on how the medical devices sector needs to position itself.

As a consequence, medtech businesses need to take a close look at what skills and behaviours they are looking for when they are employing their sales and marketing teams. Individuals need to be able to sell not only to clinicians, as in the past, but also to procurement and finance professionals. This makes good business acumen invaluable.

To address the changing needs of their customers, many medical device businesses are now implementing account management or business development structures rather than the traditional team of reps. Lessons can be learned from the changes in the pharmaceutical industry over the past ten years - employing healthcare development managers, for example, has been hugely effective for businesses in communicating with customers at a strategic level.

Up-and-coming sales talent

For some time now, there has been a shortage of high-calibre jobseekers in the medical devices sector. Businesses know who their best people are and look after them, giving them little reason to look around for alternative career options.

This creates huge competition for the talent that is actively 'on the market', resulting in Dutch auctions that inflate individuals' salaries far above their level of competence. At RMG we are frequently disappointed by the calibre of candidates we interview and assess who work for well-respected names in the industry but fall some way short of demonstrating the basic skills needed for success in today's healthcare arena. This raises the question of whether these companies are settling for what they can get, rather than focusing on talent acquisition and development.

Savvy businesses can stay clear of this scrum by enhancing their recruitment strategy and looking outside the traditional candidate talent pool. Recruiting trainees, for example, is an excellent way for a company to enhance its succession plans and nurture new talent. However, most companies are not set up to do this well, and cannot afford the period of unproductiveness before such individuals gain an appropriate level of competence.

That leaves the option of headhunting: seeking out people who are content in their current employment, but may be willing to listen if a more beneficial opportunity is correctly positioned to them. The major advantage here is the opportunity to capture an individual from a direct competitor who can both deliver a short-term gain and add to your succession planning pool. The fact that our model has moved from 80% advertising to 80% search and selection reflects the way the job market is moving.

Methods of engagement

Companies need to develop a cohesive attraction strategy that will make them the sort of employer that people aspire to work for: an employer of choice. This is where your trusted recruitment partners can be worth their weight in gold: they can give you a clear idea of the state of the current market, how your business is perceived and what today's medtech professionals are looking for.

Frustratingly for many recruitment professionals, many clients still consider recruitment to be a very transactional process. All too often, a vacancy means a desperate scramble to find a person to fill a role, with the result that the business employs someone who may fit right now, but who will not be right in the long term. Rather, employers should see a recruitment drive as an opportunity to bring in genuine talent that will impact on the business in the long term and help to differentiate them from the competition.

Some clients, however, do not fully appreciate the 'consultant' element of 'recruitment consultant', and frequently make decisions based purely on the black and white details of a CV rather than engaging in meaningful discussion concerning the rationale behind the submission of a candidate.

When engaging with potential employees, businesses should not underestimate the value of personal contact. The technological revolution has arguably transformed the recruitment process - but at a high cost. Web portals and e-mail have made it easy to gather hundreds of CVs and make contact with multiple candidates, but picking up the phone to speak to a real person - and not their digital persona - can save hours in wasted interviews and recruitment blind alleys.

Recognition and reward

A strong and well-developed HR function is essential to getting the recruitment process right. Making good decisions at the earliest stage is crucial, and a good HR team (or consultant) will look beyond technical competencies and towards cultural fit.

The initial recruitment process can also be considered as part of the new employee's personal development: it is never too early to identify strengths, weaknesses and motivations that should be addressed.

Hiring managers also need to be aware of their existing team members' motivating factors and nurture their talent. It is vital that they are not threatened by people whose skills and aspirations exceed their own - this is all part of succession planning. Employers need to ensure that their own employees are not putting barriers in place that stifle the development of others. Forward-thinking companies need to put in place a talent management programme that gives all employees the opportunities they need to make a difference to the business.

Conversely, managers have a key role in recognising when an employee is not up to the right standard and must have the difficult conversations as early as possible. Lavishing investment on an employee who does not have a future with your business, whether due to a lack of skills or a poor cultural fit, can only result in a breakdown of relationships and a bitter termination of employment - with their impressions of your business taken out into the job market and creating potentially damaging perceptions.

Nurturing talent can help to make a good company great. People are at the heart of any business, and keeping them motivated and happy reaps dividends for companies. The rapidly changing healthcare market presents a real opportunity for medtech businesses to pull away from their competition, armed with an effective talent management strategy and an ongoing commitment to people development.

Sam Meakin is Director of the Healthcare team at RMG, an executive search consultancy based in Cheshire. With over 20 years' experience of recruiting talent in the healthcare sector, RMG provides both a national and international service covering all functional disciplines and levels of seniority.

Web portals and e-mail have made it easy to gather hundreds of CVs and make contact with multiple candidates, but picking up the phone to speak to a real person can save hours in wasted interviews and recruitment blind alleys.

Part eight: Mistakes

Steve Gray answers your questions about compliance with the ABHI Code of Business Practice and other industry codes that govern commercial activity.

Thank you for the suggestions we have received regarding future articles. Do please keep sending in your questions and comments.

Dear Steve:

What can you do if you have crossed the Code line through oversight, haste or just not knowing and want to make amends? What steps do you take to get back on track?

Steve says:

This is a great question. Quite often when we present at meetings, our consultants are 'taken to one side' by a representative and asked about such situations.

It is absolutely natural to worry if you think you have done something wrong. However, this is an area where honesty is absolutely the best policy.

Imagine a scenario where our representative for Lakeshore Diagnostics has told a hospital doctor it will be "no problem" to secure funding for a departmental meeting. As the day draws closer the representative learns that the event is not an in-house educational session requiring food, but an external event at a local restaurant. The organiser has not booked a private room, but is offering the representative the chance to say "a few words" about the product before the celebrations for the unit's tenth anniversary get under way.

In effect, sponsorship of education has turned into sponsorship of entertainment in a public environment. The representative has two options: either cancel the support or go ahead and hope everything is OK.

Suppose the representative proceeds with the event. He creates the appropriate documentation to meet Lakeshore's compliance policies, including an agenda and a brief letter from the meeting organiser requesting sponsorship. The representative arranges for a cheque to be paid to the organiser, rather than settling the restaurant bill on his company credit card.

During a routine check, the finance team identify that the payment request is for an individual. They ask the representative to explain this before they release the payment. Unhappy with the explanation, the finance team escalate the issue to the compliance officer. Eventually, the truth of the matter is revealed. Everyone understands the situation the representative was in, but it looks like the representative has tried to cover up something that was inappropriate. This blemishes his professional reputation. The company has been placed at risk because there could have been a complaint raised about the meeting in the restaurant. The ABHI's principles of transparency and documentation have been breached, which means that any complaint could result in sanctions being imposed by the industry association.

However, if the representative had spoken to his manager when the issue first became apparent, the manager and the compliance officer could have supported the representative in managing the situation very differently.

Clearly it is inappropriate for the company to support the event, as it is about entertainment rather than education. A suitably worded letter or conversation with the organiser could have resulted in a withdrawal of the sponsorship in a manner that maintained the relationship or even led to a change in the meeting's structure so that it became a genuine educational event that Lakeshore could support - which would actually have enhanced the reputation of the company because of the manner in which the issue was handled.

It is important to remember that mistakes do happen - we are all human. There may be ways to resolve the issue - or there may be consequences that arise from the mistake having been made. It all depends on the circumstances. What is absolutely clear, however, is that transparent and open management of the issue is far better than being the proverbial ostrich with its head in the sand.

Raise the issue as soon as possible with your manager or the company's compliance officer. They really are there to help!

Steve Gray is Managing Director of Compliance Hub, specialists in Healthcare Codes of Practice and accredited trainers for the ABHI. The company regularly runs engaging and enjoyable(!) workshops and training courses for field-based and office-based teams.

Do you have a compliance query for Steve Gray? If so, e-mail your question to us at joel.lane@medtechbunesiness.co.uk. Your anonymity is guaranteed.

Luke Fryer is Managing Director of Medline Europe, a major privately-owned US healthcare company that entered the UK market in 2008 and has already gained 15 national NHS tenders. Medline offers a wide portfolio of medical consumables right across the healthcare market.

What are your main priorities as Managing Director of Medline Europe?

There is a fundamental shift occurring in the healthcare market, which changes our focus from reactive treatment to proactive prevention and managing incidence of disease infection to ensure quality outcomes. Medline is dedicating the account management and clinical teams and manufacturing units to help succeed in this area. In addition the teams have to stay focused on why we are in business, and why we have been successful, which is because we provide high-quality products and because we never compromise on service.

As an American owned company, it's challenging to have to orientate ourselves, and remind our parent company, towards the different needs which are specific to Europe.

What particular challenges and opportunities does the UK healthcare market hold for a company like Medline?

There is a great opportunity for Medline in Europe in the years to come. We are unique in Europe at the moment in that we are a $4 billion global company without a historical infrastructure in the UK and Europe, and that allows us to be extremely nimble and creative for our customers' needs. We do not have the historical infrastructure which many of our competitors in the market have. This really is an advantage for our customers in that, in these challenging times, we are able to look at things in a different way. If they're asking us to provide various solutions and services, it's highly likely that we'll be able to adapt and deliver them.

The challenge facing Medline is the fact that we are new and we have to build our reputation, and we can only do so by creating loyalty through serving our customers and getting it right first time - because it is a demanding market, and not one that gives you a second chance. That is extremely important to us: if we promise something, we will deliver on it.

The new Government strategy for healthcare in the UK involves the decentralisation of NHS commissioning. How will this affect your market?

To take it down to a basic level, we must be extremely strong locally, which means our team of account managers have to be the best. We have made a conscious decision to recruit professional, commercial personnel from outside the healthcare industry. They are able to bring fresh ideas and experiences. When this is coupled with the excellent clinical support team, who have worked in and alongside the NHS, we have a very powerful two pronged approach, which we feel puts us at an advantage in meeting all the requirements of good service and good products to our customers.

Medline is known for its involvement in campaigns to raise awareness of breast cancer. Why are public health campaigns of this kind important for the medical technologies industry?

We wanted to give something back into the industry in which we work, and a breast cancer awareness campaign seemed a natural fit as the demography of our customers is predominantly female. We do not brand heavily with regards to these campaigns; rather our involvement is from the outside.

Just recently we have worked on something known as the Pink Glove Dance, which you can find on www.pinkglovedance.com or on YouTube, and which hopefully adds a different dimension to an extremely challenging disease. It is great because it involves the healthcare workers and patients who suffer from breast cancer, and in times of difficulty adds a bit of fun. It has been an absolute global success and something, with which we are very proud to have been associated - but it is really down to the healthcare workers and the patients who have made it that success. Medline is proud to be associated with it on the periphery.

The Pink Glove Dance was created in a particular US hospital, and a lot of other healthcare institutions have got involved; it has been on the national cable channels and has spread right across the globe now, and it's great to see the healthcare workers and the patients coming together and sharing in a bit of fun, and raising some awareness and funds along with that.

How NHS performance is evaluated is a crucial issue for the suppliers of medical products and services. Thoreya Swage examines the new NHS Outcomes Framework, which promises to keep the patient clearly in view.

The coalition Government's scheme for the health service, Equity and Excellence: Liberating the NHS, was launched in July, proposing fundamental changes in the way our healthcare is delivered. It was soon followed by a flurry of consultation papers - one of which is a proposed outcomes framework against which the performance of the NHS will be assessed.

For a number of years, the NHS has tried to demonstrate its effectiveness using various methodologies. The latest consultation paper is no exception. Liberating the NHS: Transparency in outcomes - a framework for the NHS is the Government's attempt to refocus the accounting of the many and varied NHS interventions that are carried out on a daily basis.

Showing an improved quality of care has always been difficult - particularly with nationally determined process targets, which the current Government claims has distorted clinical priorities and restrained innovation. However, it is a tall order to measure the success of approximately 300 million consultations in general practice and 1400 different types of hospital-based treatments for 7 million routine admissions and a similar number of emergency admissions each year.

The paper proposes that the Secretary of State will, following consultation, set the national outcomes which the newly established NHS Commissioning Board will be expected to deliver. In turn, the new GP commissioning consortia will be held responsible by the Board for improving health outcomes through their local commissioning of services. The document is at pains to say that the indicators for measuring the outcomes will be based on the best available evidence, and the framework will not be used as a stick to beat providers of NHS care.

First night of the PROMs

Once the indicators are set, the Board will decide how best to deliver improvements. This will be done by working with the GP consortia and using the tools and levers available. For example, the Board will be able to commission Quality Standards from NICE. These will inform the development of commissioning guidance, which will provide details on how the national outcome goals in the framework can be met. The Board will also use the Quality Standards to design mechanisms for incentive schemes, such as Commissioning for Quality and Innovation (CQUIN) and other payment frameworks.

The principles guiding the development of the NHS Outcomes Framework include the long-held ideals of accountability, transparency and balance, with a focus on achieving what matters to healthcare professionals and patients, as well as working in partnership with other public services as necessary. The requirement for balance is what remains of Lord Darzi's proposed review of the NHS (published in 2008 under the previous administration), whereby services would be assessed in terms of effectiveness, patient experience and safety.

The new framework places emphasis on ensuring excellence and moving away from minimum standards, which are the responsibility of the Care Quality Commission. A new direction has been set with the requirement that measures must be internationally comparable and the data collected must be publicly available. Furthermore, in addition to clinical outcome measures, patient reported outcome measures (PROMs) will feature equally as a means of recognising patient experience and safety.

There will also be measures that the NHS can only meet by working with other public sector agencies such as social services and the new Public Health Service. The NHS is working to construct and consult on outcomes frameworks for these bodies so that they can integrate well with those for the NHS.

The first outcomes framework will be modest, using current indicators for which data can be collected, and is due in 2011/12. The intention is to develop this over time as the NHS landscape changes, with annual reviews of the indicators.

From process to outcome

The proposed measures, which are taken from the principles identified by Lord Darzi, are placed in five domains:

• Domain 1 - preventing premature deaths.

• Domain 2 - improving the quality of life for people with-long term conditions.

• Domain 3 - facilitating the recovery of people who have had episodes of illness or injury.

• Domain 4 - ensuring a positive experience of healthcare.

• Domain 5 - looking after people in a safe environment and protecting them from avoidable harm.

Domains 1-3 cover effectiveness, while domain 4 covers patient experience and domain 5 patient safety.

Each domain consists of three sections: an overarching indicator, improvement areas and NICE Quality Standards. The overarching indicator for each domain allows the progress of the NHS to be assessed in the broad activity areas relevant to that domain.

Under each overarching indicator, there will be identified areas where improvements are expected to be made. These will be accompanied by specific outcome indicators against which the NHS Commissioning Board will be held to account for progress achieved.

Supporting all of these outcomes will be Quality Standards produced by NICE and commissioned by the Board. The GP consortia are expected to refer to the commissioning guidance (based on the Quality Standards) when commissioning services locally.

NICE has already published three Quality Standards this year, covering stroke, dementia and venous thromboembolism (VTE) prevention. A further 10 are in development; furthest down the line are specialist neonatal care, depression, chronic obstructive pulmonary disease and chronic kidney disease, with the expected publication date June 2011 (except for neonatal care, which is October 2010). The final tally is anticipated to be around 150 Quality Standards, providing guidance on what high-quality care should look like for a specific pathway or service.

The outcomes framework has a different structure from those developed in the past. Figure 1 below shows what the five proposed domains look like. All of the domains, overarching indicators and improvement areas shown will be supported by Quality Standards.

Clearly the Government is trying hard to shift the focus of the effectiveness of healthcare from processes to outcomes, and many possible indicators have been identified in the consultation document to get the discussion going.

 

Opportunities for medtech

The Government is keen for GP consortia to have the flexibility to commission services according to local needs - which means that medtech companies need to get close to the emerging commissioning groups and start discussions around pathways of care and service redesign. Although the pioneer GP consortia will have their own ideas on how to change services, there will be many who require more help and support. Solutions such as telemedicine, near patient testing and deployment of other diagnostic equipment in the primary or community care setting will be attractive.

The first NHS outcomes framework, due next year, will use many of the current indicators that cover processes. However, in the future the indicators will need to reflect outcomes. This will mean that new indicators need to be identified and the appropriate data to support these collected. New IT systems will need to be developed to meet these needs, and the medtech industry could be an important resource here.

New or redesigned services in which innovative medical technologies are utilised will need appropriately-trained staff to use these technologies. An important role for the medtech industry will be to ensure that health workers who are handling such technologies have the appropriate competencies and skills to use them correctly.

With the dual focus on providing care closer to home and evidence-based practice, consortia will be looking hard at specific medical technologies that improve clinical outcomes. Possible examples include continuous subcutaneous insulin infusion devices as well as such homecare services as continuous ambulatory peritoneal dialysis, stoma care and administration of chemotherapy and HIV drug therapy.

Transparency in outcomes - a framework for the NHS has set the scene for assessing the performance of the NHS through patient outcomes - including measures of patient experience - rather than process targets. Much more work clearly needs to be done - but while they await the published outcome of the consultation in December, medtech companies can do much to prepare for the new world.

 
Dr Thoreya Swage has several years' experience in the NHS, both as a clinician (psychiatry) and as a senior manager, including Executive Director for a Health Authority, in various NHS organisations covering acute and primary care. She has expertise in commissioning health services, most recently working with the independent sector as part of the Independent Sector Treatment Programme at the DH. She is currently working for a number of NHS organisations, including DH agencies, to develop a more commercial approach to the commissioning of healthcare.

The Government is keen for GP consortia to have the flexibility to commission services according to local needs - which means that medtech companies need to get close to the emerging commissioning groups and start discussions around pathways of care and service redesign.

The Association of British Healthcare Industries (ABHI) comments on the Government's White Paper Equity and excellence: Liberating the NHS.

The ABHI has published its response to the Government's recent White Paper for health, as part of the wider consultation process that closed in October. Its response focuses on several key policy points that are expected to be implemented by primary legislation. Three of these issues concern national policy while one concerns the local impact of implementing these policies.

The NHS Commissioning Board

The White Paper outlines five main functions of the national NHS Commissioning Board:

1. Providing national leadership on commissioning for quality improvement

2. Promoting and extending public and patient involvement and choice

3. Ensuring the development of GP commissioning consortia

4. Commissioning certain services

5. Allocating and accounting for NHS resources.

ABHI has focused its initial response on functions 1 and 2, with further comment on the remaining functions to follow as part of its response to the separate consultation document, Commissioning for Patients.

1. Providing national leadership on commissioning for quality improvement

As a high-level statement of policy, the White Paper naturally does not specify in any detail what might be required to fulfil these functions. However, the ABHI offers some outline proposals to help specify the necessary detail for further policy development and legislation.

The status of commissioning in the NHS at local level remains varied. There is no straightforward equivalent to the role of Monitor, which has applied rigour in its oversight of Foundation Trusts (FTs). For FTs, the need for oversight of financial inputs, and for careful business planning of ensuing resource use, has been understood. This regime has resulted in the development of a cadre of providers that match the best of the commercial and/or business world, in the form of public interest companies.

There is both opportunity and need for the proposed NHS Commissioning Board to bring about a comparable change as regards commissioners in the form of GP consortia. While the White Paper provides detail on how accountability for outcomes will be developed, it is relatively silent on what needs to happen in order to promote the same kind of businesslike approach to resource use that has seen FTs become a successful model. The change in audit arrangements brought about by the abolition of the Audit Commission raises an additional risk here as regards accountability for resource use by new GP consortia.

This note suggests that some new and rigorous processes need to be first articulated and then put in place, so that the NHS Commissioning Board is able to promote GP commissioning that is every bit as robust as the corresponding provider regime, as regards resource use and business planning as well as in outcomes. The processes required to achieve this would not appear to be at variance with the proposals in the White Paper, but are not referred to in published material.

ABHI believes that development of the NHS Commissioning Board should involve a number of key features. There should be a function in the NHS Commissioning Board to address accountability for resource use by GP Commissioners. The outcomes brought about by GP consortia will be measured, though some measurements can only be approximate rather than precise and by indirect instruments. However, this function would address the choices commissioners make in terms of financial inputs and would:

• Maintain an overview of the kinds of services commissioned, in such a way as to enable the mix of services and treatments across England to be benchmarked for efficient use of resources, very much in the spirit of what the NHS Institute for Innovation & Improvement has done.

• Provide leadership and hold accountability for the existing NHS duty to innovate, so as to ensure that commissioners are able to keep a clear view of new treatments as they are developed and assessed and come into use. In doing this, the Board should adopt the functions currently led by the NHS Life Sciences Innovation Delivery Board to promote adoption of beneficial technologies.

This approach would also support the 'promoting productivity through better commissioning' aspect of the Board's fifth function: Allocating and accounting for NHS resources. These functions also need to be fully complemented by robust accounting arrangements following the abolition of the Audit Commission.

2. Promoting and extending public and patient involvement and choice

The function proposed above should work closely with one that actively involves patient representatives at national level, complementing what is promoted locally with new HealthWatch and supported by the local democratic processes as they develop. While local HealthWatch will "ensure that feedback from patients and service users is reflected in commissioning plans", such local activity is unlikely to have a clear view of the emergence of new treatments or of how local commissioners are performing against national benchmarks in terms of innovation in their treatment specifications. It would therefore be desirable if a Commissioning Board patient-oriented function were linked closely with HealthWatch England in the Care Quality Commission to help "people access and make choices about services".

It is important that the HealthWatch England functions are fully reflected by suitably sensitive machinery in the NHS Commissioning Board. To some extent this would build on the patient involvement function that NICE has had. It is arguable, however, that that activity has not connected effectively with local processes. NICE's outputs in future should feed strongly into the set of activities that is proposed here. This in turn should ensure that awareness of new treatments and of the potential for patient choice is more strongly reflected by the NHS Commissioning Board than it has been by the more diffuse arrangements that have preceded it.

In turn, these activities should integrate fully with the system for managing the tariff, Payment by Results (PbR). ABHI suggests that there is scope for a national tariff office within the NHS Commissioning Board and this office should be wired directly to the functions responsible for looking at resource use, innovation and adoption. At present, management of the tariff is a finance function and many adjustments are made solely on the basis of financial drivers. However, PbR needs to become more broadly based and also to have a strong quality and innovation function to ensure that short-term budgeting and financial issues do not continue to be at odds with quality and innovation. This is also essential to make real the White Paper's aim that "Money will follow the patient through transparent, comprehensive and stable payment systems across the NHS to promote high quality care, drive efficiency, and support patient choice".

Finally, there is one further crucial function needed to interlock with the above - a system for ensuring rigorous benefits realisation across the NHS, while not cutting across the devolution that is sought in the White Paper. This contains two elements, both of which have begun to emerge recently in the NHS.

One element concerns the need for the NHS to secure benefits of new treatments more consistently, whether evaluated through NICE or emerging through other professional channels. In a system consuming resource on the NHS scale, there is a need to find a powerful way of gaining benefits rigorously to support the continuing drive for productivity and ensure that patients benefit from new treatments. This has not been a strength. To date, there has been no comprehensive or consistent way of tackling this challenge. Measuring potential benefits of new treatments - literally, the costs of doing them set against the penalties of not taking them up - links directly back to the detailed proposals outlined above.

A second element would be an adoption support function that the NHS Commissioning Board should have available in order to promote the more active rollout of new treatments and the technologies that support them. This should comprise aspects of NICE's implementation activity and the functions of the existing NHS Technology Adoption Centre. Both of these functions are likely to be compatible with some found in the existing NHS Institute. All need to be fully integrated to support the newly- devolved NHS with the technical aspects of implementation and the business cases that are required. While local control is fundamental, mechanisms are needed to address the tension between annual budgeting and treatment benefits that may not support balance sheet changes in-year. The NHS needs direction and incentive changes to ensure that beneficial new treatments - many involving technologies - reach patients sooner, as happens in other OECD countries.

All of this interacts with NHS procurement decisions. Policy needs to balance the desirable characteristics with the devolution that actually exists; policy must therefore be developed and monitored to ensure that these issues 'join up' to support the NHS as a national system. At present there is no clear and obvious home for policy or benchmarking of performance in these aspects of commercial execution under the regime proposed by the White Paper. They are worth around £20bn per annum and need clear focus.

The nature of the tariff

At present, policy and operations for the Payment by Results (PbR) tariff are driven out of the Department of Health NHS finance function. The White Paper proposes that functions should be split between the NHS Commissioning Board for tariff structure, and the reformed Monitor for pricing, in the latter's proposed new role of economic regulator. ABHI believes that the White Paper does not make a clear case for splitting management of the tariff between the NHS Commissioning Board and Monitor. It would be more sensible to separate the question of tariff management from the issue of local price variations that arise from geography and/or may be necessary as part of market entry. These latter issues may interact or operate separately.

The argument for Monitor to become an economic regulator builds on the success of the FT regime since its inception under the leadership of Monitor. However, the UK government experience of economic regulators is not straightforward, and several of the clearest examples - in energy and telecoms - are in markets where the payer is almost entirely the private individual. This is clearly not the case for the NHS, where almost the entirety of funding is voted directly by Parliament.

Further, the question of separating tariff pricing from structure seems to cut across the purpose of the tariff as it has developed, which includes management of relativities - literally, different relative costs - of the grouped procedures in the tariff chapters. Local negotiation currently does and should take place around certain aspects of the tariff, particularly in support of service innovation. There needs to be strong local leadership on this from commissioners: a market requires the buyer to give buying signals.

The implication of price management by Monitor, however, suggests a form of market interference that does not happen in energy or telecom prices, except in circumstances where there are distinct examples of anti-competitive behaviour on the part of suppliers (providers). A properly operating tariff should not require this type of interference. If there is a flaw in the tariff structure, in policy or implementation, it needs to be addressed upfront, rather than patched up in hindsight. The tariff/DRG systems in many other countries generally have sufficiently robust methodology and projections to do this, and there is no reason this cannot be achieved in the NHS in England. Additionally, after the fact ad-hoc 'regulation' will impede efficiency and send confusing signals to providers.

There is a significant cause of price variation in the NHS provider market, but it is not discussed in the White Paper. This relates to the application of the Market Forces Factor (MFF) to the tariff.

ABHI therefore suggests that the management of the tariff structure and of the pricing relativities should be dealt with as part of the functions of the NHS Commissioning Board and remain the remit of a national tariff office. The existing MFF should be managed and developed by the new Monitor.

The development of MFF along these lines would appear to address the policy objectives as set out in both the White Paper and the consultation document. It would allow Monitor to recognise the significant existing price variations that exist across the country, for example in land costs and staff pay, already factored into payment by commissioners for NHS treatments. Moreover, it would also allow Monitor to manage these variations to support entry of new providers, recognising transitional factors at local market entry together with the policy objective of encouraging local market entry to enhance patient choice.

ABHI strongly suggests that tariff structure and development should, however, be a core function of the NHS Commissioning Board.

Review of Arm's Length Bodies (ALBs)

Overall ABHI supports the recommendations in the ALB Review, with the exception of the following:

1. Human Tissue Authority (HTA)

The functions of this body are to be transferred elsewhere before the end of the current Parliament. The HTA currently regulates the collection and donation of tissue under the Cells and Tissues Directive, but there is often overlap and confusion between functions under this legislation and other legislation covering finished product. As the reorganisation process gathers pace, we believe that any matters concerning the regulation of Product defined as a Medical Device and regulated under the Advanced Therapy Medicinal Product regulations, Cells and Tissues Directive or Medical Devices Directive should come under the control of the MHRA. Licensing of establishments should not, however, reside with the MHRA, whose expertise lies in product regulation, though the Agency should have access to dossiers on establishments and on material sourcing because this will be relevant to the final product.

We also recommend that the Human Tissue Authority, when implementing the Cells and Tissues Directive, ensures transparency and recognition with relevant medicines regulations, particularly with respect to Quality and Safety of donated tissue. Such transparency is essential in order to reduce duplication in review and approval of finished product. In addition, steps should be taken to avoid duplication of actions taken by other EU Competent Authorities under this legislation.

2. National Patient Safety Agency (NPSA)

The National Patient Safety Agency is to be abolished. When this happens we believe that provision should be made for any Medical Device safety issues to become the responsibility of the MHRA rather than being transferred to the NHS Commissioning Board. It is essential that vigilance in respect of Medical Devices is focused in one organisation.

3. NHS Business Services Authority (BSA)

ABHI seeks clarity on the management arrangements currently carried out by the BSA Supply Chain Management division in respect of NHS Supply Chain. This significant NHS commercial provider addresses a large part of the NHS non-pay spend and needs careful management. Given the White Paper proposals to delegate many existing DH functions and the absence of reference to arrangements for commercial policy, this issue needs to be handled with great care.

Existing NHS commercial contracts

ABHI has concerns about the degree of change proposed in terms of management of the NHS' commercial relationships with non-NHS suppliers, amounting to an annual spend of some £20 billion. Past transitions during periods of significant organisational change have been well managed. The concern this time is about the demise of PCTs and the likely need to pass existing contracts to successor bodies that cannot readily be defined at this stage of policy development. It is not clear whether existing contracts will need to pass to GP consortia or, if that is the case, whether all or just some consortia will need to be involved. This needs to be addressed carefully. The possible need for a successor body simply to manage the contractual transitions should be considered.

The transition poses risks to all suppliers but especially to SMEs, which are a key part of UK industry. There is therefore a need to:

• ensure orderly accountability for debtor control

• monitor changes in promptness of payment and mitigate as necessary

• be aware of risks to SMEs.

Apart from PCTs, there are a variety of commercial arrangements in place with commercial hubs that are locally owned by the NHS. The same issues apply here.

ABHI is the industry association for the UK medical technology sector. Its purpose is to promote the rapid adoption of medical technologies to ensure optimum patient outcomes throughout the UK and key global markets.

ABHI will also be responding to the consultation documents published in support of the White Paper.

In a system consuming resource on the NHS scale, there is a need to find a powerful way of gaining benefits to support the continuing drive for productivity and ensure that patients benefit from new treatments. To date, there has been no comprehensive or consistent way of tackling this challenge.

With the advent of PACS and the growing need to diagnose and monitor long-term conditions, the role of diagnostic imaging in healthcare is rapidly evolving. Peter Sutton, Chairman of the industry association AXrEM, discusses how the imaging sector fits into the wider clinical and commercial picture.

AXrEM is the Association of Healthcare Technology Providers for Imaging, Radiotherapy and Care: a UK trade association representing the interests of suppliers of diagnostic medical imaging, radiotherapy and care equipment in the UK. The majority of diagnostic medical imaging and radiotherapy equipment installed in UK hospitals is supplied by AXrEM members.

AXrEM was founded as the Association of X-ray Equipment Manufacturers. Its name has changed to reflect how technology advances have increased the scope of diagnostic imaging and treatment modalities. The recent AXrEM Industry Position Statement describes how imaging technologies can help the NHS to reduce costs and meet performance targets.

Why are diagnostic imaging technologies and related healthcare IT systems becoming more important for preventing and treating serious illness?

Firstly, the demand for healthcare is growing. It is a 'good news and bad news' scenario. On the one hand we're all living for longer, but on the other hand we are all more likely to be living with chronic diseases: we'll become sicker as we grow older. We are also starting to see a rise in the ageing population: in 25 years' time, nearly a quarter of the UK's population will be over 65 and 3.5 million people will be over 85, and with that we will see a rise in long-term conditions. An example at the moment is there are a million people in Britain suffering from COPD, but up to a further two million people are already showing early signs of that disease, so the demand for management of this condition will grow.

The challenge we face is that costs will become unsustainable to our healthcare system. Diagnostic imaging is an absolutely critical activity along the patient pathway in terms of providing diagnostics for people suffering from chronic conditions. In the past we have seen the whole diagnostic episode being something of a bottleneck to healthcare delivery, and imaging has been a critical component of that. Until quite recently we saw unacceptably long waiting times for diagnostic imaging such as a 52 weeks wait for MRI scans. We now have seen significant investment in diagnostic imaging and that has contributed to reducing the waiting lists. Waiting lists are much more under control, much more manageable, because the issues of availability and accessibility of diagnostic imaging have been solved.

The second element is that we all have greater expectations around our healthcare these days. People expect that technology will be developed in the future to help them meet their as yet undiagnosed health needs. Diagnostic imaging is also becoming more important in managing people's treatment, as we see the rise in interventional applications being performed on what were traditionally just diagnostic imaging systems. Diagnostic imaging is also playing an important role in prevention of disease: we see companies that are members of AXrEM, with diverse and expansive portfolios, starting to deliver healthcare into new care settings. A good example of this is the involvement of our sector in the area of breast screening: the use of digital mammography allows the screening of asymptomatic women in order to detect the early signs of breast cancer, which allows treatment to be performed earlier, providing a much better outcome for patients and also a much more sustainable healthcare system. We also see new technologies and applications developing from diagnostic imaging companies, which will aid in the better detection of disease and conditions. An example is the development of PET-MRI combined, which will be able to play a useful role in the diagnosis of conditions such as dementia.

In the wake of the PACS revolution, what are the new 'big ideas' - in terms of both technology and service provision - for diagnostic imaging in the UK?

We now start to see companies who are members of AXrEM engineer portfolios that meet the global requirements of healthcare, which includes the emerging markets, countries such as Brazil, Russia, India and China. These countries have very different technology requirements than maybe we would consider the norm in Northern Europe and North America. With this, we now see 'reverse innovation' coming into play: products and elements of our companies' portfolios that have been developed for emerging markets with much lower requirements are now being brought to the more mature markets to provide affordable and practical product solutions to deliver healthcare.

We now also see the advantages of miniaturisation of technology. For example, we are already starting to see small hand-held ultrasound machines being carried around by doctors, becoming the modern equivalent of the stethoscope and being a critical part of a junior doctor's examination. This allows us to take technology to the patient rather than the other way round. This also means that we will begin to provide care in many different settings, not just on the ward but in the emergency department, in the ambulance, in primary care and even in the patient's home.

There will also be more development around hybrid imaging technologies: types of imaging equipment that fuse images from different modalities, such as PET-CT and PET-MRI. Additionally, there will be newer applications developed using diagnostic imaging, and we will begin to see a move toward using diagnostic imaging technology in minimally invasive applications rather than as a purely diagnostic tool.

How do we meet the challenges of healthcare provision? That challenge can be summarised by the expression of providing high quality at an affordable cost. We are now starting to see the development of service solutions by companies to provide long-term assets and performance management solutions to hospitals. These will include procurement, risk transfer, refreshing technology when it gets to the appropriate age, and performance-related contracts that incentivise the suppliers to maximise the productivity and availability of the equipment.

What can the diagnostic imaging sector do to ensure that clinicians are not acquiring more data than they can usefully process and act on?

I think we now live in a world where we expect and live with that data explosion: it is a reality of modern-day life. The challenge is to provide clever solutions that help us manage the data. We only have to look at music to see how digital technology can actually become quite manageable and add value to our lives. And I do not think we should be fearful of the fact that we can acquire more data, because often we can acquire it more quickly and it is of more value to clinicians to benefit the patient outcome.

But with the development of systems that create more data, I think we should expect it to come with a commensurate solution for managing the data correctly. We will see the development of clinical support tools that give clinicians the help they need to manage the data so that they can start to look for pathologies using software tools that complement the way that they would have traditionally worked. It is almost like having another set of eyes. We also need to start treating the data differently. So, for example, we used to use CT scanners to acquire slices of CT data, whereas now we acquire volumes of data - so as we acquire the image data in a volume, we can start to view it and manage it in a volume rather than as many slices.

How do the fundamental changes to the health system announced in the new White Paper Liberating the NHS affect the role of the diagnostic imaging sector?

The major elements are: there is a need to manage costs in order to save £17 billion over the next three years; there will be more choice and empowerment for patients; we will start to see a change to the SHA and PCT structure, and this will have an impact on the way that services are commissioned; and GPs will be grouping together into consortia and taking responsibility for most of the budget, empowering the front line - these groups will also require support in making their decisions.

But the fact remains that for the diagnostic imaging sector, hospitals will be the main locations for the majority of those procedures - particularly the more complex ones. So to some extent, for the industry it will be business as usual for the foreseeable future. However, we now see the demand for some imaging services in primary care, much closer to the patient - examples being examinations such as ultrasound and general X-ray.

The challenge for the NHS in the current economic climate is to continue to invest in diagnostic imaging to ensure: firstly, that it has access to the latest and most suitable technology; secondly, that the asset base is refreshed at the appropriate times to ensure that quality and productivity are maintained, because these are critical for patient pathways; and finally, that diagnostic imaging can be performed in the most suitable location for patients and care providers.

How does AXrEM support and guide its member companies? What does it offer that other industry trade associations do not?

The major aim of AXrEM is to promote and develop the industry sector by creating a collective interface to meet its regulatory and technical needs relative to the healthcare market in the UK.

For example, there is our consultation with the Department of Health on regulatory matters such as payment by results and radiation protection, advice around standard contract conditions, representation on technical standard committees and on European bodies such as COCIR (the European trade association for the sector). As an executive team we meet quarterly, and our organisation is also made up of special focus groups and special interest groups that take into account the requirements of all the member organisations. Another area of value that AXrEM provides to its members is statistics collection, which provides vital information on the trends of sector development within the UK marketplace.

We have representation from all the major multinational healthcare companies in the medical imaging sector on AXrEM, and we over 30 members. AXrEM provides an opportunity for those companies to engage with the authorities, with the customer base and with each other, providing important networking opportunities for the industry.

AXrEM also provides an interface with the other UK trade associations. We are a relatively small part of the UK healthcare industry, but AXrEM gives us an opportunity to engage with the other industry stakeholders, which in turn allows a stronger single voice to be presented to Government on issues relating to healthcare from the industry side.

What are the key commercial challenges faced by the diagnostic imaging sector in the UK? What is the best way forward?

We will, of course, wait to see how Liberating the NHS affects the sector - but we should see some changes. For example: new healthcare providers entering the market, providing more choice to patients; new ways of commissioning; and obviously more focus on productivity, quality and innovation. We should also see a greater focus on prevention, and I am sure that this will create more commercial opportunities for companies.

We will also begin to see innovation around how services are commissioned and provided. For example, in the diagnostic imaging sector we will see a move towards more service provision, partnering and risk-sharing rather than purely the provision of capital equipment. So whilst the companies in AXrEM will keep on developing, innovating and bringing new technology to the market, we know that the development of the technology is not the problem. The challenge will be to bring about the changes to systems and workflow that are needed to meet the commercial and clinical challenges faced by the NHS.

So we need to show people the benefit of doing things differently. That might mean working together as part of a multi-agency approach, and we see the establishment of integrated care organisations as a good example of that way of working. But whatever we do, I think we have got to make sure that the quality is not compromised and the patient receive the care they need when and where they need it.

 
Peter Sutton is the current Chairman of the Association of Healthcare Technology Providers for Imaging, Radiotherapy and Care (AXrEM). After training as a diagnostic radiographer, Peter joined Philips Medical Systems in 1998. He has held a number of positions within Philips, including Business Line Management and Director of Sales for Imaging systems. He is currently Head of Marketing for Philips Healthcare and Philips Electronics.

 

In the diagnostic imaging sector we will see a move towards more service provision, partnering and risk-sharing rather than purely the provision of capital equipment. The challenge will be to bring about the changes to systems and workflow that are needed to meet the commercial and clinical challenges faced by the NHS.

As the NHS tightens its belt, new opportunities are arising for healthcare SMEs that can offer targeted clinical and business solutions. Sreevidhya Praveen of Frost & Sullivan looks on the bright side of NHS reform.

Recent announcements from the Department of Health indicate that the UK Government is attempting to save £11 billion of the NHS budget by 2012-13 through 'efficiency savings'. One of the ways to achieve these savings is driving down the cost of procurement. The Government has said: "Up to £1.5 billion will be saved through securing goods and services at best prices from the manufacturers."

The Association of British Healthcare Industries (ABHI) also believes that the majority of NHS efficiency savings can be made through cost reductions to the serve/acquire processes, rather than through simple price reduction.

Other significant announcements from the Government include: targeted savings by the NHS of £4.35 billion by 2012-13, support for SMEs, and measures to encourage investments. The NHS, which plays a pivotal role in the UK healthcare market, is visibly encouraging more innovative enterprises to step in to the medtech space.

The Chief Operating Officer at NHS Supply Chain has stated that the organisation is focusing on electronic streamlined routes for procuring products from suppliers, which means they are trying to minimise paper-based documentation. NHS Supply Chain will engage with clinicians, the DH and academic institutions during the procurement process to ensure that products meet current healthcare needs.

Medical technology suppliers are aware of the new DH and NHS commercial operating model, but are still working out its business potential. Figure 1 summarises some of the business priorities for medtech SMEs in this diverse and challenging, but potentially rewarding, market environment.

 
Figure 1: Business Environment Orientation for SMEs

DFM opens doors

At present, the NHS functions on a Full Service Vendor (FSV) procurement model whereby more than 80% of medical products are manufactured offshore and then purchased through suppliers. The delivery of this service adds to the overall cost of these products.

The Direct From Manufacturer (DFM) programme directs the NHS to save a considerable amount on certain product areas in the healthcare market. The programme develops a direct sourcing strategy that will result in the NHS working directly with manufacturers.

DFM means the NHS will go directly to offshore manufacturers that have the capability and expertise to produce medical products, and work directly with them. This initiative will help the NHS to have a more transparent supply chain, and can save purchasers money on product costs.

NHS Supply Chain widens net

NHS Supply Chain procures and supplies a wide range of diagnostic, therapeutic and interventional equipment. The list includes most equipment used in operating theatres, dental surgeries, ENT departments, orthopaedics and rehabilitation. While earlier NHS Supply Chain concentrated on capital equipment in medical imaging (such as MRI and CT scanners) as well as a range of disposables, now the agency has broadened its scope to general medical equipment such as stretchers, operating tables and theatre lighting.

NHS Supply Chain's Strategy and Procurement Director, Mark Patterson, said recently that the NHS is focused on what it needs to deliver, and that for uncovered product categories a business case will be submitted to the DH to outline the delivery of services. He noted that in some areas, such as renal and cardiology services, the NHS has a small number of contracts that do not cover the full range of products - but that hospital trusts are planning to widen their contract coverage in renal and cardiology services over the next few years.

With a growing focus on innovative devices in procurement, manufacturers will need to dive deeper into medical research areas to succeed in the healthcare arena.

Silver lining for SMEs

Globally, public sector expenditure is under serious pressure. But there is an upside for the SMEs with their lower overheads, local knowledge and great flexibility to win NHS contracts.

ABHI's Budget brief 2010 said: "The Government will deliver public sector spending changes in central departments by agreeing departmental targets to increase the proportion of central government procurement spend that goes to SMEs by 15% throughout the supply chain." Based on current expenditure, that would mean another £15 billion of business for the SME segment across the public sector.

The Government is recommending hospital departments to make more use of SMEs, including flagging contract opportunities as SME-friendly and increasing training to institutionalise SME-friendly procurement practices.

Moreover, the European Commission has brought in measures to assist innovative and growing SMEs in the healthcare industry. This includes making finance systems more SME-friendly to facilitate the financing of start-ups, innovation and growth as well as measures to generate more risk capital investments.

Private sector contracts are often won on price. The Government will want to see evidence of specific competencies, quality of the service or product, and compliance with health and safety and other industry standards before inviting private sector organisations to tender.

It is important for SMEs to know their customers and learn how to tailor their bid to each buyer's expectations. No two public sector bodies or departments within an NHS organisation function in the same way. They follow a basic procurement model, but have their own approaches to suppliers or manufacturers.

A clear knowledge of individual public sector requirements can allow SMEs to outperform their larger industry competitors.

 
Sreevidhya Praveen is a Senior Analyst, Healthcare for growth consultants Frost & Sullivan. For more information, visit www.frost.com.

Globally, public sector expenditure is under serious pressure. But there is an upside for the SMEs with their lower overheads, local knowledge and great flexibility to win NHS contracts.

The Government's decentralisation of the National Programme for IT moves the goalposts for healthcare IT companies. James Britton, CEO of Meddserve and consultant dermatologist, discusses new ways of meeting the data needs of the NHS.

A recent report suggested that the NHS is still resistant to the implementation of new healthcare IT systems. Do you agree with that view?

I don't think it's just the NHS: it's all business sectors worldwide - accounting systems, supermarkets, the Inland Revenue, all major projects and people's experience with them. Everyone has their own experience of computers at work or at home, frustration with software not doing what they want and so on. So to an extent the problems not the resistance of the NHS to IT systems, it's actually what the IT systems are doing or providing.

There is a real hunger for an IT solution that is standardised, global and allows good communication. GPs have adapted over a few decades: the majority have gone paperless by typing patient notes and entries into their IT systems. Hospitals are still virtually all paper-based, from the wards to the outpatients. That's actually a marker of the limitations of software product offerings at the moment: healthcare IT has a long history, but it has evolved on pre-Web technologies, and a lot of those old systems don't provide the full end-to-end requirements for clinicians in hospitals or nursing staff.

So it's not a resistance to change, it's a resistance to changes that people recognise as not quite fulfilling their needs. The demands for health IT are astronomical: one system has to do everything, and I don't think any system has got that. Where we've put our system in, we've not had any resistance to change, in fact I've been stunned at how easily it has been adopted and the enjoyment people get from using it. So with the right service, the right product, the right offering, I don't think there are any barriers.

How has Meddserve made its healthcare IT services attractive to the NHS and ensured that they deliver recognised value for it?

We've recognised what is needed by doctors. Meddserve has developed an integrated online health system that addresses both the clinical and the administrative areas of medicine. We've developed an online technology to serve and bind together these two distinct areas.

We've also created a different business model through our software service contract. It means there's no risk for hospitals or any IT infrastructure costs, so hospitals, clinics and health centres can download the latest version of the application through the Internet. They have all the administrative support to make referrals and set clinics or appointments; then the patient can have a consultation and the information is available securely and confidentially wherever that patient is referred.

What I've managed to do with the company over the last 12 years is develop exactly what I as a clinician want. I want good communication, good data and standardised data inputs, and for something to be easily used in my busy clinic - my demanding operating list, for example. We have identified the crucial need for communication between doctors, providing the GP with a specialist opinion and management where needed. For example, in wound care, which is a huge demand on NHS resources, a referral can be made with a picture, and the consultant's opinion can be given in a voice message in the referral back to the GP. That takes place at significantly less than the existing tariff - so in that healthcare sector alone, you can reduce administrative costs by 20%.

The other thing we've recognised is that you can't have a complete stand-alone clinical system, because it costs more money to get that to run. What you need is a complete end-to-end seamless solution. So Medsystem and Medrecord Online combine to provide the end-to-end administrative support with the end-to-end clinical care pathway for the patient, and when you bring everything together in one system then you have significant savings.

We've created a new online medical record, a bit like a Facebook for health: instead of sending data to each other you can log on, gaining access by duty of care and tracking confidentiality. The online medical record is dynamic, real-time and accessible globally. Existing telehealth and mobile health home monitoring applications need something to integrate with, and that something isn't there - but Medrecord Online can act as the core repository to link in and upload all these different methods of producing medical data.

Meddserve's medical software service is widely implemented in South India. What different challenges did India's healthcare market present to Meddserve, and how has it met those challenges?

The larger hospitals are much as you would expect in the West: very big organisations that have the latest technology - MRI scanners, CT scanners and so on. They also have large IT departments, and have major stresses in that area. We saw that as a challenge, because we were trying to go in with a brand new offering: we have incumbent software and big costs, and many of the major hospitals have spent significant amounts on IT projects that haven't delivered the expected savings. That was a very similar challenge to what we've encountered in the West. So we have largely not gone after that market segment - though we've been working with one very large institution for a year and have just completed user acceptability testing for it. That one stands out as being very open to new concepts and new technologies, so we're looking for success there.

The market segment that produced a distinctive challenge which we've overcome is the small hospitals. These are very often family-run: the son is the medical director, the father is the chairman, and they might have 30 to 50 beds. They don't have an IT department, and actually they don't have an IT budget. They can buy a hospital administration system for $200, so you can't take a Western system there and sell it at Western prices: that's not a business model that would work. So what the Meddserve technology team led by Arumugam Balaganapathy has done there is to set up an IT infrastructure - we embed voice technology, write our own PACS system and provide the laboratory system, the scheduling system, all systems in one - and we give it away. That means our offering is incredibly valuable to any organisation.

Small hospitals cannot necessarily afford digitisers for X-rays and radiology: they cost £20,000 each, and you're are talking about hundreds of thousands of pounds for a pack system, which is out of the reach of most (if not all) of these small hospitals. So we gave them that offering, and further to that we provide them with the service ready configured, which means the hospitals do not need to invest up-front for any IT when they use us. Then we go in and configure it. Our business model is a software and service model, and I think that's the only way it will work. Where a patient is charged 300 rupees for a scan, we add a 2% surcharge - that is 6 rupees. Even a very poor person in South India, using our system in a hospital, can afford that surcharge. That means, and we're very proud of this, that some of the poorest people on earth could travel worldwide and have their scans available wherever they were in the world. That's unique. Ironically, we in the West cannot do that when we go to India.

We have identified that market as being very responsive, very quick to make decisions: in one day we managed to secure orders from four hospitals based on meetings with short demonstrations. It's just like paying for your electricity or water rates, with all the headache and project management taken out of it for the customer. That was the challenge: we had to work out a way to make our product offering relevant to the Indian market.

How will the new Government's decentralisation of the National Programme for IT affect the market for healthcare IT systems in the UK?

There's no doubt that the National Programme for IT did centralise all IT development concepts, because everyone was saying "We're waiting for the National Programme." I think it's made excellent advances and provided a great infrastructure to build on. It's like a bridgehead, and what needs to be covered now is the last mile.

So now clinicians will look to solutions that provide that delivery to meet their specific IT needs. That will be coupled with GP commissioning, so they're going to want clinical information that links seamlessly with the specialists. So the fact that GPs will be able to commission and link locally with their specialists for care, combined with the flexibility for IT to adapt locally - I think that gives a wonderful opportunity for companies that already have telemedicine services in place to expand those in all GP localities and commissioning groups. They can provide clinical communication systems at the coal-face, in the consultations with patients and specialists.

So I think the achievements of the National Programme are a great foundation - but the most difficult bit at the end, getting IT services into the consulting room, that now has the potential to be commissioned as part of the solution provided by the clinicians. So I think it's a great opportunity for healthcare IT companies.

For more information about Meddserve and its online IT systems Medsystem Online and Medrecord Online, visit www.medserve.com.

'The fact that GPs will be able to commission and link locally with their specialists for care, combined with the flexibility for IT to adapt locally - I think that gives a wonderful opportunity for companies that already have telemedicine services in place to expand those in all GP localities and commissioning groups.'

Launching a new medtech product or service through a roadshow can highlight its significance for public health and reach new customers from the outset. David Lister, Director of Spinning Clock, explains the benefits to medtech marketing of taking your show on the road.

Roadshows are widely used to launch experiential campaigns, to publicise Government initiatives, and to market new products and services to specific target audiences across multiple locations. But how can medtech companies introduce new technologies through such a journey? This article explains how roadshows can impact on publicity, engage with the community and help to develop business relationships - with quantifiable results.

Reaching the market

The easiest way to understand how a roadshow works is to think of it as a travelling exhibition. It is a series of marketing events that companies and other organisations co-ordinate at various locations to generate interest in something they want to promote on a regional, national or international level.

Roadshows have some unique selling points that make them stand out from their static exhibition cousins. They can penetrate into local communities, enabling the company to take its specific messages out to its chosen audience.

Static exhibitions have a high number of exhibitors, which entails an inevitable fight for visibility among what may be hundreds of competitors. With roadshows, the brand is on its own and has controlled exposure: a far less scattergun and more targeted approach.

Another hindrance with a static exhibition is pressure on space. Locations such as shopping centres generally offer much more space to play with.

The first steps

The travelling exhibitor needs to have in their mind exactly what they hope to achieve. As with any field marketing strategy, an objective must be met and measured in order to reach the goal.

With this, naturally, comes the need to budget so that you can offer realistic outputs. Often a pilot roadshow is an ideal way to test the water before a roll-out. Putting a value on engagement and the leads gained from it is equally important in the first stages of organising a roadshow.

As soon as the company's objective is defined and the budget is agreed, professional advice can be sought to find the right location for a roadshow. The main factor is working out exactly where your audience hangs out, so you can take the roadshow directly to them.

The advantage that a static exhibition has over a roadshow is a captive audience. Delegates have chosen to be at an exhibition, whereas the roadshow organiser has to rely on natural footfall and attendance. If the correct location has not been identified, the people who walk by may not be very receptive to the messages, products or services being portrayed.

As with cold calling, it can be somewhat challenging to convince people to interact with a roadshow. You need to draw potential customers or the general public into contact with what is on display.

Value for money

Even with a low budget (around £5K) for a roadshow, much can be achieved when it the money is effectively allocated. Specialist contractors are not necessary, and equipment can be reused to slash production costs.

Takeaway literature, branded promotional incentives and giveaway merchandise does not have to cost the Earth either - and these items are not always the right fit for every event.

Once the set-up process is sorted, the more the company utilises the roadshow the more value for money will be redeemed - especially if multiple locations are used, as setting up at each location is quite inexpensive.

It is of the upmost importance that organisers prove their worth and are committed to measuring results, demonstrating the ROI by tracking delegates or visitors. It is often easier to do this at roadshows than at static exhibitions: the more interactive the activities onsite are, the easier it is to gain quantitative data on visitor numbers and the results of activities, including feedback.

For example, we have monitored roadshow performance through tracking the various pledges made by children at the Change4Life roadshow in 2009 (see case study 2 below).

Roadshow case studies

Two examples illustrate the potential of a roadshow to raise health awareness and to build successful business relationships. Our NHS Choices roadshow produced highly effective results for the client, whereas Change4Life engaged with the public in a particularly creative way.

1. Tesco and NHS LifeCheck

Spinning Clock was tasked by Iris London with designing and managing a roadshow for Tesco to raise awareness of NHS MidLifeCheck, a free online tool for people aged over forty to monitor the state of their health and make small changes to their lifestyle that can improve their well-being.

The roadshow, aimed at introducing MidLifeCheck to Tesco's staff, visited 10 distribution centres around the UK. This motivated a typically hard-to-reach audience to explore issues surrounding their health, since the roadshow took place in familiar and comfortable surroundings.

The event also provided an opportunity for employees to speak to a healthcare professional and have their blood pressure measured. It encouraged those with potential problems to visit their GP, which they might not have done before. To achieve this, it needed to be unthreatening and accessible to potential visitors, offering privacy for people to input sensitive information.

Individual computer stations were integrated into the stand at which Tesco personnel could easily log on to MidLifeCheck and complete the health quiz. The tool generated advice for users based on their quiz results, setting out a step-by-step plan towards healthier living.

Through the roadshow, Tesco was able to engage with 381 members of staff to raise awareness of the MidLifeCheck tool. 120 of those completed a feedback survey about their experience of the website and their working hours at Tesco. Of those who gave feedback, 50% said that after completing the MidLifeCheck and reading the results, they would implement changes to their lifestyle - and a further 43% said they might do so.

 

2. Change4Life

Change4Life is a Department of Health campaign aimed at improving public awareness of healthy lifestyles. The Change4Life roadshows of summer 2009 demonstrate the power of such events to successfully communicate a health message via community engagement.

The roadshows took place at 11 community events across London and aimed to promote the benefits of healthy eating and regular exercise, particularly to low-income families, while raising awareness of the Change4Life brand.

The concept centred on a cartoon environment designed to appeal to the whole family. Several interactive elements not only engaged visitors, but also helped to provide quantifiable data for the client. A virtual mountain bike race with motion graphics and touch screens was built into the cartoon kitchen area, allowing children to swap their snacks for healthier alternatives and access information on the importance of 'five a day' and portion sizes.

Those attending were invited to have their photograph taken in a cut-out photo board and make a health pledge. Parents were asked to fill in a questionnaire about the lifestyle of their children.

These elements were designed to encourage maximum interaction with the Change4Life brand and promote the health message, while making it possible to record accurate data.

The interactive elements helped to track movement around the roadshow and provided a precise measure of the number of people taking part in the experience. The health pledges and questionnaire assisted in data capture. Time had been spent in establishing the best events to present the roadshow at, so the data was sourced directly from the campaign's target audience.

The results speak for themselves. Over 25,000 people took part in the experience; 1,900 people competed in the virtual mountain bike race; 1,500 people had their photo taken and made a health pledge; and 1,600 parents completed the 'How are the Kids?' questionnaire.

 

Trouble shooting

What can go wrong? The regular issues that roadshow organisers can expect to be faced with (but hopefully not phased by) are unpredictable weather conditions, security, power supply and visitor access.

Sometimes internet access, parental permission and health and safety regulations can present challenges as well - but exhibitors need to adapt to the environment given to them on the day, and have back-up plans where possible.

Looking ahead

What does the future hold for roadshows and mobile solutions as ways of promoting new medical technologies? Nowadays there are many exciting IT applications - from touch-screens to 3-D vision - that were not publicly available until a few years ago. However, with increasing pressure on budgets, money will need to be wisely invested with the right professional advice.

How you organise a roadshow depends very much on what audience you are hoping to attract. As a general rule of thumb, we have found that roadshows are ideally suited to the consumer, whereas static exhibitions are well suited to the trade.

But really, the defining point in these kinds of event is that the message is kept clear to the customer and visitor at all times - right from the planning stages to the roadshow itself.

Event specialist agency Spinning Clock is well versed in creating and organising small-to-large scale medical exhibitions and roadshows across the UK. Spinning Clock has secured contracts with the likes of Unilever, Ofsted, NHS Choices, Siemens and the COI, taking the company to the £1m turnover benchmark.

As co-owner and director of Spinning Clock, David Lister has led the way in web-based event organisation with exhibition and roadshow solutions. To contact David, call 0115 943 0777 or visit www.spinningclock.com.

Roadshows have some unique selling points that make them stand out from their static exhibition cousins. They can penetrate into local communities, enabling the company to take its specific messages out to its chosen audience.

Surgeon John Llewellyn Probert lists 10 memorable moments in cinematic surgery.

My love of the cinema was what inspired me, at the tender age of ten, to become a surgeon. But it wasn't a biopic about a famous doctor or a cutting-edge transplant documentary that was responsible. It was Frankenstein and the Monster from Hell (1972), where Peter Cushing demonstrated (fairly accurately, it turned out) how to remove a human brain. My father had just bought me a copy of Gray's Anatomy, so I decided to check the facts. By the time I had read the entire chapter I was hooked.

Sadly, not all movies exhibit the same degree of accuracy in their attention to surgical detail. So here, for your amusement, are nine other moments in movies that have raised either an eyebrow of appreciation or a chuckle at their ineptitude:

â–º The Human Centipede (2010) - Is it surgically possible to anastomose the mouth of one individual to the anus of another? Apparently so, but I don't think those suture lines look as if they will hold for very long.

â–º Saw III (2006) - The Saw movies are delirious exercises in grand guignol but this one has a pretty decent scene of Burr hole access to the skull, plus a mini-lecture on apoptosis!

â–º Paradise Lost / Turistas (2006) - The insane Brazilian surgeon in this is clearly not to be trusted, as he doesn't even know the correct incision to harvest the organs he's taking out.

â–º Reanimator (1985) - "It's rather like peeling a large orange." Real pathology lectures were often as interesting at medical school, though I never told the lecturer his theories on brain death were outdated.

â–º Rabid (1976) - "Give me something to cut with, nurse!" Dr Keloid, the 'Colonel Sanders of plastic surgery' in David Cronenberg's second feature, goes a bit too far with the scalpel.

â–º Flesh for Frankenstein (1973) - The infamous scene in which Udo Kier 'assaults' his female creation's gall bladder, after making the incision on the wrong side.

â–º Blood on Satan's Claw (1970) - 17^th-century surgery as quack Howard Goorney removes a segment of skin from Michelle Dotrice's leg, courtesy of some decent Eddie Knight make-up.

â–º Night of the Bloody Apes (1969) - This daft Mexican film featured real footage of a human heart transplant for shock effect rather than to increase verisimilitude, I very much suspect.

â–º Corruption (1967) - This lurid British remake of Franju's Les Yeux Sans Visage is crazy from start to finish. The scene where Peter Cushing takes out a pituitary gland the size of a cauliflower is one of many memorable moments.

John Llewellyn Probert is Consultant Urologist at Weston General Hospital, Avon.