NHSScotland assets and facilities 2015: annual report

Annex J: A Strategic Approach to the Planning of Medical Equipment

Medical equipment is a valuable asset both in monetary terms and in the important role it plays in the delivery of quality healthcare across NHSScotland, with modern standards of available equipment used to better support person centred care and improved efficiency and effectiveness of service delivery.

The strategic management of medical equipment within each NHS Board should be aligned to its strategic aims. Within each NHS Board, the management of medical equipment involves a number of departments, including capital planning, procurement, medical physics, facilities and finance. Co-ordinating their endeavours requires a strategic approach, supported by careful planning (replacement planning and, responding to changes in clinical care, procuring different additional equipment). This would enable a sustainable and coherent service that ensures the improved availability of the right equipment required at the right time for patient care.

The importance of medical equipment to the future delivery of healthcare has been recognised by the Scottish Government in the Scottish Healthcare Science National Delivery Plan 2015-2020. One of the five improvement programmes in the delivery plan sets out to streamline health technology management. This improvement programme draws on the work of SAFR 2014 and is aligned with the Medical Equipment Management Expert Group's terms of reference. It sets out four ambitions for improvement, to:

• reduce the risk of harm to patients and staff
• reduce unnecessary variation
• improve resilience and sustainability
• reduce equipment replacement and repair costs.

To achieve these ambitions, NHS boards and healthcare science leads will work with stakeholders (including the SAFR Medical Equipment Management Expert Group) to deliver a patient focussed, high-quality, sustainable, coherent and whole-systems approach to the management of health technology by the end of 2017, with full implementation by the end of 2020.

Current examples of this across NHSScotland include:

• Continued investment in the replacement of Radiotherapy equipment at the 5 Scottish Cancer Centres brings improvements in providing state of the art radiotherapy treatment and planning systems, thus offering the opportunities for patients to receive highly targeted, image guided radiotherapy including volumetric arc radiotherapy, and replacing ageing equipment based on outdated or obsolete technology
• Modern imaging equipment is now designed to keep radiation dosage to as low as reasonably achievable thus reducing the associated risks to patients and staff.
• The NHS Scotland Breast Screening Programme has recently completed a full equipment replacement exercise with older analogue screening equipment now replaced with digital technology. This includes equipment on all of the Mobile Screening Units and at the Static Centres across NHS Scotland.
• Medical Equipment is integral to the delivery of keyhole surgery which has significantly reduced the length of stay in hospital for patients. It has enabled complex surgery, particularly abdominal surgery, to be undertaken without the associated trauma of major open surgery.
• Scotland's first Robotic-Assisted Surgical System ( RASS), has been delivered to NHS Grampian for procedures at Aberdeen Royal Infirmary which are being planned for late summer. The state-of-the-art RASS will be used primarily for minimally invasive procedures for prostate cancer. The technology will be available to clinically appropriate patients from across Scotland. The RASS equipment provides a 3D high-definition camera which shows surgeons a clear, highly magnified view of the procedure area, as well as fine instruments which go into the patient's body through small incisions and which allow the surgeon to perform procedures such as removing tumours and organs using wristed instruments - ones which mimic a surgeon's hand movements - and increased precision. The benefits to patients include reduction in recovery time and their stay in hospital, reduced blood loss and other complications including quicker return to continence. It is anticipated that additional systems will also be installed in NHS GG&C and potentially NHS Lothian within the next 24 months.
• The introduction of Digital Radiology technology provides instant image results, allowing the radiology staff to verify image clarity immediately after taking the image. This reduces the waiting time required whilst the image quality is verified.
• Networking of medical equipment such as patient monitors now allow quick and easy access of patient data to medical personnel
• Networking of ophthalmology equipment such as OCT, visual field analysers and fundus camera allows ophthalmologists to provide accurate care to patients and greatly reduce patient waiting time
• Wireless technology now allows management of patient infusion devices to quickly update drug library, reduce human errors and monitor the use these devices
• Examinations of the digestive and intestinal system (gastroscopy and colonoscopy) using flexible endoscopes provide minimally invasive methods of diagnosis of pathologies including cancer, with the ability to carry out some treatment. Developments including specialised imaging techniques (narrow band imaging to more clearly show abnormal cells) are improving the quality of the images.
• Modern standards of medical equipment enable cataract surgery to be carried out on a day surgery basis resulting in improved service effectiveness, patient convenience, and patient safety.
• Clinical Portals for example in cardiology where ECG recordings are wirelessly uploaded in real time to a data base where anyone can view them or use them to compare against previous recordings. In the event of the patient being admitted at another hospital the recordings are immediately available.
• Cooling of patients who have had an out of hospital cardiac arrest has proven to increase recovery potential.
• Initial trials of patients monitoring in domiciliary environment are underway. This involves monitoring equipment connected to a tablet device. The device collects patient test results along with data collected from prompted questions that allow algorithms to assess the patient and report these centrally for clinical intervention as required. Different clinical conditions/applications are also being investigated. At the moment this work is being carried out in individual health boards. So far this has involved relatively low levels of equipment but it is envisaged this type of technology could expand rapidly and may benefit from an NHSScotland wide approach in assessing equipment and standardisation.

Following the recommendation in the 2014 report, a Medical Equipment Management Expert Group has now been formed with representation from the NHS Scotland Medical Physics Community and others with Medical Equipment responsibilities. The Group's remit is to

• Improve the quality safety, efficacy and cost effectiveness of medical equipment management in Scotland for the benefit of patient care.
• Provide strategic advice on medical equipment and its management within Scotland; including need, selection, procurement, safety, application, environmental impact, maintenance and support, training and disposal.
• Investigate opportunities for enhancing technological advancements, smarter technology better connectivity from medical devices.
• Share and encourage best practice in medical equipment management, including lessons learnt from the successful introduction of the National Imaging Equipment Group.
• Provide a focus group for liaison with Scottish Government Health and Social Care Directorate on medical equipment management within NHS Scotland.
• Liaise with appropriate groups including Health Facilities Scotland (e.g. National Procurement and Incident Reporting and Investigation Centres), Health Improvement Scotland, the Health Care Science leadership, and eHealth / IM&T representative groups.

The Group have already identified several opportunities, which would assist in improving the strategic approach to the management of medical equipment within NHS Scotland. Work has already commenced in the areas of:

• Investigating the harmonization of databases for medical equipment across NHSScotland.
• Development of robust governance arrangements for the safe and effective use of medical equipment; including a review of current policy, best practice advice on reducing carbon footprint, and impact of workforce planning agenda.