Driving improvement, delivering results: healthcare science national delivery plan 2015–2020

1 Improvement programme to streamline health technology management

Why this matters

Medical devices and equipment are critical in many areas of healthcare, including intensive care, neonatal and renal units. Examples in acute care settings include renal dialysis machines, while patients in the community benefit from assistive technologies (such as wheelchairs), pulse oximeters, syringe pumps and home oxygenators. All devices and pieces of equipment, regardless of setting, require healthcare science input.

The Medicine and Healthcare Products Regulatory Agency (MHRA) issued new guidance on the management of medical devices in April 2014 (MHRA, 2014) and the Institute of Mechanical Engineers' 2014 report Biomedical Engineering: advancing UK healthcare highlights the importance of this area (IME, 2014).

Traditionally, healthcare science services have relied on large, centralised, hospital-based facilities utilising complex and expensive equipment, but a substantial amount of activity, including electrocardiogram tests and provision of environmental controls, is now, and will continue to be, delivered in the community. Recent innovations and developments in portable and wireless networking technology have made it possible to deepen and widen the range of healthcare science-supported technology in the community. Portable ventilators have become smaller and are now equipped with long-life compact batteries, enabling users to safely be absent from mains power for longer periods and greatly enhancing their independence and quality of life. Portable ventilators are usually provided with clinical support from specialist nurses, but healthcare scientists and technologists evaluate their use, provide maintenance and repair services, investigate adverse incidents and deal with procurement.

Medical devices and equipment represent a substantial asset - and risk - for NHS boards. Their effective management is vital to ensuring safe and high-quality care that minimises the risks of adverse events and unnecessary treatment delays. Clear lines of accountability and leadership at board level are essential to ensure effective strategic management of medical devices and equipment from procurement to disposal, bringing the potential to reduce costs and improve health outcomes.

End users, whether NHS employees, patients or carers, must understand how to use medical devices and equipment correctly, yet one NHS board has estimated that 10% of reported faults and all adverse incidents related to infusion pumps are due to user error. Standardisation of equipment within and across NHS boards would help users in different settings to become more familiar and confident and reduce training costs, errors and the incorrect reporting of faults.

Technological developments will continue to impact on the use and management of medical devices and equipment. 3D printing, for example, offers the potential for the rapid manufacture of bespoke devices, such as maxillofacial implants for reconstructive surgery, and the local production of spare parts to eliminate delivery lead times and costs. Developments in IT connectivity offer opportunities for remote monitoring, automatic fault reporting and remote fault diagnosis. In this regard, it is vital that services keep abreast of technological developments and are supported by NHS boards to acquire and effectively deploy new and innovative medical devices and equipment.

Evidence is growing across all healthcare science fields that better clinical guidelines for use of specialist equipment in the community and harmonised management approaches improve quality, increase resilience and save resources. The increasing use of sophisticated health technologies by a range of professionals, and the consequent increased risk of inappropriate use, must nevertheless be recognised as a potential threat to patient safety. The healthcare science workforce is well placed to offer the required support and training to other professions to mitigate potential problems.

Current situation

The management of health technology equipment often involves a number of key players, including medical physicists, technologists, facilities managers, external contractors, equipment services personnel and others, such as social care staff. Systems and processes vary across NHS boards and localities, which can impact on quality, procurement and repairs procedures and potentially result in safety risks to patients and staff.

Our ambitions

We want to:

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

Deliverable 1

To achieve our ambitions, NHS board healthcare science leads will work with stakeholders to deliver a 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.

Achieving Deliverable 1

NHS boards will:

• support healthcare science leads, managers and heads of service to work with the Physical Science National Lead.

National healthcare science leads, NHS board healthcare science leads, managers and heads of services will:

• work with NHS boards and relevant stakeholders to deliver a whole-systems approach to the management of health technology.

Scottish Government and others will:

• work with partnership organisations, universities, public health, social care, industry and the Health Improvement Scotland (HIS) Scottish Health Technologies Group (SHTG) to encourage the development of an evidence base for the use of health technology in the community and the adaptation and spread of proven technology and good practice.