IHEEM PAST-PRESIDENTS’ ROUNDTABLE – PART TWO
should make it an even more interesting profession to work in?” GM: “Absolutely, and the healthcare engineering and estate management function becomes ever more critical, because the old spread used to be that you had your intensive care unit, A&E, the acute wards, and then the rehabilitation wards; that was pretty much the ranking. Now your patients can be acute and severely acute patients on any ward outside of a high dependency unit, an intensive care unit, a coronary care unit, and the theatre suites. It’s all about uptime and availability, and that’s how it should be. I think we will end up using our facilities more intensely and intensively, putting an even greater burden on healthcare engineers to make sure it’s all available – a challenge, but a positive one.
Telemedicine links GM: (continued) “I think IT systems and networks will maintain the key link with the telemedicine systems out in the field, for instance in a patient’s home, or in a rural clinic. There will equally be a lot more self-diagnosis with such equipment. We’ve already seen the news about the jogging ‘app’ that can track all the jogging routes around some critical infrastructures. That’s for a leisure application, but in a telecare setting an app will not only alert the patient’s doctor or surgeon to a potential problem, but will also enable the clinician to keep a close eye on the patient’s health, and spot if his or her condition worsens and merits intervention. Society is becoming ever more ‘connected’. You no longer wait for a letter confirming a hospital appointment; it’s a phone call or a text, and that’s how it should be, so long as it doesn’t exclude older members of society or those without the connectivity. That’s the current challenge, but once you get to a connected society, it will become second nature that your smartphone monitors your health, and warns you when you need medical intervention.” LT said he was ‘enthusiastic’ about the capabilities of the latest communication technology. He said: “A friend recently demonstrated a new Apple watch to me, which I was initially a bit sceptical about. Then, however, he showed me what it did. It was measuring if he’d had a good night’s sleep, and his pulse rate; extraordinary. That could be shared with your medics, your GP, and I was in fact so impressed that I went off and ordered one.” JB: “Presumably, such ‘smart’ technology also facilitates the job of the hospital engineer out on site?”
No substitute for experience GM: “Yes, use it as a tool, but you still need that engineering interpretation of what the tool is telling you, based on
20 Health Estate Journal June 2018
Greg Markham, right, said: “When a PFI contract becomes adversarial, that’s when it gets expensive, and starts to unpick.”
knowledge, training, expertise, and experience.” PS: “There is also, of course, a strong economic case for the increasing use of remote care and telemedicine. Currently, if a patient goes to a GP, it costs ‘the system’ a couple of hundred pounds. If they attend A&E, however, the costs may be about £1,000 once staff have done all the checks and diagnostics. With telecare or telemedicine routes you’re talking pennies; there are now some GP practices at the forefront of using such technology. “So, whereas today a doctor receiving a call from a care home asking he or she to visit the facility to ‘see’ an elderly person following a fall must physically do so, using telecare they have the option to ‘consult’ via a screen, before then deciding whether to ask the staff to get the patient to a hospital, or instead, to take particular therapeutic action in situ. That type of intervention allows much more efficient and cost-effective frontline assessment to be done, in that harnessing it, the GP practice could probably deal with 20 cases in the time it normally takes it to address 1-2. At some point, the technology will have a huge impact on healthcare, and by default thus impact on our infrastructures.”
‘Nudging’ the patient GM: “It’s that opportunity to use the ‘nudge theory’ too. In fact, if you’ve got a wearable connected to your smartphone, it can already ‘nudge’ you to tell you that you haven’t moved in an hour, and to ‘go and get active’. In the future it’ll be able to tell you your temperature is a little high, or, taking into account your risk factors, that you need to book a blood test. In turn – depending on the result – you can then see a healthcare professional promptly, resulting in you undergoing further diagnostics or treatment early. Today, if you feel if unwell, you book into the GP (if you can get an appointment), and may well then need to come back for your blood test. That’s immediately a more prolonged process. Good telemedicine
can cut out some of the risk and encourage early intervention, rather like condition- based maintenance in engineering; it’s all about the asset doing its own checks and then telling you when it needs some intervention, rather than you checking it on a calendar basis. We’ve got that technology now. Most cars tell you when a service is due. If you can get wearable technology that can do that for most medical conditions, and the medical sector believes in it, it can serve as an excellent preventative measure; after all, prevention is considerably cheaper than cure.”
PFI – good or bad? JB: “Yes. Thanks for your comments on that question. I’d now like us to move on to the next topic: looking at PFI, has it generally been a good or a bad thing for the construction, and indeed long-term running and maintenance, of healthcare facilities? Is there a consensus?” GM: “I think PFI effected an amazing amount of improvement in a short time as a vehicle for getting new hospitals built; it fixed three decades of underinvestment. One of my PFI contracts was in Swindon – a perfect lifecycle story – the Great Western Hospital replaced Princess Margaret Hospital – the first new-build hospital constructed by the NHS, which opened in 1950. In the late 1990s the Trust was prosecuted for breach of health and safety regulations without anybody actually being hurt – because it declared: ‘We’ve got a new hospital coming along, so we are not going to do anything.’ That clearly wasn’t acceptable, but that’s how bad things had got, to the point where the Trust needed to replace its entire estate. “I don’t think we necessarily got value for money out of the financing side of PFI, but that was down to the bankers. Now, however, 16 or 17 years after it was built, the Great Western Hospital still looks like a good new hospital, and is serving the people of Swindon well. I would suggest that under the old NHS approach, you wouldn’t have had that same investment. “The Trust is paying the costs, but actually
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