EBME Leadership
that, once this has been achieved, there will be improved transparency on what hospitals pay for equipment, how old it is, and the resale value. “The NHS is starting to get smarter with the data,” he asserted. “It’s a big exercise at the beginning, but it’s not difficult keeping it maintained.” The forum proposed that the NHS and the
clinical engineering sector should work towards creating an ‘NHS model code’, so there is a more standardised categorisation of equipment. The forum also discussed how data insights from programmes that integrate with asset management software systems could have the potential to enable Trusts to identify huge backlogs of equipment that require urgent replacement (totalling millions of pounds in some cases). Access to this data will give Trusts the foundation to develop better technology management strategies – allowing them to produce short, medium, long-term replacement plans. Caroline Finlay said this is “the level of data insights that we all need to achieve…You can start to identify where the pinch points are.” She added that hospitals are now very good
at capturing data on equipment coming in, but there is still work to do around capturing data on equipment that’s going out – whether this is disposal or lost assets. She gave the example of a Trust with a £70 million-pound medical equipment budget for their new hospital. “Understanding what they are able to transfer in 2032 has been key to the business case, but this has to be done at RIBA stages.” (There are different RIBA stages of the programme for design, development, commissioning, etc.) “NHP is asking for that information really early,” Caroline Finlay continued It was pointed out, by another thought leader at the forum, that new hospital buildings often overrun. What this means for existing hospitals, waiting to transfer into the new hospitals, is that the assets start to “fall off the edge of a cliff”. Equipment must still be replaced, while the opening date is moved, but this can lead to difficult discussions over budgets. Should it be considered as part of the transfer and does this mean that new equipment budgets should be reduced accordingly? Some argued that there is a need to offset inflation…All of this, results in “a complicated rolling spreadsheet”, as one delegate observed.
One thought leader commented that they would
“like the certainty of having a full data set to drive replacement planning, but you never get there”. In addition, what drives technology replacement is “often clinical rather than technical.”
The 10-year replacement ‘myth’ The idea that everything is replaced after 10 years was described as “a myth”, by one member
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of the EBME Leadership Network. They pointed out that you can “keep things going – if it fits into a clinical workflow that is delivering for patients and it is delivering safely.” A delegate went on to comment: “In the hospitals that I have been involved with, we told the board that ‘we are going to have to invest 10% of the capital cost every year to keep things up to date…Very often what drives the change is an innovation in the market. Suddenly, you have infusion pumps that can go on networks that can do a huge amount of stuff, so it makes a compelling case to replace equipment that’s technically still working – because you want to adopt an innovation.” The forum members also cautioned against making assumptions that equipment such as CT or MRI scanners will transfer to the new hospital, as the logistics of doing this are extremely challenging. “The CT scanner might only be four years old, but it may still need to be replaced, as there is a need for ‘double running’, so they can carry on treating patients right up to the day of the opening of the new hospital,” one of the thought leaders pointed out. They suggested it would be preferable
to persuade government(s) to a move to a managed equipment services (MES) model – i.e. leasing the equipment from the supplier. In this case, the hospital could ‘double run for a short period’. They noted it is hard to get government “out of a year-on-year capital funding model”, however. The forum discussed how NHP is driving
a strategy of value through ‘servitisation’, aiming for procurement and supply chain gains by identifying equipment needs across the programme’s 40+ schemes. (‘Servitisation’ is a
transformative business model that shifts the focus from selling products to providing services that enhance the value of those products.) Sustainability is further driving a ‘servitisation model’, so manufacturers of the equipment take responsibility for ensuring it lasts as long as possible. Consideration is also being given to how parts can be recovered to ensure a circular economy. The forum also identified a “government knowledge gap” regarding how hospitals actually pay for technology: l The balance sheet barrier: New leasing rules (IFRS 16) mean equipment now sits on the balance sheet, counting against capital limits (CDEL). This has “killed the incentive for traditional leasing”.
l The servitisation stalemate: While models like “Pay-per-use” or “Equipment Timeshare” make clinical sense, the Treasury’s rigid funding structures prevent Trusts from signing up.
Tackling obsolescence With regards to the potential risk of obsolescence and the NHP, Caroline Finlay stated that “no one should be pressured into selecting equipment early, unless it has an infrastructure.” Others within the group pointed out that 60% of capital purchases won’t have an architecture – they will be ‘plug and play’ or go into a network. However, a major challenge is trying to foresee “what is coming clinically”, and to “imagine what will need to be integrated into the clinical IT systems in the future”. This is going to drive a lot of obsolescence. “All you can do is take a standards-based
approach. When procuring equipment, make sure that it complies with the emerging standards on connectivity and safety – and buy
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