Clinical engineering
Figure 2
Equipment replacement planning Evidence shows that there is an increasing issue that healthcare technology is not being replaced because of lack of funding. In many NHS organisations, more than 40% of equipment is already past its extended and recommended life. The NHS is struggling to fund the replacement of healthcare technology. This is an issue recognised throughout the NHS. Poor levels of investment and then ad-hoc levels of procurement, with significant capital expenditure taking place at the end of the financial year, does not deliver best value or a programme of sustainable investment. Improving financial planning and procurement
practice for capital and revenue expenditure with targeted equipment replacement plans is the approach that will ultimately reduce cost and also assist in improving the safe use and management of equipment. This will also assist with ensuring good governance and meeting CQC regulatory requirements. This is never more important than when new hospitals are being built. In January 2020, the UK Government gave the green light to build 40 digitally advanced hospital projects. Since
Figure 3
then, a number of Trusts have been preparing their outline business cases to support these redevelopments. This long-term, strategic investment in the future of the NHS, to ensure healthcare staff have world-class facilities to deliver cutting-edge care, requires investment in the right buildings and facilities where staff and patients can utilise technology and data to deliver better, integrated care and empower people to manage their own health (Figure 4).
Procurement Buying medical technology is the most important part of any clinical technology management strategy because when it is right, the evidence shows that Trust efficiency and clinical care are improved. When it is wrong, this creates risk. Purchasing activity is usually responsible for significant amounts of hospital spend. It’s important, therefore, that processes balance risk and control. Technology can be beneficial; automating processes, facilitating decision-making and its prevalence within an organisation can have a significant influence over the structure of procurement processes. Technology can also eliminate bureaucracy –
streamlining processes and eliminating waste. The results of the Lord Carter report, in 2018,
have led to significant improvements in the procurement of all assets, including medical devices, but the ever-increasing volume of medical devices and of those which are connected; commonly known now as Internet of Medical Things (IoMT), has created a need for greater integration between the procurement, information technology and finance teams, in the acquisition of medical equipment. The diagram below (Figure 5) is indicative
of how the volume of devices has increased within a typical 800 bed hospital over time. This diagram represents the increasing use of technology that is typical across all hospitals. The volume of equipment being used in hospitals has increased tremendously over the last century. The growth may slow a little in quantity, but the exponential increase in these assets being IoT connected is huge. The increase in clinical technology use means
that Trusts must take a strategic management approach to buying, using, and maintaining clinical technology. Poor procurement leads to variation and ultimately higher risks to the
14000 12000 10000 8000 6000 4000 2000 0
1970 Figure 4 1980 1990 Figure 5: Medical equipment (800 beds) 38
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