Annette Turnpenny, senior healthcare planner with responsibility for equipment advisory services at Essentia, argues that the health sector needs to take a long-term approach to equipment planning
In October, NHS England announced a £130m investment in radiotherapy equipment over two years.
While this should be welcomed as a huge step forward in the provision of state-of-the-art radiotherapy services for the NHS in England, it also brings to light major issues with regards to planning for equipment across the NHS.
The main cause for concern is the lack of detail provided about an ongoing funded replacement programme, both for units replaced in this initiative (10-12 years from now) as well as the machines that have not been included in this programme – which, although they have not reached the crucial replacement age, could be 5-8 years old currently.
Trusts and Clinical Commissioning Groups, face multiple challenges in relation to their future equipping strategies. Perhaps the greatest of all is how to fund those equipment requirements
Figures released in February 2016 stated that 63% of 111 English trusts had at least one treatment unit older than 10 years; and 21% of linear accelerators (used for external beam radiation treatments for patients with cancer) were in the same position.
It begs the question - what has been picked up by this investment programme and what still needs to be upgraded or replaced?
Secondly, what about the issue of workforce shortages and the skills mix which have been well publicised by the Royal College of Radiologists already?
We’ve been here before. In 2007, the centrally-funded MRI replacement programme was passed back to trusts. Scroll forward a few years and the units now due to be replaced are competing with all the other equipment pressures within the trusts.
The fear is that we will end up the same issue of outdated equipment but 10 years hence.
Compare this to the five-year investment programme of £39m for radiotherapy equipment and £11m for staffing announced by the Scottish Government in March, which appears to be a better-developed and well-thought-through strategy.
Of course, trusts and, more recently Clinical Commissioning Groups, face multiple challenges in relation to their future equipping strategies. Perhaps the greatest of all is how to fund those equipment requirements.
When it comes to funding, there seems to be an overwhelming desire to utilise capital rather than revenue funding to purchase equipment
This is followed closely by the complexities associated with delivering services closer to, or in, patients’ homes, for example the move toward the use of telemedicine to monitor the health of patients at home and outside the acute environment.
Central to this is identifying the most-appropriate equipment for the proposed service model and developing the business case that incorporates the most-suitable funding methods. This involves developing the scope in preparation for an OJEU compliant procurement exercise and addressing stakeholders’ requirements as part of the Value for Money and affordability exercise that accompanies any major equipment purchase.
When it comes to funding, there seems to be an overwhelming desire to utilise capital rather than revenue funding to purchase equipment on an annual basis, which has always led to difficult discussions and often-unpopular decisions.
In the current financial climate there are greater opportunities to look outside traditional funding arrangements, to provide trusts and commissioning groups with the opportunity to utilise the latest technology while delivering better patient outcomes and improving staff morale.
There are two main approaches for consideration, one for non-medical equipment – leasing - and the other for medical equipment – managed service contracts - but they support the same principles.
They enable the organisation to take a strategic approach to equipment and its lifecycle, offer a fixed budget over the agreed period of the contract, and give them the opportunity to offset the risk of equipment procurement, management, and maintenance to the provider.
Managed Equipment Service contracts have been available in the UK market for many years and initially focused on expensive and complex medical equipment such as that found in imaging departments.
The fear is that we will end up the same issue of outdated equipment, but 10 years hence
But, like all good ideas, the scope of the MES has expanded over time to cover other types of medical device used in the treatment or diagnosis of patients such as monitoring, infusion devices, anaesthetic machines, and ventilators.
The contract can be provided by vendor independent providers or the original equipment manufacturer (OEM) providing their own, and other manufacturers’, products. Over time, these type of contracts have become more flexible and advantageous to the health care provider.
The advantages of the MES are numerous, but a few worth considering are:
All of these lead to improved efficiencies within the clinical environment.
The growing need for telemedicine to enable patients to remain in their own homes for longer brings its own challenges in terms of procuring, managing and maintaining equipment.
There is a need to ensure the equipment is compatible with the systems in the organisations where the responding medics are centred and the resultant IT infrastructure is in place to maintain the bridge between patient and clinician.
The complexities that fall out of this requirement could be covered by a Managed Equipment Service contract. They may provide opportunities for whole-system collaboration between primary, secondary and tertiary care in relation to the procurement, standardisation, and management of the telemedicine function and associated equipment, IT infrastructure and services with the Clinical Commissioning Group entering into a form of Prime Contract Model.
Surely if we continue to purchase equipment in a short-term manner then we will find it harder and harder to keep up with what patients need
This would also provide the impetus to standardise equipment across the whole health system from a training, equipment management and safety perspective as well as leveraging volume discounts brought about by the combined procurement power across the system.
The premise behind any investment in equipment should be that ‘utilising the latest equipment delivers better patient outcomes’.
Surely if we continue to purchase equipment in a short-term manner then we will find it harder and harder to keep up with what patients need.