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F E A T U R E S Review of the Year Review of Parliament
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Secretary of State for Business, Energy and Industrial Strategy
This year’s Parliamentary Review reflects on a tumultuous and extraordinary year, globally and nationally. As well as being an MP, I am a keen student of history, and I am conscious that 2020 would mark the end of an era. It will be remembered as the year in which we concluded Brexit negotiations and finally left the European Union. Above all, it will be remembered as the year of Covid-19. In our fight against the pandemic, I am delighted that our vaccination programme is beginning to turn the tide – and I pay tribute to the British businesses, scientists and all those who have helped us to achieve this. But the virus has dealt enormous damage, and we now have a duty to rebuild our economy. We must ensure that businesses are protected. We have made more than £350 billion available to that end, with grants, business rates relief and our furlough scheme supporting more than 11 million people and jobs in every corner of the country, maintaining livelihoods while easing the pressure on employers. The next step is to work with business to build back better and greener, putting the net zero carbon challenge at the heart of our recovery. This is a complex undertaking, but one which I hope will be recognised as a once in a lifetime opportunity. Through the prime minister’s ten point plan for a green industrial revolution, we can level up every region of the UK, supporting 250,000 green jobs while we accelerate our progress towards net zero carbon emissions. With our commitment to raise R&D spending to 2.4 per cent of GDP and the creation of the Advanced Research & Invention Agency, we are empowering
FOREWORD | our fantastic researchers to take on groundbreaking research, delivering funding with flexibility and speed. With this approach, innovators will be able to work with our traditional industrial heartlands to explore new technologies, and design and manufacture the products on which the future will be built – ready for export around the globe. And I believe trade will flourish. We are a leading nation in the fight against climate change. As the host of COP26 this year, we have an incredible opportunity to market our low-carbon products and expertise. Our departure from the EU gives us the chance to be a champion of truly global free trade; we have already signed trade deals with more than 60 countries around the world. As we turn the page and leave 2020 behind, I am excited about the new chapter which Britain is now writing for itself, and for the opportunities which lie ahead of us. writing for itself, and for the opportunities which lie ahead of us “ “ I am excited about the new chapter which Britain is now
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Covid-19 The first pandemic since the Spanish Influenza crisis that swept the globe in 1918, Covid-19 has had a seismic effect on the health of the nation and on the NHS. From the first coronavirus death in March to the position 11 months later, more than 100,000 people in the UK have died with the virus. In February 2021, the Health Service Journal reported that the government was anticipating a spend of £35 million on temporary mortuaries, as existing public facilities as well as those in private funeral homes were overwhelmed. As late as September, the Cabinet Office had estimated the total spend with companies like Portakabin for these storage units would only be £22 million. Other countries hit by Covid have had to use cold-storage facilities that are normally used by the catering industry. This figure is not the same as the position for overall excess deaths, which includes the many people who have died waiting for cancelled major surgery, who have seen their cancers develop untreated because of delays to diagnosis or who sickened and died without any kind of medical intervention because they were too afraid to access health services in the initial stages of the pandemic. The fear of the virus was so severe that major cancer charities had to issue public warnings to persuade the government and public to take cancer as seriously as they did the coronavirus. As well as the tens of thousands of deaths with Covid in intensive care units and other wards, every part of the cancer pathway was hit. Fewer
The pandemic has led to soaring numbers of patients waiting to receive treatment
people visited their GP with symptoms meaning thousands of cancers went undetected. For those that did attend and were then referred onward for a scan, there were delays unlike any seen in recent years in diagnostics. Infection control and social distancing rules slowed England’s already severely under-funded scanning infrastructure. England has one of the lowest rates of scanners of any of the world’s rich countries. Temporary facilities in vans were maxed out. For cancer sufferers who made it through to this part of the pathway, treatment was often limited. The call for anaesthetists on the Covid wards hit the health service’s surgical capacity hard, and tens of thousands were forced to wait while the cancer’s progression went untreated or treated in a sub-optimal way. Nevertheless, the NHS overall did a great job of protecting more services from this kind of disruption in the second peak than the first, when it was all much newer. The incredible dedication and sacrifice of NHS staff saw chemotherapy and radiotherapy services continue in large numbers although experts still believe the UK’s overall improvement in cancer
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units, plumbing in new oxygen pipes to often crumbling buildings and separating bays overnight to keep them infection-free. Clinical staff learnt new techniques fast, which meant a far lower rate of people died with Covid than in the first wave, even if the total numbers were still very high. Roughly two thirds of Covid patients who needed admission to ICUs in the first wave died. Techniques like proning, advances in oxygenation and drugs like dexamethasone meant only one third of the same cohort of patients died in the second wave. personal protective equipment though. The problems with procuring enough PPE were widely reported, and serious issues around how it was done were raised. For example, in November, it was widely reported that the government had ended up paying £21 million to a Miami-based middle-man in Florida for a PPE order. This was roughly double the amount paid to the NHS and care staff who had died with coronavirus under the government’s £60,000 compensation scheme. In September, the BBC reported that 600 NHS staff had died with the virus. The British Medical Journal kept a list of doctors who had died with Covid-19. The youngest was 44, and some were medics who had retired but volunteered to come back to work to help colleagues. BMJ Editor Fiona Godlee said: “Each name (on the list) represents an irreplaceable gap in a family and a workplace. No one should have to risk their lives or health because of their work, and we honour those who have paid this ultimate sacrifice. In doing so we commit to all efforts that will bring this pandemic to an end and that will ensure the safety and wellbeing NHS staff paid a terrible price for the problems with the supply of
Over 850 UK healthcare workers are thought to have died of Covid between March and December 2020
outcomes (number of life years lost by the population) will stall and in all likelihood go backwards. During both peaks, hospital services were overwhelmed by the tide of Covid patients, and ambulance trusts saw huge delays in attendance and hospital handover. Normally, intensive care nurses work one-to-one with patients, monitoring the complex interplay of life-signs and measures of the patient’s health. In the second peak, hospitals saw this ratio stretched to one-to-two, one- to-three and in one hospital as high as one-to-six. Staff complained of mental and physical exhaustion as the wave of people that had caught Covid around Christmas came through hospitals. In February, the Royal College of Anaesthetists said one third of its members surveyed had experienced mental health problems as they worked through a higher number of deaths than they had seen at any other point in their careers. One in five said they were considering leaving the profession, something that would be a disaster for the health service’s ability to cope with another wave or to catch up with the huge backlog of patients whose operations were cancelled. Estates staff worked miracles to expand the capacity of intensive care
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of everyone working on the front line of healthcare.” Chair of the British Medical Association Dr Chaand Nagpaul said: “The vast majority who have sadly died are from a Black Asian or Minority Ethnic background, with many coming from overseas to contribute their valuable skills and expertise to the NHS to save the lives of others, only to tragically lose their own. “During the pandemic the dedication, bravery and compassion of all healthcare workers has shone through in the fight against the coronavirus. We must never allow our BAME colleagues to be taken for granted or disadvantaged. The NHS has a duty of care to protect its workforce from harm.” A report of the parliamentary public accounts committee in February said: “The BMA told us that its surveys showed between two and three times as many BAME doctors as white doctors felt pressured to work without adequate protection. It also told us that it called for BAME staff to be given risk assessments in early April, when it became clear that Covid-19 was having a disproportionately high impact on staff from BAME backgrounds.” The second wave was much more severe than the first, and senior NHS leaders were warning about it in mid- December. The government ordered a full lockdown, similar to the first, from January 5. One major London hospital reported its peak level of new Covid admissions exactly 14 days after Christmas Day. In February, the Huffington Post reported that the government had been betting on the test and trace system to prevent a second lockdown. The £22-billion system was expected by ministers to allow much of the economy to function at a more normal level than the first, saying it would be “a main
AstraZeneca Oxford vaccine also known as ChAdOx1 nCoV-19 or AZD1222
driver” in this, according to a document released to the National Audit Office but so far not released to the public. Committee Chair Greg Clark said: “If you’re spending £22 billion of public money that is an enormous amount, and you have to be able to justify it and it’s not unfair to expect answers to questions about that. The public ought to be able to see the rationale given for such a vast spending commitment and be able to assess its performance.” In January, test and trace boss Dido Harding admitted big problems with the system including many workers too afraid to get a Covid test in case it ordered them to isolate, which would mean they could not work and would then be unable to support their families. She said that in many cases workers who had been told to isolate did not do so because they could not afford to take the time off. A different committee hearing was told that the test and trace system was employing around 900 consultants from accountancy firm Deloitte, each paid £1,000 a day. Despite the problems with test and trace, PPE procurement and the timeliness of lockdowns and the damage to the economy, the UK started on the front foot with vaccines.
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Healthwatch England said the situation was so bad that others had been told they could wait up to two years for an NHS appointment. The dental sector has been hit not only by lockdown but also by serious restrictions on the number of procedures it can carry out because of social distancing rules. Dental professions obviously work in close proximity to a patient’s airways, and infection is a real risk. Healthwatch Chair Sir Robert Francis also said his team had come across one patient in so much pain they tried to extract their own teeth. Sir Robert said the pandemic “exacerbated the human impact of years of structural issues in NHS dentistry and is now pushing it to crisis point.” doses longer than recommended by manufacturers. Originally supposed to be a fortnight, the government decided to push this to more than ten weeks in order to give as many people the protection of a first shot as quickly as possible. In February, the government announced that international travellers who lied about having travelled and thereby put others at risk from new variants of the coronavirus could face a jail term of up to ten years. This was decried as illiberal by some, but others said the government had acted far too late on restrictions on travel to and from highly infected areas. But with some encouraging news on vaccine efficacy against new Covid variants and overall hospital numbers falling, the nation’s health service could move into spring more optimistically than in January.
In December, Britain became the first country in the world to approve the Pfizer/BioNTech vaccine for widespread use. Deployment of the vaccine started a week afterwards. One month later, Matt Hancock, the health secretary, said: “We begin 2021 knowing that vaccines are our way out of this pandemic. Human ingenuity and phenomenal scientific advances make it a case of when, not if, we will return back to normal life. “The cavalry is here courtesy of our vaccination programme and we have already protected more people through vaccinations than any other European country.” By mid-February, 15 million people in the UK had received a first dose of the vaccine, although there had been controversy over a decision to stretch the time between the first and second
Dentists fear a significant increase of post- lockdown tooth decay
Covid-19 pushed an already struggling dental industry even further into crisis. In February, the national care watchdog made headlines after revealing some NHS patients had been told they would need to pay for private care “if they want any treatment”.
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Urgent dental care centres have been opened up across the UK
He added: “All efforts should be made to treat those in need of urgent care and provide more accurate and up-to- date information to help people find and access NHS dental care. “In the longer term, the Department of Health and Social Care must prioritise the importance of oral health and commit to improving access to dentistry for everyone who needs it.” The NHS has set up 650 urgent dental hubs to try to increase access. The government has also set targets for the numbers to be treated, but this was criticised by dentists. British Dental Association Chair Shawn Charlwood told the BBC the government was “forcing dentists to prioritise volume over need by imposing inappropriate targets. We need government to adopt a pragmatic approach, which keeps practices afloat and ensures those who need dental care the most can secure it.”
In November, Dentistry Online reported the comments of one MP who told a parliamentary debate that Covid had supercharged the existing access crisis. Member for Bradford South Judith Cummins said dental contract reform was needed to get on top of the crisis, calling it “the single most important thing that the government can do.” She said: “Clearing the backlog will be a considerable challenge. Even in the best of circumstances it would take years, but unfortunately we are not in the best of circumstances. As people who have tried to get dental appointments since June know, dentists are operating with considerably reduced capacity. About 70 per cent of practices are operating at less than half their pre-pandemic capacity.” The fallow period following even quite minor procedures to allow cleaning and any Covid in the air to dissipate can be up to one hour.
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In January, a £700-million bid to take over a large dentistry provider was widely reported. The Pervez family, owner of Bestway cash-and-carry, were understood to be one of the final bidders to take over the IDH dental chain, one of the UK’s biggest.
She added that a “vicious cycle of underinvestment in our most deprived communities feeds inequalities in health outcomes.” In February, Ms Cummins tweeted that the new government targets forced dentists to prioritise routine check-ups over people who are in pain.
We are two months into the pandemic response and that it has taken this long for CQC data to come to light showing the potential impact of Covid-19 on people with a learning disability is appalling. This highlights structural inequities at work.” In June, the Care Quality Commission released data on the deaths of people with learning disabilities from coronavirus. The analysis, which saw the CQC’s staff work with the Office for National Statistics, showed a worrying increase in mortality. Between April 10 and May 15, care providers who provide care to people with a learning disability and/or autism (including providers of adult social care, independent hospitals and in the community) saw 386 deaths. This compares to 165 in the same period the previous year, an increase of 134 per cent. The care regulator said the “data should be considered when decisions are being made about the prioritisation of testing at a national and local level.” Kate Terroni, chief inspector of adult social care at the CQC, said: “Every death in today’s figures represents an individual tragedy for those who have lost a loved one.
Those with learning disabilities faced more hardships than usual because of the pandemic
In May, the Metro reported that coronavirus tests had been “denied” to people with learning difficulties who were living in care homes. The paper interviewed a care home manager who said the initial government advice had been to provide tests to “older people or people with dementia”. At the time, 38 per cent of care homes in England were reporting coronavirus outbreaks. The charity Voluntary Organisations Disability Group, which represents non- profit organisations caring for people with disabilities, said it was “simply unacceptable”. Chief Executive Dr Rhidian Hughes told the paper: “People with learning disabilities and/or autism already face significant health inequalities.
“While we know this data has its limitations what it does show is a
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The number of care home beds in providers of specialist learning disability has decreased
2015, NHS England pledged to move between 35 and 50 per cent of people cared for in these settings elsewhere. But the magazine reported “serious concern” that this will be missed again. Also in February, the Metro reported on the plight of people with learning disabilities when it came to getting access to the vaccine. This is despite Public Health England research showing people with learning disabilities died with coronavirus at a rate 6.3 times higher than the general population during the first wave. People with a severe learning disability are in group six, but those with milder learning difficulties are not on the priority list, it said. Dan Scorer, Mencap head of policy, said: “People with a learning disability have long been forgotten and discriminated against, and never more so than in this crisis. They have died at greater rates, had Do-Not-Resuscitate orders slapped on their files and suffered through severe isolation.”
significant increase in deaths of people with a learning disability as a result of Covid-19. We already know that people with a learning disability are at an increased risk of respiratory illnesses, meaning that access to testing could be key to reducing infection and saving lives. “These figures also show that the impact on this group of people is being felt at a younger age range than in the wider population – something that should be considered in decisions on testing of people of working age with a learning disability.” The number of care home beds registered with the CQC in providers of specialist learning disability and/or autism care, excluding care to older people or those with dementia, was 30,912 in 2020, down from 32,217 in 2019. This February, Nursing Times reported that a target for closing inpatient beds for people with learning disabilities will be missed again. After the Winterbourne View scandal of
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cited everyone from “dedicated outreach workers, the hard-working council staff to hotels that have opened their doors, and faith and community groups who provided friendship and food.” In February, charities urged the Welsh government to allow them to vaccinate the homeless and people addicted to drugs. Martin Blakebrough, chief executive of homeless charity The Wallich, said: “They often live in hostels, shared accommodation or they’re on the street, so their susceptibility to Covid is very high, and it is something that could go through the community very quickly. “It seems to me that as we provide a lot of medical services to this client group it would be more sensible for us to provide that vaccination.” The same month, The Times reported that charities and government bodies should expect a new wave of homelessness “as the economic consequences of the pandemic kick in.” Social Bite Chief Executive Josh Littlejohn told the paper: “Unless there’s significant support for people to weather the storm, then ultimately it will filter through to higher numbers of homeless people ending up in temporary conditions.” The Independent also reported an “explosion” in coronavirus numbers among the homeless. It said Tom Copley, deputy mayor of London for housing and residential development, and Dr Tom Coffey, the mayoral health adviser, also called for the government to vaccinate the city’s homeless.
Approximately 15,000 homeless people across England have been helped since the pandemic started
The first wave of the pandemic saw a huge effort to help protect the homeless from the worst effects of the virus. In May, Dame Louise Casey, the prime minister’s adviser on rough sleeping at the time, said: “For homeless people, the task was to bring as many people in off the streets and out of communal shelters. “The goal was to protect rough sleepers from the virus, give them the chance to self-isolate, and, ultimately therefore, to do the best we can to save their lives. “There was an absolutely extraordinary response, across the public sector, charities and businesses in response to my call to get ‘everyone in’.” She said this had seen roughly 15,000 people helped across England and
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Josh Littlejohn (Founder of Social Bite)
The prime minister made headlines in February 2020 by pledging to end homelessness “once and for all” and committing £236 million to tackle rough sleeping. The BBC reported Mr Johnson saying: “We must tackle the scourge of rough sleeping urgently, and I will not stop until the thousands of people in this situation are helped off the streets and their lives have been rebuilt.” In August, Dame Louise Casey “stepped back” from her job as the government’s chief adviser on homelessness. She was redirected onto coronavirus work, and homeless charity Crisis urged that a replacement be appointed swiftly to avoid a “leadership vacuum”.
In a joint letter to Public Health England, they said: “the window of opportunity presented by emergency accommodation (should be taken advantage of) to protect public health.” Emergency funding for the homeless is due to finish at the end of March. October saw reports of an increase in the number of homeless households. statutory homelessness showing an increase in the number of homeless households of 15 per cent year-on-year. The total number of families and individuals owed a “relief duty” after approaching a local authority rose to 139,800 in the year ending March 2020. Nearly three quarters of the increase was from single adults. Inside Housing reported the government’s annual report on
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Fresenius Kabi medical home worker with patient F resenius Kabi is a global healthcare company that specialises in lifesaving medicines and technologies for infusion, transfusion and clinical nutrition. Its UK operation, based in Runcorn, Cheshire, incorporates two businesses: Fresenius Kabi Limited, which provides vital medicines, devices and nursing services to NHS customers and its patients; and Calea UK Ltd, which is the homecare specialist providing specialised products and services, prescribed by clinical teams, direct to patients’ homes. Managing Director of Fresenius Kabi Limited, Niamh Furey, tells the Review more. Our products and services are used to help care for critically and chronically ill patients. The product portfolio at Fresenius Kabi comprises a comprehensive range of I.V. generic drugs, infusion therapies and clinical nutrition products as well as the devices for administering them. In the field of biosimilars, we focus on autoimmune diseases and oncology. Within transfusion medicine and cell therapies we offer products for the collection and processing of blood. With our corporate philosophy of “caring for life”, at Fresenius Kabi we are committed to putting essential medicines and technologies in the hands of people who help patients and to finding the best answers to the challenges they face. Calea in the UK strives to be the heart of homecare, facilitating the patient journey from hospital to home and delivering sustainable, meaningful and cost-effective long-term patient and nursing care directly to patients at home.
Managing Director Niamh Furey
FACTS ABOUT Fresenius Kabi LIMITED
» Managing Director: Niamh Furey » Established in UK: 1987 » A global firm with a UK base in Cheshire » Services: Lifesaving medicines and technologies for infusion, transfusion and clinical nutrition » No. of employees: over 900 » www.fresenius-kabi.com/gb
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The Covid-19 pandemic did not delay the urgency of the NHS in terms of welcoming the launch of Fresenius
Recognising issues The Covid-19 pandemic did not delay the urgency of the NHS in terms of welcoming the launch of Fresenius Kabi’s first biosimilar medicine in the UK. Biological medicines are complex medicines which are increasingly significant in many therapeutic areas as an option to treat patients. Biosimilars are biological medicines that have been shown to be equivalent to the originator or reference medicine in terms of quality, safety and efficacy and are usually better value. As key workers under the government’s definition of an NHS subcontractor, it was particularly important for us to overcome the challenges presented by Covid-19 restrictions in supplying medicines and clinical services to patients who live at home, as well
as pharmacy dispensing and nursing services for vulnerable patient groups within the community. However, being part of a global organisation, we were able to get ahead by implementing adaptations and changes to ways of working as well as listening to the requirements of our patients and customers, benefiting from shared learnings from our worldwide operations that were impacted earlier than the UK, such as those in China, India and mainland Europe. We recognised the need to avoid outpatient hospital appointments wherever possible, particularly for groups of patients that are inherently more susceptible to Covid-19, and understood that relieving the burden on NHS staffing capacity and finances was of paramount importance. Our solutions Our new medicine was a critical product that launched in the UK in 2020, amid the enormous pressure faced in maintaining the supply of key medicines and equipment to support the NHS and Nightingale hospitals during the first wave of the pandemic. We received European Commission approval for this medicine in 2019, following our 2017 acquisition of Merck KGaA’s biosimilars business. We first launched the product in Germany, perfecting the process for patients and medical professionals to enable rapid rollout in the UK in early spring 2020. In addition, Calea independently provides the homecare service that sits alongside the supply of our medicine to patients, so we recruited specific nurses and resources to deliver an aligned system that has worked effectively in alleviating the operational burden from the NHS once a referral is made to us. Provided in the UK in a pre-filled pen, pre-filled syringe or vial, this medicine is suitable for adult and paediatric patients and acts on the immune
Kabi’s first biosimilar medicine in the UK
Fresenius Kabi building, Runcorn, Cheshire
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system to reduce inflammation. The aim of the treatment is to improve a patient’s quality of life by encouraging and maintaining remission and providing respite from symptoms. It is dispensed by our Calea-registered pharmacy and is delivered via our specialised cold chain delivery service to any preferred address of the patient (such as their home, work or holiday destination), provided refrigeration is available at that address. Our involvement begins with a medical referral from a specialist. A Calea nurse will then undertake a pre-visit call with the patient, before attending their home to provide training in how to use their medicine. During the pandemic, most clinical assessments were undertaken virtually, making nurse training at home invaluable to ensure each of our patients understood and was able to administer their treatment correctly. Following their initial training, the patient may receive a follow-up visit from a Calea nurse if required, to ensure they are comfortable and competent to self-administer their treatment. All patients receive a post- visit nurse call and are assigned their own dedicated patient coordinator for ongoing treatment management and communication, as well as access to our 24/7/365 freephone advice line. In addition, patients have access to KabiCare, our online patient counselling and cognitive behavioural therapy programme. Positive results The combination of a treatment that is less expensive, yet equally as safe and effective, as the reference medicine, alongside our in-house provision for nursing advice and training at home, is the solution our patients and NHS customers needed. We are delighted that we had sufficient foresight to be in a position to deliver at the optimum time.
Fresenius Kabi nurse
The introduction of biosimilars has been found to provide increased value for the NHS, and they have the potential to be used at an earlier stage
of a patient’s disease course, and for those patients with a less severe form of disease. Our ambition is to offer patients more options to access high-quality treatments in their own home and we have a pipeline of other biosimilars that will be rolled out over the next few years. The introduction of biosimilars has been found to provide increased value for the NHS, and they have the potential to be used at an earlier stage of a patient’s disease course “ “
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Stericycle, delivering innovative specialist waste management solutions for over 30 years B ased in Leeds, Stericycle is one of the largest providers of sustainable waste services and solutions to the NHS. The company is gearing up to help the health service become the first globally to achieve net zero. Below, Commercial Director James Cardwell-Moore explains that there is no time to waste in addressing the climate health emergency, and he details what Stericycle are doing to help. Recently, the NHS set out its stall to become the first national health service in the world to achieve net zero carbon emissions. There will be many components to achieving this target, and as a business, we will be focusing our efforts on ensuring that waste management makes its vital contribution to achieving this long-term ambition. We believe that sustainable waste management practices can ensure the NHS’s sustainability drive gets off to the quickest start possible, as waste management provides a number of low-hanging opportunities in the short to medium term. As a company, we have been investing in the NHS for over 15 years, providing clinical waste management to over 60 per cent of NHS trusts, which means managing the waste from over 20,000 sites. Nationally, we offer considerable scale and infrastructure to deal with the waste capacity requirements and net zero ambitions of the NHS estate. This includes eight energy-from-waste facilities, five alternative treatment centres and four waste transfer stations dealing with a range of infectious, hazardous, anatomical and pharmaceutical clinical wastes from the NHS estate. Through our waste-to- energy facilities, we are also providing heat and power to several NHS trusts. We have recently invested in our latest alternative treatment facilities in Telford and Antrim. The Stericycle alternative treatment process involves the heating of
Commercial Director James Cardwell-Moore
FACTS ABOUT Stericycle
» Commercial Director: James Cardwell-Moore » Founded in 1989
» Based in Leeds, West Yorkshire » Services: Waste management and compliance solutions » No. of employees: Over 1,700 UK employees » www.stericycle.co.uk
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waste to disinfect it, as an alternative to incineration. This technology ensures the by-product of the waste is utilised as an alternative fuel source, making this a sustainable waste treatment process. As part of the process, waste is inspected, and any that is deemed inappropriate for alternative treatment is removed. The waste is tipped into an enclosed tipper, which sends it to the shredder unit via a bin lift. The shredded waste is then moved through a heat disinfection unit, which uses oil heated to 140 degrees to disinfect the waste. Once cool, the shredded disinfected waste is compacted, baled and used as an alternative fuel source or solid recovered fuel. We have also pioneered our award- winning reusable Bio Systems containers service, which is used by 25 NHS trusts and 300 NHS pharmacies across the UK and offers the only complete in-house end-to-end service on the market for sharps management, from collection and transportation right through to treatment at our licensed facilities. Over one million Bio Systems containers have been used by health services across the UK, and their success has resulted in two prestigious industry awards from the Health Service Journal and letsrecycle.com. In the context of supporting net zero programmes across the NHS estate, our sharps management service can dramatically reduce the environmental impact of waste collection quickly. That’s because for each reusable Bio Systems container used, up to 600 single-use plastic containers are prevented from being incinerated, which supports the drive by the NHS to turn the tide against plastic waste across its estate. It also eliminates the bulky packaging waste from the One million reusable containers
purchase of single-use containers. Furthermore, containers cost on average ten to 20 per cent less than the total costs involved in operating a single-use sharps container service, and there is potential for insurance policy premiums to be reduced due to the decrease in the number of needlestick injuries – up to 77 per cent fewer injuries according to our experience. A saving of 115 tonnes Our innovative sharps management service with reusable Bio Systems containers has helped to greatly enhance the environmental impact of clinical waste management at Birmingham Women’s Hospital. The hospital specialises in healthcare for women and babies in the West Midlands, treating more than 90,000 people a year. It was using almost 6,000 sharps containers every year to manage safely used needles and other clinical waste. Every container was incinerated along with its contents, creating avoidable additional pollution compared to recycling the containers. Working with Stericycle, the trust has moved to a reusable sharps containers service, streamlining the sizes of the sharps containers it uses and drastically cutting the number of containers used.
Nationally, we offer considerable scale and infrastructure to deal with the waste capacity requirements and net zero ambitions of the NHS
Bio Systems, a multi- award-winning sharps management service with reusable containers
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Sustainability mindset Training and creating a sustainability mindset across NHS staff will also be critical in ensuring waste management maximises its contribution to the net zero plan. In the NHS net zero plan, recognition was given to the need to build capability in all staff. It is also important to note that the NHS plans to introduce a tailored induction module for all NHS England and NHS Improvement staff to support their understanding of the links between health and climate change, and actions they can take to reduce emissions; in addition, it is looking to develop a dedicated net zero training package for staff working in estates and facilities. Changing behaviours is absolutely critical to a successful net zero programme. The workforce has to be empowered to make it happen. Again, we have been gearing up to support this requirement with the launch of our healthcare waste management CPD-accredited e-learning course. This has been designed to help keep NHS trusts compliant and their employees safe by raising awareness of the risks and penalties of incorrect waste management. The online programme is designed to promote best practice waste management for employees at healthcare organisations. Modules cover an introduction to waste management, waste audit and review, waste segregation, waste storage, transport, and treatment. It is clear that waste management has a big role to play in achieving the NHS’s ambition to become the world’s first health service to get to net zero. And no time should be wasted, as solutions and services are available now, like the ones we’ve highlighted in our business, which won’t just enhance the planet but will also present significant savings, which can go towards providing vital care services.
Bio Systems reusable sharps containers in use
Gail Alexander, hotel services manager at the hospital, said: “We have formed a really powerful partnership with Stericycle. They have helped us reduce the amount of clinical waste we create, and now dispose of it safely and efficiently. Being able to recycle so many of our sharps containers is an additional benefit, and helps us contribute to the NHS net zero target.” In the seven years since the trust has been using Stericycle’s Bio Systems recycling process, it has saved almost 22,000 sharps containers from incineration – avoiding the creation of 115 tonnes of carbon. Stericycle’s Bio Systems process, managed internally by trust staff sees full sharps containers collected from dozens of points around the trust, then taken to the collection point for collection and delivery to the Stericycle treatment facility where they are opened, emptied and disinfected using an automated wash-line that features state-of-the-art robotics. The disinfected containers are inspected and then reassembled before they are returned to the hospital for reuse. The clean replacement containers are supplied on a daily basis, which means there is no waste build up around the site. Account managers are also assigned to the contract management of the service.
Over one million Bio Systems containers have been used by health services across the UK, and their success has resulted in two prestigious industry awards from the Health Service Journal and letsrecycle.com
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Stonebridge Nursing Home
Our culture of care embraces a homelike atmosphere
Rated “outstanding” by the Care Quality Commission
F irst established in 1985, Stonebridge Nursing Home was failing when Managing Director Philip Edmunds acquired it in 2006. After he and his team assumed control, they began a concerted campaign of improvement to bring it to the standard it is now. This progress has been recognised by the CQC – in fact, in its last report the service improved from “good” to “outstanding”. Philip explains that he has more than 30 years’ experience in the sector, and discusses just how that has informed his efforts to transform Stonebridge. Alongside the general improvement we instigated, we also adapted our provision to cater for a new category of residents; these are very complex cases and, generally speaking, the residents have previously been rejected from various other provisions. Often, the choice is between our home and hospital, and we specialise in mental health and dementia care for those aged 18 and above. A commitment to staffing Our skillset is focused on dealing with complex behaviours, something essential when supporting those who have been refused by other services or come to us through direct transfer. In order to support these efforts, we have a concerted focus on staffing, with one of the highest staffing levels of the country. We do not use agency staff and have instigated a robust and effective internal training programme. Even when we have faced challenging times, we have remained committed to this training. We now have an in-house team of eight training personnel and have created our own training packages and accredited training centre.
FACTS ABOUT Stonebridge Nursing Home » Managing Director: Philip Edmunds » Company Director and Director of Nursing: Fran Edmunds
» Established in 1985 » Based in Redditch
» Services: Residential support for those with complex needs » No. of employees: 172 » www.stonebridgenursinghome. co.uk
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THE PARLIAMENTARY REVIEW Highlighting best practice
We are proud of our independence as we feel when organisations grow too large, their quality and standards quickly decrease. We have never deviated from the type of people we care for and have focused on refining and improving our standards in this area. A homely atmosphere Our provision is led by a strong senior management team, which comprises individuals with a mix of skillsets, ensuring all categories of nurses are represented. In order to deal with the level of pressure that community nurses face, we have tried to become as self-sufficient as possible. All of our senior managers are highly experienced and this has led to commissioners having confidence in our provision: the continuity among our leaders means commissioners can develop relationships with our staff and be confident they know who they are talking to.
Alongside our focus on our staff, we have also changed our culture of care, moving away from a more old-fashioned model of nursing to embrace a homelike atmosphere. We endeavour to make our provision feel like a home from home while ensuring we meet regulations: the comfort of our residents is paramount. This informs our nursing culture and we strive to make our service as much like everyday life as possible. Currently, and indeed historically, the biggest challenge we face is funding. Across our sector, and society as whole, this has always been an issue. In order to adapt to these pressures, we have moved away from being a generic nursing home and created a niche in the market, providing an alternative to hospital admission. This means we are one of the few providers in the sector who offer this The inefficiency of the funding system
The comfort of our residents is paramount
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Providing care for those living with dementia and mental illness
type of service and as our staffing levels are much higher than others, we are able to cope with demand. Because of the lack of other similar homes, we receive a lot of out-of- county referrals and we ensure we are able to provide our services to whoever may need them. On a political level, we have significant concerns about the complex funding arrangements that are required for our residents and the appalling waste that this system generates. Councils and public sector organisations often spend significant amounts of time arguing about funding arrangements and the cost of this comes directly from the public purse. Money is being haemorrhaged because of the inefficiency of this system and even though all the money stems originally from the same funding pot, arguments about who pays abound. Alongside the inefficiency of this, it also leads to long delays for placements and causes suffering for both the individual needing support and their family.
These effects are inevitable when each organisation has a separate budget and fights to protect their own share. In order to ensure that the wellbeing of the individual is prioritised, their needs must be placed above financial considerations. We often find ourselves having to fight on behalf of the people we care for, simply so they can access funding. This needs to change. As we look ahead, we are planning to expand our service, allowing us to reach and support a greater pool of people. Whether this will be through the purchase of another property or the expansion of our current site, which is currently underway, we aim to ensure we can reach as many people as possible. This expansion will also be mirrored by an expansion in our services as we adapt to the increased complexity of the needs of our residents. By continuing to adapt our model of care, and our reach, I am sure we can continue to provide a high level of support to those who need it most.
We often find ourselves having to fight on behalf of the people we care for, simply so they can access funding. This needs to change
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THE PARLIAMENTARY REVIEW Highlighting best practice
One of our homes, based in Seaford
Director Sanjeev Rajput
S ince it was founded in 2007, Jiva Healthcare has helped transform previously failing mental health services and is now a leading provider of residential and supported living placements across Sussex. Sanjeev Rajput tells The Parliamentary Review that by changing the culture in the homes, Jiva has created person-centred services that celebrate the uniqueness of the individuals they care for and has placed them at the heart of the service’s purpose. With the help of Jiva, the managers we work with have created calm, relaxing environments for the residents which have helped reduce readmissions to psychiatric hospitals. By valuing the staff and giving them a role in decision making, we managed to retain a motivated and passionate staff team at a time where the care sector faces a national recruitment crisis. This has allowed us to meet the many challenges faced by the sector and build towards a bright future as we look to develop more innovative services. Our origins We began by purchasing a number of mental health residential homes that had been struggling to meet CQC standards a few years back, and what we found was an institutionalised culture with a very strict hierarchy. Managers had lost their passion for the work, residents were not valued or treated with dignity and staff were demotivated. We brought in new managers and supported them to
FACTS ABOUT Jiva Healthcare » Director: Sanjeev Rajput » Established in 2007 » Based in East Sussex » Services: Residential homes and supported living flats » No. of employees: 55 » CQC rating: “good” » www.jivahealthcare.co.uk
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change the culture of the homes. Our first priority was to value each and every resident in our services. We gave them a voice and looked for the positives in their character. This is especially important when working with challenging people, many of whom face stigma even within the mental health sector. By working with these people in a more positive way we managed to drastically reduce readmissions to psychiatric hospitals. When talking about this change of culture to CQC, a local safeguarding manager said “The team has built a new culture. This is very much the gold standard we hope for”. the foundation of everything we do. Our managers work hard behind the scenes to create a calm and caring atmosphere in all our homes. This helps service users open up to staff and accept the support they need. As a result, we have been able to help people through difficult periods in their life and overcome issues such as self- harm, substance misuse, self-neglect and psychosis. Many of the people who live in our services have no friends or family, so what we offer is genuine compassion from staff that enjoy the company of our residents. Working with complex needs In 2012 we began working with a resident who had a long standing diagnosis of schizophrenia. He had been in and out of various psychiatric institutions since the 1960s and had never enjoyed a stable, settled life. He was on a lot of medication which he was reluctant to take and he was often aggressive towards others. He had a fractured relationship with his family and had been labelled as challenging and difficult. Over time, we got to know him and built up a good relationship with him. He had a passion for theatre so we supported Building trusting, person-centred relationships with service users is
We focus on creating a calm and caring environment in our homes Jiva Healthcare has created
him to visit the London Palladium once a month. He confided in us that he had been the victim of homophobia throughout his life and had been rejected by his community as a result. We made him feel valued for who he was and brought out the positive side of his personality. We also got him reassessed by his psychiatrist who diagnosed him as being autistic. His medication was changed and more suitable treatments were found for him. We then helped him to move into less supported accommodation and he now receives no intervention from mental health services. He has rebuilt the relationships with his family
services that celebrate the individuals they care for
Our staff are passionate and motivated to deliver high-quality care