For too many years, medical equipment management has floundered in the NHS, never quite understood by most executive management teams. Every year NHS hospitals spend money on the equipment that is perceived to be the ‘most needy’ replacement. Very few Trusts have any sort of equipment replacement plan in place, partly because of budgetary constraints, and partly because they just don’t link the investment in professional management of their technology to improved clinical outcomes, and improved efficiencies.
Trust executives have no choice but to modernize. A recent story in the Guardian Newspaper ran the headline…
‘Four in 10 NHS hospitals in England found to use outdated equipment in Lib Dem study’
In my experience it is usually more than that, but lets leave it at 40%. In terms of investment just to get up to date, the government would need to provide an additional £2Billion across the NHS. It would need to be ringfenced for medical equipment or it would disappear into a financial black hole of other under resourced areas. There are many great projects going on in the NHS that are reliant on new technology, but that is not my point; or maybe it is exactly my point. A piecemeal approach to buying technology results in higher costs for the NHS, and higher risks for the patients. In the recent Guardian article, it said that one Bedfordshire Trust was still using a 37-year-old X-ray machine. Strangely, this didn’t surprise me.
There is a mentality amongst some healthcare professionals that if its still working, keep using it, and in some cases this may be true. The only way the NHS is to become more efficient is to use a systems approach to management of medical technology. Clinical systems are interrelated – whether that is within an acute hospital or with an integrated care system. The technology used can now also be integrated.
Modern technology is data driven. A new device can communicate directly with software systems such as electronic patient records (EPR) pushing the data directly into the system, and freeing up valuable time for nurses and doctors. This can only happen if governance of medical technology is carried out in accordance with the requirements of the trust policy for medical devices management, which must also meet the requirements of the regulators (CQC).
I spoke to a NHS chief Executive recently and she admitted she didn’t know their Trust even had a medical devices policy - I don’t believe this is unusual. Chief executives are busy people, and not able to keep up with every policy, especially when it only represents around 4% of their overall budgetary spend. It’s a tiny piece of their financial cake.
Thinking of an analogy, I would put it like this: Most people service their car (Replace parts – ensure it is running well), get it regularly checked (Audit the key functions to ensure its safe to drive). They have to spend money to keep it safe and in good working order.
In my experience, the NHS Medical equipment fleet is poorly managed -
- at a country level (no government policy exists)
- and in many Trusts (No audits, reporting, or strategy)
Most NHS Trusts have policies relating to medical equipment, but the policy is often out of date. i.e. Trust practice does not align with Trust policy. Why is this?
Using the car analogy… it makes me feel like the NHS medical equipment fleet is running on bald tyres, with poor brakes.
I believe that if the NHS equipment fleet had an ‘Compliance Test’, it would fail. In many cases consultants are frustrated with using out of date equipment, which they know is not up to modern stands, and ultimately, this affects clinical outcomes for their patients.
So how should an NHS Chief Executive check to see if they were safe, legal, and practicing in accordance with the regulations?
Medical devices management – is it working well?
‘Compliance Testing’ for Medical Technology
- External demands – Laws and regulation
- Are you compliant with the Care Quality Commission / MHRA standards?
- Can you provide evidence?
- Internal demands (Evidence based)
- Do you know how many assets you have?
- Do you have user training records? (Especially on high-risk devices)
- Do you have maintenance records?
- Do you have key performance indicators reported to a senior executive committee?
- Medical devices policy (Evidence based)
- Do you have a policy?
- Does it cover all aspects required by the MHRA / CQC?
- Where is the evidence??
- Annual board report covering key performance indicators
If you are one of the few trusts in the country that has passed its medical technology ‘Compliance Test’ that great news. This means you have an annual board report for medical devices management covering:
- Equipment replacement planning
- User and technical training
- Equipment and software maintenance (including a cyber security strategy)
- Regular (at least annually) audits to provide evidence
- Reviews of the data to deliver strategic improvements
Medical technology may only represent a small portion of the NHS Budget, but without it running efficiently the NHS will not run efficiently. When the medical technology fails its ‘Compliance Test’ so does the whole of the NHS. The 2 are inextricably linked.
The Impact of regulation - The impact of the new regulations on the NHS Trust results in changes to the trust policy on medical devices management. As a result of these changes, it is necessary to then train the responsible managers on the revised policy to ensure the organisation can adhere to the new government regulations. Once managers are trained, it is necessary for them to cascade changes in policy to their teams. Department and Ward managers are expected to implement changes. The trust board and governance team have a responsibility to monitor the revised policy for compliance.
I would advise that on a regular basis, the governance team report compliance levels to the 'Governance Committee'. This committee then reports to the executives, and allows them to report to make strategic decisions based on the evidence.
The Care Quality Commission act as the external monitor for the government to ensure regulations are adhered to and can visit any healthcare trust at any time without notice. This is meant to ensure compliance with regulations and government policy, and thereby allow the government to review and improve policy.
Factor impacting on the medical devices policy
The Medical devices policy is important to the organisation to ensure selection, use, and maintenance of all devices is carried out to meet the clinical needs of the patient, but must also meet the external regulatory demands.
The regulations concentrate on the use and maintenance of medical devices. In my experience, improved procurement delivers cost savings, but is also the KEY to improving training, governance, and maintenance practices. Therefore, the trust medical devices management policy must include procurement practices, if the trust is serious about meeting its regulatory goals.
Good procurement of medical technology can reduce the size of the inventory, reducing the value of the inventory, and thereby reduce the annual spend on replacing assets.
- The procurement of medical technology has an impact on the organisation in terms of cost, availability, and suitability, and strategic needs.
- Good management of training can results in better use of the assets, reducing the risk of misuse on patients, and improving outcomes for patients. The use of medical technology has a major impact on the business of the trust and the outcomes for patients.
- Maintenance of medical technology is important to the efficient running of the organisation, aiding therapeutic and diagnostic care of patients, and also to the volume of equipment required by the organisation.
- Governance of medical technology is carried out in accordance with the requirements of the trust policy for medical devices management, which must meet the requirements of the regulators.
Excellence in medical equipment management leads to better clinical outcomes, happier staff, and a more efficient NHS.
Author: Dr John Sandham
Date: June 2023