Medical Technology is changing rapidly, with continuous growth in the number of suppliers, and an increasing variation in makes and models of equipment - creating risks and opportunities for both Public and Private sector organisations.

The medical technology market is estimated to be worth (annually) £150-170Bn worldwide. ⁽¹⁾

The UK Public Accounts Committee and the National Audit Office both raised concerns regarding the NHS's fragmented approach to buying/procuring high value capital equipment. With the NHS spending approximately £500m per year on capital equipment, the potential for savings was considerable. ⁽²⁾

Issues raised from a number of sources show that uncontrolled healthcare technology management leads to poor purchasing decisions, and ultimately creates both financial and patient safety issues.

…uncontrolled purchasing and device management, in the absence of competency-based training, were contributing factors in causing incidents. ⁽³⁾

There are serious consequences when healthcare technology is not effectively managed thereby putting patients lives at risk. A report published by the Institute of Mechanical Engineers stated that 'in 2013 over 13,000 incidents were reported to the UK regulator relating to faulty medical equipment, which led to over 300 deaths and almost 5,000 serious injuries'.⁽⁴⁾

Excerpts of this report were later published in the Daily Mirror national newspaper:

• At least 1,400 'killed by NHS equipment failures'

…As medical staff rely more and more on technology, lives are being put at risk because of a lack of engineers working to fix, maintain and test equipment…Currently six patients are dying a week and thousands more NHS and private patients have been left seriously injured after vital equipment failed to work. ⁽⁵⁾

This is not just an issue in the United Kingdom, it is an international issue:

• A study of 2000 adverse incidents in operating theatres in Australia showed that only 9% were due to pure equipment failure ⁽⁹⁾. In two reports on the use of critical care equipment by nursing staff, 19% ⁽¹⁰⁾ and 12.3% ⁽¹¹⁾ of nurses, respectively, indicated that they had used equipment improperly, which had consequently harmed a patient. ⁽⁶⁾

Improving Healthcare Technology Management saves money and lives. The World Health Organisation actively promotes good management of healthcare technology. It produced a series of reports in 2011 ⁽⁷⁾, explaining the issues of poorly managed assets such as:

1. 20-40% of equipment remains under-utilised
   1. Poor standardisation
   2. Delivered without installation
   3. Delivered without user or technical training
2. 30-50% additional cost for maintenance
   1. Purchase of sophisticated equipment where users and maintenance staff are not properly trained
3. 10-30% unplanned costs
   1. Poorly specified technology
   2. Additional costs for consumables; service parts not considered
4. 25-35% of equipment out of service
   1. Due to absence of preventative maintenance
   2. Poor equipment use
   3. Users not trained
5. Loss of 30-80% of the potential lifetime of equipment
   1. Due to all the above factors

The NHS has significant issues with healthcare technology management

Firstly, there is a lack of expertise within the NHS to determine the right equipment specification for the needs of that organisation, and to enable a managed annual replacement plan.

Secondly, there is a lack of money to buy equipment (both revenue and capital equipment), and if the management plan is not there for purchasing, then the limited funds available are not spent in the most effective way.

Thirdly, the impact of not planning the acquisition of equipment, and not spending the money wisely, then goes on to impact in terms of both risk and cost to the organisation. It is imperative that the NHS changes its approach to technology management, and introduces strategic policies to guide healthcare technology management that puts procurement at the centre, thereby allowing organisations to deliver user training and maintenance in more effective ways. The available research shows us that by applying current best practice, we can not only save lives, but it will also reduce costs.

• Across the NHS, there needs to be a means by which hospital trusts can objectively determine the right specification of machine for their needs, and be assured that they are gaining value for money from procurement decisions. ⁽⁸⁾

The strategic importance of medical technology in assisting the NHS to deliver professional levels of service cannot be understated. Technology is absolutely at the centre of healthcare delivery. If the technology is not managed effectively, healthcare is also not managed effectively. There are misguided beliefs that extending the life of individual assets is always the best thing to do. This can increase age and model variation of assets doing the same function. Allowing asset group variation to occur within healthcare organisations will increase both risk and cost. Each asset group within an organisation must be replaced within a set period of time. Each asset group must also be assessed to see whether it is appropriate to standardise for that group of technology, thereby introducing economies of scale, and ease of training. This is best practice.

• The strategic importance of medical equipment, the need for clear leadership and the implications for clinical governance, highlight the need for overall responsibility to be taken at trust board level. ⁽⁹⁾

The NHS spends approximately £5 billion a year on healthcare technology. In its current format, the NHS cannot continue to manage healthcare technology in such an ad hoc way. This puts patients lives at risk, and is unaffordable.

• The NHS spends approximately £4.6billion of its budget on equipment and consumables ⁽¹⁰⁾

I absolutely believe that the NHS can do a better job of managing healthcare technology, but we need to have a new approach, which is based in research and better practice. We absolutely understand what the issues are around lack of standardisation, and age variation across assets. Although there are many hurdles to overcome, making it difficult to standardise NHS technology, it is not unachievable if done on a site by site basis. It is imperative that we work together, combining public and private knowledge to improve the management of healthcare technology, and ultimately set an example for the rest of the world, as the NHS has always done.

Bibliography
1. HM Government - Strength and opportunity. Strength and opportunity 2011. London : Department for Business, Innovation, and Skills, 2011.
2. NHS Supply Chain. £29.5m savings through the Department of Health Capital Equipment Fund. www.supplychain.nhs.uk. [Online] October 1, 2014. [Cited: April 22, 2015.] https://www.supplychain.nhs.uk/news/company/29m-savings-through-the-dh-capital-equipment-fund/

3. National Patient Safety Agency. Standardising and centralising infusion devices. London : NPSA, 2004.
4. Finlay, Patrick. lack of NHS engineers is putting lives at risk. London : The Institution of Mechanical Engineers, 2014.
5. Gregory, Andrew. At least 1,400 'killed by NHS equipment failures'. www.Mirror.co.uk. [Online] July 25, 2014. [Cited: April 22, 2015.] http://www.mirror.co.uk/news/uk-news/least-1400-killed-nhs-equipment-3909340

6. World Health Organisation. Increasing complexity of medical technology and consequences for training and outcome of care. [Online] 2010.
7. Lenel, Andreas, et al. How to organise a system of Healthcare Technology Management. London : Lewes, 2005.
8. National Audit Office. The Management of Medical Equipment in NHS Acute Trusts in England. London : NAO, 1999.
9. Audit Scotland. Equipped to care. Edinburgh : Audit Scotland, 2001.
10. NHS. Guidance for NHS health bodies on the security and management of NHS assets. London : NHS Protect, 2011.

Author: Dr John Sandham