Engineers should be given the opportunity to help ease the burden on the UK’s beleaguered health service writes Dr Helen Meese, Head of Healthcare at the Institution of Mechanical Engineers.
The financial struggles of the NHS have been dominating the headlines for many months now; inefficient services and overwhelmed hospitals are cited as the root causes. Yet with people living longer lives, a continually growing population and more advanced and increasingly expensive treatments becoming available, the £115bn cost of the NHS can only continue to rise.
I am often asked, “Why are engineers concerned about the NHS?” Well aside from all of us being patients at some point in our lives, the reason we are concerned is the largely hidden and undervalued contribution engineers make to our National Health Service every day. I am not simply referring to the 3000 UK SMEs; designing and manufacturing cutting edge healthcare devices and equipment, but the thousands of engineers within the NHS itself, working in areas such as prosthetics and orthopaedics, renal care, rehabilitation, imaging and modelling as well as tele-health and robotics.
While the debate on ‘pressures on front-line services’ rages on, the one area that has so far been overlooked is the role of technology. Technology and the biomedical engineers who develop, procure and maintain this technology, have the potential to not only ease the burden on services but also significantly cut costs.
The Institution recently carried out a member survey and of the 200 engineers who responded, 94% said that the UK should have a Chief Engineer, similar to a Chief Nurse or Chief Medical Officer, to oversee the use of medical equipment in every NHS Acute Trust. The majority (86%) think that giving engineers more responsibility for the procurement, maintenance and calibration of medical equipment would help the NHS meet the Government’s efficiency savings, while 80% said it would ensure NHS patients have a better experience when under hospital care. Perhaps surprisingly, nearly two thirds of those surveyed (65%) also said that engineers working in the NHS should have more hands-on involvement with front-line patient care.
Technical innovations are set to revolutionise healthcare in the coming decades.
The engineering community is clearly confident that it can make a difference, and giving engineers already working in hospitals more responsibility for medical equipment would be a step-change in our approach to medical care in the UK.
Technical innovations are set to revolutionise healthcare in the coming decades. Big data, will allow doctors to undertake predictive modelling and trending to pinpoint for example, outbreaks of disease linked to environmental conditions. The development of tele-health and smart phone apps which access body-worn measurement systems are also set to transform the way illnesses like diabetes and heart disease are controlled and monitored. While surgical robotic manipulators will become more prevalent allowing surgeons to navigate deep inside the body, avoiding the risks and complications of traditional open surgery.
Such innovations will allow even complex interventions to be treated as day cases. All of these technologies not only look set to improve patient care, but also help ease the burden on increasingly overworked clinical staff. In order to properly exploit these technologies however, we need engineers.
Lack of cooperation and coordination between expert NHS engineers is preventing huge cost savings and efficiencies
Biomedical engineers are already working in the NHS, providing a crucial role in the development, selection, use, maintenance and decommissioning of technologies. However, unlike many other NHS professions, there is little uniform recognition of the biomedical engineer. NHS biomedical engineers are often assigned to different departments, operate at different levels of authority and have varying input into critical decision-making, depending on which Trust they are employed at. This inconsistency not only undermines the work of engineers, but hampers connectivity between Trusts on the development, procurement, maintenance, and sharing of medical equipment.
At a time of financial constraints, this lack of cooperation and coordination between expert NHS engineers is preventing huge cost savings and efficiencies related to medical equipment, which could be made without affecting front-line services. It is estimated that including engineering into this process has the potential to save the NHS over £700m each year.
The Institution of Mechanical Engineers is leading a campaign to create a Chief Biomedical Engineer position in each acute NHS Trust, working alongside roles such as the chief nurse and chief pharmacist; with consistent qualifications, level of authority, decision-making abilities and connectivity with other Trusts. This would not only increase the opportunity for cost savings but also encourage best practice in the procurement, maintenance and use of medical equipment as well as inspire technological innovation.
In many Trusts, this position and role will already exist, albeit under different titles, departments and levels of authority. The costs of implementation would be negligible, but the benefits to patients, services, budgets and the NHS would be significant.
I went to a dinner party a while back, where nearly all the guests, including the hosts, were either doctors or surgeons. The conversation went to what we all do at work and, after the usual ‘no I don’t fix washing machines’ chat I found myself talking about Lean engineering, kaizens, eliminating waste, etc, etc.
The general reaction was one of both ignorance of these approaches, and incredulity that the NHS hasn’t introduced these techniques, and incredulity on my part that they don’t.
I completely agree. Fortunately, I am an infrequent user of the NHS but on the occasions I do go to hospital I find that there appears to be tremendous waste and that the principles of Lean Manufacturing, that will apply equally well in hospitals, would make a significant difference to the efficiency and effectiveness of the NHS. Key thing is it needs to buy-in of senior management as well as front-line staff.
I (perhaps jokingly) regard most medical professions as (mere) subsets of engineering – repair and maintenance of the human body – although by my definition the vast majority are technicians not engineers as while they can maintain and repair they cannot create new or improved versions.
Regardless of my sense of humour though, engineering and medicine are both vital for an efficient NHS.
The classic response to this by a medical professional is ‘yeah, but we fix things while keeping the engine turned on.’
Unfortunately when I heard the fixing it while it was running, that comment was by a cardiac surgeon and it isn’t even true, when they do major surgery on a heart they bypass it and stop it! If it were true though, it is still the case that mechanics can fix an engine with it running just by accessing the ECU, (like Brain surgery with the patient awake) the difference is they know exactly what effect each change will make on the operation of the engine, unlike the Brain surgeon, (and like the Brain surgeon they can monitor it on line and in real time). The real difference is that no matter how valuable or individual a machine is it can be refurbished, rebuilt, or remade so any mistake can be remedied again and again and again until it is corrected and if necessary the whole edifice can be torn down and replaced, Medics and surgeons potentially only get the one go on an infinitely valuable and ultimately priceless individual, each of which is totally unique.
I always thought that the human body is a structural, bio-mechanical, electrical process plant, and that doctors are a subset of the engineering profession that works on the human body and its processes.
I live half way between Southampton and Portsmouth. I have had tests done at both hospitals. They can’t access my results on each others databases, nor can my GP. Which century are they living in?
I work for a Global company of 100,000 people. There are scores of different database systems. Access is controlled for each system, but if someone has the privileges, they can access the data of that system anywhere in the World. This is as you wold expect. That won’t surprise any of the engineers reading this. The surprise is why Government organisations often have difficulty with database systems where industry don’t?
Perhaps they should recruit a few engineers from industry.
Recruiting from industry would be the smart move. There have been attempts at a universal database for the NHS stretching back over the years. I have a friend who is a microbiologist who got drawn into trying to unify just 4 different systems at a hospital in Windsor back in the late ’80s in order to easily pass information between consultants, pathology, referring GPs and I think radiology. They spent some 2 years at this apparently trivial problem, with or without outside contractors I’m not sure but when he left the problem still existed to a greater or lesser extent and that has been the story of big IT projects in the NHS. It would not surpridse me that more engineering solutions have not appeared in the NHS, they are too bogged down in endless box ticking and demonstrating compliance with the latest political obssessions. More engineering would leave nurses like my daughter free to do what machines can’t, have empathy, compassion and at the end depart this world with dignity.
Perhaps the NHS should engage a few experts in BIM. which has now a long track record of faster project delivery – due mainly to the better inter-discipline coordination resulting from a Common Data Environment (aka Single Point of Truth) and real-time communication among the parties: owners, designers, consultants, contractors and operators.
I support your comments, the NHS has a huge amount to learn from the PDM & PLM systems our industries have implemented to add the necessary control enabling us to function efficiently and effectively.
Its scary the NHS is not fit for purpose and in business excellence terms it [like most off government departments] is comparatively still in the stone age
It isn’t just the pure electro-mechanical aspects of engineering. There is process and flow control, communications, to name just a few, and not least the repair and maintenance of equipment and facilities. Having been a recent in-patient I was struck by the lack of process planning and communication interaction between departments! Process efficiency is poor.
Am I the only person who has spotted the basic reason of NHS intransigence:
whatever their skills, knowledge, abilities,…these are civil servants paid by the State: and when has any State employee (in any society throughout history) had any incentive to improve from within?
“What’s in it for them to do so? ” Grief, so they don’t!-even if the ethos was to enhance what they do. I am sorry to sound so negative and callous but after 45+ years of watching ‘them’ in action (that should be inaction) I can come-up-with no alternative. The grocer’s daughter applied the standard ‘retail’ approach: developing competition between suppliers is good for them….and look where that has got us? A ‘fix’ of overheads -developed by clerks -indeed that is all they can and do do…trying to offload their costs onto some-one-elses budget. “Keep it off my desk” a game for hundreds of players that merely adds to the paper and other mountains.
For once I agree wholeheartedly with Mike, they managed to “loose” me between Theatre and the Ward, neither knew where I was nor were they expecting me. As far as my family could tell (on asking) I could have been already on the Morgue!
Years ago I recall reading about the transfer of Formula One pit-stop skills to aircraft refueling and hospital accident and emergency triage: that is the sexy part. Now what about transfering (as several bloggers suggest) the day-to-day skills, experiences and experience of Engineers in asset management, project management, time management, people management, materials science , application of science, technology, and motivation within the day-to-day running of incident management (and is a stay in hospital anything else? And whilst we are at it…do the same to the administration of the State, the resolution of disputes (practices of law) and commerce generally? But it will not happen! far too many livelihoods depend on prolonging the episodes to increase power, control and status, rather than a successful outcome? See above!
The organisation of the NHS in system terms is scary. In business excellence terms it is not fit for purpose [as is most of the Government departments] Comparatively they are in the stone age
and the NHS needs to bench mark itself against the rest of Europe. They do not have a joined up organisation and politics treats it as a sort of football with the players in the middle who cannot keep up with the movement of the goal posts
In my ‘other life’ I’m a volunteer beach lifeguard, and recently did a first response trauma course (mass casualties, terrorist attack, huge accident, lots of blood-and-gore type things such as you often encounter on the beach) and learnt about the ‘pit stop’ approach to triage and casualty management and treatment.
An engineering approach is actually used here. Know the basics, and why they are there, and then adapt and improvise that knowledge on the fly. Don’t assume, check, and work as a dynamic team to get results. Know when your efforts are being wasted, and move to where they are needed. Really good stuff.
Communications between hospitals and doctors is absolutely shocking, how one department cannot access other departments’ information in this day and age is beyond me.
One area that needs to be urgently addressed is that of Procurement and Purchasing. This should be run on more “engineering” principles. I have seen first hand over the last 6 months the amount of wasted funds applied in this area. Across all areas, from buildings and equipment through to the supply of drugs and consumables, no-one seems to be able to accurately assess value for money or fitness for purpose. The p&p departments do not seem to be able to understand the costs of manufacture of the goods and services to be supplied. Engineers generally have a good idea of the cost of production of the goods and services within their industries and get suitable value. From personal experience, it appears that contracts for supply, take no account of cost of manufacture and distribution. The whole system of procurement and purchase within the NHS, should be dismantled and specialist advisors appointed to evaluate and negotiate the purchases. Advisors with appropriate proven experience to apply their knowledge to the purchases, not simply order clerks tasked with “keeping the shelves full”. The advisors should be drawn from suitable industries, not just from the NHS or the Civil Service.
The advantage an external engineer has is that they are not blinkered by status quo.
Some years ago at the time of the introduction of a step change in hospital equipment, an in house medical physics staff member expected the supplier (me) to hand over all circuit and design information so that they could maintain it all and also expressed surprise that and warranty costs were of course built into the sales costing. Somehow they expected a “crock of gold at the end of the rainbow” to exist as a infinite supply of finance to cover such costs. Did not seem to understand that in any supplier/purchaser situation, the only source of finance to a supplier was via the purchases themselves. I have noted over the years that the same NHS trust has had many other “problems”.