The world is for ever moving away from fixed infrastructures to wire-free solutions for passing data, and the more reliable these wire-free networks become, the more suitable they are for critical data communications. Take any typical working day, and — for most of us — crucial aspects of our daily lives are reliant on the data we receive over wire-free networks. Our mobile phones are the obvious link we have for most of the information we rely on — as we check the weather forecast, get alerts on transport delays, and get the news, messages from friends and family, work communications, and reports. All these are available to us before we even leave the house.
As we then leave our homes and venture onto public transport or drive to work, our links with the data sources we rely on don’t stop. Wire-free data connections tell us when the next bus will arrive, where there are traffic hold-ups, and even switch traffic lights to optimise traffic flow. At no point throughout any 24-hour period are we not benefiting from some form of wire-free data communication; even when we are fast asleep smart meters are sending data about our gas and electricity usage, our mobiles carry out automatic updates, and the list goes on.
If you ever watch any films or TV box sets which pre-date mobile phones, those of us of a certain age will be able to reminisce having to get up and go to the hallway to answer the phone, using an ‘A to Z’ to navigate and find addresses, and having a supply of 2 and 10p coins to use in public phone boxes. Some may consider that these were happier days, but they are now long gone, and today we are no longer tethered to a certain point where a cable happens to terminate.
Wire-free solutions’ increasing use in healthcare settings
In hospitals and surgeries, the use of pagers is now seen by many as old and outdated, yet this robust wire-free technology has stood the test of time, and some resist its demise. Pagers might be the most obvious use of critical wire-free communication in healthcare settings, and in many NHS Trusts it is this technology that is in the cross-hairs to be replaced. However, there are many more data and communication solutions in everyday use throughout the NHS.
The most obvious solution that is now in everyday use in hospitals is the mobile device — be it a phone or a tablet. Data providing information about a patient’s medication, symptoms, and medical history can all be accessed at the time of need — be this during initial patient consultations, during the treatment planning process, or indeed during treatment itself.
An arguably less noticeable use of wire-free communication is on the ward, where portable monitoring devices send patient vital signs in the form of data direct to a central hosting system, which means that at any time, any authorised clinician can review, manage, and act upon, the information logged.
One of the immediate benefits of wire-free technology is to free up nursing staff, so no longer are they undertaking and logging medical tests and vital signs, but instead they are able to focus on those with a greater need, prioritising the important and urgent tasks, and leaving technology to look after the mundane and repetitive monitoring. By their nature hospitals are huge consumers of just about everything — from electricity, heating fuel, water, and clinical consumables, to food, transport, and furniture; in fact you name it, and a hospital likely uses it. More and more solutions are available to manage and monitor the logistical efforts required, and more and more of these solutions rely upon wire-free data networks.
Typically, NHS IT departments within a Trust will manage a private Wi-Fi network, allowing data to pass over it from approved devices. Providing that this network covers 100% of the site, and has resilience, security, and back-ups built in, the majority of solutions will perform perfectly well. Of course, any solution will need IT department sign-off, and processes and procedures will need to be in place before any solution can simply hook up to an NHS IT Wi-Fi network.
Some solutions will of course not be dependent on the Trust-wide IT network; instead these might use Bluetooth, NFC (near field communication), 4/5G mobile data, or RF (radio frequency); all have their place depending upon the service required. Most importantly, all need to be fit for purpose, preferably have recognised accreditation, and be certified for the purpose that they are being used for.
As already mentioned, we use wire-free devices throughout our daily work and leisure time, and the device we rely most heavily on is totally devoid of any service-level agreement. Check for yourself — read the 30-page terms and conditions that Apple or Google ask you to agree to, and you will not find any legal redress if for some reason you are compromised due to a failure in an ‘app’ or the mobile device’s operating system. Similarly, your mobile network operator that provides you with your 4 and 5G data communication has little to offer you in compensation for any consequential losses due to network outages. We’re not talking about offering you a small sum for the inconvenience due to the actual loss of service; rather it’s the consequential loss you might suffer that no network corporation will compensate you for.
Such a scenario becomes ever more serious when our health, or even our life, might depend upon a solution being able to communicate for the manufacturer’s claimed 99.999% of the time. For this reason, there are documented standards available to enable solution manufacturers to design and build their solution to be reliable. Some of these ‘standards’ are recommendations specific to the NHS, some relate to wire-free networks in general, and most can be used in order to attain certification that a product meets the standard, and is fit for the purpose it is being specified for.
Not mandatory
The unfortunate thing is that many well-intentioned and extremely important standards are not mandatory, or the recommendations are just that — a recommendation to go and find the relevant standard and make sure that any solution procured can perform to it. How, therefore, can those charged with the decision-making process within an NHS Trust be certain that a product can do what it says it can, and will be operating to a minimum standard of performance?
NHS Health Technical Memoranda (HTMs) give comprehensive advice and guidance on the design, installation, and operation, of specialised building and engineering technology used in the delivery of healthcare.
The focus of Health Technical Memorandum guidance remains on healthcare-specific elements of standards, policies, and up-to-date established best practice. The various HTM documents are applicable to new and existing sites, and are for use at various stages during the whole building lifecycle.
Healthcare providers of course have a duty of care to ensure that appropriate governance arrangements are in place, and are managed effectively. The Health Technical Memorandum series provides best practice engineering standards and policy to enable management of this duty of care. HTMs therefore put the responsibility onto the Trust’s management personnel to ensure that any technology procured is not only fit for purpose, but that it also meets the required standards relevant to the technology, Thus simply adding the words ‘must comply with HTM xxx’ in a specification or procurement documentation is not the end of the story. Manufacturers and suppliers of technology must firstly declare that their solution meets the relevant HTM recommendations, and then prove how this is achieved.
If we look more closely at Health Technical Memorandum 08-03: Bedhead services, for example, it was written in 2013 with representation from the NHS, building and facility management organisations, and technology providers, using traditional communication methods typical of that decade. We immediately identify then that a set of recommendations written over 10 years ago is going to be very outdated, especially when considering the speed of innovation in healthcare and communications technology.
That having been said, HTM 08-03 is the obvious reference document when specifying bedhead technology, and therefore the ‘go-to’ reference when procuring new services. While HTM 08-03 hasn’t changed in 10 years, the applicable technology and recognised standards have. I make reference to the following paragraph in the document:
Statutory requirements and functional guidance
3.6 It is the responsibility of management to ensure that their premises and bedhead services are safe, fit for purpose, and comply with all statutes, relevant codes of practice and standards.
3.7 Management has an overriding general duty of care under the Health and Safety at Work etc Act 1974.
3.8 Materials, components and completed installations should conform as applicable with the current Standards, including all amendments. Construction products should comply with European Standards and Technical Specifications (ESTS). Wherever reference is made to a British Standard, a corresponding ESTS (generally ISO series) should be equally acceptable.
Not time-bound
Clearly the statutory requirements are not time-bound, and must comply with current standards. For some manufacturers of technology, simply building a solution that meets the functional requirements of HTM 08-03 and declaring this in their marketing literature appears to them to be sufficient, and indeed for some NHS Trusts this might be enough to tick the ‘HTM 08-03 compliant’ box without further proof or checks.
The more prudent procurement management professional, however, will seek evidence of compliance, because as it clearly states in HTM 08-03 Section 3.8, ‘Materials, components and completed installations should conform as applicable with the current Standards, including all amendments. Construction products should comply with European Standards and Technical Specifications (ESTS). Wherever reference is made to a British Standard, a corresponding ESTS (generally ISO series) should be equally acceptable. Suppliers and manufacturers must be able to clearly demonstrate compliance; this in the form of a relevant Standard or Standards, supplemented by certification that the product/solution has been independently tested against the Standard(s) and passed all relevant tests’.
Testing solutions using wire-free communication services is not as straightforward as it sounds. Radio interference can happen with substandard design and components whereby the solution can give false messages, can fail to communicate, or can cause other wire-free solutions to fail. Only by designing in resilience and resistance to interference, and then having the solutions tested to the most rigorous of standards, leading to documented certificated approval, can NHS managers satisfy their statutory obligation and duty of care to their patients, colleagues, and Trust Board.
There is a cost associated with building in resilience, and then having a third-party test house test your solution to destruction, and this adds to the solution’s cost. As is always the case, what appears on the face of things to be a bargain, may well be a very costly mistake when it fails, cannot be supported, or causes catastrophic problems with adjacent technology.
Conclusions
The old adage is that there are some things we can change, but equally some that are outside our control and cannot change. We cannot change HTM 08-03 overnight. The guidance in it is over 10 years’ old; just think back to 2013, and about how you connected to the Internet or the mobile phone you had. This is how quickly technology moves, leaving the well-intentioned HTM well behind.
While finding the relevant standard appropriate to a product, solution, or service, is the responsibility of the service-provider, the NHS Trust customer’s management must be satisfied that this has been undertaken correctly, and that all certification is attributed to the service being offered and is current. For example, radio communications to be used in ‘life critical’ situations (hospitals) should be certified to a relevant Standard such as ETSI EN 300 220-1 v3.1.1 (2017), and be certified to Category 1 of the Standard. Page 17 of this standard clearly states that where Short Range Devices may have inherent safety of human life implications, only Cat 1 level receivers should be deployed. If in doubt NHS management teams should always ask for proof from solution-suppliers or manufacturers, and reject any solutions where this cannot be readily provided.
We can take comfort in the fact that wire-free technology in healthcare is now the norm. More and more NHS Trusts are realising that with the right wire-free solutions — designed to meet HTM 08-03, certified to relevant Standards, and that do everything they are designed to do — huge savings in installation and commissioning costs can be achieved. Hardware can be installed without needing to vacate wards, without the need to install new or disturb existing bedhead trunking, and the solution can be moved and / or adapted over its lifetime without any upheaval.
Dave Hewitt
Following a long and successful career in the electronic fire and security industry, Dave Hewitt has been the Sales & Marketing director at Courtney Thorne for the last six years. His management of the company’s diverse commercial team, together with the introduction of new solutions designed specifically for the hospital environment, have led to year-on-year growth
Courtney Thorne said: “The fire and security market is heavily regulated to comply with relevant standards, Fire, Police, and Insurers’ requirements, and it is against this backdrop that Dave Hewitt has helped drive the development of our Connect Health Nurse Call solution. This means that it not only complies with relevant standards for the NHS, but has also passed third-party testing. Connect Health gives Estates and Procurement managers documented reassurance that their decisions to use Courtney Thorne’s nurse call and staff attack solutions will be the right ones.”
Further reading
1 Health Technical Memorandum 08-03: Bedhead services. Department of Health, 2013. https://www.england.nhs.uk/wp-content/uploads/2021/05/HTM_08-03.pdf
ETSI EN 300 220-1 EN Standard for Short Range Devices (SRD) operating in the frequency range 25 MHz to 1 000 MHz; Part 1: Technical characteristics and methods of measurement. European Telecommunications Standards Institute, 2017. http://tinyurl.com/2aufzx56