In the past two years, many manufacturing companies have reported difficulties obtaining key components due to a worldwide production slowdown during the COVID-19 pandemic, followed by surging demand. They have also faced a volatile energy market and rising utility costs, exacerbated by the war in the Ukraine, and challenges in recruiting staff. HEJ’s editor, Jonathan Baillie, spoke to Executive Chairman at Leeds-headquartered medical technology specialist, Brandon Medical, Graeme Hall, and the company’s Chief Technical Officer, Nigel Davill, to find out how the business has adapted.
Brandon Medical designs and manufactures ‘world-leading technology solutions’ for operating theatres, critical care areas, and primary care institutions. It prides itself on the quality of its engineering, on innovation – with considerable investment in R&D, and much of its hardware and software designed ‘in house’ – and on its incorporation of ‘cutting edge’ technology into products ranging from theatre lights to medical AV systems. With a global customer base, it is ‘an acknowledged expert’ in medical lighting, medical power and control systems, and medical AV systems. The company also claims ‘unique expertise’ in providing integrated solutions. This is an especially valuable asset today given that many hospitals now wish to integrate a range of increasingly sophisticated medical devices using digital technology, so that not only will they operate seamlessly together in a theatre or other clinical environment, but will also connect wirelessly to equipment in other locations – for instance to allow streaming of live or recorded footage of surgery to another hospital site for training or knowledgesharing within the surgical community.
The integration factor
‘Integration’ is indeed a byword for the Yorkshire-headquartered technology specialist; it not only integrates various clinically driven innovations, but also provides open architecture solutions. These enable an operating theatre to be ‘connected’ to a hospital’s building management system, which provides a range of benefits – including the fact that the close monitoring and control thus enabled can support energy savings and a healthcare user’s Net Zero drive, while the data collected during surgery can provide valuable post-surgical insights – the company cites an aeroplane’s ‘black box’, and the data it provides post-flight, as an analogy. Equally, as Brandon puts it, ‘the ability to closely monitor the performance and utilisation of the capital equipment in an operating theatre means we can truly start to talk about the hospital of the future’.
Innovative theatre control panel
Later in a wide-ranging recent ‘Teams’ discussion with Graeme Hall and Nigel Davill – and very much along the aforementioned lines – we discussed the company’s development of an ‘intelligent’ theatre control panel, the Medicontrol iTCP, which won a 2022 Queen’s Award for Enterprise: Innovation, the Building Better Healthcare 2022 Award for Best Interior Building Product last November, and was also Highly Commended in the Best Carbon Reduction Initiative category in the same competition. Launched in 2019, the iTCP enables theatre equipment to be integrated with a hospital’s BMS system using protocols such as BACnet and Modbus – already integral to many such systems’ operation. While the iTCP hardware incorporates BACnet and other BMS protocol capabilities, Brandon says many competitor theatres panels do not, meaning that until now, many operating theatre components have not been directly accessible via a ‘traditional’ BMS.
Developed using BMS protocols
Brandon’s National Specifications manager, Richard McAuley, explains – in a video introducing the product – that the Medicontrol Intelligent Theatre Control Panel, or ‘iTCP’, was specifically developed around an industry standard control and command platform that uses BACnet. This enables it to ‘act as the bridge’ between specialist medical systems and traditional building management systems.
Developing innovatively engineered products is clearly one of the key ways that Brandon Medical maintains its competitive edge. However, like any manufacturer, it relies on the availability of parts to manufacture its products, fulfil orders promptly, and keep its customers happy. One of the reasons I had been keen to talk to Graeme Hall and Nigel Davill was to see how the business has addressed a global shortage of some components, and the steps it has taken to maintain its supply chain’s resilience.
Graeme Hall said: “Brexit has been a major disruption, we’ve had COVID, and now we have China switching lockdowns on and off. There is also the war in Ukraine, an energy crisis, and a situation where very few organisations can get the staff they need. It has also proven quite difficult to obtain some parts and materials in the last 2-3 years. Fortunately,” he added, “we’ve managed to address these challenges remarkably well – one of the reasons being that we made a lot of timely preparations in the run-up to Brexit.
Having foreseen early the potential impact on supply chains and costs, Graeme Hall explained that Brandon had secured agreement for stocks of strategic components, and undertaken work to ‘shorten and condense’ its supply chain, particularly for key, widely used items such as pendant arms, castings, spring balances, and mouldings. He elaborated: “We stocked up on difficult-to-get items, and, as far as possible, brought our supply base closer to home. So, today, for example, around 80% of the parts for our operating lights now come from within the Leeds area. Previously we obtained more of these components from overseas. Today, we are mostly using UK suppliers, and, where components aren’t available here, suppliers in nearby countries – predominantly Switzerland and Germany.”
Not an easy task
I wondered how easy it had been to find more local suppliers for critical parts. “Not that easy,” Graeme Hall replied, “but if we can’t find a local supplier, we’ll try to design and manufacture the component ourselves.” I wondered how much of an impact the widely reported difficulties in recruiting staff had had on the business. Nigel Davill said: “Recruiting good engineers has always been a challenge, but one of the things we have done recently, which has had an obvious impact on our productivity, is to install ‘smart’ assembly cells in our factory, which basically automate the assembly process, making it extremely efficient, and simultaneously help us manage our Medical Device Regulation obligations”. Nigel Davill explained that Brandon had initiated this work as soon as it realised the potential future impact on its workforce of a shortage of skilled people from a sizeable European labour pool post-Brexit.
Graeme Hall said: “So, what we did was to design all the knowledge into our production process, beginning with a visit to the smart assembly cells built for Airbus at the Advanced Manufacturing Research Centre, where they were building aeroplane wings using them. We didn’t, in the end, take up their system, but the learnings were useful when we decided to design our own smart cells, via a Knowledge Transfer Partnership with the University of Huddersfield. This gave us access to the considerable expertise of academics and engineers at the university.”
Computer-aided assembly
Graeme Hall explained that the smart assembly cells – Brandon currently has four, but plans installing more – are based on a computer-aided assembly process, which guides the operative through every step: ‘the components you need for each part, each step of the process, the tools required, and detailed instructions, via video in some cases’. He elaborated: “Cameras also monitor every step to survey production quality, recording which operative has done what. A combination of cameras and sensors can literally identify every item down to a single screw, and even how many turns it undergoes, and ensure the correct torque settings. We designed most of the equipment in conjunction with engineers at the University of Huddersfield, apart from the software. We had a Knowledge Transfer Partnership lead jointly employed by the University and Brandon, Mark Firth, on site here, throughout much of the development process.”
Installing the ‘intelligent’ assembly cells’ has had a significant impact on staffing, Nigel Davill explained that their deployment has considerably speeded up Brandon’s assembly process. He added: “One of the immediately noticeable things the cells do is eliminate a lot of the clerical bureaucracy – by recording everything automatically. This massively increases the accuracy of our production data, and means operatives don’t need to be so expert in each process, and can more easily move between machines. To date we have used the cells on parts such as surgical lights, pendant arms, and equipotential bonding components, but we will certainly extend their use. The smart cells can be used to manufacture some products from start to finish.
Training ‘built in’
I asked if their installation had necessitated additional training. “Quite the opposite,” Graeme Hall told me. “The training is built into the process. In combination,” he continued, “installing the four smart assembly cells, and condensing our supply chain, has given us a major competitive edge. Some of our competitors have been quoting 24 weeks to deliver operating theatre lights, whereas we can often deliver them in a week.” Explaining that previously Brandon had typically offered delivery within 4-5 weeks, he added: “Many of our competitors are still having to source their parts from Asia, and if you’re building a new hospital, and discover that your theatre components may take six months to arrive, it’s hardly ideal.”
In anticipation of Brexit, and as some parts became more difficult to obtain, Brandon Medical also increased the density of storage inside its main building, fitting additional high-bay racking. Nigel Davill said: “It’s not just on new parts where we have an edge, but also spares. We can deliver many of our spares the same day, whereas if you are dealing with a parts supplier in mainland Europe, it can take three weeks just to get a stock item here, including getting it through Customs.”
Significant investment
Graeme Hall would not be drawn on the size of Brandon’s spend on streamlining its production through its use of smart assembly systems, and shortening its lead times, but admitted it had been ‘significant’. Returning to the wider issue of recruitment challenges, he said: “There is definitely a shortage of skilled people – due to the perfect storm of Brexit and COVID, and an ageing UK workforce. We’ve significantly reduced the number of people coming into the country for work, particularly from the EU, while since COVID, more people are deciding to retire early. We are firm believers in apprenticeships; we currently have three mechanical engineering apprentices here, all working in manufacturing, and are now seeking a commercial apprentice
Carbon reduction efforts
Here Nigel Davill switched the focus a little, although returning to an earlier theme. He said: “The resilience of our supply chain has been key over the past 2-3 years, but the other side of the coin has been an increased focus on sustainability and carbon reduction. Obviously, one thing helps the other – i.e. shortening our supply chain has been good for our sustainability.” Brandon had also, he explained, been working on systematically working through where its main energy usage hotspots were, and how it could address them, as well as reducing embedded carbon in its manufacturing. Graeme Hall explained: “We’re currently preparing a comprehensive ‘Green Plan’ for Net Zero, and have signed up to some of the main Net Zero carbon schemes, including the Betterworld Solutions initiative (whose purpose is to encourage companies to adopt, publish, and operate an Investment Policy to Prevent Global Warming), and a construction industry scheme called Pledge to Net Zero.”
Procrastinate, or do what you can now?
As Graeme Hall sees it, there are currently two main potential approaches to the Net Zero Challenge. He elaborated: “You can either procrastinate, and do nothing, while trying to come up with perfect solutions, or – as we are doing – you can look hard at what you can do now, in terms of reducing the carbon footprint of your facilities, buildings, and transport. Product-wise,” he continued, “your existing products already have the carbon designed into them, but with any new ones, you can focus on reducing the embedded carbon.” Brandon is thus now ‘benchmarking’ the carbon in all its new products, and using special software to identify how it can cut the amount of embedded carbon incorporated – for example by using materials that can be recycled using low energy. It has also been investigating the potential to establish smart assembly overseas, ‘in key market locations close to where you want the product’. This is, however, ‘only at the planning stage’.
New considerations
Graeme Hall said: “In the past, when selecting the materials for a new product, you typically looked mainly at properties such as strength, robustness, flexibility, and antimicrobial characteristics, but carbon wasn’t ever much considered. Now, however, we are always looking at reducing carbon first, although balanced against this is the fact that for products used in medical settings, characteristics such as robustness, strength, and cleanability, are key. The primary role of a medical device is – after all – to do its job properly and safely. While I think UK industry has quite a good grasp on the actions required to reduce our Scope 1 and 2 emissions,” he continued, “it’s the Scope 3 emissions (defined under the Greenhouse Gas Protocol as ‘the result of activities from assets not owned or controlled by the reporting organisation, but that the organisation indirectly impacts in its value chain’) that are the bigger challenge.”
Reducing its EPC rating
Alongside seeking to streamline and reduce the carbon impact of its manufacturing activities, Brandon had already brought its main building’s EPC rating up from G to B. Graeme Hall explained: “We have done this systematically and progressively over the past 10 years – for instance via thermal insulation, eliminating draughts, and automation of building controls. We have sensors all over the building, actuators to turn the heating and lighting on and off, and to open vents. We also use daylight harvesting, where sensors measure the ambient light from the sun, and then will not turn the lights on if the existing light level is sufficient. Although we currently still rely on a carbon-based heating system, we operate extremely efficient gas boilers. We’ve also got four electric vehicle chargers. We haven’t yet invested in electric commercial delivery vans, because most of our deliveries are longrange, and currently such vehicles don’t tend to have this capability. While for a commercial business, formulating a Green Plan is not mandatory, we saw what NHS hospitals were doing, and it encouraged us to do likewise, so that we can play our part in the NHS’s carbon reduction drive.”
Reducing building services-related energy consumption
Nigel Davill said: “A lot of the work in existing hospitals will be about reducing building services-related energy consumption, while new-builds will have to meet increasingly stringent energy standards. One of the key features of the iTCP is its ability to link surgical equipment like ventilation, lighting, and AV systems, to a hospital’s building management system. This gives healthcare engineers the ability to see how efficiently the various theatre systems are running, and adjust as required – for example to ensure that equipment is not needlessly left running when a theatre is vacant.”
In the introduction to a Brandon Medical video explaining the iTCP’s key features, National Specifications Manager, Richard McAuley, stresses that modern BMS systems have the ability to monitor, analyse, and interrogate, almost all the characteristics and parameters of the standard built environment – from lighting power consumption, to HVAC efficiency and local air quality. He explains: “The resulting data is then used to measure and calculate climatespecific data sets such as CO2e levels, power consumption, and efficiency of the space. In an operating theatre, once data is available on – for instance – how often and when the theatre is in use, and how efficiently the various medical devices are operating, clinical staff may be able to re-think scheduling of operations, and how particular equipment is used, improving surgical efficiency and flow. Healthcare engineers, meanwhile, can identify where plant is not being optimally used, and opportunities for using it more efficiently, in the process reducing energy consumption, and helping lower their hospital’s carbon footprint.”
One significant barrier to date to obtaining comprehensive data on aspects such as the energy consumption of particular theatre equipment, Brandon explains, has been that while a typical OR accommodates a number of specialist systems, many are not directly accessible via a ‘traditional’ BMS.
Specialist user interface
Brandon Medical’s Medicontrol Intelligent Theatre Control Panel (or iTCP for short) was designed to address this. The specialist user interface for operating theatre use provides both control and alarm information to clinical staff. Harnessing an industry standard control and command platform that uses the BACnet protocol, it acts as a local control, monitoring, and alarm annunciator panel, by interfacing directly with the operating theatre systems – data from which is collected, analysed, and processed, within the iTCP for local display, decision making, and remote monitoring. The iTCP thus provides ‘the gateway’ between surgical systems and industry standard BMS platforms, allowing monitoring of power consumption, run time, alarm status, airflow, filter flow, lighting levels, room occupancy, and many other data parameters from within the OR. Brandon explains: “BACnet, which stands for Building Automation and Control Network, uses standard network infrastructure – what we commonly term LAN, or simply network points. This allows it to be connected to the BMS using the standard network facilities present in any modern building, greatly simplifying deployment.”
Beyond a standard BMS’s capabilities
Brandon Medical explains that this ‘interconnect’ between, say, an acute hospital’s medical systems, and its central building management system, ‘opens up opportunities for additional features generally beyond the capabilities of a standard BMS’ – for example power cycling and battery management of medical UPS and battery back-up systems. The iTCP can detect when an operating theatre is not active, and use this time to perform routine checks and preventative maintenance.
“In a fully integrated system,” Brandon explains, “the iTCP is connected to both the theatre surgical lighting and the dedicated battery back-up system. During theatre downtime, the iTCP can disconnect the battery system from the mains supply, and activate the theatre light at full intensity. The subsequent current drain and battery levels can be plotted over time to establish the efficiency and state of the battery cells. This information can then be submitted to the BMS, and integrated into the preventative maintenance schedule.
Engineers pre-warned
“If the battery system is performing within specification, the general servicing will not require any replacement cells, but if the system is outside specification, the visiting engineer can be pre-warned that replacement cells are required, reducing the need for a secondary visit.”
Brandon cites ‘many examples where the ability of the iTCP to connect with the BMS in a safe and isolated manner can be used to enhance the efficiency of the hospital estate as a whole’. It adds: “Inclusion of an intelligent theatre control panel within an OR project provides a bridge for data gathering and activity reporting between the medical systems and the wider estate BMS systems. This integration can form an integral part of the wider decarbonisation of healthcare delivery as we work towards fully ‘climate smart’ healthcare.”
Capabilities enhanced and refined
The Medicontrol iTCP was launched in 2019, but Brandon Medical has been adding new features ever since. Graeme Hall said: “First and foremost, we have striven to build into it the flexibility to cater for changes in equipment specification over time. For example, when plans for a new hospital are drawn up, the equipment to be incorporated in its theatres, and that equipment’s configuration, may well not have been decided upon. The iTCP is thus designed in such a way that we can build in whatever controls a hospital or its surgeons require over time via configuration of the software. This means that mechanical engineers can design the hospital based on the surgical needs identified during the project. In turn, if the configuration of a particular theatre, or the equipment within it, changes significantly over, say, a 4-5-year period, the iTCP can still cater for it. Say, for example, that the theatre is initially designed with two lighting circuits, but the surgeons later decide they require three. Here we would simply re-programme the device and incorporate an extra control. We can also tailor the iTCP to operate with any manufacturer’s equipment.”
Two GUIs
Nigel Davill added: “Equally, because iTCP uses BMS hardware, an Estates and Facilities engineer will easily get to grips with operating it. The panel, which has considerable ‘intelligence’ built in, has two graphical use interfaces – one designed for use by surgeons and other clinical personnel, and the other for engineering / estates personnel. Built in are numerous configurable pages.”
Many hospitals, of course, now require audio and visual equipment integrated into their theatres. “Again, however,” said Graeme Hall, “the early ‘spec’ may simply refer to a requirement for medical AV system integration. In this scenario, the ideal is to be able to cater for any future medical audio / video system so that, once installed, it can ‘communicate’ with all internal and external sources as required, and transfer all the data and take all the picture sources and display units to connect them all together through a control.”
Pre-configured video network
To enable this, Brandon Medical offers a pre-engineered, pre-configured, video network that will fit any operating theatre, and can be controlled by a video controller like the company’s Entoli system, or, alternatively, by the iTCP. Graeme Hall said: “The operating theatre’s walls, ceilings, floors, and finish, can thus all be completed, with all the required node points and fibre optic connections put in place ready for the engineers to connect up to the medical AV system at the appropriate juncture. As with the iTCP,” he told me, “it is all about anticipating what the healthcare sector might need not just today, but in 5-10 years’ time, as hospitals become ever ‘smarter’, and using our engineering expertise to deliver the required functionality in as seamless, flexible, and powerful, a way as we can.