Annex D: Review of NHSScotland's Medical Equipment
Information has been gathered from each NHS Board and the national imaging and radiotherapy equipment groups to gain a more accurate understanding of the scope and value of medical equipment across NHSScotland. In addition to the global overview of the value of medical equipment, it also sought more detailed information on the following specific equipment types:
- Renal dialysis equipment.
- Cardiac defibrillators.
- Infusion devices.
- Endoscopic equipment.
- Imaging equipment.
- Radiotherapy equipment.
This presented an overall estimated replacement value for Medical Equipment of £932m, which is an increase of £92m from the equivalent 2014 reported figure i.e. excluding low value medical equipment for both years (this is due to difficulties for some Board's in distinguishing between the replacement value of each medical and non-medical item of equipment). The annual change in the replacement value of medical equipment is mainly due to monetary value increases, and more accurate cost information available this year on imaging and flexible endoscopes.
The relative value of each equipment type is shown in the following chart:
Replacement Value of Medical Equipment (£932m)
A breakdown per NHS Board of medical equipment replacement value (as reported in the above chart) is provided in the following table:
|All Other Medical Equipment|
|NHS Greater Glasgow||30.0||81.3||146.1|
|NHS Ayrshire & Arran||0||12.8||31.5|
|NHS Forth Valley||0||10.5||27.7|
|NHS Dumfries & G.||0||5.5||11.6|
|NHS Western Isles||0||1.9||3.6|
|National Services Scotland||0||7.8||12.4|
|Scottish Ambulance Service||0||8.0|
Medical Equipment replacement within each Health Board is planned either on a rolling annual basis (e.g. endoscopy equipment) or in bursts to ensure standardisation (e.g. replace all defibrillators over a maximum of 2 years to ensure all devices are of the same model to ensure staff competence). Lifetime is based on clinical and technical obsolescence; the latter is often based on lack of service support and availability of parts. It should be recognised that for medical equipment, safety is the first priority, and equipment is maintained to high standards in NHSScotland to ensure low risk of failure or accidents. This high level of maintenance can enable the equipment to be operated safely over extended lifecycles.
Investment in lifecycle replacement of medical equipment can vary considerably on an annual basis and "peaks" of investment are often observed in particular years when major, large equipment is replaced.
A brief summary of the scope, operational value and funding plans associated with these equipment types is described over the following pages:
Renal Dialysis Equipment
Renal dialysis units are lifesaving facilities for people with renal disorders, providing renal replacement therapy. Dialysis machines are critical to these patients' quality of life. Dialysis machines are used within acute hospitals and increasingly in patients' homes, enabling care in the community. Increasingly hospitals are striving to use technology to improve patient's quality of life and this has resulted in the introduction of night-time dialysis sessions within acute hospitals and home dialysis. The survey found approximately 944 dialysis machines across NHSScotland with a replacement value of circa £15m. These support nearly 230,000 patient sessions per year within dedicated Renal Dialysis Units, with circa 65 patients dialysed at home.
A defibrillator is a life-saving machine that gives the heart an electric shock to restore normal heart rhythms in some cases of heart attack. Its importance in saving people from sudden death due to heart attacks is evidence by their prevalence throughout the community in places such as shopping malls. There are 2,245 reported cardiac defibrillators based in hospital environments across NHSScotland, with quantity planning based on the time required to access a defibrillator in case of emergency. Health Boards manage a further 1600 community based defibrillators, including 540 defibrillators within the Scottish Ambulance Service. Overall, these account for an asset with replacement value of c.£20m. Procurements are managed to ensure defibrillator standardisation which is crucial to ensure staff familiarity. Defibrillators are expected to have a lifespan of 10 years which would require an average annual investment of approximately £2m p.a. to replace, though in practice each NHS Board will attempt to replace theirs over a shorter period of time.
An infusion device delivers fluids and medication in solution to the patient in a controlled way. They do so safely, consistently and accurately for a wide range of clinical purposes including general medication delivery typical directly into patient's veins. They provide anaesthesia, chemotherapy, powerful heart acting medication and pain relief, with some devices enabling patients to control their own medication delivery. Their portability enables them to be used in the community, with the widespread use of portable devices, powered by batteries, supporting care in the community, particularly for pain and symptom relief (e.g. nausea and vomiting) in palliative care. Individually the infusions devices cost between about £1k and £3k, but the cumulative value of over 20,000 devices is circa £37m.
An endoscope is an investigative and screening device used to examine the inside of the body and to diagnose various conditions. Broadly speaking, endoscopy comes in two forms, those for use through natural body openings such as mouth, nose or anus (e.g. colonoscopy screening) or those devices used for surgical procedures such as keyhole surgery. This survey examined the former. These enable minimal invasive procedures often allowing patients to be treated as outpatients. This survey examined the number of flexible endoscopes in use within Scotland, including those used for upper and lower (covering colonoscopy screening) gastrointestinal examinations. There are over 3,000 reported flexible endoscopes across NHSScotland with a replacement value of c. £85m. The expected useful lifespan of a flexible endoscope is 10 years, with lifespan dictated by the wear and tear associated with their normal use and their technical (withdrawal of manufacturer support) and clinical obsolescence (improved image quality and ease of use). The flexible endoscopes are used with light sources, video processors and monitors that represent an additional important financial and clinical asset not included in the £85m figure above. Nor is the surgical endoscopy equipment included. NHS Boards will need to carefully review and monitor the whole spectrum of their endoscopic equipment and its future investment requirements.
Imaging equipment plays a significant and important role in the provision of healthcare to patients within both the acute and primary care sectors. Diagnostic procedures increased between 2003/04 and 2006/07 by 38% (according to Audit Scotland), and this trend has continued with an increase of 37% between 2006/07 and 2009/10 in the number of patients having a CT, MRI or ultrasound test. In addition to diagnostic procedures, there is also an increasing number of interventional / therapeutic procedures carried out within imaging directorates. In many cases these have replaced major surgical procedures with minimally invasive procedures that have significantly reduced morbidity and length of hospital stay. The National Imaging Inventory has an estimated replacement value of c.£270m (excl. VAT but incl. turnkey). The annual maintenance charge is £11.7million across the inventory which is nearly 6% lower than the previous year.
The 5 Cancer Centres in Scotland have had a co-ordinated national equipment replacement programme in place since 1998, which has been instrumental in ensuring the efficient and timely replacement of radiotherapy equipment across NHSScotland. The continued delivery of cancer access targets is in part due to the timely replacement of ageing equipment. The timing of replacement of equipment reflects current national recommendations and the programme is managed and monitored by the National Cancer Clinical Services Group (Radiotherapy) with the equipment financed from a ring fenced Scottish Government allocation. The success of this programme in introducing leading edge technology to enable the best possible treatment for cancer patients; with equity of access across Scotland, is considered to be a best practice model for the management and procurement of medical equipment.
Email: Alan Morrison, Alan.Morrison@scot.gov