Chris Watts Principal Aseptic Technician Guys and St Thomas NHS Foundation Trust

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1 Chris Watts Principal Aseptic Technician Guys and St Thomas NHS Foundation Trust

2 Aseptic services have evolved massively in a short period of time 1968 Medicines act Had huge impact on the preparation of medicines Breckenbridge report Stated that all I.V. medicines should be prepared in a central location Kennedy Report 2001 Stated that patients can expect to be treated by staff with the relevant experience and up to date training

3 Loss of crown Immunity in 1991 by NHS hospitals Removed the NHS belief that they didn t need a manufacturing license to make medicines Farewell report Pulled NHS unlicensed aseptic into line with industry Regular audits following set guidelines All of the above legislation has changed the way that Aseptic services have developed

4 When I started working in pharmacy we had our isolator in the back of the dispensary Background environment wasn t considered key issue In the mid to late 90 s legislation demanded that isolators be sited within graded rooms This hospital now doesn t have an aseptic services due to the high cost of running their graded rooms Rooms now converted for other uses

5 EL Audits The introduction of EL audits from 1997 started the process of driving up standards and forced departments and hospitals to asses the risk of their services and premises Standards driven up to meet that expected of industry Essence of the audit is to improve patient safety Standard of audits have become tighter and as such driven up expectations for auditors and patients

6 Aseptic services within the NHS are in serious decline Why? Cost NHS Hospitals facing financial difficulties Aseptics are an easy targets to cut costs Staff Quality staff getting harder to find Employment of band 3 posts Supposed Production Technicians Lack of interest in Tech services everyone wants to do clinical Lack of support nationally for aseptic services

7 Changes to legislation High standards expected = higher costs Introduction of sporocidal step to disinfection Introduction of gassing to aseptic disinfection Modernisation of NHS manufacturing services Trusts have cut their manufacturing and aseptic services Money is being diverted to other areas Once it s gone it s hard to get back

8 The rise of the special manufacturing aseptic services This could be seen as the greatest threat to NHS aseptic services Trusts are seeing the out sourced product as a true alternative to in house units Once services are out sourced financial restraints will see keep them out

9 Skills are being lost The NHS has to look at how we hold on to the highly skilled specialist techs that are still around The role of the aseptic tech is being eroded with the reliance on the senior assistants and the use of cheap labour from disposed employees from Specials companies or large NHS manufacturing units Senior management roles can be fulfilled by experienced techs Staff progression through to senior roles has to be seen to help recruitment of staff

10 De-skilling of staff Staff who will undertake occasional preparation can they be considered competent? The role of the aseptic tech will become obsolete in the near future I seriously believe that we could be the last generation of aseptic techs within the NHS if the current rate of out sourcing continues

11 Services offered today Parenteral Nutrition CIVAS services Oncology Gene therapy Home care services

12 With the out sourcing that is available should we just give in and except the inevitable? Trusts will save money by closing units Staff can be moved to fill other pharmacy gaps NO!!!!! As aseptic units we need to get smart and sell ourselves as well as the out sourcing units

13 How can we compete if prices are difficult to match with Units to get smart and use their procurement departments to source direct from their suppliers and negotiate better prices We need to start to look at our consumables As a department we always buy from the NHS store This isn't always the cheapest option We are encouraged to shop around for insurance/energy suppliers then why not our consumables and raw materials

14 Use the expertise of their staff to sell a better service Staff do come at cost but managers need to sell their staffs special skills and attributes to keep their services alive Be smart and look to buy helpful equipment and products For example we have been using for the last bespoke syringe pack for adult PN. Although there is a small increase price between the new packs and the individual components we were using before we have saved up to 2 hours a day of time for making and spraying in.

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17 This time saving has allowed to increase our capacity with out the need to increase our staffing = cost saving = happy managers Not only has the use of these packs saved us time but has added a quality aspect to the product. As the new packs are sterile triple packed (just what the MHRA wanted!!) Join together with other aseptic units to increase buying power and buy in larger bulk to get better prices

18 Offer truly flexible services Work shift patterns to give Dr s the opportunity to change medications to suit their patient s ever changing needs True 7 day working to allow weekend adjustments The cost of out sourcing companies to offer weekend services would price them out of the market Make ourselves so important to the medicines service so that outsourcing becomes a scary alternative for managers/clinicians

19 As I see it the future for aseptic services really lies with the following changes The NHS units set themselves up as commercial units offering the same services as the special aseptic manufacturing units These can pull together the best of the best aseptic staff to produce super units

20 Look towards offering specialist homecare services Civas homecare products As hospitals look to discharge patients early supplies of antibiotics via a homecare service Take on more clinical trial work Become specialist centres for trials/work closer with trial companies to encourage the work to come to your hospital/unit