 Good afternoon everybody. So this is William Santos from ABI Electronics here in Sunday Bansley in Morkshire. First of all, thanks very much for joining us in this webinar co-hosted by two and some may say unlikely allies, the Restart Project. The Restart Project is a London-based charity that promotes repair skills in communities and we, ABI Electronics, as I mentioned, we are a Yorkshire-based company that manufactures, designs and manufactures a balanced, diagnostic and component-level repair equipment for industries like defence, biomedical, transport, aerospace, manufacturing and so on. A few things bring us together today and one of them, or two of them potentially, being the underlying belief that our society and economy need to value maintenance and repair and for the economical and environmental benefits that they bring and an urgent concern for what the next weeks and months will bring us during this pandemic in this country. So this is just me just giving a quick introduction on myself and ABI. I'd like to ask Ugo to introduce Restart, please. Hi, I'm Ugo Valauri from the Restart Project. Here in the UK we've heard so much over the last few weeks about the need to manufacture new ventilators, but we'd like to hear more discussion also about how can we maintain and service all COVID-19 related medical equipment given that it will be put under unprecedented use in the coming weeks and months. Even the new ventilators and the CPAP machines continues positive airway pressure for those not even known that are being manufactured right now by new manufacturers like Dyson and Mercedes Formula One, they all will need to be repaired and maintained in the long run. In the spirit of learning and exchange, we'd like to explore one big question today. Are we prepared to repair equipment to save lives during this pandemic? Seen from outside the medical and biomedical field, but based on both negative and positive experience we bring from other sectors, we genuinely wonder perhaps we hope today we will put many of our doubts and worries to rest. So to get started, this is the format we will adopt and hope it's familiar for those of you joining webinars. We will ask each of our panelists to speak for five minutes and then we will have a Q&A in the last 20-25 minutes. We are very grateful for two of our speakers who come from the medical sector and have taken time out to share their experience more widely today. Dr. John Sandham from the EBME and Dr. Helen Mies from the Care Machine. We'll hear from them first and ground the conversation as best as we can. And then we'll hear from William again from ABI Electronics and hear what transferable experience from other sectors might help in a crisis situation. Then Olivia Web from iFixit will tell us all about their crisis mobilization to assemble as many official service manual as possible for medical equipment starting from the ventilators. And to wrap it up, Jim Kellock from the Open Rights Group will bring to light some of the legal barriers to repair and reuse of medical equipment. Before we get started, just a couple of housekeeping announcements. If you'd like to ask a question during the presentation, please do so using the chat. We'll ask presenters to respond at the end if the question is simple to answer or if not we will save it for the Q&A at the end. We'll give a little reminder to panelists on time just to make sure we can stick to the hour. Please know we are recording this webinar to share with a larger audience afterwards. And without further ado, let's introduce Dr. John Sandham first. John, the floor is yours. Don't know if John can hear us. John can hear us? Perhaps just someone. John is on mute at the moment. John, we can't hear you. So yeah, I've been working in the medical industry for 35 years. For the last 20 years, I've been the director or chairman. I've been chairman of the Ebony website for 20 years, a doctorate in medical disease management policy. So I've got a lot of experience. I also ran largest medical equipment in its company, TBSGP, six years. I think the biggest issue that we're facing at the moment is to airing medically. John, sorry to interrupt you John. Can you try to speak a bit closer to the microphone so that we can all hear you? Thank you. Yes, it's better now. Yes, thank you. So what I was saying is that there's an unprecedented number of devices that will be put into service in these new hospitals. For example, the Excel Center, the Notting Hill Hospital at the Excel, you're looking at 50,000 pieces of equipment. If you look across the whole of the United Kingdom and Northern Ireland, you could multiply that by four. So you could be looking at 200 pieces of equipment. In a general acute hospital, normally you would have one technician looking at potentially around 1,000. So where are these 400 extra engineers going to come from? They just don't exist. So what we have to do is look at alternative ways of maintaining and repairing equipment across the field hospitals and across the NHS hospital. There will be a lot of engineers that are going from JAS hospitals into these field hospitals. The way it's working at the moment is it's all commissioning. So this is also an upfront deluge of work for all of these field hospitals. And the commissioning work is, I would say, more important than considering the repairs. It's trying to commission over, let's say, 8 to 12 weeks 200,000 items of pedigree. So I think that sort of sets the scene. So I think with regard to carrying out the repairs, it doesn't necessarily have to be biomedical engineers that do this. Joe Helen would agree with me that there are other people who are capable of carrying out minor repairs and also on low risk equipment commissioning. Going on to your point, you go about sharing of service manuals and spare parts. I think that's also important. But I have seen some companies that are now sharing drawings and sharing service manuals. So I think there is a slight trend that I've seen in the market that sharing has happened. I think that's where I'll leave it for now because I know that everybody wants to say something. So I'll stop over to you. Okay. Thank you, John. Next up, we have Dr. Helen Mies as a funder, manager, director of the care machine. And we'll hear particularly from Helen about initiatives to bring together techs and engineers and supporters in key hospitals for maintenance and repair. Hi, everyone. Can you hear me okay? Yes, I think. Excellent. So I'm going to follow on from what John said and he's absolutely right that there are tens if not hundreds of thousands of pieces of equipment that are going into the hospitals over the next few weeks. And those pieces of equipment are going to need huge amounts of effort to maintain them. I've been very fortunate over the last week or so to be part of the clinical engineering team at Nightingale who have been trying to make sure that those engineers are available to make sure the equipment is serviced. And what I've been doing as an external person, I'm not a clinical engineer myself, but I am an engineer by profession, is work with many of our engineering institutions across the UK to recruit volunteers to support the clinical engineering community within the NHS because they are going to be flat out dealing not only with the equipment, but also working alongside their clinical counterparts with patients. And so they're going to need engineers to support them. So we've put together a team so far just covering London, Manchester and Birmingham. And I'm very, very happy to say that within the space of 24 hours of putting that call out, we have had 622 respondents to that voluntary scheme. So we've got a lot of engineers who have volunteered and these are people who are professionally trained and qualified and who will have the ability to help and support the servicing, the maintenance of these devices over the next few weeks. So that's really what I've been doing. And it really backs up what John has said in terms of just how much this technology will need to be supported and how many engineers we're going to need. Our next challenge is to focus on the rest of the country and hopefully in the next couple of days we'll be recruiting engineers to help at other field hospitals across the UK. Great. Thanks Helen. Next up is William, who is head of communication at ABI Electronics. All the way from Brazil, he's a 20 years experience of helping aerospace, rail transport, energy, biomedical and defense organization discover the benefits of repairing instead of replacing electronic circuit boards. Creator of the Repair Don't Waste Movement, William defends that teaming up with the like-minded people in business and industry creates job opportunity across the world and advances the understanding of how electronics work and what people should do when it does William, the floor is yours. Thank you, thanks Hugo and thanks everyone. So well here at ABI Electronics we design and manufacture electronic diagnostic equipment that makes PCB repairs not just possible but they can be carried out by technicians, engineers quite quickly. Okay and our systems are widely used by the MOD, by aerospace organizations, the manufacturing industry, biomedical including and so what we've been, what we have been working on for the last you know two to three weeks is defending what we call a triple approach to the crisis. Yes we need to build new ventilators but we also need to look into recommissioning old and repairing you know new and existing ventilators and other medical equipment throughout the crisis. We have the technology we are, we have reached out to several trusts, several engineers, biomedical engineers up and down the country. We've been trying to explain what our technology can do in this case. We have been, we are supporting ourselves as a business by offering our technology at heavily subsidized prices. We're offering free free of charge training as well but one big problem that we've been encountering is everywhere every biomedical engineer that I spoke to working for the NHS has said that yes you know our ABI technology is precisely what is needed at the moment because you can help a medical engineer to repair down to PCBN component level quite quickly as it happens in other industries, in other sectors. However their hands are tied by regulation and their hands are tied by liability regulations that basically stop them from doing so. So this is something that I would like to potentially discuss during this seminar and potentially hear from other participants. There are thoughts on that. We've been taking this matter up with the government and we will see what's going to happen in the next coming days. Okay back to you Hugo. Great and apologies for the slight glitch. Next I will pass it on to Olivia Webb from iFixit who's probably clinging to a cup of coffee right now all the way from California. We're very grateful for you to be able to join us at such an early time your side. iFixit is a company that sells repair tools and spare parts to people so that they can fix their stuff. But right now they're also helping to create the world's biggest archive of repair documentation and specifically to our interest right now on medical equipment service manuals as well. Olivia please tell us more. Thank you so yeah i come from iFixit we're an online repair manual and we have just been over the last 16 years creating repair documentation for normal consumer electronics like iPhones iPads MacBooks and we have been hearing for years from hospitals and technicians that the manufacturers of these medical devices are restricting their repair information they're making it very hard to access. So when we learned about what was happening with this virus and the things that people were coming up against most often we knew that ventilators would be really heavily used and that means that they were going to be breaking very often and that they would need to be fixed. So we started thinking about what would happen if a technician at a hospital got sick and couldn't prepare any of the devices in his hospital excuse me or if like you said there's only one technician in the hospital and they were overwhelmed or if they're volunteers and we don't want them to spend their time looking for manuals or trying to get access to the manuals they need to do these repairs their time is going to be very precious because they're going to be so overwhelmed. So we decided to compile all of the manuals to repair all of the ventilators that we could identify and we reached out to our community on our website and we've had a staggering number of volunteers reach out to us and help us find manuals help us identify the manuals that we need to compile the the machines that we need to find manuals for and the manufacturers that are being difficult and they're all uploaded on our site we're still looking for more and once we have them all we we've been organizing them on our site and we're going to start creating guides for them the way that our other guides look on our site so that anybody can get on to this resource and find the ventilator that they need to fix and just see exactly step by step what they need to do to fix the ventilator so that anybody technician or not can help repair these devices and once that's done we're going to translate those guides into a lot of languages with our army of volunteers so that anybody can fix them anywhere they are and then we're going to move on to other medical devices as well so we're not just focusing on ventilators but that's kind of an idea of what we're doing and how we're trying to help in this crisis thanks thanks a lot Olivia and some of the issues are probably familiar to Jim Killicks as well a company wanting to keep repair documentation closed private Jim is the director of the open rights group a UK based organization that contains on intellectual property rights which are used to keep repair documentation unlawful to copy and even make repairs unlawful to perform Jim hi there so yes uh so our concern generally is around free expression and privacy those are usually the reasons that we get involved in looking at intellectual property regimes and the consequences of them are obviously in this situation the consequences can be much much greater and so our understanding here really is around a set of technologies called digital rights management and the thing here is that you'll be familiar with the sort of restrictions on repair and accessing things like iPhones you'll know about kindles locking you into ebooks and things like that but digital rights management is spreading into many other sorts of areas of technology and that includes things like cars agricultural equipment like tractors and medical equipment and essentially what is happening is that the copyright law has restrictions on evading what they call technical protection mechanisms so technical protection mechanisms are there to stop people copying right as with your kindle or whatever to stop you from making unlicensed copies usually of copyright books and films and so on and but what has happened over the years is that the idea of software because software can be copyrighted the idea has been to embed software into devices and that could be any kind of medical equipment and it does I believe exist in in some sorts of medical equipment and the software is embedded there's copyright on that software restrictions are then placed technical restrictions are placed on accessing that software or altering it or replacing it with the result that the only person that can really access and control that there's lifespan of the machine is the vendor and this is often then locked in you know this is also can be locked into things like diagnostics information the software might be fundamental to reporting when the device is kind of needs repairs or is getting faulty that kind of thing or indeed patient diagnostics so all of those sorts of things might then go to cloud services and again the only way you can access that information and make all use of the equipment is through those cloud services so that is all backed up by law so copyright law says you can't interfere with this and if you are doing your breaking laws that makes it very difficult for people to even attempt to fix these things because disclosing information around fixing technologies that are restricted in that way is a criminal offence and can land you in jail so most famously unencryption methods for DVDs for instance somebody in Sweden I think it was one certainly Scandinavia worked out how to decrypt DVDs they published that information and they were basically threatened with long jail sentences should they ever try out travel to the USA they would face trial and probably end up in prison so you know the same situation would exist if DRM is applied to medical equipment somebody starts working out how to get around the DRM DRM and replace it they are breaking the law in most circumstances and they could face jail so you know in this circumstance the right thing to do is is for the companies to release information around how to remove that DRM should it be necessary or to simply remove the restrictions themselves so these could be important issues depending on the particular bit of equipment and and what kind of vendor you have and what sort of vendor they are whether they're responsible or not obviously because of the sheer necessity of repair and access to the full capabilities of machinery and equipment one would hope that people do act responsibly but you know it's very hard for for me to know exactly whether that is happening it's interesting to hear that even in the case of repair manuals companies are sometimes resistant and that doesn't bode well I guess they're looking to the problems that might flow from this in a few years if people have access to all this information you know will they lose certain benefits market share it'd be interesting to explore that problem and know more about whether these sorts of problems are very concrete appearingly they're concretely appearing in this arena I should say the other aspect of this is that often international treaties back up these restrictions which is even more annoying and complex to deal with because we we're in for a long fight actually to try to get some of these things dealt with new though there are a few exceptions around research and so on which which help thanks Jim very helpful so we got quite a range of perspectives going straight from medical equipment from to the spare parts and the repair manuals and legal aspects around keeping products in operation and there's all sets of questions that this is up and we would like to ask everyone to contribute questions by chat and we're trying to split questions into three key aspects one is around people and the other is around so the capacity to perform repairs we should be doing them and second one is around spare parts in the supply chain and the third around documentation diagnostic but keeping in mind that legal regulatory and liability related issues will probably run through these three things. I have a first question on people related matters and that's for Helen so I'm wondering what are the plans to train the huge number of volunteer engineers that have expressed their interest to help maintenance? That's a very very very good question actually there is a huge program going on right now to prepare the engineers for this work and that's not only the volunteer engineers but actually the clinical engineers that are going to be doing this this is an unprecedented situation that we have and whilst our clinical engineers are exceptionally well trained we this is a on a scale that's never been seen before whether that's in the UK or anywhere else in the world so they are undergoing those that are going to the sites at the moment particularly down at Nightingale are going through very strict training programs right now to to bring them up to speed with what's going to be needed of them and that's not just on the the equipment side but that's on the the process and the management of patients as well and then once they are in place then the volunteer engineers who will then come in to fill some of the the gaps that that appear in that process will then go through similar training programs to ensure that they're at the right standard and they understand the requirements that are placed upon them alongside that they will obviously be managed in the most appropriate way as well so all of these volunteers will be being small teams they will be managed by trained clinical engineers who will then supervise them to ensure that they can carry out their jobs so so there's a very strict protocol a strict process going on to make sure that they are trained to the highest standards great obviously there's a key question that everyone has seemingly tried to give an answer to and probably John can help us make sense of the different claims and numbers that we've been hearing so are we going to short in terms of ventilators in in the UK in the end and and link to that we've heard quite a bit of discussion around the potential to reuse or bring back into use the commission equipment equipment that is no longer in active use and there might be some barriers related to making sure that it works again maintenance and support have you come across any reliable numbers and of the equipment that is in that condition and is there any sort of database across the UK combining all the information around all the equipment that could be reused but isn't yet I'll start off with your first question can you hear me better now I've put the headset on oh yes it's much better thank you okay well with regard to the number of ventilators it's a bit of a moving target so it's looking like we don't need as many ventilators as we first thought but there's still a lot of ventilators needed the reason for this is because they're finding that CPAP units which are not ventilators so they're continuous positive airway pressure devices they keep the lungs inflated they can they can end up with a better recovery than use a ventilator whether that's a non-invasive or an invasive ventilator and allowing the people to use their own respiratory function to breathe as much as possible so there's been a switch to some degree to using more CPAP devices now these are the devices which are easily available and easily manufactured so to answer your question do I think there will be a shortage of ventilators if you include CPAPs in that I don't think there will be the second part of your question was around second hand ventilators now when I was at Nightingale last week I did see second hand equipment coming in so I think there will be a mix of equipment being used and I've had equipment offered to me via the website because we had a company called MTS Health who offered to put a database together but there hasn't really been much uptake from that from from what I can see and what seems to be the case is that the manufacturers especially big manufacturers like JCB Mercedes you know a lot of these what are industrial size manufacturers are stepping up to the mark to make very basic CPAP machines and ventilators I think they will be able to make them in the sorts of volumes that we need now there are second hand devices which have been kept in the country so I've been speaking to people like the British Medical Auctions and Hilditch who are auction companies that specifically auction equipment and they are holding on to stock for the UK markets and in fact a lot of that stock has been shifted into areas hospitals and the Nightingale for use I know that 250 beds arrived from an auction company last week into the Nightingale I was there when they arrived unfortunately some of them are not suitable for use because they're damaged so there is also a need to have trained technicians there not just for ventilators but beds and other devices I think going back to what Helen was saying you don't need trained technicians for everything the other thing that you need to do is to maximize the efficiency of your workforce by minimizing the traditional planned maintenance and repair maintenance functions that would traditionally be done if you can do that then you can take an hour job and take it down to 10 minutes by not following the manual so although Olivia was saying she can make manuals available if you actually follow the manual what you can end up doing is instead of commissioning the hospital in three weeks it could take three months and so I think that there have to be corners cut safely new procedures have to be written they have to be written in a way that keeps patients safe but also maximize the speed and that's what I was advising on last week when I was at the Nightingale was how can we create a speedy way of getting this equipment into these new field hospitals and so with regards to the ventilator numbers do I think there will be enough in the UK yes do I think there will be enough worldwide no that's partly because we're a very rich country and we can we can put the resources in to do that now with regard to the database do I think a database of all second-hand equipment will be made no I would love it to be and I've volunteered to help with that but I don't think that in in in reality I don't think that will happen I think the government and the supply chain people are more interested in getting hold of things as quickly as they can and also for commissioning it's better to have something that's brand new as I was just mentioning with beds if it arrives and it's come out of an auction house and a lot of them are damaged the first thing you have to do is then put a resource to repair them if it arrives and it's in a box and the first thing you have to do is unpack it and it comes out of the box brand new 99% of the time you can put it straight into use safely with some minimal checks you know switch it on does it work yes it does put it on the patient um so you can't do that with second-hand equipment you have to do a more in-depth check to make sure it's safe whereas you would assume if it's just come out the factory it is safe um so uh so that was vents the database and re-using medical equipment yes medical equipment is being reused must be reused um it's also not just about the field hospitals I was speaking to staff at various hospitals where they're they're um reusing anesthetic machines uh as ventilators to create ventilators in theatres which is also interesting um so there are different ways you can do this to look after these patients so that I think I I think answered all your questions there you go yeah thank you very much very helpful and in a way also some positive news which these days is quite rare hmm I've got ugo if you may I've got a question here from uh from one of the participants I've got a question from from Matt Lecce I'm just going to read this back to everyone um having quite a few years experience in repairing industrial and medical equipment and I'm talking the electronic parts here it's very often component failure in the power supplies and our screens and switches etc or the user interface that break down uh repair to these do not alter the product or do we do not alter the product or do we need to get involved in the software it well it doesn't often alter the product and does not uh uh doesn't mean that we need to get involved in the software we've been repairing for GE healthcare and Siemens medical on this basis for quite a while is the legal argument more of a fear to avoid repair rather than just doing it so that's a very interesting question here from from Matt thank you Matt for the question everyone else if you want to look at the questions going please I'm just going to add you know or comments on on on Matt's question here we we we very much agree to you know with with the point Matt I think there are many different systems that don't you know repairing them wouldn't really compromise the product itself or you know the patient and and and what what we could do where we could achieve if we did have a culture in this country especially when it comes to the NHS I was speaking I spoke to us you know biomedical engineers up and down the country operate you know working from different locations and trusts and I was I was really shocked when one of them said that they stopped repairing PCBs doing electronic level component PCB level repair decades ago and and this is this is something you know when when when we're now in time of crisis we're seeing a situation where they are going for the manufacturers for spare parts because there are a lot of equipment that has been um marked to be scrapped and they are trying to get those back you know back to the front line and the manufacturers are quoting months for the spare parts to come through because they are overloaded and and these engineers they cannot even attempt to do you know to repair those electronics the the onboard electronics because of the fear of you know the the legal or regulatory liabilities in place so so this is this is something that we've been trying to you know a part of the the problem that we're trying to resolve we can as a as a business here as a company technology manufacturing company we can definitely address those issues we could really empower these engineers and technicians and really help them do component level PCB level fault finding and repair quickly and I think that there are uh uh you know very good people well trained people some of them you know they share some of their experiences with me and they really are they're very passionate about electronics and they can definitely do a very good job if given the tools and the training but we definitely need the legal part to a sort of a besorted in and they need to have that backing as well so this is my my my comment on Matt's question but if perhaps John Helen or anyone else if you'd like to add any comments so back to your main question is is the legal argument more of a fear to avoid repair rather than just doing it anyone else wants to a comment on that yeah I'd like to add something to this um I was interested uh that Olivia you're putting um service manuals up on I fix it I'll be interested to come and see those Jim restrictions on repairs one of the things as somebody who has been chief executive very large maintenance company we do do electronic repairs we do replace power supplies even yeah replace components within power supplies things like that so the more simple repairs the repairs are not normally done uh very rarely seen are you're like repairing the main circuit boards rather than the power supplies with regards to the the things that cause real difficulty and not usually the the main circuit boards they're usually quite reliable it's more around software and if there's a software issue a lot of companies will not give us the documentation or the diagnostic tools which is usually a laptop to be able to get in to do any diagnostic tests without paying a lot of money and I'll give I won't give the example of a company but I'll give examples of cost so a particular anaesthetic manufacturer uh insists on you buying their laptop so you pay for their laptop their their service software so you pay for their service software and then an annual license fee by having the service software and the three things together cost more than having the service contract in the first place so there's no point in trying to do it yourself because they've put so many um obstacles in the way so that their own technicians and their own income is protected that it's it's not worth it with some companies that's generally the companies where they have high risk equipment such as ventilators or imaging equipment on the lower end they're not interested in fixing their equipment on the hull so they'll supply you with the software they'll supply you with so cheaper items so as the items go up in cost as soon as you get into capital cost things over five thousand pounds you find it becomes more and more difficult as the items get more and more expensive because the companies try to put obstacles in the way to stop you repairing them now as somebody who started out as a technician I know that I can fix anything and I know that any engineer can fix anything with the right tools and the right software and test equipment and so it would be great if legally we could get around that which I you know as somebody who's been chief executive and managing director of a few different companies I've never been able to get around that they always have a way in Europe of stopping that although I know they've they've done it in the States so I'd be interested to hear whether Jim you've got any solutions for us with regard to that I'll stop there thank you I don't know that I've got solutions as such and I think there's certainly with there are it depends exactly what it is but I think if you talk about reverse engineering software then I think there are legal reasons that you can do that I mean there is certainly no restriction on on on that as I understand it because you have to be able to make software interoperable so in more mundane fields perhaps where there's larger user bases is quite common for people to reverse engineer apis and other such things where you know people have an interest you know so people have worked out the you know spent a number of years for instance working out how Microsoft Outlook and other such things might be used on a server level people didn't want to use Microsoft service all the time and but of course a lot of people interested in email servers I guess and so the question is whether there were enough people who have enough interest and time to reverse engineer the pieces of equipment you're talking about and but I think from from point of view software that shouldn't be an issue where you get more of a problem I think is where they placed technical restrictions on accessing the software because then you may be breaking the law to even attempt it so you know there can be some gray areas but I think you know fundamentally that ought not to be the case it's really interesting to hear that example because it absolutely shows how the technology is being abused right because I mean this isn't you know you bought the thing and now you're being told you're not allowed to access the bits of the machine which actually tell you how to sort out the problems and that that is wrong but it also parallels like that exist many other places you know car manufacturers if for instance is going the same way combination of software technical restrictions licensing warranty all of this is sort of put in the way of people repairing cars so effectively you know if you buy a car you know you're pretty much renting it really you're not really owning it because the minute you try to interfere with it you're avoiding various warranties and basically you lose all possibility of help of course sometimes because you know with domestic equipment it gets even worse that you try to interfere and the machines just become unusable and I'd hope that doesn't happen in the technical field but you never know I think in a situation like this this equipment should just be given out right the point is where's the bottleneck how do we sort it one thing the companies to try to overcharge and make a profit that they shouldn't which is what you're describing but the situation like this things have to be repaired so I think we need at this point is more less of a legal thing and more of a moral pressure thing who's doing the bad things who is actually trying to get in your way shame them and there should be at this point I think it's public shaming if companies are doing what you describe and it's concerning to think that a lot of the equipment that is really necessary like ventilators is subject to arrangements like this so I think that's something that really needs to be made public and we need to explore that but where you can but yeah it's I think from a software perspective it may not be illegal it may be perfectly reasonable to reverse engineer this thanks thanks Jim I just follow to this I wonder John based on your experience and maybe the Helen can actually bring her perspective too much of the equipment a medical equipment is actually under service and trucked and are biomets actually allowed to repair these themselves in a current situation like now like sort of a force majeure I would say yes I'd say there's no legal reason why biomets can't maintain equipment the reasons why they normally can't maintain equipment is because the manufacturers won't supply the spare parts for maintaining or repairing the equipment or they won't provide the software as I just said right in reality the majority of faults I've done some research on this and the majority of faults are very simple so you could say that 90 percent of faults could be could be repaired by a reasonably able technician unfortunately that's not always a case because especially on as I was saying higher cost equipment they put a lot of blocks in the way one of the blocks is training so trying to get training for your technicians even if you have a technician that's trained so you've had some of these been trained so I've employed like Siemens technicians for example they are not allowed to cascade their training so Siemens will not certify a technician that's been trained by a previous Siemens technician and also other companies like GE healthcare I'll name and shame here they will offer training and they'll charge you a lot of money for it but they will insist on refresher training now if somebody's working on something and they look at some they look at a piece of equipment they they repair it on a regular basis I have no reason to send them on refresher training they can read they can read the service manual the only reason for a refresher training if something has changed on the equipment now it's been upgraded for example then they need refresher training so refresher training for the sake of it is something else that manufacturers do not just GE but other manufacturers as a way I think of getting more money so I think that biomeds can or clinical engineers can do repairs they can repair the majority of equipment give them the right training and tools I'll over to you Helen I don't think there's much I can add to that John I mean that pretty much covers it I would have said the same thing you know I think there is a there is an issue I think within the manufacturing industry whereby it's very easy for them to produce technology which in in relative terms is quite cheap but where they make their money is by exactly what John says is by requiring you to go through training requiring you know keeping information to themselves so that it means that you're reliant on them to to support the the maintenance of that that equipment so I think that's something certainly that's gone on for many years I don't think that's something that's new it happens in all industries not just the medtech industry and and that's really where where manufacturers have made made money over the years a photocopier is a prime example of that that situation you know you can buy a photocopier relatively cheaply but if it breaks down you've got to have somebody come in from the company to fix it and that costs money and so it's the same the same situation with medical devices so I think that's something that needs to be addressed and I think in these sort of situations where equipment is being used probably on a faster turnaround than it would normally be under normal operating circumstances the engineers have got to be able to fix that equipment and they can't fully be reliant on the the manufacturers to do that otherwise we're you know we're going to put patients at risk from that point of view and can I just add just just two points very quickly I think I think I agree with with all that both Helen and John just said in the talks that I've had with some of the NHS clinical engineers they were you know they were basically saying that the exclusive dependence of OEMs for parts turned extortionate price for spare parts into the law of the land right and and and and this this very high prices for you know mentioned about software we talked about training but also spare parts this is paid by us is paid by info by the taxpayer and just commenting on on the hardware side of things and two very quick points um an NHS hospital in the north of England two weeks ago was quoted 40 000 pounds for three printed circuit boards okay 40 000 pounds for three printed circuit boards by the OEM so that they could have a critical equipment repaired and and we all know everyone who's got some experience with repair here knows that those those PCBs and I've seen the pictures of the PCBs those PCBs could be repaired for probably you know less than a thousand pounds including the you know someone's time and on parts and everything else so this is one one example of something that is happening now if biomedical engineers were giving the tools and the training they could be saving the NHS a lot of money okay and do so a lot more quickly um and the other example is another NHS hospital had ventilated down because the power supply failed so the technician the engineer went to the OEM and the OEM said well it's going to take eight months before it can get to any parts because of the existing situation we are we were in the process of redesigning the power supply therefore we can't get any parts for you in less than eight months okay that power supply in that case was about 1500 pounds roughly according to the uh the biomedical engineer and what he did is said you know what we need to get this going so he went and and then you know he had to bend the rules a bit and using a multi-meter and you know power supply etc so he did a bit of a trouble shooting down to the PCB level and he found a faulty relay and I and he replaced that relay and the power supply is not working and I asked so how much did you pay for that that relay so I was less than a pound okay so so he resolved the situation there and then very quickly using his technical abilities the very limited you know access to tools and and and and everything else that that he had and he got that going and this is precisely what we think should be happening right now and not just for ventilators is for you know anesthetic equipment x-rays and beds and everything else and so I just just wanted to um to add that those comments okay very quickly thanks thanks William and just to clarify for our listeners what the technician did in that case of fixing it himself would have actually made that a piece of equipment no longer certified as safe to be used in medical uh environment question well I think it was one of the points that Matt Lecce made earlier on you know these these um you know power supplies don't really affect how a ventilator works but I don't know if John or Helen have any yeah so I'd like to add a comment to that so most clinical engineering departments at UBME departments they have a quality management system and it's very simple for the manager of that system to put in a certification system I've done it myself where for example using your power supply example I had a very similar issue with a power supply and a company won't name the company wanted an exorbitant amount of money for a new power supply whereas um it just needed a transformer it was a 15 pound transformer available from RS components I told my technician change the transformer put the supply back and he said well it's not it's not that manufacturer's power transformer because the transformer on the circuit board was labeled with their label I said I don't care you can buy exactly the same transformer from RS components buy put it in and I will give a certificate myself as a chartered engineer to say that this is suitable for use in this power supply and that's a perfectly legal thing to do I'm sure Jim will agree with me okay that's that's reassuring because we hear of some of the limitations and red tape around these issues I think I think you got a lot of people add to the red tape by making things up in their own heads there is no reason why you can't replace a transformer for exactly the same transformer that's broken down no reason at all I would agree as long as you're a qualified engineer and you understand what you're doing and if you want to you can get it certified by your boss or your boss's boss I've stopped people because of exorbitant planned maintenance schedules within books which manufacturers have put together I've stopped people doing multiple steps within the servicing because they're unnecessary like checking the e-prom why are you checking the e-prom a nurse is not going to get into the e-prom it says so in the service manual I don't care don't do it it'll save half an hour off the job I don't want you to do it so I think there are some engineering decisions to be made by engineers and not to be afraid to make those decisions as long as you document it and you do a risk assessment there's no reason why you can't be more efficient be more lean and I'm a keen advocate of working working lean yeah I would back John up on that any day of the week yeah you know the I apologize for my dog barking in the background um the um you know we we are trained engineers we are certified to be able to do these things we have CNG, ING, EngTech qualifications um that that give us the ability to be able to make these sort of decisions by and as John rightly says by having the quite the right QC QA programs in place there is no reason why those simple sorts of things can be not undertaken by the engineers I think there has become a um a perception across engineering to to not risk to not put oneself at risk from those legal situations and I think that's something that really we we have to address that it has to be um you know a we have to focus on on what we can do and what we can achieve and and do that by the book um and I think there's there's this um perception that you know we're going to put ourselves in a legal bind if we if we don't do that um but I think I think now I think the engineering community is beginning to realize that um they don't need to work that way that they can make sure that the processes that they put in place are adequate for um for servicing these pieces of equipment great I mean just quick thing I I mean I I'm not uh able to kind of comment on the on the specifics of of sort of those sorts of repairs what's what's been said sounds completely reasonable to me but uh you know nevertheless not not my field what I would um ask though is do the vendors try to dissuade people through contract rather than law you know you you interfere with this piece of equipment and you void my warranty uh there's a you know there's a supply contract for maintenance and you you know start poking a banked with it then you know that I'm never going to touch the machine again and that's your investment down about yes they do do that uh but um the fact is is that they will come in I I've um had this argument with many different manufacturers and the the reality is um I'll give you one example I had a company that was servicing ultrasound machines in one of the hospitals I looked after and they were charging five thousand pounds per machine and I went and shouted one of their engineers and they had about probably 15 of these machines in the hospital and they would only give us a comprehensive contract so I watched what he did he took a little a little filter out the back of the machine cleaned it put it back in and did an electrical safety test and then did a test with a phantom so I found out how much the phantom was it was like 500 quid I found out where to get these filters from not not from the manufacturer but an alternative source and then I wrote a work instruction and I got one of my own technicians to go and do the work and I cancelled the contracts and they told me you can't do that but actually I did do it and it saved the trust 30 000 pounds a year and actually their their equipment was one of the most reliable um ultrasound machines that that is around and I said to them look if you charge me a reasonable price I will probably still have you doing the maintenance because I said well you won't get the software upgrades I said well the clinicians are not moaning about the software it works perfectly well so um when I want a software upgrade I'll pay for it I said well we won't do a software upgrade unless you have a service contract with us I said well you know we'll take we'll we'll take that as it you know as it comes so they do do this sort of thing but coming back to that same story after a year I had a phone call from their managing director saying we'd be willing to to have a contract with you just to come out and do a ppm because before we used to have a comprehensive contract with you we'll charge you 288 pounds per machine so from from 5000 pounds down to 208 and we'll give you the software upgrades which I took that contract out because that was worth it and so you can you can and even then they were making a reasonable profit on it I thought so so you can actually twist the arms of these providers but I think as Helen was saying most clinical engineers seem to be risk averse you just need to say why you're doing it and make sure you're doing things which is safe excellent thanks so much for this I have one final question I know we're running a little behind um so what about the issue of ongoing maintenance of this new equipment that's been quickly designed and turned around now uh in the case of this emergency will the companies making cpap devices such as Mercedes Formula 1 open up service documentation and diagnostic tools for this effort and will there be spare parts or is anyone thinking about these issues even in terms of procurement maybe john wants to say something on this but um this is speculation but I would probably suspect not um I would think that some of this equipment will will probably be almost one shot and if it does break down then they'll just they'll just get another one out of stock and use that um I think the the numbers that are being quoted as being built in such a short space of time um and not necessarily all going to be used um and therefore I suspect that that you know some of this equipment will just um will be used and if it fails that they'll they'll just replace it with another piece that's speculation um you know it would be nice to think that they that there are proper uh documentation and everything else in place but um with the speed of the turnaround of them building these pieces of equipment um there is a worry in the back of my mind that some of those things may have been missed but it's very difficult to say at this point I agree with you Hallie and I think for the majority of the devices that these big manufacturers are now making the quick manufacturer of these CPAP machines um they'll they'll effectively be disposable um because they're brand new um they'll they'll they'll get a quick functional test possibly a quick electrical test as they come out the box and then go on to the patient if they break down I'll probably go back into a box and possibly go back to the manufacturer or be put in a corner for a repair but there'll be probably many more there waiting to go on to the patient I think that there are going to be tiered tiered um levels of care in terms of there'll all be intensive care patients going into these field hospitals but the level of the equipment won't all be intensive care level um probably the top five percent of ventilators will be really um you know the most complex types of ventilators g, penlon, those types of very high level ventilators but the majority of the ventilators on the patient will be relatively simple and with probably not not not very difficult to repair so I can't see it being being a problem I also think that companies like uh uh Mercedes will give service documentation and will uh will have spare parts available if they're required but from what I understand about the CPAP machine that Dyson are making it's basically a fan in a box so it's it's producing air pressure to keep the lungs at a certain level of pressure to make it easier to breathe in for the patient that's about all those machines will do and that's probably all that they need them to do thanks uh John and Helen worrying given the context of the shortage of the equipment globally and if we take the UK out to the picture for a moment and we should probably think about how we can advocate for spare parts and repair documentation to be available I don't know a global sense for all of this and quick comments yeah please um so just in Europe the procurement process did evolve quite a lot of documentation about what the manufacturers were to provide them as the designs that they were to use I believe that was quite interesting because you know the presumably the point there was standardization and to easily manufacture as into uh producing things that that the European authorities believed was usable I wonder if that you know whether people have got more information about about that because that might well impact these questions make things more repairable reusable and all the rest of it yeah good questions I I think if no one has an immediate comment I would like us to well we can think about how the current work on right to repair might actually happening at European and US level can actually be extended looking forward to going forward to medical equipment this is a big piece of work to think about but meanwhile I think it's time to wrap up and I'd like to ask William maybe if you'd like to have some final remarks from our side yes very very briefly we've been you know been discussing for the last hour or so about you know very important subjects that I really hope will be uh something something positive can be produced out of this discussion uh we we as as an organization we're not we're not only engaging with the NHS in the UK we are engaging with you know equivalent organizations in other countries and we're seeing some great initiatives places like Brazil where car makers are not turning to shifting their production to making more ventilators but they are actually focusing on repairing maintenance because of the timescale repair maintenance means you can increase capacity faster compared to a building a new designing and building a new ventilator from scratch I think it's very important that we try as much as possible to focus on not reinvent reinventing the wheel type of thing and we're engaging with you know energy companies in California you've seen on you know social media over the weekends and and these are interesting projects we spoke yesterday I was speaking to a minister of health in Peru over there as John was saying you know we require rich country we can you know can afford to buy ventilators and probably have more than we were going to need in in Peru they have just over 1500 ventilators for a population of 32 million people and I spoke to the director of asset maintenance and and and commissioning there and equipment commissioning and they are desperate they're desperate because they only have 1500 ventilators 30 percent of them are faulty and looking into repair and maintaining those as quickly as possible and we know that there are a lot of you know more systems hidden in any storages here and they they're likely to develop faults and they could be checked they could be recommissioned trusted the north of England after reading some of my articles I published a couple of weeks ago they went on check the storage they found 30 ventilators were you know 24 seven for a number of days with the manufacturer and managed to bring those back you know to the front line so I think I think you know this this sums up where we are as an organization I think every effort to save lives you know must keep this in mind you know the people who do this critical work must be listened to as well I think it's very important yeah they they people who are on the ground they they need to be taken into consideration okay and you know finally when when this is all over I would expect that our country's emergency preparedness plan we have been updated to make electronic repair maintenance a key subject in vocational college and university in university engineering courses as well you know we must have more skilled people ready to help maintain all critical equipment during a crisis these people need to be well paid and listened to and and they also need to be listed as key workers for providing an essential service to the country thank you thank thanks William and I'd like to add a couple of notes first from our side biomets need to know that they have our backing not just financial but also protection from the lawsuits that they might be brought into when they perform repairs when they are in breach of some of the service contracts and when they have to make critical decisions in order to save lives it sounds like a real sea change is going to happen in the profession going forward we're really happy to hear from John and Helen and their work and their experience that can really provide leadership in this field and more broadly I think this has been really useful conversation to to get us to think a bit differently about some of the challenges and the opportunities to improve the way we look at these issues of how we can shift the thinking to unreparability of products and what does it mean to provide ongoing long-term support to products and what are the barriers and the opportunities I'd like to thank all of our panelists to take the time at this moment of crisis to join us and to answer these questions and think there will be a lot of thinking and hopefully we've made some initial good connections and thanks to all of you and if any of you has information to share with iFixit on this wonderful database they're creating please go on their website and contribute to it and the big question remain are we ready and hopefully we got some reassurance in the last hour the next couple of weeks and the months ahead are critical and will reveal the answer and we hope indeed that it be positive thank you everyone