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KN33011 KEY NOTE MEDICAL EQUIPMENT MARCH 2001

ISBN 1-85765-803-5

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This report covers: medical equipment, medical consumables, medical instrumentation, National Health System, surgical instruments, diagnostic systems, electronic monitoring equipment, respiratory, anaesthetic, resuscitation, orthopaedic, prosthetic, artificial limbs, rehabilitation, medical laboratory, operating table furniture, sterile swabs, dressings, sutures, syringes, protective clothing, masks, gloves, continence products, HTA, health technology assessment,

Companies covered include: Abbott Laboratories, Baxter Healthcare, Becton Dickinson UK, BD Medical, B Braun Medical, Datex-Ohmeda, GE Medical Systems, Huntleigh Technology, Johnson & Johnson Medical, Philips Electronics UK, Seward, Siemens, Smith & Nephew, Smiths Industries Medical Systems, SIMS, SSL International, 3M, Oxford Instruments, Fisher Scientific,

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Table of Contents
Executive Summary
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TABLE OF CONTENTS

Executive Summary	1
1. Market Definition	2
REPORT COVERAGE	2
MARKET SECTORS	2
Medical Equipment	2
Medical Consumables	3
MARKET TRENDS	3
Healthcare Expenditure	3
Centralisation of the Independent Healthcare Sector	3
Health Technology Assessment	3
Advances in Technology	4
Hospital Efficiency	4
Movement Towards Interoperability and Open-Ended Systems	4
The Role of Technological Advances	4
MARKET POSITION	5
The UK	5
Table 1: The Total Market for Medical and Pharmaceutical Supplies by Value at Current Prices (£m), 1996-2000	5
Overseas	5
KEY TRADE ASSOCIATIONS	6
Association of British Healthcare Industries	6
The European Co-ordination Committee of the Radiological and Electromedical Industry	6
The European Diagnostic Test Manufacturers Association	6
The European Confederation of Medical Devices Association	6
Advanced Medical Technology Association	7
Association for the Advancement of Medical Instrumentation	7
Other Trade Associations	7
2. Market Size	8
THE TOTAL MARKET	8
Table 2: The Total Market for Medical Equipment by Value at Current Prices (£m), 1996-2000	8
Medical Equipment	8
Table 3: The Medical Equipment Sector by Value at Current Prices (£m and percent), 1996-2000	9
Medical Consumables	9
Table 4: The Medical Consumables Sector by Value at Current Prices (£m and percent), 1996-2000	9
Sales by TYPE OF User	10
Table 5: The Total Market for Medical Equipment by Type of User (£m), 1996-2000	10
The National Health Service	10
Table 6: The National Health Service Market for Medical Equipment by Sector by Value (£m), 1996-2000	11
The Independent Acute Care Market	11
Table 7: The Independent Acute Care Market for Medical Equipment by Sector by Value (£m), 1996-2000	11
The Residential and Nursing Home Care Market	12
Table 8: The Residential and Nursing Home Care Market for Medical Equipment by Sector by Value (£m), 1996-2000	12
OVERSEAS TRADE	13
Imports	13
Table 9: UK Imports of Medical Equipment and Supplies by Value (£m), 1998-2000	14
Exports	14
Table 10: UK Exports of Medical Equipment and Supplies by Value (£000), 1998-2000	15
3. Industry Background	16
INTRODUCTION	16
Recent History	16
Telemedicine and Remote Use of Equipment	16
Miniaturisation and Portability	17
Open Standards and Interoperability	17
Health Technology Assessment	17
Medical Equipment and Year 2000	18
Number of Companies	18
Table 11: Analysis of UK Medical, Surgical and Orthopaedic Equipment and Appliance Manufacturers by Turnover (number of companies), 2000	19
Employment	19
Table 12: Analysis of UK Medical, Surgical and Orthopaedic Equipment and Appliance Companies by Number
of Employees (number of companies), 2000	20
REGIONAL VARIATIONS IN THE MARKETPLACE	20
DISTRIBUTION	21
Table 13: Selected Distributors of Medical Equipment, 2000	21
HOW ROBUST IS THE MARKET?	22
LEGISLATION	22
The Medical Device Agency	22
The CE Mark	22
Notified Body	23
Table 14: UK Notified Bodies, 2000	23
Table 15: Relevant Regulation for Medical Devices and Equipment, 2001	24
European Standards for Medical Devices and Equipment	24
4. Competitor Analysis	26
THE MARKETPLACE	26
MARKET LEADERS	27
Abbott Laboratories Ltd	27
Baxter Healthcare Ltd	27
Becton Dickinson UK Ltd	28
B Braun Medical Ltd	29
Datex-Ohmeda Ltd	30
GE Medical Systems	31
Huntleigh Technology PLC	32
Johnson & Johnson Medical Ltd	33
Philips Electronics UK Ltd	34
Seward Ltd	35
Siemens PLC	35
Smith & Nephew PLC	36
Smiths Industries Medical Systems	37
SSL International PLC	38
Other Companies	39
OUTSIDE SUPPLIERS	39
Companies Supplying Components/Technology	41
Table 16: Selected Companies Supplying Components/Technology to the Medical Equipment Industry, 2000	41
Companies Providing Plastics/Polymers	42
Table 17: Selected Companies Providing Plastic/Polymers to the Medical Equipment Industry, 2000	42
Companies Supplying Sterile Medical Packaging	42
Table 18: Selected Companies Supplying Sterile Medical Packaging, 2000	42
The Telecommunications Industry	43
Table 19: Selected Telecommunications Companies, 2000	43
The Electronics Industry	43
The Computer Industry	43
ADVERTISING AND PROMOTION	44
EXHIBITIONS	44
Table 20: Major Exhibitions and Meetings, 2001	45
5. Strengths, Weaknesses, Opportunities and Threats	47
THE TOTAL MARKET	47
THE NATIONAL HEALTH SERVICE	48
THE PRIVATE HEALTHCARE MARKET	50
THE NURSING AND RESIDENTIAL HOME CARE MARKET	51
6. Buying Behaviour	53
INTRODUCTION	53
CUSTOMER PROFILE	53
The National Health Service	53
Table 21: NHS Expenditure (£bn), 1996-2000	54
NHS Trusts	54
Primary Care Groups and Trusts	54
Private Finance Initiative	55
NHS Activity	55
Table 22: Hospital Activity Trends in England (number of episodes), 1998/1999	55
NHS Purchasing and Supply Agency	57
Servicing and Maintenance in the NHS	58
The National Institute for Clinical Excellence (NICE)	58
Table 23: Summary Schedule of Health Technology Assessments by NICE, 2000/2001	59
THE INDEPENDENT HEALTHCARE SECTOR	59
The Independent Acute Care Sector	59
Table 24: Main Private Acute Care Providers by Facility (number of hospitals and beds), 1999/2000	61
The Residential and Nursing Home Care Market	61
Table 25: Long-Term Nursing and Residential Care Placesby Type of Provider (number of places), 1999	61
Table 26: The UK Market for Residential and Nursing Home Care by Type of Provider by Revenue (£m), 1996-2000	63
Table 27: Selected Major Long-Term Care Companies,(number of hospitals and beds), 1999/2000	64
Purchasing in the Independent Healthcare Market	64
7. Current Issues	65
THE ROLE OF THE INTERNET	65
Global Healthcare Exchange	65
THE POLITICAL SCENE	65
Government Funding	65
Devolution	65
Ageing Equipment and Investment	66
HEALTH ISSUES	66
Demographic Change	66
Table 28: UK Population by Gender and Age ( percent and million), 1901-1998	67
Table 29: The UK Population — Actual and Projected (million and percent change), 1961-2021	68
Main Causes of Death	68
Table 30: Deaths by Major Causes in England and Wales (000), 1998	69
Smoking	69
PRODUCT DEVELOPMENT	70
Diffusion Tensor Magnetic Resonance Imaging	70
Diagnostic Test for CJD	70
Electronic Patient Records	70
Compact Ultra-High Field MRI System	70
Tens-Based Implant	70
Harmonic Scalpel	70
Advanced Retinal Imaging System	71
Miniaturised Ultrasound Imaging	71
X-Ray Catheter	71
Neonatal Optical Non-Invasive Brain Oxygen Monitor	71
Guidance for CT Scanners	71
Acublade Laser System	71
Artificial Visual System	72
LEGISLATIVE CHANGES	72
Pre-Market Review	72
Re-Use of Single-Use Medical Devices	72
CORPORATE ACTIVITY	73
Abbott Laboratories	73
Amersham Pharmacia Biotech	73
Ampersand Medical	73
AVL Medical Instruments	73
Biomet	74
Celsis	74
ConMed	74
Eastman Kodak	74
GE Medical Systems	74
Gyrus	74
ICN Pharmaceuticals	75
Innovative Medical Solutions	75
Innovatix	75
Johnson & Johnson	75
Mallinckrodt	76
Marconi Medical Systems	76
Medisys	76
Micronics	77
Muse Technologies Incorporated	77
Nycomed Amersham	77
Novartis Consumer Health	77
Oxford Instruments	77
Perkin Elmer	78
Siemens Medical Engineering	78
Smiths Industries	78
Smith & Nephew	78
Visualisation Technology	78
Carl Zeiss	79
8. The Global Market	80
MARKET SIZE	80
MAJOR TRENDS	80
Pressures on Healthcare	80
Harmonisation	81
Corporate Advancement	81
CuStoMER profiles	81
Germany	82
France	82
Italy	82
Spain	82
Japan	83
The US	83
THE FUTURE	83
9. Forecasts	84
INTRODUCTION	84
FORECASTS 2001 to 2005	84
Table 31: The Forecast UK Market for Medical Equipment (£bn), 2001-2005	85
FUTURE TRENDS	85
10. Company Profiles	87
Baxter Healthcare Ltd	88
Becton Dickinson UK Ltd	90
B Braun Medical Ltd	92
Johnson & Johnson Medical Ltd	94
Philips Electronics UK Ltd	96
Smith & Nephew PLC	98
Smiths Group PLC	100
SSL International PLC	102
11. Further Sources	104
Associations	104
Periodicals	107
Directories	109
General Sources	110
Bonnier Information Sources	111
Government Publications	112
Other Sources	113
Key Note Research	115
The Key Note Range of Reports	116

EXECUTIVE SUMMARY

The UK market for medical equipment is a dynamic market, which is both competitive and cost-sensitive, and driven by technology. In 2000, it was worth an estimated £2.19bn, following annual growth of 5.2 percent.

The market is diverse in nature, comprising a wide range of products and different technologies. These are broadly divided into two main sectors - medical equipment and medical consumables. The medical equipment sector includes medical instrumentation and apparatus, ranging from expensive electromedical systems which can cost millions of pounds, to simple surgical and medical instruments. The consumables sector typically comprises high-consumption, low-cost, single-use disposable products.

These products are used by both the public healthcare sector - the National Health Service (NHS) - which is by far the largest customer in the UK, and the independent sector - in particular, the acute hospital care, and the residential and nursing home care sectors.

This is a highly-regulated market in which production and quality standards are high. As a result, barriers to entry are significant, although progress in global harmonisation and European agreements which promote an open market are causing these barriers to fall. The market's supply structure is becoming increasingly dominated by globalised companies.

In recent years, market growth has been severely restricted by limited budgets and by various measures aimed at containing the rising costs of healthcare, which have been caused by increasing pressure from an ageing population. The development of new technology is itself adding to the pressure on healthcare services by offering new possibilities for treatment and expanding existing markets.

Changes in hospital practices also affect the marketplace and have resulted in higher patient turnover and greater use of single-use, disposable products. Levels of day surgery and outpatient treatment are rising, while the average length of a patient's stay is falling significantly. Both users and manufacturers increasingly see the cost-effective benefits of instrumentation as crucial to success in the marketplace.

The advent of telemedicine and the increasing pace of harmonisation are likely to increase the globalisation of the medical equipment market. In an ever more competitive marketplace, products are becoming increasingly complex and have shorter life cycles. Acquisition, merger and collaborative activity are on the increase as companies aim for the timely introduction of innovative products and maximised profitability in a price-sensitive market. The market will continue to be dominated by a smaller number of larger and increasingly international players.

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Last updated by Duncan Nottage 5th May 2001