PACS all, folks

There have been many problems with the National Programme for IT in the NHS. But the Department of Health has always had one, big success story to point to – the roll-out of digital imaging systems.

Now, though, the national contracts for picture archiving and communications systems are coming to an end. They run out in June 2013 in most of the country, and a year later in London. This means that the 128 trusts that received PACS from the programme are well into the process of deciding what to do next.

Broadly, they have four options: to negotiate a contract extension; to join other trusts in a consortium to explore the market; to go out to tender themselves; or to make use of a national framework that has been negotiated by NHS Supply Chain.

Up North (Midlands and East)

In May, the Department of Health announced a one-year extension to Accenture’s local service provider contract for the East of England, East Midlands, Yorkshire and the Humber, and North East.

Accenture now sees a “clear divide” between the approach being taken by trusts in these areas, and those covered by CSC through its PACS LSP deal for the South, North West and West Midlands.

Matt Oakley, who leads the company’s work in medical imaging in the UK and Ireland, told eHealth Insider that Accenture is “hugely excited for the future” after 24 of the 32 trusts supported by the company decided to extend their contracts.

“We have spent the last three or four months closing out the deal with the DH, and we are very pleased that trusts are reflecting on the success of the last five years and wanting to work with a company that has experience of the market,” he says.

“There is some panic out there, as there is clearly a pressing issue in other regions, but I believe NHS Connecting for Health is working hard with the companies involved to overcome this.”

Oakley admits that critics of NPfIT have said it paid too much for the original PACS deals, and that it failed to secure some key functionality – such as the ability to transfer images between trusts. However, he says attitudes are starting to change.

“[The quarterly surveys of trust satisfaction run by] NHS Connecting for Health have found that Accenture’s PACS has been getting increased figures for satisfaction over the past three or four quarters, particularly around value,” he says.

He also says that Accenture has been engaging in “positive conversations” with the seven trusts that have yet to extend, with only one trust actively seeking a new partner.

Doncaster stands alone

That trust is Doncaster and Bassetlaw Hospitals NHS Foundation Trust, which has gone out to tender via the Official Journal of the European Union.

Dr Neelam Dugar, a consultant radiologist at the trust, tells EHI that information from CfH suggests that “a lot of trusts” are set to follow suite and to procure new systems through the OJEU route.

“While there seems to be a divide between the Accenture user group and others, there are a lot of trusts that are going out to tender, which I believe is a good thing both for the trusts and the market,” she says.

With the chief executive of the NHS, Sir David Nicholson, setting a ‘challenge’ to trusts to create efficiency savings of £20 billion by 2015, Dr Dugar believes that tendering is essential in an “age of austerity.”

“The main factor behind our decision was financial. But I also believe that trusts that do not go out to tender might be left behind in other ways. For example, they may not secure vendor neutral archives and or own the data their systems produce.”

Dr Dugar believes that the OJEU route will allow trusts to “define” their requirements and that the “huge market place provides lots of great vendors” keen to meet them.

Suppliers have sixty four tenders to choose from

Malcolm Hart, commercial director of Philips Healthcare, also thinks trusts will take a variety of approaches – bolstered by his company winning a collaborative procurement launched by six NHS trusts in Surrey and Sussex.

“We are not seeing a clear North/South divide – the regions are quite varied in terms of their approach as to whether they opt for an 18 month extension to take them to 2016 or not,” he says.

However, with a lot of trusts now out to tender, and even more yet to declare their intentions, there is concern that some will not get what they are looking for from an in-demand supplier community.

“There is a concern from some trusts that they might be left with something that they don’t necessarily want. In this economic climate, some trusts might not have any choice,” says Tony Tomkys, sales director for vendor neutral archiving specialists, BridgeHead Software.

Tomkys points out that there are 64 OJEU notices for PACS, and says that he can sense a “panic situation developing with trusts, especially in the South, who haven’t yet put solid plans in place.”

On the other side of the customer-supplier equation, he says one vendor has told him that it has the capacity to enter the market for just one further tender.

One area that is spared the “panic” is London, where the BT contract does not finish until June 2014. Tomkys says trusts in the capital will be “watching intently and learning lessons” from the actions of trusts elsewhere in the country.

Dr Dugar thinks this should go further, that collaboration between trusts should be improved in a “phone a friend” manner.

“There is panic and I can understand that but there shouldn’t be,” she says. “Going out to OJEU and procurement is not as difficult as people make out; you need to work together as a team.”

NHS Supply Chain to the rescue?

The big, central initiative to support the transition from one way of contracting for PACS to another is NHS Supply Chain’s national framework.

It has put together a four-year framework agreement, worth between £171m and £363m, with the DH, the Royal College of Radiologists Imaging Informatics Special Interest group, CfH and the National Imaging Clinical Advisory Group.

Dave Burns, senior buyer for NHS supply Chain, told EHI that the framework is designed to be very flexible. He argues that trusts will be able to use it to take a ‘tactical’ approach to keeping their systems running through the end of the national contracts, or a ‘strategic’ one if they are ready to make a bigger move now.

Similar, he said it would allow trusts to adopt a ‘best of breed’ approach by picking from the eight different lots ont he contract – PACS, RIS, works stations, vendor neutral archiving, data migration, off-site storage, CR and transcription services – or buy a package from a ‘single supplier.’

“At the start of the process, we sought the opinion of NHS bodies and IT directors about what they wanted to see,” Burns said. “There were two levels of interest. Some trusts wanted to manage their contracts and pursue a best of breed approach, by picking from the individual lots.

“Other trusts – which tended to be the smaller trusts – would not be able to manage those relationships, and wanted a solution from a single PACS vendor.”

BridgeHead’s chief executive, Tony Cotterill, says the framework should have been the “first thing in place.” “I understand why there wasn’t an appetite for it politically, with it being associated with trusts being dictated to from the centre, but it was left too late. Not enough has been done that would have improved the current situation.”

But Siemens Healthcare’s managing director, Peter Harrison, welcomed the move when “trusts are currently flooding the market.”

“It would have been beneficial to have the framework in place earlier, as for most hospitals there will be clear core requirements that will be needed,” he said. “The framework process is not a silver bullet, but it would certainly be a help for both trusts and suppliers in what is a challenging market with increased competition.”

This is an updated version of the feature that ran in this summer’s digital imaging special report [link].