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Collaborative Procurement. Dr Neil Crundwell Consultant Radiologist ESHT. Collaborative Procurement. Why How Lesions learnt Implementation Immediate and distant futures. Why. Why did we need a new PACS Legacy system (AGFA). Contract due to expire mid 2012.
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Collaborative Procurement Dr Neil Crundwell Consultant Radiologist ESHT
Collaborative Procurement • Why • How • Lesions learnt • Implementation • Immediate and distant futures
Why Why did we need a new PACS Legacy system (AGFA). Contract due to expire mid 2012. Initial local enquiries suggested refreshing system very expensive.
Local drivers • Contract ends in 2012- need to progress procurement activities • Image Sharing needs linked with BSUH/WSHT for Trauma and MDT • Community access to images post merger? • GP Access to Images? • Refine storage procurement & installation responsibilities
Why • Why did others need a new PACS • LSP contract due to end mid 2013 • At time very unclear how future provision would be co-ordinated. • Series of meetings arranged by local HIS late 2010, early 2011 to assess awareness of impending end of service and plans deal with this.
Possible Procurements • Individual within CFH Framework, NHS Supply Chain, own procurement process • Collaborative Sussex procurement for joint supplier PACS, RIS and/or VNA (archive) • Collaborative Sussex procurement within the CfH framework with options to choose individual or joint supplier for PACS, RIS and/or VNA (archive) • BSUH and/or WSHT extend current contracts with CSC individually – not a confirmed option at time
Why • Local PACS community highlighted a collaborative approach as the desired way forward • Joint approach involving ESHT, BUSH, and WSHT for procurement of PACS/RIS/VNA
Perceived Benefits • Cost Efficient; shared resource/expertise • Sharing of key outputs e.g. OBS, OBC,FBC • Procurement buying power • Compliments future proof technology plans • Robust governance and use of existing networks • Common standards enabling ease of service transfer and image sharing.
How • February 2011 HIS Board agreed to set up a programme for a Pan Sussex PACS / RIS • May 2011 Strategic Executive Group approved programme but requested case for collaboration submitted and approved August 2011 • Stakeholder engagement by Programme lead in May – Trusts keen to explore possible areas of collaboration on procurement and organised meetings to explore options - remembering that ESHT needed to progress their procurement.
How- possible procurement routes Option 1: OJEU notice for a framework service, with ESHT as contracting authority and WSHT BSUH as participating authorities Outcome: A single service provider however individual trusts have their own contract with the service provider. Pros: Greatest flexibility and collaboration, shared procurement costs, common OBS, doesn’t preclude local configuration, single set of evaluation criteria, single contract, all participants can pull out at any time, no sanctions for not signing a contract, trusts can still engage with suppliers independently? Cons: If ESHT pull out then the whole process closes, if BSUH or WSHT drop out then lose economies of scale Competitive Dialogue or Restricted Procedure
How- possible procurement routes Option 2: ESHT, BSUH and WSHT publish joint notice for PACS RIS Service Outcome: A single service provider however individual trusts have their own contract with the service provider. Pros:Shared procurement costs, common OBS, doesn’t preclude local configuration, single set of evaluation criteria Cons: Complicated way of doing a framework. If one trust pulls out then the whole process closes
How- possible procurement routes Option 3:ESHT contractual organisation and sells on services under SLA to WSHT and BSUH Outcome: A single service provider however individual trusts have service agreement with ESHT for services. Pros: Difficult to define any but done as a needs must e.g. Community Systems for ESHT from SCT. Cons: Complicated and requires much greater level of collaboration.
How • Option one chosen with ESHT as Trust to issue OJEU notice. • Competitive dialogue
Governance Sponsoring SRO Programme Manager Business Users: Consultant Radiologist Radiology Service Manager PACS Manager GP Commissioner Advisory: Finance PACS/RIS Expert Community SHA Lead PACS/RIS (Project team when relevant) Business Suppliers: Technical Infrastructure Current LSP Supplier New PACS/RIS Supplier Sussex Executive Group SHA, SPfIT & CfH Sussex IM&T Programme Board CSUG-Clinical & Service User Group for Southern Cluster PACS/RIS Programme Board Main Projects in the Programme Options/Business Case Procurement Surrey Sussex PACS/RIS Local Network Groups ESHT Implementation BSUH WSHT Other Partners
How • Queen Victoria Hospital East Grinstead joined August 2011 • East Surrey Hospitals joined September 2011
Procurement Strategy • The Procurement strategy was based upon best practice as described in POISE and under EC Directives. Due to the expected whole life time costs of the project the procurement was via an OJEU notice. • The specific procedure selected was competitive dialogue as this route allowed the Trust to work with suppliers during the evaluation phase and jointly understand and finalise the specification. This route is recommended for new innovative systems or where the solution will be bespoke. • The Collaborative used an external procurement specialist to assist and advise.
Who • Radiologists / Radiographers • PACS managers • Service managers • Trust and Network IM & T • Trust procurement staff • IG • Representation from Community and acute trusts • (other specialities)
Assistance • Central Project manager funded through HIS • Independent PACS expert for outline and full business cases and OBS • Independent procurement advice for OJEU/PQQ, documentation and assessment sessions and competitive dialogue • Independent legal advice as required
Procurement Process • Outline business case for each trust approved Oct 2011 • Procurement project established and OEJU notice published November 2011 by ESHT on behalf of multiple Trusts. • Initial assessment against financial criteria and if actually supplying a PACS system • PQQ assessment and long list to 8 • ITPD published early Jan 2012. • Product demonstrations by each bidder and evaluation workshop against criteria to reduce shortlist of 3 Jan 2012
Procurement Process • 1st competitive dialogue sessions February 2012 • Reference Site visits February 2012 • Product demonstrations (open invite) March 2012 • 2nd competitive dialogue sessions March 2012 • Final evaluation and preferred bidder May 2012
Complications • East Surrey left collaborative after Sectra (their current provider) left the procedure although selected for the 8 long list • Royal Surrey County and Ashford and St Peter’s joined in March 2012
Procurement Process • Preferred bidder agreed May 2012 Philips as prime contractor Philips PACS, HSS RIS and Acuo VNA • Full business case approval May- June 2012 • Implementation Sept 2012 – July 2013.
Key Contract Clauses • Service Agreement main points • One supplier contact for the service 5 year fully managed service – revenue and therefore VAT recoverable • Option to extend to 10 years at same price • No implementation costs from Supplier • No double running costs • Based on volumes of studies with 10% compound increase • Performance 99.99% uptime with <2s image retrieval local, <6s VNA • No software licensing therefore unlimited use of applications
Benefits of joint procurement • Shared procurement costs saved each Trust in the region of £65,000 compared to estimated single cost. • Previous LSP trusts made a 35% saving on cost of managed service. • ‘Increased cost’ for managed service at ESHT from £120k to £490k but no further hardware costs -£320k in 2011 alone.
What is against a collaborative approach • Increased complexity particularly around organisation of meeting / events • Tensions with group • Different expectations of outcome • Different desired outcomes • Personalities and local politics • Remembering you are not a consortium!
Long term Benefits • Difference between outcome and benefit • Measures to assess benefit • So what?
Potential benefits • Improved patient care and experience • Improver referrer experience • Improved efficiency and quality • Cash releasing • Cash generating
Expected long term outcome and benefit • Outcome: Fully Managed PACS RIS VNA Service • Benefit: Continued ability to deliver patient care beyond March/June 2013
Potential outcomes and benefits • Outcome :Redesigned workflow utilizing new functionality to be able to track abnormal results and ensure action taken by referring clinician. • Benefit: Improved Patient Safety, Reduced Litigation
Potential outcomes • Multidisciplinary Diagnosis Team processes redesigned to utilise new functionality • Provision of instantaneous reformatting of images by consultants including 5 years online data. • Images instantly available from referring organisation in collaboration • Store other images on the VNA eg gastroenterology, pathology
Potential outcomes • Electronic Requesting • Joint Booking System • Joint reporting (Voice recognition reporting) • Joint Radiologists On-Call • Interfacing with other specialities eg regional neurosurgery and Cardiology • Remote Working
Summary • It takes much longer than you think initial discussions to full implementation late 2010 to mid 2013 • Robust project management essential • Clarity and precision around OBS • Use expert resources and learn from others • ‘Procurement in a box’
