East Sussex Hospitals NHS Trust was an early adopter of digital imaging. It purchased a picture archiving and communications system from Agfa before PACS was added to the National Programme for IT in the NHS.

This meant that its contract was due to expire in 2012 – a full year before most of the trusts that took part in the programme had to think about what to do next. This pushed it into being another pioneer – this time of re-procurement, which proved to be a daunting task.

“The initial local enquiries made by the trust suggested that modernising the system was going to be very expensive,” Neil Crundwell, consultant radiologist at East Sussex Hospitals, told an event run by Acuo recently. “We hadn’t really kept up – we had quite an out of date system.”

A joint procurement

One way of reducing the pain was to collaborate with other local trusts, specifically Brighton and Sussex University Hospitals and Western Sussex Hospitals.

And there were other, good reasons for doing this. Sooner or later, these trusts would also need to procure a new PACS, and it would be easier to share images if they all had the same supplier.

“If you’re buying as a large group you can get things cheaper, and it allows a degree of future-proofing,” Dr Crundwell argued.

“We can use the existing networks – there were already good governance structures set up across the various trusts at IT level. We could ensure that we had common standards across the area, and allow an easier transfer of service.”

In 2011, the local health informatics service agreed to set up a programme for a pan-Sussex PACS and radiology information system, and a formal case for collaboration was approved in August.

The trusts then considered three different procurement routes. The first involved submitting an OJEU notice for a framework service, with East Sussex as contracting authority and Western Sussex and Brighton and Sussex as participating authorities.

The alternatives were for the three trusts to publish a joint notice for a PACS/RIS service; and for East Sussex to act as the contractual organisation, selling on services to the other two.

They chose the first option, because it offered the greatest flexibility and collaboration, and any participant could drop out without jeopardising the process. By September 2011, Queen Victoria Hospital in East Grinstead and East Surrey Hospitals had also joined the collaborative procurement.

Competitive dialogue or restricted procedure?

The collaborative had to make a decision about whether to procure through a competitive dialogue or restricted procedure.

“After some deliberation and flying in the face of all the independent advice we got, we decided to go with competitive dialogue, which was relatively unknown and relatively unused at that time,” said Dr Crundwell.

It is also a more complex and challenging procedure, but enabled the trusts to work with suppliers during the evaluation phase and work together to finalise the specification.

This was particularly helpful because the trusts had agreed to procure a vendor neutral archive along with the PACS and RIS.

“At the time, VNA was a relatively new concept within the NHS, and nobody was really sure they could say, ‘This is what I want from my VNA’,” Dr Crundwell explained.

“The idea [with competitive dialogue] was you could have an ongoing modification of the specification, rather than saying at the beginning: ‘This is what we want,’ and being told: ‘You can’t do this,’ or: ‘You could have this, but you haven’t asked for it.’”

From OJEU to implementation

Radiologists, radiographers, PACS managers, procurement staff and representatives from both community and acute trusts were all consulted during the procurement. The collaborative also took advice from an external procurement expert and external legal experts.

The OEJU notice was published in November 2011, and an initial financial assessment followed by a pre-qualification questionnaire assessment made it possible to draw up a long-list of eight.

An Invitation to participate in dialogue was published in January 2012, and after a series of product demonstrations, the list was whittled down to three.

This was followed by competitive dialogue sessions in early February, reference site visits, more product demonstrations and a second round of competitive dialogue sessions in March.

The preferred bidders were agreed in May 2012: Philips was chosen to provide the PACS, HSS to provide the RIS, and Acuo to provide the VNA.

In the meantime, there had been changes to the original collaborative. East Surrey left after its existing provider Sectra – which had been on the long-list – pulled out of the procedure. Royal Surrey County and Ashford and St Peter’s joined the collaborative in March 2012.

Implementation took place between September 2012 and July 2013. Initially, the contract is for a fully managed service over five years, with an option to extend to ten years at the same price.

The service level agreement provides for 99.99% uptime, and there is no software licensing, allowing for unlimited use of applications.

Dr Crundwell told the event that the collaborative approach had its challenges, the biggest of which was increased complexity.

“Across six sites, it became very difficult to find venues and times when everyone could come along [to meetings].

“There are tensions within the group – different people have different expectations of what the outcome might be, and you have to overcome all that. There’s also local politics – people in one organisation don’t always trust another one, and you have to get round that.”

Cost savings and patient benefits

But there have been upsides. The collaborative approach meant that each trust saved about £65,000 in procurement costs in comparison to what they would each have spent procuring individually.

The trusts that had previously been tied into a local service provider made a 35% saving on the cost of a managed service.

For East Sussex, however, the cost for a managed service increased from £120,000 to £490,000 – although it had no further hardware costs (and in 2011 alone, the trust had spent £320,000 on hardware.)

The trusts expect to see a number of positive outcomes from the implementation, Dr Crundwell adeed.

These include the redesign of workloads, so trusts can track abnormal results and make sure action is taken by the referring clinician. This will improve patient safety and, it is hoped, reduce litigation.

Images are now instantly available for the referring organisation within the collaborative, and the VNA will be able to store information from other sources, such as gastroenterology and pathology.

Eventually, Dr Crundwell expects to see other outcomes, such as electronic requesting, joint booking, joint reporting, the ability to interface with regional neurosurgery and cardiology and the ability to work remotely.

The whole process took a lot longer than anticipated, he admitted. But the collaborative learnt some valuable lessons.

“Robust project management is essential – we had a very good project manager, who’s very dogged and drove the process forward. You need to be very clear about the specification because you get what you ask for. If you don’t ask for what you want, you don’t get it.”

His final piece of advice? “Use the expert resources that are out there, and learn from others. Speak to others who have done it and find out what they did.”