National PACS Programme broke even

The programme to deliver picture and archiving communications systems to hospitals in England has saved almost as much money as it cost, according to figures released by the National Audit Office under the Freedom of Information Act.

By the end of March 2011, eight years after the National Programme for IT began rolling out PACS systems in England, the programme had cost £855.2m in 2004-5 prices.

The benefits over the same period amounted to £711.4m – £144m less than the costs. Using real prices, rather than 2004-5 prices, the total benefits came to £814.8m.

The programme’s biggest cost was its local service provider contracts, amounting to £674.8m.

Local costs came next at £140.6m, followed by the central costs of delivery and core support (£24.6m) and NPfIT delivery apportionment (£15.1m).

The greatest benefit came from improved operational effectiveness, at £542.8m.

The Department of Health, which calculated the original figures for a report on the benefits of NPfIT for the Commons’ public accounts committee, found most of the benefits came from improved turn-around times.

The spreadsheet released by the NAO, which was asked to rule on whether the costs and benefits calculations were reasonable by the committee, says the time from completion of examination to production of the clinical report fell to less than 42 hours on average.

Before the introduction of the National PACS Programme, it was 144 hours on average.

The second largest benefit came from moving to a digital process, removing the need for chemicals and film to process images (£105.4m.)

Removing the need to manage, store and transport physical images brought benefits of £47.1m, while the cost avoided with maintenance charges from previous imaging services brought benefits of £16.2m.

The figures, which date from 2012, also predict costs and benefits to the end of the programme’s life, estimated as March 2016.

The forecast cost to end of contract, in 2004-5 prices, was £1.08 billion, while the forecast benefit was £1.03 billion – a differential of only £50m.

Richard Evans, chief executive officer of the Society and College of Radiographers, said the figures demonstrated that the PACS programme had been a success.

“They indicate that given the right leadership, and backing from the clinical community, a large-scale IT project can be very cost-effective.

"There are countries around the world that look with considerable envy at the progress in installing PACS in such a short time across the whole of the NHS.”

Evans argued that that the figures may underestimate the harder-to-quantify operational benefits.

“If you can imagine the time taken for a radiographer to take a cassette to a processing machine and wait for the image to come out, that’s all disappeared,” he said.

“With computed radiography, there was still the process of taking the cassette and putting it in a loader.

"But the image was available much more quickly, and the loaders tended to be much more localised to the room, so there wasn’t so much time taken.”

The more recent move to digital radiography means that there is no cassette movement, and the image comes up directly after the exposure, Evans said.

“I think that once you add in the other benefits, they overtake the costs considerably,” he added.

England’s PACS/RIS market is currently undergoing a major refresh, as the contracts placed by the National PACS Programme come to an end, and trusts in the different LSP clusters exit onto locally negotiated deals.