Collaborative Procurement

1
Collaborative Procurement

• Dr Neil Crundwell
• Consultant Radiologist ESHT

2
Collaborative Procurement

• Why
• How
• Lesions learnt
• Implementation
• Immediate and distant futures

3
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.

4
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

5
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.

6
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
  

7
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

8
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.

9
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.

10
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, doesnt
  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

11
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,
  doesnt 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

12
How- possible procurement routes

• Option 3ESHT 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.

13
How

• Option one chosen with ESHT as Trust to issue
  OJEU notice.
• Competitive dialogue

14
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 IMT Programme Board
PACS/RIS Programme Board
CSUG-Clinical Service User Group for Southern
Cluster
Main Projects in the Programme
Options/Business Case
Procurement
Surrey Sussex PACS/RIS Local Network Groups
ESHT
Implementation
BSUH
WSHT
Other Partners
15
How

• Queen Victoria Hospital East Grinstead joined
  August 2011
• East Surrey Hospitals joined September 2011

16
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.

17
Who

• Radiologists / Radiographers
• PACS managers
• Service managers
• Trust and Network IM T
• Trust procurement staff
• IG
• Representation from Community and acute trusts
• (other specialities)

18
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

19
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

20
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

21
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 Peters
  joined in March 2012

22
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.

23
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 lt2s image
  retrieval local, lt6s VNA
• No software licensing therefore unlimited use of
  applications

24
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.

25
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!

26
Long term Benefits

• Difference between outcome and benefit
• Measures to assess benefit
• So what?

27
Potential benefits

• Improved patient care and experience
• Improver referrer experience
• Improved efficiency and quality
• Cash releasing
• Cash generating

28
Expected long term outcome and benefit

• Outcome Fully Managed PACS RIS VNA Service
• Benefit Continued ability to deliver patient
  care beyond March/June 2013

29
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

30
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

31
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

32
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

33

• Contact neil.crundwell_at_esht.nhs.uk