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NHS England – Taking Control of RIS / PACS

Tony Corkett

2nd May 2012

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Agenda

• Background• Challenges• Options to consider• Procurement routes• Example of recent project• Lessons learnt

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The successful PACS providers in England

London clusterCapital Care Alliance, led by BTPhilips / Sectra

Eastern clusterAccentureAgfa

North East clusterAccentureAgfaNorth West & West

Midland clusterThe CSC AllianceComMedica / Kodak

Southern clusterThe Fujitsu AllianceGE

GE

The CSC Alliance

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Challenges (1)

• LSP contracts ending (2013-15)• 80% of Trusts have an element of LSP

PACS / RIS• Many of the non LSP systems are also up

for renewal in the same time window

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Challenges (2)

• NHS capacity and capability• Supplier capacity• Business case sign off• Procurement process – which one• What do I replace with what

– PACS / RIS / EPR / VNA / CR / breast screening / cardiology ……

• Data migration / retrieval

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Options

• Consortium or stand alone• Shared systems or stand alone• System architecture

– PACS-RIS (single supplier)– PACS+RIS/EPR (could be EPR supplier)– VNA – what is that?– Other systems

• Managed service or cap and Rev• What about CR

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Do nothing is not an option

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Procurement Options

• OJEU

• Framework

• Extension

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OJEU

• the open procedure, under which all those interested may respond to the advertisement in the OJEU by tendering for the contract;

• • the restricted procedure, under which a selection is made of those who respond to the advertisement and only they are invited to submit a tender for the contract. This allows purchasers to avoid having to deal with an overwhelmingly large number of tenders;

• • the competitive dialogue procedure, following an OJEU Contract Notice and a selection process, the authority then enters into dialogue with potential bidders, to develop one or more suitable solutions for its requirements and on which chosen bidders will be invited to tender; and

• • the negotiated procedure, under which a purchaser may select one or more potential bidders with whom to negotiate the terms of the contract. An advertisement in the OJEU is usually required but, in certain circumstances, described in the Regulations, the contract does not have to be advertised in the OJEU. An example is when, for technical or artistic reasons or because of the protection of exclusive rights, the contract can only be carried out by a particular bidder.

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Frameworks

• Already through OJEU• May be national, local or commercial• Typically contract T&Cs set• These may also be set:

– Price– Term– Supplier choice

• Often involves local tendering from shortlist

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Personal Comments

• Frameworks are a very valuable tool• Work well for simpler or transactional

processes or products• But in my opinion for complex system the ability

of the Trust(s) to set out their own requirements, contract terms and conditions is the better route – but you will need the skills and knowledge to deliver

• Frameworks may be the only option if you don’t start soon

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Recent Example

• Actual PACS / RIS / VNA / Cardiology Project

• Starting in Feb 2011 • Went live Feb 2012• (non LSP)• Work on-going – (key lesson)

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Example Timeline

Week 1 Week 8 week 16 week 36 week 40 week 41+

OBC FBC Implemetation

OJEU/PQQNegotiations /

Competitive DialogueContract complete

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• Procurement support• Sufficient resources• Organised teams:

– Project Board– Evaluation Team

• Commercial Team• Site Visit Team• Clinical Team• Technical team

What we had

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• OJEU Notice– Kept options open on:

• Who to include as organisations• What you are looking for• If you will break it in to lots / multiple suppliers

– You can ask some questions at this stage to rule out suppliers (legal and financial)

Competitive Dialogue Phases - OJEU

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• Pre-Qualification Questionnaire– Clear timetable– stated clearly that we would reject or

disqualify at this stage– State costs are at supplier risk– Consider FOI / COI / warranty– Selection matrix and how we scored the

responses

Competitive Dialogue Phases – PQQ

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Example PQQ Scoring MatrixPQQ Section (and sub-questions)

Information Weighting (%) 

Section A Background Information  Questions 1-7 Organisation details Information only

(not scored)Section B Financial and economic information  Question 1 Banker’s details Pass/FailQuestion 2 Accounts information Pass/FailQuestion 3 Financial Turnover (minimum annual turnover of £xxm) Pass/FailQuestion 4 Insurance Details (Please note that Candidates are required to demonstrate, for each type of insurance (i.e.

employers’ liability, public liability and professional indemnity insurances), a minimum cover of £xx millionPass/Fail

Question 5 Litigation/legal proceedings Pass/FailSection C Technical information  Question 1 Experience in delivering relevant services 35Question 2.1 Experience of integration and neutral archive 22

 Question 3 References Pass/FailQuestion 4.1 Support resources & location 10Question 4.1 Staff resources 13Question 4.2 Out of hours support model 10Question 4.3 State the products that you are seeking to provide and state which ones will be through a sub contractor Information only

(not scored)Question 4.4 Confirm your commitment to performance standards linked to a performance/payment regime. Pass/Fail

Question 4.5 Provide in outline the significant product developments you have released over the last 2 years and what you are planning for the next 2 years

10

Question 5.1 Deductions for damages Pass/FailQuestion 5.2 Contract/employment termination Pass/FailQuestion 5.3 Failed contract renewal Pass/FailQuestion 5.4 Legal proceedings pending Pass/FailQuestion 6.1, 6.2 Unlawful discrimination finding Pass/FailSection D Statement relating to Good Standing Pass/FailSection E Checklist Information only

(not scored)  Total weighting 100

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• The aim was to reduce the number of candidates to a manageable number – you can suggest how many in the OJEU notice

• The PQQ needs therefore to be built around what you are trying to achieve and are able to manage

• Debrief

Outcome of PQQ

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• Invitation to Participate in Competitive Dialogue– Background to the project– Rules on completion and pricing (recommend

you do not use costs for shortlisting), and procedure

– Evaluation criteria– Timetable– Offer site visit to see the Trust– High level requirements– Example of the contract – Formal response date

Competitive Dialogue Phases - IPCD

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• Keep it high level• What are the key areas that you need

addressed• Provide the detail that will help the

suppliers:– Key systems and functional needs– Activity– Equipment– Technical– approach to implementation

Competitive Dialogue Phases – IPCD - requirements

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• Enter into dialogue with the suppliers• Discuss

– Their initial responses / questions– Consider demonstration days– Reference site visits– Presentations

• The Trust is seeking to understand what the supplier can offer and how it can solve the needs as much as the supplier is seeking to understand the Trust needs

• This is a dialogue!

Competitive Dialogue Phases – IPCD - dialogue

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• Issue the scoring criteria– You can include:

• Site visits• Demonstrations• Dialogue responses• Contract comments• Presentations

– Use a team based approach to scoring and be consistent

Competitive Dialogue Phases – IPCD - evaluation

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• The aim is to reduce the number of candidates to a manageable number – you can suggest how many in the OJEU notice – suggest 3

• The IPCD needs therefore to be built around what you are trying to achieve and are able to manage

• Debrief suppliers• (some may withdraw on their own if they realise

that they cannot deliver what you need)

Outcome of IPCD

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• Invitation to Participate in Detailed Dialogue– Key here is to build out the specification– As your needs become clearer and you can see

what is available on the market– It is an iterative process – But be consistent– Keep a record of actions and who is delivering

them by when

Competitive Dialogue Phases – IPDD

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• Are the suppliers that are left capable of meeting your detailed needs and contract terms

• Confidence to issue BAFO

Outcome of IPDD

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• Best and Final Offer• Formal Document

– Needs to be issued and received under Trust SFIs for OJEU tenders

• Issue final contract schedules

Competitive Dialogue Phases – BAFO

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• Issue the scoring criteria and be consistent with IPCD– You can include:

• Site visits• Demonstrations - scripted• Dialogue responses• Contract comments• Presentations

– Use a team based approach to scoring and be consistent

– Then look at price and see which supplier offers the best score per £

– Ensure that you are comparing apples to apples

BAFO – Scoring

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• Once decision made and approved by Trust

• Enter Alcatel period – suggest 10 days• Then complete final tidy up of contract• Sign contract• Debrief all unsuccessful bidders

• The hard work then begins – implementation….

Preferred Bidder

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Example Timeline

Stage Days / Weeks

OJEU 30 days

PQQ 3 weeks

IPCD 10 weeks

IPDD 12 weeks

BAFO 2 weeks

Total 32 weeks – (~8 months)

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Implementation• Dedicated PM• Strong Project Board• Training and change is key• Technical:

– Data migration– Data storage (if local)– Networking– Interfacing

• Supplier should be a partner – drive out any benefits

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Lessons Learnt

• It can be done!• Have sufficient skills and resources

– This is a key hospital wide system– Understand what you planning on – VNA is

bigger than just radiology• The project to BAU transition may take

longer than planned• Ensure the supplier had the resources

available to meet your needs

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Questions?

info@amorgroup.com

Tony Corkett, Health Business Unit Director

With over 15 years experience working for the NHS, Tony has a vast depth of knowledge in providing health solutions that create cross community efficiencies. Leading the Health Business Unit, Tony’s passion is developing new health products to help improve patient care across the market. At the end of a long day in the office, Tony likes nothing more than sitting down with his feet up enjoying a large glass of wine.