1. A Perspective on the PACS Programme David Whitfield 20 th April 2005

2. 2 A Perspective on the PACS Programme Introduction and Context Scene Setting Bidding Contracting Early Delivery Growing Pains Conclusion

3. 3 Scene Setting (1) Features of Successful Programmes –Have a clear vision and real sponsorship (otherwise failure is not left to chance) –Concerned with outcomes rather than deliverables –Embrace systems, processes and people aspects –Involve the stakeholders and deploy clear management –Embrace & control change rather than resist & stifle it Some Danger Signs –Over ambitious –Over complicated –Over long –Few early benefits planned

4. 4 Scene Setting (2) Some things to remember: By default, large programmes fail / under-deliver You cannot contract for the behaviour you require –Partnership is essential – it’s a long term relationship –Shared objectives, recognising different measures of success –The behaviour that you incentivise rather than penalise –Contracts are baselines/agreements not management handbooks –Contracts are the reference of last resort – in court Nothing of real value is achieved without a struggle …. it’s meant to be hard!

5. 5 Bidding – to April 2004 Small procurement team Bidder-to-user contact –Limited by process –Good reaction to supplier initiatives –Information baseline Detailed requirement specification –National solution from multiple vendors –Consultation process –National integration vision Sequence change without impact analysis Moving goalposts and short timescales

6. 6 Contracting (1) Supplier selection: end April 2004 Then, all of a sudden, nothing happened ….. …... and after a while, nothing more happened ….. ….. and then it was July ….. ….. when “things” really did start to happen Discussions on contractual matters: –commenced –faltered, and then –resumed in earnest –early engagement at 3 Trusts

7. 7 Contracting (2) Small procurement team handling multiple LSPs IT procurement model based on the core contract model Top-down deployment targets drove: –“cookie cutter” model with rapid responses committed from the NHS –introduction of “encouragements” for the contractors –significant obligations agreed on the Trusts (and the wider NHS) Governance and management model A number of cliff-edge moments After nearly 7 months had elapsed from supplier selection: –agreement reached on 11 th November 2004 –with no change in deployment target dates

8. 8 A Business Change Programme Systems Processes People …. with a contract which focuses on the delivery and operation of the enabling IT component

9. 9 …. which is only about this …. Southern Cluster Primary Image Store West Dorset Server Rack

10. 10 ….. to facilitate the changes from this …..

11. 11 ….. to support the vision of …..

12. 12 ….. film-less and paper-less imaging

13. 13 The Going-In Environment Centrally established requirements Standardised buying method Output based service charging Limited user involvement Information centralised and then…. Huge urgency Lean scaling Unclear financial arrangements Limited communications Lack of ready answers on important topics ….. hence some “tricky starts” were to be expected …..

14. 14 Early Engagement A fast start was essential but had to be sustainable and strategically aligned Pre-contract work provided a framework for wider engagement Focus on delivering early results Temporary Order mechanism avoided many start-up delays Initial equipment configured and ordered for 3 Trusts and for the Cluster Image Store within 5 weeks Working with the Trusts rather than “doing PACS to them” Finding ways round obstacles / challenges rather than using them as “explanations” for delays Striving to fill the information gaps for the Trusts ….. ….. and feeling a way through the governance arrangements …..

15. 15 Stakeholder Relationships around PACS XYZ Hospitals NHS Trust SHA National Programme for Information Technology Southern Cluster

16. 16 Contractual Relationships for PACS XYZ Hospitals NHS Trust SHA National Programme for Information Technology Southern Cluster

17. 17 Deployment Sequence Initial Meeting Prelim Config Final Config Bus Case Approval Place Order Rec & Stage Eqpt Install & Integrate Test & Accept Go Live Ongoing Service Temporary Order

18. 18 Deployment Status - Today Initial Meeting Prelim Config Final Config Bus Case Approval Place Order Rec & Stage Eqpt Install & Integrate Test & Accept Go Live Ashford & St. Peter’s Milton Keynes Salisbury Ongoing Service Dartford & Gravesham North Bristol, NOC, East Kent Cluster Store Gloucestershire Poole Worthing & Southlands Royal Surrey, MTW Plymouth Brighton & Sussex Royal Cornwall Temporary Order West Dorset

19. 19 Growing Pains Life changes after any major service goes live: –Priorities: restoration, continuity, enhancement –Environment continually changes - PACS is not an island –Technology presents new opportunities The service must evolve or risk becoming irrelevant The current “early nursing” is not scalable –Broader engagement ahead –Industrial strength processes to be institutionalised –Governance and management gear change –BUT each Trust sees their PACS deployment with fresh eyes

20. 20 Conclusion The urgency was a significant factor in building momentum The end of the beginning has now arrived –One Trust may not a Cluster be.... but it is at least a tangible start! –There is no realistic way back It will get harder ….. ….. before it gets even harder ….. but lessons can be learned to make it easier Change will be both an imperative and a potential threat The deployment will inevitably cause the vision to evolve ….. and finally…..

21. “Enabling a step change in healthcare provision” PACS...