Executive Summary

Appendix 1

(EXECUTIVE SUMMARY)

Amendment History:

Version Date Amendment HistoryV0.1 28 October 2005 First draft for review to Project Sponsor

EXECUTIVE-SUMMARY1995.DOC ROYAL UNITED HOSPITAL, BATH

CREATED BY INFORMATION SERVICES DEPT.

of 26

V2.0 13 February 2006 Second draft to Project sponsor for reviewV3.0 16th February Project Board membersV3.1 17th February 2006 Pagination correctionsV3.2 21st February 2006 Typo corrections.V3.3 5th March 2006 New finance modelling addedV3.4 9th March 2006 Typo correctionsV3.5 10th April 2006 Updated Financial modelFinal 11th April 2006

Reviewers:

This document must be reviewed by the following.

Name Signature Title Date of Issue Version

Brigid Musselwhite

Director of Planning and

Strategic Development

13th Feb 2006 V0.1

Approvals:

This document requires the following approvals.

Name Signature Title Date of Issue VersionPACS Project

BoardChair

RUH Trust Board

Chair

RNHRD Trust Board

Chair

AGW CfH Board

Chair

Document Location

This business case has been created using a template provided by the National Programme for Information and Technology (CfH) using a standard five case model.

This is a controlled document. The amendment history outlines the development of the document and those involved in the version amendment and approval process. The comments box makes it clear the version which is agreed as the final version.

On receipt of a new version, please destroy all previous versions.

EXECUTIVE-SUMMARY1995.DOCROYAL UNITED HOSPITAL, BATH of 26

Related Documents

These documents will provide additional information.

Ref no Doc Reference Number Title Version

1 CFH-NPO-GEN-IP-0067 Glossary of Terms Consolidated.doc Latest

Glossary of Terms

List any new terms created in this document. Mail the librarian to have these included in the master glossary above [1].

Term Acronym Definition

Picture Archiving and Communication System

PACS

National Care Records Service

NCRS

Radiology Information System

RIS

Local Service Provider LSP

Connecting for Health CfH


Contents

1Executive Summary................................................................................................................51.1 Introduction and Purpose ................................................................................................51.2 Strategic Case Overview.................................................................................................8Economic Case Overview....................................................................................................10

There is an ongoing piece of work to gain clarity on an issue around the accounting treatment of the refreshed assets which could affect the impact on revenue funding during the first five years. Work with reference to National guidance on refreshing the assets may have a beneficial effect on the distribution of revenue payments across the whole life of the project. ................................................................................................................................................ 17

1.6 Financial Case Overview ..............................................................................................201.7 Management Case Overview......................................................................................221.9 Conclusion..................................................................................................................... 26


1 Executive Summary

1.1 Introduction and Purpose

This document is the Business Case to support the local investment in a Picture Archiving and Communication System (PACS) to be procured for the Bath Clinical Area under the aegis of the Department of Heath Connecting for Health (CfH) programme. It is for approval by the Board of Royal United Hospital Bath NHS Trust (RUH NHS Trust), the Royal National Hospital for Rheumatic Diseases NHS Foundation Trust (RNHRD), Bath and North East Somerset Primary Care Trust (BANES PCT), Kennet and North Wiltshire Primary Care Trust, West Wiltshire Primary Care Trust (Wiltshire PCTs) and Avon, Gloucester and Wiltshire Strategic Health Authority (AGWSHA).

The implementation of PACS is now defined as a “core” part of the NHS Care Records Service (NCRS). Contracts are in place with Local Service Providers (LSP) to provide PACS services for Trusts in line with achieving the government target of all NHS Trusts to have PACS by March 2007. Implicit within this development is the requirement to ensure that compatible a Radiology Information System (RIS) exists at a local level which complements the implemented PACS solution. Radiology Information systems (RIS) services are likewise provided as part of the LSP Contracts.

Although the national procurement for an integrated NHS-wide PACS solution has achieved significant cost reductions on PACS equipment, local resources and funding in the form of cash savings and other funding sources will be required to implement it and to achieve the efficiency gains, across the health community, that PACS can bring for the benefit of patients. Detailed benefit appraisal and project objectives are described at 3.6 & 1.3

High level investment objectives are:

• To improve the patient experience by improving timeliness and accessibility of radiology reporting

• To improve the efficiency of radiology services

• To improve clinical safety through increased reporting and encouraging clinical/peer audit

• Contribute to the achievement of national access targets e.g. 18 weeks.

Approval is therefore required for a capital investment of £3.1m over the contract period until March 2017 (LSP contract ends June 2013). This represents the “undiscounted” cost for the provision of a full PACS option. Capital costs incurred for each Trust are detailed below:


RUH PACS Project Indicative Capital Costs

CfH Core Capital (40%)

SHA Core Capital (33%)

RUH Core Capital (27%)

RUH Additional

Capital (100%)

RNHRD Additional

Capital (100%)

No. of community modules

Community Additional

Capital (100%)

Service Revenue

Community Module (per module)

3£142,459.4

4£23,262.39

RNHRD

£44,907.32

£7,754.13

RUH Additional

£402,837.53 £57,393.78

RUH Core

£488,273.00

£561,114.07

SHA Core

£835,000.00

CfH Core £1,177,000.00

£488,273.0

0 £402,837.53

Total CfH £1,177,000.00

Total SHA£835,000.0

0

Total RUH £891,110.53

Total RNHRD£44,907.3

2

Total Community£142,459.4

4

Total service revenue £649,524.37

Total Project capital £3,090,477.29

Does not include building costs, networking costs or legacy system links.


PACS will be available to other radiology service users but outside the scope of this project.

Costs exclude VAT and the future impact of inflation. Service charges will not apply until April 2007 but we will be required to pay the service charges for the project over a 9-year period.


1.2 Strategic Case Overview

National Drivers

PACS is an important component of the National Care Records Service (NCRS). Recognising this, Connecting for Health (CfH) have separated PACS from the NCRS programme as an independent procurement stream to allow rapid implementation across England ahead and alongside of NCRS. It is planned to implement PACS in all Trusts in the Southern Cluster by end March 2007. The RUH timetabled go live date is November 2006.

The strategic case has been made at National level and has been mandated to the Trusts. The main strands of the Strategic case have taken into consideration the National context, local investment objectives, existing arrangements and future business needs.

1.3 Project Objectives

High Level Objective Overall Objective More Specific ‘SMART’ Objectives

To improve the patient experience by improving timeliness and accessibility of radiology reporting

Improved operational efficiency of Clinical Radiology

1. Report all activity next day. 2. Create spare capacity and income.3. Eliminate reporting waiting lists

Improved provision of images, clinical evaluations and reports

4. Provide images for out patients, in patients and MDT meetings on demand.

5. Provide images with minimum recall time.6. Provide one years worth of live image data.

More effective Clinical Radiology Services

7. Reduce use of hard copy images to < 3%8. 98% use of soft copy reporting9. Demonstrate improved Clinician satisfaction

Better service for Medico-legal and Access to Health Care Records enquiries

10. Faster turnaround of requests11. Cost effective and more useful provision of copies on

CD or DVD

To improve the efficiency of radiology services

Integration of Diagnostic Imaging Services

12. Integration of services to wider Health Care environment

13. Integration of services to NHS Care Record SystemTo ensure images are available wherever and whenever necessary

14. To reduce the time that junior doctors spend looking for and collating films by 90% within 12 months of implementation into clinical areas

15. Increase the number of images that are available for outpatient clinics to 95% 12 months after full rollout across community

16. To improve clinician satisfaction with the service provided by the Radiology Department following full implementation

To maximise the efficient use of available staffing resource 17. To reduce the amount of time that junior doctors

spend looking for and collating films by 90% within 12 months of implementation in clinical areas

18. Reduce the number of administrative staff needed within the Radiology Department by 25% within four years of full implementation at each site

19. Improve clinician satisfaction with the service provided by the Radiology Department following full implementation at each site

To reduce the need for storage space for images 20. Eliminate the need for film filing storage by 100%

following full implementation at each site

21. Reduce the number of hard copies by 95% immediately following full roll out


High Level Objective Overall Objective More Specific ‘SMART’ Objectives

To improve the quality of the service provided

22. Increase the incidence of reporting and verification of images to 100% by 2008

To improve clinical safety through increased reporting and encouraging clinical/peer audit

Governance 23. Reduced radiation exposure due to lower repeat films and incidence of “lost” films

24. Improved access to images thereby speeding up access to results

25. Increased availability of data for audit and teaching

26. More effective peer audit of scans through MDT meetings

Contribute to the achievement of national access targets e.g. 18 weeks.


1.4 Project Benefits

Economic Case Overview

The preferred solution for PACS has been determined nationally. PACS will be in place across the NHS by March 2007 with services being delivered through the LSPs. The requirement for national integration with cluster storage and the NCRS has been determined at national level. Contracts have been put in place, within each cluster, for local delivery of the national PACS solution through the LSP. The decision to procure PACS as a core service through the LSP has been confirmed to the NHS by a DH letter of direction from Margaret Edwards.

This excludes the adoption of a Do Minimum option as a viable way forwards on the grounds that it non-strategic.

The economic case is intended to confirm the preferred option, to establish the preferred scope of the local option and to demonstrate Value for Money in terms of costs, risks and benefits. This Economic case appraises the relative costs, key quantifiable risks and key quantifiable benefits of local investment in a local health community wide PACS against a ‘Do Minimum’ scenario in order to provide a comparison of the quantified cash releasing and non-cash releasing benefits for the affordability analysis in the Financial Case and the Benefits Realisation Plan and Risk Register within the Management Case.

There is no requirement to demonstrate the value for money of the LSP PACS solution at local level. The case for the preferred way forward in terms of value for money of procuring, through the LSP, as opposed to a non-LSP route is made at national/cluster level.

CfH has signed a PACS contract for the Southern Cluster with Fujitsu Services as the Local Service Provider (LSP). The PACS solution being provided by Fujitsu is based extensively on the Centricity PACS product set from GE Healthcare. In specific Trusts within the cluster, including the RUH, the contract also includes deployment of a Radiology Information System (RIS) provided by Healthcare Software Systems (HSS). The RUH has undertaken an assessment of the need to implement the HSS system it is the recommendation of the Project Board that the Trust migrate from the existing RIS as a key element of this programme of work to ensure PACS requirement compatibility.

The cluster contract for deployment of PACS to the RUH includes the deployment charges for the Royal National Hospital for Rheumatic Diseases (RNHRD) and that Trust has indicated it wishes to proceed with PACS as part of this initiative, but have elected not to proceed with the implementation of a replacement RIS.

1.5 Options

The Bath PACS procurement is based on a ‘medium sized Trust’ as determined by DoH and it is anticipated that this will finance a ‘core’ implementation. The Project Board has considered a number of deployment options:

Option A: Do Minimum

This is the status quo option and is included for baseline purposes. This option is characterised as continuation of the existing process with no implementation of PACS or replacement RIS (in RUH services). Each area in the Community continues to expand existing filing space (or contract additional external space to accommodate the projected increase in workload) and recruits additional filing and administrative staff to manage the projected increase in workload and increased capacity. Digital images provided to the patient on CD at other sites, will require laser printing with Bath Community providers. Increased levels of radiology staff, (radiologists and radiographers) will be required to maintain service levels.

Option B: Core PACS enablement only

This option will provide a partial PACS solution at RUH only. The funding model of a medium sized Trust will not fund any activity outside the Radiology Department and will provide a partial benefit to service users through increase reporting rates but limited accessibility to images. Digital images provided to the patient on CD at other sites, will require laser printing with Bath Community providers as in Option A

Option C: PACS enablement in RUH and RNHRD only

Option C extends the core service in Option B to the RNHRD and deploys the additional services identified within RUH. This option will enable wards and RUH OP clinics to benefit from PACS.


Option D: PACS enablement in RUH Centre, RNHRD and 3 Community Hospitals only (one location in BANES and 2 locations in Wiltshire).

This option is a community wide solution as described above but provides for the potential rationalisation and longevity of the 10 community hospitals reducing to 3 sites (suggested estimation and not agreed or confirmed at this stage). Community sites are calculated as a unit cost and multiplied and no account is taken of site specific issues. It is recognised that no final decision has yet been reached on the provision of clinical services in Wiltshire. This PACS option will need to accommodate flexibility in future service provision.

Non – financial option appraisal (ranked)

Non Financial Comparison Option A Option B Option C Option D

Report all activity by next day. 4 3 2 1

Create spare capacity. 4 2 2 1

Eliminate reporting waiting lists 4 3 2 1

Provide images for out patients, in patients and MDT meetings on demand.

4 3 2 1

Increase the incidence of reporting and verification of images to 100% by 2008

4 3 2 1

Provide images with minimum recall time. 4 3 2 1

Provide one years worth of live image data. 4 1 1 1

Reduce use of hard copy images to < 3%

4 3 3 1

98% use of soft copy reporting 4 3 3 1

Demonstrate improved Clinician satisfaction 4 3 2 1

Faster turnaround of requests 4 3 2 1

Cost effective and more useful provision of copies on CD or DVD

4 2 1 1

Integration of services to wider Health Care environment

4 3 2 1

Integration of services to NHS Care Record System

4 2 2 1


To reduce the time that junior doctors spend looking for and collating films by 90% within 12 months of implementation into clinical areas

4 2 2 1

Non Financial Comparison Option A Option B Option C Option D

Increase the number of images that are available for outpatient clinics to 95% 12 months after full rollout across community

4 4 3 1

To improve clinician satisfaction with the service provided by the Radiology Department following full implementation

4 2 2 1

Reduce the number of administrative staff needed within the Radiology Department by 25% within four years of full implementation at each site

4 2 2 1

Eliminate the need for film filing storage by 100% following full implementation at each site

4 3 3 2

Reduce the number of hard copies by 95% immediately following full roll out

4 3 3 2

Reduced radiation exposure due to lower repeat films and incidence of “lost” films

4 2 2 1

Total 84 61 45 23


Financial Option appraisal

RUH PACS Business case summary

Option ADo

Minimum(with

growth)

Option BPACS

RUH core only

Option CPACS

RUH + RNHRD

Option DPACS

Community wide

Staff 0 -84,400 -646,400 -363,200

Non Pay 4,864,798 4,334,775 3,953,595 4,101,961

Project costs 0 122,958 122,958 122,958

Capital 255,000 647,423 1,095,165 1,237,624

Net Additional Cost 4,864,798 4,982,198 3,953,595 5,339,585

NPV 3,920,598 3,674,747 3,380,866 3,516,788

EAC 391,999 367,418 338,034 351,624

EAC including risk 392,169 371,124 342,147 356,155

Rank 4 3 1 2

Note: These options are ranked not scored.

On the basis of cost, benefit and risk analysis Option D is the preferred option. If the Bath Clinical area stakeholders do not wish to proceed with PACS solutions on the grounds of cost, Option C will fulfil the national contract and deliver most of the benefits to the RUH and RNHRD.


RUH PACS Business case version 2 Option D - RUH Total + RNHRD + Community x 3 with increase in images but no increase in activity, income or staffing

Additional costs if do PACS


Year 2005/6 2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

Year 1 2 3 4 5 6 7 8 9 10 11

Staffing:

Radiologist - - - - - - - - - - -

Other med staff - - -10,000 -10,000 -10,000 -10,000 -10,000 -10,000 -10,000 -10,000 -10,000

Radiographers snr - - - - - - - - - - -

Radiographers jnr - - - - 23,600 23,600 141,600 141,600 141,600 141,600 141,600

Nurses - - - - - - - - - - -

Filing clerks - - - -84,000 -84,000 -84,000 -112,000 -112,000 -112,000 -112,000 -112,000

secretaries - - - -54,000 -54,000 -54,000 -54,000 -54,000 -54,000 -54,000 -54,000

other admin - - 60,000 20,000 20,000 20,000 30,000 30,000 30,000 30,000 30,000

RDAs - - - - - - - - - - -

Travel - - -5,000 -5,000 -5,000 -5,000 -5,000 -5,000 -5,000 -5,000 -5,000

- - 45,000 -133,000 -109,400 -109,400 -9,400 -9,400 -9,400 -9,400 -9,400

Non-pay :

Film & Processing costs 2,858 75,235 -474,382 -468,811 -468,811 -468,811 -468,811 -468,811 -468,811 -468,811 -468,811

Storage - 22 - - - - - - - - -

2,858 75,257 -474,382 -468,811 -468,811 -468,811 -468,811 -468,811 -468,811 -468,811 -468,811

Project costs 35,000 87,958

Capital charges - 56,868 637,297

618,523

599,761

581,011

562,273

256,839

248,336 10,863 10,537

Service charge - - 649,524

649,524

649,524

649,524

649,524

649,524

649,524

649,524

649,524

Old Maintenance contracts - - -113,000 -113,000 -113,000 -113,000 -113,000 -113,000 -113,000 -113,000 -113,000

Total Costs 37,858 220,083 744,439

553,236

558,074

539,324

620,586

315,152

306,649 69,176 68,850


Total Additional Income 0 0 0 0 0 0 0 0 0 0 0

Net Additional Cost of Option D £ 37,858 220,083 744,439 553,236 558,074 539,324 620,586 315,152 306,649 69,176 68,850

Discount Factor % 1.0000 0.9662 0.9335 0.9019 0.8714 0.8420 0.8135 0.7860 0.7594 0.7337 0.7089

NPV £ 37,858 212,641 694,942 498,987 486,329 454,097 504,847 247,707 232,873 50,756 48,809

EAC £ 351,624

CapitalReplacement of equipment :

PACS capital costs - 1,078,474 - - - - - - - - -

Associated costs - 159,150 - - - - - - - - -

Total Capital - 1,237,624 - - - - - - - - -


There is an ongoing piece of work to gain clarity on an issue around the accounting treatment of the refreshed assets which could affect the impact on revenue funding during the first five years. Work with reference to National guidance on refreshing the assets may have a beneficial effect on the distribution of revenue payments across the whole life of the project.

Financial Summary for preferred option ‘D’. Split of costs

RUH PACS Business case version 2 - Option D

Year Total Additional Wilts Banes RNHRD RUHYear

Staffing:Radiologist 0 - - - - Other med staff -100,000 - - - -100,000Radiographers snr 0 - - - -

Radiographers jnr 896,800 35,872 8,968 8,968 842,992

Nurses 0 - - - - Filing clerks -924,000 - - - -924,000secretaries -486,000 - - - -486,000

other admin 300,000 12,000 3,000 3,000 282,000

RDAs 0 - - - - Travel -50,000 - - - -50,000

-363,200 47,872 11,968 11,968 -435,008

Non-pay :Film & Processing costs -4,615,588 - - -140,722 -4,474,866Storage 22 22

-4,615,566 0 0 -140,722 -4,474,844

Project costs 122,958 4,918 1,230 1,230 115,581

Capital charges: PACS 3,592,529 104,943 52,472 49,622 3,265,037

Capital charges: associated 3,233 1,437 - 115,786

Service charge 6,495,240 155,080 77,540 77,540 6,185,080

Old Maintenance contracts -1,130,000 - - - -1,130,000

Total Costs 4,101,961 316,047 144,646 - 362 3,641,631

Total Additional Income - - - - -

Net Additional Cost of Option D £ 4,101,961

316,047 144,646 -362 3,641,631


Discount Factor % 10.0016

NPV £ 3,516,788 270,961 124,011 -311 3,122,127

EAC £ 351,624 27,092 12,399 -31 312,164

CapitalReplacement of equipment :

PACS capital costs 1,078,474 94,972 47,486 44,907 891,111

Associated costs: 159,150 DICOM Interface 4,272 1,899 - 36,980 Building - - - 106,000 Other - - - 10,000

Total Capital 1,237,624 99,244 49,385 44,907 1,044,091

1.5 Commercial Case Overview

The PACS and RIS service required will be sourced through Fujitsu Services who is the LSP for the Southern Cluster. The contractual arrangements are as specified between the LSP and the DH as the contracting Authority on behalf of the NHS. The contract will run until 30 June 2013, with an option for a one year extension, in line with the existing LSP contracts of which PACS and RIS is a component part. As part of the contracted LSP arrangements additional elements of PACS and RIS equipment and service can be purchased from the negotiated additional services catalogue.

The timetable for the acquisition of PACS by the local health community is as follows.

Activity Date

Determine Local Requirements Specification January 2006

Complete and Approve Outline PACS Business Case Mid February 2006

Initiate baseline measurements of anticipated benefits February 2006

Establish Final Local Requirements Specification and agree in detailed discussions with LSP

February 2006

Complete and approve PID [as part of Management Case] 30th April 2006

Agree central capital and other required funding 8th March 2006

Complete and gain approval of Full PACS Business Case with all relevant Authorities – at Board level where required

10th April 2006

Complete Purchase Requisition and any Additional Services Request Form for additional items. This form must be countersigned by RID. NB This is a key event that triggers many activities including ordering

May 2006


Activity Date

equipment.

Order any associated upgrades May 2006

Confirm timetable slot for local PACS with Cluster & SHA April 2006

Commence RIS and PACS Implementation April 2006

Complete installation of RIS September 2006

Complete installation of PAS January 2007

Completion of Acceptance Testing and issue of Milestone Achievement Certificate

January 2007

Review Benefits Ongoing after go live

No Transfer Undertakings for the Protection of Employment (TUPE) implications have been identified as there will be no transfer of existing staff to a new employer as a result of the implementation of PACS.

On completion of the milestone achievement certificate the Trust will become liable for the deployment charge payment. This payment, approximately 30% of the contract cost will be capitalised and will appear on the balance sheet of the Trust being depreciated over the remaining lifetime of the contract. Additional elements and other capital costs will also appear on the Trust balance sheet and be treated accordingly. The refresh of additional elements will be either included as part of the service or will be subject to further capital investment as shown within the financial case The most significant risk within this project relates to the local health community financing within AGWSHA. Within 2006/07 there must be no revenue pressure as a consequence of this project. Such pressures would jeopardise SHA approval, the consequences on the contractual commitments with Fujitsu have to be determined.


1.6 Financial Case Overview

In the Financial Case the affordability of the preferred option, D has been explored, taking into account both the expenditure and anticipated funding. The results are summarised in the table below.

RUH PACS Business case version 2 - Summary

No PACS PACS models

Option A Option B Option C Option D

Do Nothing RUH core only RUH Total + RNHRD Community wide

Increase Images (modality) Increase Images (modality) Increase Images (modality)

No increase in activity or income



Total Net Additional Cost

4,864,798

4,334,775 3,953,595 4,101,961

NPV 3,920,598

3,674,747 3,380,866 3,516,788

EAC 391,999

367,418 338,034 351,624

EAC including risk 392,169

371,124 342,147 356,155

Rank 4 3 1 2

The total expenditure (comprising hardware, software and support costs plus the cost of extra local area networking and peripherals to support PACS) over ten years will cost £6.37m.

The Capital cost is being funded by a combination of CfH and Strategic Health Authority capital with an allocation from Trust block capital for 2007/08. This will split as follows.

The Director of Finance has confirmed that funding is available for the period in which funding is known (3 years) and that it will be accommodated in future years.


Plans are in place to ensure delivery of the benefits across the Trust/Community


1.7 Management Case Overview

The project, to acquire and implement PACS, is being managed according to PRINCE2 with the following management structure

JOINT PACS PROJECT BOARD

JOINT PACS PROJECT STEERING GROUP

Orthopaedics

Comms

Community Radiology TrainingMDM/

Education

A&E RNHRD ITUResp/

Medicine

RNHRD BANES PCT WILTS PCTSRUH

Stakeholder Boards

Operational Groups One member of each group

PACS PROJECT STRUCTURE

BATH & WILTSHIRE CfH BOARD

The membership of the PACS Project Board

Member Job Title and OrganisationSpecific Project / Assurance

Role

Brigid MusselwhiteDirector of Planning and Strategic Development

Project Champion / Chair

John Williams Director of Finance Financial Governance

Richard Smale Head of IT IT and Comms Governance

John Travers Specialty Divisional Manager Implementation Assistance

David GlewConsultant Radiologist – Clinical Director Radiology

Clinical Lead and champion

Diane Fuller Director of Patient Access Operational Governance

Steven Haynes Director of Finance RNHRD rep

Hazel BraundDirector of Service Improvement and Delivery

BANES rep

Jenny Barker Director of Operations Wilts rep

Steve Boxall PACS Project ManagerReporting to Project Board for delivery

The Project Board will have:

• Joint strategic oversight for PACS Programme• Ownership by all participating organisations of Joint PACS Programme• Control of PACS investment

The terms of reference are as follows:

• Act as a decision making forum for all matters related to the Joint PACS Programme


• Account to the respective Trust Boards (or their delegated authorities such as NHSCRS Programme Board) to whom its Minutes will be sent

• Be chaired by one of the Board-level members agreed to by the JPPB members or an agreed combined-Board chair

• Ensure that the respective Trust Boards or their delegated authorities are kept fully briefed on all relevant matters and that an agreed schedule of specific decisions are referred to the Trust Boards for determination by them

• Consider issues related to the impact of the Programme on clinical objectives and operational activities of the participating organisations and advise accordingly

• Approve the Programme Plan and monitor overall progress on achieving the Plan• Take responsibility for the agreed financial framework, including sources and

applications for the Programme, and monitor the progress of the Programme to ensure financial targets are met to agreed timescales

• Monitor the commitment of central finance for the Programme to ensure that it is expended as intended and that the SHA and cluster receive adequate financial briefing

• Receive regular reports on the progress of the Programme from the Joint PACS Programme Steering Group (JPPS)

The Membership of the PACS Project Steering Group

Member Job Title and OrganisationSpecific Project / Assurance

Role

John Travers Specialty Divisional Manager Operation Lead

Steve Boxall Project ManagerProject Management and Coordination

Craig ForsterManager of RUH Radiology Services

Specialty input and Service redesign

Terence Gregory Superintendent RadiographerSpecialty input and Service redesign

Stephen Hayward, Dominic Fay and Graham Robinson

Consultant RadiologistSpecialty input and Service redesign

Derek Harland IT IT input

Sara WellingsSpecialty Divisional Accountant

Finance Input

Rachel IngramSpecialty Division HR Manager

HR Input, role redesign

Ian Orpen GP , BathRepresent GP interests and pathway development

Nigel Harris Represent RNHRD interest

The PACS Steering Group will have responsibility for:

• Financial management of PACS Programme• Programme plan monitoring and management• Communication with staff of participating organisations & public• Delivery of project against objectives to time, cost and quality.

They will:

• Act as a steering group for the PACS Programme ensuring that Programme implementation plans are viable and monitoring progress against those plans

• Account to the Joint PACS Programme Board (JPPB) or appropriate combined-Board to which its Minutes will be sent, for the delivery of the Project.

• Be chaired by one of the clinical representatives agreed to by the JPPS members


• Consider change management issues related to clinical processes or operations generated by or impacting on the Programme advise accordingly

• Monitor detailed progress on achieving the Programme Plan and agree detailed amendments

• Commission communication about the objectives of the PACS Programme and its progress against the anticipated timetable to staff of the participating organisations and the public

• Monitor detailed financial expenditure and commitments within the agreed financial framework, to agreed timescales

• Receive regular reports on the progress of the Programme from the PACS Operational Groups.

• Regularly review Project risks and issues and determine appropriate management actions as necessary, including escalation of major issues to Project Board for approval and/or decision.

Operational Groups will be set up by the Project Steering Group and receive work packages from the Project plan. They will consist of:

Communications

Clinical users

Emergency Medicine

ITU

Orthopaedics/theatres

Respiratory Medicine

Urology

RNHRD

Community pathways

Radiology

Nuclear Med

Breast Unit

Ultrasound

Training and Workforce

Registration on spine

Smart cards

RIS training

PACS training

Role review and redesign (including KSF development).

MDM/Education

IT

Estates

The following milestones have been identified. More detail can be found in the Project Implementation Plan (appendix 12).

Milestone Date

LSR complete February 2nd 2006

Financial Model complete February 10th 2006

Draft Business case complete w/e February 11th 2006


Milestone Date

Project Board approves draft Business case March 2006

Business Case to Trust Boards for sign off April 2006

Business Case to stakeholder Boards April 2006

Installation configuration Completed April 2006

PACS / RIS Order May 2006 – Week 1 of Project

Additional PACS / RIS Order (clinician/theatres workstations and enhanced RIS features)

May 2006

Agreed RIS/PACS Implementation Plan April 2006

RIS Installation and Delivery June 2006

PACS Installation and Delivery November 2006

Master Training Completed RIS July 2006; PACS November 2006

Data Migration Completed RIS July 2006; PACS November 2006

Testing Completed RIS August2006; PACS December 2006

Go Live RIS September 2006

Go Live PACS January 2007

PACS Deployment Key Milestone Certificate January 2007

Hand off to Service January 2007

Project Closure February 2007

The following people have been consulted in the development of this business case:

Local Health Community

Royal United Hospital Bath NHS TrustRoyal National Hospital for Rheumatic Diseases NHS Foundation TrustBath and North East Somerset PCTKennet and North Wiltshire PCTWest Wiltshire PCTMendip PCTBath and Wiltshire CfH Programme BoardPACS Programme BoardRadiology Dept RUHOrthopaedic Dept RUHCardiology Dept RUHNuclear MedicineITUFinanceIM&THR Dept RUH

External

SHA - Avon, Gloucester and Wiltshire SHACfH PACS implementation AdviserLSP – Fujitsu Services and associated contract suppliersEarly Adopter sites


1.8 Risks

The table below outlines the possible placement of risk under the LSP contract structure for PACS.

Risk CategoryPotential allocation

Community LSP Shared

1. Design Risk

2. Construction & Development Risk

3. Transition & Implementation Risk

4. Availability and Performance Risk

5. Operating risk

6. Variability of Revenue Risks

7. Termination Risks

8. Technology & Obsolescence Risks

9. Control Risks

10. Residual Value Risks

11. Financing Risks

12. Legislative Risks

13. Other Project Risks

1.9 Conclusion

The local health community will gain significant advantages by being an adopter of the PACS programme.

PACS will provide considerable benefits in terms of improved workflow, for all those using medical images that will have benefits right across the local health community leading to efficiencies in many areas and contributing to central targets such as eighteen week targets from referral to treatment, four hour waiting in A&E departments, diagnostic services and reduced working hours for junior doctors.


Executive Summary

Documents

Transcript of Executive Summary