Queens Hospital PFI: Siemens Healthcare Services (SHS) has signed a 33-year managed equipment service agreement with the consortium responsible for the design and construction of Queens hospital in Romford – part of the Barking, Havering and Redbridge Hospitals NHS Trust

SIEMENS Managed Technology Services: The main focus of SMS Managed Technology Services is the provision of a seamless asset management service that offers significant benefits in providing modern and reliable technology to meet each hospital’s ongoing requirements to meet a defined clinical need.

项目管理在医院医疗设备管理中的应用: 医疗设备管理是医院微观管理的重要组成部分。随着现代医疗技术的飞速发展,国内外各种先 进医疗设备的大量引进,对医疗设备管理水平的要求也越来越高。

Managed Equipment Services M.E.S.

A Managed Equipment Service (MES) is the planned and coordinated approach to the purchase, installation, training, management and maintenance of medical equipment on a long-term basis. It can be as a stand-alone contract or as part of a PFI framework.

It is the outsourcing of functions away from hospital management and staff to a specialist commercial organisation. This provides a professional strategic approach and transfers risk away from the NHS. It is often a catalyst for wider service reform.

Questions & Answers

1. What is MES?

A Managed Equipment Service (MES) is the planned and coordinated approach to the purchase, installation, training, management and maintenance of medical equipment on a long-term basis.

It is a different and unique concept when compared to Multi-Service Vending (MSV) and Operating Leases.

An Operating Lease focuses purely on the financing of capital equipment. MES provider looks after all elements of the equipment process, from procurement and financing through to installation, plus the ongoing training of users and maintenance of the equipment. It is more than just the arrangement of equipment finance.

Multi-Service Vending is a customised approach to the maintenance of medical equipment. This can be useful, but it lacks the coordinated and long-term approach of MES.

2. Is MES a PFI or a PPP?

A MES provider can be as a stand-alone contract or as part of a PFI framework. It is not a PFI and does not need such an initiative in place to be considered by Trusts.

PPP (Public Private Partnership) is the umbrella term for all arrangements where the Public and Private sectors work together, or where the Public Sector employ the Private Sector to provide services. As such MES can be considered a PPP arrangement.

3. What type of equipment can/ should be included in a MES?

All types of medical equipment can be included, for example, radiology, theatres, pathology or radiotherapy. Smaller equipment, such as infusion pumps may need to be managed in a different way from larger medical equipment and fixed rooms.

4. How long should a MES contract run for?

MES provider evaluates the exact capital investment plan and recommends the optimum contract length on a case-by-case basis.

The key to the length is a balance between long-term, which delivers economical benefits, and shorter term, so that the Trust is not contracted too far into the future. An average length is 15-20 years.

5. What does a MES cost? Doesn't MES cost more?

MES contract has been shown to cost less than the cost of the NHS delivering the same equipment investment programme, equipment uptime, training and management programme itself.

Where the NHS has put together its own Public Sector Comparator (PSC), this has proven that an MES represents value for money.

The exact cost per annum of a MES depends on numerous factors such as the term of the contract, the type of equipment, agreed lifecycles, and the level of risk transfer.

6. What risk transfer is achieved through a MES?

Numerous risks are transferred away from the NHS to MES provider. As a specialist organisation developed to manage medical equipment and the associated risks, MES provider is best placed to manage these risks.

Examples of risk transfer:

	Cost of medical equipment
	Cost of maintaining medical equipment
	Reliability of medical equipment
	Speed of rectifying faults
	Cost of installing and commissioning
	Time taken to install and commission equipment
	Overall availability (uptime) of equipment
	Long-term cost of maintenance
	Long-term cost of financing capital investments (interest rates)
	Risk of technology obsolescence
	Room design risk
	FM interface risks

7. What type of legal contract is used for a MES?

The basis for the legal contract varies from scheme to scheme. These form the basis for new contractual arrangements. Typically, the contracts have a number of schedules detailing the exact services to be provided, the performance monitoring arrangements and the payment scheme.

8. How long does it take to procure a MES?

This depends on the urgency and level of resource a Trust can commit to working through all the relevant matters. Typically the procurement will take 6 - 12 months.

9. What are the key steps to procuring a MES?

	1. Appoint a project lead and form a Trust project team
	2. Request a presentation from Asteral on key issues, including a Q&A session
	3. Agree the scope of the MES (equipment type etc.)
	4. Issue OJEU notice
	5. Evaluate bids, including visits to existing MES sites. Appoint 'Preferred Bidder'
	6. Finalise and sign contract.

10. What are the benefits to clinicians?

A MES ensures that clinicians can continue focusing on the patient, leaving the entire procurement process and follow on activities to a specialised MES partner.

Clinicians will benefit from a planned and sustainable investment in essential equipment and technology. The latest upgrades and innovations will be available.

Clinicians will notice that they not only have the latest equipment, but that it is always available and fully functional.

11. What are the benefits to the Trust as a whole?

The benefits of MES approach have already been realised by many Trusts. Equipment uptime and clinical availability has been improved and new, innovative technology, such as direct digital imaging, has been installed. This quickly impacts on risk management, clinical productivity, improves care pathways, reduces waiting times and delivers a better quality of care.

12. What are the financial benefits?

An MES provider offers a stable, planned long-term strategy, moving capital equipment off the balance sheet and transferring risk away from the NHS.

Procurement, maintenance, training and ongoing costs are cut from the outset and continue during the MES lifecycle demonstrating the return on investment in a relatively short time. This in turn helps to achieve operational targets.

13. What is PFI? (Private finance initiative (PFI)

The Private Finance Initiative specifies a method by which the United Kingdom government provides financial support for "public private partnerships" known as Public-Private Partnerships (PPPs) between the public and private sectors.

These projects aim to deliver all kinds of works for the public sector, together with the provision of associated operational services. In return, the private sector receives payment, linked to its performance in meeting agreed standards of provision.

PFI is used in central and local government. In the case of projects procured by local government authorities, the capital element of the funding enabling the local authority to pay the private sector for these projects is given by central government in the form of what are known as PFI "credits". PFI is basically just a different way of purchasing. The local authority does the buying, just as it does at present.

Each PFI project is different depending on local circumstances. However there are some common threads that run through all projects. The public sector authority signs a contract with a private sector "Operator". During the period of the contract the Operator will provide certain services, which are currently provided by the local authority. The Operator is paid for the work over the course of the contract and on a "no service no fee" performance basis. The authority will design an "output specification" which is a document setting out what the Operator is expected to achieve. If the Operator fails to meet any of the agreed standards it will lose an element of its payment until standards improve. If standards do not improve after an agreed period, the public sector authority is entitled to terminate the contract.

It is also a very controversial program, with many trade unions across Britain launching campaigns against it. PFI has also been a centre of the Old Labour resistance to New Labour. Many see PFI as 'creeping privatisation' claiming that the plan is privatisation in all but name. There have been many problems with PFI, many of which have been monitored by the Private Eye magazine, a British satirical magazine.

The National Audit Office scrutinises public spending on behalf of Parliament and is independent of Government. It provides review reports on the value for money of many PFI transactions and makes recommendations pointing out how public sector authorities can improve their practices so that these transactions can be made even better value for money in the future

PFI has now been adopted by parts of Canada, France, the Netherlands, Portugal, Ireland, Norway, Finland, Australia, Japan, Malaysia, the United States (reference the Trans Texas Corridor highway development project [1] and Singapore (amongst others) as part of a wider reform program for the delivery of public services which is driven by the WTO, IMF & World Bank as a part of their 'deregulation' and privatization drive.

These projects aim to deliver all kinds of works for the public sector, together with the provision of associated operational services. In return, the private sector receives payment, above the price that the Public Sector could have achieved the work, linked to its performance in meeting agreed standards of provision.

http://www.dh.gov.uk/en/Procurementandproposals/Publicprivatepartnership/Privatefinanceinitiative/index.htm

http://thinkingaustralia.com/thinking_australia/wikipedia/default.php?title=Private_finance_initiative