They normally lose the contract because as so many trust have found out to their costs is they are usually more expensive than the tendered price as there are so many hidden costs. All those little jobs we do (that outside MES companies charge a premium for) add up to a significant amount. Hospitals do not care if an outside MES is efficient, they only care if they meet the agreed Service Level Agreements and are within budget.

Efficiency at the moment is not a trusts main driving factor, cost is. Unfortunately, cost outways efficiency in the NHS (which is why most ebme departments are under resourced). Untill S.L.A.s are mandatory for medical device servicing (as with A&E waiting time targets), the NHS has no real incentive (except the threat of litigation) to provide adequate funding.

+ you are only going to hand on business if it is not meeting your forecast profit margins.

Can we clarify if we are taking about MSV, MVS or MES. There is a big difference as the last few posts seem to be discussing MSV or MVS.

Bioman,

Given my limited knowledge and experience with MVS, MSV and PFI, I tend to associate MVS with PFI builds and MES with traditional maintenance methodologies that can be used by EBME & Medical Physics if management chooses to do that. I think that irrespective of the definitions of the services being provided the points being made above were about contracts between service providers and customers. I think what's being discussed above, particularly in the statements made by tbs_user, is the move from a MSV that is no longer providing that type of service to that Trust to one that is based around is MVS or MES. The NHS Trust mentioned has a large PFI build on the way so perhaps the MVS or MES is just mirroring the trend asociated with PFI builds elsewhere.

Depsite these issues being viewed as ones for each trust to manage locally it's apparent to me that there are definitely "preferred" options despite the "impartial" nature of tendering processes, etc. When a single MSV is adopted by a number of trusts involved in seperate tenders for the provision of medical equipment services, nationally, then these tend to be subsequently replaced by a single company providing MVS or MES a few years later, for contracts of widely varying cost, awarded at different times in different trusts, it's not difficult to envisage that there may be some "bias" irrespective of the deliberations of the trusts entering into the contracts, the attractiveness of the services on offer or even cost.

In a truly competitive environment the bottom-line is that the services provided, whatever they be, are costed depending upon the level of activity that's required. For MSV and MES they still probably need to be managed, to some extent, by an in-house team (purchasing departments do not have all the requisite skills necessary to do this) and it's likely that some staff are also going to be needed to give an immediate response to situations that are outside the remit of contracts - such as clinical support and training to operators. Otherwise costs could spiral - these are the situations that can't be tied-down to predictable costs at specification - to avoid extra-contractual obligations like, emergency response charges, 400% markup on spares used for repairs of equipment that's not tied in the specification plus exorbitant labour charges to arrive at the minimum 25% profit margins expected by one particular MSV provider, for example.

There has always been the option for MES and MVS types of activity to come under the umbrella of an in-house Medical Physics or EBME department - using service contracts. MVS and MES probably give flexibility for the provision of services that meet wide-ranging requirements but, due to the unpredicatable nature or costliness of some of the highly specialised services required in the NHS environment, this is still likely to leave a requirement for individuals to manage contracts, perform equipment evaluations prior to purchase, carry out acceptance testing, provide clinical support, maintain asset databases and records, advise on accessories, consumables, deal with indident reporting, evaluation & dissemination of bulletins, etc.

This leaves the routine work that can be specified and costed more predictably to those employed by the service providers, i.e. PPM, servicing and some types of breakdown where fixed price repairs can be agreed on. I think some people forgot about this when they agreed on the MVS contract, at the site that tbs_user mentioned, which allegedly turned out to be more of a burden financially and contractually, for service provider and customer, than anyone except individuals in the original Medical Physics Department, imagined.

tbs_user:

Which one - the in-house manager who wrote the specification or the MES manager who has to meet it? Assuming they're not one and the same (that's a safe assumption I think) then I'm certain they will have differing views. Remember it's only Day 3.......

Hi Richard

From attendance of the NHS Confederations Future Healthcare Network and the MES conference earlier this year MES is the concept involved with PFI. The MES provider owns the equipment, replaces it at agreed time intervals and maintains it in exchange for a yearly fee which should be lower than the the Trust spends on yearly capital purchases and maintenance contracts.

Some existing MES only involve big ticket items like imaging, pathology etc and run without threat to the existing EBME department who traditionally never looked after these items. Some of the commercial presenters report working side by side with EBME departments who sometimes were paid to provide first line.

Unlike the older MSV/MVS contracts which were outsourced ebme services like the one in Salford. Join the FHN, the contact at the NHS confederation is Kay Rulton and the chair is Lawrence Bunnett.

Another point to bear in mind which I don't think has been a mentioned above is the assumption that your work pattern, your trust's that is, will remain the same for the duration to the MES contract.

With the current push by the government for PCTs creating their own local treatment centres many of which we would regard as modern "cottage hospitals" there will be a drop off in demand for the facilities at traditional hospitals. Indeed we are considering such measures at our own trust.

3, 4 or 5 years down the road the requirement for certain types of equipment may be significantly reduced but hey, we signed up for an 8 year MES and they are insisting on payments for equipment we don't use. Where will the savings be coming from then, when even less money is flowing in from the PCTs?

Paying a fixed rate for goods or services against a decreasing or unknown income stream has never been a good a good idea.

Wether you agree or disagree over the benefits or otherwise of MES, PFI etc these are the realities of the modern NHS.


Brian

I would be interested in knowing if any colleagues out there have been involved with successful MES for Radiology equipment ?
and if they would be interested in sharing the details/experiences (good or bad) with me.
Many Thanks

Steve

I think Airedale went down the MES route for their radiology kit, might be wrong but you could give Geoff a ring.

Brian

Law, Barnet, Belfast, Dudley, Worcester, Woolwich to name but a few

Anyone at the aforementioned sites like to volunteer any useful info please ?

Hiya. In about 3 months, our Imaging MES comes on line. I'l be able to answer some questions at Xmas.

Eddie.