Digital scanning systems look set to revolutionalise diagnostics. Alexis Nolan examines the progress of England's Connecting for Health 'vanguard sites'

There was no fanfare, but a major milestone was passed when the first two 'vanguard sites' for the picture archiving and communications systems offered through NHS Connecting for Health went live in March.

PACS is not new technology. The trouble is it is used in fewer than 30 acute trusts. That means the vast majority are missing out on the advantages of it. CfH aims to change that, and the experiences of West Dorset General Hospitals trust and Hillingdon Hospital trust should help to create some impetus.

Digital imaging eliminates the use of film, saving the cost associated with the use and disposal of chemicals and reducing problems with storage and retrieval of images. Lost or missing films lead to cancelled operations and one in five legal cases being lost by the NHS.

PACS can play a central part in the service redesign essential to help speed up diagnostics and cut down waiting times; staff and financial resources can be redirected. It can have a positive influence on recruitment and retention of radiographers and radiologists. As an enabler of good clinical service it could help in standardising good service delivery.

And the benefit of CfH's PACS package is the link into the national data spine that means images will be available across England with a touch or two of the keyboard.

CfH PACS implementation manager David Jennings says the vanguard sites are progressing well. 'The key modalities within departments are linked and being used on a day-to-day basis. And that gives them the opportunity to generate all the normal benefits of PACS. So images are now electronic and several people can now look at that image at one time, ' he says. 'They are not reliant on doing the paperchase or the wet film chase you would have had historically. You do not have any lost films so procedures do not need to be repeated.

'These are real benefits that are happening here and now. Trusts are building up pathways to support multidisciplinary teams. They can actually run teams of special interest groups who are caring for the patient - so you would have physiotherapists, radiologists, orthopaedic surgeons all in looking at these images at the same time and discussing the best way forward with the patient's care.' And the more trusts that use the technology the more the vision of clinical PACS communities to support diagnostics will become a reality, he says. 'It is a clinical solution with the patient as the focus, ' adds Mr Jennings. 'That patient flow ultimately is England-wide and that is the vision for the PACS solution.' CfH group programme director Claire Mitchell is confident about the progress of PACS - roll-outs at the rate of six or seven a month per cluster from early autumn and full deployment by March 2007 - but there are inevitably hurdles still to be cleared.

The solution is delivered through the five CfH clusters in England. There are separate lead service providers for each cluster and each has either completed or is still in the process of appointing a provider of PACS and of the cluster data store needed to hold images from trusts and allow for the sharing of images nationally.

Three of the clusters signed contracts at the end of last year. CSC, local service provider for the North West, agreed a deal with ConMedica for its PACS solution and for the company to provide a cluster data store for images. In the South, Fujitsu signed up GE for PACS and in London BT is providing Philips PACS equipment and is also using the group for cluster data storage. service providers for the North East and East have not yet agreed their deals, although they are 'imminent', Ms Mitchell claims.

'With the other two clusters everything's not stopped, ' she adds. 'The negotiations are continuing, but at the same time we are working to get draft implementation plans so we know which trusts are first up in terms of vanguards and what the roll-out profile looks like over the course of the next 18 months. People are bringing together business cases based on the draft pricing.' Perhaps the biggest issue with PACS is that unlike some other elements of CfH, trusts have to pay their own way. This means that PACS is competing for scarce financial resources.

'You have got a lot of capital investment and You have got a huge amount of clinical appetite for this [PACS]. It is getting that joined up at your board level, so your financial director is behind it as much as your clinicians and actually working for a way to explore business cases and make sure it is robust, ' says Ms Mitchell.

Although CfH talks of 'hard, tangible pound notes' and the help it is giving to trusts with their business cases, it seems unable, or unwilling, to provide indicative figures for costs, savings and timescales for achieving savings.

Department of Health national implementation director for PACS Katy Mason says: 'I do not think we are looking to save money by implementing PACS. We are going to use that money in a more efficient and better way, in a way that improves the quality of service to the patient and improves the facilities that clinicians have got to do their jobs better and more efficiently. Clearly the business cases have to be made at organisation level. For them to get signed off by their boards they have got to show that the cost benefit works out.' Ms Mitchell says that insufficient identification of benefits is a weakness the CfH team consistently sees in trusts. Too often the bigger picture elements around patient flow and process benefits are lost.

But more than likely, the progress of PACS will be dictated by a game of cat and mouse between trusts and the government over funding. One senior observer says trusts are playing a familiar gambit: resisting pressure to invest in the hope of getting DoH funding. The business case is a nobrainer but people are still holding out for more money from the centre.' l