3millionlives: Worcester Pathfinder issues business case (UK)

Update on the 3ML site: Worcester has issued its Assistive Technology (including telecare and telehealth) Business Case Document.

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Comments

  1. Cathy

    Well they include definitions which we always like … but really?

    [quote]Telehealth is the utilisation of dispersed call alarm linked technology to monitor vital health signs of a patient.[/quote]
    So all that other stuff that does vital signs monitoring without the dispersed call alarm link is not telehealth? Ouch!

    Notwithstanding the outcome of the options appraisal [i]- no sorry you need to read it for yourself! -[/i] the timescale of procurement and contract award does not sit well with fulfilling their Pathfinder share of the 100,000 extra patients/service users during 2013. Especially when training is only beginning in June 2013 …

  2. Jo

    I like the idea of combining the various AT services but there seems to be a lack of clarity in where telehealth ends and telecare begins. I’m thinking in particular about long term conditions such as epilepsy and functions such as improving medication compliance. The current technologies that are effectively alarms are considered to be telecare while the potential savings are also claimed to be telehealth benefits by the providers. I suspect that the business case is therefore subject to several instances of double counting which improves the case for telehealth (due to the outcome savings claims) while leaving the costs with telecare (thereby reducing the cost-benefits).

    The real weakness of the business case is, of course, the total reliance on “partner” claims regarding both costs and savings. The evidence is so weak to be laughable when none of the claims has been independently verified and when all of us “in the game” know that the exaggerations are profound and are only seen as plausible by naive social care directors and finance people who are desperate to find some savings. In contractual terms, shouldn’t there be a mechanism to claw back money from a managed service provider who does not facilitate the savings that they had promised?

    I could go on, but I will make only two more points:
    1. the reason that managed services seem to be the only game is town is down to the inefficiencies of existing provision. Council AT staff are knowledgeable and hard-working. Reducing the cost of assessment and service delivery through outsourcing may be possible by using a single (hopefully local) monitoring centre, or by offering a poorer service. Let’s hope that sufficient safeguards are put into place to ensure that quality standards are maintained – and that the measuring and monitoring of quality isn’t seen as being an expensive inefficiency that isn’t affordable; and
    2. Nowhere in all of this does the issue of patient choice come in. What about personal budgets and personal health budgets. Surely these will only work if people can exercise choice not only at the service provider level, but also at the level of actual devices deployed. We are talking about technology – and it must be the case that we will see continuous improvement along with cost reduction. Will service users and patients be locked into an arrangement with a provider in 3 years time which offers them equipment which is already digitally redundant? There is a need to ensure that the available inventory is wide and not exclusive to the products promoted by the managed service provider (especially if they happen to be an equipment provider in their own right). It is good to see that the estimated cost per household has dropped significantly from the rip-off prices charged in the WSD (and which made the QALY costs ridiculous) but they are still a factor of 2 higher than they need to be – especially when we see the opportunities available through various forms of m-healthcare. What about including a requirement that the independently assessed satisfaction rate amongst patients and their relatives is above 90%?

    Just a final word to congratulate Worcestershire for having the guts to publish their business plan. I have a feeling that they are doing so in the hope that the Great British public will help them to develop their tender specification so that they can achieve a high quality service without lining the pockets of the private sector.

  3. UNATTR

    The Referrals Risk in Point 12 on Page 45 needs significant highlighting as this is HUGELY integral in the success of this proposal.

    Analogue, analogue, analogue that is all I can hear. Installation Risk – you need a fixed phoneline – come on people what year are we living in? Is this the plan or is this the past. This tender will be bid for by certain companies that live on the reliance of fixed lines. These are disappearing at Rain Forest speed. Big fat fibres instead of big fat copper is here to stay. Clouds. 4G, even 3G and mobile broadband. Even if the dark ages are required for the ye olde worlde Telecare that they are proposing it definitely is not needed for Telehealth – unless certain companies products are being looked at and certain companies sales talk is being listened to.

    I am not the brightest star in the sky when it comes to technology but I can listen, I can ask questions and I have a decent enough knowledge of the subject area to look at this BC and see that it has been put together at a strategic level where input has been mainly from suppliers/er and not from anyone in the ‘general know’.

    Page 50 – B (TH) – oh come on. ‘Assistive Technology (TH) will be made available to patients with specified long term health conditions, as an extra to the health service that they currently receive.’ – As an extra, as an extra!!! Sounds integrated. Sounds like pathway redesign. No it doesn’t. It is hurting my head now. I spotted dust on this page and had it analysed. It came back as being from 2006!!!!

    Page 53 – Transport is affected because people travel less to GPs, hospitals, clinics. Relatives don’t have to respond as much as they would do if it was just a phonecall from the person if sensors, alerts and alarms are in place to assist remotely.

    A lot of very infuential people have signed off as approving this document. Either they haven’t given it the time and effort it deserves (an hour from me) or they are not necessarily the best placed people to approve its content. They may all have experienced in some way some form of AT. But not at the sharp end. Not at the assessor end. Not at the real person end. The trouble is that this then gets signed off and you get the service you have asked for.

    I really am not an expert (see my other posts on TA for proof) but I am someone who is passionate about this who wants it to succeed but but I fear for its survival. I’ll have a loaf; you know a bread loaf. Can’t go wrong with that, can you?

  4. Alasdair

    Amazing!!! Just amazing!

    Let’s outsource everything as the figures provided by industry say this and this. Bonkers.

    First we had the PTG which manufacturers picked up a nice share of £70m, now we have pathfinders where again, manufacturers can provide sound business cases for outsourced delivery and bags of cash. Whilst the actual trailblazers in these types of delivery (North Yorkshire and Birmingham come to mind)have yet to identify any significant savings or any savings and a failure of take up for Telehealth in particular.

  5. Alasdair

    I do hope that any of these contracts with external providers are based on payment by results / outcomes and not cost of boxes / service.

  6. Cathy

    [quote]I have a feeling that they are doing so in the hope that the Great British public will help them to develop their tender specification so that they can achieve a high quality service without lining the pockets of the private sector. Read more: http://www.telecareaware.com/index.php/3millionlives-worcester-pathfinder-issues-business-case-uk#comments%5B/quote%5D
    The business case was created on 1 October 2012 – there is no evidence of consultation with the public in the version log.

    There are still legal issues to address around charging which gives rise to installation risk – surely this needs to be addressed before tender? and we know how long “legal” can deliberate over things

    Then there is this little gem regarding how to fund all this – (my underlining):
    [quote]option b. Risk sharing with strategic partner – this will determined following procurement. Initial conversations with major providers indicate their willingness to bear the financial risk in return for a large scale deployment. They clearly have confidence that the benefits are there and can be measured.

    Option c. 3millionlives pathfinder site funding – WCC is currently in talks with The Department of Health over the funding of the provision of a fully managed service for 10,000 referrals. The announcement by Jeremy Hunt refers to “no upfront costs”.

    Option d. [u]Social finance funding – this is not considered to be a viable option at present, due to the uncertainty of benefits for telehealth[/u].

    This detailed business case has been written on the assumption that we are undertaking procurement based on option b, but we are still discussing the opportunities available under option c.[/quote]
    I was under the impression that 3ML had no funds to dish out … and we are going ahead with this even though there is uncertainty as to the benefits of telehealth? which also appears to contradict Option b’s statement!

    and finally this:
    [quote]June 2013: Contract award (The timescales above will only be met if the Programme Board will sign off and agree the tender document, evaluation framework, draft contract etc by end of February).[/quote]
    Doesn’t sound much to me like there is going to be the public helping to develop any of this. These are incredibly tight timescales for the public sector and with a project team and board of this size.

  7. Steve Hards, Editor

    @Cathy – small point – by ‘Great British public’ perhaps Jo meant Telecare Aware readers. Certainly, you have all been doing a good job of kicking it apart and exposing the flaws so far!

    Perhaps it is also worth remembering (if organisations are thinking of charging telehealth users) that the NHS cannot charge for providing equipment and neither can councils in England and Wales if the equipment costs less than £1,000.

    Steve

  8. Cathy

    @Steve – they do clearly state that telehealth will be provided free of charge.

    BUT the installation risk is around the phone line and whether the householder already has one – so since their telehealth has already been defined as connected to a dispersed alarm system this is a problem for both telecare and telehealth. If telehelath is free does that mean the NHS are expected to stump up for the landline installing etc too?

    Whilst it is not widespread there is a small but determined minority of people who refuse to have a phone line installed just to receive community alarm services. Where an authority is stating that the telewhatever support is by policy the preferred option they need to know how they will deal with this situation to comply with policy and deliver their services.

    As UNATTR points out restricting services to landline linked is a big part of this problem but many local authorities cannot get their collective heads round that. What if the mobile service isn’t maintained (topped up etc)? well that is easily addressed by acquiring informed consent on the part of the service user/patient that they understand their responsibility in that respect.

    Another example of how ‘we’ do not work in partnership with people but deliver things to them.

  9. Alasdair

    Question Steve and Everybody,

    Can any one tell me what the cost of a telehealth system is???? Are there costs for just buying 1 off the shelf or does it depend on how many you buy? Is there an average cost taking account of all those available in the market?

    As Cathy says, the timelines / involvements needed and scale as well as financials are more than 50 shades of grey :-)

  10. UNATTR

    If you are referring to the Community Care (Delayed Discharges etc) Act (Qualifying Services) (England) Regulations 2003 then it is community equipment and minor adaptations under £1000, Steve. The definition of Community Equipment ‘means a qualifying service(1) which consists of the provision of an aid, or a minor adaptation to property, for the purposes of assisting with nursing at home or aiding daily living; and, for the purposes of this paragraph, an adaptation is “minor” if the cost of making the adaptation is £1000 or less’.

    If you include the service behind Telehealth (currently around £70 per month per patient; see Worcester BC above) and add the equipment on you can get it to above £1000 easily.

  11. Steve Hards, Editor

    @UNATTR Yes, that’s exactly what I was referring to :-) The intention was to level the playing field for smaller equipment provision between the NHS which couldn’t charge and councils, which, at the time, could. Fortuitously, ‘community equipment’ is defined as a service, and not kit alone.

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