Telecare Soapbox: Northern Ireland’s ‘unhappy first birthday’ approaches

We are now approaching a year since Northern Ireland’s Centre for Connected Health published its Prior Information Notice (PDF) for a large-scale, province-wide remote patient monitoring service.

It’s not a happy first birthday because, as far as anyone can tell, the procurement process is not likely to come to a satisfactory conclusion any time soon.

For us on the outside it is hard to tell whether this is due to the complicated nature of the task, or incompetence, or a mixture of both.

However, as a matter of opinion, it didn’t help that the tender invitation did not include information that the selection criteria would exclude ‘small’ suppliers with relevant experience, some of whom committed resources to prepare a bid for a process in which they later discovered they would not be allowed to participate…

Nor did it help that some of the companies meeting the criteria for the initial long listing did not have any ‘real world’ experience of implementing a telehealth remote patient monitoring system larger than a small pilot and just seemed to be there because they were ‘big names’ and could presumably talk a good talk. (See Telecare Aware item 5 December 2008.)

As a matter of fact, what I can report is my limited experience during this year as I kept an eye on “developments” so that I could keep Telecare Aware readers informed.

First the website, which, given the Centre’s ambitions and resources, including its illustrious Core Team and Clinical Forum Advisory Group members, should be a vibrant and interesting place to visit. It is far from that: one update apparently in April, and before that in December 2008.

Next, I contacted the EU Centre for Connected Health via its website form on 26 January 2009 asking if there were any progress in the short listing. I received no reply, not even a standard or automated acknowledgement.

I prompted for a reply with an email on 29 January and again the next day. I then received a reply, addressed to ‘Mr Hands'(!), from ‘The ECCH Admin Team’. After a couple of other exchanges that day, the message was “We are currently moving from long-listing stage to short-listing. The obstacles encountered with this process will set the timescale for the announcement.”

I waited and watched the website. 10 weeks later on 15th April I decided to email the responsible Minister’s Private Office in the hope that some more information might be forthcoming. The text was as follows:

Dear Sir or Madam

I’m sorry to bother you, but I have some questions about the European Centre for Connected Health which is funded by your Department.

In January 2008 Minister Michael McGimpsey announced £46 million over three years to improve care for people with chronic conditions.

1) Please can you find out for me what percentage of this was intended for the European Centre for Connected Health for a) set up and operating costs, and b) for commissioning the proposed NI Remote Monitoring Service?

Regarding the monitoring service tendering process which formally began eight months ago in August, I was informed by the ECfCH at the end of January that they were “currently moving from long-listing stage to short-listing”. The result has still not been announced.

2) Please can you tell me the Minister’s view on the continuing lack of progress?

Finally, I note that the Centre pays US$35,000 on annual membership of the Continua Alliance, which is an association whose members are predominantly large multi-national, indeed global, companies in the telehealth industry: http://www.continuaalliance.org/about-the-alliance/member-companies

3) Please can you tell me if the Minister believes this is an appropriate use of taxpayers’ money?

Sincerely,

Steve Hards
http://www.TelecareAware.com
Telecare Aware: Help Spread the Telecare News

Again I received no reply, not even a standard or automated acknowledgement, and chased it by email a week later. Still no response. On 7 May, I followed this up with an enquiry via the NI Executive’s website contact form:

Do the Ministers’ Private Offices have standards they are expected to meet regarding speed of response to emails sent to their addresses as published on this website?

I emailed Mr McGimpsey’s office (private.office@dhsspsni.gov.uk) on 15 April (followed up 22 April) but have not have even an automated acknowledgment to either of them.

This brought a response from the web team that the Minister’s Private Office was being contacted and soon after I received a copy of a letter from the EU Centre for Connected Health’s Interim Chief Executive, Andrew Hamilton.

Apparently it had been written on 24 April, nine days after my email to the Private Office but “due to an oversight we omitted to issue the response to you.”

Here is the text of the letter:

Dear Mr Hards,

The Minister has asked me to reply to your letter of 15 April regarding the European Centre for Connected Health and the commissioning of the NI Remote Monitoring Service.

The commissioning of the remote monitoring service is an extremely complex initiative involving the clinical and management teams of all five Trusts in Northern Ireland and covering three major disease areas – Heart Failure, diabetes and COPD. The successful implementation of the initiative requires the development of new patient pathways involving community nurses, primary care practitioners and secondary care professionals and we have developed an inclusive approach to ensure their engagement from the outset in developing our requirements. Although this takes time, we are firmly of the view that securing such involvement in the procurement process will bear dividends in the future.

Substantial progress is being made. Following receipt and evaluation of supplier submissions to the first round Invitation to Participate, eight companies were invited to participate in the second stage. Supplier submissions to this invitation are due in early May and these will be subject to detailed evaluation with a view to develop a further short list of companies shortly thereafter.

Given the ongoing procurement process, we are not in a position to disclose the proportion of the funding for chronic disease that is intended for the Remote Monitoring Service. A small proportion (<1%) of the funding has been directed towards the set up and operating costs of the European Centre for Connected Health.

You have also asked whether our membership of the Continua Health Alliance represents an appropriate use of taxpayer’s money. Membership of the Alliance has provided the Centre with access to technical advice and guidance on issues such as interoperability and allows us to keep abreast of developments in the Connected Health field. The Alliance has also helped us demonstrate the potential of technology in improving patient care to our clinicians and service users.

I trust the above addresses your questions.

Yours sincerely,

Andrew Hamilton

I am sure readers are already forming views, so I’ll confine my comments to:

• Agreed that an inclusive approach to stakeholder consultation and commitment is vital. Except that the time to get their input is before the construction of the tender documentation.
• ‘Less than 1% of £46 million’ would be civil service speak for £450,000. That’s £150,000 per year, as the £46m is over three years. I just do not believe that the EU-CfCH with its offices, salaries, Board, Continua Alliance fee and Andrew Hamilton’s travel to conferences and meetings abroad could be run for so little. Perhaps a zero is missing?
• “Membership of the Alliance has provided the Centre with access to technical advice and guidance on issues such as interoperability and allows us to keep abreast of developments in the Connected Health field.” There are several points here: 1) this sounds like after-the-event justification, 2) I find my (free) subscription to the Continua Alliance newsletter keeps me quite well informed of developments – if I do not get them from other sources first, 3) is it proper to get “access to technical advice and guidance” from this source when leading members of the club are also bidders to the tender and 4) companies that could deliver the programme but which may not be Alliance members may be being discriminated against.
• Finally, there is no mention of whether the Minister is aware of, and approves, the EU-CfCH expenditure.

So now we wait for the announcement of the outcome of the short listing stage.

I wonder if the extended delay means that the contract is not going to fall into the lap of the Tunstall/Fold/S3 consortium (known as TF3) as most people expected when they saw the long list? If it were, I think we would have seen more progress by now.

Perhaps that is why TF3 decided to nudge the process along and had an article (advertorial?) published in April’s AgendaNI. AgendaNI describes itself as “Northern Ireland’s leading public policy magazine, reaching over 7000 key decision makers in government, business, voluntary and community sectors”. However, other bidders complained that this was indirect canvassing, which is a serious breach of procurement protocols.

Following this, Tunstall and S3 seem to have rapidly pulled information about TF3 from their websites, but Fold, at the time of writing, still has the article as a news item, although you cannot navigate to it. (I can’t find it on the AgendaNI site, either.) Whether this rapid corrective action by the TF3 partners will redeem them enough to stay in the running for the final short list remains to be seen.

Finally, as this project appears to be sliding into a fiasco, I do wonder whether the position of Mr Hamilton as Interim Chief Executive is sustainable much longer.