Telecare Soapbox: Reflections on the UK’s telecare, telehealth and telecoaching framework agreement

There are some people (OK, a few, maybe, and not just my 85-year-old mother) who share my opinion that I [Ed. Steve] am a nice person. As a long time supporter of telecare and telehealth for everyone who needs it I do not relish the reputation I seem to be acquiring as the Grumpy Old Man of Telecare just because I call it as I see it, which frequently contrasts with the positive spin put out by other interested parties. Enough of me! I just wanted to put what follows into context.

Background

First, a little history of telecare procurement to explain why the UK now has its second ‘national framework agreement’.

NOTE: If you prefer to download and read this long item as a PDF (7 pages), right-click here, and select ‘Save As…’

In 2005 the UK’s Department of Health (DH) announced that over two years from 2006 it was going to make a total of £80million available to councils with social services responsibilities to encourage them to develop telecare services. [Disclosure: the impetus for this initiative came from one of the Ministers, based on some preparatory work I had done when contracted to work at DH. My contract finished in 2005, so I was not involved in what followed.] The funding was known as The Preventative Technology Grant. Because there was a danger that councils would spend the grant on other things (that was an option) and because time was pressing, and because each council would have to go through the laborious and bureaucratic European Union tendering processes, the organisation that facilitated procurement for NHS organisations, called NHS PASA (now defunct), was asked to see if it could help.

PASA suggested that a procedure called a ‘national framework agreement’ be set up. An NFA for the purchase of, say, office supplies for NHS organisations would work like this:

  • PASA would run an EU tendering exercise based on the office supplies requirements of the NHS.
  • Suppliers would bid their best stationery prices to be listed on it.
  • Companies that could deliver the goods and meet certain business criteria were approved.
  • Any NHS organisation could, while the NFA was in place, buy their pens, etc. directly from supplier at the NFA price.
  • It was possible to demonstrate price savings owing to the massive bulk purchasing.

The big advantage was that each NHS organisation (there are hundreds of them) did not need to conduct its own tendering process and the suppliers did not have to waste resources responding to them. For a mature market of goods it worked reasonably well and was probably a sensible way to proceed.

But …yes, here’s the ‘but’… For an immature market of mixed goods and services, such as telecare, the shortcomings of such a framework soon became apparent. Some of them will pop up in the following sections because many of the same problems apply to the new framework agreement and will get a mention there.

As a footnote, NHS PASA was able to put such a good spin on their ‘innovative’ framework agreement that it won a procurement industry award for their work just before it, PASA, was abolished. This probably goes some way to explaining why someone (who lobbied for it?) thought that a new framework agreement, to be organised by the pan-Government procurement organisation Buying Solutions (BS), would be a good idea.

Good points about the BS agreement

There are good points:

  • There is no doubt that councils, NHS organisations, etc., and supplier companies will save time and transaction costs for their procurements, and taxpayers and clients/patients will benefit. When it works as intended.
  • Companies can add new products or services to be available through the agreement every three months instead of one year, as on the old agreement. That reduces the previous criticism of lack of choice.
  • Umm…
  • Oh… Potentially, it will be easier for commissioners to ‘mix and match’ providers with complementary offerings to meet their specific needs.

Flaws: micro to macro levels

Starting at the micro level, one can point to minor flaws around the setting up of the agreement. None of these may be significant in themselves, but they do give the impression of it having been a process run by people with a tickbox mentality who do not understand the field:

  • Unless we see a series of framework agreements such as ‘Assistive Technology – Wheelchairs’; ‘Assistive Technology – Daily Living Aids’, etc., the inclusion of ‘Assistive Technology’ in the title is pointless and unhelpful, as readers of Telecare Aware’s terminology discussions will know.
  • The delay of over two months in the timetable was attributed at the beginning to the change of Ministers after the general election in May, but it remains unexplained in the light of Ministers having no day-to-day control of BS’s activities.
  • The recent slow process of press release approval, is commented on here. From what I’ve heard about it since, it appears to have been assigned to least two different people because there have been inconsistencies in what has been censored. [As an even smaller aside, ‘Framework Agreement’ was amended to ‘framework agreement’ Whether this was for grammatical reasons or whether someone had noted my comment in March on the abbreviation BSFA, is not known.]
  • In the matrix list (PDF) of companies on the agreement, Airedale NHS Trust is missing its middle ‘e’ and Bosch is spelled ‘Bosh’! [Link to now corrected version sent by BS.]

Bigger flaws

Setting the above minor irritations aside, we reach a higher level of flaws, concerning the structure, content, and expected functioning of the agreement:

  • The agreement is constructed around fairly meaningless categories of what companies do (‘telecare products’, ‘personal telecare services’, ‘telehealth products’, ‘telehealth services’ ‘telecoaching products and services’ and ‘managed services’) rather than the needs of people receiving the services.
  • At least one company is misnamed on the matrix: Telecare Technology is a trading name of CareCalls Ltd. In addition, being founded in 2009, it does not meet the framework application requirement for three years’ accounts. What other exceptions were made, and why?
  • In the bid application instructions companies were told that to increase their score on the ratings they should answer questions in particular ways. Looking at who is in and who is out (below), I am sure that this led to an exercise in many companies in the ‘Art of BS’.
  • The applying companies did not have to state what their products are. They have only been judged on the quality of the company, their answers to the questions, and a small amount on their experience. They can now add whatever products they want.
  • It’s the company that is approved under the agreement, so there are no controls on buying rubbish from a company once it is on the list.
  • The agreement is a charter for uninterested or lazy commissioners. It has been noted that recently more and more council and NHS commissioners of services (people who are responsible for specifying and purchasing services to meet the needs of the local population) seem to be keen to wash their hands of their responsibility for telecare/telehealth. They know it needs to be ‘done’ but it is not a high priority for them. They want to tick the box and get on with something else, like looking for another job if employed by a PCT, which are in the process of being abolished.
    The framework agreement is therefore a godsend to such people because there is no need to undertake a procurement process that makes them think about what they want. Worse, there are six companies (Chubb; iPlato; Philips; Questmark; TBS; Tunstall) on the framework which are approved to supply goods and services in all six categories and these commissioners will be tempted just to ‘hand over’ the provision of the service to one of them – because they can do everything. Big Mistake! No disrespect to the two companies of the six that have a substantial track record in the UK, but BS must have been susceptible to the Art of BS when it came to awarding the approvals. One of the six companies, Questmark, whose expertise is in videoconferencing, I have never heard of until now!
  • Conversely to the previous point, it is a charter for the companies with the sales people best versed in BS to fleece unwary and naïve purchasers.
  • Moving on from the simple ‘we’ll pick a company from this list’ approach, there will be commissioners who still want a fig leaf of respectability in their choice and who will now find it much easier to set up a ‘beauty contest’ with a predetermined result. They are happy to waste the time and resources of companies with whom they have no intention of contracting.
  • Companies can introduce partner companies (in the loose sense) into the agreement. I have heard reliable rumours that under the old agreement this was done at the cost of a sales commission paid to the introducing company. No doubt this practice, which is wide open to abuse, will continue.
  • Last, but not least, organisations that purchase through the agreement will automatically be paying more than they should be able to negotiate directly, because BS gets a 1% sales commission!

Who’s on the agreement, who’s not

I think there is a lot more to be said about the companies on the list than I am able to put here and readers may want to add comments. However, let me start the unpacking process…

Companies I’d never heard of before the framework came out:

  • Engage Now (touch screen kiosks) http://www.engagenow.net/
  • Connect For Care (“connecting older people to their loved ones”) http://www.connectforcare.com/
  • Grosvenor Telecom (installation and maintenance) http://www.grosvenortelecom.co.uk/
  • Healthways International (“global well-being”) http://www.healthways.com/
  • Mediaburst (bulk SMS messaging) http://www.mediaburst.co.uk/
  • Questmark (videoconferencing http://www.questmark.co.uk/)
  • RedAssure, (part of Worthing Homes ) http://www.redassure.org.uk/
  • SEA (installation and maintenance) http://www.sea-systems.co.uk/
  • Safe Patient Systems (have a hospital focus) http://www.safepatientsystems.com/
  • SOConsultancy (“grassroots engagement”) http://www.soconsultancy.com/
  • System C Healthcare (software and services company) http://www.systemc.com/
  • Tallon Monitoring (timesheet replacement and telecare) http://www.tallonmonitoring.com
  • Telecare UK (who? Cannot locate a website)

Known companies whose track record in the telecare/telehealth field – my opinion only – is, to date, either primarily local or minimal in the UK:

  • Accenture (consultancy)
  • Air Products Healthcare (oxygen supplier)
  • Airedale NHS Trust
  • Ascom (UK) (a GE Healthcare partner)
  • Bayer
  • Broomwell Healthwatch (health monitoring)
  • Cheshire Peaks & Plains Housing Trust (local)
  • Chester & District Housing Trust (local)
  • Cross Keyes Homes (local)
  • Fold Housing Association (local but has profile)
  • Fora Care
  • GE Medical Systems (just getting going on telehealth and new company with Intel in the pipeline)
  • Hewlett-Packard
  • Icom Projects
  • iPlato Healthcare (“mobile health solutions”)
  • iSOFT (healthcare software)
  • KPMG (consultancy)
  • McElwaine SMART Technologies (local but has profile)
  • Pfizer (some telecoaching with NHS Direct)
  • Philips Healthcare (disappointingly little achieved for such a large company)
  • Red Alert Telecare (local but growing rapidly)
  • TBS GB (Viterion equipment provider. Virtually invisible despite being on the previous agreement)
  • Telefonica O2 UK (only just gearing up)
  • UnitedHealth UK
  • Wealden and Eastbourne Lifeline (local)

So that leaves…

Twenty-four companies with a track record and national presence:

  • buddi
  • CarelineUK Monitoring
  • Chubb Community Care
  • Cirrus Communication Systems
  • Docobo
  • Home Telehealth
  • Honeywell Hommed
  • Hugh Steeper
  • Invicta Telecare
  • Jontek
  • Just Checking
  • MyAmego Healthcare
  • NHS Direct
  • OBS Medical (includes t+Medical and Vivatec)
  • Possum
  • Robert Bosch
  • S3 Group
  • Supra UK
  • Telecare Services Association
  • Telecare Technology
  • Telehealth Solutions
  • TeleMedCare
  • Tunstall Healthcare (UK)
  • Tynetec

And…not on the agreement?

Finally, let me turn my attention to some of the companies one would expect to see on the list and that are not. I’ve noted the following but please let me know others I have missed:

  • ADL Smartcare
  • Alertacall
  • Burnside Telecom
  • BT
  • Choose Independence
  • Cisco
  • Eldercare
  • Everon
  • Halliday James
  • HPS Consulting

If they are not on the agreement, are they flawed in some way?

It should most certainly NOT be assumed that because companies are not on the framework agreement that they made flawed applications.

The acceptance criteria appear to have been so loose that it is difficult to image that their applications would have failed. So why did they not compete, if that were the case?

The reasons will be varied, but here’s an interesting one from the major independent provider of alarm monitoring services, Eldercare, whose Chief Executive Chris Hopkinson told me “Frankly, after we had gone through that massive form, we felt that the way the agreement was structured would have distorted our business if we had to comply with it.”

That sounds like a bold decision to me. (And no, I do not mean ‘bold’ in the ‘Yes, Minister’ sense!)

Similarly, other companies either felt they had such a niche or unique product that they need not compete, or they have plans to come in under the wing of one of the approved companies.

Another UK-based company, which shall be nameless, has pulled out of its home market altogether and is focusing its efforts elsewhere because it finds the conditions for doing business in the UK are so unconducive.

Macro level flaw

At the macro level, the very existence of the agreement will call into question the neutrality of commissioning tenders in this area in the future.

If an organisation is conducting its own tender process for telecare, telehealth or telecoaching outside of the agreement – as it is perfectly entitled to do – the suspicion will be that it is because it wants to attract a bid from one of the companies not on it. Why bother otherwise?

If that is the intention, then the presumption of neutrality of that particular procurement is undermined and, presumably, open to legal challenge if the companies who are on the agreement are unsuccessful.

Conclusion

There are some readers who may argue that my surprise at some of the companies on the agreement merely shows that BS’s selection represents a wider view of telecare and telehealth than that with which I operate.

But I would argue that it reflects BS’s naivety at setting up a process whereby they told companies the answers they were expecting and then took those answers at face value.

The UK now has a telecare and telehealth market where the market forces and procurement processes that normally act as gates to keep out the wolves in sheep’s clothing have been torn down. More than ever the motto has to be ‘buyer beware’!

Steve Hards
14 August 2010

Categories: Soapbox.

Comments

  1. Leslie Morson

    Buying Solutions v Bull S**t – never saw that one coming!

    Steve,

    Let me be the first to reassure you, as one Grumpy Old Man to another, if reassurance be needed, that I’m certain you are a very nice man too. Now I went to an inner city comprehensive school for my education and Latin wasn’t on the curriculum but fortunately for me old Bulldog Evans, my old English teacher, wasn’t very good with change and Caveat Emptor became my motto of choice during all my tuck shop excursions.

    Now it is possible that my current ‘long term condition’ of diabetes is directly attributable to the expertise I developed of the goods available from my old school tuck shop [For readers unfamiliar with the term: see here]. Now the modern fashion in the Telecare sector may just be for undertaking trials before committing full investment. However back in my day (and yes I appreciate the economic climate was not as fragile as it is today) flush with income from my paper round and my milk round to boot, I was able to acquire indepth knowledge and expertise in all the tuckshop offerings. My purchases were therefore informed. Also, if the tuck shop was out of stock of say ‘Curly Wurly’ I was able to circumvent the schools procurement rules and sneak out through the gap in the fence at dinner time and access the wider market place.

    I have concerns therefore, with the BS of BS if you get my drift. My fear is that colleagues in procurement or in commissioning roles will not be experts, and I know far too many that wouldn’t be able to tell the difference between a bar of peppermint Aero and a peppermint Fry’s Chocolate Delight. Then even if they could and realise that what they need isn’t on offer in the BS tuck shop, they are likely to settle for the inferior rather than put the effort into organising a dinner time raid behind enemy lines.

    If you’re reading this you guys… you know who you are… let me tell you… why settle for pineapple chunks when you can have rhubarb and custard? As my old English master would say, Carpe Diem!

    (The author of this piece would like to say that it was not his intention to offend any particular brand of confectionery).

  2. Cathy Stephenson

    Buying Solutions?

    I too had a close affinity with the school tuck shop … but I should hastily add that chocolate was not the attraction then and shiny silver paper wrapped treats still don’t get my attention now! (As the team I sit with will verify when the biccy box gets circulated).

    Then as now, it was people that got my attention … and the important bit of BS is the … SOLUTION … if that doesn’t fit we should not be interested whether it is on an national agreement or not!

    I am not generally grumpy, don’t consider myself old and am not planning on being identified as male, however, I agree with Steve … suppliers … you want to be in my Buying Solutions? Convince me that your products will offer solutions by working with me – your name on a list doesn’t impress! I live in an agricultural area and can collect real BS any morning whilst out with the dog … but I choose not to.

  3. Kevin Doughty

    Buying Solutions

    Much as I enjoyed reading Steve’s soapbox article (and Leslie and Cathy’s recollections from their youth), I feel that I need to jump in to support, not the Buying Solutions exercise, but the dozens of organisations that have committed significant resources (and energy) into their submissions.

    I doubt if anyone will deny the effort involved on their part – yet there is a real danger that some of the BS will be thrown in their direction for simply being part of a process. It wasn’t their fault, so let’s congratulate them for their success.

    Maybe it is also unfair to treat equipment vendors in the same way as service providers. The former includes a number of new companies who saw the Buying Solutions framework perhaps as a marketing exercise, enabling their name to be put on the same page as well-known organisations with a long track-record in this area. We may not have heard of them previously, but now we do, so thanks Buying Solutions for enabling us to investigate some potentially new propositions.

    There are a number of notable absences from the vendor list – and there could be some good reasons why these organisations chose not to commit the effort required. However, rather than waiting (what has been a very long time) to come up with reasons that could now sound like excuses, it would have been more helpful if they had made public before the submission date that they were not intending to be part of the process, detailing their reasons. In a quickly changing market, some of the likely suspects might no longer exist!

    Telecare service providers (and there are many more of them than there are equipment vendors) should receive further congratulations for their efforts. They are, generally, smaller organisations with few resources and smaller budgets for exercises of this type. How can they expect to grow and to become known nationally without the sort of exposure that this framework will give them? Indeed, how can they differentiate themselves from competitors without being able to show some sort of externally validated quality approval? Aren’t the organisations with a profile the same ones that were previously on the PASA framework, and wouldn’t we expect their scores to be really good in the new exercise, showing that they have taken on-board some important lessons?

    Whilst the BS measures of quality may be imperfect, and prone to manipulation by consultants, they are still a step in the direction of outcome-based success. Perhaps the way forward is for Buying Solutions to start to work with the industry (perhaps through the TSA) to agree on the measurement criteria. Then, perhaps, we can reach a situation where the framework agreements do not become such easy targets for criticism.

  4. Steve Hards

    Framework Agreement – excellent points

    Those are excellent points Kevin, thanks.

    I certainly didn’t mean to belittle the efforts of the companies who undertook the arduous task of completing the application. I understand the successful companies have a meeting with Buying Solutions on Wednesday to learn more about how they are now expected to proceed.

    A very good point too about companies who didn’t apply not getting out some publicity in advance.

  5. Jeremy Linskell

    BS – not such excellent points!

    Kevin, there is no question that the process isn’t one of therapeutic value(!) so it is clearly doubly unfair to blame companies for having traversed it. But to try and argue that BS has performed a public service by legitimising their activities is, to say the least, ‘amusing’. There is no meaningful investigation or evaluation of the validity of their respective product/service ranges, let alone any confirmation that individual products are actually fit for purpose, in deed as well as in spirit.

    I look at the matrix and I see a recipe for quick fixes that stifle innovation and encourage poor, lazy strategic planning. It is a recipe for myopic councils to buy piles of yet more unnecessary products that will sit in the cupboard until it’s time to replace them; or no better, hand out goody bags to everyone so that they can tick the boxes and carry on doing everything like they did it before.

    I agree strongly with Steve w.r.t. those companies that tick all the boxes will be ‘budget magnets’, especially as rapidly declining budgets will force worried commissioners to ‘play safe’ (ha! at a time when innovative solutions are needed more than ever).

  6. Cathy Stephenson

    If only life came with a Pret a Porter tag

    Actually I am glad it doesn’t – I rather like to access made to measure solutions and why should someone who is assessed as benefiting from telecare be any different?

    Any framework agreement is aimed at bulk purchase of best price goods – it works for exercise books in a school, latex gloves in a clinic and basic dispersed alarm units in telecare (not to exclude other frequently supplied telecare items).

    Unfortunately it also brings a mindset that this is the shopping list to select from; if it is not there one cannot buy it. Thinking outside the box stops being an option because the authority culture is to clamp the box lid tight shut. The focus shifts to the financial aspect – the quantity surveyor approach to care?

    Kevin you seem to have taken my comments to mean that I was disrespectful to companies who had succeeded in their Buying Solutions application … not so. No one with an understanding of balance sheets would criticise any commercial concern for maximising their profits – for those organisations the framework agreement is a business tool. However, extrapolate that to health and local authorities looking for savings; there will be few big savings from large scale deployment of basic dispersed alarm.

    Pareto would suggest that 80% of the cost savings will come from those 20% of telecare service users who are assessed as needing complex care packages which can incorporate personalised and creative telecare solutions. The saving won’t come in the purchase of the equipment … the saving will follow because the ongoing cost of their care package is less; but that requires brave decisions up front.

    Of course the public purse has to consider the financial aspects of providing any service but let’s not remove choice and the options for creative high quality practice; an engineer uses ingenuity to solve people’s problems … Telecare needs engineers as well as quantity surveyors.

  7. Kevin Doughty

    BS again

    I hope that Jeremy is the only one who has managed to misinterpret my comments as a defence of the BS process. My intention was certainly to defend the telecare industry only, and especially those smaller organisations that took the time and the trouble to apply to be accepted onto the BS Framework.

    However, I think that I now may need to extend this defence to include local authority commissioners from the suggestion that they are lazy, short-sighted and lacking in the vision or courage to try anything new. In my many dealings with social services/work departments right across the UK, I have found officials to be dedicated, hard-working and conscientious. They are working with reduced budgets and increased pressures to improve their performance through better and more appropriate outcomes. The targets are anything but trivial, so they cannot afford the luxury of giving goodies away. They would love to try new things but with elected members scrutinising their spending decisions, can they afford to risk products that haven’t been proved or which may not actually work as part of the local delivery system? After all, interoperability remains elusive in the world of telecare and the potential for buying a “pig in a poke” remains a real threat.

    So rather than criticise the councils for playing safe, let’s be more constructive in trying to help them make informed choices. Nobody doubts the need for better training at all levels – and the development of the workforce should remain a priority. Fortunately, the TSA, FAST and the NHS are already addressing training needs. Staff need courses to be both interesting and well researched; courses need to be delivered by people who believe in what they say and who can transfer this enthusiasm to those at the sharp end of delivery, as well as to end-users, their families, politicians and anyone else with an interest in increasing quality and choice. In addition, prescribers need to be made aware of the very latest developments and how they might impact their selections. This means equipment catalogues, product reviews and support resources that are up-to-date (and available on-line) and produced independently of suppliers so that they can be trusted to be fair and accurate. Perhaps experienced technologists in this industry would like to offer their help and support in producing such materials so that in the future commissioners can be fully informed about the choices available to them.

    There does indeed remain a likelihood that some organisations will have excess telecare inventory lying on their shelves for years. This could be due to a simple case of over-ordering or it could be due to equipment being recovered following a short-term project. In this case, surely the best answer is to offer it on loan to other service providers or commissioners who have a need. This form of equipment loan (which we refer to as TeleCycling) has been proposed already for CUHTec members and a dedicated web-site is soon to be launched. Details of the plan will appear in the next edition of the Journal of Assistive Technologies which is dedicated to Telecare.

    P.S. I enjoyed Cathy’s (and Leslie’s) comments, agree with most of the points made and their analogies, but didn’t read them as criticms of organisation who are on the Framework. However, I’m not going to go too far down the school analogy route with this or I would end up looking at the quality of A-level examinations (and the individual questions), the values of the grades, and whether we should be criticising kids for sitting the exams, or universities for accepting the results! We all want to increase the quality of schooling – and we should all congratulate the successful pupils irrespective of how we grumpy old men think that standards may have slipped.

  8. Nick Dyer

    It’s a far cry

    It’s all a far cry from things like this from pre-election days.

    Remember lines like this: http://www.channelregister.co.uk/2010/03/11/tory_tech_manifesto/

    “The party said it would open up UK.gov IT contracts to small and medium-sized businesses by dividing large tech projects into smaller components”

    The quality of your service or products has nothing to do with your ability to land government work in the UK anymore. It appears the power of your lobby does though, and it does not just apply to Healthcare related contracts.

  9. Jeremy Linskell

    To interpret ot not interpret

    If I have misinterpreted Kevin’s comments then an apology should be forthcoming, although I should probably delay because I fear that I am about to do so again! In his reply he said that he was merely providing justified recognition of the efforts of the companies, especially smaller ones, but then goes on in the next paragraph to argue strongly why bulk purchasing off large, existing suppliers should not just continue but represent the bulk of telecare work.

    Cathy is right that the real wins for telecare are in the complex cases, well away from the model that the matrix extols (yes I think that this is the correct word in this instance) and this approach is taking us well away from the dream of genuinely self-funding telecare that realises real savings and really changes lives. This is a time to be brave, and even councils who are finally taking the plunge into large scale telecare activities, where before there were none, need to understand that mass roll-outs are a small part of a means to and end, rather than an end in themselves.

  10. Kevin Doughty

    BS – my final thoughts

    Maybe I’m not a grumpy old man after all!

    Perhaps, I am simply old enough to recognise that there are decisions made by people high up the tree that I, and others at the sharp end, cannot control. So is Steve’s original soapbox complaint about the BS Framework only, or does it go all the way back to the way that the PTG was distributed? Only he can answer that, but I suspect that he sees the BS process as the most recent of a catalogue of official errors.

    I have a feeling that other contributors to the comments section might have preferred to have seen the PTG money given to the NHS rather than to local authorities. If that had been the case, then I think that we might have seen far more people with very complex needs benefitting from some very sophisticated (but relatively expensive) systems. Perhaps as a consequence, far fewer people with low-level needs might have received any equipment or service – and without the economies of scale, we probably wouldn’t have seen emergency telecare response services introduced. So would telecare as a service be as well-developed in the UK as it is today?

    In the same way, if the focus of the PTG had not been on older people, then more people with physical, sensory or intellectual disabilities might have received more and better equipment. But this would have meant a delay in tackling the problems of falls, cognitive impairment, social isolation, inappropriate residential care home admissions and unscheduled care which are inevitable for a country with an ageing population.

    We should be debating the best way to use resources in the future. But for now, I fancy there may be concensus on the need to provide more personalised, and innovative AT and telecare packages within services which have the necessary skills and resources. The ALIP projects offer good partnerships between equipment designers, vendors and service providers that should ensure that new products are introduced in efficient and cost-effective ways. I am confident that technologists and end-users will also share their knowledge to produce the necessary training resources that will allow the workforce to be developed in such a way that vulnerable people and their families will have confidence in the equipment and service prescriptions that they are offered.

    My glass is definitely half full!

  11. Steve Hards Editor

    BS – Response to Kevin

    First, may I thank everyone who has taken – and, I hope, still will take – the time to comment at length here. I have been heartened to see that the focus hasn’t been on the detail of the agreement, but on the wider issues it raises.

    If I may, I’ll pick up on Kevin’s perceptive observation that my unease about what has happened in the UK reaches back to the time of the Preventative Technology Grant (PTG). However, it was not the decision to put it with councils rather than the NHS, or the decision not to ring fence it that has coloured my perception since, but the decision, against many people’s better judgement, to define telecare in Building Telecare in England thus: “It can be as simple as the basic community alarm service”. (Page 8)

    Those eleven words undermined the focus of telecare which, until that time had been understood as a step beyond basic (pendant alarm) services. Kevin will recall from the Telecare Policy Collaborative discussions in 2004-05 that at the time we were looking very positively at the emerging range of devices that did not depend on a person pressing a button to trigger them, and we were also excited by the new possibilities we were seeing for home-based health monitoring. It is those that we were looking to the PTG to introduce.

    The inclusion of the ‘old’ paradigm was a compromise born of concern that without it councils would be unable to meet the indicative numbers of new users funded by the grant and such a failure would, of course, be unacceptable to the Minister. And many still failed on that measure, even with the watering down of the definition. However, the compromise, coupled with the workings of the first framework agreement, was the best thing that ever happened to the suppliers of pendant-based systems.

    I am pleased that Kevin, with his wider experience of people in councils and in the NHS with responsibility for guiding and commissioning these services than I have, has a positive view of them. My view – until now, as I’m prepared to give Kevin the benefit of the doubt – has been that no matter how well intentioned they are the circumstances they operate in conspire to make it almost impossible to achieve their best aspirations.

    I don’t believe that the new framework agreement will help halt the downward spiral, but I will be happy to be proved wrong.

    Any readers old enough to remember the story of ‘Tubby the Tuba’ [YouTube Pt1, Pt2] will recall how at first Tubby mangled all tunes despite his best intentions. I must confess that this tends to cross my mind each time I see a typical ‘Telecare Strategy’. The difference is that I don’t see the outcome as being the discovery of a delightful new tune. 

  12. Posted by Editor Steve for Anonymous1

    Framework – calling foul. Serious questions that need answers

    Well, Steve, I have some specific issues with the framework agreement itself (not just the wider issues)!

    In your original item, you raised (second bullet, Bigger Flaws section) the question of how CareCalls Ltd (Telecare Technology) got onto the framework without a track record. [The issue of needing a track record is dealt with here. Ed. Steve, Aug 2010] Well, how can the Telecare Services Association have been awarded supplier status in the managed services section? Does this not conflict with its role as a trade association?

    As the TSA does not have a track record in consultancy, how did they swing that since all tendering organisations were required to demonstrate their past competence in the supply of the relevant products to the telecare / telehealth sector?

    If the TSA is developing a managed service for a customer it will have to make choices between different member organisations! Do they not anticipate complaints? More than that, they will be directly competing for work with their consultancy and service provider members!

    Next I turn my attention to the two NHS trusts: NHS Direct and Airedale NHS Trust. Here there are some serious concerns that demand answers!

    There are strict rules about local authority trading and these exist to protect the public purse and prevent public organisations from competing unfairly with private organisations.

    However, these two Trusts will be able to use their reserves and the funds that they have obtained for the delivery of their core NHS business to compete against private sector suppliers – in a framework for the supply of goods and services to the public sector. Should not NHS Trusts only be able to use their resources for suitable purposes, that is the provision of health services to their direct beneficiary group? These organisations appear to have commercial ambitions beyond their original remit and using their funds to pursue those ambitions is questionable.

    If the private sector organisations with which they are competing make poor commercial decisions, that’s tough on them. However, if these Trusts do, the tax payer will pick up the financial consequences. Indeed, the tax payer is underwriting the very participation of these organisations in the framework because they will have relied upon their public funding to avoid the requirement to lodge a bond with Buying Solutions.

    This means that if one of these Trusts fails to deliver on quality, on specification, or at all, the tax payer will end up funding the damages that will accrue under the framework contract. (For each contract that these organisations enter into, there will be a damages clause… Clause 13.4 of the framework model contract sets out that the liability of the supplier to the customer shall be limited to 125% of the contract value subject to a MINIMUM of £1 million.) Therefore, every time these two Trusts sign a contract to supply goods or services under the framework, they are creating a reserve liability against public funds of at least £1 million per contract. Are they permitted to commit this is a form of public sector borrowing? If so, why?

    Both these Trusts are Crown bodies and they will be signing a contract with the Crown (Buying Solutions is part of the Treasury), in which many of the framework’s more testing conditions will be unenforceable against them. (The issues are Crown immunity, not suing yourself, and the general practice of organisations treating disputes between their departments differently to disputes with external bodies.)

    The Trusts therefore have an unfair advantage against their commercial, third sector and local government sector competitors.

    Finally, unlike the other organisations and companies on the framework, as both of these organisations also qualify to be customers under the framework, they can access the e-catalogue and use this information to arrange their pricing to beat off the competition.

    The potential for these public sector organisations to play both sides of the market is clearly unfair, and should be resolved before they can participate in the framework.

  13. Grant Tookey

    Buying Solutions – Telecare Technology

    Kevin Doughty makes some very good points and I can certainly empathise with his comments on Telecare Service providers and why smaller organisations looking to establish themselves in the market place would see this as a worthwhile exercise. Our company has worked very hard over the last 12 months to establish ourselves within this competitive market and thank you Steve for recognising this within your list of organisations that have a “track record and national presence”, as it makes all of our efforts worthwhile.

    Grant Tookey
    http://www.telecaretechnology.com

  14. Trevor Single

    Buying Solutions – Telecare Services Association

    Can I first thank you for generating an interesting and thought provoking discussion on the Buying Solutions framework.

    I also want to respond to the anonymous comment about TSA being on the Framework Agreement. I am delighted that TSA was successful and now has the opportunity to build on its hard-earned reputation for quality through this framework. To clarify, TSA submitted a bid under Lot 6 to provide training and quality assurance services. The services will be build on TSA’s expertise in this area and will include offerings that complement the services TSA currently offers to its membership, as well as being focused on driving improved standards and quality across telecare and telehealth. A goal that I trust we all support.

    Should your anonymous commentator wish I would be pleased to continue this discussion off-line. Contact can be made with me through the TSA office.

    Trevor Single
    Chief Executive
    http://www.telecare.org.uk

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