Frankly, the last thing I [editor Steve] want at 7.00am on a Friday when I’m about to prepare the day’s alerts email (sign-up box above), is to receive documents that demand to be read and for an item to be written. But ‘thanks’ to a reader that is what I’m now doing. I therefore apologise that the alerts email is late this morning.
Late last Wednesday night I published a link to the 3millionlives (3ML) website which had published a document by Worcestershire County Council, prepared in October 2012, that set out its ‘business case’ for tendering its telecare and telehealth service as a 3ML Pathfinder Site. Yesterday it attracted nine highly critical comments from four TA readers. If you have not done so yet, read the item and the comments, now running onto two pages.
The two documents the aforementioned reader sent me are Worcestershire’s follow-on documents that are part of the formal pre-tendering process: the Prospectus (PDF) and the Pre-Qualification Questionnaire (PQQ) (Word Document). The latter is for return by the end of February if you are interested in bidding.
So what, on the basis of early morning skim-reading, has compelled me to write this item?
Leaving aside the minor but outrageously patronising reference to ‘Affluent Greys’ and ‘Prudent Pensioners’, and leaving aside the philosophical and technological concerns raised by yesterday’s commenters, the Mandatory Requirements section of the PQQ illustrates a problem that I highlighted in October: Telecare Soapbox: Who can purchasers trust?
2.5, page 11, requires compliance with the TSA code of practice. It has the weasel words ‘or compatible to’ thrown in, but the intention is clear: unless you are TSA Code accredited, and therefore a TSA member, do not bother to apply.
Bear in mind too that one of the Soapbox commenters (#2) points out that “EU/UK tendering law may not allow a procurement specification to specifically identify membership of an organisation or compliance with a code or standard. Adding these types of spec clauses may be open to legal challenges by providers who are able to meet requirements but do not have the appropriate registrations and accreditations.”
Worse still, it appears that the PQQ has been written to favour one particular supplier.
3.5, page 11, mandates that “contracting parties will be able to demonstrate conformity with ISO/IEC 270001:2005” [it is actually 27001, but let the typo pass]. Now, if Tunstall’s press release Tunstall Healthcare spearheads quality standards in telehealthcare is to be believed it is the only telecare/telehealth company in the market to have achieved that particular accreditation. PLEASE CAN READERS LET US KNOW IF THEY KNOW OF ANY OTHERS THAT HAVE.
Where has this requirement come from? Not Tunstall directly, of course, but it was lifted word-for-word from the 3ML document Recommendations from Industry on Key Requirements for Building Scalable Managed Services involving Telehealth. Telecare & Telecoaching (PDF, November 2012), where it says: “contracting parties will be able to demonstrate conformity with ISO/IEC 27001:2005”.
In fact most of Worcestershire’s requirements are copied from that document, including the TSA one above. And we note that the authors of that document are…
I did say in my comment on the original TA article on the Business Case put ogether by Worcestershire’s expert team that it some of the requirements seem to be suitable to particular companies/y. This time I think Worcestershire may have a challenge or two from at least one other potential bidder who has a global presence and whose legal team is vast and possibly well up for a fight.
Steve, just a quick point worth checking up on. Twice recently I’ve been at events where it was stated that TSA accreditation was now open to non-members. No doubt, that will be at an increased cost to mitigate the loss in membership income – Whoops, sorry additional administration involved in dealing with non-mambers.
Does this now re-position requirements for accreditation within tenders legally?
Did they require the inclusion of The KIRO-M5? Might come in handy because it already sounds like their might be some soiled boardroom diapers 2 or 3 years down the line when this goes the same way as others seem to be going.
Never mind in a few years – there ought to be soiled boardroom diapers already with the adoption of such patronising terms to refer to the people who have paid their taxes to keep the Council Officers in gainful employment …
@ Mark, last time I asked, a few months ago, it was confirmed that it is not open to non-members but that they were thinking about it. I’ve not seen anywhere that that has changed. Happy to be corrected if someone can dig up a link.
Thanks, Steve
Very strange this, finding myself in search of something to back up the TSA, but it appears to be a fruitless search. Nothing on their site or google I can find. Anybody else at the London Telecare meet last week, that can confirm what was said?
If this Worcester document becomes a template for other Pathfinders we could have multiple NYY situations and it won’t be 3 million lives, more like 3 million boxes to keep all the kit neatly on shelves.
Section 4 (4.3 & 4.5) Weighted Scoring are interesting ones. Interoperability of partners – what, like one company’s peripherals connecting to another’s alarm hub? Yeah right! Interoperability of systems to one server? Maybe. Interoperability as in working together? I don’t know based on previous.
At scale deployment of technology – does this narrow the field ever so slightly? I can only think of one ‘at scale’ project. The largest one. Can’t quite remember the name of the main supplier of technology. Jog my memory people, please.
Be prepared for a knock on the LA door asking for a reference soon.
Oh and one last thing; remember my questioning in a prvious TA article about whether 3ML was just Telehealth; or was Telecare in there also. The suggestions back were pretty much in agreement that it was just Telehealth. Looking at this, I may be wrong, I would suggest Worcestershire is going along the Telehealth and Telecare route; pretty much as I had predicted. Telehealthcare almost. Call me ‘Mystic UNATTR’ from now on.
You know the worst thing? This is car crash TV, is going to happen and we are going tovwatch it.
Monee is evil thrill
Painful sitting on the sidelines isn’t it Mystic UNATTR? but at least we can take some comfort that it is doing what 3ML set out to achieve – they are scaling it up … but in the same way two wrongs don’t make a right a bigger mess doesn’t make it a tidy solution!
Just think what we might have got if instead of Pathfinder sites they had chosen to call them Trailblazer sites?
Oh is that an error or has the timetable already slipped between the business case being published and the prospectus? The award of contract is now approx August 2013 … does the approx mean it might be July or September or it might be August 2014?
I wish it was “unbelievable” but sadly it is not.
Mark,
Either both of us are going crazy or I too had seen that TSA accreditation was open to non-members! Can’t for the life of me think where though.
Oh dear – it now looks certain that Worcestershire were first out of the blocks because they accepted both the propositions and the analysis provided by their equipment partner, rather than doing their own homework. If they had only bothered to look into the problems seen in Birmingham and North Yorkshire, they would have seen that all the financial claims in their plan are fantasy.
If the council proceeds with this approach then they will be challenged not only by other consortia who are being effectively excluded by demanding irrelevant compliances but also by consumer groups who can see more clearly than their elected members how they have been taken for a ride by an unholy alliance of Tunstall, BT Health and the TSA designed to remove choice and impose the standard processes which will remove any chance of personalisation.
So how can they now right the wrong?
1. Stop talking about managed services – what they mean are end-to-end outsourced services
2. Remove references to industry codes of practice – they don’t help deliver quality outcomes
3. Forget about asking for evidence that they can deliver at scale – nobody has done it well yet at scale (whatever they might say)
4. Require a consortium approach so that smaller (and more agile and innovative) providers can play a role; and
5. Ensure that providers are compelled to deploy the most appropriate devices rather than the ones supplied by their partners.
Under pressure from DH (and the devolved governments), the TSA has agreed to open their Code of Practice to non-member organisations. Non-members will, of course, need to pay audit fees and their accreditation will need to be achieved without the support of TSA officers and courses (unless they are prepared to pay for this too).
If the Telescope project leads to an alternative Code of Practice, it will be interesting to see if this will be acceptable for the pathfinder projects. After all, it is being evaluated and tested by the best and most independent people in the field across Europe.
“So how can they now right the wrong?”
Quite simply unless either:
(1) what you refer to as the unholy alliance, declines to compete in the tender, or
(2) someone makes objection on Procurement Legislation grounds,or
(3) the citizens of Worcestershire all get together and demonstrate the largest local government ‘vote of no confidence’ in history, this wrong cannot be righted. They would have to receive proof that what they have tendered was untenderable or illegal to be able to start again.
I struggle to think of any consumer group which is informed enough to challenge this; there has been little or no interest from consumer groups in challenging the framework agreements.
I can see one possibly significant factor for Worcestershire compared with North Yorkshire – the CCGs will be established before the contract is awarded and are parties to the contract tender; of course that assumes that the CCGs are knowledgeable about telehealth and not just simply looking at the £ signs.
Sadly, you may be right Cathy.
However, the cosy 3ML arrangement between BT, Tunstall and the TSA, which may gift Cornwall to one and Worcestershire to the other, could fall apart if they have to go head to head in the other sites. Unless, of course, BT offered to use Tunstall equipment when they were successful, and Tunstall offered to use BT for internet, communications and other back office functions when they win a tender.
Taking the conspiracy theory to the extreme, maybe the TSA have brokered a deal for BT to buy Tunstall and take over the whole of England’s telehealth service delivery.
I don’t think we need to spin off into a conspiracy theory. This is worse than that because it is real life.
What we are seeing with the Worcestershire prospectus is what happens when tender documents are put together by people who try to compensate for their lack of knowledge by over-relying on material produced by an organisation they believe to be an authority in the field.
Leaving aside the deeper issues of whether Worcestershire is trying to purchase the right things, let’s look for a moment at the source document, the 3ML ‘Recommendations on Key Requirements’…
From the perspective of the authors it was rational to throw in the words ‘where appropriate’ in recommendations such as the one suggesting that conformity with ISO/IEC 27001:2005 is a good idea. They probably reasoned that not all commissioners looking at the suggestion will think it appropriate.
Whoever subsequently adopted it word-for-word into Worcestershire’s mandatory requirements just didn’t think it through. Either it is mandatory, making the ‘where appropriate’ redundant or it is not, making the requirement non-mandatory.
There are more examples which are too many to list. However, I would just like to highlight a point touched on by other commenters.
To stack the odds so heavily in favour of one supplier and then to include other requirements that that supplier is going to struggle to meet (interoperability and ‘to enable patients/service users to access a range of technology from a range of suppliers’ (4.2)) is incompetent because they run the risk of excluding all bidders.
Sadly, considering the depth of knowledge and experience that is available in the UK, this situation should not exist. There is surely an opportunity here for a consortium of independent consultants to come together to advise commissioners and to quality assure their tender documents.
A fine suggestion Steve, but methinks that there may be a few problems in finding a panel of experts who could be deemed truly independent by all parties. However, if you could start with a strong chairman who was NOT himself or herself an expert in this field then progress could be made by requiring the genuine experts on the panel to justify every proposal and accept challenges as they are aired. Teletechnologies are not rocket science; there should be no need for complex definitions and technobabble. If the focus is placed fairly and squarely on the needs and opinions of service users then we should create service opportunities that are innovative, flexible and liked by both the end users and the health and social care professionals that propose or prescribe them. Thus, we will have in the UK the services that we can be proud of and which the rest of the world will want to copy or buy.
Who would you go to for independent advice and guidance? Are there any Telehealth or Telecare consultants or consultancies out there that have experience of large scale deployment, engaging all the relevant partners and succeeding? There are lots of people (look at this site for example) that know stuff and some even have teams and units specially set up to look into the market and are asked to attend various events and conferences to take part in presentations and workshops etc. But do people really listen? Do they grasp what it is when they are asking for something like a service such as this? If the Worcestershire BC is evidence then the answer to that is NO.
If there are then these are the people that the LAs and NHS bodies need to be speaking to. These consultants also need to be seeking assistance and guidance from others which they invariably do not. They need to be learning, absorbing, studying and looking outside of the box continuously in this fast changing world. Some consultancies state that have set up services and worked with NHS and LAs – it would be good to hear from them and their experiences.
Busines Cases like Worcestershire’s are not future proofed and are out of date by the time they are written, let alone implemented. You then end up retro fitting 5 years down the line the type of equipment that was actually available 5 years previous.
I will keep saying it until they change their BC – fixed lines are not necessary. If you stipulate fixed lines you are reducing the number of eligible customers. Do not do this, remove this clause. FIXED LINES ARE NOT NECESSARY. If you carry on saying this then you are saying we know who we want to supply us and we have written the BC accordingly and all other competitors will waste time, effort and money on a tender that they will never get. Also TSA accreditation – really? Do you even know what it is? Do you understand that it is moving more in the realms of myth and mystery than in real life? I know a few services that have the TSA accreditation – same as anything – what’s written down does not always match what is really happening.
I too heard that the TSA planned to open accreditation to non-members and emailed Marian Preece about it, who replied:
“Hi Sharon
Thank you for your email.
Trevor did announce at Conference that applications for accreditation to the Code would be accepted by Non Member Organisations. We are currently putting the finishing touches to the process for such applications and should be in a position to move on this early in the new year.” 20.12.12
I was at the London Telecare Group where Trevor from the TSA stated that they were opening up their verification to non members but he then went on to add that they were still working on the costing likely start date end of the financial year
Until then the requirement to comply with the TSA code of practice does not comply with the public contract regulations and would be open to challenge.
It is reasonable to include the requirement in the mandatory requirements so long has they do not exclude any potential provider because of non-compliance.
Worcester will of course have to feed back on the reasons why any potential provider was not invited to tender.
Interesting how they have dealt with risk sharing, the business case mentions discussions with a partner and then includes lease of equipment Note F – P33
However, in the PQQ 2.2 – … Do you agree to share the risk – Yes/No then 2.2.1 asks for their understanding of risk sharing with relation to mainstreaming AT. This is a pass/fail evaluation. Interesting in seeing how this is evaluated ?
Have they pre-judged the type of arrangements for risk sharing they are going to be presented with – leasing of the equipment???
Unless there is some really quite clever payment by results requirements within the contract then its not really risk sharing is it ?
Regarding the option appraisal its doesn’t include the creation of any social enterprise or even a Council controlled company for delivering this programme.
I would also point out that the key risks identified does not include technical risks including the in-operability of equipment leading to over dependence on one supplier, equipment replacement, etc.
A comment concerning providers being able to participate in the process the PQQ is quite specific that they will accept proposals from single providers, consortiums, etc. which they had to do in law but really the question is how will smaller providers participate in any consortiums which inevitability dominated by large providers/equipment manufacturers
Finally due to the nature of the procurement is the EU restricted route the best way forward. I just wondered if they considered using the negotiated regime instead?