The easily available public facts
Fact 1) A trial using 100 telehealth units had started in parts of the area covered by NHS North Yorkshire and York (ex. North Yorkshire and York Primary Care Trust, the largest PCT in England) in September 2009 and was due for evaluation in April/May 2010. (See timeline on the final page of this PDF.)
Fact 2) At the end of January 2010 a reporter for a local newspaper reported that the PCT was heading for a deficit of £8million at the end of March, its financial year end. She also noted that it was planning to introduce the use of 100 telehealth units. (TA note)
Fact 3) A Tunstall press release in June 2010 states “NHS North Yorkshire and York unveiled plans to purchase a further 2,000 Telehealth systems… Tunstall, was awarded the contract to provide the additional 2,000 systems following a competitive tender process.” (Longer, undated Tunstall version of the release.)
Fact 4) The PCT’s website (reflecting the plan set out in 1, above) currently says: “The Telehealth project in North Yorkshire and York is being rolled-out in two phases. The first phase runs until September 2010 and involves an investment in 120 Telehealth systems. In June 2010 we announced that the second phase of the project will involve the purchase of a further 2,000 Telehealth systems.”
The not so public facts
Fact 5) Pre-empting the outcome of the future evaluation, preparations for the additional procurement were being made in October/November of 2009: the invitation to tender was issued (not openly advertised) within the context of the old PASA Telecare National Framework Agreement in mid-December 2009. Three companies participated.
Fact 6) The £3.2 million procurement (two thirds funded by the Strategic Health Authority, the rest by the PCT) was completed in March 2010.
Fact 7) In addition to the upfront cost, the PCT committed to paying a substantial sum [believed to be in the order of £500,000] in annual maintenance and other charges.
Fact 8) The Tunstall RTX units do not meet requirements specified in the bid invitation. Specifically:
• to enable clinical staff to teleconference directly with a patient.
• to allow for the use of multi users in community settings, such as nursing homes and extra care schemes
The units are also several times the cost of alternatives that are in this marketplace.
Fact 9) The PCT’s invitation to tender had the standard ‘get out clause’ which stated that it reserved the right not to award all or any of the business to the service provider that scored best against the criteria.
Fact 10) Of the 2,000 RTX units only 5 have been put to use since they were purchased. [Source: an anonymous insider.]
And finally…
Mr David Cockayne, who was Director of Strategy at NHS North Yorkshire and York at the time of the procurement and whose name keeps popping up in the above news items left the employment of the PCT in July and took up employment with Tunstall yesterday, 11 October 2010. [This is a fact. But before readers jump to conclusions I wish to point out that there is no evidence that Mr Cockayne’s employment is related to any of the above in any improper way and it should not be construed as such.]
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Not the first time
I am surprised you didn’t mention the fact that there is a pattern here! Do you remember that Tunstall hired David Kelly from West Lothian in Scotland – not long after the huge West Lothian Telecare and Telehealth project award?
I am sure this is just a coincidence – isn’t it???
[Hmm…Coincidences do happen. Steve]
Progress monitoring
Can we monitor the progress of implementation? Say, every 6 months. FOI requests could be used if details are not forthcoming from other channels.
How many eggs does your basket hold?
Ambitious project, incompletely scoped? OR perhaps the classic “pilot cannot scale to reality”? I suspect many of us have been in those positions during our careers and it is uncomfortable.
Of course it is right that appropriate questions should be asked about the expenditure of public monies; however life offers us the unending challenge of change and we have to make the opportunities to address this so I’m curious but I think I’ll put my efforts into making sure we always have enough baskets to accommodate our eggs – scoping projects well, making good business cases and growing a strong strategy for telecare and telehealth … and if I get it wrong I’ll advertise the surplus baskets through Telecare Aware … if I may?
Ambitious telehealth projects
Once more the Tunstall sales machine has succeeded in finding someone who has enough ambition and clout to cut corners to push through a big plan using tax-payer’s money!
But should we be congratulating the Tunstall salesman for planting the right seed in the right head, or should we be supporting the company for finding their man with the money a job for a few months rather than have him publicly fall on his sword?
The fair approach would be to judge the project on its outcomes – but these won’t be known properly for a couple of years (and we’ll probably need to wait another 12 months before the official evaluation report is produced). By then both the PCT and the SHA will have disappeared, so nobody will care.
So perhaps the plans should be reviewed BEFORE all the money is spent. Someone from the PCT and the SHA needs to explain why they chose to buy so many of the same Danish systems when informed opinion suggests that a mixture of equipment (with different features) would be best to meet the various levels of need amongst the population. Perhaps this decision would have been justified had they chosen the lowest cost option. But they didn’t, and the price paid, despite any economies for volume purchases, was well above the £1200 per unit mark that is now standard across the telehealth industry in the UK. As manufacturers from South East Asia enter this market, average system costs will fall below £600 within 2 years, making Yorkshire look stupid and Tunstall greedy.
Of course, neither greed nor stupidity are crimes (especially when you are up to your eye-balls in debt)!
Not the first time
There are other examples of ‘close’ partnership working from Tunstall within this field that can leave them open to accusations, real or imagined, e.g. Director’s wife paid £300-a-day in fees. There have been clear benefits for the development of telecare within the UK from the trust that Tunstall has managed to develop with many organisations, and it is clear that this process is, and probably needs to be, based largely on personal relationships. However, if this strategy is not to backfire on them and the field in a very messy way, then Tunstall have to take more responsibility for what their operational staff promise and then deliver and how they do this. It’s just as well for them and everyone else involved that the Audit Commission will not be around to lift the curtain on this and similar situations.
A small matter of ETHICS
Isn’t the procurement process supposed to ensure ‘fairness’ across the board? i.e to suppliers, advisers, medical staff and of course patients as well as tax payers in general who pay for these ‘projects’. Presumably decisions are not made by one man but by a team and if that is the case, who made up the team and what are their comments, I wonder? If one man was allowed to make this decision, however questionable it may be, who permitted this procedure and what will be done in the future to prevent it from happening again? As jobs in PCT’s begin to disappear the risk of this happening on a larger scale is high, although great news for the bigger companies who can afford these ventures, it is very bad news indeed for patients, smaller companies and UK medical ethics in general. Now back to watching Pakistan cricket team…
[Editorail note: There is no evidence to suggest that, within the terms of the NHS PASA Framework Agreement in force at the time, the procedure was unfair, improperly conducted or unduly influenced by one person. The main loser here, it seems, is the taxpayer. Ed. Steve]
Local paper questions PCT about the £3.2m spend
The PCT’s local paper has picked up the story and raised the point about the delay. £3.2m Telehealth units ‘delayed’.
[We are still waiting for Received 18 Oct: the statement that the PCT’s Communications Department said on Tuesday that they would send, disputing some of the facts set out in the item. Read it here.]
Private Eye
Private Eye (08.11.10) has also picked up this story in the ‘in the back’ section.
[Private Eye is a “British satirical and current affairs magazine” according to Wikipedia.]
Private Eye
I was disappointed that the current edition of Private Eye (12th to 25th November) doesn’t contain the article on the North Yorkshire Telehealth fiasco. It would be refreshing to read the Private Eye’s spin on a situation that involves either gross stupidity (the PCT), terrible greed (Tunstall), or something even more unsavoury! Could the delegates to next week’s TSA conference not be treated to a photocopy of the article in their goody bags?