Telecare Soapbox: LTC demonstrator sites to kill off small telecare suppliers?

Speculation by Steve Hards, concerning the potential double-edged effect of the Department of Health's large 'White Paper pilots: whole system long term conditions (LTC) demonstrator programme'.

Small telecare manufacturers and suppliers who may have been popping a few champagne corks at the news of the Department of Health’s ‘White Paper pilots: whole system long term conditions (LTC) demonstrator programme’ should be hearing alarm bells instead.

The reason lies in the scale of the programme. What is known is that DH has announced that three sites will be chosen, covering a population base of about one million people. What is not known is how much funding there will be because, of course, DH isn’t announcing that. However, someone (not me!) who is supposed to be in the know has talked to Computing for its article which suggests that it will be about £30 million.

The lure of having an average of £10 million in dedicated funding per site – two-and-a-half times Newham’s huge project – should flush out some very good bids.

Why should this good news be a problem?

The programme is, of course, good news. The lack of a large evidence-base for the effectiveness for telecare- and telehealth-supported interventions has been bemoaned by the funders of services across the world and the demonstrator sites should, at last, provide this. The problem is that with a timescale as short as two to three years to show results, there will be pressure to spend the funding quickly and, with all the governance issues that such money brings, the inclination will be to ‘take no chances’ in those spending decisions. There will therefore be tremendous pressure within councils to buy conservatively, which means great business for Tunstall, the leading company in the UK market.

Furthermore, councils may require support from suppliers in the preparation of the bids. If the smallest of the three sites has a population of, say, 275,000, that puts 61 of the 150 councils with social care responsibilities (Nottingham and larger) in the frame to compete for the funding. And, of course, small companies have nothing like the resources of Tunstall with which to respond.

When the projects are over and the evidence-base is rooted in Tunstall products and systems, Tunstall will not need to do anything to freeze out of the market the smaller telecare telehealth companies with the leading-edge or niche products. Councils in the UK will do that for it, simply by following the lead of the demonstrator sites.

Creating a monopoly

The effect will, of course, be one of stifling the evolution of the mixed telecare and telehealth economy that we have at present and, in the end, councils and PCTs will have a smaller range of options for meeting people’s needs. In entrenching Tunstall as the supplier of choice the customers themselves will, in effect, have handed it a monopoly.

Is this inevitable? Consultants and advisors to the demonstrator sites may warn them against putting all their eggs into one basket, but the pressure to play it safe makes the chances of that advice being heeded are slim. It might be possible that DH will make it a requirement to spread the funding amongst different suppliers. This is even less likely, as DH will not direct local spending decisions, especially when to do so would also impinge on the dynamics of a commercial market.

What if you are a telecare or telehealth supplier?

What then, are the implications of the demonstrator programme if you are a telecare or telehealth supplier other than Tunstall? I think there are two:

• Large non-UK based suppliers poised to enter the UK market need to move quickly to stand a chance of breaking in.
• Small UK suppliers (who tend to believe that they will survive owing to their uniqueness carving them out a niche) should forget their desire to do their own thing and either sell to Tunstall or, if that is a step too far, put aside their differences and pool resources and form an effective consortium to offer an alternative.

And if you are Tunstall? You are sitting pretty - you don’t need any advice!