Telecare Soapbox: Are Partnership Agreements Stifling Innovation?

Paul Mitchell, an experienced consultant and troubleshooter in social care in the UK argues that partnership agreements between councils and telecare providers may be anti-competitive, anti-choice, and not in the best interests of service users.

Many social care authorities who have signed up to so-called exclusive 'partnership' agreements may now regret having their hands tied.

All is not lost however because unless those providers can live up to the implicit and explicit terms of those agreements I would urge the customers to review the validity of the agreements. First let's look at some of the frequently recurring terms in such agreements and their implications.

Telecare: effectively a meaningless term unless precisely defined within the agreement. There is no legally or universally accepted meaning for this word, so any agreement which does not satisfactorily define its scope cannot be enforceable unless there is clear, documented evidence that both parties fully understood its scope at the time of reaching the 'agreement'. The same would apply to 'Telehealth' or 'Telemedicine' or even 'Assistive Technology'.

Partnership: implies some mutual benefits from the agreement, but what actually are those benefits? I have seen a provider undertake to provide expertise in connection with the customer's Community Care Management System. On what basis can the supplier claim to be an expert? If the customer relied on the supply of that expertise, have they been satisfied with the 'expert' advice they have received – or has there been some mis-representation?

Best value: I would advise any customer to look very closely at the claims for this benefit since it is an extremely technical term to unpick and demonstrate an effective delivery. The term would include not only best price, but also best up-to-date technology fit for purpose, not forgetting compliance with government policies. I could run a coach and horses through any claim to this by the leading "Telecare" providers.

Programme of work: an inference here that the supplier would work with the customer on a regular basis to set out and manage a clear strategy for delivery of the partnership agreement. I cannot comment on how much this has been achieved in customer organisations up and down the country, but I would be very surprised if any provider could afford that overhead, or even has the necessary competence in depth.

Advice and consultation: there is a clear conflict of interest here between offering 'expert' advice and exclusively promoting the supplier's products. One assume that this is the main partnership aspect of the agreement since all of the other advantages seem to accrue to the Telecare supplier.

What's missing?

More interesting to me is what is missing from many of these agreements. Nowhere is there any mention of any benefits to service users of the promoted products.

Is this therefore purely a supply of equipment – a box-pushing exercise, without any regard to whether the products actually can deliver any benefits to users?

Nor are such agreements particularly verbal on the performance of the provider's equipment. Surely an exclusive agreement should be backed up by a commitment to ensure that all equipment supplied through the care organisation is fit for purpose and performs competitively against the competition? Otherwise, service users are at risk of being short changed and, in some cases, at avoidable risk to loss of life from reliance on poorly performing equipment.

I freely admit to wanting to promote my company's products...I am also convinced as to their relative superiority over most of the competition...nevertheless, I also believe implicitly that all products purporting to support people at home in safety, should be fit for that purpose.

Let us be clear here: much of the so-called telecare in people's homes is not fit for purpose; some of it never was of acceptable quality but is still available on the market; a lot of other equipment is about to become redundant because the technical infrastructure (eg BT21CN) has or will very soon render it so when rolled out in the UK. I would be interested to know which providers have proactively advised every one of their customers of which particular specific individual boxes do not comply with the new infrastructure, in accordance with the 'partnership' agreement? How good is that 'objective' advice the customer has every right to expect? If any customers are dissatisfied with the advice they have so far received from their provider, I would suggest that their particular partnership agreement has been breached by the non -performance of the supplier and is no longer enforceable. Consult your lawyers! More importantly, act now to safeguard the welfare and safety of the users sitting in their homes blithely relying on those boxes.

Now to turn to government policy and Putting People First: This advocates, amongst much else, choice for the service user. Exclusive partnership agreements deny that choice to service users subject to exclusive supply agreements with care organisations. It would mean that a user has to decline the service of the social care authority or health provider in order to be able to exercise choice. I would ask all affected organisations to look carefully at how they propose to give users a level playing field on which to select the system which the user may prefer, and more importantly, the impartial advice on which the user can make that decision.

The next issue is the exclusivity of a closed proprietary monitoring system. This is anti-competitive, anti-choice, and ultimately cannot be in the best interests of service users. If competitors are deterred by anti-competitive practices from making their equipment compatible with 'closed' call centre systems, they are being prevented from offering choice to users of that closed service.

Illusions

Finally, to the focus on equipment. This may as well simply sit in its box and inertly takes up space on a store shelf (as much of the kit purchased in haste under partnership agreements with PTG money is allegedly doing) unless it forms part of a proper care system. I fear that many support systems are ineffective and provide a fig leaf of protection which may prove an illusion when a real emergency arises. Telecare and telehealth installations require full health and social care system transformation to become fully effective. Too many technology-based solutions have been grafted on to existing care pathways and services and therefore fail to deliver a joined-up or effective service. The technology needs to be mainstreamed rather than prescribed as an after-thought. The whole system should be geared up to learning something significant about the service user from the operation of the equipment. Services should be re-commissioned to take full advantage of the equipment. Most important of all, though, care and support plans should be re-assessed to strip out services or service levels which are inconsistent with giving the user greater independence, but only as part of a whole system transformation.

I urge organisations to go back to their 'partners' to get their best advice on how not only the Community Care Management System (about which they purport to be professed experts), but also health and housing systems, should be transformed. They may be very short conversations.