After months of discussion, conjecture and rumours, The NAEP (National Association of Equipment Providers) conference, held at the end of June provided professionals, suppliers and some retailers with the opportunity to really focus on the key issues regarding the retail model over a pretty intense two day period. Here's is a snapshot of some of the views and discussions

Confirmation that the green light has been given

Lynne Horn, Implementation Manger for the programme was the keynote speaker at NAEP. Along with Lynne there was also Phil Stephens and Danny Doherty from the DoH team too.

Lynne made it quite clear at the conference that the foot would not be taken off the pedal in terms of progressing the programme. She explained that she had recently met with Ivan Lewis, the Care Minister and that he has given the green light to implement the model across England. “He decided to give the go ahead to implement across England and he is considering writing, along with David Nicholson, the NHS Chief Executive, to all LA/NHS partnerships to encourage implementation.”

A series of tools and techniques have been developed to help steer people through the implementation process, from start up readiness assessment packs to management toolkits and refurbishment case study templates. It's all very detailed, as you would expect after some two years of development and it is designed to give areas all the information they would need to persuade them that the retail model is an option they should take up.

So, the government has given the green light and it's full steam ahead. That won't please everyone. Having been asked to chair the conference again, I was conscious that delegates taking the time to come to Blackpool wanted to hear answers to a long list of questions. I wasn't 100% confident that they would get all the answers that they were looking for and that proved to be the case. However, as is becoming increasingly clear, the whole TCES retail model programme is evolving almost day by day and so it's not that easy to be that precise with answers. Whether that is the right way to implement something like this is another big question of course and one that everyone you speak to has different views on.

In my introduction to the conference I highlighted four facts that I felt very few people could argue with. They were that we are living longer, we are using more equipment, we won't be able to fund it and that we need to change something. I think that pretty much everyone now recognises that something has to change if the NHS is going to be able to offer any kind of service to people who need equipment to help them live more independently in the future.

The TCES programme and retail model is all about change, but it just happens to be massive change and a step too far for some right now.

The DoH has been keen to point out, right from the very start of discussions and presentations that the new model is aimed at the whole population and not just those who are supported by the state and that it is part of a large range of policies and initiatives designed to move in the same direction. Lynne, in her address, suggested that the feedback the DoH had received through surveys from October to December 2006 showed that generally professionals could see the benefits of a change and some 75% of people would like to see it used, as long as it wasn't implemented in their own areas!

We have mentioned before the MORI survey that was commissioned by the DoH. There is more information about the survey on the THIIS website.

We now know that only 100 or so people took part in the survey and questions have been asked about the validity of such a small number of responses. Most of the results were unsurprising. Lynne told conference delegates that 89% of users thought that it was either very or fairly important to have a choice of equipment and a 78% said that it was very or fairly important to have a choice of retailers to go to. According to the survey, an overwhelming majority of users (90%) valued the ability to ‘top up', 61% saying that it was very important and 29% that it was fairly important. However, top up's weren't in evidence that much.

The top up figures from the pilot retailers are low (around 2% at most), but Lynne did point out that the communication on the top up system at the point when the prescription was issued was not very good and so it is likely that the first time some of the users would have heard about the ‘top up' system was when they were asked the question by the Mori pollsters. In her presentation, Lynne told the audience; “Regarding top ups, we didn't do very well here, with only 44% of people knowing that they could top up and so we are doing some work with Ricability to produce some information to make it clearer but it is reassuring to see that some services concerns about retailers overselling just didn't stack up.”

We have already published the short interview we did with Mike Williams of Ableworld regarding this issue. Ableworld handled a total of 864 prescriptions in a six week period since May 1^st, when a new system commenced. That equates to some 36 prescriptions per week per store on average. On the top up issue, he told me; “This has been such a big event for us it's still very new to us. Our team has been extremely busy and so maybe haven't got to the stage where they are explaining to people each time they come with a prescription that they can top up. But, and it's a big but, to me it's such a big opportunity for the future. As things are calming down a little and the staff are getting more used to dealing with the prescriptions, we are seeing more top up's. You can't blame the DoH for the fact that people didn't top up that much. That's down to the retailers and the training we have to do”

I also asked Mike whether he felt it would be good practise for the retailer to point out to the user that they could top up or whether it should be left to the marketing of the service through messages on the prescriptions etc to do that job. “I think that as long as there isn't any pressure involved and at Ableworld there will never be any pressure involved, then I think there's nothing wrong in saying to a customer, if you don't like that brown commode, then we have another model but it is going to cost another £20. I think that's a service more than anything else.”

Other figures from pilots show that the lead partners (Cheshire etc) had a reduction in the average number of days from referral to assessment from 18 to 9 and from assessment to case closure from 45.5 to 27.5. In the seminar on the legal concerns from the new model, solicitor Jonathan Nash highlighted a concern connected to the period of time when a user might redeem a prescription. If, for example, the assessment is made, the prescription issued, but there is then a delay of some time before the prescription is redeemed, then what would be the consequences if the needs of the user had changed so much that the original prescription was then not valid? It seems though, from the figures that Lynne used in her presentation, that the timelines are reducing on the whole, which has to be a positive thing.

In answer to the question, “What is the risk to statutory organisations if there is a delay between the prescription and redemption for equipment?” the DoH response is: “The same risk occurs now. Practitioners undertake a risk assessment as part of the needs assessment process and make recommendations based on that assessment.”

One of the other key issues brought up time and again in the early presentations by professionals and users, was that retailers would ‘prey' on the prescription holders and attempt to sell them unsuitable or unwanted equipment.

According to the Mori figures, over 90% of people were satisfied with the service received from the retailers involved in the pilot and as many as 73% of them would speak highly of the retailer they used. This doesn't come as a big surprised to me as the companies involved in the pilots are well run and have good reputations. Indeed, the total from the categories of “Would you be critical of the retailer either without being asked or being asked” was just 3%.

Whether existing retailers have the capacity, logistical expertise or desire to get involved is another question. The problem for them is, that if they don't, then they would well be inviting competition which would not only service the retail model demand but also, eventually, eat into their private marketplace too. The competition could come from the big boys or it could be from the Third Sector charities and organisations that I believe are becoming increasingly aware that they too could become a retailer. In a simple show of hands vote at the conference, it was clear that the majority of people in the room felt that it could be an option to ‘go retail' themselves in the future.

Recycling still seen as an issue

Still high on the agenda of issues that many people have with the retail model is the thorny issue of recycling. The team at the DoH is very aware that this is a sticking point for many people and so have produced a financial framework that helps services understand the true cost of recycling.

“We absolutely still believe that the complex equipment should be issued, brought back, decontaminated and reused” Lynne confirmed. She also re-iterated the challenge that has been mentioned on a number of occasions to manufacturers and suppliers, of producing their products from recyclable components.

The DoH response to the question “The model is wasteful as it does not encourage recycling?” is as follows:

The model supports recycling of equipment and the national waste strategy.
The national waste strategy employ the terms ‘re-use' and ‘recycle' as distinct and separate steps in the waste hierarchy. This contrasts with the use of the terms within the community equipment service currently. In order to remove the confusion the model uses the following terms:

* ‘Refurbishment' describes the process for collecting, decontaminating and refurbishing equipment for re-use

* ‘Recycling' describes the practice of working closely with equipment manufacturers and retailers to encourage and promote the production of equipment using recyclable materials. It also covers the segregation of waste that households increasing undertake so that as little unwanted material ends up in landfill.

Susan Heap, Project Manager for TCES in Cheshire gave an honest account of the past few months. She explained that, in Cheshire, there was a realisation that something had to change. “We have to look at the demands on our future services and in Cheshire we have a higher than average number of elderly people and resources are not keeping up with demand. We did a series of consultations in 2003 and 2004 and worked very hard to find out what people wanted.”

As she pointed out, it hasn't been and it isn't an easy task. “We are the only area that has gone live without a safety net. It isn't easy and we are having to work extremely hard to make it work, but there are opportunities for our customers to have more choice. I'm not saying that it is happening right at this minute but that's what we are aiming at. There is also an opportunity to free up time for the staff to work with the more complex cases. There is also an opportunity to remove some of the stigma that is attached, or was attached to the retailers and to promote trust, encourage them to train staff and assist in opening up the marketplace and normalising the equipment and opening up the market will hopefully lead to more innovation on products. There are also opportunities for suppliers to become more directly involved in the commissioning of equipment to our customers.”

She touched on just hard it had been to move in a new direction. “It's a big change and change is difficult. Change management is extremely difficult, believe me, but it can be rewarding as well. Like everyone, we want an excellent service and with the retail model we have made mistakes and got things wrong and we are learning all the time as it evolves. For Cheshire, this is not a money saving exercise. If we do save any money, then it will go straight back into the service.”

For Cheshire, the choice was maybe easier than for other areas. “We had two external contracts providing equipment. Both of those contracts finished at the end of March this year and one of the providers gave notice that they had no intention of continuing to provide the service, so we were in a position where we had to make decisions.” Susan added. “We did think about re-tendering the service and of a social enterprise taking over the service but eventually decided to become a pilot for TCES.”

Susan said that the communication strategy had proven to be quite challenging as they had a potential 700+ prescribers in their area. “A lot of staff has needed support through this and some areas have found the transition extremely difficult”

Like everyone else, she was waiting to see the tariffs in the National Catalogue. “We are waiting for the national tariffs to see if that has any affect on financial modelling. Retailers have driven some of the costs down to achieve some profit and the relationship between the prescribers and the retailers is developing quite positively and we have had feedback from prescribers that the retail experiences have been good.”

It hasn't all been a struggle though as Susan went on to explain; “There have been some highlights” she told the audience. “Our relationships with retailers and suppliers has been one of the highlights for us. We have 16 retailers (outlets) in the programme and that number is increasing and we will have our own Independent Living Centres too. Our relationship with the suppliers has been very strong from day one. We have had some rocky times but we are very grateful to them for sticking with us.”

Cheshire has now issued over 3000 prescriptions and over 90% of them have been redeemed. 43% of people redeemed the prescriptions themselves. “We don't yet know why 10% haven't been redeemed, that's something we need to find out next” Susan explained. She then quoted figures that had been supplied to her by Ableworld and confirmed that the company was their largest retailer in the programme. “Items are generally being delivered within three days, with many items being delivered the next day if in stock” she added. “About 16% of the equipment is being delivered by the retailer because that is what we have ordered. The average number of items per prescription is 1.75 and the average cost of a prescription is £56.26 (which includes prescription cost and deliveries). Top ups are small at the moment, but Ableworld has found that 43% of people have purchased additional items either at the time or afterwards. A 22% increase in footfall has also been recorded and the satisfaction levels for the retailers have been in the 90%'s. Deliver and fits were 16% overall of the prescriptions (139)”

More from the pilot coalface in Wirral

Also giving a view on the realities of life as a pilot area for the model was Denise Cotter, ICES Lead Officer for Wirral. The equipment service is funded jointly between the borough council and primary care and the annual budget for the service is £1.6 million.

There are over 400 ordering officers and they are drawn from Physio's, OTs, Community Nurses and a number of others. Last year the service provided some 38,000 items of equipment and collected and returned almost 25,000 items for recycling. Almost 95% of the items were delivered with 7 working days. The value of the equipment provided was £2.9 million. “When you sit that beside our annual budget of £1.6 million, you can see that we will have issues with our financial modelling.”

Denise told the conference that the prescribers working in the model had been drawn from the full pool of the 400 ordering officers. “We wanted people who were operating in all of the different care environments.”

We identified four retailers in the area and developed an interim catalogue which included over 100 items. We discussed the prescription fee and also the delivery and fit fee and Wirral took the view that we weren't prepared to pay either.

The pilot went live in January with 32 prescribers and the 4 local retailers with 5 outlets in total. There has been an average of 53 prescriptions issued each month. Mystery shoppers have been used in the process for instant feedback. A snapshot of the prescribing data showed that in one period a total of 55 prescriptions were issued, with 42 redeemed and 13 not redeemed. Of 88 items prescribed, 68 had been provided and 20 items were not.

The value of the redeemed equipment was £1,271.24 and the recycling asset of the equipment issued was £1206.23 which represented 94.9% of the budgetary value. “I have to say that the figure set some alarm bells ringing” Denise admitted.

Denise went on to say that one of the emerging themes for the Wirral was one of financial risk. “There is definitely something in the financial area that Wirral perceive as a risk.”

The original plan was that it would run until March which gave some 8 weeks to monitor the progress. However, as the date approached, we recognised that we needed more time and more data to make decisions and so the latest date is that we will be running the pilot until the end of July.

From the other side of the retail counter

The figures quoted by Susan, which were given by Ableworld are very likely to be significantly different to figures that other retailers have experienced. The retailer's perspective was given by Peter Johnson, Community Equipment Co-Ordinator at Ross Care.

Ross Care has been involved with NHS and Local Authority supply for as long as most if not longer and so their take on the retail model should be worth listening to. The company has been involved in three different pilots, in Cheshire, Oldham and the Wirral. As Peter explained, this involved three different sets of prices etc.

The company's sales from October to May showed a total of 697 sales with a value of £17,837. A 21.0% margin equated to £3,747. As Peter told the audience; “As any retailer will tell you, a margin of 21% is very low.” The margin figures included both the product margin and the prescription charge. Two products, representing less than 5% of the items issued (which totalled some 31 items) contributed nearly 50% of the margin achieved.

Other figures showed that less than 10% of the prescriptions were collected by the end user and less than 1% of the prescriptions resulted in the purchase of an alternative higher priced item. “90% of all the prescriptions were collected by a family member, friend or even the professional who had issued the prescription in the first place” Peter told the conference. As you might imagine, the possibility of a professional collecting the items from the retailer did cause some comments from the audience.

One of the issues people had raised about the model throughout the past 12 months centred on the fact that clients were elderly and could not or would not be willing to travel to retailers to pick up their prescriptions. In Lynne's presentation, she had said that all the users that had been spoken too had redeemed their prescription, with 80% redeeming it for themselves. As you can see, these figures are in sharp contrast to those presented by Peter for Ross Care. I spoke afterwards to Mike Williams of Ableworld about this issue and he told me that initially, they too had seen a few OTs picking up the prescriptions, but that this was more about the OT getting to know the company and, almost certainly, checking them out to make sure that they were competent. That's understandable but there does need to be a better idea of whether this is the case or whether, in a few years time, we are going to see professionals used as delivery and installation staff, simply because they want to ensure that the client is looked after in the right way.

Less than 2% of the prescriptions going through Ross Care resulted in the purchase of an alternative product. Again, this differs greatly from the figures presented by Susan and produced by Ableworld. Can two businesses have such totally different experiences – it seems that they can.

Peter also mentioned the fact that they had questioned the suitability of one of the products included in Cheshire's start up catalogue produced for the pilot. “We believed that the product was dangerous when used in certain circumstances” he said. “If it's in the catalogue and it is prescribed and we issue it without delivering it and so we cannot do a risk assessment in the home, then who is responsible if there is an accident? We think that there should be some clarification on this point. Delivery and fit was at a level of around 30% when we started the model in October last year and that has reduced to about 10% and so there are more people just taking the products and installing them themselves.”

Peter concluded by telling the audience that until the National Catalogue is published, it just isn't possible for a retailer to make a decision on the viability of the retail model as prices etc may well change. “At the moment we can not make any projections, cannot produce a business plan and we really don't know where we are going with the retail model and don't know whether we will stay involved.”

One of the votes during the conference, to gauge people's attitudes to different aspects of the model was regarding retailers around the UK. The results showed that few delegates believed that the current retailers in their area were set up to deal with all the aspects of the model at present. The question was….

Retailers you know …… Can they do it?

The vote results were…

Yes, they can do it very well - 10%

They could do it, but would struggle - 43%

Focus on the financials

As reported previously, Danny Doherty of the DoH started his presentation with a warning. “You've got a demand coming your way that you cannot cope with.” He suggested. “That demand you are struggling to meet currently. People are living longer and guess what; the number of people who can pay taxes to cover that are reducing. We've got a very clear challenge financially. If we carry on delivering the service, at the level we are and in the way that we are, we will go bankrupt. It's as simple as that.”

However, he re-iterated that he wasn't here to simply push the model onto people. “We are not here saying, you will do this. We are challenging you to look at yourselves.”

There has been a lot of frustration that very little financial data has been forthcoming from the DoH over the past few months in terms of what they are using to prove their model and Danny attempted to explain why the figures, even if they were presented, would mean very little to people. “The national model is a collation of 150 services and to each of you individually today, it's not going to mean anything. You won't be able to identify with it, because it's not your service.”

Some people may have thought that this way of looking at this was an easy way out for the DoH, but part of the problem is the lack of information that the DoH team has been able to gleam from current service models – more of that shortly.

Danny said that the model is about a number of things including value for money. “Value for money is just a modern day term and I would rather refer back to a good old fashion term which is return on investment. Within the public sector and within these services we tend to see it being focused on the quality of the service and we tend to divorce that from just money and that's something to applaud, that's the right thing to do. However, there is a challenge for us and that is, are we getting the best return in terms of what we are delivering to users.”

He stressed that, going forward, it would be very much on a one to one basis. “We've built the financial model over the past twelve months simply for services to do their own evaluations. That model has been proven and been tested and it doesn't need an anonymous paper to challenge it. We can do that very directly and very effectively with each individual service and that's what we are strongly recommending to each service.”

However, he did give an insight into just how difficult it has been to put the financial model together. “In building the financial model, one of the real concerns to me and that disturbs me quite a bit when I look at this service is that there is an awful lot of passion and individually, people are committed to delivering a high level of care and there is no doubt about that. What is clear, is that, when it comes to understanding ourselves, we understand how we deliver the care that we provide, but when it comes to understanding the cost structure, I have to say, you don't know your costs well enough.”

He went on; “We went out to 150 authorities and we asked them to provide key bits of information that would help us build the model. Do you know how many services actually could respond to that? 24 out of 150. That was frightening to me. That's why we have done a lot of research to make sure that the financial model was correctly structured. If we don't know ourselves what the service is costing us, then it's a bit of a challenge for someone from outside to come in and tell you how the service looks in terms of its costs. And that's why we have elected, as we go forward, to work with each service individually. Look at your current costs, the costs of products and the cost of service and believe you me, to extract that information from your services is quite a challenge and we have not been able to do that effectively. And when I say us I mean us all here today, in the individual services. We have not been able to provide the cost data and it has taken a lot of work on our part to make sense of the data that we have been provided. From the data we have we were then able to look at the projected costs of a retail model and to calculate what the true costs of transitioning to the new model would be and we've built a model that help individual services address effectively the questions in the anonymous paper and so when that paper comes into a service, we will have all the answers and we won't have to stand up at presentations and say that we can't give out that information because it is commercially sensitive and that I cannot speak for 150 services.”

He recognised that there was still a lot of work to do to convince people the model will work for them. “Our view is that there is a compelling case for the retail model but until we give you your individual business cases, you are not going to get to that point. In the vote this morning, some 79% of you said that you didn't agree with it and that you didn't understand it. That's no surprise to me but the challenge is yours. You do need to get to understand it and you need to get to understand it through your own individual services.”

It isn't just the financial information that has been difficult to collate though as Danny explained; “I would suggest that when you look at your individual services that you don't need to first concentrate on the money, you need to concentrate on what the current service looks like in terms of demand. Again we have found it very difficult to get information about total levels of demand and that's because demand is coming into a service through a variety of different means and a variety of different points, geographically, physically and functionally and in terms of departments and, in consequence, very few services can collate that information and say, that's the total number of people we see and of that, this is the total number of people we refer for an assessment and this is how many we issued equipment requisitions for and of that, this is how we determined our level of performance in terms of responsiveness.”

The users are a focus too. “And, quite critically, within this model, you have to look at what users in your area truly want” Danny added. “And there you have an even bigger challenge. We talk about the standard of service to our current users. I have to say that we are missing a massive element within this. For everyone who comes through the state, by our calculations, there is at least one, if not two who self fund. They do not come near the service. A lot of people out there exercise their choice by simply doing it for themselves. The model we have built helps you extent the same level of service that users currently get to self funders.”

He then turned to the cost of recycling or refurbishing. “The cost to refurbish an item based on the study that we've done is £66.00 per item and a lot of people will say that this isn't correct. I'm not going to agree or disagree. What I am saying to you for your own individual service is, show me your data. What we are saying is that, in terms of refurbishing items the cost certainly isn't zero. It is a significant cost. We have built a financial model that will enable you to work that out for yourselves.”

As the conference continued it became clear that one of the weakest links of the argument against the retail model is the suggestion from the DoH team of the inability of current services to provide the adequate financial arguments which proves that what they are doing and the way they are doing it right now, it is a better and more cost effective solution than the proposed retail model.

Interestingly though, Danny did suggest in an answer to a question from the floor that the DoH were very aware that there was still a good deal of work to do when it comes to developing the retailers that could support any new system. He stated; “When we tested this model, one of the very clear things that we felt was that the retail sector was just not ready for this at this stage, because it's a completely new concept”

The DoH team intend to sit down face to face with each area and work their figures through their model to explain how they believe it will work. What's absolutely clear is that we won't be seeing detailed figures published. As Danny suggested, it's very much an individual area exercise.

No argument with the demographics, just with the way forward

Delegates were left in no doubt whatsoever about the position Bill Moran from the Liverpool Community Equipment Partnership was taking when it came to the retail model.

Bill told delegates that NAEP members should be celebrating their achievements but that they needed to take a position. “I think that NAEP should be about celebrating what equipment providers do…what store managers do and celebrating what drivers and technicians have done to improve and transform the service since 2001.”

Bill believed that the ICES (Integrated Community Equipment Services) had made a difference and had produced real change. He told the delegates that over £350 million had been invested in ICES by the government. Although he challenged the thinking on TCES, he emphasized that it didn't mean that he disagreed with the issues it raised about demographic changes etc. But, he suggested that there was evidence that retailers had not geared up to deliver in all areas and that the retail model prescription costs would be higher than the current procurement hub costs. In short, he felt that the TCES model would threaten the work he and his colleagues were doing in Liverpool.

“We need to take a position, because, if we don't we are turkeys voting for Christmas.” Bill suggested. “I've made it clear since last year my opposition to these proposals and my belief is that the real way forward is to continue to develop what we have developed in ICES. If we do go into the retail model I believe that we will be back, looking at local solutions, in five years time because the cost will have gone off the scale.”

In 2001 in Liverpool, we delivered about 12,000 items of equipment from two scrappy stores that were fairly run down with limited recycling facilities. ICES was only launched in 2001 and it was to deliver an equipment service that was to cope with at least the first part of the new millennium. We're not even at the end of the first decade and we are talking about throwing it out of the window. It beggars belief. The government has invested £350 million at least into ICES.”

Although he challenged the thinking on TCES, he emphasised that it didn't mean that he disagreed with the issues it raised about demographic changes etc. I would argue that, so far, there is no evidence that ICES is unable, by developing, to respond to that challenge. My case is this. 12,000 items of equipment in 2001 were delivered. In 2007/8, we delivered, in Liverpool, over 38,000 items of equipment. We collected around 18,000 items. We collected, by volume some 60% and we have done that in the past two years. By value, that was 88% of what we delivered. We've been able to expand and cope with a huge increase in demand in this decade by getting smarter, more efficient, better at procurement and recycling. Recycling, in my view, is not just an issue about the planet, but it's also an issue in that it's how we have managed to cope with the demand.”

Bill gave his own local take on recycling with some figures for commodes. He told the delegates that his service delivered 10,000 commodes worth £200,000 last year and collected 6,300 with a value of £135,500. “Are 6,300 commodes a year really going to end up in the landfill?” He asked.

Bill was also dubious about the level of support current retailers could give the model. “I don't think that there is any evidence that retailers are fully geared up to meet the retail model. And it's interesting that a number of the pilot sites have run out of retailers prepared to deliver the model. That's a challenge. It doesn't mean that they won't be able to in the future. I think that there is an whole issue about developing the retail market but it's going to take time and it needs time and we need to be a part of it and not junked to be replaced by it.”

As for he product prices he stated; “From what I have heard from suppliers, the prescription costs are likely to be hugely higher than the kind of costs we are currently paying through a purchasing consortium as we are involved with. And something that the TCES team don't mention is the damage that could be done to partnerships as I believe it drives a super tanker right into the middle of the issue of pooled budgets as a lot of the retail items are what used to be classed as social care equipment and I can see the pooled budget holders saying…hang on a minute, we're now going to manage a prescription service, with transferred costs because care staff are going to be picking up prescriptions. How do you fit a walking frame if you haven't got the person there? What about the skills of driver/technicians who can do that onsite and on the spot?”

He also had an issue with the degree of consultation. “The biggest bugbear for me is unquestionably the issue of users and customers being consulted. We've heard precious little evidence of that. The Mori poll is actually quite a small sample (Bill believed the figure to be some 300. However, it was actually just over 100). Our advisory board has representatives of the local senior citizen organizations and we asked them if they knew about the model and whether they had been asked about it. Why did I ask them? Because 80% of our customers are pensioners. 37% of our customers are over the age of 80 and a significant proportion of those are living alone. The organisations were aghast when we explained about the retail model.”

Bill then turned his attention to the home delivery issue for what he termed ‘the big kit issues'. “I don't think that DHL/Logistics have proven their capacity to deliver more than parcels. The beauty of the service for me is that now we have contracted down from the number of stores that we had originally, we're now in a position where we can call a driver on the road and say, on your way back, can you just check this and just do that. It's flexibility and it's local. You can't do that from Birmingham to Liverpool in a day.”

This was one of the questions that the DoH answered later by stating….

“We are in discussions with NHS/DHL, and other organisations, as part of our understanding and evaluation of the options that are available to develop a more efficient home delivery service. DHL are a global leading logistics provider. Home delivery, warehousing and distribution, technical delivery, installation services and engineering services form part of the wide range of services they provide internationally. The evaluation process is expected to be completed by the autumn when it will be discussed with LA/NHS senior executives.”

Bill raised other financial matters too. “The biggest financial question for me is that I can't now see, between the retail model and running a national delivery service and still having to do bespoke equipment, how the financial model stacks up. And, more importantly, how can they say it stacks up, when we don't have the national tariff and we don't have the costs for a national delivery service. Those are key parts of the business plan. If you don't know what you are going to pay for your equipment and you don't know what your logistics costs are, it beggars belief to say that we are inefficient and we can't do it just as well. I just don't see it.”

“I say this more in sorrow than anger, but I am passionate about this” Bill added. “If we are into offering real choice and flexibility why aren't we saying to people, we will give you a choice, like we do with the wheelchair service? You can have a voucher. You can go to an approved retailer and get what you want, top up, have something slightly different, have it in purple or pink or, you can ask us to do it. We'll deliver it, it might be bog standard, it might be recycled, but we'll do it for you and collect it back. That to me is real choice.”

Finally, he told the delegates; “My message is that the real transformation is the one that we have already undergone. That it's unfinished business. Instead of TCES coming in and throwing out the bathboard with the bathwater, the real job should be to ask where do we take ICES next? What's the next step. I would advocate that the next step is bringing in more partners and bring in wheelchairs, bringing in adaptations and so on and building capacity and building advice for those who want to self-fund.

More information on the National Catalogue

The first taster of the National Catalogue and those all important tariffs has now been seen. At the conference, Phil Stephens of the DoH gave an overview of the catalogue, the tariffs and the options when it comes to a national home delivery service.

Phil has been the DoH team member leading the national catalogue creation and production. He told the audience that the catalogue content has been worked on by a number of clinical experts. “Take 26” bathboards for example” he said. “There were a dozen or so different products in the data we had in from the authorities. What we didn't know was whether we needed a dozen to meet every clinical need or did we need less. Using a group of health professionals we narrowed the products down. They also added products that they felt were missing. They also helped write a generic specification for each product because the catalogue does not contain specific manufacturer's products, it contains generic descriptions of products. The NAEP special interest group kindly helped me with this task and where they felt that they didn't have the clinical expertise, then they invited other groups to join. There were Physiotherapists, OTs, Tissue Viability Nurses, bariatric and sensory impairment specialists. We then decided that we needed it validated by someone and so the College of OTs did that for us. They went through all the work that the clinical groups had gone through. We went through a procurement exercise, a clinical exercise and also a professional validation.”

Phil then answered the question as to why they had decided to go down the route of using generic descriptions rather than specific products from specific suppliers. “There were a number of reasons. We took legal advice and the legal advice was very clear. Also, if we want innovation in this marketplace, then suppliers have got to do something with the products and make their products more attractive to the retailers. And, if we took all the bathboards from a single supplier, we might get a great price, but next year, if all the other companies went out of business, we would be stuck with one supplier and that price might rise. The other reason was that the retailers have their own sourcing policies, whether they are a small retailer with a single shop of a national company with 100's of outlets, they all have their own preferred suppliers and our position is that not to dictate to them whose products they should purchase.”

Phil went on to explain how they had created the tariff. He acknowledged that this is a question that he and the team are being asked all the time. “We've done two things” he explained. “First, we have created an initial tariff and this has been created by looking at the prices that you guys are paying for all the individual products and then we did some statistical work with that, taking out the highest and the lowest prices. We then averaged the price and have gone for the lower quartile prices. But then we understand that the retailers would not be able to buy at the same price that you are buying at, because of the volumes involved. That may change as the bigger retailers come on board but, at the moment, that is the reality. And so, to the price, we have added a percentage profit for the retailers because we have to recognise that, for this to work, we have to have retailers and for them to be in it, they need to make some money out of it. But, we also recognise that we can't afford to trash local authority budgets by giving retailers massive profit margins and so it is a fine balance”

Phil went on to say that the DoH were in the process of ‘sense checking' the tariff. “We are doing that with a small number of the supplying companies, with retailers and the areas in the North West that have already taken part with the model. If their prices and our prices are roughly in line, then we are not going to be too far adrift. The final piece of work that we are doing with the tariff and which won't be done until probably September, is that we have commissioned a procurement specialist to go into the marketplace and get actual trade prices for all these products. In doing that, we are talking to suppliers over here, in Europe and in the Far East. They are putting together a whole range of prices for us that we can then sense check against the tariff.”

The National Delivery Service is also something that has generated a lot of questions and opinions. “Who is going to provide the nationally commissioned home delivery service?” Phil asked. “Well, we don't know yet.” Phil then explained the three options that the DoH team are considering. “First of all we are looking at a partnership between NHS supply chain. They belong to DHL that are national logistics company and so they really do have logistics expertise. Although you may think they don't, they do. But they don't have expertise in equipment and they don't have expertise in decontamination, installation and demonstration. And so the first option we are looking at is a partnership between them and existing stores. But instead of having 138 plus of them, lets have less than that. Let's work on a regional basis, because, if all of the low level equipment is taken out of the equation, you have an awful lot of spare capacity in your stores to handle the larger equipment on a regional basis. How many regional stores? We don't know yet. It could be as low as 5, but it could be 13 or 20. The second option that we are looking at is the same as the first, but without NHS Supply Chain providing the national logistics and procurement. And the third option that we are considering, is to contract the whole lot out on either a national basis or a regional basis.”

Finally, Phil highlighted another area that is causing people concern. “People ask us how we are going to manage a hospital discharge with this process. How can we expect someone who requires palliative care to go to a retailer on their way home. Well, we don't. The national home delivery service will provide the products for those patients. So, if you have a discharge from hospital and the person needs a bed and a hoist and a pressure care mattress and also a bathboard, then that's what they will get.”

The first question for Phil was probably one of the most interesting for suppliers. It was from an OT who asked “Will the national catalogue be available to areas that don't move to the retail model?”

Phil answered by saying “Yes it will. As apart of the business case that we present to authorities, they will need to see the catalogue.” When the OT clarified the situation by asking “Do we have to go through the process of the business case or can we just see the catalogue anyway? Phil responded by saying; “I haven't been asked that before, but I don't see why not. The information will be in the public domain.”

There was slight confusion about whether people could buy from the catalogue but, as Phil pointed out, the catalogue will just be a list of products with tariffs alongside. However, he did say; “If you want to use the information to negotiate with your own suppliers, I don't see why not.”

When asked what the percentage added on for the retailer was, Phil replied; “It varies product by product and it's still being verified and so I cannot tell you that.” Pushed to give an average, he said; “I can't tell you as it varies.” He added; “We are going to set a tariff that we think is absolutely right for both parties. We're going through a validation process using stakeholders from every part of the marketplace. We're asking suppliers whether they think that they can sell to retailers at the price we have come up with for each item. Equally, we are giving the prices we are looking at to retailers. I really can't give you percentages right now as whatever I say will be wrong. We have to set it at a level where retailers want to play though.”

A question from a supplier asked whether the prices would vary from those they were using at the moment on contracts for hoists and slings. “It depends which option we use for the national home delivery service” Phil replied. “If we use the first option and use NHS supply chain, they will come back to us with the recommendation on the prices that we should purchase at. If we do the regional option, then there will be regional procurement groups but I am sure that they will be looking at price advantages if they are looking at greater quantities.

Another delegate asked a question about prescription fees. “Is the prescription charge still going to be £4.00, that's £2.50 to the DoH and £1.50 to the retailer?”

Phil answered that they didn't yet know. “There are two prescription charges. There is a prescription charge for the retailer and the other part of the prescription charge is for funding of the national commissioning body which the local authority will pay. These two elements haven't been decided.”

How will the provision be monitored was the subject of another query. The questioner stated; “Many years have been spent implementing an IT system as required for ICES. Will these systems be rolled out for the retailers and will they be able to operate it in an integrated way?”

“Not by us” Phil responded. “We are not insisting that retailers have to have any particular IT system to take part in this. We decided that the process was fairly simple. Is there an opportunity in the future for IT systems to make this easier? Yes, but we're not trying to put together any IT solution as the paper system works”.

A delegate asked; “Am I right in thinking that when a user is issued a prescription for, say a slatted bathboard, then they could take the prescription to four or five retailers and each retailer is able to buy whatever brand that they want to? My point is that, as a store, we are aware that there are a variety of slatted bathboards but that they are all very different. We evaluate the product. How would this work through a retailer?”

Phil responded; “The user will make a choice in terms of the retailer they choose to go to. But, the retailer can buy whichever product they choose to from whichever supplier. All they need is the generic specification that has been laid down and that specification has been written by a wide variety of clinical specialists. The products that are sold to retailers have to be fit for purpose, but as long as the product meets the generic specification, then it can be any slatted bathboard.”