ANNEX F. London Focus Group Tender - Commissioning Support Services ITT Clarification Questions: FINAL Summary7

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1 ANNEX F London Focus Group Tender - Commissioning Support Services ITT Clarification Questions: FINAL Summary7 Srl. Question Response 1 According to the memorandum of information, the draft ITT was supposed to have been issued 25 th October. It was issued 29 th October. Please can you clarify whether the deadline for bidder clarification questions has moved, or whether it remains 5 th November? 2 Please can you let me know if you are in a position to let me know where we scored well and where we scored not so good? The period for CQs has been extended to close-of-business on 7 th November. However, the tender return date of 29th November will not change. Sorry, beyond confirming pre-qualification, the processes we have established for the procurement do not provide for feedback on successful PQQ submissions unless, in seeking to respond to legitimate requests for specific clarification of the ITT, this becomes necessary and appropriate. 3 Are we able to see indicative information on the likely TUPE transfers that Refer to PQQ clarification #1. could occur, should we be asked to deliver this service. 4 If not, are we able to price our bid, subject to TUPE? Yes. 5 What proportion of the referrals to the London Trusts are tertiary referrals, ie. consultant to consultant. This information is not readily available - if critical to your bid, state the dependency & likely impact. 6 Are the current contracts independently held by each CCG or are they This information is given in the ITT (p. 6). associates to a contract held by another CCG? 7 In Section 4, paragraph 17, reference is made to Right Care or any successor organisation. Please advise the nature of information you are seeking for a compliant response. We would be looking to see that in their comparative analysis and commissioning tools Service providers demonstrate awareness of these types of national benchmarks and use of them where appropriate ie looking at unwarranted variation in services commissioned and that where there is variation in age/need profiles for each CCG they could respond to sensitivity requirements. It is envisaged that this would be achieved through the Service provider's individual meetings with CCGs via their reviews of activity and contract performance.

2 8 Please can you advise the date at which the Final ITT will be issued in light of the extension of the CQ period to 7 th November. Will this still be 8 th November 2013, per section 3.1 of the ITT? 9 Please can you confirm who the Lead Commissioner is/will be for the contract? 10 Thank you for providing the information in relation to the estimated annual contract values. Please could you provide any additional information with regard to the Services covered/current performance in year in so far as it relates to these contracts. 11 Section 9: Financial Model ref (f) makes reference to accommodation costs. Noting the current geography over which services are currently delivered, it would be helpful to us if you could provide us with further information on the following: a) the current accommodation and its geographic dispersal and b) whether the Commissioner has any preferences for either of 1) a single local accommodation base, 2) a single remote accommodation base or 3) dispersed accommodation across the current geography - as this will impact on the costs included. 12 In line with the above, is the intent for the Provider to identify/locate an accommodation solution or does the Commissioner already have something in place? 13 We anticipate over the life of the contract, a significant number of meetings will be required. For consistency across bidder solutions, please can you provide an indication of the number of meetings we should reasonably include within our submission as well as where we might expect these to be held - given the geographic area concerned, the impact on resource/costs and with the overall objective of demonstrating a VFM solution. 14 Will the Commissioner accept any variant bids which include innovative solutions and which may demonstrate better value for money? 15 Please could you provide some further information with regard to any TUPE implications of the new contract scheduled to commence on 1 April That remains our aim but this is subject to the weight of CQs emerging from tenderers over the next 2 days and the possible impact on the final documents. At the very latest, we envisage the final ITT being sent out during the weekend of 9th/10th November. Please see the MOI & ITT. Not at this stage. Bidders are free to propose their preferred delivery model(s). See response to 6. Please read the ITT, particularly Section 4. Bidders should submit a fully compliant proposal. The Commissioner is prepared, without commitment, to consider variants offering clear and demonstrable additional benefit. This Q has previously been dealt with as a PQQ CQ.

3 We note the process for Clarification Questions in Section 3.4 of the ITT. Please can you confirm whether bidders will be notified when responses have been uploaded by the Commissioner to the website or whether it will be for bidders to regularly check the website. 17 Section 7: Service Fees and Payment. We note the intention that fees will comprise a mix of fixed and incentivised-based fees based on costs savings (ref 1b). In the case of service redesign, it may be that any savings are realised later in the process or beyond the duration of the contract period. Would the Commissioner be in acceptance of a solution which makes provision for such forecasted savings and for these to be enjoyed earlier in the contract period. 18 Please can you provide further information with regard to the CCG Commissioning Intentions for 2014/15 or provide guidance on where we can locate these. 19 We note in Section 9: Financial Model of the ITT, Section requires the model to be constructed in a format and using a software tool as specified by the Commissioner. Please can further clarification be given as to whether a format or further details will be supplied. 20 Section 9: Financial model Ref refers to indexation assumptions relating to input costs. For consistency across bidder responses, please can you confirm the indexation assumption (indice(s)) for us to use. Bidders are expected to be proactive, having been alerted to this mode of notification/promulgation (id est via the website) in the initial advertisement, the MOI, the PQQ and the ITT. Bidders are free to propose their solutions for consideration, without commitment, by the Commissioner and subject to contract. The LFG commissioning intentions (London acute providers) are available on the website and at Annex G to the Final ITT. No further clarification is available; bidders to use their experience. Please feel free to use such assumptions as you deem appropriate - but be careful to state clearly the assumptions you use. 21 Please can you confirm which DSCRO(s) the CCGs are currently aligned to? The significance of this, in the context of the tender, is not understood. 22 Please can you confirm the primary source of data for reporting? Is it SUS Please read the ITT, particularly Section 4. or SLAM? 23 Please can you confirm how many data flows are currently received by There are multiple data sources. UHUK? Is this just SUS or are there others? 24 Please can you confirm how many data flows are monitored by UHUK including reconciliation to provider invoicing for a) SUS There are all the standard acute data flows, including those instanced in the question and high cost drugs. Inpatients/Outpatients/A&E, b) unbundled diagnostics, c) pathology etc 25 Please confirm the level of detail at which reconciliation is carried out? Is this at the patient or aggregate level? Please read the ITT, particularly Section 4.

4 26 Please confirm how reports are currently presented back to CCGs. Is this via an automated system, by , other? 27 Please confirm how many AIV challenges are currently carried out by data set? Is AIV currently conducted on High Cost Drugs? 28 Please can you provide the current success rates for AIV with London providers? Which particular AIVs are useful? 29 Please confirm whether the reporting also covers maternity activity? Is this in scope or is this part of current contracts held by the CCGs with their main provider? Please feel free to propose. (a) Information not readily available. (b) Yes - as stated. This information is not available. The Commissioner comments: "On the basis that CCGs do purchase maternity services from provider then the answer would be yes; however in practice I have, on our reports, not seen any maternity activity as most of this would happen locally." 30 How frequently does the LFG meet and at what location? Normally monthly, at NHS Slough CCG. 31 Will the Service Provider be required to attend CCG meetings as well as Yes. LFG meetings? 32 Is the Commissioner able to share any examples of incentive structures No feel free to propose. currently in use (both in respect of the current service provider and the provider trusts) and if so which, if any, structures they wish to continue using? 33 Does the commissioner have an existing process for agreeing / releasing LFG meetings. the minimum 5% retained overall service fee? 34 Does the LFG have existing reporting formats and timescales that it expects to be used by the Service Provider? Reporting formats and timescales must meet the requirements of the ITT : Does the Commissioner / LFG require the provider SLAM reports Please read the ITT. (referred to as monthly contract transaction data in the ITT) supplied for all CCGs in collaboration as a combined report / file, or is a separate report / file required for each CCG? 36 Is the expectation that monitoring reports are to be sent to a central point, or delivered individually to each CCG commissioner? Consolidated reports will be required by the LFG; individual reports are to be sent to CCGs : Are contract plans / budgets in place at practice level for each contract? Are contract plans / budgets at practice level to be provided by the CCG collaborative to an agreed timetable and in an agreed format for each contract year? Or is the Service Provider expected to liaise with each CCG separately to obtain practice-level plans / budgets. Is any non-standard reporting required e.g. on CCG-specific QIPP The information required to enable tenders is set out in the ITT.

5 delivery. (We assume the reference to contract management of QIPP schemes in clause 20 on page 15 is referring to provider-wide QIPP requirements) : Does the commissioner envisage a pay-as-you-use model for bespoke reporting or a capacity service which will prioritise requests for bespoke reports? : does the Commissioner have an existing directory of services that it would expect the Service Provider to build on, or will the Service Provider be required to build this? 40 What has the Commissioner s activity growth over the last three years been across all London-commissioned activity? 41 What are the historical referral trends into London and what success has there been in managing demand in recent years? : Does the LFG and the CCGs in the collaborative have an agreed approach / methodology to how forecasting of projected outturn positions (finance and activity) is to be undertaken, either across the collaborative as a whole or by provider? Would IFG expect this to be adopted by the Service Provider? : references other data Is the Commissioner already aware of other data sets aside from SUS and can any details be provided at this stage? (e.g. SEM, PbR Mart or both?) : Is there a list of current data validation steps used by the Commissioner available? : "...track and confirm agreed changes to previously submitted data up to and beyond the recognised 'freeze date'..." - can this be explained in more detail as it is not clear what this requirement stipulates? : references benchmarking of services provided by Trusts can further detail be provided on this scope of this requirement? : Will the commissioner require direct or self service access to the data warehouse and analytical tools? Is there any particular format for the data warehouse required? Does the Commissioner have any existing data warehouse functionalities they expect to see from the Service Provider? Proposals are invited. Bidders should assume they will be required to build this. Such information as is available is set out in the ITT. Such information as is available is set out in the ITT. Please refer to the ITT esp. Section 4. Please refer to the ITT esp. Section 4. The Commissioner expecrs to be provided with quality indicators overall as part of very comprehensive analysis. Not readily available at this time. No further explanation available it is felt that experienced practitioners will understand this. No further detail available it is felt that experienced practitioners will understand this. This is not envisaged. No.

6 : Do all commissioners have access to MS Office 2010 (or later) applications, or is an earlier version of MS Office required? Please state your assumptions in your proposals (refer also to Section 6 of the ITT) the requirement for IT systems to comply with 'all appropriate national and international standards' is very broad and subject to interpretation. Can the commissioner provide any more specifics around Bidders are required to use their experience in order to state and explain how they will comply with known current standards within the NHS and nationally and internationally. particular standards and Best Practice? 51 Section 8 - What is the date for interview for the three highest scoring tenderers? Currently, we have set aside 9 th December; this may be subject to change TUPE please provide full TUPE information to enable us to prepare the response Please see responses to PQQ CQ and ITT CQ all uploaded to the NHS Slough CCG website. 53 Could we have the following information please: Last year s activity by HRG Not at this stage. for elective and non- elective admissions, including by Admission type and HRG Activity, Length of Stay, by Specialty - new and follow-up outpatients attendances 54 Section 9 what time frame would you like the financial model to cover? The term of the intended contract. 55 Section 9, For what time period do you need indexation Ditto. assumptions? 56 Section 9, What software format is specified by the Commissioner? None please use your experience. 57 Please clarify exactly which NHS Standard Contract the ITT refers to The NHS Standard Terms & Conditions as may be amended for and annually thereafter. 58 Annex A Could you please give more details on how you are scoring the Please read the ITT esp. Section 8. sub levels in the evaluation criteria? 59 Annex A On what basis will you give maximum marks for each individual Please read the ITT esp. Section 8. evaluation criteria? 60 Annex A Serial D Could you please clarify what you mean by Total Fixed Fee (if any) + savings payable to Service provider. commitment for Commissioner 61 What are the current arrangements for monthly performance meetings Individual. with the 18 providers? are these undertaken on an individual basis or as a group? 62 Is there some feedback available on the current service to identify the No. vision for service delivery for commissioners? 63 Would it be possible to share the number and risk rating of current issues to enable us to identify current resolution of issues to date. This information is not readily available.

7 64 What KPIs does the Client expect the service provider to work to? As stated in the ITT to be agreed between the Commissioner and the Service provider. 65 Clarity around negotiation of contracts what stage is the current Please use your experience. service provider expected to reach by 31 March 2014? ie all IAPs & QIPP schemes, etc modelled & shared with the Trusts? Draft schedules prepared & shared? 66 Who are the stakeholders, how many are there? Please rely upon your own knowledge and reading of the MOI and ITT. If you have specific queries, please refer. 67 Who is managing the London Community & Mental Health contracts? Not part of the contract portfolio If clarification questions are required after the Final ITT is produced There is no provision for further CQs following issue of the final ITT. what is the process for asking further questions? What criteria is provided to evaluators when evaluating tenders? Please read the ITT, esp. Section Bidders Warranty: do you have standard wording you would like used No. Suggest you base the wording on 3.8 as written. for the warranty? 71 Section 5 Mobilisation Plan would you like to receive this in any No. particular format? Ie MS Excel / Project 72 For absolute clarity, please can you confirm who the Co-ordinating Not necessary at this stage. Commissioner is for each of the London Trusts. 73 With reference to the above, please can we have sight of the Associate Not necessary at this stage. Agreement in place which underpins the above arrangements. 74 Section 4: Ref 28 of the ITT refers to monthly reporting. Please can you clarify whether the financial performance reports form part of month end ledger reporting for the CCG? If so, will there be a set timescale for delivery and set format for receipt of information to enable input to the ledger by each CCG s management accounts team? Yes. The timetable and format can be discussed at the appropriate stage. 75 While we note that elements of this document will be of a commercially sensitive nature, to assist us in our understanding of the proposed contract, please can you provide a copy of the United Health contract (excluding any commercially sensitive information) but which includes information on permance mesasures (KPIs). In addition, please can details of performance/achievement of these measures by United Health (to date) be provided. 76 In the MOI section 2.3 (p7), reference is made to Acute Invoice Validation. Yes see Section 4. No. KPIs for the new contract will be agreed between the Commissioner and the Service provider.

8 In the ITT, we have searched for this reference and it does not appear to be included. Please can you confirm whether this is still a requirement of the contract? 77 Please can we have a list of locations, and details of N3 connections into the sites. 78 Please can you provide details on who currently provides IT support into the sites? Not available at this time. 79 Please confirm whether each of the sites have a secure server/comms room where we would be able to install equipment if required? 80 Please can you provide a contact within the local IT Service provider for us See above. to discuss the detail of any local IT provision, so that we can ensure we can price our response accordingly. 81 As a collaborative, please can you clarify what your over-arching strategic Not available at this time. quality measures/ objectives or CQUIN schemes are based on and how the various providers are currently performing against these? 82 Please can you provide details of your QIPP targets or the value of the QIPP Not necessary at this stage. schemes for each of the Acutes? Please can we have sight of the schemes currently contributing to the targets or at least an overview? 83 We note your responses to Q6 and 7 of our earlier questions and for the Provider to propose our preferred delivery model. To enable us to provide a robust price, please can you confirm whether opportunity exists for Provider staff to locate/hot desk at existing (local) accommodation - used in the current delivery of this contract - or whether alternative accommodation needs to be procured. In summary, is there existing accommodation(s) available for a Provider to use. 84 We note your responses in so far as they relate to TUPE at both the PQQ NO! Refer to earlier responses. Currently, IT services are provided by the CSUs supporting the CCGs. This is a legacy issue which will need to be reviewed with the successful bidder. For the purposes of the tender, bidders should separately itemise their costs for IM&T together with such assumptions, exclusions, risks etc. as are appropriate, enabling the Commissioner to draw comparisons between competing solutions. Bidders are also reminded of the opportunities for considering solutions utilising Commissioner Responsibilities in accordance with Section 6 of the ITT. See above. Existing provision is housed in the Current Provider s own premises in London.

9 and ITT stage. To enable us to put together a robust resource and pricing solution, we need to understand the number of staff, their grade, length of service by that grouping and pension rights within that grouping. Please can this be provided. 85 We note your response to Q9 of our earlier questions. To the extent helpful, we will need to understand how we obtain the SUS and other data flows required to support the contract. DSCROs are at different stages of development across the country and to understand the existing relationships for data flows and whether there is the opportunity to offer DSCRO services ourselves to simplify the process will be quite significant to our bid. 86 With regard to the above and as referenced in Section 4: para 25, please can you elaborate on the likely sources of "other data directly received" as stated and who these might be. 87 Section 4: Ref 28 (among other paras) references monthly performance reports. Please can you confirm whether there is a requirement to provide any local analytical interpretation of the reports as generally referenced in the ITT. 88 Section 4 (para 25 onwards): relates to establishing an IT data platform and data flows etc. The cost of this service will include transfer and warehousing of data to support reporting. As this cost is dependent on volumes and complexity of flows, some quantification of these flows would be helpful to us in providing our response. If this information is not available, we will only be able to include a proposal based on standard, mandated national data sets. We trust this will be acceptable. 89 While we note the focus on acute contracts in the ITT, to assist us in providing quality and efficiency impacts across the system, please could you provide a map of whole service provision which includes community service providers/home care. 90 What are the clinical leadership arrangements in the LFG to support the commissioning of non-specialised care from London providers and what clinical networks do the commissioners participate in? Noted / 4.16: With respect to the annual contracting round, do the CCGs in Both. Please rely upon your own experience. This is a catch-all statement with no particular examples in mind. Yes in accordance with the ITT Section 4. Yes any assumptions to be clearly stated. Not available/necessary at this stage. Clinical leadership will be different for each CCG. No direct clinical post on LFG but LFG would be able to co-opt in if required. TV CCGs will be part of the TV clinical networks, Wessex CCGs part of Wessex.

10 the collaborative require support to produce costed activity proposals for submission to providers (that is in addition to the demand modelling referred to in clauses 15 and 16 on page 14), or is the expectation that the CCGs require support in responding to provider costed proposals, or both? 92 Is there an agreed format for provider SLAM reports that Service Providers are request to work to (e.g. the requirement is set out in the contract information schedule)? And if so, do the providers all use such a format? 93 Is any non-standard reporting required e.g. on CCG-specific QIPP delivery. (We assume the reference to contract management of QIPP schemes in clause 20 on page 15 is referring to provider-wide QIPP requirements) Is there a consolidated annual version produced of each CCG s Prior Approval agreements, that will be made available to the service provider 95 Given the level of services which have transferred to NHSE - reducing the overall contract values from 130m down to 50m, has there been any agreements reached with Trusts to provide dual reporting of NHSE data to ensure transparent charging? 96 Will validation checks be required based on agreed National Identification rules or something more specific to a particular trust? sets out systems for Sus data refers to Non-PbR claims as well as PbR claims. Is there a requirement to make claims against Non-SUS data? If so, will the Service Provider be granted access to Patient Identifiable Data for Non-SUS datasets. This is set out in the contract schedules. All providers are expected to work to the standard format. The Commissioner expects the Service provider to deals with any ad hoc requests for specialist analysis and reporting to support individual CCG QIPPs. Details of each CCG s Prior Approval agreements will be made available to the Service provider. No. Generally, National validation rules are used. However, should specific rules local to a Trust arise, the Service provider will be expected to use these by ad hoc agreement with the relevant CCGs. Q 1 yes, as appropriate. Q 2 yes in accordance with information governance requirements.