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Call for Proposals

A Model for Developing Decision Support Tools to Support Realistic Health and Social Care: Prototyping with a  Mobile App  for Social Care Homecare Workers Delivering ​Palliative and End of Life Care

Tuesday, June 12, 2018
Ann Wales, Programme Manager

1. Purpose

The Digital Health &  Care Institute (DHI) is commissioning this project to progress digital transformation and delivery of the vision for knowledge and decision support across health and social care by:

  • a) Defining a framework for future development of decision support tools that support social care and healthcare staff on an equal basis within integrated teams. This framework will reflect the principles of realistic health and care as set out in the latest Realistic Medicine report[1] and the Digital Health and Care Strategy[2]. It may include:
    • Person-centred co-design methods and processes aligned with the social care ethos of relationship-based care.
    • Approaches to clarify the scope of decisions that lie within the full professional role remit of social care staff , and those which need collaboration with other members of the multi-agency team.
    • The types and sources of knowledge from research, context, lived experience, and data about the individual, which underpin person-centred decisions.
    • How these types of knowledge can be captured, combined and presented effectively in a decision support tool.
    • How decision support technology can support communication across members of the multi-agency team to enable timely and collaborative decision-making.
  • b) Apply this model to create a decision support mobile app which supports care at home social care staff delivering palliative and end of life care, as members of the wider multi-professional integrated team. This will serve as an exemplar of a “realistic” decision support tool.

 

2. Strategic context

2.1 National policy and Strategic plans

The Health and Social Care Delivery Plan[3] sets out the national programme to further enhance health and social care services, so that people can live longer, healthier lives at home or in a homely setting and we have a health and social care system that:

  • is integrated;
  • focuses on prevention, anticipation and supported self-management;
  • focuses on care being provided to the highest standards of quality and safety, in all settings, with the person at the centre of all decisions

This plan requires health and social care services to transform and evolve to meet new patterns of care, demand, and opportunities from new treatments and technologies.

The Digital Health and Care Strategy for Scotland makes a national commitment to digital transformation to realise the potential of information and technology as enablers of these new integrated models of health and social care. It highlights knowledge and decision support as key tools to enable this transformation. A new plan for knowledge and decision support is under development, building on the success of demonstrator projects since 2016.  The project defined in this tender will provide important information to help shape this plan to meet the needs of social work and care staff and integrated health and care teams.

Realistic health and care approaches have created  a growing recognition that  person-centred care depends on combining research-based evidence with personal and experiential knowledge  - i.e. “What matters to the person” – through a shared decision-making process. The new Information and Knowledge Plan which underpins the Digital Health and Care Strategy centres on these principles. It describes a “realistic knowledge” approach to knowledge and decision support. This combines knowledge derived from personal data about the individual with knowledge of context and life experience and scientific knowledge from research, to support holistic care across both health and social care  contexts.

2.2 Decision support tools in social care

While decision support tools are well-established as a high-impact approach for health care improvement, their role in social work and social care is less well developed.   Key factors contributing to this lower prevalence of decision support tools in social care are:

  • The social work and care ethos, where decision-making prioritises the relationship with the client and insight into their individual needs and circumstances. Use of research evidence and guidelines, which are the traditional basis for decision support tools, is not the cultural norm, and is only one element in the decision-making process.
  • In many integrated care contexts, lack of a clear definition of the scope of the decisions which social care staff (i.e. support worker grades, not professional social workers) are expected to make, and which types of decisions should be referred to professionals within the wider multi-agency team.
  • The fact that communication mechanisms and joint decision-making approaches across the multi-agency team are still emergent, as delivery of integrated health and social care evolves.

The proposed project will help to make this realistic approach to knowledge and decision support a reality for both health and social care. It will provide a tested model for development and delivery of decision support tools that apply high quality research evidence to support relationship-based, person-centred and context-specific care.

2.3 Focus on palliative and end of life care

Social care workers providing  palliative and end of life care in the home care setting have been chosen as the focus for the exemplar decision support tool because:

  • a) Improving palliative and end of life care is a national strategic priority. .The implementation plan for the national palliative care strategy emphasises the need to equip care at home workers with the knowledge, tools and support to deliver their key role in palliative care effectively. These staff generally spend more time with a client than any other health or care professional, and often have to face very challenging situations alone, with minimal or no specialist support or training.
  • b) There is a key opportunity to build on work to date to design and deliver a decision support solution that meets identified needs.

As part of delivering the Evidence into Action strand of the Social Services Strategy for Scotland, Scottish Care and the Office of the Chief Social Work Adviser (OCSWA) in Scottish Government  have analysed the knowledge support needs and current challenges in decision-making by care at home staff. Both projects  confirmed the need for the realistic knowledge model as set out in the Digital Information and Knowledge Plan to  support care at home staff in:

Shared decision-making  grounded in relationship-based care - including:

  • Anticipatory care planning and conversations about end of life care
  • Grief and bereavement support for families and carers.
  • Enabling clients to do as much as they can for themselves, for as long as they can.

Decisions about clients’  healthcare needs, including:

  • Pressure sore management
  • Mobility needs
  • Hydration
  • Pain management
  • Medicines administration
  • Continence care
  • Caring for people with dementia
  • Basic knowledge about symptoms and treatments so that they can better understand and support their clients’ experiences.

Partnership working with the wider multi-agency team, so that decisions can be made jointly or referred on to specialists as appropriate.  Enablers identified for improving  collaboration and mutual support  included use of technology to optimise communication, and to standardise structuring and sharing documentation.

 

A decision support mobile app was specifically suggested as a solution in the OCSWA project, and some key functions of such an app were identified. The OCSWA project was delivered by the Programme Manager for Knowledge and Decision Support, who will also lead the project proposed in this paper. This provides a direct link with the stakeholders and agreed priorities for action in the earlier project. 

The Edinburgh City Council Homecare Team was the key partner in delivery of the OCSWA project and will provide the stakeholders for consultation, requirements analysis and testing in this project.

 

3. Specification

3.1 General requirements

  • Requirement 1
    • Conduct a review of the evidence base on methods for development and delivery of decision support for: a) social work and social care; b) delivery of integrated health and social care.
  • Requirement 2
    • Conduct a landscape review to identify existing digital decision support solutions in use in the UK for a) social work and social care; b) delivery of integrated health and social care.
  • Requirement 3
    • Produce a draft framework for design, development and delivery of decision support tools for social work and social care staff, and integrated health and social care teams. Production of this framework will involve:
    • Review of the evidence base, both formally published and grey literature
    • A landscape review to identify existing digital decision support solutions for these audiences in use in the UK context.
    • Consultation with existing and potential users and providers of decision support solutions for these audiences.
  • Requirement 4
    • Apply this framework to design, develop and deliver a decision support mobile app for social care homecare workers providing palliative and end of life care as part of multi-professional and multi-agency teams. Conduct initial evaluation of the app.
  • Requirement 5
    • Based on the learning from the development of the decision support app, refine and optimise the development framework for decision support for social care and integrated care teams.

 

3.2 Specific requirements for mobile app

The mobile app will:

  • a) Be rendered concurrently from the same content source and content management system as a website and downloadable mobile app that is fully functional without Internet connectivity.
  • b) Provide Plain English guidance, tools and resources to support social care homecare staff in delivering palliative and end of live care as part of a wider multi-professional health and social care team.
  • c) Support the key areas of focus detailed in section 2.3 above:
    • Shared decision-making
    • Service user healthcare needs
    • Communication and collaboration with the wider multi-agency team.
  • d) Be extensible, with the capacity to accommodate further content and functionality in future.
  • e) Comply with the technical requirements within the draft Quality Assurance Framework for Mobile Apps for Scotland’s Health and Care (see Appendix).
  • f) Be HTML 5 compliant and provide an optimised user experience on all widely used modern web and mobile browsers, tested on MS IE11 and Edge as well as the latest versions of Chrome, Firefox and Safari. The web interface must be tested to show that it remain usable on older browsers, to take into account the wide variety of IT standards in use across PCs and devices across Scotland’s health and social care.
  • g) Work with IOS, Android and Windows 10 mobile operating systems.
  • h) Format content to ensure it is usable on a variety of different devices and screen sizes, in both landscape and portrait orientation.
  • i) Provide a responsive web interface when accessed via mobile devices.
  • f) Adhere to W3C accessibility standards (minimum Level AA).
  • g) Incorporate mechanisms for  reporting on levels of usage and analysis of user behaviour.
  • h) Align and integrate with the national decision support infrastructure currently under development, sponsored by Scottish Government eHealth. This alignment requires suppliers to define:
    • How their solution will make accessible both its data and services using open standards, such as openAPI (https://www.openapis.org) in order that integration and interoperability with the outputs of the National Decision Support Infrastructure is possible.
    • How their solution will be designed to enable individual content elements and functional components (e.g. drug monographs, search functionality) to be re-used and shared across applications.
    • How their solution will enable links to and from resources within the National Decision Support Infrastructure.

 

4. Eligibility to apply

The following eligibility criteria apply to this grant award:

  • a) The applicant organisation must be a Scottish Higher Education Institution (HEI).
  • b) Funds cannot be redistributed by the awarded party, except without express permission by the DHI.
  • c) Some small amount of the grant can be used to cover equipment and consumables.
  • d) Bids must be costed in line with the Higher Education Institution’s bidding policies. DHI expects the  HEI research office to be involved in communication.
  • e) DHI expects bids to be costed at 70% Full Economic Costing.

Bidders will be required to adhere to University of Strathclyde Terms and Conditions for Grant Awards.

5. Deliverables

5.1 Framework of guidance, methods, tools and resources for development of decision support tools for social work and social care staff, and integrated health and care teams. Appendices to this guidance should include:

  • Evidence review.
  • List of UK decision support resources for social work/ social care and integrated health and social care teams,
  • Report of consultation with current and potential users and providers of decision support tools.

5.2 Mobile app providing decision support for social care homecare workers providing palliative and end of life care as part of multi-professional and multi-agency teams.

5.3 Requirements specification and report on stakeholder consultation informing development of this mobile app.

5.4 Report on evaluation of mobile app and recommendations for next steps in implementation.

 

6. Methods

Suppliers are invited to put forward their proposed methodologies as part of their bid. The following are some key approaches which suppliers are asked to include as part of their proposals for specific aspects of this project. Within their bids, suppliers should expand on their proposed approach to each element:

  • a) Evidence review – to include systematic searching of published and grey literature, and follow-up with contacts for key initiatives.
  • b) Stakeholder consultation to inform production of development framework – to include interview and focus group approaches, with face to face and virtual options.
  • c) Requirements gathering to inform development of the mobile app will include:
    • Analysis of reports by Office of the Chief Social Work Adviser and Scottish Care.
    • Interviews and focus groups with staff within the Edinburgh City Council Homecare Team and with the wider multi-agency team involved in palliative and end of life care.
  • d)Technology development – to include application Agile methodology to ensure active stakeholder input throughout the process.

 

7. Milestones, deliverables and  timescales

Indicative timescales for this development are as follows:

Milestone / Deliverable

Timescale

Tender process and award

 

·         Issue call for bids

Week beginning  11th June 2018

·         Bids received

6th July 2018

·         Award contract

By 20th  July 2018

·         Project initiation meeting

By  27th July 2018

Project milestones with deliverables

 

D1 Report of scoping review and identification of existing decision support tools.

By  31 August 2018

D2 Report of consultation with current and potential uses and providers of decision support tools.

D3 Draft development framework for decision support tools for social work/social care and integrated health and social care teams.

By 28 September 2018

D4 Requirements specification for decision support mobile app

By 26 October 2018

D5 Release of mobile app

By  22 February 2019

D6 Evaluation report on mobile app with recommendations for next steps in implementation.

D7 Revised and optimised development framework

By 29 March 2019

 

8. Skills required 

The supplier will offer, either directly, or through engagement with third parties, a combination of experience and expertise in the areas listed below.

Since this project will make a key contribution to implementation of the new Digital Health and Care Strategy, the supplier will be expected to propose innovative digital methods wherever possible, to widen reach and stakeholder participation.

  • a) Sourcing and summarising research evidence and grey literature.
  • b) Stakeholder consultation and needs analysis across complex systems, using co-production principles, qualitative and quantitative approaches – e.g. interviews, focus groups, surveys.
  • c) Production of practical guidance and toolkits for use by non-experts in digital development.
  • d) Agile development and delivery of mobile apps.

 

9. Governance

A project steering group with representation from the Digital Health and Care Institute, Scottish Government eHealth Division and Edinburgh City Council Homecare Team will oversee delivery of this project. It will sign-off project deliverables and advise the providers on key issues.

 

10. Budget

The total budget available for this project is £20,000, excluding VAT.

Phasing of payment

Milestone

Completion

Payment

 

 

£5000 on 3rd August – for project initiation.

D1 Report of scoping review and identification of existing decision support tools.

By  31 August 2018

 

D2 Report of consultation with current and potential uses and providers of decision support tools.

D3 Draft development framework for decision support tools for social work/social care and integrated health and social care teams.

By 28 September 2018

 

D4 Requirements specification for decision support mobile app

By 26 October 2018

£5000 on 2nd November – on sign-off of D1-D4.

D5 Release of mobile app

By  22 February 2019

 

D6 Evaluation report on mobile app with recommendations for next steps in implementation.

D7 Revised and optimised development framework

By 29 March 2019

£10,000 on 29th  March – on sign-off of D5-D7.

 

11. Response

You are invited to respond to this document with the following information:

11.1 Your proposals for delivering on:

The requirements, scope, methods and deliverables described in sections 2-5. You should detail:

  • a) your understanding of the main issues to be addressed.
  • b) how you intend to deliver on the requirements.  
  • c) the methodology you propose to use
  • d) how you will work in collaboration with key leads and stakeholders.

 

11.2 The expertise and experience of the team undertaking the work, referencing the skills detailed in section 7. This should include CV[s] and statement of availability of the individual/s who will undertake the work.

11.3 Summaries of similar work undertaken, including contact information (name and telephone number or email address) for at least one reference.

  • Details of risks identified, and how these will be mitigated.

11.5 A realistic timetable of activities, including contingency management, to meet the timescales outlined in section 6.

11.6 A breakdown of costs, including any expenses.

Response proposals are to be submitted to ann.wales@gov.scot. To assist with the completion of your response, you may contact ann.wales@gov.scot  for further information.

 

12. Evaluation

Proposals will be evaluated against each other in an objective manner. The Evaluation Panel will score each Bidder’s response using the criteria shown in the following table.

The Bidder(s) selected will be chosen based on the best value for money. This means suitable quality, delivery, level of risk and response to customer needs at best price. 


Criteria

Description

Weighting

Understanding the purpose of the work, context and background and proposes a methodology that meets all the requirements of the tender specification

 

See Section  11.1

 

The proposal clearly demonstrates understanding of the context of this project, the strategic and policy drivers, and how it will contribute to transformation of health and social care to deliver better outcomes for patients.

 

Proposal demonstrates that all the requirements of the specification have been addressed and understood and that the proposed methodology is appropriate and capable of successfully delivering the project.

40%

Relevant skills and expertise of team to be appointed to deliver the project

 

See Section 11.2

Proposal demonstrates availability of the required combination of expertise and experience among team members to be appointed to the project.

15%

Experience and reputation in undertaking similar work

 

See Section 11.3

Proposal demonstrates evidence of previous work undertaken in the past 3 years relevant to this project including the names(s) of clients who can be approached for comments. 

10%

Timetable

 

See Section 11.4

 

The proposal provides a detailed timetable of events to ensure that deadlines can be met and explicitly identifies any contingency.
10%
Risk Management and Quality Assurance.

 

See Section 11.5

 

The proposal provides evidence that the main risks involved with the project have been identified and adequately addressed. Details of the bidder’s risk management and quality assurance methodology are also outlined.
5%
Price

 

See Section 11.6

The proposal is competitively priced and represents good value in the context of the goods/services to be delivered over the life of the contract. Costs are clearly demonstrated and justified. Best value bids will demonstrate an appropriate combination of cost and quality.
20%

 

As part of the tender evaluation process short listed Bidders may be invited to provide a presentation to the Evaluation Panel or interview to demonstrate their understanding of the project.

The following scoring convention will be used to assess each of the responses to the above quality questions.

Score

Descriptor

4

Excellent response - is excellent overall and will include a balance of completely relevant elements of the Contract as specified (but not limited to the specifications)

The response is comprehensive, unambiguous and demonstrates a thorough understanding of the requirement and provides details of how the requirement will be met in full

3

Good response - is relevant and will include a balance of elements of the Contract as specified (but not limited to the specifications)

 The response is sufficiently detailed to demonstrate a good understanding and provides details on how the requirements will be fulfilled

2

Acceptable response - will include some elements of the Contract as specified (but not limited to the specifications)

The response addresses a broad understanding of the requirement but lacks details on how the requirement will be fulfilled

1

Poor response - is partially relevant and will include few elements of the Contract as specified (but not limited to the specifications)

The response addresses some elements of the requirement but contains insufficient/limited detail or explanation to demonstrate how the requirement will be fulfilled

 

 

0

Unacceptable - Nil or inadequate response

Fails to demonstrate an ability to meet the requirement

 

The Evaluation Panel reserves the right to recommend that if the score for any one criterion is “0”, that the Contractor not be recommended. That is, they reserve the right to veto a Contractor if it does not meet at all any one of the criteria.

 

Appendix:  Technical requirements for Mobile Apps for Health and Care Professional. Extract from Draft Quality Assurance Framework.

Stage 2: If the app is not a medical device, does it fulfil all essential Quality Assurance Framework Criteria?

 

All mobile apps that are not classified as medical devices are required to complete all Stage 2 criteria within the Quality Assurance Framework.  These criteria are all concerned with different aspects of quality and risk management to ensure that the app is safe and appropriate for use in NHS Scotland.

 

International standards relevant to individual criteria are highlighted where available. These standards are intended to be useful references to guide your response to each criterion. While the Quality Assurance Framework does not mandate full compliance with these standards, app providers which adhere to these standards will as a matter of course meet the relevant criteria.  

 

Adherence to these standards will also provide robust evidence for CE marking should the app develop into a medical device in future.

 

 

S2.1 Usability engineering

 

Describe the process used to analyse, specify, develop and evaluate the usability of the app.  You should highlight particularly how this process has:

 

  • identified human factors that could affect safe use of the app
  • enabled assessment and mitigation of risks associated with errors arising in normal use of the app.

Description of design processes.

 

Risk register

 

Test plan

 

Test reports

 

User guides.

S2.2 Software lifecycle process

 

S2.2.1 Please describe how your app adheres to the British Standards Institute Code of Practice BSI PAS 277: 2015 Health and wellness apps. Quality criteria across the life cycle.

 

S2.2.2 Please outline the delivery process planned for the app.

Description of methods, including each of the lifecycle stages specified in S2.2 .

 

Requirements specification

 

Test plan

 

Test reports

 

User engagement documentation

 

Delivery and implementation plan.

S2.3 Quality Management System

Please describe the Quality Management System used by the organisation or organisations  responsible for development, delivery and ongoing maintenance of the app.

Relevant standards:

  • ISO 9001 Quality Management System

 

Description of Quality Management System

Requirements specification / s.

 

Test plans

 

Test reports

 

Arrangements for technical support, maintenance and updating of content and software, including decommissioning when this is appropriate.

S2.4 Risk management

 

Please describe the methods used to:

 

  • Analyse and mitigate risk, particularly risks to patient safety.
  • Continually review and update risk assessments.
  • Assess whether clinical benefits outweigh risk to patients and users.

 

Description of risk management process

 

Risk register, including analysis and mitigation of risk.

 

Risk-benefit assessment.

 

Plan for monitoring and addressing risks and issues as they arise.

 

.

S2.5 Accessibility Standards

Please confirm:

 

  • Level of adherence to WCA3 2.0  standards or their equivalent in other

countries.

  • Adherence to the colour contrast standards at WCA3 2.0 AA level 2
  • That your app can be used with screen readers and/or other assistive technologies.
  • That it operates with the minimum specifications for desktop and mobile devices in NHS Scotland.

 

 

 

 

Confirmation of adherence to standards.

 

Results of accessibility testing.

 

Statement of minimum desktop and mobile specifications required for the app to run.

S2.6 Interoperability standards

 

S2.6.1 Please provide details of the interoperability standards your app adheres to.

 

Examples include:

  • JSON, XML, HTML5
  • HL-7 suite of standards including HL-7 FHIR
  • OpenEHR
  • Metadata standards for description of information  – e.g. Dublin Core, GMS.
  • Terminology and coding standards – e.g. SNOMED-CT.
  • Operation with the range of browsers used across NHS Scotland

S2.6.2 How will the app enable sharing and re-use of content and functionality with other NHS Scotland apps?

 

S2.6.3 Please provide details of any APIs employed by the app, including where these are published and how they are accessed.

 

Suppliers should note that they will be required to demonstrate adherence to the standards specified for the NHS Scotland Digital Platform when these are fully defined.

 

 

Details of standards employed and how these are used within the app.

 

Statement of web browser compatibility.

 

Outline of how the app will enable sharing and re-use of content and functionality.

 

Details of APIs.

S2.7 Evidence base

 

Please provide details of:

  • The evidence sources which inform the content of your app.
  • How this evidence was sourced and evaluated.
  • How the content of the app aligns with best practice in NHS Scotland – for example, as defined in SIGN guidelines, local formularies and medicines management guidance.

 

 

 

 

Detailed response to each question.

S2.8 Sustainability

 

S2.8.1 Maintaining content

 

Please describe the arrangements for reviewing and updating the evidence base and content of the app in a timely manner.

 

S2.8.2 Maintaining software

 

Please describe the processes for reviewing and updating the mobile app. This includes, for example,  addressing bugs in the software, and implementing patches  as new versions of mobile operating systems are released.

 

S2.8.3 What is the release plan for the app?

 

S 2.8.4 Please describe the version control arrangements for the app.

 

S2.8.5 Please explain whether an archive of previous versions of the app is required, and if so how this will be maintained.

 

S2.8.6 Please provide your plan for ongoing monitoring and addressing of risks and issues with the app as these arise.

 

S2.8.7 Please provide your plan for decommissioning the app when this is necessary.

 

 

S2.8.8 Review date

 

The default review date is 2 years from accreditation for the NHS Scotland Mobile App Delivery Platform. If you wish to propose a different review date, please provide a rationale.

 

Relevant standards

 

The Quality and Risk Management standards outlined above in S2.3 and S 2.4. cover several aspects of sustainability. These points are called out specifically in this section to enable the Quality Assurance Panel to record the review date and to quickly confirm that the app will be kept up to date to ensure long term safety and appropriateness.

 

 

 

 

 

 

 

 

Details of arrangements and plans, including staffing and financial resourcing.

 

 

Release plan

 

 

 

 

Monitoring plan.

 

 

Decommissioning plan.

 

 

Proposed review date and rationale.

 

[1] http://www.gov.scot/Publications/2018/04/6385

[2] http://www.gov.scot/Publications/2018/04/3526

[3] http://www.gov.scot/Publications/2016/12/4275/downloads

Note: DHI is funding this call from its Scottish Funding Council Innovation Centre budget – meaning that only Scottish Higher Education Institutes are eligible to receive DHI monies.