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PAPER 1 – Public Board

Rolling out NHS 111 across Yorkshire & the Humber

1. Introduction As early as 1997, the Chief Medical Officers recommended that telephone access using a 3 digit number should be introduced into the NHS in his review of developing emergency services in the community but this was not implemented. The White Paper “ Equity & Excellence “ in 2010 made a commitment to introduce the establishment of a single telephone number for “every kind of urgent health and social care need” Prior to this OFCOM had released 111 – a telephone number to be used by the NHS to deliver against the Governments vision. Pilot sites had been invited and in August 2010 the first of 4 pilot sits was launched in Durham and Darlington. By December 2010 a further 3 pilots sites had also been established – Nottingham City; Luton and Dunstable and Lincolnshire. The Secretary of State announced the establishment of the Darlington and Durham pilot and at the same time announced there would be universal coverage across England of NHS 111 by 1st April 2013 In September 2011 the DH issued a gateway letter which required by SHA Chief Executives to ensure that the planning was taking place to secure delivery across their region. It required SHAs to submit detailed plans around how they would secure delivery through procurement or pilots. Most SHAs were already proceeding to procurement although a further 10 pilot sites were in the pipeline and are being established by March 2012. It is expected that the operating Framework for 2012/13 will require universal coverage of NHS 111 to be in place by no later than 1st April 2013 thus confirming this as a commissioning priority for PCT Clusters and CCGs.

Rolling out NHS 111 across Yorkshire & the Humber –Board paper Nov 2011

2. What is NHS 111? NHS 111 is a free to call number available 24 hours per day; 7 days per week; 365 days per annum to respond to people healthcare needs when They need medical help fast but its not thought to be a 999 emergency They don’t know who to call or don’t have a GP to call They think they need to go to A & E or another NHS urgent care service They need health information or reassurance about what to do next Callers are put through to a team of highly trained call advisers, who are supported by experienced nurses/clinicians. They use a clinical assessment system and ask questions of the caller to assess needs and determine the best course of action. That course of action may be that it is assessed that the patient does face an emergency which needs an ambulance despatched without delay, and the NHS 111 provider will be able to do so It may be just that the caller needs advice; information or reassurance and that will be provided It may however be that the caller needs further care or advice which needs to be provided by a local service. The call handler will have access to a Directory of Services (DoS), maintained and validated by Commissioners which will detail services available at that time . Calls will be transferred without the caller having to repeat their information or being retriaged; where possible appointments will be booked and call backs will be the exception rather than the norm Callers may also be signposted to other services where the nature of their need is outside the scope of NHS 111 The NHS 111 service will be expected to deliver a range of benefits:Improving the public’s access to urgent healthcare services Increasing the efficiency of the NHS by directing patients to the right care, right place, right time Increasing public satisfaction and confidence in the NHS Increasing the efficiency of the 999 emergency ambulance service by reducing the number of non emergency 999 calls and the number of avoidable ambulance journeys Providing health professionals with a contact point to access information around service availability – on line and where there is no access to the internet via a telephone line Rolling out NHS 111 across Yorkshire & the Humber –Board paper Nov 2011

The NHS 111 service will also be able to provide Commissioners- ie the CCGs with essential information around patient needs; identifying services which are currently over or under used; increasing the understanding of the shape and demand for each service – powerful information for commissioning purposes which in turn will Enable the commissioning of more effective and productive healthcare services that are tuned to meet the needs of patients NHS 111 should be seen as an enabler to support the development at local level of a seamless service between primary care and the urgent care system

3. The position in Yorkshire & the Humber There were no planned pilot sites in Yorkshire & the Humber and no detailed programme to deliver the procurement of NHS 111 by 2013. PCT Cluster Chief Executives in Yorkshire & the Humber therefore committed to proceed to a Regional wide procurement process for the NHS 111 service across Yorkshire & the Humber, recognising that work to date across the region on this agenda was variable and that there was a need for a consistent and systematic approach if delivery was to be achieved within timescales Mike Potts, Chief Executive of Calderdale, Kirklees and Wakefield Cluster was appointed as SRO and a Programme Director was appointed to undertake a stock take of the current position across the region, whilst also establishing robust programme management arrangements and wider stakeholder engagement to ensure delivery. The Programme management arrangement that have been put in place, are detailed below:

SRO Mike Potts YORKSHIRE & THE HUMBER PROGRAMME BOARD - NHS 111 ensuring strategic leadership; vision and providing assurance to Boards on implementation



t o address:-

to address:-

- Clinical Governance Issues including patient experience

- Number of calls and Processes

- target operating model

- Assessment Tool

- Procurement Service Spec

-- Directory of Services/CMS - Enabling technology



to address:to address:-

-Business case - Revenue/cost model

- Communications and Engagement

- Procuremnt process

- Stakeholder Management

- KPIs, Data analysis and contract monitoring

- OD & HR issues

Rolling out NHS 111 across Yorkshire & the Humber –Board paper Nov 2011

The Programme Board meets monthly and is supported by a range of work streams as detailed aimed at ensuring delivery against the 3 phases of the Progarmme:Planning Procurement Implementation The programme management arrangement is supported by a team led by Programme Director (Eleri de Gilbert); Programme Manager (Gulnaz Akhtar); Programme administrator (Helena Charlton); Regional Communications Lead (Mary Hardie); Telephony & IT lead ( Tony Megaw); Clinical Lead (Dr Damien Riley); Finance Lead ( Julie Lawreniuk); Procurement Lead (Martin Pursey). This team works closely with work stream leads to ensure delivery of their key objectives within challenging timescales The Programme Board includes clinical and operational representation from each PCT Cluster; the Local Authorities; Patient representative; Work stream Leads; IT & communications experts and both Yorkshire Ambulance Service & NHS Direct are also members but the meeting is managed in two parts in order that matters which are clearly commercial in confidence at this stage exclude any potential bidders for the service. Both NHS Direct and YAS have declared conflict of interest as potential bidders. The Programme Board has met monthly since September 2011 although work streams have met much more often in order to meet the challenging timescales required for procurement. The Programme Board received advice and feedback from the National operational Group for NHS 111, which the Yorkshire & the Humber Programme Director is a member of.

4. Clinical Engagement Since July there has been extensive clinical engagement. Dr Damian Riley, GP & Medical Director at NHS Leeds has been appointed as Clinical Adviser to the programme. Each PCT Cluster have identified clinical champions who are contributing to the work streams but are also engaging with their constituent GPs. The Cluster Clinical champions are all GPs with a mix of PCT Medical directors and CCG urgent care leads. A regional wide event for CCGs on NHS 111 has been held which generated much interest in being engaged in work streams and in influencing the specification for the service. Clinicians

Rolling out NHS 111 across Yorkshire & the Humber –Board paper Nov 2011

are leading two of the work streams, supported by programme management and subject expertise. Visits have been made by Cluster Operational Leads to CCGs who recognise the requirement to deliver NHS 111 by 1st April 2013 but are clearly concerned around the potential cost implications and have reservations around clinical confidence in the assessment tool. Discussion is taking place with colleagues at Connecting for Health to set up road shows to enable GPs to test the tool, to receive an update from clinicians from pilot sites around their experience of the tool in order to build up confidence. Nevertheless it is recognised that CCGs are facing conflicting pressures on their time at this moment and the level of engagement in the planning of NHS 111 needs to built on as we move towards procurement and selection of preferred provider and the implementation phase. Importantly CCGs are well aware of the importance of getting the services right which will underpin the success of NHS 111. Many already recognise that NHS 111 will be an enabler to help transform local services, including primary care. It is crucial that Local operational groups have been established with wide stakeholder engagement to influence QiPP urgent care delivery at local level and ensure that local services have been redesigned in readiness for the delivery of NHS 111 otherwise the potential benefits of NHS 111 will be significantly diluted 5. Timetable for delivery Delivery of NHS 111 across Yorkshire & the Humber is intended by no later than 1 st April 2013. As the 1st April 2013 is Easter Bank Holiday we do not envisage implementation that weekend and will therefore work with the preferred provider to agree a Go Live date in advance of that weekend. We have therefore agreed the following timetable Key dates for delivery are as follows. (Please note this is supported by a more detailed Programme plan and timelines)

Planning pre procurement phase

Sept – Nov 2011

Full Business Case & Spec to PCT Cluster Boards for approval & seek endorsement CCGs

Nov/Dec 2011

Advert placed

6 January 2011

Bidder Information day

20 January 2012

Closing date for expressions of interest

13 February 2012

Rolling out NHS 111 across Yorkshire & the Humber –Board paper Nov 2011


w/c 20 February 2012

ITT & Supporting documentation published

w/c 5 March 2012

Deadline for tender submission

20 April 2012

Tender evaluation

May – June 2012

Approval of Recommended bidder by PCT Cluster & CCG Boards

31 July 2012

Implementation phase starts

September 2012

This procurement timeline is supported by a detailed procurement plan

6. Business case and specification A business case and specification for the service has been developed but due to the commercial sensitivity of the information at this stage of the procurement process it will be considered by the Board in confidential session. 7. Risk management The Programme Board is currently identifying the strategic risks associated with the Programme, as part of its assurance role. The Programme Board will report all risks identified to PCT Clusters so that local risk registers/ assurance frameworks can reflect such risks and oversee the mitigation of those risks. 8. Action required of the Board The Board is asked to NOTE the content of this report and to NOTE that the business case and specification will be considered in confidence due to the commercial in confidence nature of the discussion and content at this stage of the process The Board is also asked to ENSURE that local action is taking place to transform urgent care services, including daytime primary care services, in readiness for the delivery of NHS 111. Eleri de Gilbert NHS 111 Programme Director Yorkshire & the Humber

Rolling out NHS 111 across Yorkshire & the Humber –Board paper Nov 2011


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