Operational Plan 2018/19

Operational Plan 2018/19 Operational Plan M McGurk 050418 1

CONTENTS Section A: Introduction to the Operational Plan...3 Section B: NHS 24 Strategic Objectives...3 Section C: Delivery Principles...4 Section D: Recent Key National Developments...6 Section E: Scottish Government Health and Social Care Delivery Plan The NHS 24 Contribution and Summary Collaboration Proposals...6 Section F: Performance...7 Section G: Financial Plan...9 Section H: Workforce Plan... 11 Operational Plan M McGurk 050418 2

Section A: Introduction to the Operational Plan This Operational Plan sets out the key objectives and recommendations from the NHS 24 strategic planning and resource allocation (SPRA) process for 2018/19. It reflects the system-wide context within which NHS 24 operates and describes how our current strategy aligns with that. The SPRA process also references our agreed strategic objectives and our delivery principles. Section B: NHS 24 Strategic Objectives Strategic Objectives There are three main themes to our strategic objectives over the next 5-year period. Supporting people to live longer healthier lives The Scottish Government s 2020 vision outlines We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. We know that people are living longer, and that the prevalence of people living with long-term conditions is significant; 46% of adults (aged 16 or over) have at least 1 long term condition. We will identify and support the introduction of new digital services and apps to support the self-management of health and wellbeing for people with long term conditions, building on the work we are progressing in home and mobile health monitoring, digital telecare and video enabled services. Our organisation s role in helping to deliver the Health and Social Care Delivery Plan Our staff deliver a high quality Unscheduled Care Service to approximately 1.5 million callers every year. We will support the delivery of the aims of the Health and Social Care Delivery Plan, the National Clinical Strategy and Realistic Medicine. We will do this in the context of consistently delivering value based health and care services. NHS 24 has a vital role in delivering services to support new models of urgent care as identified within Professor Sir Lewis Ritchie s independent review of the Primary Care Outof-Hours Service in Scotland. NHS 24 is already discussing with partner Boards and Health & Social Care Partnerships how we can shape our future role and remit to support these national programmes. Our multi-disciplinary focus extends to our contribution to Prescription for Excellence, the National Pharmacy Strategy and the emerging Mental Health Strategy for Scotland. Building a stronger organisation NHS 24 is on a journey to build a stronger organisation and working with the public and stakeholders will be key in helping us deliver our future remit and purpose. Through this we will continue our work to foster an organisational culture that is supportive of all staff and Operational Plan M McGurk 050418 3

promotes quality improvement in all areas of business to improve services to patients as well as increasing our effectiveness and efficiency. Our strategy helps us to plot the path to success and prioritise what we can do in support of the Scottish Government Health and Social Care Delivery Plan. We will ensure our staff have the skills and capabilities to deliver services across multiple channels, expanding the service offering beyond the telephone. Our internal vision will be underpinned by our values and organisational culture. Section C: Delivery Principles Virtual and public facing We will utilise to best effect, our contact centre capability during the day and in the out-ofhours period. Our infrastructure and technology will provide the backbone to delivering safe and effective services. Our services will provide a first contact option for advice, information, support and care, as well as direct access for urgent medical care, and other health and social care services. Multiple channels and technologies Using appropriate technologies, we will offer safe and effective channels for the delivery of health and care services to the public. Our intention is to provide advice, support and care across a range of digital channels, including; telephone, web chat and social media, email, video conference and sms/messaging. Serving everyone in Scotland according to their need We will take all reasonable steps to provide the public, patients, their carers and families with equality of access to our services. Our aim is to provide an inclusive service free from barriers and disadvantage. To support our aim we will work with communities and their representatives to achieve equality of access for the people of Scotland. We will work in partnership with other Health Boards to provide appropriate access to services across Scotland, including vulnerable and disadvantaged groups and those within remote and rural locations. We will continue to tackle health inequalities, arising as a consequence of individual socio-economic status. A key principle is our approach to designing, developing and delivering our services in partnership with our public, patients and partners. Supporting the whole health and care system We will deliver person-centred services which provide the best outcome for the public at that point in time. Our services will be developed in partnership with the public and our stakeholders, and will be monitored and evaluated to ensure we continue to add value across the health and care system. We will provide an environment in which to carry out tests of change in a protected setting. Operational Plan M McGurk 050418 4

Delivering services 24/7 We will deliver services which make the most effective use of our resources and capability 24/7. We will deliver health and care services during the day, as well as during the out-ofhours period. We are working on a range of initiatives, which will enable us to test this approach with our partners and key stakeholders. Supporting Self-Management We know that meaningful promotion of wellbeing with the public improves health outcomes overall. Our focus will build individual and collective confidence of people to self-manage, particularly for the increasing population with one or more long-term conditions, e.g., Diabetes. Using language that is understandable and devices that are familiar, and working in partnership with our partners and public, we will signpost to locally based, self-guiding advice. Examples of this include our Home-based monitoring service which can help improve quality of life, prevent avoidable hospital admissions, assist with an earlier hospital discharge and enable patients to feel more in control of their health condition. It also gives our public a central role in the management of their condition and can reduce the level of intervention/contacts with the primary care sector. Value Based Health and Care and Service Sustainability We are committed to adding value to the health and care system across Scotland and delivering value based health and care services as efficiently and effectively as possible. Our out-of-hours model of care is well established and adds value to those who use our service, but there is always room for improvement. We are reviewing the way in which we deliver our services in conjunction with our public and partners, to further strengthen our service model. Through more efficient utilisation of our capability during the day we are seeking to further expand our offer of support to the health and care system to ease pressure and reduce demand on local systems. Evidence and data will underpin everything we do. As a national organisation we are data rich, we receive almost 5 million patient and public contacts to our services every year and record every call that comes into our 111 service. We will use that data and the other demographic information available to us; including the Scottish Index of Multiple Deprivation to create compelling, evidence based proposals to support change and drive service redesign. Strong and supported workforce NHS 24 will be an inclusive and welcoming place to work. We will further develop our workforce to be available, adaptable and affordable to meet the needs of the services we offer; this will include appropriate access to and training to deliver multi-channel capability. We recognise that the biggest opportunity we have to reshape the workforce for the future lies in developing the skills of the current workforce. Our aim is to have in place the right skills and roles to enable us to enhance the services we offer. This will ensure we have the right blend of clinical and support staff to deliver safe, effective and efficient services. NHS 24 aims to become an employer of choice for Scotland s citizens, attracting the best staff with the appropriate range of skill sets to deliver our services. In line with our values, Operational Plan M McGurk 050418 5

NHS 24 will demonstrate a commitment to openness and transparency that is responsive to the needs of staff, engaging with them effectively and recognising our frontline staff as ambassadors of the service. Section D: Recent Key National Developments The 2018 General Medical Services Contract in Scotland A new Scottish General Medical Services contract was issued for consultation in November 2017 and later accepted in February 2018. The new contract offer proposes a refocusing of the GP role as expert medical generalists and the development of Primary Care multidisciplinary teams. The proposals will help people access the right person at the right time. NHS 24 will have a role in supporting and improving access through a number of initiatives within our own strategy including in-hours GP Triage and the improvements planned in relation to developing our information and digital services. The latter involves NHS 24 developing a national standardised website for each practice in Scotland. We will also seek to be involved, as appropriate, in the specification for the proposed new Out of Hours opt-in enhanced service for GP practices to maximise the long-term effectiveness of our role. Targets and Indicators in Health and Social Care in Scotland A Review Professor Sir Harry Burns Scotland has highly challenging targets for public services and there is recognition that targets for the NHS have driven levels of improvement by transforming waiting times for patients and improving safety. This review considers how targets and indicators for health and social care align with the Government s strategy for the future of NHS and social care services and supports the best use of public resources. The review suggests that with complex systems like health and social care, what can be measured is often not sufficiently detailed to allow for meaningful performance monitoring. The result is often oversimplification of the system to a set of numbers which do not provide adequate information to allow improvement of the outcomes of the complex system. In this operational plan for 2018/19, we have reflected on the key messages from this review and also the detailed internal review undertaken to create a performance management framework which includes a review of existing key performance indicators or targets. Section E: Scottish Government Health and Social Care Delivery Plan The NHS 24 Contribution and Summary Collaboration Proposals Service Improvement and Development In 2018/19, we will continue to deliver and develop a safe and effective unscheduled care service to the population of Scotland, as efficiently and effectively as possible, utilising the skills of different staffing groups in the most appropriate way. We will work with partners to provide models of care that will support capacity and capability within Health and Social Operational Plan M McGurk 050418 6

Care provision supporting the shift from unplanned contacts to planned responses 7 days per week. Scottish Ambulance Service & NHS 24 Collaboration The Scottish Ambulance Service and NHS 24 recognise the added value they can deliver to the wider health and social care system through continued and indeed increasing collaborative planning and working. A shared strategic planning function is currently being tested and will continue during 2018/19 however a range of other internal and external facing initiatives will be collaboratively progressed as part of both organisations delivery commitments for 2018/19. Elective Care and Outpatient Services The Scottish Government aims to increase elective capacity and reduce unnecessary outpatient appointments. We will work with the Scottish Ambulance Service, GJNH and the territorial boards and regions to support the development of new elective centres using optimal pathways for care, digital triage, pre and post-operative telehealth consultation and self-management services for people who may not require a face-to-face outpatient appointment. This will release capacity and an improved elective and outpatient model which ensures people are directed into the most appropriate care pathway as part of the wider programme of modernising elective care, including the outpatient experience. In addition, we will develop a national Patient Reminder System to help reduce the level of do not attends (DNAs). Mental Health Service Development NHS 24 continue to develop and implement a tiered offering in relation to Mental Health services. The current model provides support to the population with low-moderate mental health needs, and we recognise the broader requirements around complex care needs and the support required to maintain good mental wellbeing. We will ensure that safe and effective access to the management of mental health across the spectrum of mental wellbeing and illness is at the core of our approach and implementation. We will work with the public, our staff and our partners to develop digitally enabled mental health services which help reduce waiting times and improve access for people with mental health distress and/or mental health problems. This will also help the National Unscheduled Care Programme improve hospital capacity and patient flow and enable more people to be cared for at home or in a homely setting. This initiative will also better align national board mental health services including NHS Inform, Breathing Space and Living Life. Section F: Performance NHS 24 is not proposing any fundamental change to the delivery of its core services but rather is proposing a suite of measures which more appropriately reflect the value and effectiveness of the services it delivers. Operational Plan M McGurk 050418 7

During 2017/18 NHS 24 worked on a proposed performance framework and associated targets and outcomes aligned to the aims and outcomes in the NHS 24 strategy. This framework has been approved by the NHS 24 Board and the Scottish Government have indicated their support for the direction of travel. The current suite of key performance indicators for NHS 24 is primarily focused on timeliness of response, both in answering the initial call and in respect of subsequent call back where clinician input is required and is initially unavailable. There is an acknowledgment that these indicators do not always meaningfully measure either the effectiveness or appropriateness of NHS 24 s response or indeed the experience of callers, nor do they offer insight into how effectively NHS 24 supports whole system integration and patient pathways. At this stage no change is being proposed in relation to the main access target of answering 90% of calls in 30 seconds. It is anticipated however that 2018/19 will be a transitional year where more evidence will be gathered to support any potential move from this current metric. A range of strategic areas for measurement have been identified and these have informed the proposed suite of key performance indicators, specifically; Access to NHS 24 services; Managing demand and flow; Clinical effectiveness and safety; Personal experience; Whole patient journey and improved outcomes It is recognised that there are number of key areas and services within NHS 24 strategy that are under development, for instance, mental health and supporting the elective centre national programme. Clearly, performance measures will be required for these services as they are developed and included in the wider performance framework for NHS 24, however, given the timing of this work, it is not proposed to include these in this operational plan. It is also important to recognise that NHS 24 is not proposing any fundamental change to the core 111 service its provides. These indicators continue to reflect the importance for NHS 24 in ensuring timeliness of access and an effective response to callers, both clinically and in onward referral to our partners. Operational Plan M McGurk 050418 8

Performance Targets Average of 90% GP priority calls responded to within 20 minutes. 90% Average of 90% GP routine calls responded to within 60 minutes 90% Quarterly average of 98% of P1 calls responded to within 60 minutes 98% Quarterly average of 90% of P2 calls responded to within 120 minutes 90% Quarterly average of 80% of P3 calls responded to within 180 minutes 80% Less than 5% of Call Demand abandoned after the Threshold 5% Average of 90% of Unscheduled Care Calls to be answered within 30 seconds 90% Average of 80% of NHS inform calls answered within 60 seconds 80% Provide at least 30% of patients with self care advice 30% 90% of Breathing Space Calls to be answered in 30 seconds (propose discussion on reducing this to 80%) 90% NHS 24 will commit to supporting successful Smokeline quits through a 5% referral rate to local Boards. 5% Measured an average of at least a 60% decrease in CBT PHQ-9 scoring. 60% Measure an annual average of at least a 60% decrease in GAD-7 scoring. 60% Maintain 95% of D1 calls responded to within 45 minutes 95% Maintain 90% of D3 calls responded to within 180 minutes 90% Convert at least 75% of Category C calls transferred from the SAS to primary care or home care outcomes 75% Achieve and maintain an average attendance rate of 94.75% throughout 2017/18 94.75% 90% of complaints are responded to within 20 working days 90% Section G: Financial Plan The budget setting process is an integral part of the NHS 24 SPRA process. Anticipated Revenue Allocation Uplift 2018/19 2022/23 It has been confirmed that there will be a baseline uplift in 2018/19 of 1%. It has been assumed that there will be an additional 1% uplift year on year to 2022/23. Pay Policy and Award The Scottish Government has set out its 2018/19 pay policy, which recommends a 3% pay increase for public sector workers earning 36,500 or less and a cap of 2% on the increase in the pay bill for staff earning more than 36,500. In addition, there will be a cap on the pay increase for the highest paid with a maximum cash increase of 1,600 for those earning above 80,000. There is no formal clarity beyond 2018/19 therefore the current financial planning assumption is a year on year additional %age uplift similar to 2018/19. National Investment in Transformation Scottish Government have announced a transformational change fund of 126 million to provide support to the regional delivery plans for implementation of new service delivery models, improved elective performance and investment in digital capability. There is also further investment of 17 million to support the delivery of the national Mental Health Strategy and an additional 50 million to support Primary Care transformation. Operational Plan M McGurk 050418 9

All of the above are relevant to the NHS 24 Strategy and the Strategic Delivery Programme and proposals will be made through the National Board Collaborative Plan to support the investment required in 2018/19 to deliver against our key improvement programmes in these areas. It will be important to ensure that funding for the national board transformational work streams is allocated directly to those boards delivering new services in 2018/19. High Level Financial Position Summary Financial Position 2018/19 m Core and Anticipated Allocations 68.90 Transformation Programme 4.95 Repayment of Brokerage -5.06 Revenue Resource Limit 68.79 Clinical 42.28 Non Clinical (Including Underpinning Technical Infrastructure) 21.56 Transformation Programme 4.95 Total Expenditure 68.79 (Over)/Underspend 0.00 Efficiency Savings NHS 24 has to identify and achieve the level of savings required in order to break even year on year. On top of that NHS 24 must maintain the level of brokerage repayment planned for 2018/19. Over the past 2 financial years NHS 24 has reduced the support and non-clinical frontline services budgets recurrently by a cumulative 20%, i.e., 10% in each year. In that context we have recognised a lower level of saving (5% 0.72 million) across support and non-clinical frontline services for 2018/19. This target is currently assessed as high risk and non-recurring and will fund the NHS 24 share of the national boards 15 million saving of 0.353 million in 2018/19. No formal commitment to the 15 million national saving can be confirmed until the target risk rating has been reduced and firm plans to deliver the saving have been agreed. Efficiency Savings Target 2018/19 m m Non Recurring 5% (incudes share of national board target) 0.72 Depreciation recurring 0.23 New Technology contracts 18/19 recurring 1.12 Total 2.06 More information on the core financial planning assumptions and risks at Annex 1. Operational Plan M McGurk 050418 10

Section H: Workforce Plan The NHS 24 Strategic Delivery Programme will provide an opportunity to support health and social care partners to manage changes in demand and workforce issues by ensuring access to clinical and non-clinical advisors in a manner appropriate for the era of digital technology, which supports a digital first approach to the delivery of health and care services supporting wellbeing and self-care and self-management. It also builds on existing infrastructure to provide services that are clinically and cost effective and responsive to the patterns of demand and in a way which meets its public and partner changing needs and expectations. It is anticipated that over the next five years, to support the programme of development, an additional 371 WTE staff will require to be recruited. This represents an increase of approximately 40% of NHS 24 s existing workforce. The majority of the resource requirements, approximately 65%, are for nonclinical staff, call handlers in particular, however, there will be a requirement for NHS 24 to grow its requirement for clinical staff, including more nurse practitioners, advanced nurse practitioners, mental health nurses, general practitioners, and allied health professionals. NHS 24 recognises that careful consideration requires to be given to the approach of recruiting these clinical staff, and this will require effective planning and engagement with partners across the primary care landscape, in particular its Health Board partners. In addition NHS 24 is also exploring career pathways which would allow its existing staff to build on their skills to advance their career opportunities within NHS 24. Operational Plan M McGurk 050418 11