PROJECT BUILD OUTSOURCED RESOURCE REQUIREMENTS

							NHS 24                                                                    20 MARCH 2002
BOARD MEETING                                                             FOR APPROVAL
                                                                          ITEM NO. 6.4


                      PROJECT BUILD OUTSOURCED RESOURCE
                                 REQUIREMENTS


INTRODUCTION

This paper seeks the Board’s approval of the key principles underlying NHS 24’s plans for
securing the necessary outsourced resources that will be needed to complete the NHS 24
roll-out in the North, establish new contact centres in the West and East and roll-out the
integrated service in these regions over the next 12 to 18 months. These resources are time
limited, specialist in nature and do not form part of the mature organisation and therefore
require to be outsourced to support the NHS 24 Executive Team to deliver the very
aggressive project build and roll-out programme.

The services required are currently provided in the main by Cap Gemini Ernst and Young
whose contract terminates at the end of April 2002. In a previous paper tabled at the NHS 24
Project Board in November 2001, the Executive indicated that the ongoing requirements for
such services would be reviewed in February/March 2002 and this paper is the result of that
deliberation.

The paper broadly outlines the requirement as it is understood at this point in time. A
tendering exercise has commenced to identify suitable outsourcing partners and associated
costs and further detail will be presented to the Board in May. This future paper will also
identify the additional temporary in-house resources required within each Directorate to meet
the project build workload over the next 12 to 18 months.

The Board is asked to endorse the pursuit of a partner to supply Programme and Project
Management, Business Analysis and Systems Integration resources for a 12 to 18 month
period commencing June 2002. The paper will be supported by a presentation at the Board
Meeting.


BACKGROUND

The First Implementation Phase

Following the approval of the high level design blueprint for NHS 24 in May 2001, the project
team embarked on the detailed design, build and implementation phase that will culminate in
the launch of the NHS 24 service in Grampian in Spring 2002.

The programme of work to date has required the skills of a diverse range of expertise
ranging from clinical algorithm enhancement, through contact centre build and staff
recruitment, to systems development and integration.

The management of the various workstreams that were put in place has necessitated the
application of rigorous programme planning, reporting and issue management techniques
supported by suitably experienced practitioners and a number of “subject matter” experts
who have addressed specific requirements as they arose.




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In order to achieve this the NHS 24 Executive Project Board approved the appointment of
Cap Gemini Ernst and Young, a major consultancy firm, who currently provide the services
surrounding programme management and business analysis.

The roll-out programme developed in the blueprint was created without the understanding
which is now available of the organisational capacity within partner organisations. The
detailed technology and process work which will be required to link NHS 24 with each
individual partner organisation will need to be effectively planned, controlled and resourced.
It is clear that this requirement cannot be met at Health Board level as knowledge of NHS 24
systems and its key technology partners and their effective coordination are vital in this
respect. The volume of this work will increase over time as NHS 24 increases the number of
service partners it is working with in parallel.

In addition, work to establish a preferred solution for linking with remote and rural areas,
which are not covered by Co-ops, has provided an insight into the considerable practical
challenges, which need to be overcome at local level and realism to the original roll-out
schedule and future resource requirements. This paper was presented to the Board at its
February meeting.

Outsourced project management and technical expertise are required to meet this challenge
across the Service and Systems Integration workstreams. In their presentation to the Board
in February NHS Grampian, GDocs and MorayDocs referred to the importance of this
resource and the impact it has had within the work programme to date, and their view that
this would be even more important when working with smaller Co-operatives and more
disparate out-of-hours arrangements elsewhere in the country.

The project build programme for the West and East contact centres overlap, with the North
roll-out programme running in parallel to the West build programme. As a result of this
sequencing, the recruitment programme and the core induction and training programme of
the frontline staff for these centres will be a large scale, high volume activity. Effective
project management of this will be essential.

A detailed assessment of the programme and the overall timescale for roll-out for the North
will be completed by the end of April and begun in the West, to provide a firmer roll-out
schedule and greater clarity on the associated resource requirements.


THE PROGRAMME FOR THE NEXT 12 TO 18 MONTHS

The scope of the NHS 24 programme of work will be split into:

Core Service and Systems Development:        The work required to manage the development
                                             of the underlying business processes and NHS
                                             24 infrastructure.
Integration and Interface Development:       The work required to develop the end-to-end
                                             services in conjunction with NHS 24’s service
                                             delivery partners elsewhere in NHSScotland.

Each of these is described in more detail in the following sections:




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Core Service and Systems Development

Service and Business Process     As each of the contact centres goes live there will be a
Development                      continuing need to review and refine the business
                                 processes that have been developed during the
                                 implementation phase.
People Resource                  The build of the West and East Contact centres plus
                                 the roll-out of the North centre will call for intensive
                                 recruitment induction and training programmes during
                                 which the NHS 24 HR department and Nursing
                                 directorate will require significant support from
                                 additional resources.
PRM core functionality           A future programme of further development for PRM
                                 has already been established beyond the
                                 configuration baselined for the launch of the service in
                                 the North region.
Website Development              As the NHS 24 service matures it is envisaged that
                                 there will be greater use of the channels to market
                                 afforded by Web technologies.
Knowledge Management             NHS 24 aspires to be at the forefront of healthcare
Infrastructure                   knowledge management in NHSScotland. To fulfil this
                                 objective there will be a need for a core infrastructure
                                 to support the frontline staff and the development of
                                 and subsequent maintenance of this will be one of the
                                 key challenges facing the Service and Systems
                                 Integration Team.
Performance Management           This will necessitate the development of a number of
Infrastructure                   specific PM systems and integration of a wide range
                                 of reports drawn from various other sources
                                 throughout the organisation.
Clinical Development and         NHS 24 requires to build and operate clinical
Continuous Improvement of AXA    development and quality assurance processes in
PRM                              order to ensure that the AXA PRM system supports
                                 current and future service delivery.
Health Information Service       Resources will be required to further develop and
                                 extend the Health Information Service which will be
                                 delivered in Grampian on Day 1. (Ref. Health
                                 Information Service Board Paper)

Integration and Interface Development

North Roll-out                   Although the service will go live in April 2002, the full
                                 roll-out across 6 Health Board Areas that comprise the
                                 North region will take a further 9 -12 months. There
                                 will be a continuing requirement for significant
                                 planning and service integration work with the various
                                 service delivery partners in the region.




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West Implementation and Roll-out   The West implementation and roll-out will challenge
                                   NHS 24’s team in terms of the size of the population
                                   served and the nature of the healthcare landscape. It
                                   compares therefore in scale to the work already
                                   completed to launch the service in the North.
East Implementation and Roll-out   The East programme which completes the NHS 24
                                   roll-out schedule will follow but overlap with that of the
                                   West.
Co-op Interface Development        This integration workstream will focus on the
                                   development of the interfaces between the NHS 24
                                   system and the various front-line systems deployed by
                                   the GP Out-of-Hours Co-operatives.
HUB development                    There are many areas of Scotland that are not served
                                   out-of-hours by a GP Co-operative. Recent
                                   discussions on this issue have focussed on the
                                   possible development of a number of “Hubs”, located
                                   around Scotland, which would be responsible for co-
                                   ordinating the required services. This could have a
                                   considerable impact on the roll-out schedule.
CHI Integration                    There will need to be significant integration work
                                   between NHS 24 and the CHI systems managed by
                                   the central ISD team in the Common Services
                                   Agency.
Computer Telephony Integration     CTI will permit better control of the passing of calls
Development                        and associated data and will eventually lead to the
                                   ability to use all three data centres as a single “virtual”
                                   call centre.
Scottish Ambulance Service         The Scottish Ambulance Service itself has an
Integration                        ambitious service and systems upgrade programme
                                   planned for 2001-2003. This programme will reduce
                                   the number of SAS Command and Control centres
                                   from 8 to 3 and will introduce a new system – AMPDS
                                   – to the new centres in a phased implementation.
                                   Once this has been achieved NHS 24 will be entering
                                   into detailed discussions regarding on the further
                                   integration of their service and associated systems
                                   with NHS 24.
Accident & Emergency Integration   Integration with A&E requires further engagement and
                                   communication at local level which will require
                                   considerable clinical resource input. Integration with
                                   A&E departments will not initially be focussed on
                                   system-to-system data transfer as there is currently
                                   little commonality of A&E systems deployed in the
                                   departments concerned. Nevertheless NHS 24 will
                                   have to support call transfer/hand-off by whatever
                                   mechanisms are chosen, whether that be by phone,
                                   fax, e-mail or web-based data transfer.

To deliver this work programme NHS 24 will require additional internal and external
resources.




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THE EXTERNAL RESOURCING REQUIREMENT

The resourcing skills required to deliver the programme of work described above falls into
two categories:

1) Business Design and Programme Management

A base Service and Systems development and integration capability is needed regardless of
size and scope of SI projects. This will cover the functions of:

   •   Programme Management
   •   Design Authority
   •   Configuration Management
   •   Change Management
   •   Resource Management
   •   QA Management

In addition for each element of the SI programme there will be a project-focused capability
required in the areas of:

   •   Business Requirements Capture and Management
   •   Design
   •   Development
   •   Risk and Issue Management
   •   Human Resources / Training
   •   Test
   •   Implementation

2) Service Integration

   •   Detailed project planning, monitoring and reporting support resources for each
       Regional Project Manager to develop joint implementation plans with each partner
       organisation.


OPTION APPRAISAL

There are three main options that are open to NHS 24 in terms of how the resources and
skills described above can be secured.

1) Extend the CGEY contract

While it is feasible to extend the CGEY contract again and possibly desirable from the point
of view of the quality of work to date, knowledge retention and maintaining momentum, it is
contrary to the spirit if not the detail of the public sector procurement rules that should apply
to such an engagement. CGEY may of course participate in any open procurement
alternative and NHS 24 will in any event have to develop a knowledge transfer plan to
ensure that key skills and understandings are captured and held within the business.
Consequently, this option is not recommended.




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2) Establish the capability in-house

This is not a viable option, NHS 24 only requires this capability to satisfy a high volume of
work in the short to medium term. The resources will not be required within the mature
organisation. It is not a strategic objective of NHS 24 to build a permanent IT team capable
of designing and building large IT systems. It would be extremely difficult to secure all the
types of skilled resource needed within the constraints of the current NHS staffing terms and
conditions. What will be needed however is an in-house IT team capable of managing a
small number of key suppliers in a firm but collaborative way and able to establish the skills
needed to define and manage the technology requirements that emerge from the evolving
business objectives.

3) All resources are supplied by an outsource partner

This is not a viable option, whilst NHS 24 requires some specialist resources which are
available on the open market, it also requires individuals who have a detailed understanding
of business and IT functions within NHS 24 as well as the Health Service in Scotland, to
effect good relationship management.

NHS 24 would require that the successful vendor would work with NHS 24 as a partner,
whose scope of work extended across the full spectrum of activities from Business Analysis
and Programme Management to (where appropriate) the delivery of specific service
integration projects and systems integration workpackages.

Further more, this approach would prevent the level of skills transfer from the project build
team to the mature operational management team that is necessary for NHS 24
sustainability in the long term and would leave NHS 24 overly dependant on external
partners. This option is therefore not recommended.

4) Combination of in-house plus partner

This is the recommended option as it provides for the greatest flexibility and is almost
certainly the only way in which NHS 24 can meet the very demanding timescale and quality
targets that have been set for the launch and roll-out of the service. NHS 24 needs to
benefit from the experience and skill sets that exist within the NHS with respect to strategy,
project management, clinical expertise, operational management and experience, strategic
development, communication, engagement and those of programme management and
technical support which are shorter term in nature and can be obtained from a partner
organisation. The total resource requirements set out will be obtained via a combination of
NHS secondment/short term employment contracts and via an external partner.


BENEFITS

The benefits of the proposed approach are:

   •   Using an out-sourced partner will provide immediate access to specialised skills and
       knowledge and experience while the recruitment of internal resources would take
       considerable time. The combination of outsource and internal resources proposed
       permits the right degree of flexibility in the scope and level of resources required to
       meet the “bulge” in workload.
   •   Use of an out-sourced partner brings managed resources reducing the pressure on
       the Executive Team, also providing potential contingency to meet unexpected
       requirements.




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   •   A continuing strong programme centre with high quality management processes and
       controls; effective communication across the width of the work programme; good risk
       and issue identification; strong change management and control. This is essential
       during the high volume and highest risk period of the programme.
   •   Each partner can play to their core competences in delivering the overall solution.
   •   The various tasks within the project build and roll-out activities can be managed and
       implemented in parallel alongside the effective management of the operational
       service .
   •   We can deliver what we have promised.


FINANCIAL APPRAISAL

Partner Procurement

Once a preferred supplier has been chosen and a draft contract constructed a further paper
containing a more detailed financial forecast on outsourced partner costs and additional in-
house resources and costs will be tabled for Board approval in May.

The cost model makes allowance for project build costs, although excludes costs associated
with detailed Service Integration. The budget allocation for financial year 2002/03 is fixed at
£22.8m within which some contingency element exists. Once the costs are known the Board
will be advised of the adequacy of existing contingency and any consequent impact on the
roll-out timescales, if applicable.


RISK ASSESSMENT

The risk associated with not pursuing the approach set out is that the considerable
momentum which is now behind the build element of the programme is lost and the
development timetable is extended. The reputation of the organisation will be put at risk and
stakeholder confidence will diminish.

The main risk in adopting this approach to securing the required resources lies in a possible
over-reliance on an external agency to carry out what is a critical role in the next phase of
NHS 24’s development. This risk will be mitigated by ensuring that the functions undertaken
by the chosen supplier are well defined and properly scoped and that all deliverables
produced are ultimately owned by an NHS 24 Director.


FINANCIAL ASSESSMENT

It is not possible to determine the costs at this stage, however once the tender process is
complete and its internal resourcing requirements established these will be brought back to
the Board for approval. The cost plan clearly budgeted for project build costs, particularly
work programme management design and testing, however the programme build specifically
excluded the costs of Service Integration which could not be established at that stage.




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A project contingency was included and there may be scope to use some of the operational
funds through careful management of the operational roll-out timescale. The Board will be
presented with a draft budget at its April meeting outlining the broad position, however given
the set-up nature at NHS 24 the detail within the budget will change and there is a clear
need to be flexible as the project moves forward, particularly in the area of project build. The
detailed project build costs will be presented in May as a separate paper for the Board’s
approval.


MANAGEMENT

The overall responsibility for the content will initially rest with the CEO, with the programme
management elements being managed by the Director of IT and the Service Integration
elements managed by the Director of Service Integration, with support from other Directors
as appropriate.

The work to be carried out by the chosen suppler will be managed by the Directors of
Service Integration and IT with input from the CEO and other Directors as appropriate.


RECOMMENDATIONS

The Board is asked to:

   •   approve the pursuit of a partner to supply Programme Management, Business
       Analysis and Systems and Service Integration resources for a 12 to 18 month period
       commencing June 2002.

   •   note the Executive’s intention to provide a more detailed paper in May setting out the
       detailed costs associated with the above procurement process and the costs
       associated with additional in-house resources required by each Directorate.



LIZ MALLINSON                   GRAHAM DIXON                     JIM MCINTYRE
DIRECTOR OF SERVICE             DIRECTOR OF IT                   CHIEF EXECUTIVE
INTEGRATION




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