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									         KNOWLEDGE MANAGEMENT SYSTEM



                       OUTLINE BUSINESS CASE




                                    23RD JUNE 2004




Page 1                    NHS 24 Knowledge Management System
                                         Outline Business Case
                                                 23rd June 2004
                                             TABLE OF CONTENTS

1        Title .................................................................................................................................3
2        Executive Summary.......................................................................................................4
3        Introduction/Purpose – Assessment of Need ..............................................................6
4        Background/Strategic Context......................................................................................9
5        Service Specification...................................................................................................13
6        Project Objectives and Scope.....................................................................................15
7        Options Considered.....................................................................................................17
8        Exploration of PPP/PFI ................................................................................................19
9        Appraisal Process .......................................................................................................20
10       Preferred Option ..........................................................................................................31
11       Risk Transfer (Potential PPP/PFI Projects Only) .......................................................32
12       PPP/PFI and Legal Issues ...........................................................................................33
13       Personnel Issues .........................................................................................................34
14       Timetable for Option 2B ..............................................................................................35
15       Project Management....................................................................................................37
16       Conclusion ...................................................................................................................38
17       Appendices ..................................................................................................................39




Page 2                                                                                       NHS 24 Knowledge Management System
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                                                                                                                    23rd June 2004
1 Title
The Project, as it appears in the NHS 24 Five-Year Plan, is titled the Knowledge
Management System (KMS). At the time of preparation of the Capital Expenditure Plan for
2004/05 and thereafter, the KMS was considered as revenue expenditure. However, with
more information now available, capital expenditure associated with the Project has been
identified and can be covered within the Capital Resource Limit agreed for the year, as the
capital expenditure is not considered substantial.




Page 3                                                       NHS 24 Knowledge Management System
                                                                            Outline Business Case
                                                                                    23rd June 2004
 2 Executive Summary

 2.1      Service Objectives of the Project

 NHS 24 operates from three Contact Centres across Scotland, and functions as a ‘virtual’
 service which requires access to a shared national database. Frontline staff require a broad
 range of quality assured information resources in a timely manner. These resources include
 details of Locations of Care, voluntary organisations, clinical processes and information on
 diseases and conditions.

 The Knowledge Management System Project aims to provide efficient and intuitive access to
 up-to-date information which is required in NHS 24 service delivery. It aims to improve
 quality and reduce the risk of providing inaccurate information to callers as well as make the
 job of NHS 24’s frontline staff easier and more efficient. It also aims to support a knowledge
 management culture within NHS 24 and provide a flexible platform for further strategic
 growth.


 2.2      Summary of the Short-Listed Options

 There is one short-listed option for consideration:

 •     Option 2B: procure a Knowledge Management System through the Official Journal of the
       European Union (OJEU) procurement process.


 2.3      Results of the Economic and Financial Appraisal

 The following section outlines the estimated costs associated with the procurement of a
 Knowledge Management System. Initial funds have been allocated in the NHS 24 2004/05
 budget.

 Note that the Knowledge Management System costs are included in the eHealth Gateway
 Business Case1 as the KMS is a foundation part of that Project. Proceeding with the KMS,
 may decrease the overall cost of the eHealth Gateway Business Case.


 2.3.1     Option 2B: Procure a Knowledge Management System

 The financial investment required across five project years is estimated at £1.1m. The
 division of costs is shown in Table 1 below.

Cost Grouping                 Yr 1 - £k   Yr 2 - £k     Yr 3 - £k     Yr 4 - £k     Yr 5 - £k     Total - £k
Programme - Revenue                  31           0             0             0             0             31
Technology - Revenue               642            0             0             0             0           642
Technology - Capital               112            0             0             0             0           112
Content – Revenue                    21           0             0             0             0             21
Running – Revenue                    15          59            62            65            68           269
Contingency @ 5%                     41           3             3             3             3             53
Totals                             862           62            65            68            71         1,128
                             Table 1 - Five Year Building and Operating Costs


 1
     NHS 24, July 2004, eHealth Information for Patients Programme Initial Agreement/Business Case


 Page 4                                                                NHS 24 Knowledge Management System
                                                                                      Outline Business Case
                                                                                              23rd June 2004
Capital costs for the Knowledge Management System are estimated at £112k. Revenue
costs are estimated at £1,016k.


2.4      Preferred Option

The preferred option is Option 2B, Procure a Knowledge Management System. This is the
only effective option to reduce the risks, provide a clinically safe virtual service, provide the
required capabilities, including alignment with the IT Strategy, and deliver the benefits
outlined in Section 3.1.2.


2.5      Support of the Project from the NHS 24 Board

The NHS 24 IT Strategy and Five-Year Plan identifies health information development as
one of the priority areas for development by NHS 24 and therefore the KMS is aligned with
the objectives of the Board. This Business Case is fully supported and has been approved
by the NHS 24 Board, including all resulting revenue consequences.




Page 5                                                           NHS 24 Knowledge Management System
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3 Introduction/Purpose – Assessment of Need

3.1      Clinical Need and Benefits


3.1.1     Clinical Need

Although the necessary information is being provided at present to the service, there are
numerous issues with current NHS 24 knowledge systems, which include; Health Information
System (HIS), Knowledge Web and Helpline Directory. The latter two systems were
implemented as temporary solutions to fulfil specific gaps which HIS could not address.

Consequently the ability to provide a clinically safe and quality service is becoming
increasingly compromised as NHS 24 integrates with additional partners; takes on an
increased role as the front-door to all out-of-hours emergency care in response to the new
General Medical Services (GMS) contract; and more fully understands the extent of the
services’ information needs. These concerns include:

•     inability to support efficient electronic information upload and update and maintenance;
•     inflexibility of the structure of the underlying database such that only two fields are
      searchable;
•     inability to effectively display unstructured information, such as process-related
      information;
•     inability to effectively support health alert information;
•     unacceptable search capabilities for a contact centre environment;
•     inadequate graphical user interface;
•     inability to display locations based on road distance from a caller;
•     incapability to deliver real knowledge management functionality.


3.1.2     Benefits

A new Knowledge Management System will deliver many benefits including:

•     increased patient safety through the reduction in the risk of providing inaccurate or out-of-
      date information;
•     a Knowledge Management System which is fit for purpose, with a flexible data structure
      that meets the business needs;
•     improved information management and ease of upload and maintenance where
      information providers can maintain their own data, eliminating the need for duplicate data
      entry;
•     a single point of access for staff to their service delivery information needs;
•     improved confidence of frontline staff in the quality and usability of an information system;
•     an inter-operable system which supports information sharing with NHSScotland (NHSS)
      organisations;
•     alignment with the NHS 24 knowledge management strategic direction;
•     knowledge management capability, not simply data management;
•     support for NHS 24 in enabling compliance with the Freedom of Information Act;
•     a system which can grow and develop to address changing business needs and strategic
      intent. This includes the ability for the KMS to form the foundation of the eHealth
      Information for Patients Gateway.




Page 6                                                             NHS 24 Knowledge Management System
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3.2      Implications of Not Meeting the Need

The implications of not providing a flexible and robust system to support knowledge
management are as follows:

•     high clinical risk in providing inaccurate advice such as where the nearest Location of
      Care to a caller is situated;
•     continued duplicated effort through manual input of information;
•     continued use of a number of temporary information systems for frontline staff to access
      information not supported by HIS;
•     inefficient information management whereby data may be held in three different systems;
•     ongoing creation and use of hardcopy resources by frontline staff which are not
      effectively monitored for currency and accuracy, but are considered easier to use than
      the existing system;
•     retention of local knowledge in the heads of staff, adding extra pressure to their role,
      particularly given that NHS 24 operates a ‘virtual’ service and therefore staff members
      must be able to answer enquiries from a caller in any area of the country;
•     increase in the number of different search techniques which do not efficiently meet the
      need and are entirely unintuitive;
•     longer call time and time taken to refer patients on to other services, thereby impacting
      on performance improvement;
•     use of web-based resources considered more user-friendly, which have not been
      authorised by the website owners for business use by NHS 24;
•     conflict with the NHS 24 knowledge management strategy where the update and
      maintenance of information is duplicated by NHS 24 staff and content owners;
•     lack of ability to efficiently grow and develop the system to address changing business
      and strategic needs.

Against this backdrop, content providers such as NHS Boards are also expressing frustration
with the requirements NHS 24 is placing on them, due to the inadequate systems,
particularly given that they are often providing this information to numerous other
organisations. NHS Boards have also indicated that the lack of a nationally co-ordinated
information resource into which they can feed local information, results in confusion over
where is the best source for accurate and up-to-date information and therefore a lot of
duplication of effort, information redundancy, and inconsistency, both within and across
Board areas.

A project was commenced in early 2003 to address these issues through a new Knowledge
Management System. However, this was halted in order to align with the Scottish Executive
Health Department (SEHD) eHealth Information for Patients Programme.

At the end of 2004, NHS 24 will have fully rolled-out across Scotland. Therefore there is a
business imperative to address these issues as soon as possible, not only to ensure clinically
safe national delivery of the service, but also to support the key NHSS role of NHS 24 with
regards to the GMS contract.

The NHS 24 Board has agreed, as part of approving the Five-Year Plan, that NHS 24
develops a Knowledge Management System in the current financial year as a business
necessity.




Page 7                                                          NHS 24 Knowledge Management System
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3.3      Explanation of the Services Required

NHS 24 is a patient focused, telephone nurse assessment and health information service
which needs to effectively respond to a broad range of patient/caller queries. Frontline staff
require access to a broad range of quality assured information resources in a timely manner
for service delivery. The services required to support NHS 24’s information requirements
include:

•     a Knowledge Management System which will support the Clinical Assessment, Advice
      and Referral, and Health Information Services offered by NHS 24;
•     provision of information resources that include;
        o Locations of Care2;
        o processes;
        o voluntary organisations;
        o leaflets;
        o knowledge resources;
•     communication and collaboration tools, including support for Health Alerts and general
      NHS 24 communications;
•     contact centre processes and workflow to support the use of NHS 24 KMS by Contact
      Centre staff;
•     content management processes and workflow to support the creation and maintenance
      of content;
•     integration with NHS 24 frontline applications to support seamless interaction;
•     content management capability that supports the maintenance of content by authorised
      NHS 24 staff and external information providers.




2
  NHS 24 is involved in the Practitioner Services Division GMS GP Contractor Database Project which
will provide a system to meet the requirements of a number of customers and stakeholders. This will
require:
• a database to retain and manage all GP and GP Practice information;
• web-browser data capture forms;
• data extraction to a variety of interfaces.




Page 8                                                            NHS 24 Knowledge Management System
                                                                                 Outline Business Case
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4 Background/Strategic Context

4.1      Description of NHS 24 and its Catchment Area

NHS 24 was established as a Special Health Board following a period of wide consultation
conducted by the SEHD with Healthcare Professionals in Scotland. NHS 24 is a national 24-
hour service providing clinical assessment and referral, health advice and information by
telephone to the people of Scotland. The service will be available to the whole population of
Scotland - for the cost of a local telephone call - by December 2004. The aim of NHS 24 is to
simplify access to local healthcare services by providing a 24-hour service, which allows
patients and their families to access health advice when they need it and to improve the
patient’s journey of care.

The demand for the service has been increasing progressively since it was launched in May
2002. The service can currently be accessed by well over 50% of the population, including
Glasgow, Grampian, Fife, Ayrshire and Arran, Highland, Dumfries and Galloway, Lothian and
Western Isles, and by May 2004, over a million calls had been received. NHS 24 employs
more than 880 staff. When the full national roll-out of the service is achieved, the demand is
estimated at 150,000 calls per month, with approximately 1.6 million calls annually.


4.2      Description of the Five-Year Plan, Strategic Direction and Business Objectives

‘Securing Our Future Health: Taking a long-term view’, the evidence-based assessment of
the long-term resource requirements for the NHS, outlines the vision for a high quality health
service in 20 years’ time. This includes the provision of “better information to patients”. The
present day reality however, outlines a different picture where patients feel that “there is no
one to talk to about anxieties and concerns, insufficient information is provided to family and
friends and there is not enough information about recovery”.3

The Health Plan ‘Our National Health: A plan for action, a plan for change’4 also identifies
that “time and time again people say they want more information. They want to know how
and where to access services. They want to know more about their illness or about their
health more generally. They want to be involved in decisions about their treatment and care
and to be able to exercise informed choices.” Successive SEHD documents such as
‘Partnership for Care’ and ‘Patient Focus, Public Involvement’ have also highlighted the
priority of information provision in the healthcare setting.

The services NHS 24 delivers contribute to supporting these policy commitments.

NHS 24 has also identified a number of strategic objectives within the Five-Year Plan. Whilst
sustaining acceptable organisational performance in line with the expected service levels
agreed with partners and stakeholders, the key priorities are as follows:

•     partner roll-out and full national coverage;
•     operational performance improvement;
•     health information development;
•     implementation of the GMS arrangements.



3
    Wanless, Derek. (2002) “Securing Our Future Health: Taking a Long-Term View”
4
    SEHD (2000) “Our National Health: A plan for action, a plan for change”


Page 9                                                             NHS 24 Knowledge Management System
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The above priorities/commitments place NHS 24 at the centre of national service delivery
within NHSScotland. The NHS 24 Board has recognised that the development of a KMS is
critical in order that NHS 24 can safely and effectively deliver on the above and future
priorities. The delayed development of a KMS remains a risk on the organisational risk
register.


4.3     Current Activities of NHS 24 and the Range and Quantity of Healthcare Services
        Provided

NHS 24 operates two core services for the public: Clinical Assessment, Advice and Referral,
and a Health Information Service.


4.3.1     Clinical Assessment, Advice and Referral Service

Callers have the opportunity to talk directly to highly qualified and experienced Nurse
Advisors, working in one of three Contact Centres, in the North, West and East of Scotland.
Nurses can arrange for callers to be seen by a doctor at a primary care emergency centre,
hospital or, if it is appropriate, in their own home. Our nurses may also be able to provide
advice which will help callers to look after themselves at home, when appropriate, without
having to refer them to anyone else.


4.3.2     Health Information Service

The Health Information Service is designed to provide the public with general information
across a broad range of healthcare issues. It offers callers a single point of contact to Health
Information Advisors (HIA) for obtaining information about specific diseases and conditions
as well as services; voluntary and social care organisations; and general health resources
across Scotland.

The NHS 24 Health Information Service has been growing with the migration of telephone
helplines including:

•     the NHS Helpline, sponsored by the SEHD Health Planning and Quality Division;
•     the Organ Retention Helpline;
•     the Healthy Living Helpline;
•     the Breathing Space service;
•     special Health Alert Helplines which are provided on behalf of SEHD and NHS Boards as
      required.


4.4     Assessment of NHS 24’s Current Financial Position and Cost Structure

NHS 24’s Revenue Resource Limit for 2004/05 has been notified by SEHD as being
£48,586k. There was an additional allocation of revenue funding in respect of the increase in
Employers’ Superannuation contributions of £513k and a carry-forward under-spend from
2003/04 of £1,183k.

This gives a revised Revenue Resource Limit for 2004/05 of £50,282k.

NHS 24’s Capital Resource Limit for 2004/05 has been set at £2,464k.




Page 10                                                         NHS 24 Knowledge Management System
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4.5   Assessment of the Resources and Their Current Utilisation in Service Provision

NHS 24 presently receives over 70,000 calls per month from eight NHS Board areas and the
vast majority of these generate a need for frontline staff to use knowledge systems. The
amount of information that is required is extensive. As the roll-out of the service is achieved,
the breadth and depth of required information increases.

There are a number of frontline knowledge systems in use within NHS 24. These include
HIS, Knowledge Web and Helpline Directory. The latter two systems were implemented as
temporary solutions to fulfil specific gaps which HIS could not address.

Access and usability of these systems is cumbersome and inefficient for frontline staff, and
could not be considered fit for a contact centre purpose. Although these systems exist,
frontline staff often consider it easier to create their own hardcopy information resources or
retain the information in their heads. The quality and currency of this information can not be
assured.

Additionally, as data is duplicated across three systems the Knowledge Management Team
who are responsible for maintaining the information, is faced with many challenges in
ensuring the information is accurate and up-to-date.


4.6   Assessment of the Current Service Performance Relative to NHS 24’s
      Requirements

NHS 24’s Five-Year Plan and Clinical Governance Strategy outline that a clinically safe,
quality service is at the core of NHS 24’s objectives. The Five-Year Plan also states that
NHS 24’s Information Technology should be maintained and be at the leading edge. None of
the systems outlined in Section 4.5 support these requirements. Both individually or as a
whole, current knowledge systems can not effectively address the needs of frontline staff,
and they have not been considered suitable for the business needs of NHS 24 since the
launch of the service.


4.7   Overview of NHS 24’s Knowledge Management Strategic Approach

The knowledge management strategy for NHS 24 is to identify, where practical, local content
providers who ‘own’ and have responsibility for updating and maintaining information, and
form strategic relationships with these organisations to establish access to the content. NHS
24 does not wish to duplicate effort by bringing the update and maintenance of resources in-
house and contribute to the ‘cottage industry’ when other organisations are already
undertaking this work. NHS 24 aims to advocate the principle of ‘produce once, use many
times’. This approach requires flexible and robust information systems to support this. NHS
24 is unable to support this strategy with its existing knowledge systems.




Page 11                                                         NHS 24 Knowledge Management System
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4.8   Assessment of any Changes in the Pattern of Services Needed to Meet the
      Board’s Requirements and Future Demand

NHS 24 is facing a number of challenging priorities as outlined in Section 4.2. To address
these requirements, the use and maintenance of the existing information systems that
support knowledge management are not sustainable - an effective Knowledge Management
System is paramount.

The Knowledge Management System Project will render HIS, Knowledge Web and Helpline
Directory obsolete. However, it is recognised that an IT implementation alone will not
provide the solution. There will also need to be a change in the working practices of frontline
staff where the creation of hardcopy resources and the retention of information in the heads
of staff are not considered appropriate. In order to encourage changes in behaviour, a
robust and easy-to-use Knowledge Management System must be implemented.

There is no impact on the Property Strategy through this Project.


4.9   Description of     the   Trust’s   Strategy    for   Meeting     the    Board’s      Service
      Requirements

Not applicable.


4.10 Justification of the Assessment of Future Services and Functions Required by
     Reference to NHS 24’s Requirements, Projected Catchment Population, Changes
     in Medical Technology, and Other Factors Influencing the Demand for Services

When the full national roll-out of the service is achieved, demand for the NHS 24 service is
estimated at 150,000 calls per month with approximately 1.6 million calls annually. The
infrastructure of NHS 24 also supports the delivery of further Helplines as required, which
align with SEHD’s health area priorities. The existing knowledge systems are not considered
fit for purpose and as such require replacement in order to be able to best respond to both
present and future demand.




Page 12                                                         NHS 24 Knowledge Management System
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5 Service Specification

5.1     Description of the Services Covered in the Proposed Project

The scope of services delivered via the NHS 24 KMS Project is outlined in Section 3.3.

Additionally, the following information resources are within the scope of services to be
delivered via the Project:

•     locations of care – facilities to which patients can be directed to receive care/information.
      These include Accident & Emergency (A&E) units, GP practices and pharmacies, and are
      generally physical locations that offer a specific range of services at specific times.
      Information required includes maps and directions to these facilities;
•     clinical processes and local details for accessing care – guidelines on how services are
      delivered in specific areas of the country and the way in which NHS 24 interfaces with
      these services;
•     voluntary organisations and support groups – local and national organisations which offer
      a variety of health related support services to the public;
•     information on diseases and conditions – public-focused information on medical
      conditions and treatments that may be affecting a caller personally, a family member or a
      carer;
•     information on health improvement topics such as giving up smoking, healthy eating,
      physical activity, etc;
•     information on health benefits and health related rights and responsibilities – this includes
      information such as how people can follow the complaints procedure and understand
      what services they are entitled to expect from NHSScotland;
•     health alerts – information on current health alerts that have been circulated by sources
      such as the Scottish Executive Health Department, Food Standards Agency, and Scottish
      Centre for Infection and Environmental Health. These can cover information on food
      safety, drug alerts, immunisation programmes, adverse incidents, bio-terrorism and
      topics raised by the media;
•     leaflets – hardcopy health information resources, generally published by NHS Boards,
      Government bodies and voluntary organisations. Leaflets are stored at each Contact
      Centre and sent by frontline staff to callers for further reading;
•     training and continuing professional development resources – resources to assist
      frontline staff in the delivery of a continuously improved service;
•     communications material – internal communications published to ensure frontline staff
      are up-to-date and armed with consistent knowledge across the three Contact Centres.




Page 13                                                            NHS 24 Knowledge Management System
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5.2     Summary of the Output Specification for the Project

An Architecture and Design exercise conducted by NHS 24 has developed comprehensive
specifications for the NHS 24 KMS Project across the aspects of business, information,
information systems, technology infrastructure, security, governance and design for use. A
summary of the documented Project specifications is as follows:

•     business;
          o specification of business services to support the following business activities;
                      identify need for information;
                      write/source information;
                      publish information;
                      manage information access and personalisation;
                      channel delivery;
                      assess effectiveness;
          o development of business processes, including;
                      provision of information in response to a health information enquiry;
                      searching for Locations of Care and local service delivery information;
                      fulfilment of leaflet requests;
                      content production and maintenance;
                      publication of and access to Health Alerts;
                      publication of and access to Special Helpline information;
•     information;
          o definition of required content;
          o metadata recommendations;
                      an important information aspect is the metadata, often described as
                      information about information. The metadata provides an intelligent layer
                      above the content that IT systems use to manage and integrate content
                      from multiple sources. The system’s users will use the metadata to assist
                      in search and navigation of the content;
•     information systems (IS);
          o development of IS services required to support the business services and
              processes identified;
          o arrangement of these IS services into a logical architecture;
•     technology infrastructure (TI);
          o definition of all TI components required to support the proposed IS services and
              architecture;
•     security;
          o security requirements and recommendations developed in accordance with
              Caldicott, BS7799 and the eGovernment Security Framework regulations;
•     governance;
          o governance requirements have been specified across the following areas; patient
              confidentiality legislation, non-discriminatory legislation, accessibility standards,
              NHSScotland and NHS 24 standards and guidelines, business continuity, data
              disaster recovery, service levels and quality;
•     design for use;
          o detailed design for use requirements pertaining to the user experience of NHS 24
              Contact Centre staff;
          o detailed design for use requirements pertaining to the user experience of content
              managers who will use the system to create, publish and maintain content.

The specifications as outlined above will be used during procurement to evaluate prospective
vendors.




Page 14                                                            NHS 24 Knowledge Management System
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6 Project Objectives and Scope

6.1     Description of Project Objectives and Their Link to NHS 24’s Strategy and
        Overall Business Objectives

The objectives of the Knowledge Management System include:

•     support the efficient delivery of the NHS 24 Nurse Assessment and Health Information
      service, through the provision of timely and reliable access to quality health information
      resources required in service delivery, including:
          o Locations of Care;
          o processes;
          o voluntary organisations;
          o information on diseases and conditions, health improvement topics, etc;
          o health alerts;
          o leaflets;
          o training and continuing professional development resources;
          o communications material;
•     reduce the risk of providing inaccurate information to patients/callers;
•     make the job of NHS 24’s frontline staff easier and more efficient by working with leading-
      edge technology5;
•     assist in embedding a knowledge management culture in NHS 24 through the support of
      technology;
•     support both a distributed and centralised approach, as required, to information
      management;
•     create a scalable and flexible platform for future growth, including the ability to form the
      foundation of the eHealth Information for Patients Gateway.

These objectives are directly linked to NHS 24’s overall business objectives of delivering a
clinically safe, quality service, as outlined in the Five-Year Plan. They are also aligned with
NHS 24’s Values of Customer/Patient Focus, Continuous Improvement and Partnership, as
well as support NHS 24’s desired knowledge management strategic approach.




5
  Improving the use of information and communication technology in the health service was a key
issue identified in the Wanless Report for improving quality and productivity; Wanless, Derek. (2002)
“Securing Our Future Health: Taking a Long-Term View”




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6.2     Description of the Desired Benefits and Why These Cannot Be Delivered Under
        the Current Configuration of the Estate

The desired benefits (as outlined in Section 3.1.2), and objectives of the NHS 24 KMS
Project cannot be delivered by existing NHS 24 infrastructure for the following reasons:

•     there is no central content repository from which required information can be sourced;
•     current knowledge systems do not provide the following content management
      capabilities;
          o remote content management and publication;
          o workflows to support content management processes;
          o application and maintenance of metadata;
•     there is limited integration between knowledge systems and core frontline applications;
•     there is no ability to support the development and maintenance of presentation templates
      in order to support the delivery of information in a consistent manner;
•     there is a lack of design for use consideration in current systems;
•     crude security and user management capability exists;
•     current knowledge systems are inflexible and cannot meet NHS 24’s growing information
      needs.


6.3     Identification of Any Constraints on the Means of Achieving the Objectives of the
        Investment

The following constraint will need to be managed in order to deliver the objectives of the NHS
24 KMS Project:

•     the level of interoperability and flexibility of current NHS 24 frontline applications may
      constrain the degree to which seamless interaction with the proposed NHS 24 KMS can
      be achieved.




Page 16                                                          NHS 24 Knowledge Management System
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7 Options Considered
An appraisal of a range of options has been considered and evaluated following the
guidance in the Scottish Capital Investment Manual (SCIM), considering costs, benefits and
risks.


7.1     Description of the Long-List of Options for Meeting the Project Objectives

There are three long-list options:

•     option 1: do nothing;
•     option 2: a Knowledge Management System;
          o option 2A: develop a bespoke Knowledge Management System through in-house
             development;
          o option 2B: procure a Knowledge Management System through the OJEU
             procurement process.


7.1.1     Option 1 - Do Nothing

This option involves doing nothing/continuing with the use of existing systems.


7.1.2     Option 2 – A Knowledge Management System


7.1.2.1 Option 2A - Develop a bespoke Knowledge Management System through in-house
        development

This option involves obtaining a bespoke solution through in-house development.


7.1.2.2 Option 2B - Procure a Knowledge Management System through the OJEU
        procurement process

This option involves undertaking a procurement process to select a Knowledge Management
System solution.




Page 17                                                        NHS 24 Knowledge Management System
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7.2     Reasons for Early Rejection of Options

The following options have been rejected:

•     option 1: do nothing;
•     option 2A: develop a bespoke Knowledge Management System through in-house
      development.


7.2.1     Option 1

By doing nothing/continuing with the use of existing systems, the resolution of NHS 24’s
fundamental knowledge management needs will not be addressed. The ability to deliver
current services and develop quality services into the future becomes compromised, and the
clinical risk of providing inaccurate information remains high.


7.2.2     Option 2A

Technology is not the core business of NHS 24. To divert focus to technology would impact
the day-to-day operation of the business. This option is not aligned with the NHS 24 IT
Strategy.


7.3     Description of the Short-Listed Option

The short-listed option is Option 2B, Procure a Knowledge Management System.

This is the only effective option to reduce the risks, provide a clinically safe virtual service
and deliver the benefits and objectives outlined in Sections 3 and 6. Additionally, this option
adheres to the design principles specified in the NHS 24 IT Strategy.




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8 Exploration of PPP/PFI
PPP/PFI is not considered applicable for the following reasons:

•   the Project is not being funded through financial savings that NHS 24 is going to make;
•   the Project’s primary aim is to reduce clinical risk which does not result in cost savings;
•   the size of the Project is too small to attract a commercial investor;
•   transferring the risks associated with the NHS 24 KMS is not a practical option for the
    private sector.




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9 Appraisal Process

9.1   Benefits Appraisal

The benefits associated with Option 2B, the procurement of an NHS 24 KMS, are outlined in
Section 3.1.2.

These benefits are qualitative and difficult to quantify. Consequently they have been
analysed according to measurability, impact of benefit and likelihood of benefit.

           Benefit                        Measurability                 Impact           Likelihood
Reduction in the risk of •            age of content stored on       High               High
providing inaccurate or out-          KMS;
of-date information          •        feedback from patients;
                             •        feedback from Contact
                                      Centre staff.
Flexibility in the addition of •      number       of    changes     High               High
new        content      and/or        processed per specified
functionality                         period;
                               •      Knowledge Team staff
                                      effort      required     to
                                      maintain KMS.
Reduction in manual effort •          Knowledge Team staff           High               High
through automation                    effort      required     to
                                      maintain KMS.
Improved          operational     •   call times;                    High               High
efficiency through a single       •   feedback from Contact
point of access                       Centre staff.
Elimination    of   personal      •   feedback from Contact          High               Moderate6
information resources used            Centre staff and Team
by Contact Centre staff               Leaders.
Improved NHS 24 response          •   time to publish and            Moderate           Moderate7
to new information services           disseminate            new
                                      information;
                                  •   Knowledge Team staff
                                      effort required to support
                                      promotion       of     new
                                      information.
                                      Table 2 – Benefits Appraisal




6
  Deemed moderate as it will take time for staff to alter their mode of working and gain confidence in
new knowledge systems.
7
  Deemed moderate as there are other factors (that are outwith the scope of the NHS 24 KMS) that
determine NHS 24’s ability to respond quickly to requests for new information services.


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 9.2     Financial Appraisal


 9.2.1     Investment Required

 The financial investment required across five project years is estimated at £1.1m.

 The financial investment can be split into a number of cost areas, which are further described
 in Section 9.2.2. The division of costs is shown in Table 2 below.

Cost Grouping               Yr 1 - £k    Yr 2 - £k     Yr 3 - £k     Yr 4 - £k     Yr 5 - £k     Total - £k
Programme - Revenue                31            0             0             0             0             31
Technology - Revenue             642             0             0             0             0           642
Technology - Capital             112             0             0             0             0           112
Content – Revenue                  21            0             0             0             0             21
Running – Revenue                  15           59            62            65            68           269
Contingency @ 5%                   41            3             3             3             3             53
Totals                           862            62            65            68            71         1,128
                            Table 3 - Five Year Building and Operating Costs


 9.2.1.1 Considerations

 The following points relating to the financial investment should be considered:

 •     no income is expected to be generated by the Project;
 •     the Business Case covers a five-year time period and includes technology, content
       migration, programme and operating costs;
 •     years on the Business Case represent project years;
 •     the Business Case is inclusive of VAT on external resources and technology products
       only;
 •     development costs and/or technology replacement costs have not been included in Years
       3 through 5. This is because NHS 24 is unable to predict these needs or costs at this
       stage;
 •     note that the Knowledge Management System costs are also included in the eHealth
       Information for Patients Initial Agreement and Business Case as the KMS is a foundation
       part of that project. Proceeding with the KMS, may decrease the overall cost of the
       eHealth Single Gateway Business Case.


 9.2.2     Key Cost Areas

 Costs associated with the creation and ongoing maintenance/support of the Knowledge
 Management System have been identified in four key areas:

 •     programme;
 •     technology;
 •     content;
 •     running costs.




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9.2.2.1 Programme Cost Area

The Programme costs cover the roles outlined in Table 4 below.

Programme
Programme Co-ordination
Supplier Manager
Quality Assurance/Configuration Management
Architect
User Acceptance Testing
System Admin Contractor
                            Table 4 – Programme Cost Breakdown


9.2.2.2 Technology Cost Area

The Technology cost area comprises the cost of infrastructure and applications; and build
costs.

Technology Infrastructure and Applications
Portal and CMS Product
Minor Product Purchase Allowance
Base Deployment Infrastructure
Portal Hardware (Deployment)
Environments (Test, Training and Development)
Programmer and Analyst Workstations
Technology Build
Design for Use
Design Consultancy
Build
Implementation
Application Integration - Design/Test
Transition
Infrastructure Set-up and Maintenance
Initial NHS 24 Staff Training
Database Analysis and Design and Build
Process Design
Requirements Analysis
Project Management
                            Table 5 – Technology Cost Breakdown




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9.2.2.3 Content Cost Area

The Content cost area comprises the cost of migrating content from existing systems into the
KMS. Migration costs cover the cost of adding metadata. (Costs for actual content are not
included in this Business Case as the content already exists in present NHS 24 systems.)

Content
Locations of Care Initial Migration and Cleanse and Merge
Migration of Contact Centre Content (Technology and Content)
Health Alerts
Project Management
                                Table 6 – Content Cost Breakdown


9.2.2.4 Running Cost Area

The running costs incorporate the day-to-day technology costs for running the KMS.

Running Costs
Maintenance of Portal and CMS Product
Base Deployment Infrastructure
Portal Hardware (Deployment)
Environments (Test, Training and Development)
Environment Maintenance and Management
                                Table 7 – Running Cost Breakdown


9.2.2.5 Risk Mitigation

It was determined appropriate to allocate a financial allowance to cover risk. This is covered
as ‘Contingency’ and 5% has been included in the total cost.


9.2.3     Identification and Assessment of Capital and Revenue Costs Associated with
          Short-Listed Options

Capital costs, based on hardware costs, for the Knowledge Management System are
estimated at £112k.

Revenue Costs are estimated at £1,016k.


9.2.4     Statement of How Much the Board is prepared to Spend on the Services to be
          Covered by the Proposed Project

In 2004/05 £112k of capital resource is available for this Project out of the annual budget.

Revenue costs in Year 1 of £750k are included in the current, agreed Revenue Resource
Limit for 2004/05. Subsequent operating costs will be included in the internal allocation of
each year’s Revenue Resource Limit.




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9.2.5     Revenue Implications of the Preferred Option

See Section 9.2.4.


9.2.6     Impact on the Board’s Balance Sheet, Cash Flow Position and Operating Cost
          Statement

The cash flow impact of the Project (including VAT) is shown in Section 9.2.1.

Capital costs will be capitalised and depreciated over 5 years (in line with NHS 24’s
accounting policy for depreciation) at an annual charge of £22k. Revenue costs are
expensed to the Operating Cost Statement as incurred.


9.2.7     Key Assumptions Underlying the Financial Appraisal

See Section 9.2.8 for a list of Key Assumptions.




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9.2.8     Sensitivity Analysis on the Key Assumptions Underlying the Financial
          Appraisal

The assumptions underpinning the financial appraisal for Option 2B have been subjected to
a Sensitivity Analysis.

                  Key Assumptions                              Estimated     Sensitivity            Value
                                                              Susceptible       (+/-)                 £k
                                                                 Value                               (inc
                                                              £k (inc VAT)                          VAT)
Programme effort has been costed at the NHS 24                           318   10%                        3
rate.
External resources have been costed at a blended                          4559         10%              45
consultant/contractor market rate of £940 per day.
NHS 24 IT resources have been costed at the                              33110         2%                 7
relevant NHSS rate of £160 per day.
Annual product maintenance has been costed at                            10611         2%                 2
15% (over 4 years).

Annual hardware maintenance has been costed at                             6512        2%                 1
20% (over 4 years).

Product costs have been assumed for 500 users.                           17613         10%              18
6 servers have been costed at £1500 per server                            1114          5%               1
(exc VAT).
Year 1 training costs are absorbed by NHS 24.                              5015        10%                5
Migration effort has been estimated at                                     4916         5%                2
approximately 0.1 days per page, or 500 records
(assuming automation) per day for structured data.
Data Disaster Recovery (DDR) will be absorbed by                           1117        5%                 1
NHS 24.
                  TOTAL – Worst Case Scenario                                       +/- 7%18            85
           Table 8 – Sensitivity Analysis on Key Assumptions Underlying the Financial Appraisal




8
  Total value of Programme Costs.
9
  Total value of external resource effort throughout the project. This cost is included in the following
Cost Groupings: Technology – Revenue and Content – Revenue.
10
   Total value of NHS 24 resource effort throughout the project. £220k of the £331k referenced is
absorbed by NHS 24 and has not been included in the business case.
11
   Total cost of product maintenance over 4 years, beginning Year 2. This cost is included in the
Technology Run cost grouping.
12
   Total cost of hardware maintenance over 4 years, beginning Year 2. This cost is included in the
Technology Run cost grouping.
13
   Total cost of product. This cost is included in the Technology Build – Revenue cost grouping.
14
   Total cost of servers. This cost is included in the Technology Build – Capital cost grouping.
15
   Year 1 training costs which are absorbed by NHS 24 and not included in the business case.
16
   Total value of content creation / migration cost. £28k of the 49k is absorbed by NHS 24 and not
included in the business case.
17
   Total cost of production servers which would reflect the cost of DDR servers.
18
   +/- 7% reflects the worst case with regard to the sensitivity of assumptions made, consequently 5%
is deemed to provide a sufficient cost contingency.


Page 25                                                                NHS 24 Knowledge Management System
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 9.2.9     Explanation of How the Cost of Risk Has Been Factored Into the Financial
           Appraisal

 A 5% cost of risk has been assigned to this Project.


 9.2.10 Explanation of Whether there is Flexibility to Fund Any Additional Revenue
        Requirements and Likely Source of Funding

 Any additional revenue requirements will be funded from the Revenue Resource Limit as a
 business necessity.


 9.2.11 Evidence of the Board’s Involvement in the Development of the Project

 The NHS 24 Board has been involved at every step throughout the development of the
 Project. The commitment to the Project is also included within the NHS 24 Five-Year Plan.


 9.3     Economic Appraisal

 9.3.1     Presentation of Capital and Revenue Costs, Excluding VAT

Cost Grouping                Yr 1 - £k    Yr 2 - £k    Yr 3 - £k        Yr 4 - £k     Yr 5 - £k     Total - £k
Programme - Revenue                 31            0            0                0             0             31
Technology - Revenue              546             0            0                0             0           546
Technology - Capital                96            0            0                0             0             96
Content – Revenue                   17            0            0                0             0             17
Running – Revenue                   15           53           56               59            62           245
Contingency @ 5%                    35            3            3                3             3             47
Totals                            740            56           59               62            65           982
                     Table 9 – Five Year Building and Operating Costs, excluding VAT


 9.3.1.1 Considerations

 The following points should be considered when reviewing the VAT exclusive capital and
 revenue costs in the above table:

 •     the Financial Appraisal (Section 9.2.1) only includes VAT on external resources and
       technology products. Consequently, not all line items in the financial appraisal will be, as
       a ratio, exactly 1.175 greater than the corresponding line items in the above table.


 9.3.2     Identification and High-Level Assessment                of     Risks     and     Uncertainties
           Associated with Short-Listed Options

 See Section 9.4.




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 9.3.3     Key Assumptions Underlying the Assessment of Costs, Benefits and Risks,
           and the Results of Sensitivity Analyses Undertaken

 9.3.3.1 Key Assumptions Underlying Costs

 See Section 9.2.8.

 9.3.3.2 Key Assumptions Underlying Benefits

 The following assumptions have been made with regard to the non-financial benefits
 identified in Section 3.1.2.

 •   the proposed KMS will support the identification of out-of-date content and automated
     processes that notify content owners when content requires updating;
 •   the proposed KMS will be sufficiently flexible in that new types of content can be easily
     incorporated with minimal system modification;
 •   the proposed KMS will automate tasks where possible, specifically with regard to the
     ability to automatically upload Locations of Care data;
 •   the proposed KMS will provide a single point of access to required information;
 •   the proposed KMS will replace ALL knowledge systems, i.e. there will be a single NHS 24
     KMS;
 •   NHS 24 staff will use the NHS 24 KMS to source all required information and will not rely
     on personal information sources.

 9.3.3.3 Key Assumptions Underlying Risks

 The following assumptions have been made with regard to the risks identified in Section 9.4:

 •   integration between current NHS 24’s frontline applications and the proposed NHS 24
     KMS can be supported without modification of the core frontline applications;
 •   integration between current NHS 24’s frontline applications and the proposed NHS 24
     KMS will be carried out by NHS 24 resources;
 •   the selected NHS 24 KMS solution will provide a suitable foundation upon which NHS 24
     Online can be developed.

 9.3.3.4 Sensitivity Analyses

 See Sections 9.2.8 and 9.4.4.

 .
 9.3.4     Results of the Appraisals of the Short-Listed Options in Net Present Values

Cost Grouping              Yr 1 - £k    Yr 2 - £k    Yr 3 - £k     Yr 4 - £k        Yr 5 - £k     Total - £k
Programme - Revenue               29            0            0             0                0             29
Technology - Revenue            613             0            0             0                0           613
Technology - Capital            108             0            0             0                0           108
Content – Revenue                 19            0            0             0                0             19
Running – Revenue                 15           54           54            54               55           232
Contingency @ 5%                  39            3            3             3                4             52
Totals                          823            57           57            57               59         1,053
                                 Table 10 – Net Present Values (NPV)


 The NPV is estimated at £1,053k. Note that NPV is calculated on capital and revenue costs
 inclusive of VAT from the beginning of Year 1 at 4.5% per annum.


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9.4      Risks and Uncertainty Appraisal


9.4.1     Description of the Risks Associated with the Leading Options

Risks surrounding the Knowledge Management System include:

•     delayed decision-making regarding funding and pre-implementation timescales may lead
      to loss of momentum and continued high clinical risk for patient safety if the system is not
      implemented as soon as practicably possible. This is particularly pertinent given that the
      procurement process will take 6 months;

      Risk Type = Clinical Safety

      This risk poses no financial impact to this business case.

•     operational change is required by frontline staff. If this change is not addressed and
      effectively managed, then the success of the Knowledge Management System will be
      jeopardised;

      Risk Type = Operational

      This risk poses no financial impact to this business case.

•     to ensure frontline staff are able to seamlessly access information within the Knowledge
      Management System relevant to a caller’s needs, integration with NHS 24’s frontline
      applications is required. A logical technical design for integrating with NHS 24’s frontline
      applications has been defined; however, the implementation of this design may raise
      challenges;

      Risk Type = Implementation

      This risk has an associated financial impact of approximately £6k.

•     the Knowledge Management System can form the foundation of NHS 24 Online – ‘the
      Gateway to Health Information in Scotland19’. If the right solution is not selected with this
      in mind during the KMS procurement, this may constrain the ability to respond to the NHS
      24 strategic direction or become a ‘throw-away’ solution;

      Risk Type = Procurement

      This risk has an associated financial impact of approximately £18k.


9.4.2     Estimated Cost of Risk Associated with the Leading Options

See Section 9.4.4.




19
     SEHD (2000) “Our National Health: A plan for action, a plan for change”


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9.4.3     Description of the Methodology Used to Quantify and Value Risks

Costs of risks have been calculated based on the value of the associated business case cost
and the impact that the risk will have on the relevant cost.


9.4.4     Results of the Sensitivity Analysis on the Key Assumptions Underlying the Risk
          Evaluation

              Assumptions                          Estimated        Sensitivity               Value
                                                Susceptible Value      (+/-)                    £k
                                                  £k (inc VAT)                              (inc VAT)
The selected NHS 24 KMS solution will                         17620   10%                           18
provide a suitable foundation upon
which NHS 24 Online can be
developed.
Integration between current NHS 24’s                                 221      50%                       1
frontline applications and the proposed
NHS 24 KMS can be supported without
modification of the core frontline
applications.
Integration between current NHS 24                                   922      50%                       5
frontline applications and the proposed
NHS 24 KMS will be carried out by
NHS 24 resources.
        TOTAL - Worst Case Scenario                                            2%                     24
            Table 11 – Sensitivity Analysis on Key Assumptions Underlying the Risk Appraisal




20
   Total cost of product. This is the value that would be deemed ‘throw away’ if the product were not a
suitable foundation for the proposed eHealth Information for Patients Gateway.
21
   Cost of integration if carried out by NHS 24 resources.
22
   Cost of integration if carried out by external resources.


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9.4.5     Risk Probability Analysis

                    Risk                     Probability                      Mitigation
Delayed      decision-making       regarding Medium                 A commitment from SEHD on
funding       and       pre-implementation                          timescales will be sought and
timescales may lead to loss of                                      robust       pre-implementation
momentum and continued high clinical                                planning and management will
risk for patient safety if the system is not                        occur.
implemented as soon as practicably
possible. This is particularly pertinent
given that the procurement process will
take 6 months.
Operational change is required by Low                               A change management stream
frontline staff. If this change is not                              will continue to focus on
addressed and effectively managed, then                             addressing       operational     and
the     success     of     the   Knowledge                          behavioural changes, which need
Management System will be jeopardised.                              to occur for the successful
                                                                    implementation and operation of
                                                                    the Knowledge Management
                                                                    System.
To ensure frontline staff are able to Medium                        This is difficult to mitigate at this
seamlessly access information within the                            stage, however, the integration
Knowledge        Management        System                           method has been designed so
relevant to a caller’s needs, integration                           that no development work is
with PRM is required. This will most                                required to be performed by
likely involve a frontline staff member                             partner organisations.
having to type in the Call ID from PRM in
order to activate a query in the KMS. A
logical technical design for integrating
with PRM has been defined, however,
implementation of this may raise
challenges.
The Knowledge Management System Low                                 The evaluation process in
can form the foundation of NHS 24                                   procurement         will     include
Online – ‘the Gateway to Health                                     weighted criteria to ensure that
Information in Scotland23’. If the right                            flexibility and strategic capability
solution is not selected with this in mind                          is     a      key    consideration.
during the KMS procurement, this may                                Additionally an Architecture &
constrain the ability to respond to the                             Design         exercise,       which
NHS 24 strategic direction or become a                              addressed both NHS 24 KMS
‘throw-away’ solution.                                              and NHS 24 Online objectives,
                                                                    has identified detailed and
                                                                    comprehensive          requirements
                                                                    which will be used to evaluate
                                                                    vendors during procurement.
                                    Table 12 – Risk Probability Analysis


9.4.6     Risk Mitigation

See Section 9.4.5.



23
     SEHD (2000) “Our National Health: A plan for action, a plan for change”


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10 Preferred Option

10.1 Description of the Preferred Option

Option 2B, the Procurement of a Knowledge Management System, will deliver the following:

•   a central content repository of information;
•   comprehensive and robust content management capabilities;
    o workflows to support content management processes;
    o remote content management and publication;
    o application and control of metadata;
    o development and maintenance of templates;
•   a Knowledge Management System which will support the Clinical Assessment, Advice
    and Referral, and Health Information Service offered by NHS 24;
•   provision of information resources that include;
    o Locations of Care;
    o clinical processes;
    o voluntary organisations;
    o leaflets;
    o information on diseases and conditions;
    o general health information;
    o health related rights and responsibilities;
    o training and continued professional development resources;
•   communication and collaboration tools, including support for Health Alerts and general
    NHS 24 communications;
•   integration with NHS 24 frontline applications to support seamless user interaction;
•   business processes to support the following;
    o efficient information searches
    o controlled content management
    o quality assured content
•   a supported commercial application;
•   alignment with the NHS 24 IT Strategy;
•   a flexible, scalable platform that will meet NHS 24’s growing information needs and form
    the foundation of the proposed eHealth Information for Patients Gateway.


10.2 Key Factors Responsible for Superiority

Option 2B is the only option to reduce clinical risks, provide a clinically safe virtual service,
provide the required capabilities, including alignment with the IT Strategy, and deliver the
benefits outlined in Section 3.1.2.




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11 Risk Transfer (Potential PPP/PFI Projects Only)
Not applicable.




Page 32                                      NHS 24 Knowledge Management System
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12 PPP/PFI and Legal Issues
Not applicable.




Page 33                       NHS 24 Knowledge Management System
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13 Personnel Issues

13.1 Present Staffing

The NHS 24 Knowledge Team presently collects and manages the information resources
required by frontline staff.


13.2 Future Requirements

Following implementation of the Knowledge Management System, no new NHS 24
personnel for maintaining the KMS are anticipated at this stage. Additionally, despite the
operational efficiencies that the proposed NHS 24 KMS will introduce, there will be no need
to reduce the size of the Knowledge Team as this team will then be able to focus on
supporting NHS 24’s knowledge management related business and strategic objectives
which are not presently being addressed.


13.3 Policy on Openness – Consultation and Involvement

NHS 24 strives to be an attractive employer, committed to incorporating leading employment
and people management practices, such as the Partner Information Network (PIN)
Guidelines into action. In line with the rest of NHSScotland, NHS 24 has a people
Governance Committee, which makes sure that staff are treated fairly in the organisation,
dealing with topics such as remuneration, conditions of employment and policies.


13.4 TUPE

Not applicable.




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14 Timetable for Option 2B

14.1 Summary of the Project Plan from Development of the Outline Business Case to
     Completion of the Project, Including Key Milestones

Key Milestones of the NHS 24 KMS Project are outlined below

Pre-Implementation Pre-Implementation Pre-Implementation       Project Year 1              Project Year 1        Project Year 1          Project Year 1
   Months 1-3         Months 4-6          Months 7-9            Months 1-3                  Months 4-6             Months 7-9                10-12




A&D*
A&D*   NOW


Business Case
Business Case          BC
                        BC
  Approval
  Approval           Approval
                      Approval




 Detailed Implementation Planning
 Detailed Implementation Planning



                                                           Vendor(s)
                           OJEU Procurement
                           OJEU Procurement                 Vendor(s)
                                                           Selected
                                                            Selected




                                                                          Initial Build
                                                                           Initial Build                      Go Live
                                                                                                               Go Live



                                                                                                              Develop Extra Content and Functionality
                                                                                                              Develop Extra Content and Functionality




                                                            Figure 1 – Key Milestones


* A&D refers to Architecture and Design, this phase is completed.


14.2 Pre-Implementation

An Architecture and Design Scheme for the Knowledge Management System has been
developed by NHS 24. This will be used to evaluate vendor solutions in procurement.
Detailed implementation planning is underway and communications/change management will
take place both prior to and during implementation.




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14.3 Implementation Overview

The Knowledge Management System will take a phased approach and address the following
aspects. This is a draft plan and will be validated with the Systems Integrator, to enable the
delivery of quick wins where possible.

          Phase 1                       Phase 2                                                            Phase 3
KMS Framework Build – Processes                                                                 Leaflets and ordering
underlying infrastructure to
support the KMS
Locations of Care            Searching      on     external                                     Communications material
                             websites, including health
                             improvement, diseases and
                             conditions,    benefits     and
                             rights and responsibilities
Voluntary Organisations      Enquiry Support Resources                                          Training resources
Health Alerts                Healthy Living material                                            Bulletin Boards/Forums

Integration     with    PRM,                        Migration of remaining NHS Forms      and    feedback
including distance calculation                      Helpline and Knowledge channels
and tagging                                         Web content
Reporting Phase 1                                   Reporting Phase 2          Reporting Phase 3
                                          Table 13 – NHS 24 KMS Implementation Phases


Future phases will likely include exploiting the functionality a portal product can offer. These
phases will be treated as new projects and channelled through the existing NHS 24
programme of work. Approval of the Business Case for the eHealth Information for Patients
Programme, will also allow the KMS to be further developed to form the eHealth Gateway.

A draft implementation plan is outlined below (post-procurement); however this will need to
be validated with solution providers during the procurement phase.

     Project Yr 1, Months 1-3             Project Yr 1, Months 4-6   Project Yr 1, Months 7-9          Project Yr 1, Months 10-12




                          KMS Framework
                          KMS Framework
                                                                                      NHS 24 KMS Project
                                                                                 Implementation Overview
                                Phase 1
                                Phase 1




                                                                            Phase 2
                                                                            Phase 2




                                                                                                             Phase 3
                                                                                                             Phase 3




                                             Figure 2 – High-Level Implementation Plan



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15 Project Management

15.1 Description of how it is Intended to Manage the Various Phases of the Project

This section outlines the Project Management considerations for Option 2B, procurement of
a Knowledge Management System.

The principle responsibility for the management of the Project will rest with NHS 24, with
appropriate input from partner organisations. An implementation and evaluation plan will be
developed during the Detailed Implementation Planning Phase which is currently underway.

The initial 12 months of the NHS 24 KMS Project are the focus of a period of intensive work,
with a number of sub-projects being undertaken simultaneously. An experienced Project
Management team will be put in place to ensure compliance to timescales and common
standards. An NHS 24 Health Information Manager and IT Project Manager will lead the
Project and will also be responsible for overseeing the Project Managers of each sub-project.

This Project, as per the NHS 24 IT Strategy, will adhere to the PRINCE 2 project
management standard.




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16 Conclusion
This Business Case sets out the recommendation of NHS 24, fully supported by the NHS 24
Board, that Option 2B, the procurement of a Knowledge Management System, should be
pursued.




BILL TEMPLETON
ACTING CHIEF EXECUTIVE, NHS 24




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17 Appendices

17.1 Procurement Process

Outlined below is the main part of the draft advert for the KMS which is intended to be placed
in the Official Journal of the European Union – the details on responding have still to be
added. The Business Advisory Group, NHS National Services Scotland is providing advice
on the format of the address to ensure compliance with OJEU regulations. The advert
includes mention of a potential further phase to the Project – the eHealth Gateway. The
Business Case for that has not yet been approved. However, it has been included to provide
a significant incentive for Suppliers, potentially resulting in best value for money for
NHSScotland. The contract will contain a clause that reserves the right to not proceed with
that phase if necessary.


17.1.1 Draft Advert for OJEU

NHS 24 is a Special Health Board within the NHS in Scotland. NHS 24 operates two core
telephone services for the public: Nurse Assessment and Advice, and a Health Information
Service. The Health Information Service is designed to provide the public with general
information across a broad range of healthcare issues. It offers callers information about
specific diseases and conditions as well as voluntary and social care organisations and
general health resources across Scotland.

The delivery of these services necessitates access by the frontline staff to accurate and
timely information that is relevant to a specific user’s/caller’s circumstances and needs. NHS
24 has developed an architecture and design scheme for a new Knowledge Management
System to address these and other knowledge needs. This design covers four main
architecture aspects:

•   business;
•   information, with robust metadata/taxonomies as a key aspect;
•   information systems;
•   technical infrastructure.

Security and Governance requirements have also been defined and ‘Design for Use’ is a key
aspect in the design to ensure users’ information and accessibility needs are met.

NHS 24 wishes to partner with a systems integrator who will deliver and implement a solution
for this architecture and design. It is required that this solution addresses the functional
areas of; knowledge management, content management and portal functionality that enables
both intranet and extranet access. In addition to the functional areas specified the solution
must address interoperability with applications and/or external data sources. The systems
integrator should provide options for infrastructure management (i.e., both internal NHS 24
hosting, and managed services).

Potential Future Phases

NHS 24 has also developed the requirements for an Online Gateway to quality assured
health information and tools for the public. The Knowledge Management System is seen as
forming the foundation of this Gateway. Objectives of the Gateway include:

•   providing patients/public with a leading-edge online health information service;


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•   providing content that:
    • is patient-centric
    • is localised where appropriate
    • encourages self-care where applicable
    • addresses frequently requested health information
    • is quality assured;
•   co-ordinating and improving knowledge and information functions across NHSScotland;
•   creating a scalable, flexible platform of both business and technology infrastructure for
    NHSScotland that can adapt to meet changing requirements in the long term;
•   leveraging information initiatives currently underway across Scotland;
•   establishing strategic partnerships with key NHSScotland stakeholders;
•   constructing a Gateway so as to allow expansion to kiosks, iDTV and mobile channels
    when required without redevelopment;
•   integrating with clinical information systems, in particular the Electronic Care Record in
    the longer-term.




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