April 2011

QIPP Digital and Technology Vision work stream – Phase 2Quick Win – Online Meeting Services

V2

Commercial in Confidence

Contents

Scope & Vision Benefits Summary Stakeholders Engaged Implementation Approach

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Scope & Vision

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The Vision The Vision

• An “On Demand” web conferencing service, either locally procured or through a national framework• A budget reduction initiative (Travel & Subsistence) realised by an aggressive Change Programme to encourage the adoption of Web

Conferencing in preference to Face to Face meetings, underpinned by the “On Demand” Web Conferencing Service

The Transformation “Leap”• A culture where “On Line” meeting is default option – “why not online?”

The key business drivers are:• More efficient working, cost reductions and protection of frontline services through cost and efficiency gains that mitigate budget

constraints. • Specific reductions in CO2 emissions• Consistent service quality and user experience• Contributes directly to the QIPP agenda in having cash releasing benefits case

What is it?• Ubiquitous Web Conferencing service accessed through the desktop, as simple to use as email• No reliance on having video conferencing equipment available• A Business Change Programme, enforced T&S budget reduction enabled by a PAYG pricing model

Why’s it different?• …than voice conferencing – N3 VC available as a catalogue item but uptake has been low due to lack of clear rationale for

investment. but if VC works for a particular application, incorporate that in the change programme• Patients can be engaged in a viable alternative to F2F for “advisory” engagements

Benefits Summary

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Use Case Scenarios– specific uses of Web Conferencing internally within the NHS

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Primary Care• Peer to peer and peer groups• Patient and patient groups

Secondary Care• Programmes• Peer to peer• Training & Support

Community Care• Peer to peer• Patient

Back Office• Project management• Procurement• IT help desk• Training & Support• Pandemic Planning Use Cases

We have used approximately 30 Business Scenarios the following categories to estimate benefits

Benefits Summary

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Benefits based upon a set of candidate use cases worked in conjunction with NE SHA

Cash releasing benefit of £22m, FTE savings of 13,000 man years arising from internal use of Web Conferencing with 30% adoption of the service

Non cash releasing benefit of £7.9m per 1% adoption, arising from patient – clinician efficiencies

Use of SaaS on the basis of cost effectiveness

Input parameters

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average cost/ mile £0.40

average travel time/ mile (minutes per mile) 1.50 minutes/ mile

local journey 7 miles

regional journey 25 miles

long regional journey 50 miles

national journey 100 miles

international journey 500 miles

Cost per GP appointment £27 GP costs from DH Channel Shift Data

Costs per Hospital apponitment £59 (use A&E Type 2, 3 costs from Channel Shift Data) - this is used only on the "internal costs" sheet

Number of staff in NHS 1,500,000 uptake % in NHS for internal use 30% this is the number of staff in the NHS who could use the service. 51% of NHS employees are professionally

qualified clinical staff. Assume a further 10% staff who would use Web Conf(NHS Confederation Data)

uptake across clinician - patient engagements 1% benefit will be quoted per 1% adoption rate

Static Data

Internal Meeting Use Case Inputs Triage Use Case InputsActivity or Event type patients attending the meetings

No of Activities reduction in GP appointment

Meetings/ Activity cost per GP appointment

% of meetings which are F2F reduction in hospital appointment

NHS Attendees/ meeting Cost per hospital appointment

journey type to attend meeting

average journey distance (look from input data)

meeting duration (mins)

time or efficiency saving/ meeting over F2F

activity duration (days)

time or efficiency savings/ activity

These parameters differ for each of the 30+ use cases

Benefits calculated for internal use cases

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For each use case the following benefit (savings) estimate is used• Number of Web Conf opportunities

= no. of events x no. of F2Fs per event x no. attendees

• Travel saving= travel (local or regional or national) per F2F meeting(where travel estimate is specific to the Use Case)

• Efficiency Saving= reduction in event duration due to timeliness of ad hoc meetings

• Reduction in GP/ Hospital appointments for very specific Use Cases (eg Pandemic Triage)

Internal and patient engagement benefits case summary

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The Use Cases provide a representative profile of usage, and with the scaling method employed, the NHS wide benefits are largely independent of the number of staff in the Use Cases. The Use Cases provide a pattern of usage rather than absolute figures. Absolute usage is derived from the scale up.

The external clinician - patient usage essentially realises channel shift efficiencies

no. of staff 45,622 Back Offi ce £1,687,288 Back Offi ce £0 Back Offi ce 270,903 number of uses per staff 3.25

Secondary Care £471,768 Secondary Care £0 Secondary Care 28,531

Primary Care £51,240 Primary Care £45,200 Primary Care 4,087

Community Care £2,520 Community Care £0 Community Care 21

TOTAL £2,212,816 TOTAL £45,200 TOTAL 303,543 #

Total saving per Use Case user p.a. £48.50 Total saving per Use Case user p.a. £0.99 Total saving per Use Case user p.a. 6.65

Total saving for NHS £21,826,438 Total saving for NHS £445,837 Total saving for NHS 2,994,039 #(at assumed adoption rate of) 30% (at assumed adoption rate of) 30% (at assumed adoption rate of) 30%

per 1% adoption £7.87 per 1% adoption £26.20

Total saving for NHS £79 Total saving for NHS £262(at assumed adoption rate of) 10% (at assumed adoption rate of) 10%

NHS Savings from patient - clinician engagement (£m)

(Non Cash Releasing)

Patient Savings from patient - clinician engagement (£m)

(Non Cash Releasing)

Savings from internal NHS use (£)(Cash Releasing)

summary of usage for internal use casesSavings from internal NHS use (Days)(Non Cash Releasing)

Savings from internal NHS use (£)(Non Cash Releasing)

Commentary on benefits case input parameters (Internal Use)

For each use case the following benefit (savings) estimate is used• Number of Web Conf opportunities

= no. of events x no. of F2Fs per event x no. attendees

• Travel saving= travel (local or regional or national) per F2F meeting(where travel estimate is specific to the Use Case)

• Efficiency Saving= reduction in event duration due to timeliness of ad hoc meetings

• Reduction in GP/ Hospital appointments for very specific Use Cases (eg Pandemic Triage)

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Commentary on benefits case input parameters (clinician - patient engagement)

For each “home visit” engagement between clinician and patient (defined in DH Data) benefits to NHS are:• (Cost of home visit – cost of surgery attendance) x Volume of engagements x

adoption rateo Rationale is that the clinician does not need to visit the patient, which is more expensive; there

are 54m home visits per year

For each type of “surgery or clinic visit” engagement between clinician and patient (defined in DH Data) benefits to Patient are:• (Cost of surgery attendance – cost of home visit) x Volume of engagements x

adoption rateo Rationale is that the patient does not need to attend the surgery/ clinic, which is more expensive;

there are 254m surgery/ clinic visits per year

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Stakeholders Engaged

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Who wants it – Key StakeholdersWho Role Status / Support

CIO Forum All SHA CIOs Support from the CIO Forum for a step-wise change in usage of online meeting servicesRecognise the need to address the interoperability issues of having different local solutions when trying to collaborate across localities

Dr Graham Evans NE SHA Budget allocated and would prefer to use a national procurement framework

Sam Phillips Royal Surrey County Hospital Budget allocated and would prefer to use a national procurement framework

Mike Holderness Care Quality Commission Budget allocated and would prefer to use a national procurement framework

David Johnson Yorkshire Ambulance Service Budget allocated and would prefer to use a national procurement framework

Martin Liddament Director of IT at Information Centre Budget allocated and would prefer to use a national procurement framework

Natalie Hersey Devon PCT Budget allocated and would prefer to use a national procurement framework

Sarah Overton Kent PCT Budget allocated and would prefer to use a national procurement framework

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IM& T directors were polled on if they see the value in online meeting services, and if so if they had budget and plans for implementation: Of the 49 responses, the following results were obtained:

• 32 organisations see value in online meeting services, but have no budget allocated or plans for implementation.• 7 organisations who have allocated budget/plans for implementation have indicated that they would prefer to use a national procurement framework.

Implementation

Pros and Cons National Procurement Framework

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Pros Cons

Lowest costs through volume procurement Potential change in local vendor of choice

Consistent user experience across NHS communities May require compromise in specialist local requirements

Interoperability between separate NHS collaborative communities

Potential requirement to re-engineer local processes

Cost based on demand Experience indicates lead-times of around 3 months to develop the framework

Simplified local procurement process If a locally deployed solution is already in place then local organisations are unable to realise the cost benefits due to sunk costs

Shortened local lead-time to adoption Central setup costs to develop and negotiate the framework agreement with vendors

Simplified user training for single solution

Known national infrastructure impacts

Simplified service integration

Known local infrastructure impacts

Local organisations not limited to single national solution

A single set of technical issues to manage for local ICT organisations

Decreased local resource required for procurement and service introduction

Pros and Cons of Locally Procured Service

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Pros Cons

Freedom to select local vendor of choice Unable to leverage volume procurement

Supplier can be selected based on specialist local requirements Inconsistent user experience across NHS communities

Supplier can be selected to suit local business processes No guarantee of interoperability between separate NHS collaborative communities

No delays arising from the timescales of negotiating a central framework

Minimum expenditure commitments maybe required

Option to extend local solutions leveraging existing investment Local procurement process dependency

Least central cost Increased local resource required to evaluate solutions

Least central effort

Least central risk

Where the local solution differs from that of the National Framework

The solution may not be optimised to function with national infrastructure

User training for local solution

Local SME required

Local bespoke service integration requirements

Unknown local infrastructure impacts

Multi vendor technical issues to manage for local ICT organisations

Additional local resource required for service introduction

Maximum local risk

Potential barrier to broader adoption of collaborative services.

Options for Implementation with NHS

Option Supplier selection IT Director Support*

Purchase online meeting services through a National Procurement Framework

Preferred online meeting supplier selected through a national competitive tender

59%

Purchase online meeting service locally from a local provider of choice

Local NHS organisations select their own preferred online meeting supplier, which may differ by region

19%

Option Activities required for WebConf enablement Estimated cost

Purchase online meeting services through a National Procurement Framework

• Identify key requirements for online meeting services

• Identify and review existing online meeting services frameworks to confirm fit/applicability

• Confirm pipeline of local projects • Investigate levers to scale adoption

BAU Informatics Directorate resource

Purchase online meeting service locally from a local provider of choice

• Develop Advice & Guidance Already exists