BusinessPlan2010 11

NHS Direct
Business Plan
2010/11
Contents
Section 1 Strategic Context 5
Section 2 Business Plan 10
Strategic objective 1: raise the quality and productivity of our services 11
Strategic objective 2: increase the value we create for patients, public,

the NHS and social care 15
Strategic objective 3: improve the culture of our organisation through

a strong set of values 18
Strategic objective 4: be a great place to work and an employer of choice 19
Strategic objective 5: take advantage of new opportunities and plan

effectively for the future 21
Strategic objective 6: improve our corporate effectiveness and efficiency 23
Risks 25
Section 3 Financial Plan 2010/11 26

4
Section 1:
Strategic
Context
Business Plan 2010/11

NHS Direct We’re here 5
Section 1: Strategic Context
Introduction External environment
NHS Direct’s aim is to provide people in England with expert health In developing our plan for the next 12 months and beyond we have
advice, information and reassurance to care for themselves at home considered the factors that are likely to have the greatest impact on
or to access appropriate healthcare, using world class web and future health needs and how they can be met, which will influence
telephone services. Our core health information and advice service, the specific contribution that we can make. In our plan we have
is available 24 hours a day, 365 days a year, and receives around 5 sought to balance responding to the “now” and anticipating the
million calls each year and 5 million uses of our online health and future.
symptom checkers. We also offer a range of other nationally and
locally commissioned services which account for an additional 4
millions calls. We employ around 3,400 staff, over half of which are
Demographic changes
trained nurses. Our core service is commissioned by the East of
England Strategic Health Authority (SHA) on behalf of the 10 The UK population is forecast to grow significantly over the next 15
England SHAs. years. Over this period the 65+ age group will grow from 10 million
to 14 million, and from 16% to 20% of the population.
More information about our core and locally commissioned services
is available from our website http://www.nhsdirect.nhs.uk. Older people are increasingly located in rural areas, further away
from centralised care, and in many cases from family support. One
in three of England’s population already lives with a long term
The context for this plan condition. This is expected to increase by a further 20% over the next
25 years. A large proportion of these are over the age of 60 years.
This strategic framework and business plan sets out NHS Direct’s
The population will remain ethnically and culturally diverse, and there
direction of travel for the next four years, and our detailed plan for
will continue to be significant socio-economic and health inequality.
2010/11. At the beginning of 2009, we carried out a comprehensive
review of our services, capabilities and organisation - the Strategic
We will work with our commissioners to improve our understanding
Development Programme (SDP). Input to the programme was
of how changes in the size and make-up of the population will
provided by a wide range of external partners and stakeholders as
impact on the scale and range of demand for health services,
well as our own staff. This helped us to understand how to use our
including urgent care, and develop and target our services to help
specific expertise and assets to continue to make a significant and
meet these changes.
targeted contribution to the health of the nation, and how to further
improve our performance.
Our vision describes where we want to be in four years’ time, the role
75 68m
we expect to be playing in meeting the country’s health needs as a 62m 64m
20% 65+
partner to the wider NHS and social care sector, and the objectives 16% 19%
50 30-64
we want to achieve. We have significant, but limited resources and
15-29
there is an opportunity cost to everything we do. We have developed
0-14
a richer understanding of where and how we can add most value 25
UK Population
through remotely delivered care 24 hours a day, 7 days a week on a
national basis – our core service – and will focus this service 0
2010 2015 2025
accordingly. Working with our lead commissioner, East of England
SHA, we have also developed a process and funding framework that
encourages us to innovate, introducing new services where we can
demonstrate that there is a service need and that we are the provider
best placed to deliver them.
We will use our resources more effectively and imaginatively,
spending an increasing proportion on front line services that address
the changing needs and aspirations of patients and the wider NHS.

6
Changing nature of health demand Economic climate
Alongside changes in demand driven by the make-up of the Whilst the NHS generally, and NHS Direct specifically, faces an
population, we are also seeing changes driven by people’s increased increasing level and complexity of demand for their services, it is
level of expectations about the type of services they want, and how equally clear that there will be significant pressure on resources.
they want to access those services. The rise of consumer culture Efficiency savings of between £15 and £20 billion will be required
applies as much to the health sector as it does to other areas. across the NHS by the end of 2013/14.
Patients are consumers. They want more information about their We have already begun to respond to these challenges. By the end of
health needs and more say in how they are met. They are increasingly 2010/11 we will have reduced the cost of our core service by £16
sophisticated in where and how they want to access information. million or 12% in real terms, whilst continuing to increase the
They want to take more control both in managing how they stay numbers of patients who benefit from our services. We have plans to
healthy and, when relevant, in managing their illnesses and related achieve further recurring efficiency savings of £20.1 million in
conditions, and those of their families. Meeting these demands 2010/11, and to continue to improve our efficiency in the years
through remote and virtual services will improve patient experience, beyond this.
help take pressure off traditional face to face services and reduce
costs. We do not underestimate the scale of this challenge; but we see it as
a positive one. We will meet it by ensuring that we focus our services
Around 53% of the population now use the internet every day, and very specifically on areas where we can provide greatest value, and
69% use it every week. There were 18 million broadband lines in not to seek to provide services that other providers are better placed
2009, and the Government has set ambitious growth targets for to offer. We will focus on further developing our understanding of
broadband availability. More and more services and information will the requirements of our different patient and stakeholder groups and
be delivered via the web. The number of people using social developing and targeting our services to address those different
networking sites has increased from 7% of the population to 34% in needs. We will rigorously drive the efficiency of our services whilst
the last three years. Public sector service providers are increasingly maintaining and improving their safety and quality. We believe that
using social networking sites to communicate with their customers responding to the economic challenges will enable us to position
and stakeholders – over 120 local councils have Twitter accounts and ourselves much more effectively to meet the needs of patients and
60 councils are present on YouTube. This trend is set to continue with support the wider NHS and social care sector.
greater numbers of people, across all sections of the population,
expecting to be able to get information and services in a range of
different ways.
The technology which powers these new communication channels

also supports developments in telehealth and telecare. New tools are
being developed to allow patients and health professionals
collaboratively to monitor and manage a range of conditions on a
remote basis.
We will identify specific areas where our infrastructure and expertise

in remote care mean we are ideally positioned to support and extend
such approaches.

Health policy initiatives Our plans for the future
Our vision and plans for the future include consideration of the most Five broad but related themes have emerged from our analysis. These
significant national policy initiatives on health. We have identified encapsulate the most important challenges – and the potential for
the key elements directly relevant to NHS Direct and its plans for improvement - for health provision over the next three to four years.
the future, and which will remain significant for at least the medium
term. Many of these relate or respond to the wider environmental • enabling and supporting people to do more for themselves;
issues identified above.
• understanding the health needs and behaviours of
individuals, and providing high quality services in flexible
The NHS Constitution sets out clearly the legal rights of patients in
ways, that respond to those needs;
reference to the service they are entitled to receive from the NHS,
and makes pledges that go beyond these legal requirements for • developing more efficient and innovative ways of delivering
the level of service that the NHS aspires to deliver. Importantly, the services in order to address the twin challenges of increasing
Constitution also sets out similar rights and pledges in respect of demand and economic constraints;
all staff employed within the NHS, and lays out the responsibilities • collaborative working amongst health service providers, both
of both patients and staff to contribute to managing health. Lord across and outside the NHS, to share expertise and avoid
Darzi’s report and recommendations in “High Quality Care for All” duplication; and
similarly address the concept of patient empowerment - the need to • challenging, empowering and supporting staff to deliver safe
give patients greater control over the type of healthcare they receive and valued health care services.
- and the importance of personalising care. The report stressed the
importance of maintaining health as well as treating sickness. Remotely delivered health services have a crucial contribution to
play in addressing these challenges. NHS Direct has a key role in
These themes are reinforced in the previous Government’s vision for supporting NHS and social care organisations to understand and
health “From Good to Great”, which focuses on the importance of exploit the opportunities of moving from traditional face to face to
staff empowerment and seeks a transformation in the treatment remotely-delivered services in line with patient choice and to improve
of people with long term conditions. The vision also emphasises patient experience whilst maintaining high quality and safe services.
partnership, collaborative working and integration of services across
and between health providers. The NHS Operating Framework for
2010/11 maintains the priorities it has established in the previous
three years, including improving patient experience and emergency
preparedness.
Finally, we will need to respond to the continuing challenges and

expectations of the quality, innovation, productivity and prevention
(QIPP) and World Class Commissioning agendas. East of England
SHA’s commissioning approach acknowledges NHS Direct’s role as
the key provider of national telehealth services for the immediate
future and places a priority on the continuing provision of our current
core services; but identifies that we may become subject to greater
competition in the future. It challenges us to build on and extend
the efficiencies we have already achieved and to integrate our offer
more effectively with the wider NHS. It also sets an explicit priority
for NHS Direct to continue its work in developing, testing and
implementing innovative approaches to the provision of telehealth
and telecare services. The contract negotiations with East of England
for 2010/11 have been challenging and rigorous, but also positive
and collaborative. The resulting contract achieves an effective
balance, establishing realistic but challenging performance standards,
with increased levels of penalties for underperformance accompanied
by incentives for us to improve performance. It also incorporates a
shared risk in developing innovative approaches to the provision of
remote care.
We are working with the NHS to develop innovative services, and we

are introducing tighter performance management and reporting to
chart and manage our progress with improving the services that we
deliver.

8
Our vision for the next four years:

NHS Direct will provide remotely delivered care that is increasingly
valued by patients and the wider health and social care system.
1. Raise the quality and productivity of our services 2. Increase the value we create for patients, public, the NHS
and social care
Patients will continue to use our services where they are confident
that the services are clinically safe, and that they address their specific The more patients that use our services the more value we can add.
needs in the ways they want. By delivering our services more We have begun work, in partnership with our lead commissioner, to
efficiently, we can create capacity to improve the quality of existing develop a clear and shared understanding of how NHS Direct adds
services and to extend and enhance the range of services we provide. value for patients and for the wider NHS, and to quantify this value.
This value model focuses on how we create value for patients and for
We will maintain appropriate standards of clinical care, including the NHS by providing advice and information which helps people do
compliance with statutory regulations, and improve those standards more for themselves. Where we prevent patients from accessing
in line with best practice. urgent care inappropriately we can avoid unnecessary disruption of
their lives and reduce avoidable stress and demand on heavily
We know that patients currently value our services - our patient subscribed urgent and emergency care services. For example, in 2008
satisfaction is currently 90%. We will develop a regime of continuous 3.6 million unnecessary visits to healthcare professionals were
improvement for all our services by improving our understanding of avoided through use of NHS Direct, creating a long term saving of
the patient’s experience of our services through more systematic, £162m as well as convenience and benefits for patients.
timely and sophisticated engagement with patients, the public and
members, reflecting current best practice in the public and Whilst the longer term economic impact of NHS Direct’s services is
commercial sector. This will provide richer intelligence about what positive, the contribution that we can make by making better use of
drives levels of satisfaction across our full range of services, channels our national infrastructure is even greater. Every additional £1 of
and amongst different patient segments. This in turn will enable us to activity in NHS Direct creates £2.95 in cash releasing savings for the
take targeted action to improve satisfaction levels. NHS. By understanding more about the types of patients who use
NHS Direct we have begun to identify how use of our services varies
Through our core telephone service, each year we currently handle between different areas and across different patient groups in order
around 5 million calls a year, and we also receive the same volume of to make an even greater contribution.
contacts again through our on line health and symptom checkers.
The average cost of a call handled by one of our Health Advisors We will work with our lead commissioner, and with the wider NHS at
using our 0845 number is £8, the average cost of a contact with one national and local level, to develop this model further. We will use it
of our Nurse Advisors or Health Information Advisors is £21.02, and to identify how we can target our services to support more effective
the cost of a web visit is 12p. and efficient use of urgent care for the benefit of patients and the
NHS. We will also review the range of our other services that are
We will develop further our web offering, which will drive two commissioned locally. We will identify whether they focus on the
significant improvements: it will address the increasing demand from areas where we can provide greatest value, and represent the most
patients and the public to access services and information over the efficient use of resources. In collaboration with our commissioners
internet, and other mobile channels; and it will drive efficiencies in and relevant local partners we will decide whether we should seek to
how we provide our services. We will increase the availability of our extend their useage where they deliver an appropriate strategic fit, or
services across a full range of channels, and promote their use, whilst consider discontinuing them where we do not feel we add value.
retaining easy access to our trained nurses and health advisers by
telephone for those patients who want or need this service. We will develop stronger and more constructive relationships with
our commissioners and partners in the NHS and social care sector, at
We will improve the effectiveness and efficiency of our call centres. both national and local levels, to highlight the benefits of remotely
We are developing more sophisticated models for forecasting levels delivered services, and to collaborate on the design and
of demand, and for monitoring performance in meeting that implementation of new services. We will use robust criteria to focus
demand, which will enable us to plan our staffing in more flexible investment where we are best placed to add most value through the
ways. We will partner with other organisations to meet forecast exploitation of our particular assets, expertise and experience. We
patterns of demand and so that we can respond swiftly to will not divert resources to developing or delivering services which
circumstances which challenge performance levels. other providers can do more effectively. In the immediate future, we
will play a full and constructive role in the delivery of the 3-digit
number pilots.

3. Improve the culture of our organisation through a where and how we can increase levels of satisfaction by improving
strong set of values our internal management and operations, as well as capturing input
from staff on ways in which we can improve our services to patients
We want our values to permeate and influence every aspect of our and the wider NHS.
behaviour, both internally and externally. We have adopted the
following set of values: 5. Take advantage of new opportunities and plan
effectively for the future
• We’re here In order for NHS Direct to continue to provide efficient and
• We deliver high-quality remotely delivered health care, it is essential that we
understand the pressures and challenges that the NHS and social care
• We care will face in the coming years. We will improve how we anticipate and
• We empower respond to those challenges, and how we identify and exploit any
opportunities that may present themselves. The services we provide
• We think ahead must respond to current and future health priorities, and they must
• We listen complement and align with – rather than duplicate - the services
being provided by national and local NHS and social care partners,
We will work with our staff to embed these values in the way we and private health providers.
conduct ourselves individually and corporately, through the front line
services we provide and in the ways we engage with our patients, We will gather and analyse intelligence on the external environment,
the public, our members and our partners. These values will underpin and establish effective processes for engaging with strategic partners
the delivery of our objectives and the achievement of our vision. to test our understanding of developments in the wider environment
and the impact on our role and activities. With our commissioner we
4. Be a great place to work and an employer of choice will implement a process to identify innovative approaches to
meeting changing health needs, through the use of remotely-
As with all organisations, it is the quality and commitment of our delivered services and using new technologies. We will pilot and test
staff to deliver our objectives that makes the difference between new services rigorously against clear and challenging criteria before taking
success and failure. A valued, empowered and appropriately skilled decisions on whether to offer them more widely across the NHS.
workforce in crucial to delivering the improvements sought from the
NHS. There is also clear evidence that high levels of staff satisfaction We will review how we deploy the complex range and balance of
correlate with high levels of patient satisfaction. We will develop and resources available to us – financial, human, technological and
support our workforce so that every member of staff is motivated and physical – to achieve our objectives in the form of a target
challenged to provide the highest possible level of service she or he organisational design. The design, which will include a full review and
can, in whichever role they fill. appraisal of our current estate, will provide a robust and structured
framework for the modernisation of our operations over the medium
We will build on the strong performance and potential that exists to long term. Circumstances change, and we must be ready to
within the organisation and we will address the workforce challenges respond to new demands and exploit new opportunities for the
we face. In conjunction with the work we are carrying out to improve benefit of patients and the wider NHS. Therefore, the model will
our capacity planning, we will develop a more flexible workforce combine rigour and sustainability with flexibility and agility.
model which supports us to manage the peaks and troughs of
demand for our services more effectively, and will be more responsive 6. Improve our corporate effectiveness and efficiency
to the needs of existing and potential employees to meet their
work-life balance aspirations. This will include implementing options There will be significant pressures on public expenditure over the
for partial or permanent home-working. coming period, combined with increasing demand for health services.
Our commissioner will seek to secure efficiencies in the services we
We will improve the attractiveness of NHS Direct to current and provide, to meet the objectives of World Class Commissioning and
potential employees by providing opportunities for staff to develop the Quality, Innovation, Productivity and Prevention initiatives. We will
their careers, by offering structured programmes for skills use our available resources as effectively as possible, focusing them
development and, where appropriate, accreditation. clearly on the development and delivery of high performing services,
and reducing the proportion spent on overheads and administration.
We currently have higher than acceptable levels of sickness and
attrition. The approaches set out above will address this to some We will rigorously evaluate our corporate performance, to make our
degree. Additionally, we need to develop the capability of our line operations as streamlined and efficient as possible in order to devote
managers. We will implement a range of training and development the maximum possible proportion of our available resources to the
to provide them with the skills and tools to manage their teams more provision of front-line services. We will develop a clearer
effectively, to recognise and reward strong performance and, where understanding of what drives our performance and our costs, and
it is necessary, to feel confident, equipped and empowered to introduce new, more efficient systems to produce the information we
constructively challenge and improve poor performance. need in order to drive down costs and our resources more effectively.
Over the course of the next financial year, we plan to achieve over
We will introduce a more sophisticated and systematic approach to £20m savings in our costs.
engaging with staff to seek structured and practicable feedback on

10
Section 2:
Business Plan
Business Plan for 2010/11
We expect our six strategic objectives to remain our focus for the
next four years, though we will review them regularly with those
who use our services, our members and our stakeholders to test their
continuing relevance and importance. Each year we will develop a
detailed business plan, setting out what we want to achieve and the
specific activities we will undertake to support the achievement of
our strategic objectives. We welcome feedback on our business plan
and planning process. Please send any comments to
brendan.carey@nhsdirect.nhs.uk
Our vision is that NHS Direct will provide remotely delivered care that
is increasingly valued by patients and the wider health and social care
system.
To achieve this vision we have six strategic objectives, which are to:
• raise the quality and productivity of our services;

• increase the value we create for patients, public, the NHS and
social care;
• improve the culture of our organisation through a strong set
of values;
• be a great place to work and an employer of choice;
• take advantage of new opportunities and plan effectively for
the future; and
• improve our corporate effectiveness and efficiency.

Strategic objective 1: raise the quality and

productivity of our services
The NHS faces the significant challenge of continuing to improve its services against a backdrop of lower resources. NHS Direct will play
its part in meeting this challenge, by improving its own quality and productivity. This means reducing the costs of its own services whilst
maintaining or improving the quality it offers to its patients and the NHS. Over the next three years, we will chart our achievement of this
strategic objective using the following Key Performance Indicators.
Category Deliverable/Key Performance Indicator KPI 09/10 Lead

Target Baseline Director
Patients Patient satisfaction ≥ 90% 92% Chief Operating Officer
Number of complaints ≤ 1 per 0.8 per Chief Operating Officer
10,000 10,000
calls calls
Actions arising from complaints implemented to 95% Unknown Clinical Director
deadlines
Expert call reviews scoring good/excellent 80% 69% Clinical Director
Quality and CQC registration without condition Achieved Achieved Clinical Director
Safety Incidents reported to national review that have given < 10% ≤ 1.4% Clinical Director
rise to harm
Access Time to answer - within 60 seconds ≥ 95% Met consistently in Q4 Chief Operating Officer
Abandonment rate < 5% Met consistently in Q4 Chief Operating Officer
Time to clinical assessment urgent calls - ≥ 95% Met consistently Chief Operating Officer
within 20 minutes
Time to clinical assessment less urgent calls - ≥ 95% Not met Chief Operating Officer
within 60 minutes
Time to clinical assessment non urgent calls - ≥ 95% Not met Chief Operating Officer
with 120 minutes
Productivity Time with patients ≥ 50% 40% Chief Operating Officer
Time waiting for calls < 15% 18% Chief Operating Officer
Cost per health advisor contact tbc £8 Chief Operating Officer
Cost per health information advisor/nurse advisor contact tbc £21.02 Chief Operating Officer

12
The section below sets out the key priorities for 2010/11 and lists the associated deliverables and measurements for each.
1.1. Improve the patient experience through better integration with other health and social care services
We have a role to play in making the patient’s journey as seamless as possible, streamlining their movement between services, ensuring that
patients reach the right place, first time.
Deliverable Measurement Owner

Patient information can be transferred Technical links are in place with all Ambulance Trusts. Chief Information
electronically between NHS Direct and Officer
Ambulance trusts for 999 calls and Category C
transfers.
Technical capability in place for patient details A plan in place for staff to be able to use the Patient Chief Information
to be recorded using their NHS number linked Demographic Service to access patient information. Officer
to the Patient Demographic Service to support
transfer of information for onward referrals.
Accurate information is available on local Health Information Directory in place. Chief Operating Officer
services to direct patients to the right place,
first time.
1.2. Use our relationships with patients, the public and members to improve our services
The services we provide have an increasingly valued place in the minds of patients and the public because of the experience they have of using
them. It is core to our vision for the next three years that we increase the levels of satisfaction that patients derive from using NHS Direct and
use our relationships with patients, the public and members to improve our services.

There is executive and non executive ownership A non-executive director is supported to act as the ‘patient Director of Strategy
of ensuring NHS Direct has customer champion’. and Planning
experience as a high priority. A new post will be established to co-ordinate actions to Director of Strategy
capture insights into patient, members and staff experience. and Planning
Feedback is actively used to inform service New system in place for collating real time patient feedback Director of Strategy
redesign and development of new services. across all services and channels. and Planning
X% of patients using services provide feedback [metric to be Director of Strategy
baselined by the end of the first quarter]. and Planning
Reference groups in place with patients and members as part Director of Strategy
of innovation and service development process. and Planning
Net promoter score will be a key measure of A net promoter score baseline has been established. Director of Strategy
individual, team and corporate performance and Planning
and will be used to drive up positive patient
experience.

1.3. Maintain and improve the safety and clinical effectiveness of our service
The clinical safety and integrity of our services is fundamental to maintaining the trust that we have built up with our patients and the public.

Continuous improvement of our services by ≥ 95% of complaints are responded to within timescale. Clinical Director
learning from complaints and feedback in line ≥ 95% of complaints are resolved first time. Clinical Director
with new complaints regulations. ≥ 95% of actions identified through complaints implemented Clinical Director
to deadlines.
≥90% of actions arising from clinical audit are implemented Clinical Director
within agreed timescales.
Continuous improvement of our services < 15% of actions identified through reviews of serious Clinical Director
through learning from incidents. incidents are outstanding.
Maintain the clinical safety of NHS Direct’s 100% contract compliance in our handling of P1 calls. Clinical Director
performance. 100% contract compliance in our handling of P2 calls. Clinical Director
100% contract compliance in our handling of P3 calls. Clinical Director
90% of staff have completed clinical mandatory training. Clinical Director
1% or 3 calls (whichever is highest) are reviewed for each Clinical Director
agent each month.
≥ 90% clinical algorithms/protocols subject to review within Clinical Director
the last year.
Maintain registration for remotely-delivered Demonstrable continued compliance with all registration Clinical Director
services with relevant healthcare bodies. regulation requirements.
Exception reporting of significant areas of non-compliance Clinical Director
with registration regulations.
Ensure all policies, procedures and algorithms ≥ 95% relevant external policies and guidance implemented. Clinical Director
reflect latest national guidance e.g. DH, All eligible staff have had a Criminal Records Bureau (CRB) check. HR Director
Health Protection Agency and other national ≥ 80% clinical requests for change implemented. Clinical Director
professional, voluntary and accredited bodies. Achievement and maintenance of Level 1 NHS Litigation Clinical Director
Authority Risk Management Standards.
1.4. Improve patient access to NHS Direct services through web and telephone, encouraging use of the most cost
effective channels
Increasingly the public is looking to access NHS Direct in different ways. We will develop new channels at the same time as improving the
telephone service.

A range of contact channels are available to 60 Self Assessment Tools are in place. Chief Operating Officer
patients. 5.4 million people use the online symptoms checkers. Chief Operating Officer
2,000 people use the web chats. Chief Operating Officer
30,000 people use the Online Enquiry Service. Chief Operating Officer
<16% of users of the online symptom checker need a nurse Chief Operating Officer
call-back.
Able to consistently meet peaks in demand for 100% of contacts are responded to within contract targets. Chief Operating Officer
our services. Service availability is retained at or above 99.5%. Chief Operating Officer

14
1.5. Create a more efficient and affordable contact centre operation
In the next three years the costs and flexibility of NHS Direct’s contact centre operation will be increasingly subject to competition. We will take
dramatic positive steps to increase our effectiveness and affordability. One of the ways we will do this is through creative use of partnerships.

Streamlined management structure is in place New divisional directorate structure is in place. Chief Operating Officer
with robust processes to improve efficiency and Call centre management development programme has been
enable staff to spend more time with patients. undertaken by all management staff.
All inbound calls for health information and A review has been undertaken of the quality and capacity Chief Operating Officer
advice are provided across the national network, implications of fully networked services.
where it is most cost effective to do so.
A new forecasting process has been Demand forecast accuracy is increased [metric to be baselined Chief Operating Officer
implemented to ensure optimal alignment of by the end of the first quarter].
scheduled staff to demand and to maximise
cost effectiveness.
Reduced staff sickness. Total number of employees on long term sick leave is reduced HR Director
to under 50.
Fewer staff leave within first 12 months of < 15% front-line staff leaving within their first year. HR Director
being employed by NHS Direct.
Effective team working is in place. 10% improvement in staff satisfaction in team working. Chief Operating Officer
Shorter, better processes in place. Maintain Call Centre Association accreditation. Chief Operating Officer
Cheaper, better, more flexible operation. Increased use of partnerships with other delivery organisations. Chief Operating Officer
1.6. Maintain our contribution to emergency planning and national resilience, responding to emergencies and times of
unprecedented demand
We are called upon to provide support in national and local health emergencies, including the management and operation of the National
Pandemic Flu Service. We will maintain our readiness to respond to an incident or emergency.

National Pandemic Flu Service is demonstrated Successful completion of the annual test and dress rehearsal. Chief Operating Officer
to be ready to mobilise within seven days.
NHS Direct is able to respond effectively to an Emergency response plans demonstrate that all disciplines have Chief Operating Officer
emergency situation. procedures in place to respond to an emergency.
NHS Direct is positioned to make a full Business case has been signed off by commissioners and Director of Strategy
contribution to supporting the 2012 Olympics. project manager has been recruited. and Planning
Enable the Health Protection Agency to provide ≥95% data agreed for provision to HPA is provided. Director of Public Health
increasingly useful surveillance information
to the NHS through the regular provision of
meaningful data for Syndromic and Sporadic Project timescales for NHS Direct actions in Sporadic Director of Public Health
Surveillance/Maximise the use of NHS Direct Surveillance Schemes are met.
data for public health surveillance.

Strategic objective 2: increase the value

we create for patients, public, the NHS
and social care
We need to show NHS Direct creates more value to the NHS than it costs to run, and we will target our services to where they create greatest
value. Over the next three years, we will chart our achievement of this strategic objective using the following Key Performance Indicators.

Use of core No. of users of health and symptom checkers per 88 20 Director of Strategy
services 10,000 population per month contacts contacts and Planning
(including three
Telephone contacts per 10,000 population per month 82 83 Director of Strategy
digit number
contacts contacts and Planning
services)
Outcome of core % Telephone contacts not requiring onward referral ≥60% 58% Director of Strategy
services and Planning
% Urgent and emergency onward referrals <25% 24% Director of Strategy
and Planning
Locally Value of locally commissioned services £17.6m £17.6m Director of Strategy
commissioned and Planning
services
Stakeholders % of stakeholders rating NHS Direct good/excellent 70% 66% Director of Strategy
and Planning
2.1. Increase the value of our services through increased usage, better targeting and service design
Over the next year we will work closely with our commissioners to target particular groups of patients who would benefit most from our
services and free up resources for the rest of the health system.

NHS Direct is able to clearly demonstrate the The value proposition tool has been agreed with our Director of Strategy
value that it contributes to health and social commissioners. and Planning
care organisations. Five PCTs have completed the patient segmentation/ value
proposition tool.
Bespoke local advertising campaigns are being ≥ 10 PCTs have completed a pilot on segmented marketing. Director of Strategy
delivered in partnership with PCTs. and Planning
Improved appropriate useage of our services by Mechanism established to track the increase in value delivered Director of Strategy
the public. to the NHS. and Planning

16
2.2. Ensure all new services meet the needs of the NHS and social care and use our assets effectively

NHS Direct is keen to play a leading role in the provision of healthcare services in order to responsively meet the demands of our patients, the
NHS and increasingly, social care. There is significant opportunity to use our infrastructure to deliver a wide range of services across a number
of specialities, for example, urgent care and long-term conditions.

All locally commissioned services cover the cost All locally commissioned services are priced using the Service Director of Strategy
of provision. Line Reporting methodology. and Planning
The NHS and social care increasingly choose 70% of locally commissioned services contracts relate to GP Director of Strategy
NHS Direct as their supplier. Out of Hours, Dental Out of Hours, health alerts and Single and Planning
Point of Access.
£17.6 million of income is received from locally commissioned Director of Strategy

services. and Planning
All locally commissioned services have standard Standard service specifications in place for all locally Director of Strategy
specifications which have been agreed across commissioned services. and Planning
the organisation. New procedural and governance arrangements in place for the Director of Strategy
design and development of new services and bidding for new and Planning
services.
Health and social care organisations are able ≥ 25 organisations have NHS Direct content on their website. Director of Strategy
to use NHS Direct developed content on their and Planning
websites.

2.3. Deploy our capabilities and expertise in support of the development of the three digit number for access to
non-emergency care
NHS Direct has a key role to play in each of the pilots to test the introduction of a three-digit-number for access to non-emergency
care. We will use our experience of delivering a single point of access in West Yorkshire for the benefit of others wishing to establish
similar services. We will work closely with the Department of Health and local NHS commissioners and providers to ensure these pilots
offer patients a truly seamless and high quality service and to promote web access to the service. As part of this we will work with the
NHS to develop common assessment for non-emergency symptoms.

Established sustainable, safe, cost effective NHS Direct has membership on all national and local three Director of Strategy
pilots. digit number groups. and Planning
Field trials of NHS Pathways within NHS Direct have been
completed.
Service Line Reporting pricing in place for all pilots.
NHS Direct meets performance standards on all pilots and
deliver on time and within budget.
Subject to evaluation, NHS Pathways is being used to support
all pilots.
Robust internal project management and Effective operating model and supporting technical Director of Strategy
governance processes in place to successfully architecture agreed and in place. and Planning
deliver the three digit number pilots. Risks are identified and managed through relevant Director of Strategy
committees/boards. and Planning
2.4. Strengthen relationships with the NHS and social care organisations
Being a national organisation, NHS Direct has to work particularly hard to engage with local NHS and social care stakeholders at a
local level. We will ensure that our regional outward facing teams are actively engaged in local discussions and developing effective
solutions to support high quality patient services.

NHS and social care organisations value ≥ 80% of urgent and emergency care networks have NHS Director of Strategy
NHS Direct. Direct membership. and Planning
A stakeholder engagement strategy is in place and outputs are Director of Strategy
being measured. and Planning

18
Strategic objective 3: improve the culture

of our organisation through a strong set
of values
Our values are:
• We’re here
• We deliver
• We care
• We empower
• We think ahead
• We listen
These values were defined last year as part of the NHS Direct Strategic Development Programme. The next phase of this work is the
implementation of these values in all that we do, lining up our behaviour with the values we have developed and to which we aspire.

Values Staff at Grade 8 and above have used our values as part 100% 0 HR Director
of their appraisal and Personal Development Plan.
3.1. Embed our values in all that we do
We now need to grow a culture in which our values are true. This means embedding our values in all that we do with staff, patients
and the public and our health and social care partner. This culture change needs to be led by the NHS Direct board and management
teams.

Our patients, wider stakeholders and staff Board development activities have addressed implementation Chief Executive
recognise our values in their interactions with of our values.
NHS Direct The senior management development programme has HR Director
addressed implementation of our values.
The cross-functional “Values Ambassador Team” has been HR Director
established and met quarterly.
A toolkit has been issued to managers to help them embed HR Director
the values into their day-to-day individual team management
activities.
A “Values Implementation Co-ordinator” has been appointed. HR Director
Staff survey, stakeholder survey and patient feedback tells us HR Director
that we live up to our values.

Strategic objective 4: be a great place to

work and an employer of choice
There is strong evidence that high levels of staff satisfaction lead to high levels of patient satisfaction. We want our staff to be fulfilled in their
work and to be proud to work for NHS Direct. We want to select people who will thrive and we will train and motivate them in order to keep
them longer. In particular, NHS Direct needs to provide a career path that is attractive to nurses and is considered a desirable part of a nurse’s
career trajectory.
Over the next three years, we will chart our achievement of this strategic objective using the following Key Performance Indicators.

Sickness Sickness per whole time equivalent 10 days 21 days HR Director
Number of people on long term sick leave 50 people 104 people HR Director
Recruitment and % of front-line staff leaving within their first year < 15% 29% HR Director
retention Projected fulfilment of nurse staffing requirements 100% Unknown HR Director
Staff satisfaction % rating in annual staff satisfaction survey ≥ 60% Unknown HR Director
4.1. Develop flexible and responsive ways of working
We want to increase the job satisfaction of groups of our staff, attract new types of healthcare professionals into the organisation,
and enable us to service our peaks in call volume more successfully. We will achieve this through the implementation of a variety of
alternative ways of working, which will include permanent home working and “peak” home working, and will be underpinned by
new staff contracts and roster system.

Proportion of nurse advisors operating as Reflect Plymouth evaluation in design of model. HR Director
permanent home-workers. Clinical, technical and employment policies in place. HR Director
Proportion of nurse advisors signed up to work 15% of nurse advisors undertaking additional hours at home HR Director
additional hours from home. (‘peak’).
1% of nurse advisor hours being covered by “peak” HR Director
homeworking.
Certainty for frontline staff of their rotas 100% of frontline staff (excl health information staff) on new HR Director
throughout the year. contracts.
≥ 70% staff satisfaction on rostering. HR Director
100% of all staff (excl health information staff) showing HR Director
increased utilisation by 10%.

20
4.2. Provide opportunities for staff to develop their careers within NHS Direct and reward exceptional contributions to
the service
We want to make NHS Direct a “destination employer” for health care professionals and an organisation where talent is identified and
nurtured.

Nurses consider NHS Direct to be a “destination Nurse advisor skills set has university accreditation. HR Director
employer” for healthcare professionals. Assistant Practitioner role accreditation by a further education HR Director
establishment.
≥ 2% of nursing staff are on rotation from other organisations. HR Director
Survey programme in place with Royal Colleges. HR Director
Staff with potential are identified and ≥ 95% of staff have had their Personal Development Plans HR Director
supported to progress within NHS Direct. reviewed.
≥ 95% of Knowledge Skills Framework outlines in place. HR Director
≥ 30% of vacancies are filled by internal candidates. HR Director
NHS Direct talent map has been produced. HR Director
Exceptional performance is recognised and An innovations academy has been established. HR Director
rewarded. A staff recognition scheme has been implemented. HR Director
4.3. Implement robust processes for measuring staff satisfaction and taking on board their feedback
In 2010/11 we will for the first time undertake the Care Quality Commission staff satisfaction survey. In addition we will also develop a regular,
more limited surveying system to measure and understand the effect of changes and initiatives on the staff group.

Care Quality Commission staff survey is ≥ 60% of staff participate in the survey. HR Director
implemented.
The leadership team collects, understands and 5 “short” surveys have been performed. HR Director
acts on feedback from staff.
4.4. Improve our leadership and management capability and build our teams
NHS Direct is looking to achieve significant cultural change, building on the patient centred values of the NHS to create an ethos where we
are more responsive to the changing environment in which we deliver services and are capable of leading the remote health care agenda for
the NHS. We will realign our management structure to make it more patient centred and productive, and develop our leadership team and
provide further training to our first and second line managers.

Leadership development programme is in place. All senior managers have a Personal Development Plan in place. HR Director
≥ 80% satisfaction amongst senior managers. HR Director
All senior staff have a succession plan in place. HR Director
First and second line managers are skilled up Reduction of 20% in disciplinary and grievance cases. HR Director
with good people management skills. ≥ 20% increase in satisfaction levels of first and second line HR Director
managers.
≥ 10% increase in overall staff satisfaction. HR Director

Strategic objective 5: take advantage of

new opportunities and plan effectively
for the future
It is essential that we anticipate the pressures and challenges that will be faced by the sector, and respond with offers of innovative service
solutions. We will work with public and private sector partners and stakeholders, locally and nationally, to ensure that we are able to develop
and implement services that are clearly focussed on meeting current and future needs.
Over the next three years, we will chart our achievement of this strategic objective using the following Key Performance Indicators.

Innovation Successful local health economy pilots initiated. 25 1 Director of Strategy
and Planning
5.1. Develop a target organisational design
Analysis of the external and internal environments will allow us to design our organisation to most effectively flex the balance and
deployment of our human, financial, intellectual, physical and technological resources to respond to internal and external factors.

Medium-term organisational design has been Board sign-off by October 2010. Director of Strategy
developed and agreed. and Planning
Supporting strategies have been developed Board sign-off by December 2010. Chief Operating Officer
covering: Finance Director
• IM&T HR Director
• Finance
• Estates
• Workforce

22
5.2. Influence national policy and local innovation in the delivery of remotely-delivered services
The services we provide must continue to evolve to support future health priorities. We will ensure that we have informed and
practicable intelligence on the external environment, and establish effective processes for developing and testing new approaches to
meet emerging needs. We will continue to explore new ways of exploiting the use of remotely delivered services in address health and
social care needs.

Number of innovation proposals for 2011/12 in 4 Director of Strategy
the pipeline. and Planning
Innovation governance arrangements in place ≥ 2 meetings per year. Director of Strategy
including establishment of Board and Planning
sub-committee.
Inform the development of our services National reference group in place for development of new Director of Strategy
through monitoring of our external services. and Planning
environment and stakeholder engagement. % of stakeholders rating NHS Direct good/excellent Director of Strategy
and Planning
5.3. Put in place processes, capability and capacity to ensure that the organisation has plans to respond to new
challenges and opportunities and delivers on those plans
NHS Direct must develop structured but flexible plans for the services it will provide both in the immediate and longer-term. These will
be kept under review to be adapted to take into account our performance and the perspectives of patients, partners and stakeholders.

Strengthen internal processes to support New business planning and review process in place. Director of Strategy
horizon-scanning external and internal and Planning
environments and plan accordingly. Horizon-scanning and new service development process in Director of Strategy
place. and Planning
Sufficient focus on delivery of priorities and Quarterly Chief Executive reviews have been undertaken on Chief Executive
projects. progress against the business plan.
New processes in place for monitoring progress in project Chief Executive
implementation.
Research and service evaluation evidence is An executive sponsor is identified for each project. Clinical Director
available to support improvement of existing
and development of new services. Assigned budget is spent and the programmes are delivered Clinical Director
to time.

Strategic objective 6: improve our corporate

effectiveness and efficiency
NHS Direct has a successful financial track record. We recognise that with the financial challenges now facing us over the next three years, we
must improve our performance management, financial systems and controls and governance arrangements even further. This is part of our
continuous improvement programme that will deliver 21st century performance management systems and controls.
Over the next three years, we will chart our achievement of the strategic objective using the following Key (Financial) Performance Indicators.

Finance Recurring financial balance (monthly run rate) 1% 1% Finance Director
Department of Health Financial Health Index 2.5% 2.8% Finance Director
Management Achieve management cost target by 30 April 2011 12% 16.9% Finance Director
Costs of turnover
6.1. Improve performance management and information reporting processes
We will implement improved enterprise business systems to support delivering high quality and cost effective services including an
automated corporate scorecard and new operational scorecards to improve management and advisors’ performance. We will also
implement a new data warehouse to ensure consistent and accurate reporting of information. We will put in place an automated
system for Service Line Reporting as well as upgrading financial systems.

New financial ledger systems implemented. System sign-off and go live. Finance Director
i-Expenses system implemented. System sign-off and go live. Finance Director
e-Procurement system implemented. System sign-off and go live with complete roll-out. Finance Director
Corporate Scorecard automation in place. ICT system delivered to generate monthly score card data. Finance Director and
Chief Information Officer
Data Warehouse implemented. System sign-off and go live. Finance Director and
Chief Information Officer

24
6.2. Reduce our management, ICT and back-office support costs

Successfully deliver all Cost Improvement Plans. Achieve £20.1m savings. All Executive Directors
6.3. Reduce the cost of premises and the organisation’s carbon footprint, in line with the development of alternative
ways of working and target organisational design

Reduced estates running costs. NHS Direct HQ site evaluation completed to establish best value. Chief Operating Officer
Carbon emissions have been reduced. A carbon emissions reduction plan is in place. Chief Operating Officer

Risks
Corporate Risk
1. A Corporate Risk Register for 2010/11 has been approved by the Audit Committee and Board.
2. The key risks to delivery of 2010/11 business plan are as follows:
a. achieving financial balance in the face of increasing budget constraints whilst also maintaining the front line service provision. This
presents a significant risk to our objective to provide best value to our commissioners and will be managed through focusing our services
on areas where we can provide greatest value whilst reducing management costs.
b. improving the patient experience through better integration with other health and social care services. To do this we need to be
innovative whilst also remaining competitive. The risk of balancing innovation against competitive services is being managed through the
development of a corporate design authority to ensure innovations are cost effective, efficient and clinically safe.
c. delivering the improvements set out in the business plan. This relies on senior managers feeling competent and capable to meeting the
challenges. To improve the support to senior managers a leadership development programme will be delivered which will mitigate
this risk.
d. increasing the value we create for the NHS to ensure our services meet the needs of the NHS. Our relationships with the wider NHS could
present a risk to achieve this increase and this is being managed through engagement with key stakeholders at the national and regional
levels.
Financial Risk
3. In preparing our budget for 2010/11 a detailed financial risk assessment has been made as described in the Financial Plan 2010/11.

26
Section 3:
Financial Plan

Financial Plan
2010/11
Introduction
1. The financial year 2009/10 marked a significant turning point for the Trust with an emphatic shift towards substantial efficiency
improvement. Up until then NHS Direct had, in common with the rest of the Health Service, seen real term growth in funding and
services. The Trust set itself a considerable cost improvement target for 2009/10 of £17million in order to meet contract reductions
and implement a major strategic development efficiency programme.
2. The current NHS Operating Framework very clearly indicates the need for further substantial efficiency and financial savings to be
identified and delivered going forward. All health bodies will have to significantly ramp up their capability and capacity to drive through
cost efficiencies and drive down operating costs.
3. The core contract recurrent baseline settlement for 2010/11 of £118.9million represents a real term reduction in funding of over £11million
(8.5%). Further non-recurring support of £4.5million is being provided to cover Strategic Development Plans (SDP) and Innovation; both
designed to improve our efficiency, effectiveness and value to the NHS for our range of patient services. The funding reduction, combined
with in-year cost pressures and initiatives, requires a cost improvement programme of £20.1million to be achieved in 2010/11. Through this
programme we will continue to rigorously examine our use of resources and explore all routes possible to deliver significant and substantial
cost and productivity improvements over the next three years.
4. It is essential that quality must remain at the top of our agenda whilst costs are brought down. Patient experience and satisfaction remains
paramount. We will work collaboratively with our colleagues across the NHS in order to better provide value for money for the health
system and to be able to quantify this value.
5. Our lead commissioner continues to work with us to drive forward significant increases in productivity and significant reductions in
infrastructure costs. The non-recurring addition for 2010/11 recognises the timeline challenge in delivering such significant efficiency
reductions and taking forward our innovation of patient services.
6. Performance will remain crucial for us in 2010/11. We aim to deliver our Key Performance Indicators each and every day. Our contract
with the East of England includes a significant increase in both the frequency of assessment and the penalties associated with poor levels
of performance (quarterly and 2% 2009/10, monthly and 5% 2010/11).
7. Key challenges for the Trust in 2010/11 include:

• full achievement of the Phase 1 Strategic Development Programme and the early progression of Phase 2 schemes;
• sustaining continuous improvement in quality of service and patient experience including the delivery of all Key Performance
Indicators; and
• achieving the planned surplus and meeting our statutory requirements.

28
Financial Projections 2010/11
8. Our financial forecasts reflect our intention to continue to deliver surpluses and to provide for planned investment to drive future
improvements in efficiency and effectiveness.
9. We aim to deliver a planned surplus of £0.2m in 2010/11 after providing for investment to potentially fund a range of Strategic
Development and Innovation Initiatives. A full financial bridge of the movements between forecast outturn 2009/10 and the proposed
budget 2010/11 is set out in Appendix F.
Income and Expenditure Forecast 2009/10 Proposed 2010/11

Outturn £million Budget £million
Income:
Core Contract Income 124.6 123.3
Locally Commissioned Services/Other Income 66.2 35.0
Total Income 190.8 158.3
Expenditure 189.3 158.1

Net Surplus 1.5 0.2
A full Income and Expenditure base budget is set out in Appendix A.
10. Key assumptions and headlines within the financial plan for 2010/11 include:
• business as usual budgets based on current commitments plus full year effect of any agreed developments;
• pay and price inflation to be internally funded through the Trust’s efficiency programme;
• core contract reduction from £127.7million for 2009/10 to £123.3million, including £4.5million non-recurring for 2010/11;
• activity patient volumes of 5million with marginal rate of £8.46 for volumes 4.8million to 5.2million;
• locally Commissioned, non-core service contract income levels of £17.6million consistent with 2009/10
(with any loss of income requiring offsetting cost reduction);
• cost inflation provided at: 2.4% for pay awards and 2.5% for other costs;
• fully funded SDP Phase 1 costs of £3.3million;
• funding provision established of £1.5million to support progress of SDP phase 2 and other business case initiatives; and
• innovation and field trial funds of £1.75million.
Furthermore:
• CIP targets of £20.1million (13%) to be achieved through Strategic Development Plans detailed within appendix E;
• corporate downside contingency provision of £2million;
• innovation and field trial reserves £1.75million;
• other reserves and contingencies of £1.5million; and
• capital Investment of £28million.
11. It is clear that the NHS and NHS Direct are entering a period of significant income constraint for which costs must be managed down
significantly in order to deliver financial surpluses and service improvements into the future.
12. A full set of financial statements are set out in the following appendices:
A. Income and Expenditure

B. Balance Sheet
C. Cashflow Forecast
D. Capital Investment Programme
E. Cost Improvement Programme
F. Risk and Opportunities Schedule
G. Financial Bridge 2009/10 - 2010/111
1
Forcast outturn 2009/10 - Draft Budget 2010/11
Cost Improvement Programme
13. A challenging cost improvement programme savings target of £20.1million has been set for 2010/11 representing circa 13% of our current
turnover. As part of the budget setting and Strategic Development processes savings schemes have been agreed for Phase 1, in line with
previous reports to the Board.
14. Further areas of opportunity have been identified in addition to those incorporated into budget plans above. These include potential
SDP phase 2 schemes ‘Right First Time (DT5b) £4.3million, extended virtualisation (DT1b) £0.7million and sickness absence management.
In total £1.65million has been targeted against this for achievement and cost release in 2010/11.
15. The achievement of the cost improvement programme will be reinforced by monthly performance management meetings to be held with
all budget holders and reported back to the Trust Board.
Treasury Management
16. As a consequence of successive years of surpluses, a significant surplus cash balance has built up, forecast to be £21.4million at the end of
2009/10. The cashflow forecast for 2010/11 is set out in Appendix C.
Capital Plans for 2009/10
17. The proposed Strategic Investment Programme for 2010/11 is set out in Appendix D. A summary of proposed investment is as follows:
Business Area £’000s

ICT Infrastructure 3,069
Estates 2,918
Corporate Systems Upgrade 1,200
Clinical Content/Other 20,325
General Contingency 500

Total Forecast Programme 28,012
18. Key schemes include:

• securing clinical content rights and in-perpetuity licence;
• Health Information Directory;
• Enterprise Information System; and
• premises improvements.
19. The Trust will be developing and working to a 3-5 year programme of strategic investment.

30
Financial Risks
20. Key financial risks to the delivery of the Trust’s statutory duty to breakeven and deliver its planned surplus for the year include:
• the need to deliver such a significant cost saving programme;
• delivery against Key Performance Indicators (KPIs)
• locally commissioned service contracts not being renewed or secured leading to the need to remove the cost of their operation;
• managing down and out of the system any potential cross subsidisation on locally commissioned services which will otherwise be
reclaimed by the Strategic Health Authority;
• skills, expertise, capacity and capability to deliver in more stringent financial circumstances;
• systems, processes and performance management to support delivery;
• management tools to enable financial delivery i.e. data and information availability;
• cost escalation over and above budgeted provision;
• potential competitive challenge together with the impact of national initiatives and developments including
three digit number, single point of access; and NHS Pathways and NHS Choices; and
• expectation of further significant financial efficiency requirements going forward and the pace of change to realise expectations.
21. It is essential that these risks are managed in order to deliver the Trust targets.
Financial Opportunities
22. The Trust’s residual cash in 2010/11, together with cash generated from depreciation, will be available for strategic capital investment
to improve our efficiency. As part of the strategic development project, schemes are currently being developed that would fit the required
criteria.
23. We will continue to seek opportunities for increasing the level of income from locally commissioned services beyond the budget baseline
in 2010/11, subject to agreement on individual schemes with our commissioners.
24. The Trust must seek to swiftly progress and maximise other opportunities including:
• SDP phase 2 schemes ‘Right First Time (DT5b) £4.3million;
• Extended virtualisation (DT1b) £0.7million;
• Sickness absence management of up to £5million;
• Further development of self assessment tools;
• Mobile applications; and
• Development of patient decision aids from innovation funds
25. In summary, the Trust has set itself a challenging and stretching financial plan that will deliver a contract reduction for the SHA of
£6million, fund pay and price inflation of £5million and make good cost improvement plans that were not fully identified from 2009/10 of
£6.4million. It will also enable significant levels of internal investment to drive forward further and greater efficiency and innovation.

Annex A
Annual Budget Forecast Outturn Income & Expenditure Base Budget

2009/10 2009/10 2010/11
£000’s £000’s £000’s
127,615 124,617 Core Income 123,342

7,116 7,586 The Appointment Line Income 8,114
17,629 16,947 Other Enhanced Services Income 17,638
0 39,473 Fluline 6,576
778 2,165 Other Income 2,632
153,138 190,788 Total Income 158,302
79,223 79,663 Service Delivery Staff 71,148

20,125 19,974 Other Regional Costs 19,906
46,129 47,470 Directorate Costs 45,452
0 38,147 Fluline 6,576
3,815 306 Allocated Reserves 4,426
7,126 445 Contingency & Development Reserves 5,101
(7,856) CIP schemes still to be identified
148,562 186,005 Total Costs 152,609
4,576 4,783 EBITDA: Earnings Before Interest Tax Deprecation and Amortisation 5,693
2,794 2,963 Depreciation 4,796

(112) (74) Net Interest (112)
394 394 Dividend 794
1,500 1,500 SURPLUS / (DEFICIT) 215

32
Annex B
Forecast Balance Sheet Base Budget

March 2010 March 2011
£000's £000’s
NON CURRENT ASSETS
12,450 Property Plant and Equipment 13,854
3,663 Intangible Assets 25,476
0 Other Assets
16,114 Total Non Current Assets 39,330
CURRENT ASSETS
4,552 Trade and Other Receivables 3,750
8,779 Other Current Assets 6,250
21,351 Cash and Cash Equivalents 12,568
34,682 Total Current Assets 22,568
50,796 TOTAL ASSETS 61,898
CURRENT LIABILITIES
4,192 Trade and Other Payables 15,200
0 Borrowings
11,187 Other Financial Liabilities 12,500
1,827 Provisions 418
0 Other Liabilities
17,476 Net Current Assets/(Liabilities) (5,550)
33,590 Total Assets less Current Liabilities 33,780
NON CURRENT LIABILITIES

798 Provisions 773
0 Other Liabilities
798 Total Non Current Liabilities 773
32,792 TOTAL ASSETS EMPLOYED 33,007
Financed by:-
24,513 Public Dividend Capital 24,513
7,819 Revaluation Reserve 8,034
460 Income and Expenditure Reserve 460
32,792 TOTAL TAXPAYERS EQUITY 33,007

Annex C
Forecast Cashflow Base Budget

March 2010 March 2011
£000s £000s
1,794 Operating Surplus / (Deficit) excluding interest 897

2,963 Depreciation and Amortisation 4,796
500 Impairments and Reversals
0 Interest Paid
(364) Dividend Paid (794)
(4,393) (Increase) / Decrease in Trade and Other Receivables 3,331
2,663 Increase / (Decrease) in Trade and Other Payables 1,141
(3,040) Increase / (Decrease) in Provisions (1,434)
123 Net Cash Inflow / (Outflow) from Operating Activities 7,937
70 Interest Received 112

(886) (Payments) for Property, Plant and Equipment (4,319)
13 Proceeds from Disposal of Propery, Plant and Equipment
(2,747) (Payments) for Intangible Assets (12,513)
0 Proceeds from Disposal of Intangible Assets
(3,550) Net Cash Inflow / (Outflow) from Investing Activities (16,720)
(3,427) Net Cash Inflow / (Outflow) before Financing (8,783)
0 Public Dividend Capital Received

0 Public Dividend Capital Repaid
0 Other Loans Received
0 Other Loans Repaid
0 Other Capital Receipts
0 Cash Transferred (to) / from Other NHS Bodies
0 Net Cash Inflow / (Outflow) from Financing Activities 0
(3,427) Net Increase / (Decrease) in Cash and Equivalents (8,783)
24,778 CASH / EQUIVALENTS / (BANK OVERDRAFTS) AT START OF FINANCIAL YEAR 21,351
21,351 CASH / EQUIVALENTS / (BANK OVERDRAFTS) AT END OF FINANCIAL YEAR 12,568

34
Annex D
Capital Investment Programme Budget Plan

2010/11
£,000
Information and Communications Technology
Network Management 148

Network File Access 213
IVR & offsite CS Usage 212
Communications Server Telephony Platform 500
Health Information Directory 1,896
Purchase of Hardware equipment 100
Total ICT 3,069
Premises Related
Replacement Chairs 120

Great Place to Work Pathfinder Sites 500
Air conditioning enhancements - Bristol 440
Air conditioning enhancements - Datacentre 550
Uninterruptable Power Supply - Nottingham 158
Refurbishment and Fitout - HQ relocation 500
Refurbishment of Ground Floor Newcastle 300
Refurbishment and other estates costs 350
Total Premises 2,918
Corporate and Financial Systems
E-Procurement 190
Enterprise Information System 750
ESR/CCC Intergration project 196
Upgrade of Ledger System/Service Line Reporting 64
Total Financial Systems 1,200
Other
CS Content and Perpetual IPR Licence 19,995

Self Assessment Tool (SAT) 210
Mobile Access to NHSD Website 120
Total Other 20,325

Contingency 500
TOTAL 28,012

Annex E
Cost Improvement Programme Savings Cost Net

2010/11 2010/11 2010/11
£'000 £'000 £'000
Strategic Development Programme - Phase 1
Rationalise Business Support (CP2) 1,668 0 1,668
Business Intelligence system (CP4) 0 296 -296
Virtualisation - Networking Dental (DT1a) 759 0 759
Service Delivery Roles; Contracts Framework (DT2) 3,371 688 2,683
Build Team Performance & Team Leader capability (DT3) 2,976 295 2,681
Band 5 Nurses (DT5a) 900 16 884
Knowledge Management (FS1) 0 359 -359
Prepare and deliver 3DN and SPA pilots (FS2) 0 76 -76
SAT Development (FS6) 3,278 1,531 1,747
Our Values (CE1) 0 32 -32
Strategic Development Programme - Phase 2

Mobile Version of NHSD Website (FS3) 0 69 -69
Senior Management Development Programme (CE2) 0 80 -80
KSF Appraisals 0 60 -60
Sickness Absence Reduction 400 120 280
Homeworking 0 430 -430
Web Analytics 0 159 -159
Patient Satisfaction IVR 0 150 -150
Clinical and Non Clinical Content of SAT 0 70 -70
Implement revised portfolio of enhanced services (FS3) 0 33 -33
Great Place to work (DT6) 0 140 -140
Project Management Framework (CP1) 0 80 -80
Target to be achieved via SDP2/other 1,250 0 1,250
Relocation of HQ 30 0 30
ICT Contracts 5,476 1,400 4,076
Total 20,108 6,084 14,024

36
Annex F
Risk and Opportunites Maximum Probability Realistic

2010/11
£,000 % £,000
RISKS
Cross Subsidisation 2,000 50 1,000
KPIs 6,000 33 2,000
Enhanced Services Income 3,000 50 1,500
Capacity Plan assumptions not fully achieved 18,000 33 6,000
Target SDP Phase 2 Savings 3,000 33 1,000
Target SDP Phase 1 Savings 12,952 30 3,880
3 Digit Number costs/losss of income TBD TBD TBD
TOTAL RISKS 15,380
OPPORTUNITIES
Application of Risk Reserve 3,500
Accelerate SDP Phase 2 Savings 2,000
Sickness Absence Improvement 5,000 50 2,500
TOTAL OPPORTUNITIES 8,000

Annex G
Analysis of Changes to Income and Expenditure

Forecast Outturn 2009/2010 to Proposed Budget 2010/2011
£,000 £,000
FORECAST OUTTURN 2009/2010 1,500
Changes to Income
Changes to core contract funding -10,923
Add back estimated penalties and contract variation 2009/10 2,998
Inflationary funding for core contract 4,900
Development funding for the core contract 1,750
Changes in other enhanced services income 1,220
Changes to fluline -32,897
Other income changes 429
Total Changes to Income -32,523
Changes to Expenditure
Inflation @ 2.4% for pay, 2.5% non pay, incremental drift 4,900
Strategic Development Programme Increased Savings Phase 1 -12,952
Strategic Development Programme Increased Savings Phase 2 -1,680
Strategic Development Programme Cost of delivery (net change) 2,907
Capital charges changes including review of ICT contracts 2,233
Review of ICT contracts -5,476
Changes to Fluline -31,571
Non recurrent benefit in 2009-2010 from Financial Recovery Plan 1,000
Changes in front line staffing for volume and other changes 1,158
Cost pressures 1,611
Development funding for the core contract 1,750
Other allocated reserves 1,483
Contingency reserve 2,000
Changes to anticipated provisions from 09-10 1,399
Total Changes to Expenditure -31,238
PROPOSED BUDGET 2010/2011 215

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NHS Direct

Section 1 Strategic Context 5

Section 2 Business Plan 10

Strategic objective 1: raise the quality and productivity of our services 11

Strategic objective 2: increase the value we create for patients, public,

Strategic objective 3: improve the culture of our organisation through

Strategic objective 4: be a great place to work and an employer of choice 19

Strategic objective 5: take advantage of new opportunities and plan

Strategic objective 6: improve our corporate effectiveness and efficiency 23

Section 3 Financial Plan 2010/11 26

Business Plan 2010/11

Section 1: Strategic Context

Introduction External environment

Business Plan 2010/11

Changing nature of health demand Economic climate

The technology which powers these new communication channels

We will identify specific areas where our infrastructure and expertise

Business Plan 2010/11

Health policy initiatives Our plans for the future

Finally, we will need to respond to the continuing challenges and

We are working with the NHS to develop innovative services, and we

Business Plan 2010/11

Our vision for the next four years:

Business Plan 2010/11

Business Plan 2010/11

• raise the quality and productivity of our services;

Business Plan 2010/11

Strategic objective 1: raise the quality and

Category Deliverable/Key Performance Indicator KPI 09/10 Lead

Business Plan 2010/11

Deliverable Measurement Owner

Deliverable Measurement Owner

Business Plan 2010/11

Deliverable Measurement Owner

Deliverable Measurement Owner

Business Plan 2010/11

1.5. Create a more efficient and affordable contact centre operation

Deliverable Measurement Owner

Deliverable Measurement Owner

Business Plan 2010/11

Strategic objective 2: increase the value

Category Deliverable/Key Performance Indicator KPI 09/10 Lead

Deliverable Measurement Owner

Business Plan 2010/11

Deliverable Measurement Owner

£17.6 million of income is received from locally commissioned Director of Strategy

Business Plan 2010/11

Deliverable Measurement Owner

Deliverable Measurement Owner

Business Plan 2010/11

Strategic objective 3: improve the culture

Category Deliverable/Key Performance Indicator KPI 09/10 Lead

3.1. Embed our values in all that we do

Deliverable Measurement Owner

Business Plan 2010/11

Strategic objective 4: be a great place to

Category Deliverable/Key Performance Indicator KPI 09/10 Lead

4.1. Develop flexible and responsive ways of working

Deliverable Measurement Owner

Business Plan 2010/11

Deliverable Measurement Owner

Deliverable Measurement Owner