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NHS Direct chief executive’s e-mail to staff on uncertain future

More than half of NHS Direct jobs faces axe as service loses bids, says Nick Chapman

Exaro today publishes a devastating e-mail sent by NHS Direct chief executive Nick Chapman to staff about the uncertain future for the helpline service.

He sets out how NHS Direct has lost out on most of the local contracts to run new 111 helpline services in England. He says that more than half the 2,500 jobs at NHS Direct will go.

Exaro publishes the e-mail in full below. Sent a fortnight ago, it outlines which contracts were won by NHS Direct. It reads:

From: Nick Chapman
To: All NHS Direct staff
Subject: November Update on Our Future

Dear colleague,

Since the day that I joined NHS Direct in April 2009, I have sought to keep you informed about all of the important developments that affect us. I hope that you feel that I have done this honestly and conscientiously. I shall continue to do this throughout the changes that the next few months will bring. Today, I am writing to you to fill in some more important details about the future NHS Direct, and how we shall move forward to create the future organisation.

I am sorry that this e-mail is quite lengthy, but there is a lot to cover. Here is a quick overview of the contents:

• Our position on 111 bids
• Sites that will definitely be retained and a note on other sites
• An overview of staffing in the future NHS Direct
• An update on staff transfers to other 111 providers
• The picture for the coming months, including delivering the 0845 service, the up-coming all-staff consultation and open forums

111 bids

Since 2010, we have been on a journey set by the government’s decision to replace the 0845 service. We expect that when the bidding process is complete there will be 44 new locally-commissioned NHS 111 services in England. The most recent competition to end is the one for East London and the City, and I am pleased to report that, in partnership with two local GP out-of-hours organisations, we have been selected as the preferred provider for this area of London. This brings our share of the 111 service nationally to 33.7 per cent, with 11 new services. This leaves only two areas that have not chosen their 111 providers (Devon and Leicestershire & Rutland), which together account for just four per cent of England. I have added an updated map to the end of this message [see PDF below], which shows the providers of the 111 service selected for each area of England.

We have emerged as the single biggest provider of the 111 service. This is a testament to the hard work and skill of our bid teams led by Ruth Rankine, our director of strategy and planning, and to everyone who has contributed to our reputation as an organisation that provides excellent services for patients, and which local health communities regard as a trusted delivery partner.

Mobilising the new 111 services

While this is good news, we have not hidden from the fact that the decommissioning of the 0845 service and its replacement by 111 will bring with it change for all of us who work for NHS Direct. We now face the task of rapidly mobilising the necessary people, facilities and systems needed to enable the new 111 services to ‘go live’ for the public over the next five months. This work is being led by Tricia Hamilton, our chief nurse and clinical director.

I know that what most people really want to know is, which sites will host the new services, and what the future holds for our other sites. I can now confirm that the new 111 services will be provided from:

• Carlisle
• Middlebrook [Bolton]
• Dudley
• Milton Keynes
• Exeter
• London
• Home working (where suitable and appropriate to the needs of the service)

The configuration in London has not yet been finalised, as the decision by East London and City was only announced by the commissioners this week, and we are finalising contracts with Sutton and Merton and South East London commissioners. We shall update you on the London configuration shortly.

These decisions have been based on careful consideration of the contracts that we have won, commissioner requirements and the capacity that we need to deliver these services.

The future of other sites

Chatham, Milton Keynes and Hedge End [Southampton] will remain open until November 2013 to continue to provide the appointments-line service. We do not yet know the process for the re-procurement of the ‘choose and book’ service, including the appointments line, but we shall keep you updated as news of this is released by the NHS Commissioning Board.

Beyond this, the future of the remaining NHS Direct sites is uncertain, as we await decisions from the NHS Commissioning Board on the future of services that are not directly replaced by the new 111 service (including ‘health and symptom’ checkers and ‘click for nurse’ assessment, ‘health information and medicines’ enquiries, and ‘dental nurse’ assessment). As I mentioned in my e-mail last week, we currently expect these decisions to be made by the end of November, and we shall keep you up to date with developments. We are also continuing to seek other locally-commissioned services, for example support for patients with long-term conditions and supporting ambulance trusts with further nurse assessment.

Staffing in the future NHS Direct

Trevor Smith, our finance and performance director, and interim managing director of the future NHS Direct, has been leading the team designing the future NHS Direct. The new organisation will look and feel very different to the current NHS Direct.

The type and number of jobs at each of the new 111 sites – both for front line and supporting staff, and the processes for appointing staff into these, has not yet been finalised, but we do know that the overall number of jobs in NHS Direct will be substantially lower than it is currently – most probably, less than half the current number. We shall be entering a period of consultation with staff and staff representatives beginning on December 3, during which all of these details will be presented and discussed.

Transfers of front-line staff

Health advisors, nurse advisors, senior nurse advisors, clinical leads, shift managers and team managers in areas where NHS Direct has not been selected as the preferred provider have known for some time that they should expect to be transferred to the new 111 provider for their area. This is through the so-called ‘Cabinet Office guidelines’ process, which is being led by Roger Rawlinson, our HR and transition director. Transfers of staff to other NHS providers (mostly, ambulance trusts) have been proceeding smoothly, with the notable exception of the North East. Members of staff in these areas have been engaged with their local transition teams in discussing the details of transfer arrangements.

However, movement of staff to non-NHS providers (such as GP out-of-hours providers) has encountered legal problems relating to the protection of employment rights. We have sought a resolution of these problems with the Department of Health, but have not been able to find one. This is no reflection on the non-NHS providers, and is not of their making; indeed, many of these providers are very keen to have NHS Direct staff transfer to them to help with their own mobilisation of the 111 service. The position, which I can now confirm, is that the movement of staff in the areas won by non-NHS providers will proceed now on a volunteers-only basis. Only members of staff who volunteer to move to non-NHS providers (in the full knowledge of what employment-protection rights they do have) will do so.

If you are in the groups listed above and/or are unsure of your position, please speak to your manager or local transition lead… They will be able to help you with further information on the circumstances in your local area. You can also pass any questions you may have through your engagement champions, who will happily bring up any issues on your behalf.

Delivering our existing services

We are rising to the challenge to continue to provide our existing 0845 and other associated services safely for our patients and to a high standard until the progressive switchover of 0845 to 111 is completed. Most of the switchovers happen in March, with the majority not until March 21. This presents us with a double-running problem, since during January, February and March we shall be running both our new 111 services and 0845. For this reason you will see an increasing number of agency and in-sourced staff joining our service so that we have enough staff to cover this period.

You will also know that we are progressing with training on the ‘pathways’ system to ensure that we continue to deliver safe and effective 0845 and 111 services during this double-running and switchover period. This training will also equip front-line staff to work in the new 111 services, whether that is with NHS Direct or another 111 provider.

Formal staff consultation

We shall be entering a period of formal consultation with staff and staff representatives from December 3. We have been discussing the consultation arrangements and process with staff representatives for some weeks, and shall continue to work closely throughout.

A consultation document outlining as much information about the structure of future NHS Direct as we can, including job roles and locations will be made available to all staff on December 3. During the consultation, we shall agree the process by which appointments will be made to the new posts. Above all, this process will be fair and transparent, and will give prior consideration for permanent posts to permanent NHS Direct staff. Anyone who becomes redundant following the consultation period will not receive their formal redundancy notice until after March 2 at the earliest. For the avoidance of doubt, any redundancies for NHS Direct staff that do occur will adhere to the ‘agenda for change’ agreement, including periods of notice and redundancy payments.

Next steps

November 26: staff consultation submitted to NHS Direct board for approval
December 3: staff consultation commences
December 3: first collective consultation meeting held
Early December: open forums commence for all sites

Open forums

As I mentioned last week in my email to everyone, we shall be holding open forums at the beginning of December. We shall be able to give you much more information at that point. At these open forums, members of the board will present the information available, and we shall ensure that there is a good opportunity for discussion and questions.

And finally

I understand that you will most probably still feel uncertain about the future, and have questions to which you would like the answers. I understand how frustrating it is to still be in this position. My board colleagues and I shall to continue to keep you up to date with developments as soon as we are able.

Arrangements to support all staff have been put in place, with dedicated space at our major sites, and online and telephone support. Details can be found on the support zone on the intranet. This provides practical help to find new employment or to consider a career or retirement option, as well as understanding the opportunities to remain with the future NHS Direct. I would strongly urge you to make use of these facilities.

As always, I welcome feedback and questions directly to me. You can also post questions to [e-mail address redacted].

In the meantime, thank you for your continued commitment to the service, and patience and good sense in handling the uncertainty that we are all facing.

Nick

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