1. Background and context

1.1 This System Co-ordination Centre (SCC) specification builds on the previous version released in August 2023. It reflects the expansion of the national OPEL Framework and broad learnings following implementation of version 2.0.

1.2 ‘System’ in this document refers to Integrated Care System (ICS). The SCC provides an operational platform within the ICS for the whole health economy, including local authority, primary care, and voluntary, community and social enterprise partners.

1.3 This SCC specification makes clear the purpose, key deliverables and minimum operating requirements, referred to as the Required Operational Standards (ROS), that all SCCs should meet. A breakdown of the ROS is available in Section 8.

2. Purpose

2.1 The SCC exists to be a central co-ordination function for providers of care across an ICS footprint, with the aim to support patient access to the safest and best setting possible.

2.2 As part of their role, SCCs will be responsible for the co-ordination of an integrated system response using the Operating Pressure Escalation Level (OPEL) frameworks alongside constituent ICS providers and ICB policies. The OPEL frameworks contain specified and incremental core actions for the SCC at each stage of OPEL escalation.

2.3 The SCC is responsible for facilitating interventions across the ICS on key systemic issues that influence patient flow. This would include a concurrent focus on UEC and the system’s wider capacity including, but not limited to, NHS111, Primary Care, Intermediate Care, Social Care, Urgent Community Response and Mental Health services.  

3. Expected outcomes from SCC operations

 3.1 Real time visibility of operational pressures and risks across the patient pathway

Senior operational and clinical leaders will have an aligned view of the operational pressures, performance and risks within ICS footprint which should support collective action, mutual support and dynamic management of risk to improve patient safety.

3.2 Central co-ordination of capacity and action

A system capacity view of all cross-sector providers in community, mental health and acute care should lead to a collaborative effort to improve performance to benefit patients. In line with local policies and OPEL Frameworks, the SCC should utilise and share data to identify trends, and predictable and emergent activity to support forward planning and early intervention.

3.3 Improved clinical outcomes

The SCC’s unique position supports collaborative working across the ICS which enables a timely response at a system level, assisting local providers to deliver the right care at the right time.

4. Governance

4.1 The SCC is a constituent part of the ICB and, as such, should facilitate collaboration within the system through its operational and clinical leadership. It is important that the SCC is recognised as the ICB’s ‘real-time’ forum for operational oversight, co-ordination, communication and decision-making.

4.2 An identified executive-level member will be accountable for the SCC at ICB Board This executive will ensure that there is co-ordination across the whole patient pathway using a shared network of escalation policies including OPEL frameworks. The executive member will be supported by a senior responsible officer (SRO) or equivalent who will lead the business planning and strategic oversight of the SCC.

4.3 The ICB will ensure that there is appropriate clinical oversight and support for SCC operations. Further detail available in Section 5.

4.4 Where the ICB chooses to collaborate with another ICB to share one or more functions of the SCC, the Required Operational Standards (ROS) as described in Section 8 of this specification must be met for each ICB to maintain operational maturity.

4.5 The ICB will support the SCC in developing and maintaining a reporting framework for the ICB Executive either as part of wider reporting arrangements or on its own. This would include a set of local metrics based on Sections 3 and 4.7 of this specification and would cover frequency of Where relevant, due consideration will be given to:

• all parameters outlined in the OPEL Frameworks
• urgent and Emergency Care flow measured by Time in Department (TiD) including 4 hour performance
• ambulance Category 1 and 2 response

As part of its reporting, the SCC may highlight areas of greatest risk across the patient pathway including noting any unwarranted variation in system performance, and whether SCC’s actions are harnessing the desired impact. This could cover (but is not exhaustive of):

• ambulance to hospital handover and individual long handover waits
• time of Arrival to 12-hour delays and patients being cared for in inappropriate settings
• delayed discharges (acute and community)
• bed occupancy (acute and community)
• alternatives to admissions including Virtual Wards
• urgent Community Response (UCR) response times and other relevant community-based operational data

4.6 The ICB will consider the role of the SCC

4.6.1 In embedding and complying with the Patient Safety Incident Response Framework 2022 and which may include:

• providing intelligence and participating in the development and review of patient safety incident response plans across the system as required
• encouraging providers in the ICS to work together to explore Patient Safey Incidents which highlight opportunity for learning across relevant pathways
• supporting proactive safety improvement by facilitating the sharing of good practice

4.6.2 Reducing health inequalities in line with local policies and programmes

4.7 Complementing the role of the SCC as defined in the OPEL Frameworks, the ICB will ensure that the SCC has a defined role within system policies, covering but not limited to: 

4.7.1 Local provider Full Capacity protocol (or similar) that seeks to maintain the timely flow of patients through the emergency department (ED), mental health, community settings and other parts of the health system. This may include the role of the SCC in brokering conversations between health and social care providers on identifying capacity to support providers within the ICS footprint at times of surge.

4.7.2 Protocols covering ambulance conveyance and handover pressures (or similar) that ensures an effective response to increased pre-hospital demand, long waits in the community for ambulabces and/or an incident that requires specialised resources. This may cover ambulance handover waits in excess of local and national thresholds, and the role of clinical member (s) of staff involved in the SCC regarding ambulance diverts.

4.7.3 Protocols covering access to mental health inpatient services (for all ages) or similar that would specify system actions to mitigate risk of patient waits in excess of local thresholds, heightened clinical risk and poor patient

4.7.4 System communication policies or similar that would cover the interface between the SCC and the ICB communication team. Enabling patient choice or providing guidance to the public during critical events or dates should be a key aim of a joint communications plan.

4.7.5 Inter-hospital and intra-hospital transfers or similar policies that would cover the role of the SCC in monitoring, actioning and escalating cases of patients awaiting specialised care or return to local hospital or place of care in excess of local and national thresholds. It would also define a minimum level of information required to support with such transfers.

4.7.6 Incident management including EPRR, ensures that the role of an SCC is outlined in the ICB Incident Response Plan and describes how it will provide real-time data and system intelligence to the Incident Co-ordination Centre (ICC).

4.7.7 Protocols covering escalation of primary care pressures that seek to ensure patients who can be treated in primary care remain in primary

4.7.8 Protocols covering access to intermediate and social care including escalation of issues to ensure a joined up approach to co-ordination of actions in the wider system, and to support with delays for patient transfers. This may also cover interface between the SCC and Transfer of Care Hubs, and access to intermediate care data collections to support monitoring of discharge delays and balancing of risk within the system.

4.8 The SCC leadership is expected to lead a regular review of the effectiveness of the (SCC related) actions as defined in local system policies and seek amendments as required.

5. Roles and responsibilities

5.1 The ICB will ensure that the SCC has sufficient resources to meet the ROS (Section 8). This section covers recommended roles and responsibilities, although ICBs will be expected to adapt these to their local context as long as the ROS (Section 8) continues to be met. The recommended occupational standards for staff in the SCCs is available in Appendix A.

5.2 During operating hours, a senior member of staff will assume the role of SCC room lead (or equivalent). This role adopts day-to-day senior decision-making and will ensure the SCC is delivering the operating protocol to full effect as detailed in section 6. The SCC room lead is responsible for the oversight of system capacity, demand and escalation across the ICB. This includes briefing the SRO (or equivalent) on prospective and actual deployment of system protocol or exceptional intervention during this time.

5.2.1 Outside the SCC’s core operating hours, the SCC room lead will provide a handover and action plan to the Director on-call (DOC) who will assume responsibility for the SCC function, as specified in section 5.5.

5.3 Depending on the size and complexity of the ICS, the number of personnel and skill mix required to support the SCC room lead will be determined locally. This should be based on an assessment of the resources required as a minimum to deliver the ROS as laid out in Section 8 and with due consideration to the Recommended Occupational Standards for SCCs. As part of this assessment, due consideration should be given to the roles and function of operational staff, analytics and business support to support the SCC room lead.

5.4 The ICB will ensure it has either SCC room leadership (SCC room lead) with current clinical registration (medical, nursing or paramedic), or an operating structure that enables input from senior clinicians in the This is to ensure that there is clinical insight to planning the SCC’s local actions and co-ordination of mitigation in response to pressure in the UEC and wider system pathways. The ICB will agree locally how it ensures access to clinical support, dependent on its chosen operating model. Further guidance is available in Appendix A.

5.5 To support oversight outside the SCC’s core operational hours, a Director on-call (DoC) will be available to provide strategic leadership, support local decision-making and co- ordinate system actions as required. The ICB will be expected to ensure that the role of the SCC DOC is embedded within local system protocols (section 4.7) with consideration given to OPEL Frameworks and national requirements that would determine escalation of relevant issues and risks to the

5.6 The SRO (or equivalent), in consultation with the SCC room lead, will be responsible for determining the suitability of location for SCCs with local consideration for hybrid or virtual working as appropriate.

5.7 SCC staff will be trained to optimise the use of local digital solutions, real time data and other related reporting This may include identification of unwarranted variation within the ICB footprint, data quality issues and opportunities for improvement. This would support staff in being able to proactively identify emerging risks to performance, flow and patient safety.

6. Operating protocol

6.1 The SCC will be required to develop and maintain a Standard Operating Protocol (SOP) that defines its function and key deliverables. This will be reviewed on an annual basis.

6.2 The SOP will include the following as a minimum:

6.2.1 The role of SCC in ensuring the ICB and the providers are compliant with the OPEL frameworks and local system policies. This may include reporting of the OPEL score and delivery of key actions as defined in the OPEL Frameworks and local system policies (Section 4.7) are noted.

6.2.2 A consistent operational cadence that factors in meetings with ICS partners and regional NHS England teams in alignment with OPEL Frameworks and local policies.

6.2.3 Systems and processes in place to co-ordinate and manage returns to regional and national teams. This includes ensuring SitRep and other mandated national and regional returns (or other required reports) are accurate and provided in line with timelines and the Capacity Tracker is completed, including for community-based beds.

6.2.4 Recording and management of notes and the decision-making for all actions in line with the NHS England’s Corporate records management policy.

6.2.5 Minimum staffing profile that allows the SCC to deliver its function and respond effectively to system Roster planning should ensure the availability of a staffing model to meet peaks in demand, both operational and emergent.

6.2.6 SCCs will provide 7-day cover in-line with the regional/national operational model between 0800 hours and 1800 hours. The SCC will have processes in place to provide suitable cover beyond its core operating hours during OPEL 4, or other locally agreed threshold, to ensure a proportionate response to operational challenges or risk of patient harm.

6.2.7 The process for reviewing, co-ordinating and actioning issues relating to data quality, including but not limited to local digital solutions.

6.2.8 Process for undertaking risk assessments within the system, modelled on the National Quality Board’s Principles of Assessing and Managing Risks across the ICS. This would cover changes in OPEL and thresholds for escalation. The SCC is expected to consider risk across a pathway or system, recognising that increasing a risk in one area may reduce a risk in another part of the pathway. The SCC can support providers to manage pressures through a risk-sharing approach.

6.2.9 A set of Internal Professional Standards for the team; modelled on the Recommended set of Occupational Standards for SCCs.

6.2.10 Business continuity arrangements covering events which may impact on the ability of the SCC to co-ordinate response to UEC pressures. This include loss of access to real-time data.

6.3 To support system co-ordination, SCCs should maintain an up-to-date directory of the in-hours and out-of-hours (OOH) system, contacts that cover the entire patient pathway. This would include primary care, urgent community response, intermediate care, NHS111, social care and mental health. Relevant OOH details of such services, including Local Authority, should be available to the DOC.

6.4 As a minimum, the SCC must function during the core operational hours as a single point of contact (SPOC) for local system and NHS England regional operators for correspondence meeting the defined scope of the This will include the availability of a SPOC mailbox that can be accessed by SCC staff.

7. Data and digital

7.1 SCCs will be expected to ensure that their digital enablement meets current and future technical guidance (for SCCs) issued by NHS England.

7.2 The ICB is expected to support the digital enablement of the SCC by ensuring relevant data sharing agreements are in place between the SCC and provider organisations. The agreement will also cover interoperability between the SCC and provider digital systems to support with flow of data to the SCC.

7.3 The SCC must have real time digital software and a process in place to monitor, as a minimum, the following key metrics across the ICS:

7.3.1 OPEL scores, visibility of data for each parameter and scores for the pillars outlined in the current OPEL Frameworks.

7.3.2 Ambulance provider Resource Escalation Action Plan (REAP) level and Clinical Safety Plan or Surge (CSP) level.

7.3.3 System level Ambulance Category 1, 2, 3 and 4 response standards.

7.3.4 Ambulances enroute, on site including volumes and individual waits to be offloaded and handover intervals/mean.

7.3.5 Local CRITCON level and capacity

7.4 The SCC reviews and identifies additional real-time metrics required to support core operations as per its role in the system policies (section 4.6). These are reviewed annually with provider organisations within the system to ensure they remain fit for purpose. The review will also cover internal validity of data flows and adjustments to thresholds.

7.5 The digital software must have the following capabilities as a minimum:

7.5.1 Be able to evolve to meet local needs and future iterations of the SCC specification and OPEL framework.

7.5.2 Accessible through both ‘desktop’ and mobile.

7.5.3 Able to generate notifications to its users on locally determined thresholds for metrics noted in 7.3, to support with rapid action and decision-making.

7.5.4 Able to identify at pace issues with quality of data, including relevant detail to support with resolution.

7.5.5 It is recommended that the local digital software has the functionality to support predictive modelling and forecasting to enable early intervention

7.6 To ensure national, regional and ICS alignment on operational and performance data, SCCs will also have devolved access for their ICB-level data to the following dashboards as minimum:

7.6.1 National UEC SitRep and/or Emergency Care Data Set or

7.6.2 National Ambulance Performance Dashboard.

7.6.3 National Integrated Urgent Care Dashboard (111).

7.6.4 Virtual ward utilisation and

7.6.5 Discharge and length of stay (acute and community).

7.6.6 Capacity tracker.

7.6.7 Primary care dashboards.

7.6.8 Mental health pathway dashboards.

7.6.9 Summary Emergency Department Indicator Table (SEDIT) dashboard.

7.6.10 Adult and Paediatric Critical Care dashboards.

7.7 To support proactive planning and co-ordination of local pressures, ICBs will ensure that the SCC team have access to the following:

7.7.1 System level data, including early warning, on infectious disease and environmental hazards through local UKSHA teams.

7.7.2 Relevant demand and capacity planning data, including forecasting tools to support with pre-emptive operational planning.

7.7.3 System-agreed performance trajectories for UEC standards as well as locally agreed improvement trajectories for operational performance and patient

7.7.4 Local population health insights including health inequalities relevant to the SCC’s core operations that provide additional context on drivers for pressures.

8. Required Operational Standards (ROS) for SCC operations

8.1 Based on the specification in this document, SCCs will be expected to be compliant with the ROS as per the following tables. These are grouped into ‘People’ and ‘Processes’. Each ROS has a corresponding section from this specification noted which provides additional detail.

8.2 The ROS will be subject to an annual assessment as part of seasonal planning and preparedness. This will also include maturity indexing in summer and winter (H1 and H2).

People (PE)

Process (PR)

9. Glossary

• AEO – Accountable Emergency Officer
• CSP – Clinical Safety Plan
• DoC – Director on-call
• ED – Emergency Department
• EPRR – Emergency Preparedness, Resilience and Response
• FCP – Full Capacity Protocol
• G&A – General and Acute
• GMC – General Medical Council
• ICB – Integrated Care Board
• ICC – Incident Co-ordination Centre
• ICS – Integrated Care System
• iUEC – Integrated Urgent and Emergency Care
• NCC – National iUEC Co-ordination Centre
• NMC – The Nursing and Midwifery Council
• OPEL – Operational Pressure Escalation Levels
• ROC – Regional Operations Centre
• ROS – Required Operational Standards (SCCs)
• SCC – System Co-ordination Centre
• SOP – Standard Operating Protocol
• SRO – Senior Responsible Officer
• SPOC – Single Point of Contact
• UEC – Urgent and Emergency Care
• UCR – Urgent Community Response

10. Appendix A: Further guidance on clinician support

10.1 This section sets out guidance on the requirement for clinician / clinical model and recommends practical steps for the SCCs to consider.

10.2 Selecting Clinicians and practical considerations:

10.2.1 For the purpose of the delivery of the SCC specification, SCC may give due consideration to system clinical leaders with current clinical registration (medical, nursing or paramedic backgrounds) with relevant expertise urgent and emergency care pathways and who could support the work of the SCC at pace. It is up to the ICB to determine the level of seniority required to support the SCC.

10.2.2 SCCs are encouraged to use existing clinician on-call arrangements within the ICS (system level) to seek relevant advice where practical.

10.2.3 SCC leadership with clinical background is encouraged but not mandatory or to be used on an exclusionary basis when recruiting to such positions.

10.2.4 The level of clinician coverage for the SCC during in and out of hours may be determined through local risk assessment. This is to ensure clinician cover is proportionate to the level of pressure within the patient pathways and complement existing on-call processes.

10.3 The role of a clinician within the SCC, and as guided by local protocol, is to:

10.3.1 Support the SCC in taking a proactive view and approach on clinical risk mitigation to ensure decisions taken are based on the population’s interests.

10.3.2 Provide clinical expertise in response to system pressures in line with OPEL Frameworks.

10.3.3 Support the SCC room lead to achieve required balance of clinical risk within the system and in line with Dynamic Risk Assessments.*

*The SCC is expected to consider risk across a pathway or system, recognising that increasing a risk in one area may reduce a risk in another part of the pathway. For example, decision to divert ambulances to another provider may lead to ambulances travelling longer distances but could support reduced pressure in the emergency department. The SCC can support providers to manage through a risk-sharing approach.

10.3.4 Support patient centric care during escalation and surges, and guide SCC in achieving clinician on boarding to local policy changes on work led by the SCC.

The clinical responsibility for patients remains at the local trust level. Unless agreed locally, clinicians supporting the SCC are not expected to make patient level decisions.

10.4 The SCC can support the role of the clinician by:

10.4.1 Embedding the role in its daily protocols and processes, and which supports early intervention on clinical risk mitigation.

10.4.2 Co-designing a decision-making framework with the clinicians (part of SCC’s clinical model) that would define the specific thresholds for escalation in line with local and national requirements.

10.4.3 Ensuring that the clinician has timely access to relevant data and dashboards; specific data requirements co-designed locally with the clinician.

10.5 Examples of clinician support models are available on the NHS Futures page for System Co-ordination Centres.

11. Appendix B: Occupational Standards for System Co-ordination Centres

11.1 Context and purpose

This section sets out Occupational Standards for staff operating in SCCs to consider adopting and adapting in support of their roles and as ongoing Continual Professional Development (CPD). Guidance in this section must be read in conjunction with the System Co-ordination Centres Required Operational Standards. 

11.2 Roles covered

11.2.1 Section 5 of the SCC’s Required Operational Standards sets out core roles and responsibilities within each SCC. It is being recognised that

• actual role titles and the nomenclature of roles will vary between SCCs
• staff in some SCCs may undertake core roles on a rotational basis
• seniority and banding of similar roles / job titles may vary between SCCs
• some SCCs may also deliver Emergency Preparedness, Resilience and Response (EPRR) system level functions

This document therefore covers core roles as noted in the Required Operational Standards as opposed to job titles.

11.3 Defining seniority of roles

11.3.1 SCCs are encouraged to benchmark local role banding with those of other SCCs in the region and beyond. Support with benchmarking could be requested either through contacting other SCCs in the region using the SCC Directory available on the SCC Futures page and/or NHS England Regional Teams.

11.4 Internal Professional Standards (IPS)

This section recommends an overall set of IPS for SCC teams.

11.4.1 Purpose: The SCC has a mission statement that defines its purpose in the local system, core values and lays out the ambition for the team. The statement is patient oriented and is co-designed with the team to ensure overall ownership and is reviewed periodically.

11.4.2 Skills: The SCC has a mix of both clinical and operational skill sets to support with system co-ordination. It also annually undertakes a team training needs analysis as part of service delivery strategy and quality assurance to ICB. This may be supported by a localised induction framework which may identify shadowing opportunities for SCC staff across various pathways.

11.4.3 Protocol: Staff in the SCC have a clearly defined role to support the day-today operations and co-ordination. Where action cards are utilised, these align to the actions within the current OPEL Frameworks with exceptions agreed through local clinical governance. These define the routes and thresholds for escalation and align to the escalation algorithms within the OPEL Frameworks. Local protocols include debriefs for team following OPEL 4 / Business Continuity Incident (BCI) / Critical Incident (CI) / Major Incident (MI) for internal learning and reflective practice.

11.4.4 Values: The SCC leadership ensures and leads by example in fostering an inclusive approach on system calls and interactions with provider organisations and internal stakeholders.

11.4.5 Communication: Staff in the SCC are supported to adopt and adapt ‘dynamic’ communication and information recording digital tools for internal and external contacts, and to improve overall pace of response. This could include use of applications that support live multi-user collaboration to maintain a single version of the truth and to support co-ordination of action in real time.

11.4.6 Continuous improvement: Staff in the SCC are supported and empowered to undertake specialised programme activity such as transformation or policy development to support the overall delivery of the SCC and for personal development, and which may be separate to the core day-to-day operations.

11.4.7 Specialist training: Staff in the SCC can demonstrate the role that the SCC plays during incident management and are supported to undertake incident management training such HMIMMS, Principles of Health Command, local equivalent or similar. (Incident management training should be seen in the context of improving the overall health response, of which the SCC will be part of).

11.5 Occupational Standards aligned to SCC roles

This section contains Occupational Standards (OS) recommended for roles within the SCC. Where relevant, the National Occupational Standards (Skills for Health) are reflected in the table below, and indicated accordingly. SCCs are encouraged to support staff in undertaking Continuing Professional Development to develop the role where ‘optional for role’ is indicated, with ongoing CPD to achieve all other NOS.

Skills Requirements for System Coordination Centre Roles

Note: R – Recommended for role, O – Optional for role

Incident Management

Knowledge and understanding of joint working during incident management and the role of SCC in supporting the response to an incident

• Room lead: R
• Room support: R
• Director on-call: R
• Clinician support: O
• Senior Responsible Officer: O
• SCC Executive Board member: O

Risk Sharing and Assessment

Understanding of and ability to deploy risk assessment tools and methods as part of system co-ordination, as set out in the Principles for Assessing and Managing Risks across ICBs

• Room lead: R
• Room support: R
• Director on-call: R
• Clinician support: R
• Senior Responsible Officer: R
• SCC Executive Board member: R

Data and Digital

Locally tailored training covering functionality and use of digital systems and dashboards. This may also cover the effective use of live data to support with system co-ordination

• Room lead: R
• Room support: R
• Director on-call: R
• Clinician support: R
• Senior Responsible Officer: R
• SCC Executive Board member: O

Patient Safety

System level patient safety risk management and mitigations – Levels 1 and 2 including relevant sector modules as a minimum

• Room lead: R
• Room support: R
• Director on-call: R
• Clinician support: R
• Senior Responsible Officer: R
• SCC Executive Board member: R

Management and Administration

INSBA007 Prepare and coordinate operational plans and procedures (Skills for Health)

• Room lead: R
• Room support: R
• Director on-call: Not specified
• Clinician support: Not specified
• Senior Responsible Officer: Not specified
• SCC Executive Board member: Not specified

Foundations in System Leadership; collaborating for Health and Social care

• Room lead: O
• Room support: O
• Director on-call: Not specified
• Clinician support: Not specified
• Senior Responsible Officer: Not specified
• SCC Executive Board member: Not specified

Resilience

SFJ_CCAD1 Develop, maintain and evaluate business continuity plans and arrangements (Skills for Health)

• Room lead: R
• Room support: O
• Director on-call: Not specified
• Clinician support: Not specified
• Senior Responsible Officer: O
• SCC Executive Board member: Not specified

12. Further information and contact

For queries about specification, please contact the National Integrated Urgent and Emergency Care Operations Team at NHS England.

Publication reference: PRN00572