title: Developing and validating a new national remote health advice syndromic surveillance system in England.
abstract: Public Health England (PHE) coordinates a suite of real-time national syndromic surveillance systems monitoring general practice, emergency department and remote health advice data. We describe the development and informal evaluation of a new syndromic surveillance system using NHS 111 remote health advice data.
  
  
  
  NHS 111 syndromic indicators were monitored daily at national and local level. Statistical models were applied to daily data to identify significant exceedances; statistical baselines were developed for each syndrome and area using a multi-level hierarchical mixed effects model.
  
  
  
  Between November 2013 and October 2014, there were on average 19 095 NHS 111 calls each weekday and 43 084 each weekend day in the PHE dataset. There was a predominance of females using the service (57%); highest percentage of calls received was in the age group 1-4 years (14%). This system was used to monitor respiratory and gastrointestinal infections over the winter of 2013-14, the potential public health impact of severe flooding across parts of southern England and poor air quality episodes across England in April 2014.
  
  
  
  This new system complements and supplements the existing PHE syndromic surveillance systems and is now integrated into the routine daily processes that form this national syndromic surveillance service.
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Harcourt
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Morbey
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: P
authors.initials: P
authors.lastname: Loveridge
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: L
authors.initials: L
authors.lastname: Carrilho
authors.affiliation: South Central Ambulance Service NHS Foundation Trust, Bicester OX26 6HR, UK.
authors.forename: D
authors.initials: D
authors.lastname: Baynham
authors.affiliation: Digital Assessment Service, Health and Social Care Information Centre, Leeds BL1 2AX, UK.
authors.forename: E
authors.initials: E
authors.lastname: Povey
authors.affiliation: NHS Pathways, Health and Social Care Information Centre, Leeds LS1 4HR, UK.
authors.forename: P
authors.initials: P
authors.lastname: Fox
authors.affiliation: NHS Pathways, Health and Social Care Information Centre, Leeds LS1 4HR, UK.
authors.forename: J
authors.initials: J
authors.lastname: Rutter
authors.affiliation: Operations and Assurance Services, Health and Social Care Information Centre, Exeter EX2 5SE, UK.
authors.forename: P
authors.initials: P
authors.lastname: Moores
authors.affiliation: NHS Choices, Health and Social Care Information Centre, Southampton SO30 2UN, UK.
authors.forename: J
authors.initials: J
authors.lastname: Tiffen
authors.affiliation: NHS Choices, Health and Social Care Information Centre, Southampton SO30 2UN, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bellerby
authors.affiliation: NHS Pathways, Health and Social Care Information Centre, Leeds LS1 4HR, UK.
authors.forename: P
authors.initials: P
authors.lastname: McIntosh
authors.affiliation: Nursing and Quality Directorate, NHS England, South Region, UK.
authors.forename: S
authors.initials: S
authors.lastname: Large
authors.affiliation: Respiratory Team, Health Protection Scotland, Glasgow G2 6QE, UK.
authors.forename: J
authors.initials: J
authors.lastname: McMenamin
authors.affiliation: Respiratory Team, Health Protection Scotland, Glasgow G2 6QE, UK.
authors.forename: A
authors.initials: A
authors.lastname: Reynolds
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: S
authors.initials: S
authors.lastname: Ibbotson
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: G E
authors.initials: GE
authors.lastname: Smith
authors.affiliation: Real-time Syndromic Surveillance Team, National Infection Service, Public Health England, Birmingham B3 2PW, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Elliot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D004739:England / Q000453:epidemiology; D005260:Female; D058006:General Practice; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health; D019114:Remote Consultation; D013222:State Medicine; D013223:Statistics as Topic / Q000592:standards*; D055815:Young Adult
keywords: epidemiology; primary care; public health