ITEM 13 Risk Management Report
North Lanarkshire Council · 19 June 2024
Back to Health and Social Care Integration Joint Board — 19 June 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 13 SUBJECT: Risk Management Report TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie , NL HSCP Chief Officer Author(s) of Report Stacey Anderson, Support Services Project Manager DATE: 19th June 2024 1. PURPOSE OF REPORT This paper is coming to the IJB for: For approval ☒ For endorsement ☐ To note ☐ The purpose of this report is to provide a summary to the IJB on risk management activity, noting any amendments or additions to the current risk register. 2. ROUTE TO THE BOARD This paper has been: Prepared By: ☒ Reviewed By: ☐ Endorsed By: ☐ By: The Support Services, Project Manager and Chief Officer North HSCP.
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3. RECOMMENDATIONS 3.1 The IJB is asked to note the contents of the report which includes the latest version of the IJB risk register and a note of those operational risks highlighted by the Heath & Social Care North Lanarkshire partnership that impact upon delivery of IJB business. 3.2 Following changes to the financial position across NHS Lanarkshire, North Lanarkshire Council and North Lanarkshire IJB it is recommended that the financial challenges risk is reviewed and consideration made to increasing the risk level of the risk from High to Very High. 4. VARIATIONS TO DIRECTIONS? Yes ☐ No ☒ N/A ☐ 5. BACKGROUND/SUMMARY OF KEY ISSUES From a good practice and sound governance perspective, all public bodies are required to identify and take account of the impact of any potential risks in delivering their business. 5.1 BACKGROUND/SUMMARY OF KEY ISSUES (CONT.) 5.1.1 The PFA Committee has delegated oversight and responsibility for financial and performance risks associated with the remit of the Integration Joint Board. 5.1.2 A full review of the risk management reporting within the IJB has taken place as part of the risk strategy review and in line with the dynamic developments and changes the new NHS Lanarkshire Risk Manager is implementing within the board. This review included how risk reporting is managed and presented at IJB and a further evaluation of the improvement methodology aligned with the risk actions. In order to provide a robust overview of these developments, a risk management session was held at the IJB Liaison Session in November 2023. Moving forward the IJB will continue to receive a risk management overview report and the IJB PFA will receive a risk in focus report to enable deeper discussion around risk actions and mitigations and strength the IJB risk governance processes. 5.1.3 Following on from the risk report presented at the IJB meeting on the 27th March 2024, alongside the financial update report, it was agreed by the board that the Financial Challenges risk rating would increase from High to Very High. 5.1.4 At the IJB PFA meeting on 22nd May 2024, the following risk changes were approved: 2
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3 Delivery of CAMHs service, risk rating reduced from High to Medium Ineffective Governance arrangements, risk rating reduced from Medium to Low. Unscheduled Care, risk rating reduced from Very High to High. Introduction of a new risk relating to pharmacy pressures within prison service rated high and adult social care (this risk is currently being developed). 5.1.5 Following these changes there are currently two other risks rated as Very High on the IJB risk register. IJB 06/21 – Prescribing Activity and Costs IJB 01/21 – Financial Challenges 5.1.6 There following risks are rated high on the IJB risk register. IJB 04/21 - Notional Set Aside Budget IJB 12/21 - Staff Health & wellbeing IJB 15/22 – Cost of Living IJB 16/22 – National Care Service IJB 19/23 – Service Sustainability IJB 20/23 – Workforce Sustainability IJB 21/24- Pharmacy Pressures within Prison Service IJB 12/22 – Unscheduled Care 5.1.7 There are a number of high/very high rated operational risks that have been identified as having or potentially having an impact on IJB objectives and/or delivery of services and these are highlighted within the Risk Register (Appendix 1) and Risk Dashboard (Appendix 2). .
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4 6. CONCLUSIONS 6.1 The IJB currently has 19 risks identified on its IJB risk register with 10 risks rated as high or very high. 6.2 Risks identified by H&SC NL as potentially impacting on IJB business are highlighted in the report. 6.3 Following changes to the financial position across NHS Lanarkshire, North Lanarkshire Council and North Lanarkshire IJB it is recommended that the financial challenges risk is reviewed and consideration made to increasing the risk level of the risk from High to Very High. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centered on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐
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5 People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) 7.3 FINANCIAL This paper has been reviewed by Finance: Yes ☐ No ☒ N/A ☐ 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner IJB Risk Register Choose an item. Multi 7.5 ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details Involve stakeholders in the development work aimed at achieving the national outcomes 1. Provide stakeholders with information on how to get involved Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs
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6 1. Measure how well we involve community stakeholders in the planning, design and delivery of our services Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes ☐ No ☒ N/A ☐ EQIA added to website: Yes / Date added ☐ No ☐ N/A ☒ 8. BACKGROUND PAPERS None.
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7 9. APPENDICES Please include a glossary of terms if not already included. Appendix 1 – Risk Register Appendix 2 – Risk Overview Dashboard CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Stacey Anderson Stacey.Anderson3@lanarkshire.scot.nhs.uk
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8 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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9 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 1 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges. The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. HIGH CONTROLS 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between North and South Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plans have been agreed and are reviewed regularly. 7. IJB medium term financial plan 2023‐26 and reserves strategy 2023‐24 approved at March 23 IJB 8. Capacity plans in place to maximise efficiency. 9. IJB Integration Scheme setting out the budget recovery processes. 10. IJB Financial Regulations and financial procedures. 11. Consultation and involvement with key stakeholders including service users and carers. 12. Prescribing Quality and Efficiency Programme, SWEG, ARG and Home Support monitoring groups are in place. 13. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 13. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 14. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. ACTIONS 1. Annual budget setting processes within each of the partners. 2. HSCP participating in NHSL Sustainability and Value process 3. Partnership will also be connected to new national whole system groups around budget VERY HIGH M edium Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.06.2024 Previously IJB2, IJB7, IJB10 and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and updated Jan 2024. Reviewed and updated March 2024. IJB02. 21 Financial Reputational 01/04/2021 Prevention and Detection of Fraud, Bribery and/or Corruption There is a risk that the IJB is unable to prevent and detect fraud and corruption within services because of inadequate governance arrangements and inadequate internal control systems which could lead to financial and reputational damage. LOW CONTROLS 1. Fraud awareness e‐learning. 2. National Fraud initiative. 3. Locality/SW Enablement Groups. 4. Segregation of duties in relation to authorising and processing direct payments. 5 Whistle blowing policies. 6. Procurement processes and standing orders. 7. Oversight via NLC Audit and Scrutiny Panel and NHSL Audit Committee. 8. Effective governance arrangements are in place and subject to internal and external audit review. 9. IJB and IJB PFA meetings established ensuring effective oversight of financial performance. 10. The IJB does not maintain its own policies relating to the prevention and detection of fraud and error but instead depends on those in place at its partner bodies. The IJB has a Code of Conduct in place to which members subscribe and the Members’ Registers of Interests are publicly available on the IJB’s website. LOW LOW Ross M cGuffie Amanda Kilburn SLT, IJB PFA, IJB 31.08.24 Previously IJB6. Reviewed and updated on March 2023. Reviewed and Updated Oct 2023, (previously title ineffective governance arrangements). Reviewed May 2024 ACTIONS 1. Continue to raise fraud awareness through teambriefings. 2. Annual planned Procurement and Standing Financial Instructions presentations. 3. Annual review of Code of Conduct 4. Review of how Members' Declaration of Interests are collated andreviewed. 5. IJB to request Fraud prevention and detection reports from both partners for oversight at the IJB PFA.
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9 Report Prepared by Stacey Anderson on behalf of the Chief Officer IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH CONTROLS 2. There is complete transparency and ongoing dialogue between the IJB and the Health Board on the challenges associated with the implementation of the notional set‐aside concept. 3. Bed modelling and capacity planning arrangements are in place. 4. Effective working relationships between both partners and the IJB have been established. 5. Since the inception of the IJB, an agreement is in place whereby the NHSL Health Board will manage the overspend or underspend across the notional set‐aside budget. This arrangement continues to be in place for 2022/23 ACTIONS 1.The Chief Officer and the Chief Financial Officer continue to raise this concern at a national level. 2. Discussions ongoing with NHSL Director of Finance around unscheduled care spend in 2023/24 and budget for 2024/25 HIGH MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed Jan 2024 Reviewed May 2024 IJB05. 21 Financial Strategic 01/04/2021 Hosted Services There is a risk of dispute between the North Lanarkshire IJB and the South Lanarkshire IJB in respect of the financial allocations underpinning the Hosted Services particularly as a result of the budget changes linked to the implementation of devolved locality models. This could impact on the ability of each IJB to achieve its commissioning intentions and may also have an adverse impact on service users across Lanarkshire. VERY HIGH CONTROLS 1. North and South IJBs aim to co‐operate to ensure a pan‐Lanarkshire approach is achieved across all hosted services. 2. Financial and budgetary controls. 3. Performance reports on service delivery. 4. The Hosted Services principles in respect of the management of the overspends and underspends are agreed for each financial year. MEDIUM MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.2024 Reviewed Jan 2024 Reviewed May 2024 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. Medium CONTROLS 1.. Prescribing Quality and Efficiency Programme. 1. Prescribing Management Board functions and membership. 2. Deputy Lead Pharmacist supporting HSCP Senior Leadership Team. 3. Locality Pharmacist input. 4. Earmarked reserve established to address prescribing costs. 5. Regular HSCP monitoring. In respect of the regulation of medicines and medical devices, the Medicines and Healthcare products Regulatory Agency (MHRA) became the UK’s sovereign regulator. 6. The new trade deal contains specific clauses that mean both the UK and EEA states formally recognise each other’s good practice in medicine manufacturing. 7. To reduce the risk of divergence from the EU rules, there are three interrelated factors; the technical annexes of the new trade deal, the Northern Ireland protocol and the UK Internal Market Act. 8. The effectiveness of the Border Operating Model to import and export goods to and from the EEA, which was being implemented in stages from 2020 to minimise any risk of disruption, is still being assessed. The risk of border delays is still evident. Other measures were also implemented specifically to mitigate the risk of supplies of medicines and medical devices being disrupted. In August 2020 the UK government instructed medicine suppliers to maintain a stockpile equivalent to six weeks’ supply though the first three months of 2021. In addition, the Department of Transport has secured additional freight capacity to bring medicines into the country via other routes. ACTIONS 1. Review of Locality Prescribing Action Groups. 2. Prescribing part of NHSL Sustainability and Value structures 3. Continuation of Scriptswitch. 4. Prescribing updates being provided to IJB as per financial reports VERY HIGH LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.08.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated (risk increased) October 2023. Reviewed Jan 2024 Reviewed June 2024. IJB07. 21 Financial Strategic 01/04/2021 Third and Voluntary Sector There is a risk that Third Sector organisations in North Lanarkshire are vulnerable because of the lack of certainty in respect of long‐term funding security. This uncertainty has the potential to lead to service instability, recruitment and retention challenges and an increasing reliance on statutory services. HIGH CONTROLS 1. Third Sector Interface represented on key strategic groups. 2. Community capacity building and carer support infrastructure embedded across North Lanarkshire. 3. Community capacity building is regularly reviewed. 4. Maximising funding opportunities for the third and voluntary sector will continue to be progressed. ACTIONS 1. The annual HSCP funding which is directed to the third sector is recurring funding. Funding will be confirmed each year in line with the agreement of the IJB Financial Plan and subject to the Scottish Government financial settlements for future years. 2. Updated SLA with VANL nearing completion LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.06.24 Previously IJB16. Reviewed April 2024.
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10 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 1 North Lanarkshire Integrated Joint Board Risk Register 1 w R IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.10. 21 Financial Strategic 01/04/2021 Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. There is no / limited public access to IJB and PFA meetings during the period of the pandemic, in line with Public Health advice. 4. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 5. Communications with employees, patients and service users may be ineffective. 6. There will require to be changes to the working environment including remote working and working from home. 7. There is a reduced ability to protect the wellbeing of employees, patients and service users. 8. There may be adverse media coverage locally, a loss of public confidence and reputational damage. MEDIUM CONTROLSa t i o n a l N e t o r k s a r e LOW LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 30.10.24 Reviewed and updated June 2023. Reviewed and updated Oct 2023. Reviewed and updated Jan 2024. Reviewed and risk level lowered June 2024. IJB.11 21 Performance 30/07/2021 Oversight of Performance Activity There is a risk that the IJB is not provided with adequate or sufficient performance information to enable it to discharge its scrutiny and oversight role; make informed decisions and recommend remedial actions to address any performance concerns. LOW CONTROLS Regular (quarterly) reports on the IJB performance framework, providing updates on areas for improvement, remedial actions (and timescales) and updates on performance issues previously reported. Chief Executive Performance Review arrangements. Hosted Services Performance Review arrangements. Sector/Locality Performance Review arrangements. LOW LOW Ross McGuffie M orag Dendy SLT, IJB PFA, IJB 31..10.24 Reviewed May 2024. IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium Controls Strategic Staff Health & Wellbeing Committee established reporting to NLC & NHSL corporate management teams. Range of support services available both nationally and locally e.g Occupational Health, Spiritual care, Psychological Services, national wellbeing hub (www.PRoMIS.scot.uk). Rest & Recuperation areas identified. Peer Support Networks established Well established Occupational Health supports available to support staff sickness. Actions Short Life Working Group for wellbeing with targeted approach for immediate actions including Staff Health & Wellbeing Champions, access to online supports, access to Occupational Health Services, helpline established and dedicated resource identified for wellbeing officers to be recruited. Funding received by Scottish Government specifically targeting staff wellbeing programmes and supports. Local plans for use of funding being developed. Managers supporting & encouraging staff to take planned leave/use full leave allocation HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.08.24 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed May 2024. IJB.13. 2021 Performance 30.08.21 Care Homes Inability of care homes to sustain service due to staffing and cost pressures resulting in closure to new placement and closure of care homes. This may increase delayed discharge numbers putting additional pressure on acute site capacity and impacting on recovery. High Controls Establishment of Care Home Assurance Team. Escalation Process in place. National protocol to support discharge of Covid 19 patients in place. Actions Public Health teams providing guidance on infection control. Care Home assurance team undertaking support visits to all care homes & action plans in place for each care home. All care homes advised to use PPE in line with national addendum. Development day on 12th May 23 to agree structures and approach for year ahead medium medium Ross McGuffie Trudi M arshall IJB, PF&A, SLT, SC&SC, A H &SC 28.08.24 Reviewed and updated Oct 2023 Reviewed May 2024. .
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11 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 1 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.14. 2022 Strategic & Performance 30.04.22 CAMHS ‐ There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Very High Controls ‐ Prioritisation of referrals; all referrals 1vetted daily with urgent referrals prioritised Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments Secured significant national investment to fully implement new service model Active review of skill mix to utilise medical staff only when required for highly complex patients Vacancy gap analysis with active recruitment commenced. Expected to have recruited 75% of gap by end of May 2023 Continuous review and validation of the waiting list Action Incremental implementation of the new service model CAPA appointments begin on 1st May 2023 ‐ first cycle (16wks) nearing completion Medium medium Ross McGuffie M orag Dendy IJB,PF&A, SLT 28.02.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and risk level lowered May 2024. IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High CONTROLS NLC Silver command group stood up focused on cost of living NHSL commenced review through CMT Population Health Committee to review activity around cost of living NLC approved cost of living contract increases in May 2023 ACTIONS Survey of NLC hybrid workers to see if home working remains financially viable Business case being developed to expand 'support for people' arrangements used in pandemic to support resident access to welfare rights and other supports 3% increase in individual budgets to support service users to maintain current levels of supports at higher cost Recommendation from adult social work, care and wellbeing committee to review all charges to service users and wider cost of High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.08.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed May 2024. IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High CONTROLS NLC establishing NCS working groups Key HSCP leads involved in national developments Ongoing progress updates to IJB and IJB PFA ACTIONS IJB response submitted on proposed Bill Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups SG/COSLA working groups being established ‐ local reps nominated for each High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 31.08.24 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High CONTROLS Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision NHS CMT and Covid response group oversight of performance Daily PDD meetings to review every planned supported discharge and delayed discharge Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges ACTIONS Expansion of Home Support service Roll out of Home Assessment Teams across all 6 Localities by Feb New CSW roles in District Nursing teams to proactively support Care Managed patients Additional Nursing capacity in District Nursing Teams Expansion of Equipment and Adaptation Service to support rapid access in community Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand 5 Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.08.24 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024. Reviewed and risk level reduced May 2024.
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12 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 1 North Lanarkshire Integrated Joint Board Risk Register IJB ID Category Opened Date Description of Risk Risk level (initial) Mitigating Controls Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.18. 2022 Strategic and Performance 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. High CONTROLS Working group established to coordinate all activity Oversight through Home Support Programme Board Reporting to Adult Social Work, Care and Wellbeing Committee Reporting to IJB ACTIONS NLC Committee approval to purchase 1000 digital alarms so the service can support any imminent changes over to digital in individual areas NLC part of SG once for Scotland procurement process for a new digital alarm receiving center Communication out to all community alarm service users Instructions issued to all community alarm service users on how to do test calls to ensure alarms are operational Engagement with telecommunication suppliers to ensure sight of roll out plans across NL Medium Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASW C&W B 28.07.2024 Reviewed and updated June 2023. Reviewed Oct 2023. Reviewed Jan 2024. Reviewed April 2024. IJB.19. 2023 Performance 27/02/2023 Service Sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety High Controls IJB PFA Committee. IJB Chief Officer is a member of each partner's key decision‐making forums. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. Regular budget meetings with Chief Executives and Directors of Finance. Regular HSCP budget monitoring meetings across Senior Leadership Team. The IJB Financial Plan is regularly reviewed and agreed. Capacity plans in place to maximize efficiency. Consultation and involvement with key stakeholders including service users and carers. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. Strategic Planning Group, Locality engagement sessions and Partnership Boards. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions Sustainability plans to be reviewed regularly Re‐introduction of scrutiny panels Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. Review of reporting process into IJB to ensure continuous review of services/ service developments. Development of the programme of work to ensure regular reporting structure in place for service review. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond. High Low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.02.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024. Reviewed April 2024.
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13 Report Prepared by Stacey Anderson on behalf of the Chief Officer Appendix 1 North Lanarkshire Integrated Joint Board Risk Register IJB.20. 2023 Workforce Sustainability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. High CONTROLS All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. Development of the Care Academy Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support ACTIONS Annual workforce plan being prepared NHSL programme underway to support international recruitment On the day recruitment events being trialed in Home Support Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support. High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.07.24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24 Reviewed April 2024. IJB21. 24 Financial Pharmacy Pressures within Prison Service Pharmacy costs have traditionally been the highest area of non‐pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. High CONTROLS Review of the dispense processes within the prison Implementation of guidelines Improved communication with pharmacy provider ACTIONS Prescribing Action Group re‐established to try and manage the number of items prescribed Development of pain and medicine management pathways Review of prescribing habits High Low Ross McGuffie Ross McGuffie IJB PFA, IJB 30/07.24 Added to register May 2024.
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15 Appendix 2 NL H&SCP Risk Overview Report Meeting Name – IJB PFA Reporting Period: IJB PFA Risk Register – May 2024
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16 NL HSCP IJB Risk – Dashboard 2024 Executive Summary Risk movement since last report No Change Increase Decrease New Closed Risks with updated actions 4 3 2 10 IJB Highest Scoring Risks NL H&SCP Risks Reported to Assurance Committees Service risks‐ Service level Level 3‐ North Health Professional/ Operational Group and Support Care and Clinical Governance Risk Overview Process NL H&SCP IJB Risk Register – IJB and IJB PFA Level 2‐ Core Risk Register Number of Risks IJB 19 NL Council NHS Lanarkshire 21 Risk Score Trend IJB 06/21 Prescribing Activity and Costs VH IJB.01/21 Financial Challenges VH
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17 Level 3‐ Very High and High Risks ‐ Summary IJB ID Category Opened Date Description of Risk Risk level (initial) Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.01/ 21 Financial Strategic 01/04/2021 Financial Challenges There are a range of financial challenges which will impact on the IJB's ability to deliver the Strategic Commissioning Plan intentions within the financial envelope available. These include: 1. The absence of a unique IJB financial settlement from the Scottish Government. 2. The IJB is dependent on funding from both partners. 3. Late Scottish Government financial settlement. 4. Budget reductions due to insufficient Scottish Government financial settlements and/or partner contributions. 5. New Scottish Government policy commitments e.g. Carers (Scotland) Act 2016. 6. Demographic growth. 7. Competing service priorities. 8. Conflicting partner efficiency savings programs which adversely impact on the HSCP's ability to deliver services. 9. In‐year cost pressures emerging due to the underachievement of planned savings, pandemics and other emerging risks which may lead to an overspend. 10. Each partner may be unable to maintain their financial contributions to the IJB in future years which would impact on frontline health and social care services. 11. The agreed transformational plans and service redesigns are not implemented in full and in line with the original implementation plan and/or do not secure the intended improvement outcomes in both performance standards and financial efficiency targets. 12. Future savings targets will continue to be challenging and are likely to impact on essential core services. 13. The IJB Financial Plan cannot be adhered to and budget recovery plans fail to achieve financial balance for both partners. 14. The continuing recovery from the pandemic on the financial sustainability of external providers in particular social care providers. 15. The financial implications of the continuing impact of the pandemic on the workforce e.g. increase in sickness absence, early retirement requests and recruitment challenges The above factors would lead to a failure to achieve the desired strategic aims and would also impact on service delivery. HIGH VERY HIGH MEDIUM Amanda Kilburn Amanda Kilburn SLT, IJB PFA, IJB 28.06.2024 Previously IJB2, IJB7, IJB10 and IJB12. Reviewed and Updated May 2023. Reviewed and Updated Sept 2023. Reviewed and Updated Jan 2024. Reviewed and risk increased March 2024.
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18 IJB ID Category Opened Date Description of Risk Risk level (initial) Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB04. 21 Financial Strategic 01/04/2021 Notional Set‐Aside Budget There is a risk that resources will not be transferred from Acute Services to the HSCP in line with the shift in the balance of care from residential and acute settings to community based alternatives as expected in terms of the notional set‐aside concept. This includes the ongoing development of locality pathways to support maintaining people at home e.g. transitional care models. VERY HIGH HIGH MEDIUM Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28.026.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed Dec 2023 Update being provided to IJB in Jan 2024. Reviewed May 2024 IJB06. 21 Financial Operational 01/04/2021 Prescribing Activity and Costs The cost of prescribing is growing due to issues in supply chains driving increased wholesaler cost of medicines, advance treatment developments resulting in the need for more expensive medications, aging population and increase in patients requiring regular medication. Medication availability has been impacted following the EU withdrawal the UK 's membership of the common regulatory bodies and EU agencies, such as the European Medicines Agency, (EMA), European Centre for Disease Prevention and Control and the European Atomic Energy Community. The risk is that this could impact on the availability of medicines, healthcare techniques and technology and in respect of the supply of medicines and medical devices, additional checks are now required at ports in the UK and the EEA before goods, including medical products, can cross the border. New customs checks are required when moving medicines between the EEA and the UK. Medium VERY HIGH LOW Ross McGuffie Amanda Kilburn SLT, IJB PFA, IJB 28..06.24 Previously IJB11. Reviewed and updated June 2023. Reviewed and Updated October 2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024
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19 IJB.12. 21 Performance 30/08/2021 Staff Health & Wellbeing There is a risk to the delivery of the Strategic Commissioning Plan as a result of sustained pressures on staff availability due to additional pressures associated with Covid 19, current sickness absence levels and potential for further staff redeployment due to winter planning contingency arrangements. medium HIGH low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB, SC&CG, AH&SC 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Report on Staff Health and Wellbeing due to IJB in March 2024 Reviewed and updated May 2024
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20 IJB ID Category Opened Date Description of Risk Risk level (initial) Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.14. 2022 Strategic & Performance 30.04.22 CAMHS ‐ There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. Very High Medium medium Ross McGuffie Morag Dendy IJB,PF&A, SLT 28.06.2024 Reviewed and Updated May 2023. Reviewed and updated Dec 2023. Reviewed and updated March 2024 Reviewed and risk reduced May 2024 IJB.15. 2022 Strategic & Performance 05.09.22 Cost of Living There is a risk that the IJB's Strategic Commissioning Plan will be unable to be delivered or not have the desired impact due to the cost of living rises being faced by residents across North Lanarkshire, leading to a further widening of the inequality gap, reduced quality of life and increased health and social care demand due to individuals and families having insufficient funds to support basic requirements such as food and heating. High High Medium Ross McGuffie Ross McGuffie SLT, IJB 30.06.2024 Reviewed and Updated May 2023. Reviewed Oct 2023. Reviewed and updated March 2024. Reviewed and updated May 2024 IJB.16. 2022 Strategic 05.09.22 National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. High High Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASWC&WB 31.06.24 Reviewed and Updated May 2023. Reviewed and Updated Oct 2023. Updated being provided Jan 2024. Reviewed and updated May 2024. IJB.17. 2022 Strategic & Performance 05.09.22 Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. Very High High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.026.2024 Reviewed and Updated in June 2023. Reviewed Oct 2023 Reviewed Jan 2024. Reviewed and risk lowered May 2024
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21 IJB ID Category Opened Date Description of Risk Risk level (initial) Risk level (Current) Risk level (Target) Risk Owner Risk Register Lead Assurance Source Next Review Date Closed Date IJB.18. 2022 Strategic and Performance 05.09.22 Community Alarms There is a risk that the community alarm system will be destabilised due to the national change from analogue to digital telephony by 2025, leading to community alarm users not getting a response when required. High Medium Low Diane Fraser Ross McGuffie SLT, IJB PFA, IJB, ASWC&WB 28.06.2024 Reviewed and updated June 2023. Reviewed Oct 2023. Reviewed Jan 2024. Reviewed May 2024 IJB.19. 2023 Performance 27/02/2023 Service Sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety High High Low Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.06.2024 Reviewed and Updated May 2023 Reviewed and Updated Oct 2023. Reviewed and updated Jan 2024 Reviewed and updated May 2024. IJB.20. 2023 Workforce Sustainability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. High High Medium Ross McGuffie Ross McGuffie SLT, IJB PFA, IJB 28.06. 24 Reviewed and Updated May 2023 Reviewed and updated Oct 2023. Reviewed and updated Jan 24 Reviewed and updated May 2024
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22 Current – High Target – Medium Risk in Focus – De‐escalated Risk Trend Risk Level Reduced A range of controls, actions and mitigations have been put in place since the risk was initially created in April 2022. On creation the risk was originally provided with a risk level of very high. The risk level was reduced to high in May 2023 following implantation of a range of actions by the service. Following further implementation of regular report, reviews by the scrutiny panel and further actions being implemented it is for consideration by the IJB for further risk rating reduction. Risk Description Risk Owner Risk Lead Delivery of CAMHS Service There is a risk that the CAMHS service cannot meet the increasing clinical demands due to a significantly high number of cumulative staff vacancies for both clinical and non‐clinical posts and challenges recruiting to new posts identified through the national recovery and renewal fund. This is impacting on community, in‐ patient and out‐ patient care with the potential to adversely affect response time to referrals; longer waiting times; poorer outcomes; delays in redesign and reputation of the IJB. RMc MD Current Controls 1. Prioritisation of referrals; all referrals vetted daily with urgent referrals seen 2. Commenced programme of work and implementation of a more structured partnership approach through Choices & Partnership Approach (CAPA) service model, with tier 1 & 2 referred through 3rd sector and interfacing with North & South Education Departments 3. Secured significant recurring investment to fully implement new service model 4. Completed review of skill mix to utilise medical staff only when required for highly complex patients 5. Vacancy gap analysis with active recruitment commenced. Expected to have recruited 50% of gap by end of May 2022 (5 3 % achieved) 6. Continuous review and validation of the waiting list 7. Waiting list validation exercised completed in April 2022 with reduction in list by 16% 8. New SL CAMHS facility at Udston Hospital became operational in June (this is a vital development to create physical capacity for implementation of the new CAMHS model) 9. Established programme board to oversee both incremental implementation of the service model and performance 10. All work streams in train 11. Dedicated Recruitment Team Actions 1. Incremental implementation of the new service model 2. Performance monitoring through the programme board 3. CAHMS IT Board in train to plan and oversee implementation of SCI gateway for referrals 4. Waiting list initiative commenced 5. Udston opened for patients September 2022 6. upgrade to North physical infrastructure agreed. Update 28th December 1.CAMHS WLI now embedded. 2. Monthly monitoring at board ongoing. 3.CAPA be introduced AND will be on trakcare to go live March 2023. There will be a concurrent WLI as above. 4.Close working with health improvement and GP reps
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23 Current medium Target - low Risk in Focus – De‐escalated Risk Trend Risk Level Reduced and details updated The risk was originally created in April 2021 and detailed concerns around the ineffective governance arrangements following the Covid Pandemic. The risk was updated in Dec 2023 to review the mention of Covid. Following implementation of a range of actions and a review of the governance processes across the H&SCP it is for the IJB to consider if the risk level can be reviewed. Risk Description Risk Owner Risk Lead Ineffective Governance Arrangements 1. There is a risk that the intensity of the required response to Covid‐19 may have resulted in a failure of governance impacting on the effectiveness of the IJB decision‐making, IJB directions to partners and IJB oversight of operational service delivery. Routine governance processes could be overwhelmed. 2. New or amended legislation and Scottish and UK Government guidance may not be adopted effectively and timeously. 3. Ineffective information governance controls could lead to data breaches and an impact on the General Data Protection Regulations. 4. Communications with employees, patients and service users may be ineffective. 5. There will require to be changes to the working environment including remote working and working from home. 6. There is a reduced ability to protect the wellbeing of employees, patients and service users. There may be adverse media coverage locally, a loss of public confidence and reputational damage. RMc AK Current Controls CONTROLS 1. National Networks are established which are providing the framework to support a national approach where appropriate. 2. Public Health advice and support is in place. 3. Increased numbers of agile workers and increased number of laptops/tablets. 4. Continued working from home arrangements supported by the roll out of MS Teams / Zooms. Regular updates on the guidance for the use of MS Teams / Zoom Meetings is circulated. A blended approach to home/work‐based working is being developed going forward. 5. Risk registers are in place for the IJB and each partner. Each partner has a specific HSCP Covid‐19 Risk Register in place. 6. The IJB and both partners aim to comply with the European Working Time Directive (WTD) and minimise the risk of all staff working beyond 48 hours per week, in particular front‐line service delivery. As a result of the withdrawal from the European Union, the WTD ceased to apply to the United Kingdom at the end of the transition period (31 December 2020). However, the UK's Working Time Regulations which implement the EU Working Time Directive will continue to apply unless and until amended by UK law. 7. Back to Basics exercise has helped to focus on the underpinning governance requirements across the whole HSCP Actions ACTIONS 1. Staff health and wellbeing is a key priority for both partners and all key stakeholders. The commitment to staff health and wellbeing is being actively promoted through all available forums. 2. Work carried out to embed governance processes within the H&SCP including risk review, complaints, patient feedback, adverse events. 3. IJB Governance reporting reviewed and associated documents updated.
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24 Current – VH Target‐ Medium Risk in Focus – De‐escalated Risk Trend Risk Level Lowered The risk was created in Sept 2022, due to a concern regarding sustaining flow during peak winter due to increasing patient demand. The risk was originally provided with a Very High Risk Rating. Since the creation of the risk a range of mitigations and actions have taken place including Operation Flow, increase resource and service development of key areas including frailty, H@H, discharge support. It is for the IJB to consider if the implementation of these actions now reduced the risk rating for this risk. Risk Description Risk Owner Risk Lead Unscheduled Care There is a risk that we cannot sustain whole system patient flow through peak winter pressures due to increased front door demand; hospital workforce capacity; delays in onward movement of patients due to care home capacity/outbreaks and care at home capacity; and community health and social care workforce capacity leading to reduced ability to meet 'routine' and increasing bed demand for more unwell patients, deteriorating delayed discharge performance and an inability to recover services. RMc RMc Current Controls CONTROLS 1. Care Home Assurance Group and associated supports for care homes through liaison service, IPC advice and support, risk assessment for onward movement of patients etc. 2. Care at Home Assurance group and associated activity to try to support and sustain independent sector provision 3. NHS CMT and Covid response group oversight of performance 4. Daily PDD meetings to review every planned supported discharge and delayed discharge 5. Operation Flow now underway to ensure whole system approach to unscheduled care/delayed discharge challenges Actions ACTIONS 1. Expansion of Home Support service 2. Roll out of Home Assessment Teams across all 6 Localities by Feb 3. New CSW roles in District Nursing teams to proactively support Care Managed patients 4. Additional Nursing capacity in District Nursing Teams 5. Expansion of Equipment and Adaptation Service to support rapid access in community 6. Expansion of H@H service (hours of provision as well as moving to support discharges as well as admission prevention) 7. Expansion of Integrated Rehabilitation Teams in all six Localities to support rehab in the community and reduce long‐term service demand 8. 5 Task and Finish groups now established to roll out the key actions agreed through the Operation Flow programme (Phase 2 to be completed by Sept 23) 9. Firebreak implemented Jan 2024.
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25 Current – High Target‐ Low Risk in Focus – Review Risk Trend Risk Review The risk was created in Feb 2023 due to competing service priorities and workforce/operational and financial challenges. A range of actions have been implemented following the creation of the risk including introduction of scrutiny panels, improved risk reporting across H&SCP and development of the programme of work. Risk Description Risk Owner Risk Lead Service Sustainability Due to competing service priorities and workforce/ operational and financial challenges there is a risk that the IJB will be unable to implement the strategic plan/commission plan. Failure to achieve the desired strategic aims of the IJB poses a risk on operational service delivery and the achievement of financial balance and patient safety RMc RMc Current Controls Controls 1. IJB PFA Committee. 2. IJB Chief Officer is a member of each partner's key decision‐making forums. 3. Effective joint working between Chief Financial Officer and both Council and NHS Finance Departments. 4. Regular budget meetings with Chief Executives and Directors of Finance. 5. Regular HSCP budget monitoring meetings across Senior Leadership Team. 6. The IJB Financial Plan is regularly reviewed and agreed. 7. Capacity plans in place to maximize efficiency. 8. Consultation and involvement with key stakeholders including service users and carers. 9. Joint Strategic Needs Assessment and ongoing move towards preventative and anticipatory approaches. 10. Strategic Planning Group, Locality engagement sessions and Partnership Boards. 11. Effective and ongoing service user engagement, staff consultation and Trade Union liaison at strategic and local levels. Actions Actions 1. Sustainability plans to be reviewed regularly 2. Re‐introduction of scrutiny panels 3. Improve linkage across all risk registers (tiers 1 to 3, council and NHS) to help ensure areas of concern are identified and reviewed regularly. 4. Review of reporting process into IJB to ensure continuous review of services/ service developments. 5. Development of the programme of work to ensure regular reporting structure in place for service review. 6. Operation Flow Task and Finish Groups analyzing service challenges and implementing phased changes to support winter pressures and beyond.
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26 Current – High Target‐ Low Risk in Focus – Review Risk Trend Risk Review The risk was created in Feb 2023 due to competing service priorities and workforce/operational and financial challenges. A range of actions have been implemented following the creation of the risk including introduction of scrutiny panels, improved risk reporting across H&SCP and development of the programme of work. Risk Description Risk Owner Risk Lead Workforce Sustainability It is becoming increasingly difficult to recruit to particular roles across Health and Social Care. Gaps in the workforce can result in reduction of service provision, increase in staff workload and inability to deliver the strategic plan. Following EU withdrawal there is no longer the free movement of labour between the UK and EEA countries. All workers arriving from the EEA and non‐EEA countries are subject to the same immigration rules. The new points‐based immigration system makes exceptions for the majority of health care professionals with an NHS job offer and for qualified social workers via a new fast‐track visa route, known as the Health and Care Worker Visa. There are however no exceptions made for other social care roles, such as care workers. The Mutual Recognition of Professional Qualifications Directive is an EU‐wide directive that allows professional regulators in all member states to automatically recognise professional qualifications. The UK government has decided to continue recognising qualifications gained in the EEA for at least two years after the transition period ends. This however is not a reciprocal and there is no guarantee that qualifications gained in the UK will be accepted by professional regulators in EEA nations. RMc RMc Current Controls CONTROLS 1. All successful Health and Care Worker Visa applicants are exempt from the Immigration Health Surcharge, a one‐off charge levied against arriving migrant workers as part of the visa application process. The system has been designed to make international recruitment into health and social care roles more straightforward for employers and employees alike. These changes to immigration rules are in law as part of the Immigration and Social Security Co‐ordination (EU Withdrawal) Act 2020. As such, from 1 January 2021, they apply to all workers arriving to work in the NHS or adult social care. All workers from EEA nations who are already resident in the UK had until 30 June 2021 to apply for the EU Settlement Scheme which will guarantee their right to work in the UK indefinitely. 2. In respect of the mutual recognition of professional qualifications, professional regulatory bodies are working with the UK government to review future registration requirements for those with qualifications gained in the EEA and decide what they will be from January 2023. 3. Development of the Care Academy 4. Dedicated HR support identified in NHSL and NLC to support key priority areas of recruitment such as Mental Health and Home Support Actions ACTIONS 1. Annual workforce plan being prepared 2. NHSL programme underway to support international recruitment 3. On the day recruitment events being trialed in Home Support 4. Use of university status being explored following positive gains in Podiatry and Psychological Therapies recruitment 5. Recruitment of 15 Modern Apprenticeships within the H&SCP working within Business Admin, Comms and Health Care Support.
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27 Risk in Focus – National Care Service Current – High Target‐ Low Risk Trend Risk Review This risk was initially created in September 2022. Although the North Lanarkshire IJB has little control over the National Care Service, work is ongoing to ensure NL IJB is involved in the decisions has much as possible. NL IJB received an update paper on the National Care Service on the 24/01/24., with a recommendation for the IJB to review the current National Care Service risk to ensure it fit for purpose. Risk Description Risk Owner Risk Lead National Care Service There is a risk that the ongoing work around a National Care Service could destabilise current service delivery due to significant change activity, time demands around the co‐design process, staff uncertainty and partner organisations having to focus inwardly due to the impact of change leading to an impact on the ability to deliver the significant ongoing change programmes already approved by the IJB and the Strategic Commissioning Plan for 2023‐26. RMc RMc Current Controls CONTROLS 1. NLC establishing NCS working groups 2. Key HSCP leads involved in national developments 3. Ongoing progress updates to IJB and IJB PFA Actions ACTIONS 1. IJB response submitted on proposed Bill 2. Strong partnership links into working groups at Chief Officers, Chief Finance Officers and Social Work Scotland groups SG/COSLA working groups being established ‐ local reps nominated for each
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28 Risk in Focus – Pharmacy Pressure within Prison Service Current – Very High Target‐ Low Risk Trend New Risk Following the Prisoner Healthcare Report presented to IJB PFA on the 22nd May 2024. The IJB PFA recommended that a Pharmacy Pressure within Prison Service Risk was added to the risk register. Risk Description Risk Owner Risk Lead Pharmacy costs have traditionally been the highest area of non‐pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. There is currently a large overspend (559K reported May 2024) for the actual drugs bought and £246K associated with the management fees for the contract. MT RMc Current Controls CONTROLS • Review of the dispense processes within the prison • Implementation of guidelines • Improved communication with pharmacy provider Actions ACTIONS • Prescribing Action Group re‐established to try and manage the number of items prescribed • Development of pain and medicine management pathways • Review of prescribing habits
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29 Risk in Focus – Adult Care Staffing Target‐ Low Risk Trend Risk Description Risk Owner Risk Lead Currently being developed MT RMc Current Controls Actions