Copy of Strategic Risk Register IJB Sept 24
Argyll and Bute Council · 25 September 2024
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 25 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Classification: OFFICIAL# ARGYLL & BUTE INTEGRATION JOINT BOARD STRATEGIC RISK REGISTER UPDATED AUGUST 2024 Risk Ref and xRef to Strategic Objectives Description Of Risk Consequence Likelihood Impact Risk Rating /Score Mitigations/ Control Measures 2024/25 Likelihood Impact Risk Rating /Score Proposed New Control Measures Risk Owner(s) SSR01 links to B,E,F,J Medium Term Financial Sustainability - risk of financial failure arising from costs and demand outstripping funding. This could be as a result of demand, cost pressures, inflation, failure to deliver savings or as a result of the level of delegated resource to the IJB from Scottish Government and / or partners being insufficient to deliver on strategic objectives. Inability to deliver on the Strategic Plan, reduction in performance, progress not being made in respect of national priorities and targets, reputational damage to IJB and partners and the requirement to implement service changes or reductions that don't line with strategy. Possibility of intervention in management of HSCP. 4- Likely 5 - Extreme VERY HIGH 20 o Financial information reported to Finance & Policy Cttee and IJB for current year and the 3 year budget outlook o Review of funding allocations and settlements from government and partners and engagement with sector networks oFinance & Policy Committee scrutiny of financial performance, risk management, savings programme and financial planning oDelivery of Savings, project management approach to monitor and record progress oFinancial governance, integrated financial reporting, financial risk register, operational and strategic reporting along with modelling of cost pressures. oindependent external audit of accounting and financial planning and reporting process of partners and HSCP oEngagement with budget holders, SIO's and finance teams to improve financial forecasting. oUse of general reserves to protect services and enable longer term approach. 4- Likely 5- Extreme VERY HIGH 20 o Detailed plans under development for use of reserves and refresh of Transformation Programme o Engagement with NRAC funding team and allocations o External audit highlighting risk to IJB, NHSH and A&B Council o Development of both short term and long term savings plans being worked up earlier o HSCP inclusion in NHSH enhanced expenditure control processes being implemented o Plan for investment of reserves and pension fund savings o Awaiting publication of new Scottish Government Spending Review to update financial plans Chief Finance Officer / Chief Officer / SLT ↑ SSR01 (b) Going Concern Status - Risk of financial failure within a 1 year time horizon due to overspending of service budgets, inflation and cost pressures or reductions in funding Inability to deliver on the Strategic Plan, reduction in performance, progress not being made in respect of national priorities and targets, reputational damage to IJB and partners and the requirement to implement service changes or reductions that don't align with the strategic objectives. Possibility of external intervention in management. 4- Likely 5 - Extreme VERY HIGH 20 Mitigations are as above. Budget for 2024/25 has a significant gap, however the HSCP has reserves in place which will able it to fund the anticipated budget gap arising during the year. 3 - Possible 5- Extreme HIGH 15 Level of reserves currently in place mitigate but clawback of funding by partners, spend of reserves and Scottish Budget are increasing this risk at present. Chief Finance Officer / Chief Officer / SLT ↑ SSR02 links to A,B,C,D,E,F, G,H,I,J,K Delivery of Strategic Objectives - Lack of resources to deliver transformational change could lead to a failure to deliver on strategic outcomes and the Strategic Plan. The pace of change to re-design services doesn't keep up with the demographic pressures. Inability to engage with the workforce and communities on the need for change could lead to reputational damage and the increased fragility of health and social care services and poorer health outcomes for local people. 4- Likely 4- Major HIGH 16 ○Locality Planning Groups with agreed terms of reference and engagement strategy guidelines ○Delivery of the annual Savings Plan with EQIAs produced to highlight impacts ○Medium term budget planning integrated with strategic planning ○Performance reporting - management information and transparent reporting to IJB ○Communications and engagement strategies ○SLT reporting structure and links with partner organisations, including Chief Officer representation on partner senior management teams ○Engagement with staff representatives ○Clearly articulated impact on Quality and Performance in all service redesign plans 4- Likely 4 - Major HIGH 16 o New Strategic Plan and Commissioning Strategy consulted widely upon and approved o Roll out of Integrated Performance & Reporting o Further embedding of Locality Planning Groups o Review of transformation programme structure and increased resourcing of key projects o Financial and staffing constraints putting ability of HSCP to deliver on strategic objectives at increasing risk - consideration being given to increasing to very high Chief Officer / SLT ↑ SSR03 Links to B,E,G,H,I Demographic Changes - failure to implement strategies and actions to address future demographic challenges of declining population, reduced working age population and an increase in older people. Failure to accurately forecast the impact on services including shifting the balance of care and implementing new models of care. This could lead to service failure to meet needs of service users and deliver against the Strategic Plan objectives. 5-Almost Certain 4 - Major VERY HIGH 20 ○Strategic Plan and role of Strategic Planning Group ○Incorporation of demographic forecasts into Strategic Planning and Locality Planning ○Locality Planning Groups to inform service re-designs in each locality in line with needs of the population OStrategic Workforce Planning Group established to share data and good practice and develop 3 year workforce plans ○Demand pressures for services incorporated into budget process ○National awareness of demographic changes been driver for change in the way services are delivered ○Ongoing engagement with Community Planning Partners and joint planning 4- Likely 4- Major HIGH 16 ○Resourcing and commencement of prevention agenda and co-production work ○Planning for future workforce demographic changes in Workforce Plan OUpdated Adult Health Strategic Needs Assessment OReview of Transformation and change programme and re-commencement of transformation activities OUpdated population modelling and indication of increasing demand for Older Adult Services Chief Officer / SLT ↑ SSR04 links to J Governance and Leadership - IJB arrangements are not conducive to effective working and lead to poor decision making and lack of strategic direction and inability to have appropriate risk management, contingency and resilience processes in place to reposnd appropriately to emergencies and changing circumstances. Service and reputational damage, lack of confidence in the IJB and inability to deliver on strategic objectives in a consistent manner. 3 - Possible 4 - Major HIGH 12 ○Appropriate representation on the IJB. ○Programme of development sessions for IJB members. ○Integration Scheme reviewed March 2021, Strategic Plan, Standing Orders and Code of Conduct. ○Effective sub-committee structure in place ○Internal Audit review of governance arrangements and recommendations implemented. ○External Audit review of governance and annual governance statement ORegular engagement with Standards Officer and regulatory bodies OFull engagement of Board in development of Strategic Plan and Commissioning Strategy 3 - Possible 4- Major HIGH 12 O Development of continuous improvement to achieve an holistic approach to the overall Governance of the IJB and regular review of performance O Implementation of governance improvement actions and audit recommendations O Strategic Plan approved and in place O Turnover in SLT O Resilience and contingency planning now incorporated within SLT rather than as a separate group and contingency plans in place O Out of Hours pack updated Chief Officer ↑ Gross Risk Residual Risk
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Classification: OFFICIAL# SSR05 links to G,H Partnership Working - service delivery failure due to inadequate relationships with partners including the Council and Health Board and commissioned service providers including NHS GG&C and the third sector. May lead to duplication of effort, poor relationships and the inability to effectively negotiate the IJB's position. The partnership may be viewed as failing or not achieving objectives, leading to reputational damage and loss of confidence in IJB. Could also result in a reduction or loss of services to the community and failure to exploit opportunities for joint working, innovation and efficiencies. 4 -Likely 4 - Major HIGH 16 ○Integration Scheme reviewed outlining roles and responsibilities ○Independent scrutiny arrangements in place and work of internal audit, including assurance mapping. ○Representation on IJB from partners, community representatives and third sector representatives. ○Clear channels of communication and information sharing protocols in place ○Directions are issued to partners in line with strategic direction and operational delivery of services. ○Strategic Planning work with Commissioned Service providers and new Commissioning Strategy ○Third Sector representation on the IJB & commitment to co- production 3 - Possible 4- Major HIGH 12 OApproval of Commissioning Strategy following consultation with partners OResourcing and Commencement of Prevention and Co- Production work and activities and integration of these within Transformation programme OReinvigoration of locality planning groups and engagement with the Local Area Group. ORe-establishment of regular meetings with GGCHB OImproved engagement mechanisms and establishment of prevention and co-production workstreams OImproved engagement with RSLs and the Housing Crisis agenda. ODiscussions with partners over funding becoming increasingly challenging and change management processes within HSCP and partners present a risk to working relationships Chief Officer ↑ SSR06 links to E,J Infrastructure and Assets - Assets are owned by the Council and Health Board. Risk that these do not meet the current and future requirements due to underinvestment in maintenance, equipment and ICT or that assets are not being used or managed efficiently and effectively. Risk assets not being maintained / replaced or being otherwise appropriate to support the IJB's strategic outcomes and do not enable efficient, safe and effective service delivery. Properties will fail to meet standards required by regulators and fail to deliver on carbon reduction commitments. Equipment will become unreliable with additional downtime and ICT infrastructure will not support Digital Transformation ambitions or may add to cyber security risks. Increasing risk of failure which could result in facilities or equipment being unavailable. 5-Almost Certain 4 - Major VERY HIGH 20 O Progressing co-location options with Argyll & Bute Council O Represented on Council and NHS Highland Asset Management Boards O Partnership working to reflect joint planning approach with membership of both partner asset groups ○ Appointment of new senior management post to increase capacity O securing of additional external resource for investment in Tiree and in carbon reduction. o Establishment of Infrastructure Transformation Board 5-Almost Certain 4 - Major VERY HIGH 20 oHSCP Digital / IT strategy now complete to enable TEC / remote working oDevelopment of a strategic approach to the estate and the identification of priorities for investment and replacement of infrastructure assets. oNew Strategic Estates & Sustainability Post and Infrastructure Transformation Board. oBudget suggests NHS capital replacement projects will be halted, costs of projects increasing and insufficient funding to replace or maintain assets. Limited flexibility to spend reserves on asset replacement. oStrategic Assessment work underway to try and get replacement assets in capital pipeline at Scottish Government level - now halted. oFocus to shift to maintenance of existing assets and rationalisation and do minimum approach. Budget is not sufficient to address backlog maintenance or essential asset replacement. Risk increasing. Chief Officer, Head of Strategic Planning and Performance, Head of Finance ↑ Risk relates to both local operational and strategic impacts. SSR07 links to B,D,E,H Sustainability of commissioned service providers - financial and operational sustainability of care at home and care home commissioned service providers deteriorates as a result of financial and workforce pressures. Market failure would lead to disruption of service, the implementation of contingency plans, increased costs and an adverse impact on individuals and their families. Would also impact on the ability of the IJB to deliver on the planned shift in the balance of care. 5 - Almost Certain 5 -Extreme VERY HIGH 25 ○Commissioning team supplier relationship and market management, including contract management and review processes and solvency checks as part of contract management ○Additional funding for providers to facilitate the implementation of wage increases and Fair Work Practices ○Engagement with national work supporting the National Contracting OContingency planning in localities for care at home. Care Home and Care at Home Assurance Group for Argyll and Bute to identify and manage local and short term risks. OStrategically the Care Home Programme Board will assist planning ahead with forecasting demand. ○Engagement with national workforce planning and local training providers around promotion of care professions. 5 - Almost Certain 4- Major VERY HIGH 20 ○ Continuing work with providers in partnership O Ongoing engagement nationally with financial sustainability plans and flexible approach to local support where necessary O Implementation of Strategic Commissioning Plan based on Joint Strategic Needs Assessment O Ability to respond effectively to issues as they arise (eg KCC, Cowal Care @ Home) O Engagement with key providers and project planning to address issues as they arise. O Regular management escalation where issues arise O Effective use of additional winter planning funding to try and improve sustainability of providers O Positive internal audit review provides assurance risk is being managed appropriately. O contingency planning where there are specific issues O Work with Hub North to progress strategic assessment work. Heads of Adult Care, Head of Strategic Planning and Performance ↔ SSR08 links to A Equalities - services are not delivered in a way that addresses inequality or takes into account the needs of those with protected characteristics. Service users are put at unnecessary risk of harm and people with poorer life chances may have their health and wellbeing impacted. Groups with protected characteristics may be perceived to be impacted unfairly. 4 - Likely 3- Moderate HIGH 12 ○Equalities Outcomes Framework in place ○Equalities impact considered as part of IJB decision making and service change. ○Communication with service users as part of implementation of service change using engagement and communication strategies. ○Adjustments to implementation plans are actioned where appropriate to mitigate any potential negative impact. ○Service changes not implemented where this would constitute unlawful discrimination. 4 - Likely 3 - Moderate HIGH 12 o EQIA process are improving but provider sustainability issues have a significant impact on those with protected characteristics Review of Equality outcomes in line with policy o requirement to make savings may result in increasing adverse impacts Chief Officer ↑ SSR09 links to B.C,D,E,F,I,J Scottish Government Policies - risk of further legislative, policy developments or change which impacts on the IJBs ability to deliver on the current Strategic Plan. Inability to deliver SG policies alongside the Strategic Plan and IJB's agreed objectives and the impact of additional unfunded cost pressures. 5 - Almost Certain 4 - Major VERY HIGH 20 ○Horizon scanning for policy developments through partners and SMT network groups ○Regular liaison with senior officers in the Scottish Government and through Cosla Groups ○Respond to Scottish Government information requests on impact of future policies ○Early impact assessment locally for national policies, including any impact in budget outlook ○Implement and adopt innovative ways of implementing policies ○Role of Elected Members and IJB members to influence Scottish Government decision making through political routes OOn-going monitoring of developments with NCS 4- Likely 3 - Moderate HIGH 12 o Engagement in sector developments and networks relating to the implementation of the National Care Service and Single Authority Model proposals oEngagement with government officials including visits to area and meetings to discuss local impacts of NCS oRespond to requests for evidence from parliamentary committees oPositive relationships with key partners, civil servants and politicians oWork on-going tre implementation of Staffing Act oPerceived disconnect between policy landscape and available resources (staff and finance) Chief Officer, Heads of Service ↑
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Classification: OFFICIAL# SSR10 links to B,C,E,H,I,J Workforce Recruitment and Retention - inability to recruit and retain the required workforce because of local or national workforce shortages. This may result in increased costs, increased risk or reduced service. Applies to commissioned services as well as direct provision. Service users needs for particular disciplines or in particular areas may not be met if workforce is not in place. 5 - Almost Certain 5 - Extreme VERY HIGH 25 ○Joint and integrated Workforce Plan ○Strategic Workforce Planning Group to ensure overall visibility of recruitment, retention and development challenges across HSCP ○#abplace2b campaign framework for attracting people into area. OService re-designs to plan for changes to services in line with workforce capacity O Modern Apprentices to reduce average age of workforce O Support commissioned service providers with recruitment and retention, for example supporting implementation of Living Wage and pay rate increases. O Links with Open University assisting recruitment of students for social work and nursing O Programme for delivering SVQs for social care 5 - Almost Certain 4 - Major VERY HIGH 20 ○Strategic Workforce Planning group to implement Workforce Strategy ○Heads of Service and Managers engaged in workforce planning ○Explore further opportunities for Growing our Own including MAs in NHS ○Promote ABC and NHSH as employers of choice and ensure all vacancies promoted using abplace2b.com. OWork to reduce reliance on locum and agency staff OEnsure on-going support for CPD OProgressing options to address housing shortages and progress key worker housing in partnership with Housing Associations, Shelter Scotland and Argyll & Bute Council. SLT / Head of People, Planning and Reward / People Partner ↔ SSR11 links to B,E,F,J,K Communications and Engagement with Communities - risk of inadequate arrangements in place to communicate with stakeholders, communities and partners. Could result in failure to gain community support for service changes and ineffective partnership working with communities. Reputational damage from failure to adequately consult and engage. Could result in failure to deliver planned change. 5 - Almost Certain 4- Major VERY HIGH 20 ○Communication and Engagement Strategies delivered but require to monitor practice through assurance frameworks. ○Openness and transparency of publicly available information ○Communications events and information widely available to engage stakeholders in conversations about service changes and the need for change. ○Engagement with politicians to ensure the Argyll and Bute position is shared and understood. ○Locality Planning Groups and other forums are used to communicate with communities and explore new ways of getting the IJB message across ○Communication plans developed as part of implementation of service changes 4- Likely 4- Major HIGH 16 ○Support local ownership of communications and engagement ○Roll out of social media use at a local level ○Review of Communications and Engagement Strategy and framework. O Deliver communication and engagement plans within guidelines. Ensure conforms to SG guidance "Planning with People" and standards for community engagement. OEffective engagement on strategic plan, commissioning strategy and co-production work. OLocality Planning groups meeting regularly OSupport from Health Improvement Scotland and staff training and awareness raising OImproved budget consultation process launched in 2024 Associate Director Public Health, Communications team, Heads of Service ↑ SSR12 links to B,E,F,J,K Workforce Shift - risk that there is not appropriate engagement with staff groups, particularly over the need for service changes and the requirement to work in a different way. There may be professional concerns about inter-disciplinary working and cultural barriers will prevent effective integration. Would result in poor morale and the failure to gain staff support for the workforce shift and culture change required. Resistance from the staff group would in turn limit the flexibility required to deploy the workforce in line with changed models of care, full integration will not be achieved and teams will be disjointed. Ultimately impacting on the service provided to communities. 4 - Likely 4 - Major HIGH 16 ○Joint Partnership Forum and Staff side Liaison facilitate communications and information flow between management to staff side and Trade Unions ○Communications plan for each service change project, including staff as stakeholders ○Support from staff side partnership to support staff with new ways of working with an integrated partnership approach. ○Compliance with terms and conditions of employment for both staff groups ○Individual staff development plans and training programmes ○Workforce Planning ○Staff surveys used to inform targeted improvement work with individual teams ○Strengthened communication and cascade of information from Chief Officer 4- Likely 4- Major HIGH 16 OClarity over role and function of teams working in our communities.OD support will be offered to Area Managers to support teams. OOngoing work of the culture and staff wellbeing workstreams OImplementation of the Workforce strategic plan OImprove management of redeployment Ostaff side involvement in SLT meetings and Transformation Board OPlanning for reductions in working week for NHS employed staff underway Chief Officer ↔ SSR13 links to A,B,H,J Safety of Services - inability to maintain the safety of services due to demographic changes, increasing need and complexity and the ability to recruit staff for direct employment and for delivery partners May result in harm to service users or patients, the failure to provide appropriate care and reputational damage to the IJB and partners. 4-Likely 5 - Extreme VERY HIGH 20 ○Clinical and Care Governance Committee and professional leadership ○Risk Management Strategy recently updated and operational risk management arrangements ○Recruitment, retention and training of staff ○Triggers for service re-designs including ensuring clinical safety is not compromised ○Prioritisation of need frameworks in place to determine need for access to services ○Develop and implement contingency arrangements for localities and services, Improved clinical and care governance at service level 4-Likely 4- Major HIGH 16 O Increased focus on training and development of staff and improved flexibility O Increased engagement with commissioned service providers O New Contingency, Risk and Resilience group Oimproved Health & Safety Training and governance arrangements Onew focus on establishment setting and risk management to comply with Staffing Act requirements Lead Nurse/Chief Social Worker ↔ SSR14 links to A,B,H,I Waiting Times -failure to meet waiting times targets and treatment times guarantees for treatment in specialities in NHS GG&C and outreach clinics in Argyll and Bute. Waiting times have increased due to Covid-19 response and disruption and pressures within the Health system continue. Poor level of service for patients, the potential to have to travel further for appointments, and is not in line with the anticipatory and preventative approach to care. 4-Likely 4 - Major HIGH 16 ○ Continued engagement with NHS GG&C to agree a strategic jointly planned approach to outreach services ○ Monitoring and reporting of waiting times ○ Development of new delivery models such as specialist nurses, tele-consultation and direct or follow up referral to primary care or AHP professionals O Plans for use of Waiting List and winter planning funding 4- Likely 4- Major HIGH 16 OInclusion in NHS Highland Remobilisation plan to request additional funding to redesign services and address backlog. Initiatives include increasing virtual clinics/services, digital and appointment modernisation, enhanced role of AHPs and waiting times initiatives additional clinics. OUse and expansion of Near Me and Outreach Clinics. OEvidence of continuing disruption to services and staffing shortages throughout local and national healthcare system continuing to make it challenging to address increased waiting times. This is a serious national issue at present. Pass through of funding required. Heads of Service ↔ SSR15 links to A,B,C,D,E,F, G,H,I,J,K Support Services - risk that support services do not adequately support front line service delivery. Inability to integrate support services which are not fully delegated to the IJB. Continued reliance on two systems, processes and approaches may lead to confusion and ongoing inefficiency. Risk that partners will not support changes to current arrangements. Could adversely affect services experienced by patients and service users if support services cannot fully support front line services. Wasteful duplication and inefficient use of resource. 4-Likely 4- Major HIGH 16 OCo-location of staff OSome IT systems integrated and further plans to review this and to facilitate access to joint systems ORollout of MS Teams - IT services and remote working are much improved as a result OCommittee support arrangements in place OContinuous improvement in support service provision 4- Likely 4- Major HIGH 16 OReplacement programmes for new systems Social work (eclipse), Hospital Telecoms, and portal (link systems) funded and in place. O Office 365 implementation ODevelopment of corporate services agreement with partners O Work to improve recruitment processes on-going O Implementation of staffing act presents an additional pressure on support services, particularly HR Heads of Service ↔
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Classification: OFFICIAL# SSR16 links to A,B,C,D,E,F, G,H,I,J,K New General Medical Services Contract - risk that the HSCP are not in a position to support the implementation of the new GP contract as a result of availability of funding and capacity for the HSCP to deliver services transferred from GPs. Higher risk of implementation across remote and rural areas. Could adversely affect services experienced by patients as gaps in service may arise. Potential for negative impact on relationships with Primary Care practitioners. 4-Likely 4 - Major HIGH 16 ○Ongoing collaboration between the HSCP and Primary Care to support practices ○Primary Care Modernisation Board with priorities established and Programme Manager in place ○Regular updates on progress to Transformation Board and the IJB, constructive progress being made pharmacotherapy, physiotherapy and mental health workstreams 4- Likely 4- Major HIGH 16 ○Head of Primary Care in place to add management capacity. OEngagement with Scottish Government in respect of funding to enable permanent workforce structures to be developed and implemented and agreement of some concessions within Argyll and Bute OFunding for Primary Care improvement reduced substantially by Scottish Government and acknowledged that the contract cannot be delivered in full within existing resourcing. Associate Medical Director / Head of Primary Care ↔ SSR18 links to A,B,C,D,E,F, G,H,I,J,K Culture - risk that perception of negative culture results in increased difficulties in recruiting and retraining staff, staff wellbeing and wider reputation of the HSCP. Adverse impact on reputation and ability to recruit. Also impacts on service delivery if teams are unhappy or short staffed as a consequence 4-Likely 5 - Extreme VERY HIGH 20 o Wellbeing groups and workforce strategy group in place o Whistleblowing process in operation o extensive roll out of courageous conversations training 3 - Possible 3 - Moderate MEDIUM 9 oSome indications of improving culture oStaff surveys and analysis of results Chief Officer ↔ SSR19 Statutory/Mandatory Training - risk that patient / service user harm could result directly from, or be attributed to, a failure to comply with statutory and mandatory training requirements. This could result in harm to an individual or group of service users, members of staff and could result in financial claims and reputational damage. Adverse effect on quality and safety of care and service delivery. -Potential to result in Adverse Events with harm to service users and staff which could result in civil claims being made with a risk of high financial cost. -Potential for enforcement action being taken against the HSCP by the HSE with severe financial and reputational consequence 5-Almost certain 5- Extreme VERY HIGH 25 - Stat/Man training policy in place. -Training programmes in place via on-line training and face to face -Induction programme 3-Possible 5- Extreme HIGH 15 • Head of Service/senior managers to compile service improvement plans with local delivery based on individual service position. Plans in place for online training and for face to face training. • Heads of Service to ensure there is a regular forum for reviewing the plan, ensuring implementation and escalating barriers. • All staff to receive a communication from the Chief Officer on responsibilities for undertaking mandatory training. • Managers to ensure that they are up to date with their own training. • Managers to monitor compliance, support staff to access computers and have time to bring their mandatory training up to date. • Managers to support staff who are falling behind with their compliance with mandatory training and follow up until the training has been completed. • The Health & Safety Committee and Strategic Leadership Team to review, compliance is improving. Chief Officer ↓ SSR 21 Climate Change - risk that the HSCP will not achieve the climate change decarbonisation and emissions targets set for it. This is likely to result in reputational damage at both a community and political level as well as a financial cost. -Perception that the HSCP is not fully committed to delivering on the Scottish Government Climate Change targets as a result of lack of capital and revenue funding or management capacity to prioritise this work. 4-Likely 3- Moderate HIGH 12 oOn-going engagement and participation with A&B council, NHS Highland and Scottish Government partners in respect of all health and care areas producing CO2 emissions including procurement decisions, estate, travel and transport. Services provided by the HSCP. - Access to funding revenue and capital to undertake CO2 reduction projects e.g. zero emission NHS fleet by 2025 4-Likely 3- Moderate HIGH 12 oSecured funding for carbon reduction consultancy but no capital available in 2024/25 and targets being pushed back nationally. oDevelopment of capital and revenue investment plans in HSCP, Argyll and Bute Council and NHS Highland . oLocal projects underway, climate change report submitted and potential for case study oNew Estates and Sustainability manager now in post and some HSCP funds available for investment but SG reducing capital resource for this Head of Finance & Senior Manager - Estates & Sustainability ↑ SSR 22 Socio-Economic Situation & Increasing Poverty and Deprivation - multiple risks relating to the current socio economic situation. Risk is driven by direct and indirect implications of high inflation, expected increase in poverty, increasing interest rates and tightening public funding position. Linked to impact of lockdowns on mental and physical health. Risk that the health and wellbeing will deteriorate and the HSCP will be unable to respond appropriately to increased service demand. Consequences may include: -increased staff and non-staff costs reducing real terms values of budget and reserves. -potential for strike action within HSCP, partners and in other services and industries. -additional service demand arising from cost of living crisis, increased poverty levels, increased pressure on mental health services may be a particular pressure. -shortages of supplies and services which could include supplies of drugs and other critical supplies and care provision. 4-Likely 5 - Extreme VERY HIGH 20 o recognition that this is a national socio-economic issues and local mitigations and influence is limited o resilience and contingency planning o remobilisation of services o involvement in sector discussions in respect of strike exemptions o may need to consider prioritisation of services and resources 4-Likely 5 - Extreme VERY HIGH 20 o HSCP planning sensitive to issues facing local communities o awareness of pressures and careful financial and service planning to mitigate impact particularly on most vulnerable o initial evidence of increase in cases requiring expensive residential care packages which could result in severe cost pressures. ocontinuing to work with key partners and community planning to help mitigate the impact. o largely outwith the control of the HSCP Chief Officer & SLT ↑ Suggested Removal from Strategic Risk Register SSR20 Vaccine Delivery - Whilst responsibility for the delivery of the vaccination programme sits with NHS Highland, there is a risk that locally the vaccine programme may not be delivered as quickly as communities and government wish, -Reputational damage may arise as a result of the local management of the vaccination programme -communities may not benefit from the impact of the vaccination programme to the maximum possible extent 4-Likely 4 - Major HIGH 16 engagement with Highland Health Board to ensure that the vaccination is programme is delivered as quickly and efficiently as possible oRecruitment of vaccination staff on a permanent basis oEffective communication with local communities 3-Possible 3-Possible MEDIUM 9 oPermanent recruitment of vaccination staff oGood local performance levels to date Extended messaging on all vaccination programmes for all ages Chief Officer ↓ Now Mainstream activity SSR17 links to A,B,C,D,E,F, G,H,I,J,K Contingency and Resilience risks including responding to winter pressures, service pressures and emergencies Adversely affecting service delivery and waiting times performance, and ability to deliver planned transformation 4 - Likely 5 - Extreme VERY HIGH 20 oRegular testing of emergency scenarios oAdditional management post created and improvement leadership of winter planning. 4- Likely 4- Major HIGH 16 oDigital / IT & Telecoms infrastructure enhanced oContingency, Risk and Resilience Management group established including representation from partners oon going high demand for services combined with workforce issues oSystem under increasing pressure as winter approaches and evidence of increased delayed discharges locally - winter plan in place. Chief Officer / SLT ↓ Incorporated in SSR04 & winter planning now mainstream activity