Strategic Risk Register IJB Jan 23
Argyll and Bute Council · 25 January 2023
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 25 January 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Strategic Objectives 2019-22 A We will work to reduce health inequalities B We will plan and provide health and social care services in ways that keep people safe and protect them from harm C We will ensure children have the best possible start in life and plan services in a person centred way that benefits the person receiving the service, so they have a positive experience - right service, right place, right time. D We will plan for and deliver services in person centred ways that enable and support people to look after and improve their own health and well-being E We will prioritise community based services, with a focus on anticipatory care and prevention to reduce preventable hospital admission or long term stay in a care setting F We will deliver services that are integrated from the perspective of the person receiving them or represent best value with a strong focus on the well being of unpaid carers G We will establish "Locality Planning, Owning, Delivery" operational and management arrangements to respond to local needs H We will strengthen and develop our partnership with specialist health services with NHS GG & C and Community Planning Partners as well as with the third and Independent sectors I We will sustain, refocus and develop out partnership workforce on anticipatory care and prevention J We will put in place a strategic and operational management system that is focused on continuous improvement, with a clear governance and accountability framework K We will underpin our arrangements by putting in place a clear, communication and engagement arrangement involving our staff, users, the public and stakeholders
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ARGYLL & BUTE INTEGRATED JOINT BOARD STRATEGIC RISK REGISTER UPDATED DECEMBER 2022 Risk Ref and xRef to Strategic Objectives Description Of Risk Consequence Likelihood Impact Risk Rating /Score Mitigations/ Control Measures 2021/22 Likelihood Impact Risk Rating /Score Proposed New Control Measures Risk Owner(s) SSR01 links to B,E,F,J Financial Sustainability - risk of financial failure arising from costs and demand for services outstripping the available budget. This could be as a result of unbudgeted demand, cost pressures and inflation, failure to deliver savings targets or as a result of the level of delegated resource to the IJB from Scottish Government and / or partners not being sufficient 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 the IJB and partner bodies and the requirement to implement service changes or reductions that are not line with the strategic objectives. Possibility of intervention in management of HSCP. 5 - Almost Certain 5 - Extreme VERY HIGH 25 ○The Integration Scheme outlines the consequences of overspend - partners required to supplement resources ○ Financial information reported to Finance & Policy Cttee and IJB for current year and the budget outlook for future 3 years. o Review of funding allocations and settlements from government and partners and engagement with sector networks ○ Finance & Policy Committee which meets regularly and scrutinises financial performance, risk management, savings programme and financial planning ○ Increased focus and resource on delivery of the Savings Plan, project management approach to monitor and record progress oDevelopment of financial governance, integrated financial reporting, financial risk register, operational and strategic reporting along with careful modelling of cost pressures. independent external audit of accounting and financial planning and reporting process of partners and HSCP oEngagement with budget holders, SIO's and finance teams to ensure accurate financial forecasting is in place. oEarly repayment of debt to reduce future cost pressures 4- Likely 5- Extreme VERY HIGH 20 o Detailed plans under development for use of reserves o New savings programme being developed o development of medium term financial plan Chief Financial 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 priorities in the Strategic Plan and the targets and expectations from the Scottish Government. The pace of change to re- design services might not keep up with the demographic pressures of an ageing population and the progress with the shift from institutional and acute care will impact on resources available for re-designed services. 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 where appropriate ○Medium term budget planning integrated with strategy development ○Performance reporting to the IJB, including progress against Health and Wellbeing indicators and MSG targets with actioned performance management ○Communications and engagement strategy ○Published Annual Performance Report oMonitoring through Service Transformation Board and Finance & Policy Cttee with clearly articulated links to Strategic Planning Group ○Improved governance for IJB and committees ○SMT 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 3 - Possible 4 - Major HIGH 12 o New Strategic Plan and Commissioning Strategy consulted widely upon and approved, this re-states and validates strategic objectives o Roll out of new Integrated Performance & Reporting Regime in 2022/23 o Locality Planning Groups o Review of transformation programme structure and increased resourcing to projects o Implementation of new technology Chief Officer ↔ 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 the proportion of older people. Failure to accurately forecast the impact on services including shifting the balance of care and implementing new models of care. The population decline will reduce resources available in future. This could lead to service failure to meet needs of service users and deliver against the Strategic Plan objectives. 4- Likely 4 - Major HIGH 16 ○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 o Strategic 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 3 - Possible 4- Major HIGH 12 ○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 Head of Strategic Planning & Performance ↔ 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. 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 in place. ○Committee structure below IJB, including Audit & Risk Committee, Clinical and Care Governance Committee, Strategic Planning Group, and Finance & Policy Committee. ○Internal Audit review of governance arrangements and recommendations implemented. ○External Audit role oRegular engagement with Standards Officer oFull engagement of Board in development of Strategic Plan and Commissioning Strategy 3 - Possible 3 - Moderate MEDIUM 9 o Development of Code of Corporate Governance 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 Increased stability in senior leadership team o New Strategic Plan approved and in place Chief Officer ↓ SSR05 links to G,H Partnership Working - inadequate partnership arrangements with all partners including the Council and Health Board and commissioned service providers including NHS GG&C for acute services, the third sector and other commissioned providers. This would be as a result of lack of clarity around roles and responsibilities and the ability of the IJB to articulate commissioning intentions for all services and manage these appropriately. 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 and partners. It could also result in a reductions 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 recently reviewed outlining roles and responsibilities ○Independent scrutiny arrangements in place and work of internal audit, including assurance mapping. ○Representation on IJB from both partner bodies. ○Clear channels of communication and information sharing protocols in place ○Chief Officer member of both Council and Health Board Senior Management Teams and has overall strategic and operational responsibility for service delivery ○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 oRegular meetings with key partners including NHS GG&C and Scottish Ambulance Service 3 - Possible 3 - Moderate MEDIUM 9 ○Ongoing work required with NHS GG&C to agree financial impact of IJB commissioning intentions ○Alignment of roles and responsibilities through the code of corporate governance and induction training for new members of the IJB oApproval of Commissioning Strategy following extensive consultation with partners oShift from annual grant funding to longer term contracts to facilitate longer term security / planning 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. Chief Officer ↓ Gross Risk Residual Risk
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SSR06 links to E,J Infrastructure and Assets - Assets remain under the ownership of the Council and Health Board, there is a risk that these do not meet the current and future requirements due to underinvestment in property maintenance, equipment and ICT or that these are not being used or managed efficiently and effectively. The IJB does not have full control/flexibility over the assets it uses to deliver services. May result in 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. Accommodation provided for residential and short episodes of care result in poorer outcomes. 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. 4 - Likely 4 - Major HIGH 16 o Progressing co-location options with Argyll & Bute Council o Represented on Council and NHS Highland Asset Management Boards ○ Partnership working to reflect joint planning approach with membership of both partner asset groups ○ Regular joint infrastructure meetings to support digital service delivery 4 - Likely 4 - Major HIGH 16 oHSCP Digital / IT strategy now complete help enable TEC / remote working oDevelopment of a strategic approach to the combined HSCP estate and the identification of priorities for investment and replacement of infrastructure assets. oNew Strategic Estates & Sustainability Post oDetailed review of care home estate and analysis of old equipment underway oInsufficient confirmed resource available to enable this risk to be reduced and increasing demand for space as services grow and require to relocate due to poor quality accomodation. Chief Officer, Head of Strategic Planning and Performance, Head of Finance & Transformation ↑ 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 Care Home Contract oContingency planning in localities for care at home during the pandemic. Care Home and Care at Home Assurance Group for Argyll and Bute (recently amended to encompass care at home) which looks at identifying and managing daily risks. oStrategically the Care Home Programme Board will assist planning ahead with forecasting demand. oThere is a Care Home Task Force communicating with Independent Providers. ○Engagement with national workforce planning and local training providers around promotion of the caring profession 5 - Almost Certain 4- Major VERY HIGH 20 ○ Continuing work with providers in partnership o Ongoing engagement nationally with financial sustainability plans and consideration of need for further local support ○ Implementation of Strategic Commissioning Plan based on Joint Strategic Needs Assessment 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 Heads of Adult Care, Head of Strategic Planning and Performance ↑ SSR08 links to A Equalities - services are not delivered in a way that addresses inequalities. 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. 3 -Possible 3 - Moderate MEDIUM 9 o EQIA process are improving 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 Strategic Plan, examples include Independent Review of Adult Social Care & National Care Service, the Living Wage, the Carers Act, and increased monitoring of performance. 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 4- Likely 3 - Moderate HIGH 12 o Carers Act officer in post and working on plans to implement the objectives of the Carers Act o Engagement in sector developments and networks relating to the implementation of the National Care Service o Engagement continuing through professional networks to respond to IRASC o strengthen relationships with Cosla through using our Board representatives oSpending Review published in May 22 outlines prioritisation for Health and Care sector oEngagement with governement officials including visits to area and meetings to discuss local impacts of NCS oInclusion in the GIRFE pathfinder project with SG Chief Officer ↔ SSR10 links to B,C,E,H,I,J Workforce Recruitment and Retention - inability to recruit and retain the required workforce because of national workforce challenges and local challenges particularly in remote and rural areas and for clinical specialties. This leads to increased costs from reliance on medical locums and agency staff, not only for the IJB but also for commissioned service providers. 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 led by NHS Highland ○Strategic Workforce Planning Group to ensure overall visibility of recruitment, retention and development challenges across HSCP ○#abplace2b campaign framework for attracting people into area. abplace2b.com provides information and current vacancies and signposting to housing and business. oContingency plans for clinical posts to reduce reliance on locums oMedical Workforce Productivity work stream led by NHSH assisting with hard to fill vacancies and recruitment oService re-designs to plan for changes to services in line with workforce capacity oTargets for new Modern Apprentices to reduce average age of workforce ○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 o Development and roll out of community team standards o Detailed data on workforce available to managers 5 - Almost Certain 4 - Major VERY HIGH 20 ○Finalisation of Workforce Plan to support strategic plan ○Heads of Service and Managers actively engage 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. oContinue to reduce reliance on locum and agency staff through scrutiny oEnsure on-going support for CPD oUtilisation of new funding to increase staffing oidentification of options within current estate in HSCP to address housing shortages and progress key worker housing in partnership with Housing Associations and potentially Shelter Scotland. oInternal audit review oindustrial action remains a high risk and is likely to impact negatively on workforce retention and recrutiment Head of Customer Support Services / 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 wider communities and partners as a result of gaps between the IJB requirements and strategic direction and the expectation of service need from communities. 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 and transformation projects. 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 (including MH advocacy groups, carers centres etc). ○Communication plans developed as part of implementation of service changes 4- Likely 4- Major HIGH 16 ○Support local ownership of communications and engagement ○Continue roll out of social media use at a local level ○Ongoing review of Communications and Engagement Strategy. 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 Associate Director Public Health, Communications team ↔
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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. This 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 o Action plan in response to Sturrock and 6 local culture workstreams set up and progressing ○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. o ongoing work of the culture and staff wellbeing workstreams o development of workforce strategic plan o increased focus required on progressing with redeployments of staff who are supernumerary o development of plans and engagement with staff in respect of how to invest wellbeing funds in improving staff wellbeing 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, both for direct employment and for delivery partners This 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 ○On-going 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 4-Likely 4- Major HIGH 16 ○ Increased focus on training and development of staff and improved flexibility ○ Increased engagement with commissioned service providers ○ New Contingency, Risk and Resilience group 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 already increased due to Covid-19 pandemic and disruption and pressures within the Health system continue. This would result in a 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 ○ Offer alternative services to patients 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. Cover mental health, CAMHS, Acute and AHPs oThe development of Near Me and Outreach Clinics needs further scoped across all sites/clinics following the pandemic. 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 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, including IT, HR, Finance, Governance, Communications, Improvement & Performance, Procurement and Commissioning, Legal Services etc. 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 ○Range of system workarounds in place to ensure business as usual ○Co-location of staff ○Some 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 o Committee support arrangements in place o Continuous improvement in support service provision 4- Likely 4- Major HIGH 16 ○Replacement programmes for new systems Social work, Hospital Telecoms, and portal (link systems) funded and in place. oOffice 365 implementation ○Development of corporate services agreement with partners o Need to improve HR support for recruitment processes where lengthy delays are being experienced Heads of Service ↔ 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 appropriately support the implementation of the new GP contract as a result of the availability of funding and capacity for the HSCP to deliver services transferred from GPs. Higher risk of implementation specifically 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 - who are key to delivery of services within our local hospitals 4-Likely 4 - Major HIGH 16 ○Ongoing collaboration between the HSCP and Primary Care to support practices oNationally agreed extension of 1 year for delivery ○Primary Care Modernisation Board with priorities established and Programme Manager in place until Autumn 2021 ○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 ○New 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 oreduced financial support for primary care improvement increasing this risk Associate Medical Director ↑ SSR17 links to A,B,C,D,E,F, G,H,I,J,K Business Continuity and resilience risks including responding to 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 oResponse to Covid-19 pandemic 5 - Almost Certain 4- Major VERY HIGH 20 oDigital / IT & Telecoms infrastructure enhanced 2021/22 - Additional SWAN network and replacement hospital telephone system by June 2021 oContingency, Risk and Resilience Management group established including representation from partners opercieved risk of widespread energy sytem outages during winter 22-23 oon going high demand for services combined with workforce issues and potential winter pressures make this a red risk at present. All SLT ↑ SSR18 links to A,B,C,D,E,F, G,H,I,J,K Covid-19 and other respiratory illnesses- risks of further waves of covid and other infections with more people becoming ill and requiring health care Adversely affecting service delivery and waiting times performance, and ability to deliver planned transformation. Risk would result on further pressure on available workforce. 5 - Almost Certain 5 - Extreme VERY HIGH 25 o there is an effective vaccination programme in place and we follow public health guidance and evidence that. o experience and project planning of previous mobilisation from first and second waves 5 - Almost Certain 4-Major VERY HIGH 20 oContinuing evidence of covid related absence and disruption as cases require careful management resulting in disruption and closure of services All SLT ↓ SSR19 links to A,B,C,D,E,F, G,H,I,J,K Culture - risks from impact of negative reports around organisational culture following Sturrock report 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 Culture Oversight Board and local A&B Culture Group in place with 6 workstreams o Whistleblowing process in operation o Guardian Service in operation - independent and confidential o extensive roll out of courageous conversations training 3 - Possible 3 - Moderate MEDIUM 9 o continued work of A&B Culture Group and associated workstreams o need to ensure that it covers whole of HSCP including social care Chief Officer ↓
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SSR20 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. Specific plans put 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 actions outlined above will be progressed and there will be an Argyll and Bute HSCP-wide review to examine the position. An action plan will then be drawn up to support employees to complete. • The Strategic Leadership Team will review compliance performance regularly. Chief Officer ↓ SSR21 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 oEngagement 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 4 - Major HIGH 12 oPermanent recruitment of vaccination staff oGood local performance levels to date Extended messaging on all vaccination programmes for all ages Chief Officer ↓ SSR 22 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 oParticipation and inclusion in NHS and Council project to address climate crisis. 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 post includes responsibility for aspects of this. Head of Strategy, Planning, Performance and Technology ↓ SSR 23 Socio-Economic Situation - 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. 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 largely outwith the control of the HSCP Chief Officer & SLT ↑ Deleted Risk Service Delivery - ineffective leadership and management of services and resources Patients and service users receive poor service. Fail to meet agreed performance levels. 4-Likely 4 - Major HIGH 16 ○ Clinical and Care Governance Framework and Committee in place to hold to account the quality of existing services o Professional representation at SMT and the IJB ○ Role of Chief Social Work Officer ○ Performance management framework and service delivery plans ensure a focus on performance and achievement of strategic objectives with regular reporting to IJB. 3 - Possible 3 -Moderate MEDIUM 9 ○ New Integrated Performance Management regime in process of delivery ○Performance reporting maintained Chief Officer ↔
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Risk Matrix Risk Rare (1) Unlikely (2) Possible (3) Likely (4) Almost Certain (5) Extreme (5) MEDIUM 5 HIGH 10 HIGH 15 VERY HIGH 20 VERY HIGH 25 Major (4) MEDIUM 4 MEDIUM 8 HIGH 12 HIGH 16 VERY HIGH 20 Moderate (3) LOW 3 MEDIUM 6 MEDIUM 9 HIGH 12 HIGH 15 Minor (2) LOW 2 LOW 4 MEDIUM 6 MEDIUM 8 HIGH 10 Insignificant (1) LOW 1 LOW 2 LOW 3 MEDIUM 4 MEDIUM 5 Table 1 Assessment of likelihood Score Description 1 Rare 2 Unlikely 3 Possible 4 Likely 5 Almost Certain Table 2 Assessment of Impact Descriptor Insignificant Minor Moderate Major Extreme Score 1 2 3 4 5 Patient Experience Reduced quality of patient experience / clinical outcome not directly related to delivery of clinical care. Unsatisfactory patient experience / clinical outcome directly related to care provision – readily resolvable. Unsatisfactory patient experience / clinical outcome, short term effects – expect recovery <1wk. Unsatisfactory patient experience / clinical outcome: long term effects – expect recovery - >1wk. Unsatisfactory patient experience / clinical outcome: continued ongoing long term effects. Injury (physical and psychological) to patient / visitor / staff. Adverse event leading to minor injury not requiring first aid Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Significant injury requiring medical treatment and/or counselling. Major injuries/long term incapacity or disability (loss of limb) requiring medical treatment and/or counselling. Incident leading to death or major permanent incapacity. Complaints/ Claims Locally resolved verbal complaint Justified written complaint peripheral to clinical care. Below excess claim. Justified complaint involving lack of appropriate care. Claim above excess level. Multiple justified complaints. Multiple claims or single major claim. Complex justified complaint. Strong possibility that this could happen again This is expected to frequently happen again – more likely to re-occur than not LIKELIHOOD IMPACT Chance of Occurrence Can’t believe this event would happen again – will only happen in exceptional circumstances Not expected to happen again, but definite potential exists Has happened before on occasions – reasonable chance of re-occurring
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Staffing and Competence Short term low staffing level temporarily reduces service quality (< than 1 day). Short term low staffing level (> 1 day), where there is no disruption to patient care. Ongoing low staffing level reduces service quality. Minor error due to ineffective training/ implementation of training. Late delivery of key objective / service due to lack of staff. Moderate error due to ineffective training/implementati on of training. Ongoing problems with staffing levels. Uncertain delivery of key objective / service due to lack of staff. Major error due to ineffective training/implementati on of training. Non-delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to ineffective training/implementat ion of training. Financial (including damage/ loss/ fraud) Negligible organisational/ personal financial loss (< £1k) (NB. Please adjust for context) Minor organisational/per sonal financial loss (£1-10k). Significant organisational /personal financial loss (£10-100k). Major organisational/ personal financial loss (£100k - £1m). Severe organisational/ personal financial loss (>£1m). Adverse Publicity / Reputation Rumours, no media coverage. Little effect on staff morale Local media coverage – short term. Some public embarrassment. Minor effect on staff morale / public attitudes. Local media – long- term adverse publicity. Significant effect on staff morale and public perception of the organisation National media / adverse publicity, less than 3 days. Public confidence in the organisation undermined. Use of services affected National / International media / adverse publicity, more than 3 days. MSP / MP concern (Questions in Parliament). Court Enforcement. Public Enquiry/ FAI.