11. Strategic Risk Register
North Ayrshire Council · 20 August 2026
Back to Integration Joint Board — 20 August 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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+ Integration Joint Board 20th August 2026 Subject: Strategic Risk Register Purpose: To present the updated IJB Strategic Risk Register for consideration and approval. Recommendation: To approve the updated IJB Strategic Risk Register Direction Required to Council, Health Board or Both Direction to:- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms IJB Integration Joint Board NHS National Health Service PAC Performance Audit Committee PSMT Partnership Senior Management Team SRR Strategic Risk Register ORR Operational Risk Register 1. EXECUTIVE SUMMARY 1.1 This report presents the updated Strategic Risk Register and seeks approval of the revised register. It highlights the escalation of one new strategic risk from the Operational Risk Register and confirms that no existing risks have increased in score. The report supports the IJB in identifying, monitoring and managing risks to the successful delivery of the Strategic Plan. 2. BACKGROUND 2.1 A Strategic Risk Register (SRR) is a requirement of the Clinical and Care Governance Framework and as part of our Risk Management Strategy, which was last approved by the IJB in June 2025. 2.2 The Strategic Risk Register (SRR) was last reported to the IJB in April 2026 and the next review was planned for April 2027. This report is being presented earlier following a recent review of the Operational Risk Register (ORR), which recommended that one risk be escalated to the SRR.
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2.3 New Risks: One new Strategic Risk is proposed for inclusion following escalation from the ORR. This risk has been brought onto the Strategic Risk Register to reflect both the national and local pressures affecting the availability of placements. The principal impact is on service provision, with a potential indirect financial impact. This is shown in the table below: Ref Title Description Risk Rating Gross Risk Rating Residual ORR 64 (now SRR 17) Children’s Services Placements The availability of placements for children and young people locally and nationally is at a critical shortage. This risks provision not being available for children and young people who require to live away from home. 25 Very High 25 Very High 2.4 There are no risks with increased scores. 2.5 The narrative for SRR01 Financial Sustainability has been updated to reflect the 2025/26 outturn position. 2.6 The actions required to manage and control the risks have been identified and they will be subject to ongoing monitoring and review by the PSMT with an update to be reported to the Performance and Audit Committee. 2.7 There are now 13 risks noted on the Strategic Risk Register, with a number of these graded as very high or high risk. While there are a number of controls and mitigations in place there may be further actions required to reduce the risks further in line with the level of risk tolerance. The current Strategic Risk Register is included as Appendix A. The risks are summarised below: Ref Title Gross Risk (score pending further controls) April 2026 Residual Risk (score after further controls) April 2026 Gross Risk (score pending further controls) August 2026 Residual Risk (score after further controls) August 2026 SRR01 Financial Sustainability 25 Very High 25 Very High 25 Very High 25 Very High SRR02 Infrastructure (ICT Integration) 12 High 9 Moderate 12 High 9 Moderate SRR05 Transformational Change Programme 12 High 9 Moderate 12 High 9 Moderate SRR06 Governance 9 Moderate 3 Low 9 Moderate 3 Low SRR07 Demography and Inequality Pressures 16 High 12 High 16 High 12 High SRR08 Workforce 12 9 12 9
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High Moderate High Moderate SRR09 Local Impact of Scottish Government Policies 16 High 12 High 16 High 12 High SRR12 Clinical and Care Governance 9 Moderate 9 Moderate 9 Moderate 9 Moderate SRR13 Provider Failure (commissioned services) 16 High 16 High 16 High 16 High SRR14 Asylum Arrivals 12 High 12 High 12 High 12 High SRR15 Risk of Harm 16 High 16 High 16 High 16 High SRR16 Growth and expansion of specialist complex care developments 25 Very High 15 High 25 Very High 15 High SRR17 Children’s Services Placements n/a n/a 25 Very High 25 Very High 2.7 The scoring of the risks is based on the severity of the risk multiplied by the likelihood of it happening. Further detail is provided in the extract from the approved Risk Management Strategy in Appendix B. 2.8 The operational risks of the Partnership are regularly reviewed and considered at service management meetings. The Clinical and Care Governance Group is responsible for oversight of operational risks within the Partnership. The Group considers any high or very high risks, as defined by the approved Risk Management Strategy, and may, where appropriate, escalate these to the Partnership Senior Management Team (PSMT) for consideration for inclusion on the Strategic Risk Register. 3. PROPOSALS 3.1 It is proposed to approve the risk register detailed in Appendix A including the action required to manage, mitigate and control the risks. 3.2 Anticipated Outcomes Risk management is an integral part of governance, and it is essential that the IJB has assurance that risks are identified and managed appropriately to ensure the safe and sustainable delivery of services.
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3.3 Measuring Impact The risk register will be monitored, with individual risk owners responsible for keeping the register up to date under the oversight of the Principal Manager – Finance / Chief Finance Officer. It is recommended that risk assessments are reviewed at least annually. 4. IMPLICATIONS 4.1 Financial None 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic None 4.5 Risk The report falls in line with the agreed risk appetite statement which is low-risk appetite in respect to adherence to compliance duties. 4.6 Community Wealth Building None. 4.7 Key Priorities Appropriate and effective risk management practice will deliver better outcomes for the people of North Ayrshire, protecting the health, safety and wellbeing of everyone who engages with the IJB or for maximising opportunity, delivering innovation and best value, and increasing performance. 5. CONSULTATION 5.1 The strategic risks have been reviewed by the relevant risk owners. For more information please contact: Eleanor Currie, Chief Finance Officer – Finance at eleanorcurrie@north- ayrshire.gov.uk
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Appendix A Strategic Risk Register Glossary of Terms Term Definition Term Definition NAHSCP North Ayrshire Health and Social Care Partnership ARG Allocation of Resources Group SAHSCP South Ayrshire Health and Social Care Partnership ICT Information and Computer Technology EAHSCP East Ayrshire Health and Social Care Partnership MDTs Multi-Disciplinary Teams NHS/ NHS AAA NHS Ayrshire & Arran EKSF Electronic Knowledge and Skills Framework MTFP Medium Term Financial Plan TURAS Training Management System CRES Cash Releasing Efficiency Savings SPOG Strategic Planning Officers Group LD Learning Disability ICF Integrated Care Fund IJB Integrated Joint Board RMP Records Management Plan PSMT Partnership Senior Management Team CPAG Child Poverty Action Group NAC North Ayrshire Council
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Appendix B Extract from the Risk Strategy on Risk Scoring
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SEVERITY CONSEQUENCE MATRIX - Description and definition of the CONSEQUENCE / IMPACT of the risk should it occur (these are a guide) Severity “Domains” 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Extreme Objectives and projects Barely noticeable reduction in scope / quality / schedule Minor reduction in scope / quality / schedule Reduction in scope or quality, project objectives or schedule. Significant reduction in ability to meet project objectives or schedule. Inability to meet project objectives, reputation of the organisation seriously damaged and failure to appropriately manage finances. Injury (physical and psychological) to patients/staff. Adverse event leading to minor injury not requiring first aid. Minor injury or illness, first-aid treatment needed. No staff absence required. Significant injury requiring medical treatment and/or counselling. Major injuries or long- term incapacity/ disability (loss of limb), requiring medical treatment and/or counselling. Incident leading to death or major permanent incapacity. Patient experience / outcome 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.
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Complaints / claims Locally resolved complaint Justified 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 claims. Staffing and competence Short term low staffing level (< 1 day), where there is no disruption to patient care. Ongoing low staffing level results in minor reduction in quality of patient care 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 / implementation of training. Ongoing problems with staffing levels Uncertain delivery of key objective / service due to lack of staff. Major error due to ineffective training / implementation of training. Non delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to insufficient training / implementation of training. Service / business interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care. Some disruption in service with unacceptable impact on patient care. Temporary loss of ability to provide service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked. Permanent loss of core service or facility. Disruption to facility leading to significant “knock on” effect. Financial Negligible organisational financial loss (£< 1k). Minor organisational financial loss (£1- 10k). Significant organisational financial loss (£10-100k). Major organisational financial loss (£100k- 1m). Severe organisational financial loss (£>1m). Inspection / assessment / audit Small number of recommendations which focus on minor quality improvement issues. Minor recommendations made which can be addressed by low level of management action. Challenging recommendations but can be addressed with appropriate action plan. Enforcement Action. Low rating. Critical report. Prosecution. Zero Rating. Severely critical report.
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Adverse publicity / reputation No media coverage, little effect on staff morale. Local Media – short term. Minor effect on staff morale / public attitudes. Local Media – long term. Impact on staff morale and public perception of the organisation. National Media (< 3 days). Public confidence in the organisation undermined. Usage of services affected. National Media (> 3 days). MP / MSP Concern (Questions in Parliament). Organisational / Personal Security, and Equipment Damage, loss, theft (£< 1k). Damage, loss, theft (£1-10k). Damage, loss, theft (£10-100k). Damage, loss, theft (£100k-1m). Damage, loss, theft (£>1m). 1 Remote 2 Unlikely 3 Possible 4 Likely 5 Almost Certain Probability Will only occur in exceptional circumstances. Unlikely to occur but definite potential exists. Reasonable chance of occurring – has happened before on occasions. Likely to occur – strong possibility. The event will occur in most circumstances.
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Risk Rating LIKELIHOOD SEVERITY 1 Insignificant 2 Minor 3 Moderate 4 Major 5 Extreme 5 Almost Certain 5 10 15 20 25 4 Likely 4 8 12 16 20 3 Possible 3 6 9 12 15 2 Unlikely 2 4 6 8 10 1 Remote 1 2 3 4 5
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North Ayrshire Integration Joint Board Strategic Risk Register Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Severity Probability Score Rating Proposed New Control Measures Previous Severity Probability Score Rating Risk SRR01 Financial Sustainability of the Health and Social Care Partnership - Resources have not kept pace with the demand for and cost of health and social care services. The 2025/26 financial outturn was an overall year-end underspend of £2.501m on an IJB basis, reducing to £0.696m after new earmarked reserves of £1.805m. This improved position reflected the impact of financial recovery actions, strengthened controls and non-recurring benefits realised during the year; however, it does not remove the underlying recurring pressures across a number of service areas. Financial modelling continues to indicate significant medium-term challenges, with 2026/27 remaining particularly challenging due to cost and demand pressures, pay and inflation, demographic pressures and limited flexibility to absorb further in-year variation. The IJB approved a one-year balanced budget for 2026/27 on 13 March 2026. This included new budget pressures of £22.007m and approved savings of £8.644m. The funding increase assumed within the budget was £15.861m, comprising £11.147m from North Ayrshire Council and £4.714m from NHS Ayrshire and Arran. A remaining Health/NHS services gap of £0.494m will be monitored closely during 2026/27, with further recovery actions identified as required. Unearmarked reserves remain below the recommended level. At 31 March 2026, unallocated reserves were £0.696m, representing 0.2% of the 2025/26 budget, compared with the recommended reserve level of 2% to 4%. There is therefore limited scope to absorb in-year variances, with any material overspends requiring additional recovery action or support from partners. The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. The opening projected overspend for 2026/27 is £2.992m, predicated on maintaining Financial Recovery Plan controls and delivering agreed mitigations across key pressure areas including care at home, care packages, Brighter Pathways, supplementary staffing and high-cost placements. The main areas of continued financial risk include physical disability and learning disability care packages, integrated island services, inpatient ward staffing, UnPACs, psychiatry and ongoing demand and workforce pressures. Chief Finance Officer * The IJB has established financial governance arrangements in place to monitor, manage and report on the financial sustainability risk. This includes regular budget monitoring reports to the IJB, detailed financial reporting to the Partnership Senior Management Team, and ongoing oversight by the Finance Working Group, chaired by the IJB Vice Chair. Financial updates are also shared with the Directors of Finance of North Ayrshire Council and NHS Ayrshire and Arran, supporting whole-system oversight of the delegated resources. * The IJB continues to take an integrated approach to managing the totality of resources delegated by North Ayrshire Council and NHS Ayrshire and Arran. * The Integration Scheme requires recovery plans to be developed where overspends are forecast, and financial recovery actions have been approved and monitored throughout 2025/26. These actions contributed to a significant improvement in the projected financial position and supported delivery of financial balance by the end of 2025/26, although the position remains dependent on sustained grip, control and delivery of recurring savings. * Financial recovery controls remain in place, including vacancy scrutiny, recruitment delay arrangements, enhanced scrutiny of high-cost care packages, controls over supplementary staffing, and additional oversight of areas with material overspends. * The high-cost care package group has been expanded to include children with disability care packages and all UNPACS placement requests. All care packages, excluding in-house care at home and older people placements agreed through CARG, are subject to approval through this enhanced governance route. * Specific demand management controls are in place for key pressure areas, including care home placements, care at home, residential placements for children and young people, mental health inpatient services, learning disability services and community care packages. These controls are intended to ensure that expenditure decisions are based on assessed risk, need and affordability, while recognising that the measures may impact on waiting times, delayed discharges, unmet need and wider service performance. * The IJB approved a balanced budget for 2026/27, supported by additional partner funding, identification of unavoidable service pressures, and approved savings. The budget includes significant savings requirements, including implementation of revised adult social work and social care eligibility criteria, operational efficiencies, service redesign and transformation actions. 25 5 5 25 Very High * Recovery plan controls will be maintained into 2026/27, including vacancy controls, recruitment delay arrangements, high-cost care package scrutiny, supplementary staffing controls and targeted oversight of areas with recurring overspends. These controls will be reviewed regularly to ensure they remain proportionate, effective and aligned with safe service delivery. * The Finance Working Group will continue to provide enhanced scrutiny of the financial position, savings delivery, recovery actions, transformation progress and emerging risks. * The group will also support development of the 2027/28 budget and the next update of the Medium- Term Financial Outlook. * Focus will be given to the delivery of savings linked to revised eligibility criteria, care package reviews, operational efficiencies, transformation projects and areas of recurring overspend. * The Eligibility Criteria Programme Board will provide strategic oversight, assurance and direction for implementation of the revised Eligibility Policy for critical-only access to funded adult social work and social care services. This will include monitoring of financial delivery, operational impact, risk, governance, equality considerations, service user impact and any unintended consequences. * Financial monitoring arrangements will continue during 2026/27 to improve early identification of emerging cost pressures, demand trends, savings delivery risks and service areas requiring escalation. This will include continued focus on low-volume high-cost placements, commissioned services, provider sustainability, supplementary staffing, care at home, delayed discharges and children’s residential placements. * The Chief Officer and CFO will continue to engage with Scottish Government, national networks and partner organisations to highlight the scale of the financial challenge and the need for sustainable investment in community-based health and social care services. * A further update to the Medium-Term Financial Outlook will be developed to inform 2027/28 budget planning. 16 5 5 25 Very High Treat SRR01 (cont) * The Partnership undertook extensive community engagement, commencing in early December 2025, on the challenges of delivering social care services within budget. £5.828m of savings will be met through the review of eligibility criteria and three interlinked proposals developed to implement reductions to care packages:1) changing eligibility to support only people at critical risk; 2) introducing a Best Value Care Funding Framework; and 3) prioritising personal care. * The Medium-Term Financial Outlook is updated on a rolling basis and is used to identify future financial gaps, recurring pressures and the implications of demographic change, inflation, pay awards, policy commitments, workforce pressures and rising demand. This supports forward planning and informs budget development, transformation priorities and discussions with funding partners. * The Transformation Plan has been refreshed to ensure that remaining projects have clear objectives, defined benefits and alignment with the Strategic Plan and financial sustainability requirements. Oversight is provided through the Transformation Board, with updates reported to the IJB. Transformation activity is focused on redesigning services, shifting support closer to home, improving outcomes, reducing reliance on high-cost provision and supporting longer-term financial sustainability. * The IJB has a reserves policy and reports regularly on reserves as part of financial monitoring and annual accounts. Unearmarked reserves remain below the recommended level, which limits the IJB’s ability to absorb in-year financial shocks. This is recognised as a key element of the financial sustainability risk and is kept under review as part of financial planning. * The IJB continues to engage with North Ayrshire Council, NHS Ayrshire and Arran, the Scottish Government, Chief Officer networks, Chief Finance Officer networks and national IJB forums to highlight the local and national financial sustainability challenges facing health and social care partnerships. SRR02 Infrastructure - ICT System Integration and Property - lack of an integrated IT system to meet the needs of NAHSCP leading to non-robust and inefficient information recording and sharing resulting in inefficient business models, duplication of effort, inaccurate or lack of data on service demand and delivery and risk to service users, patients and staff. Principal Manager Transformation (usually updated by Neil McLaughlin) * Access to systems can be requested to allow NHS-Partnership staff access to NAC systems, and NAC-Partnership staff access of NHS systems. * Work has progressed to reduce the number of MH ancillary recording systems and consolidate data on centralised systems. * HSCP systems and performance team supporting work across the partnership and progressing developments and issues with systems * NHSAAA are undertaking a review of all MS Access databases in use for removal to centralised systems. - local review linked to MH reporting completed to plan removal * Implementation of Trakcare functionality within Adult Community Mental Health Services to manage patient clinics across all three Partnerships. * MH Digital Transformation board established * MH digital business case being developed to address future planning needs. * Digital pilot for CYP neurodevelopment transformation with Strata Health. 12 4 3 12 High * Two groups have recently been established to better coordinate ICT issues/concerns/developments: (i) HSCP Digital Leads with NAC, SAC, EAC and NHS IT and HSCP digital leads which is chaired by NHS (ii) NAHSCP Digital Working Group which includes representatives from each Service. A ToR was recently approved at Transformation Board in February. This group will have oversight of digital projects on the Transformation Board. * Network access issues at NHS/NAC sites being explored and supported by NAC IT 12 3 3 9 Moderate Tolerate SRR05 Transformational Change Programme - failure to deliver the transformational change required to meet current and future demands and ensure our long term financial sustainability. Principal Manager Transformation (Stuart MacMillan) * Senior Manager leading on the delivery of the Transformation Plan. * NAHSCP Transformation Board for oversight of programme development and delivery. * Reporting regularly to NAHSCP Integration Joint Board. * Development of Workforce Plan, and Digital and Data Plan, to ensure alignment with transformed products and services. * Programme risk register in place, with high rated risks escalated to the Board. * Alignment of service change/transformation plans to Strategic Plan priorities * Raise awareness of Programme within the three parent organisations (including elected members and board members) via established reporting arrangements. * Transformation Plan has been refreshed, updating project scopes and anticipated benefits * A benefits management approach has been introduced and all projects will have benefit trackers assigned * Transformation Board terms of reference has been approved 12 4 3 12 High * Regular meetings in place with planning managers and Finance colleagues to ensure coordinated approach to change and transformation * A new transformation strategy is in development which will articulate the partnership's strategic approach to delivering transformation * Diarised meetings between Principal Manager (Transformation) and each Head of Service aimed at better coordinating transformation activity at Service level * Discussions taking place with Senior managers to understand areas of challenge and opportunities for change underway. 12 3 3 9 Moderate Treat SRR06 Governance - IJB governance arrangements are not conducive to effective working and decision making, Leading to a lack of confidence in the IJB and reputational damage. Failure to comply with governance requirements such as Freedom of Information, Complaints and other regulations laid down within the Public Bodies (Scotland) Act. This could lead to a breach of specific regulations resulting in enforcement action from governing bodies, adverse public reaction and/or prosecution. Statutory Instrument to revise voting membership of IJBs to include lived experience, unpaid carer and third sector representatives will come into effect in September 2026. Revisions will be required to Integration Schemes, Standing Orders. Governance Officer (Karen Andrews) * Statutory governance arrangements defined by Integration Scheme are in place for representation at the IJB and sub- committees and reviewed within prescribed requirements. * Integration Scheme, Strategic Plan, Standing Orders and Code of Conduct in place. * Policies and procedures developed and in place for each function including Complaints, FOIs/Adverse Events for both HSCP and IJB. * Operational Governance / Delivery groups in place to ensure appropriate action planning and monitoring including Performance and Audit Committee, Clinical and Care Governance Group, Adverse Events Review Group, Health and Safety Groups and the Staff Partnership Forum. * IJB receives 6 monthly updates on Clinical and Care Governance activity including details of adverse events; significant case review; complaints. This update includes details of outcomes and lessons learned. The Adverse Event Review Group now includes a fortnightly update for all AERs across the North HSCP. *Approved a Risk Management Strategy, Strategic Risk Register and risk appetite statement. *Health and Care Governance Framework in place 9 3 3 9 Moderate *Strengthened induction programme and governance training including code of conduct to be delivered throughout 2026 following the changes to IJB voting rights. * IJB Carer Representative was appointed following a successful recruitment campaign. Additional stakeholder appointments still to be confirmed. *Statutory Instrument to extend IJB Voting Rights to include lived experience, unpaid carer and third sector representatives * HSCP reviewing resourcing and capacity for demand to undertake SAERs. Proposal to enhance process with training and reviewing capacity across the three HSCPs. *Ongoing Integration Scheme and Standing Orders review is underway to ensure fitness for purpose. *Refresh of induction programme for new IJB members and refresher of code of conduct and standing orders planned during 2026. *Regular PAC/Internal Audit review of governance processes. 3 3 1 3 Low Treat Gross Risk Residual Risk
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North Ayrshire Integration Joint Board Strategic Risk Register Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Severity Probability Score Rating Proposed New Control Measures Previous Severity Probability Score Rating Risk Gross Risk Residual Risk SRR07 Demography and Inequality Pressures - failure to adequately plan for and respond to changes in our population profile and in the levels of poverty in North Ayrshire will result in more people experiencing higher levels of physical and mental ill health, resulting in increasing demand on services, an inability of services to provide adequate care and negative impact on health and wellbeing. Chief Officer (usually updated by Seony Ross) • A full review of demographics was carried out throughout 2025. The Strategic Needs Assessment was published in August 2025 and reviews information regarding general health and wellbeing, mental health, hospital and community care, children and young people, economy and inequality. This has supported the review of the Strategic Plan as well as other internal service reviews and other pieces of work, and has been shared with partners to support their workstreams. •The HSCP reviewed and refreshed its Strategic Plan ‘Caring Together’ for the remainder of the plan period, which will be in place from 1st April 2026 to the 31st of March 2030. In addition to identifying Service Delivery Priorities which support the health and wellbeing of our communities, the Plan identified 3 Strategic Priorities which are and intended to reduce the pressures on the HSCP by anticipating future demand and aiming to improve outcomes at a population level. • Demography increases are factored into budget planning to ensure the resource requirements are understood and funding is identified to meet needs. The budget has also been considered in the development of the new Strategic Plan priorities. • The transformation programme is focused on reviewing services and ensuring transformation of services is focussed on meeting the needs of service users, including ensuring appropriate support is in place for complex and intensive support needs. • A new set of Equality Outcomes was published in April 2025 which considered inequality and demographic data, and the lived experience of equality groups within North Ayrshire. The new Equality Outcomes were published alongside a set of actions to be achieved between 2025 and 2029 to support mainstreaming equality activity and equality of opportunity for marginalised groups. • Equality and Children’s Rights Impact Assessments are carried out for new policies, proposed projects and service change proposals which are considered by IJB to inform decision making. These integrated assessments consider impacts for protected characteristics, socio-economic disadvantage, island consideration and impacts on consumers of services. • The HSCP has recently analysed all previous engagement carried out across the HSCP over the previous 3 years and developed a new Participation and Engagement Strategy for 2026-2030. This strategy outlines how communities, carers, and families will be able to share their views, and ensures the HSCP has the opportunity to hear people’s lived experience when developing services This will allow people’s own experiences of inequalities to be considered in our review and 16 4 4 16 High • The Strategic Plan outlines 3 Strategic Outcomes which aim to address future service requirements based on demographic changes and local inequalities and aim to better understand and assess how we may influence improved health and wellbeing. The Strategic Priorities are: Supporting the improvement of population health, Addressing the Changing needs of an ageing population, and tackling the root causes of health inequality. During 2026, the HSCP will begin a programme of work with Public Health Scotland Analysts to research anticipated future demographic changes, how services are currently responding to these issues and where improvements can be made. The 3 workstreams will inform the HSCPs transformation programme and complement participation in the CHES programme. • The CHES Programme will continue with extensive engagement activity to ensure lived experience influences the recommendations made through the programme. • The HSCP will develop locality plans which will consider the individual needs and circumstances of people living in smaller communities, and will outline how our services will meet the needs of those specific communities • the Strategic Planning group will continue to monitor the HSCPs Strategic plan and related strategies and respond to any demographic changes that may impact strategy delivery. 12 3 4 12 High Treat SRR07 (cont) * A new Learning Disability learning plan was published in 2025, which comprises of service information and engagement insights, and explores where there may be further need for development for this specific client group. • A new Strategy for unpaid carers: Together we care 2026-2029 was agreed by IJB in December 2025. It advises carers of their rights, sets out plans to identify carers, routes for assessment and support, and information about local and national services. The aim is that all North Ayrshire carers are identified, supported and valued and are afforded an opportunity to live, work, thrive and stay connected to their communities enjoying a life alongside caring, where they choose to continue to care. Care needs are becoming increasingly complex in North Ayrshire due to demographic changes, and the strategy will support the unpaid carers that provide care in the community. • North Ayrshire is participating in the Collaboration for Health Equity in Scotland Programme which will consist of intensive research and engagement in order to make recommendations for reducing health inequalities for North Ayrshire Residents. In North Ayrshire, the programme will focus on 3 principles in 3 specific areas: - Give every child the best start in life, in the Fullarton, Castlepark south, Bourtreehill area of Irvine - Create fair employment and good work for all, in the Ardrossan central, Saltcoats central and Stevenston Hayock areas of Three Towns - Strengthen the role and impact of ill health prevention, in the Garnock Valley. • In our Drug and Alcohol Services, we are implementing actions to reduce the number of local drug and alcohol related harms and deaths. This includes implementing the national MAT (Medicated Assisted Treatment) standards and increasing the number of ABIs (Alcohol Brief Interventions) delivered across North Ayrshire. * North Ayrshire is one of 3 areas in Scotland as part of the CHES programme (Collaboration for Health Equity Scotland) which launched in February 2025 - this programme is a partnership between NAC and the IJB and will involve all public sector partners to determine: - What are the most impactful areas for intervention for Scotland to make meaningful progress in closing the inequalities gap in healthy life expectancy? - What action can be taken to enable national and local organisations to work more effectively together to close the recognised implementation gap between policy intent and impact? SRR08 Workforce - failure to recruit and retain and plan workforce requirements effectively leading to an insufficient workforce (number of staff, key roles and competency levels), resulting in a reduction in capacity to safely and effectively care for local people and a negative impact on service user and patient's needs being met Chief Officer (usually updated by Seony Ross) • In March 2025 the HSCP submitted a workforce template to the Scottish Government which outlined workforce challenges for the HSCP including the agenda for change pay reform, demographic changes and increasingly complex needs, financial pressures, and recruitment challenges. No further guidance has yet been issued by the Government • To develop the refreshed strategic plan for 2026, service engagement was carried out which asked services for their challenges and opportunities which included staffing and resource challenges for specific teams • The learning and Development strategy for social work and social care 2023-2028 continues into its third year, continuing to offer training and succession planning. • HR and service leads will continue to meet quarterly to review, update and align workforce plans in line with evolving service demands and strategic planning requirements. Workforce Planning meetings incorporate a structured review of external factors using PESTLE to ensure workforce strategies remain responsive and proactive. • The Care at Home service has an ongoing recruitment review in place as part of budget savings plan, with regular establishment meetings taking place to review all vacancies and high-cost areas of spend to ensure all critical vacancies are being filled where applicable. This is done via regular recruitment events and advertising. The service has a robust recruitment strategy which includes a retention plan which is monitored via stay/exit questionnaire completion by senior members of the management team. • The iMatter staff experience survey continues, to ensure senior managers are able to get feedback from employees about what is important to them in the workplace. • In Arran, there are ongoing high costs of agency to support Montrose House Care Home to meet staffing legislation requirements for residents. A contract with the agency is in place to help reduce these costs and there is a rolling recruitment programme for vacant posts and a variety of recruitment opportunities have been explored including a recruitment campaign with assistance of an external agency. • Roles have been diversified to support challenges, e.g. Psychiatry has expanded MDT responsibilities to enable psychiatrists to focus on the most complex cases, and Health Care assistant roles have been developed in wards for long- term conditions. • Collaborative recruitment in A&A for areas including ICT, Primary Care Implementation plan, Mental Health and Clinical Leadership • Exit interviews with staff to understand reasons for leaving using this intelligence to inform plans to improve working 12 4 3 12 High • A new workforce plan for the HSCP which considers the above information, as well as projected demographic challenges, will be developed in 2027. • With the addition of a Workforce Data Analyst, a review of workforce information was undertaken and a phased release of new efficiently produced information developed. This information is being phased into use starting with the extension of core absence information to include - absence reason, absence cost, recruitment, vacancies - now as a core element included in the Partnership's quarterly performance report to the IJB Performance and Audit Committee. • A revised approach to jointly managing waiting lists has been implemented. Adult Providers have access to current waiting lists at all times and face to face meetings are also taking place to minimise waiting times for services users as much as possible and maximise providers staffing resources. • A review of provider forums is almost complete - the focus has been on consulting with providers to ensure a clear understanding of what the key issues are that the HSCP could support providers with at this time. • The HSCP continues to review the structure on an iterative basis with opportunities progressed as they arise to look at senior roles and to undertake gap analysis on roles and levels within the HSCP to better deliver on team and partnership outcomes. Examples of this being the recent review of the leadership structure in relation to finance and transformation and the review of disability services which introduced Senior Practitioner roles to the team. The review will continue on that basis, led by opportunity and service need • Increased focus on vacancy management and recruitment alongside service impact and for service areas with workforce shortage proactively looking to skill mix and different roles to address recruitment challenges - examples being SLT and OT. 9 3 3 9 Moderate Treat SRR09 Local Impact of Scottish Government Policies: risk of further legislative, policy developments or change which impacts on the IJBs ability to deliver on strategic objectives, examples include the NHS Agenda for Change in the Reduced Working Week, the Promise, the Living Wage, Free Personal Care and other future policy developments including the now amended National Care Service. The impact being the inability to deliver on these alongside strategic plan commitments and objectives and the impact of funding for new policy and legislative commitments. Chief Officer * Horizon scanning for policy developments through partners and professional networks, including links with Scottish Government policy teams. * Regular liaison with Scottish Government and COSLA senior officers. * Attendance and participation at the national Chief Officer network. * Responses to consultations on potential implementation of new policy areas. * Early local impact assessments for national policies, including operational and financial service impact. * Financial modelling to respond to requests for information and support full funding. * Fully brief IJB members and wider partners on policy implications for the IJB to gather support and awareness of any implementation issues or concerns. 16 4 4 16 High * Promote and develop pan-Ayrshire approaches to impact assessment of policy implementation * Reinforce the role of Elected Members and IJB members to influence Scottish Government decision making through political routes. 12 4 3 12 High Treat SRR12 Clinical and Care Governance: Failure to have an appropriate framework in place leading to an adverse impact on the culture resulting in a reduction in the quality of the delivery of the highest quality of care and support is understood. Chief Social Work Officer and Associate Nursing Director *continuous review of arrangements for Clinical and Care Governance are essential for the delivery of statutory, policy and professional requirements and the achievement of our quality ambitions. *ongoing review of established structures and processes to assure Integration Joint Boards, Health Boards and Local Authorities *empowering clinical and care staff to contribute to the improvement of quality *making sure that there is a strong voice of the people and communities who use our services. * ensure that professional leadership develops good governance for each of the following components: culture, systems, practices, performance, vision and leadership. * delivery of the highest quality of care and support is understood to be the responsibility of everyone working in the organisation - built upon partnership and collaboration within teams, and between health and social care professionals and managers. * Health and community Care have developed a governance Board to ensure feedback to the overarching Clinical and Care Governance arrangements. 9 3 3 9 Moderate * Continue to develop and monitor key performance indicators and report effectively through governance framework. * Ensuring we further develop clear and consistent reporting frameworks acknowledging the growing risks posed to service delivery due to financial and resource constraints. 9 3 3 9 Moderate Tolerate SRR13 Provider Failure (commissioned services) There is an ongoing risk of social care supplier failure due to staffing and recruitment challenges and the financial viability of care providers. Particularly across community based support and also in residential settings including care homes. Supplier failure leads to risk to service users, potential for withdrawal of care and disruption to care plans. Senior Managers - Lorraine Dyet. Louse Davidson, Julie Barrett * Reviewed and monitored via CAHOG and CHOG, where intelligence and early warning signs are shared across agencies, including the Care Inspectorate. * Enhanced contract management is in place, supported by monitoring tools. * Monthly or quarterly management meetings with companies are held where required. * Formal support measures are in place, including quality of care monitoring. 16 4 4 16 High * Continue with current governance, mitigation and control measures. * Ongoing engagement with current Community Support Providers. * Where possible, scope opportunities for additional providers to support capacity and contingency plans. * Promote an open-book approach with providers in relation to their financial position. 16 4 4 16 High Treat SRR14 Asylum Arrivals - there is a growing risk to health, primary care and social care sustainability, as the numbers of adult asylum seekers dispersed by the Home Office grows, the number of unaccompanied children and young people asylum seekers and trafficked young people grows. Head of Service - Elizabeth Stewart Senior Managers - Louise Henry * North Ayrshire Refugee taskforce led by NAC Housing, attended by Home Office and MEARs dispersal agents, * Agreed targets with COSLA for Mears and resettlement schemes - new MOD scheme has not yet set targets. * NHSAA Public Health continues to screen and treat TB and blood borne virus issues, * HSCP Refugee Support Team continues to screen all new arrivals including UASC linking with Public Health, social work, and other services as required 12 3 4 12 High *Continue governance approaches * Finance team continues to map impact on children's houses from unaccompanied asylum seekers and trafficked young people, * NHSAA Public Health continues to screen and treat TB and blood borne virus issues, *HSCP Refugee Support Team continues to screen all new arrivals including UASC linking with Public Health, social work, and other services as required * Impact statements provided to Home Office and MEARs about on-going stresses on primary care, HSCP Health and Social Care in specific towns and villages as agreed targets likely to be exceeded, 12 3 4 12 High Treat
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North Ayrshire Integration Joint Board Strategic Risk Register Risk Ref Description of Risk Risk Owner Mitigations/Control Measures Previous Severity Probability Score Rating Proposed New Control Measures Previous Severity Probability Score Rating Risk Gross Risk Residual Risk SRR15 Risk of Harm - A lack of resources combined with an increase in both demand and complexity is leading to increasing numbers of residents waiting for services, whether that be for referral, assessment or the provision of care and support. Resources will be directed at those with the greatest need, reducing capacity for early intervention and prevention supports. This results in a greater likelihood of residents experiencing harm as a result. The gross risk increased from 16 to 20 which reflects the current financial position and the move to critical eligibility criteria for access to social care services. Operational Heads of Service and CSWO * Children, Families and Justice Services: waiting list guidance has been produced and cascaded across teams, setting out arrangements for managing cases awaiting allocation, including escalation processes. A duty social work system is in place as the point of contact for cases not yet allocated. Monthly waiting list reports are produced to support Head of Service oversight of unallocated cases. Where appropriate, review meetings are convened to discuss cases where risk is escalating. * Community Care and Health: standard operating procedures are in place across Social Work and Service Delivery Teams for the management of risk. A social work duty system is in operation. The Health and Community Care Unmet Need Oversight Group meets weekly, supported by daily delayed discharge oversight, daily Care at Home waiting list review, weekly resource group meetings with senior managers, and monthly multi-disciplinary meetings with Health and Community Care teams and partners to identify people requiring support and escalation as early as possible. * Mental Health: weekly resource group meetings are held to consider new care packages and revisions to existing care packages. Waiting lists are reviewed regularly. Standard operating procedures are in place across Social Work and Service Delivery Teams for the management of risk, supported by the social work duty system. * Allied Health Professionals: referrals are prioritised at the point of referral, with higher-risk patients prioritised for support. Telephone support is offered to others where appropriate, alongside review of criteria and access routes for specialist, targeted and universal responses. 16 4 4 16 High * Ensure clear reporting of risks and trends in waiting lists through appropriate governance groups. * Maintain reporting and escalation to Scottish Government through regular unmet need returns and ongoing engagement and discussion regarding the level of resource required. * Review referral pathways and eligibility criteria to ensure available resources are directed to those with the greatest need. * Pursue opportunities across the wider system to support investment in early intervention supports, enabling residents to receive support at an earlier point where possible. 16 4 4 16 High Tolerate SRR16 Growth and expansion of specialist complex care developments - there has been a rapid increase across the independent sector in North and South Ayrshire since 2020 which lack alignment with local commissioning plans. This results in an exponential growth in un-forecasted referrals to community and inpatient Mental health and Learning disabilities services leading to an impact on capacity and demand on MDT's and inpatient occupancy levels when placements breakdown. The out of area demand lacks alignment with the principles enshrined in the Scottish Government 'Coming Home report', resulting in significant delayed discharge and high costs associated with inpatient stay and Scottish Government guidance regarding 'ordinary residence' and dual health board responsibility for NHS health care provision is exacerbating this position. Jan Thomson and Gillian Duffy * Engage with Housing and Planning Departments to be aware of new applications at an early planning stage. * Use provider forums to discuss emerging risks/concerns/developments and agree appropriate contingency plans. * Work with Scottish Government (HIS) to contribute and influence the national work on dynamic support registers to ensure these are being utilised appropriately. * collaborative working across Ayrshire HSCP’s to develop local complex care solutions * Share information through existing governance groups including Care Home and Care at Home Oversight Groups * Pro active escalation of our of area placement breakdown with placing authority to ensure consideration of social work intervention from responsible area and engagement with care provider. * Seek early legal advice from NAC and NHS Legal teams on accountabilities and position for NA 25 5 5 25 Very High * Develop a collaborative framework of communication to influence registration applications to the Care Inspectorate for specialist and highly specialist units. * Review service models, including learning disability acute assessment. * Continue to review and develop outreach support models as an alternative to admission. * Agree and deliver recommendations of the complex care business case in collaboration with housing and future Strategic Housing Investment Plans, where required for future years, to ensure we can meet the needs of our own local population. * Proactively work with incoming providers to develop referral pathways and ensure appropriate staffing and support are in place, including GP local enhanced services. * Escalate cross-boundary concerns to the Care Inspectorate, Scottish Government and Mental Welfare Commission to seek resolution and support. * Ensure that anyone placed in North Ayrshire by other authorities is on the placing authority’s Dynamic Support Register. Where there is risk of placement breakdown, ensure they are identified as red and that fortnightly action plan meetings are convened. Open and maintain dialogue with the allocated workers from the placing authority to determine actions being taken by them to assist in reviewing and/or stabilising the situation. * Where information is known about someone being at risk of placement breakdown and requests for admission to an in-patient setting are made, the General Manager for Woodland View and bed manager should be made aware at the earliest opportunity. Where the situation allows, a multi-disciplinary and cross-authority pre-admission discussion should be convened at the earliest opportunity 15 3 5 15 High Treat SRR17 (NEW) Children’s Services Placements - Critical shortage of appropriately matched local and national placements for babies, infants, children and young people leads to reduced ability to provide suitable care away from home when required, resulting in delayed or inappropriate placement decisions, increased use of higher-cost or out-of-area provision, reduced placement stability and potential impact on safety, wellbeing and outcomes. Elizabeth Stewart and Scott Hunter * Focus on Brighter Pathways programme of service transformation for care placements in North Ayrshire * Fortnightly residential placements review meetings * Fortnightly Resourcing Coordination Meeting - reviewing foster care and residential requests * Closer liaison with housing services via monthly Moving On Up Forum * Development of Boyle Street, Irvine, Supported Model of Accommodation as per Brighter Pathways work * Launch of new Fostering Scheme - Fostering Futures (1st April 2026) as per Brighter Pathways work * Ongoing Review of Intensive Support Services (to prevent family breakdown and requirement of placement). n/a 5 5 25 Very High The placement issue is being taken forward by SWS to COSLA and NSWA, concerns have been escalated nationally by all areas with further discussions happening at a national level. n/a 5 5 25 Very High Treat