CHIEF EXECUTIVE S REPORT. Caroline Lamb, Chief Executive

Transcription

1 NES Item 4 December 2017 NES/17/96 (Enclosure) CHIEF EXECUTIVE S REPORT Caroline Lamb, Chief Executive December 2017 Chief Executive s Report to the NES Board 1

2 1 INTRODUCTION The agenda for our Board meeting today contains substantive items for discussion around our Risk Appetite and our joint working with Health Protection Scotland. Board members will also wish to note that this will be the last Board meeting for Dr Colette Ferguson who will retire as Director of NMAHP at the end of December, we are very grateful to Colette for her very significant contribution to NES. 2 MEDIA INTEREST AND COMMUNICATIONS On 25 th October, we held the NES Staff conference and Annual Review in Perth. With a blend of video and reporting on the day, we aimed to make the event as accessible as possible for those NES staff who were unable to attend. As well as the good turnout (mostly staff) at the Annual Review component, we also streamed the Annual Review on our Facebook page, for anyone to view. On 21 st November, our web-based 2017 Annual Report went live: We will be promoting this over the coming weeks and into early In terms of media coverage, a Conservative party campaign sparked interest in GP recruitment numbers. We supported SG with answers to questions, and dealt with the Times (negative) and GP magazine (positive) ourselves. Our news release on the Improving Surgical Training Campaign got good and positive pick-up from the Scotsman, with them reusing one of our latest recruitment videos: 3 DIGITAL Turas Appraisal is on timetable for an MVP (Minimal Viable Product) to be in place by the end of December The team are working on the support arrangements which will be in place for the Boards to ensure its successful implementation. The Turas Learn Team are working to refine the roadmap on function for April 2018 and completing content categorisation. Meetings are taking place with LearnPro to ensure contingency agreements and future joint working agreements. Internally the Digital team are keen to maintain a high level of service. Operations are therefore focussed on removing Novell products from the internal systems landscape and delivering infrastructure improvements. These include data centre consolidation, ISO implementation, VC improvements, improved security and supporting departments in making more use of features available on Office DENTAL, OPTOMERY, HEALTHCARE SCIENCE & KNOWLEDGE INTO ACTION Healthcare Science Update Commissions: Following our expressions of interest process to service, we hope to support around 25 clinical scientist pre-registration posts either by outright full-support or shared funding with host departments. We should be able to confirm allocations before the year s end. Chief Executive s Report to the NES Board 2

3 NES Healthcare Science attended two significant discussions potentially adding pressures and expectations on the workstream. The first, led by CMO specialty advisor for neurological services, included a focus on the challenge sustaining neurophysiology services. From the healthcare science perspective, as reported last time, the clinical physiology service did not pick up our offer of clinical scientist trainees for 2018; this specialty has also had major difficulties at Board-level in securing authorisation for NHS undergraduate trainee posts despite the national programme having its highest ever intake (but comprising other physiology specialties). The second conversation, also referred to in the last report, was led by NSS and focussed on the genomics service. This is experiencing major pressures as the technology works its way into other aspects of the diagnostics pathway. The scale and pace of genomics is outstripping the supply of scientific and genomic counsellor staff. Further conversations are imminent regarding building a refreshed genomics strategy that will undoubtedly have an impact on NES training measures. In mid-november, we ran the first tele-viva for a Scottish candidate undergoing a clinical scientist exit viva with assessors based in Birmingham. This development spun out of our close working relationship with the Academy for Healthcare Science; we anticipate this could become the norm for our candidates with the possibility of using NES offices around Scotland to minimise travel cost, loss of clinical time and the difficulty of scheduling diaries. A further cohort of at least 7 such viva candidates is due in the early New Year. CPD: In partnership with the UK Academy for Healthcare science, we ran a successful Study Day (North) on the work of the Academy, with training opportunities for clinical scientist assessors and potential registrants to the Academy s accredited register for non- HCPC grades. Quality monitoring: We completed our annual surveys of postgraduate trainees and supervisors in mid- October and will publish summary findings soon. Respectively responses were received a 55% (trainee) of 123 and 48% (supervisor) of 162. Our annual surveys will help inform our February (2018) postgraduates event and that is now at an advanced stage of planning. We have focussed on establishing a basic review of progression check, that began in September Sign-off by supervisor and trainee is recorded on TURAS and the exercise has helped cement our us of this digital platform. However, we anticipate the need to expand the Specialty Leads team to address new trainees being recorded on the TURAS system, new training centre accreditation work and an emerging requirement to refresh our CPD offer. A Kennexa case has been lodged to address vacancies in the current establishment. 5 NMAHP Transforming Nursing, Midwifery and Health Professions Roles The Chief Nursing Officer (CNO) has established a programme board to oversee the transformation of nursing, midwifery and health professions (NMAHP) roles to address the NMAHP contribution to service transformation. NES is playing a central role in this work with the development of a structured coordinated and future focussed approach to education and career pathways from registration through to advanced and consultant practice for these professions. The first step has been to develop a career pathway model which demonstrates flexibility in acquiring knowledge, skills, formal qualifications and continuing professional development to support practice at all levels towards advanced and consultant practice. The principles Chief Executive s Report to the NES Board 3

4 underpinning the model include a focus on higher level generalist skills with a more flexible approach to advanced knowledge and skill development to allow for changing service needs. A key aim of the Pathways approach is to develop a workforce pipeline, attracting and feeding into specific areas of practice, combined with structured and transparent career pathways to attract and retain skilled practitioners. Summary of progress to date An overarching framework for structured sustainable education and role development pathways from transition at registration through to advanced and consultant level practice has been developed and agreed with key stakeholders. In response to service transformation needs and SG commitment to train an additional 500 Advanced Nurse Practitioners over 5 years, a nationally consistent approach to Advanced Nurse Practitioner (ANP) education based on agreed definition and role expectations is progressing. Service and Education Needs analyses for advanced nurse practitioner roles by NHS Boards/Integrated Joint Boards/Primary Care/Care Homes/Hospices have been carried out to identify ANP education required over next 4 years. Specific competencies have been outlined for ANPs in paediatrics and neonatal, primary and community care, mental health and acute settings to shape education in these areas. The recommendations from the Review of District Nursing regarding CPD and initial education to enable the development of the senior practitioner within the integrated community pathway is being progressed National programme of work for General Practice Nurse development commenced June 2017 Next Steps The first phase of this work has focussed on Transforming Nursing Roles, in particular developing a pathway and consistent approach to Advanced Nurse Practitioner roles and preparation. Moving forward, the focus is on widening application to Allied Health Professions and Midwifery and to build on the strong education foundation established in phase one. Under the auspice of the Transforming Roles programme Board, priorities for development will be agreed in alignment with service needs. A key element of the work will be to explore and agree an approach to strategic education commissioning for high volume and high priory education to ensure a skilled, flexible NMAHP workforce is adequately prepared to maximise their contribution to care delivery now and in the future. 6 PSYCHOLOGY BA Scotland 2017 NHS Education for Scotland has been implementing Behavioural Activation for Depression since 2010 through a network of practitioners (Nurses, Allied Health Professionals, Social Workers), supervisors and trainers within the local NHS boards across Scotland. Behavioural Activation is an evidence based psychological therapy and intervention that Chief Executive s Report to the NES Board 4

5 provides good clinical outcomes for people with depression. NES has trained 86 NHS staff as BA Trainers and training has been rolled out to over 967 staff in local boards between NES brought together the Behavioural Activation for Depression network as a learning community on the 9 th & 10 th November to reflect on their provision of BA, share good practice, improve connectivity and celebrate the work that has been achieved within local boards. Dr Dean McMillan presented the results from the COBRA study which compared BA and CBT. Keynote presentations and workshops were facilitated by Professor Carl Lejuez, the originator of the low-intensity Brief Behavioural Activation for Depression (BATD). Webinar technology was used to connect with Dr Christopher Martell, the originator of high intensity BA for Depression, in the USA, for a plenary on recent research. The impact of the local training was evidenced both through posters at the poster exhibition, and Mr Frank Oliver s presentation of his experience in receiving Behavioural Activation for Depression. Webinar technology also provided service leads with an opportunity to join the event remotely from their work bases. Trauma Workstream NES Psychology Trauma workstream has been commissioned by Scottish Government Justice Department to consider the proposed new development of an NHS Shetland onisland forensic medical examination (FME) and how we could support meeting the local training needs to ensure that this potentially retraumatising experience is trauma informed, in line with the NES Transforming Psychological Trauma: A Knowledge and Skills Framework for the Scottish Workforce. This project is being progressed partly by contributing specialist psychological knowledge to the NES Medical Directorate current update of the training for FME s. It is also involving understanding the broader pathway of people involved during the process of disclosing rape and sexual assault/abuse, and in consultation with partners including other NHS colleagues, Police Scotland and 3 rd sector organisations such as Rape Crisis to consider how the framework can inform training needs. We plan to design/co-produce, deliver and evaluate specialist trauma training to that broader workforce. 7 MEDICAL UK Consultation on the future regulation of the health professions The Department of Health (on behalf of the four nations) has launched a consultation 1 to gather views on what changes need to be made to the way doctors, nurses and other healthcare professions are regulated in the UK. It is hoped that reforms will make the process of professional regulation more efficient and ultimately deliver better protection for patients. This consultation seeks views on the reforms needed to help maximise public protection while supporting workforce development. The proposals aim to design a flexible model of professional regulation that secures public trust, fosters professionalism and improves clinical practice, while also being adaptable to future developments in healthcare. This consultation takes forward the Government's commitment to legislate to reform and rationalise the current system of regulation of healthcare professions. 1 regulation/regulatory reform/ Chief Executive s Report to the NES Board 5

6 GMC Outcomes for Graduates Outcomes for graduates 2 (originally published in Tomorrow s Doctors) sets out the knowledge, skills and behaviours that new UK medical graduates must be able to show. Medicine and medical education and training, respond continually to changes in the health of the population, to changes in healthcare systems and to developments in the technologies used to diagnose, treat and manage illness. The GMC first published the outcomes in 2009 and now need to review them to make sure they take account of changes in these areas, over recent years. As a first step, the GMC asked medical educationalists, postgraduate training organisations (including NES), employers, doctors in training, medical students and lay people for feedback on the content and format of the current outcomes. Using this feedback, they have produced a revised draft of the outcomes which they are consulting on now. GMC will consider the consultation responses in early 2018 and hope to publish a new version of the outcomes in summer GMC Medical Licensing Assessment In a very substantial change to the current position, the GMC has been considering for some time the introduction on a Medical Licensing Assessment 3 - to create a common threshold for entry on to the UK medical register. They have defined the aim of the MLA as to create a single, objective demonstration that those applying for registration with a licence to practise medicine in the UK can meet a common threshold for safe practice. Currently, there are three main routes (for graduates of UK Schools, for international medical graduates and for EEA graduates) to practice in the UK and differences in the standards required for entry on to the medical register. Current thinking is that the MLA would focus on applied knowledge and clinical and professional skills, all UK students would need to pass the MLA to obtain a Primary Medical Qualification. Medical school final examinations would include a combination of MLA components and assessment components set by each school to reflect their own curricula. We expect the GMC to bring forward final proposals late in Shape of Training Implementation The Shape of Training report was published in October 2013 and established principles around which medical training could be structured, with a particular patient and society centred focus. In response to this, a key stakeholder group was established (UK Shape of Training Steering Group UKSTSG - to consider the practical implementation of the report. The four health ministers signed off the recommendations 4 of this group on August 11 th 2017, and instructed the health officials in each country to proceed with implementation in order to deliver the benefit to patients expected from the reforms 5. This will enable both restructuring of medical careers to allow more flexibility for trainees, but also should lead to a more responsive way of curricular design and implementation. In Scotland, the Shape of Training Implementation Group has been reformed by government, & the first meeting has been held. NHS Education of Scotland is well represented, the group being co-chaired by Professor Stewart Irvine, with representation from Profs Parks and Reid. Implementation will take some time, as it will involve changes to the way medical specialty curricula are constructed and approved, but there are aspects that are well in train already, 2 uk.org/education/undergraduate/undergrad_outcomes.asp 3 uk.org/education/29000.asp Chief Executive s Report to the NES Board 6

7 most notably in General Medicine training, mooted to be implemented in 2019, but particularly in Surgical Training. General Practice reforms are also planned. Improving Surgical Training (IST) 6 is a pilot project, entirely in keeping with Shape of Training principles, initially planned by Health Education England and the Royal College of Surgeons of England, looking at aspects of surgical training that could be improved. By increasing simulation exposure, formative support through better and more frequent trainer contact and supervision, more relevant training/service balance and a more supportive training environment, it is hoped that skills acquisition could be quicker and more complete, leading to a surgeon better trained in a shorter time. Non-technical skills will be encouraged and developed through simulation and more reflective practice. In England, the pilot will only encompass a new runthrough General Surgery programme, but in Scotland we felt that it would be iniquitous to have some early years surgeons with a five star experience, and we have widened the project to all 49 new entrants to what was core surgical training, so that all get the benefit of the pilot. 18 of these posts will follow the English model, but the rest will be core posts as before. This makes the Scottish participation the largest in the pilot (49, vs 32 in total in England). The pilot will be subject to independent evaluation after the first 2 years. Currently the team, led by Graham Haddock, Surgical STB chair, supported by Bill Reid and Rowan Parks, are engaging with boards in their plans 7 - as can be seen from our excellent video. Recruitment to medical training Recruitment to postgraduate training places remains challenging with insufficient graduates to fill foundation and insufficient foundation completers to fill specialty training. Specialty Recruitment for 2018 Round 1 Core and Run-Through Training - with an August 2018 Start is currently underway. Applications opened on 8 th November, and will have closed (on 30 th November) by the time the Board meets. Full details are on the ScotMT website 8. This year, in addition to the IST project mentioned above, we have also launched the first Broad Based Training 9 programme in Scotland (the only one in the UK) along with a number of innovations designed to restructure and improve the attractiveness of our GP training rotations. 8 WORKFORCE Executive Level Leadership and Talent Management On 24 th October, Shirley Rogers, Director of Health Workforce and Strategic Change confirmed Scottish Government approval of a proposal by NES to establish a hub and spoke infrastructure of centrally managed but both nationally and regionally oriented expert staff resource to lead delivery of the leadership development approach. This will also support the adoption of new talent management and appraisal processes, and was recommended by the Associate Director for Organisational & Leadership Development as an alternative to the 4 options presented by KPMG in September. These focussed on externally designed and delivered leadership development that it was felt would not have delivered the same benefit to wider leadership networks across Scotland as a similar investment in staff infrastructure, supported by technical partner expertise. 6 in surgery/trainees/ist/ based training.aspx Chief Executive s Report to the NES Board 7

8 Whilst this proposal has secured additional funding from Scottish Government, it is lower cost than the cheapest bespoke option presented by KPMG. It includes repurposing some of the funds previously used by NES for Playing to Your Strengths and Delivering the Future, and additional top up funding of 1.24m to establish the new programmes, talent management approach, and test the new hub and spoke expert support infrastructure between 18/19 and 20/21. Work will include design and delivery of packages of development to be offered to three streams: Aspiring Directors, Aspiring Chief Executives, and existing Directors and Chief Executives identified through talent management processes from April This is central to the Project Lift initiative launched by Scottish Government at its Future Leaders event attended by 95 Chief Executives, Chairs and other Executive Level leaders on 15 th November. Our Way Our Way was introduced at the NES Staff Conference (October 2017) at a session for staff attended by around 150 participants. Our Way is in the process of being developed as a way of working that will be written by staff, for staff. This approach was suggested as a direct response to our IMatter Staff Engagement Report (2017). NES scored very well overall as an organisation, however our lowest score was around I am involved in decisions that affect me. It was identified that ownership of this work by staff was necessary if it is to be brought to life in NES. Through a facilitated working group, staff will decide on what is Our Way and what is Not Our Way. Most staff exemplify behaviours that complement NES leadership behaviours and values. The code will provide a framework to define our way of working, and address unacceptable and inappropriate attitudes and behaviours when it is appropriate to do so. It will protect and support staff to challenge behaviour that is not Our Way and a point of reference for everyone and the behaviours we display at work. CALENDAR 24 th October: NHS Education for Scotland and Scottish Social Services Council Partnership Group I joined our regular meeting with Scottish Social Services Council by telephone. Also attending the meeting were the Chair, Carole Wilkinson and Dr Colette Ferguson. Attending from Scottish Social Services Council were Professor Jim McGoldrick, Chair, Anna Fowlie CEO and Professor Joyce Lishman, Harry Stevenson and Philip Gillespie. We discussed Digital learning, an overview of our joint work, Workforce Planning and the National Workforce Plan. We also received feedback on the SSSC/NES Development session, and we reviewed our Memorandum of Understanding. 25 th October: NES 2017 Staff Conference & Annual Review This year we decided to host our Annual Review alongside our Staff Conference which took place at Perth Concert Hall. The Staff Conference was well attended, with over 200 staff from across Scotland. The aims of the day were to increase awareness of the changed landscape for National NHS Boards and the need to work together, sharing and exploring of our educational impact to enable excellence in health and care, celebrating our success with the NES STARS Awards and to reflect on our performance and showcase our achievements in our Annual Review. We achieved these aims through a series of world café, Chief Executive s Report to the NES Board 8

9 presentations, interviews and stands. 26 th October: SOLACE Scotland Seminar: Health and Social Care Developments in Regional Planning I attended this seminar and we were welcomed by the Vice Chair of Solace Scotland, Joyce White. This was followed by an introduction from Andrew Kerr, Solace Scotland Portfolio Lead, Health and Social Care. A presentation was then given by Tim Davidson on behalf of the Implementation Leads and then we had an overview from COSLA, followed on by a discussions on how we can work better together. 30 th October: NHSScotland Implementation Leads Meeting I Chaired this meeting and we looked at options for a Review of National Planning Arrangements and discussed emerging issues and the potential role of the Regional and National Leads in shaping the new arrangements given the new planning landscape that exists. There was also feedback from the COSLA/SOLACE meeting of 26 th October, as well as a paper presented on Communication and Engagement Plan update which provided next steps and respective roles and responsibilities including the testing of key messages and the timeline 1 st November: Sustainability and Value Programme Board During this meeting we discussed the exception reports from the following workstreams: Workforce, National Facilities and Procurement, Clinical Transformation, Clinical Transformation and Effective Prescribing, followed by a session on Finance Network Discovery output and proposals. 2 nd November: Public Audit and Post Legislative Scrutiny Committee John Burns, Tim Davison, Malcolm Wright and I were invited along to the Committee to give evidence on the Auditor General for Scotland s report on NHS Workforce Planning in our roles as Implementation Leads. We submitted a Joint Submission, which reflected on the responsibilities and recommendations for Boards and Regions identified in the Auditor General s Report on NHS Workforce Planning the clinical workforce and secondary care. It also reflects the key themes and issues for boards and regions identified in the Official Report of the Committee s evidence session with the Auditor General 2 nd November: Scottish Health Awards 2017 NHS Education for Scotland were delighted to sponsor the Leader of the Year award at the 2017 Scottish Health Awards, which recognise the extraordinary efforts of those on the frontline of the Nation s Health and Care Services. The Award was presented by our Chair, Dr Lindsay Burley to John Pritchard, Paramedic Team Leader, Scottish Ambulance Service. For further information on the evening please click on the link below: Chief Executive s Report to the NES Board 9

10 8 th November: NHS Chief Executives Business Meeting I attended the Chief Executives Business meeting. Caroline Gillan, Programme Manager, Stonewall Scotland attended the meeting to discuss the Stonewall Scotland and NHSScotland Partnership 2016/17 End of Year Project Report and discussed the support and advice given to public, private and third sector organisations on how to improve their practices to be more inclusive of LGBT staff and service users and the work in particular, that they have been doing across NHSScotland. Sir Lewis Ritchie also provided an update on the Public Holiday Review, following on from the announcement that the Scottish Government plans to review the way health and social care services are provided over public holiday weekend periods. 9 th November: Health and Social Care Delivery Plan National Programme Board I attended this meeting and we discussed the update of progress against the Programme Plan, Communications and Engagement, and Shifting the Balance of Care, as well as an update on Realistic Medicine. 9 th November: Paul Gray, Scottish Government I met with Paul Gray to discuss the work of the Tayside Support Team. 10 th November: NHSScotland Implementation Leads Meeting I chaired the Implementation Leads meeting and we discussed Communications and Engagement Plan, feedback from the Audit Scotland Report Parliamentary Debate and feedback from the Public Audit and Post Legislative Scrutiny Committee. 13 th November: Scottish Trauma Network Steering Group I Chaired this meeting at which we agreed our priority option for implementing the 4 Major Trauma Centres in Scotland. We also received a presentation on the public health factors impacting on major trauma. 15 th November: NHSScotland Showcasing the Future Event For Today s and Tomorrow s Leader in NHSScotland I attended this event, which was held at the Quincentenary Building, Royal College of Surgeons. Shirley Rogers, Director of Health Workforce and Strategic Change, opened the event and setting in context for the day and for the future. The purpose of the event was to set out the vision for our transformational approach to leadership development and talent management in NHSScotland and to showcase exemplars of leadership programmes and stimulate different thinking, approaches and ambitions. This event builds on the Executive Level and Leadership Talent Management Overview Paper which was published in May RISK REGISTER There are no changes to the risk register in this period. The Board will be having a substantive discussion in relation to risk appetite at this Board meeting. Chief Executive s Report to the NES Board 10

11 Key Corporate Risks - December 2017 Currrent Period Last Period Brief Description I x L Inherent Risk I x L Residual Risk Notes Appetite I x L Residual Risk Strategic/Policy Risks 1 Retaining a strong focus on the importance of education and training through structural change 4 x 4 Primary 1 4 x 4 Primary 2 The Health and Social Care delivery plan published in December 2016 clearly sets out the requirement for organisations to work together differently in order to support the delivery of health and care in the future. We have had supportive feedback from SG in relation to our LDP 4 x 4 Primary 2 2 Signififcant pressure on budgets for 2017/18 and beyond 5 x 5 Primary 1 4 x 4 Primary 1 3 Lack of capacity and continuity at SGHD 4 x 4 Primary 1 3 x 3 Contingency Approach to workforce development is driven by HEE without due attention to requirements and views of the devolved nations Challenges in managing changing relationships with partner organisations Operational/Service Delivery Risks Ability to continue to support core business and respond to new demands in an agile and responsive manner. 4 x 4 Primary 1 3 x 4 Primary 2 4 x 4 Primary 1 3 x 4 Primary 2 5 x 5 Primary 1 3 x 4 Primary 2 6 Dependency on key individuals 4 x 4 Primary 1 3 x 3 Contingency 7 Turbulence and lack of cohesion due to internal organisational changes 4 x 4 Primary 1 3 x 3 Contingency The Board has approved a draft budget for 2017/8 which includes a relatively high level of unidentified savings to be delivered from programmes of work within NES, and also through collaboration across the National Special Health Boards High inherent risk due to staffing reductions at SGHD which risks the loss of some corporate memory which is important in UK wide discussions. Increasingly NES is the repository for this level of expertise and experience. There is an opportunity for us to demonstrate this through joining up some of the data we hold, and through working with other organisations, such as NSS. High inherent risk due to size of England as compared to other nations and extent of cross border flow. In response to this NES continues to work with the other devolved nations, with SG and to meet regularly with HEE. The changing environment will also drive shifts in our relationships with existing partners and identify new partners. Of particular importance will be our ability to craft collaborative relationships which play to each of our stregnths, with the other national NHS Boards, and to build supportive relationships with the emerging regional structures. We continue to experience pressures in maintaining core business in the face of increasing demands, and in the face of our Senior staff being asked to take on more national roles. We continue to review areas where we have the potential to release capacity and to use our workforce resource differently. Equally we will press SG for additonal resources where possible. Over the last year we have experienced some considerable turnover in senior roles and we have demonstrated our resilience in managing this. We are also now moving forwards with the development of our 'Potential and Career Management Strategy'. A number of significant organisational changes have been fully implemented. The budget paper that was considered by the Board in March highlighted a number of further areas that we will now be considering, we are committed to bringing a paper on our full programme of work to a future Board meeting. Open 4 x 4 Primary 1 3 x 3 Contingency 3 x 4 Primary 2 3 x 4 Primary 2 3 x 4 Primary 2 3 x 3 Contingency 3 x 3 Contingency

12 Key Corporate Risks - December 2017 Currrent Period Last Period Brief Description I x L Inherent Risk I x L Residual Risk Notes Appetite I x L Residual Risk 16 Challenges in workforce supply in some areas 4 x 4 Primary 1 3 x 4 Primary 2 We are experiencing difficulties in recruitment to a number of key medical specialties and this is making it difficult to sustain services in some areas. There is a risk that NES is blamed for some of this, equally it is an opportunity for us to promote the position that good quality training and employment environments are essential to recruitment & retention; and to think creatively and innovatively about what we can do to maximise recruitment and retention and to support the contribution of other groups. 3 x 4 Primary 2 19 We lose the integrity of some of our reporting systems as a result of the introduction of e:ess 5 x 5 Primary 2 3 x 4 Primary 2 8 Major adverse incident - impacting on business continuity 4 x 4 Primary 1 2 x 4 Housekeeping Finance Risks 9 Risk of underspends & resulting negative perception 4 x 5 Primary 1 3 x 3 Contingency 10 Reduction of resources puts NES into deficit 4 x 5 Primary 1 3 x 4 Primary 2 Reputational/Credibility Risks 11 NES is unable to demonstrate that it makes a positive contribution to patient safety/patient experience 4 x 5 Primary 1 3 x 4 Primary 2 12 NES does not deliver on key targets 4 x 5 Primary 1 3 x 2 Contingency Accountability/Governance 13 Failure in Corporate Governance 5 x 5 Primary 1 2 x 2 Negligible 14 Data security issue 4 x 5 Primary 1 3 x 2 Contingency 19 Preparartion for GDRP 4 x 5 Primary 1 3 x 2 Contingency NES is committed to the implementation of e:ess and we have now implemented core e:ess. We are continuing to experience some difficulties in replicating our reporting from the new system and this is causing some issues for us. We now have a direct influence on the review of NHS Business Systems which will help to drive developments in this area. We have significantly improved our resilience in this area through roll out of more agile working, and the recent implementation of O365 has further enhanced our capabilities here. We achieved a modest underspend for 2016/17. We will be managing our budgets very carefully in 2017/8 The budget approved by the Board includes a high level of unidentified efficiency savings. This has been identified as a key objective in our refreshed strategic framework. Work is underway to identify existing data and ways of using this to demonstrate impact. We have also considerably increased our external PR activity, particularly on social media. Strong measures in place to demonstrate performance against key targets and to identify and remedy areas where performance falls behind. Very strong internal audit opinion relating to system of internal controls. Good quality reporting from all NES Committees to Audit Committee. We have strong data security processes in place. We were not impacted by the recent ransom attack on the NHS We have a structured proramme in place to address the new regulations and engagement with all Directorates. We have brought Iinadditional resources to address the workload. 3 x 4 Primary 2 2 x 4 Housekeeping 3 x 3 Contingency Averse 3 x 4 Primary 2 3 x 4 Primary 2 Cautious 3 x 2 Contingency 2 x 2 Negligible Averse 3 x 2 Contingency N/A N/A