The following tables define the impact and likelihood scoring options and the resulting score: - Risk score. Category

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1 DRAFT Wirral Clinical Commissioning Group: Quality Assessment Tool v1 Overview This tool involves an initial assessment (stage 1) to quantify potential impacts (positive or negative) on from any proposal to change the way services are commissioned and/or delivered. Where potential negative impacts are identified they should be risk assessed using the risk scoring matrix to reach a total risk score. Quality is described in 6 areas, each of which must be assessed at stage 1. Where a potentially negative risk score is identified and is greater than (>) 8 this indicates that a more detailed assessment is required in this area. All areas of risk scoring greater than 8 must go on to a detailed assessment at stage 2. Scoring A total score is achieved by assessing the level of impact and the likelihood of this occurring and assigning a score to each. These scores are multiplied to reach a total score. The following tables define the impact and likelihood scoring options and the resulting score: - LIKELIHOOD 1 RARE 1 MINOR IMACT Risk score 2 UNLIKELY 2 MODERATE / LOW 1-3 MODERATE / OSSIBLE 3 3 SERIOUS LIKELY 4 MAJOR ALMOST CERTAIN 5 FATAL / CATASTROHIC Category Low risk (green) Moderate risk (yellow) High risk (orange) Extreme risk (red) A fuller description of impact scores can be found in the 'Risk Scoting Matrix' tab. IMACT LIKELIHOOD lease take care with this assessment. A carefully completed assessment should safeguard against challenge at a later date.

2 Stage 1 The following assessment screening tool will require judgement against the 8 areas of risk in relation to Quality. Each proposal will need to be assessed whether it will impact adversely on patients / staff / organisations. Where an adverse impact score greater than (>) 8 is identified in any area this will result in the need to then undertake a more detailed Quality Assessment. This will be supported by the Clinical Quality & Nursing team. Title and lead for scheme: Eastham Walk in Centre - Sheena Hennell/Heather Harrington (Lead) Brief description of scheme: There are identied and safety issues at Arrowe ark Hospital with long waiting times at A&E, in addittion to delays in ambulance turnaround times at Arrowe ark Hospital resulting in limiting the avaialblity of ambulances for emergency calls. Our proposal is to change the function of the Eastham Walk in Centre (WIC) by transferring the Advanced Nurse ractitioners (ANs) from the Eastham WIC to the Arrowe ark site to support the redesigned streaming model and reduce clinical risk. Clinical streaming will commence on 4 September, in line with plans agreed with NHS England and partner organisations. This action is in response to an immediate safety concern. The long term requirements for a Walk in Centre at Eastham will be explored as part of the upcoming public consultation. Sinec April 217 the Walk in Centre at Eastham has had to close at short notice on three occassions which has resulted in a reduced level of an accessible service without prior notice. 12% of patients attending Eastham clinic WIC attend for a dressings service. This element of the service will be retained at Eastham and will move to bookable appointments every afternoon (7 days a week). Following implementation of the proposal, feedback from patients and stakeholder, and activity levels will be closely monitored to assess impact. This impact assessment will be reviewed and updated monthly to reflect any additional considerations/ unintended consequences and consider any additional mitigating actions that may be required. Answer positive/negative or not applicable (/N or N/A) in each area. If N, please score the impact and likelihood. If score greater than 8 a full stage 2 assessment will be required. Quality question /N or N/A Full Assessment - Stage 2 to be completed Duty of Quality Could the proposal impact positively or negatively on any of the following - compliance with the NHS Constitution, partnerships, safeguarding children or adults and the duty to promote e? atient Experience atient Safety Clinical Effectiveness Could the proposal impact positively or negatively on any of the following - positive survey results from patients, patient choice, personalised & compassionate care? Could the proposal impact positively or negatively on any of the following safety, systems in place to safeguard patients to prevent harm, including infections? Could the proposal impact positively or negatively on evidence based practice, clinical leadership, clinical engagement and/or high standards? N 3 3 9

3 revention roductivity and Innovation Vacancy Resource Could the proposal impact positively or negatively on promotion of self-care and health ine? Could the proposal impact positively or negatively on - the best setting to deliver best clinical and cost effective care; eliminating any resource inefficiencies; low carbon pathway; improved care pathway? Could the proposal impact positively or negatively as a result of staffing posts lost? Could this proposal impact positively or negatively with regard to estates, IT resource, community equipment service or other agencies or providers e.g. Social care/voluntary sector/district nursing N lease describe your rationale for any positive impacts here: Duty of Quality atients who wait longer to be seen in A&E are at greater clinical risk and may achieve poorer outcomes. The action to relocate clinical staff from Eastham WIC to the Arrowe ark site will support the system to improve waiting times via clinical streaming. The introduction of clinical streaming (involving Gs, Advanced Nurse ractitioners and Emergency Nurse ractitioners) will support us in meeting the constitutional targets. atient Safety The proposal will help to prevent harm by ensuring a timely response to patients presenting to A&E. The patients currently seen within the Eastham WIC will be able to access an equivalent or enhanced level of care from an alternative site (Arrowe ark site, Victoria Central or St Catherine's). Clinical Effectiveness The proposal will provide consistent, standardised care for patients. Clinical streaming is a national mandate and is based on evidence based practice and gives the system the opportunity to work together and demonstrate clinical leadership and engagement as well as delivery a high standard. revention The proposal may encourage some patients, who utilise the current walk in centre at Eastham due to proximity to home, to manage their own conditions and/or arrange an appointment with their own G. It is estimated that at least 4% of patients currently utlising the walk in centre would not require an additional urgent care service and would either self-care or visit G/pharmacy. roductivity and Innovation The proposal will aims to deliver clinical and cost effective care as it directs clinical resource to our areas of highest demand i.e. Arrowe park site. There is greater demand in areas of areas of social economic deprivation. There is also the opportunity to increase productivity and innovation within the additional space created at Eastham clinic. The proposal will mean dedicated planned dressings clinics delivered by specialists will be retained at Eastham and will be available 7 days a week. This may be a preferable offer to previous long waits as part of the walk in centre queue. Resource The proposal will provide an opportunity to review the usage of estates at Eastham. Options are being explored to expand the centre including use by voluntary sector organisations. The positive impacts of this initiative relate to clinical safety by reducing wait time for patients attending the arrowe park site for urgent care.

4 SH/HH Commissioning Manager Aug-17

5 Stage 2 Risk (5x5 risk matrix) (ositive or negative) What is the impact on the organisation s duty to secure continuous improvement in the of the healthcare that it provides and commissions. In accordance with Health and Social Care Act 28 Section 139? Does it impact on the organisation s commitment to the public to continuously drive improvement as reflected in the rights and pledges of the NHS Constitution? DUTY OF QUALITY Does it impact on the organisation s commitment to high workplaces, with commissioners and providers aiming to be employers of choice as reflected in the rights and pledges of the NHS Constitution? What is the impact on strategic partnerships and shared risk? What is the e impact on race, gender, age, disability, sexual orientation, religion and belief, gender reassignment, pregnancy and maternity for individual and community health, access to services and experience of using the NHS (Refer to CT E Assessment Tool)? Are core clinical indicators and metrics in place to review impact on improvements? Will this impact on the organisation s duty to protect children, young people and adults?

6 Risk (5x5 risk matrix) ATIENT EXERIENCE What impact is it likely to have on self reported experience of patients and service users? (Response to national/local surveys/complaints/als/ incidents) How will it impact on choice? (ositive or negative) It is anticipated that there will be a mixed response to the implementation of the proposal with - positive response to improved services on the Arrowe ark site - reduced waiting times at A&E - negative response to removal of WIC facility at Eastham. This will be closely monitored by each partner organisations and reported to CCG. It is anticipated that the number of incidents will be reduced as A&E will become a safer service. atients who would previously have attended Eastham WIC (excluding for dressings) will need to either selfcare or attend an alternative service i.e. own G, pharmacy or an alternative WIC (Victoria Central, St Caths, Arrowe ark) or minor injuries service (Moreton Health, Miriam, arkfield) Clear joint communications plan delivered by all partners emphasising: - the rationale for change - the services available - pharmacies, G, alternative WICs, Minor injuries etc. - upcoming Urgent Care Consultation which will consider the future direction of travel for WICs including Eastham. Comms will also be shared with our G practices and Ms as well as wider stakeholder groups. WCCG will closely monitor the impact of this change over and above our usual processes with weekly review. This will include safety huddles across partner organisations to assess impact of the changes. There will also be breach analysis processes undertaken by each organisation and a review of harm. The aim of this to demonstrate a clear reduction in avoidable harm. This monitoring will be reviewed by our Urgent Care Transformation Steering Group which includes Healthwatch Wirral. Clear communications will be shared with patients that provide a list of alternative services (pharmacies, G, alternative WICs, Minor injuries etc.) As noted above, WIC provision will also form part of our upcoming consultation. The impact of the changes on patients will be closely monitored with a weekly review of all feedback received.

7 Risk (5x5 risk matrix) (ositive or negative) Does it support the compassionate and personalised The proposed implementation will care agenda? facilitate compassionate and personalised care - both in terms of ensuring patients that present requiring A&E services can receive them in a safe and timely manner but also in respect to patients that are streamed into an alternative, on site service.

8 Risk (5x5 risk matrix) (ositive or negative) CLINICAL EFFECTIVENESS ATIENT SAFETY REVENTION How will it impact on patient safety? How will it impact on preventable harm? Will it maximise reliability of safety systems? How will it impact on systems and processes for ensuring that the risk of healthcare acquired infections is reduced? What is the impact on clinical workforce capability care and skills? How does it impact on implementation of evidence based practice? How will it impact on clinical leadership? Does it support the full adoption of Better care, Better Value metrics? Does it reduce/impact on variations in care? Are systems for monitoring clinical supported by good information? Does it impact on clinical engagement? Does it support people to stay well? Does it promote self-care for people with long term conditions? Does it tackle health inequalities, focusing resources where they are needed most? Does it ensure care is delivered in the most clinically and cost effective way? RODUCTIVITY AND INNOVATION Does it eliminate inefficiency and waste? Does it support low carbon pathways? Will the service innovation achieve large gains in performance? Does it lead to improvements in care pathway(s)?

9 Risk (5x5 risk matrix) Does the proposal involve reducing staff posts? If so describe the impact this will have (ositive or negative) VACANCY IMACT Is the loss of posts likely to impact on remaining staff morale? Can arrangements be made to prioritise and manage workload effectively? Are vacancies likely to impact on patient experience? Will services be negatively impacted by the loss of posts for a short term, medium term or longer term? RESOURCE IMACT Describe how this proposal may/will have a resource impact with regard to: Estates IT Resource Funding streams/income Other providers (specify how/what) Social care/voluntary/third sector Signature: Designation: Date: Aug 17