CHIEF EXECUTIVE S REPORT. Caroline Lamb, Chief Executive

Transcription

1 NES Item 4 March 2016 NES/16/15 (Enclosure) CHIEF EXECUTIVE S REPORT Caroline Lamb, Chief Executive March 2016 Chief Executive s Report to the NES Board March

2 1 INTRODUCTION The agenda for our Board meeting today includes an opportunity for the Board to consider three reports: The National Clinical Strategy; The Annual Report of the Chief Medical Officer: Realistic Medicine ; and the Review of Public Health in Scotland. These three publications which have all been issued over the last 6 weeks, together set the context for the environment within which we work and have the potential to influence the shape of services, and therefore the shape of the workforce which is required to deliver those services. Our agenda also includes consideration of our draft budget for 2016/17. 2 ANNOUNCEMENTS Following the retiral of Murray Duncanson from the Board at the end of February, Carole Wilkinson has now formally taken up the role of Vice Chair. Board Members will also wish to note that after a full competitive recruitment process, Audrey McColl has been appointed to the post of Director of Finance. We are in the process of seeking her appointment as an Executive Director of the Board. 3 MEDIA INTEREST AND COMMUNICATIONS The Corporate Communications Team was recently at the inaugural NHS Communications Awards. There were 120 entries for 11 categories and NES were shortlisted for three categories - Best Publication (Annual Report ), Best Website (Annual Report ) and Best Use of Innovation in Communications (NES animations) and won Best Use of Social Media, which was the NES Christmas Baubles Campaign highlighting the different NES services in the run up to Christmas. In terms of media work we dealt with a Sunday Express approach regarding the financial challenges for 2016/17, as discussed in the paper to our January Board meeting. The story ran on 14 th February 2016 and focussed on any potential impact on the salaries of doctors in training which was clearly prompted by the Junior Doctor strike in England. This was not picked up by any other media outlet. We were approached again by the Sunday Express on 25 th February about comment that they had picked up in the Australian media about NES staff attending a conference in Perth in March and offering clinics for GPs who might be interested in returning to practice in Scotland (more information is contained at paragraph 8.3). A story ran on Sunday 28 th February. We facilitated a media interview with BBC Scotland regarding our partnership with Bridges and refugee doctors, and we also supported a NES Learning Disabilities conference which was attended by two BBC documentary crews. The focus of the two programmes was support for parents with children affected by Down s syndrome. The communications team have been supporting Scottish Medical Training as we have approached the latest recruitment round, and we have seen a lot of interest across our social media sites. An increase in outputs has led to a further 600 followers over the last month. NES is the most followed Territorial or Special Board on Twitter. Chief Executive s Report to the NES Board March

3 Our national conferences including Building Momentum - An Event for Non Learning Disability Student Nurses and How Can We Make A Difference: 2 nd National Health Care Support Worker Learning Conference have both received praise from Scottish Government. Our internal communications efforts have been focussed on supporting the transition to Office MINISTERIAL ANNOUNCEMENTS 4.1 Medicine, Nursing and Midwifery On Wednesday 10 th February the First Minister announced a funding package of 27million directed at the health workforce. Of this total 23million was announced for measures to improve the sustainability of medical workforce supply. These include (i) an expansion of medical undergraduate places by 50 for 2016 entry, (ii) the development of a new entry level programme available to help secondary school students from deprived backgrounds prepare more effectively for undergraduate medical education and (iii) the development of a graduate entry medical degree programme, with a target start date of These initiatives will be accompanied by the establishment of a clinical placement levy on overseas medical undergraduates. Scottish Government are to write to the Scottish medical schools inviting proposals for a graduate entry school and have indicated that they would wish NES to be involved in reviewing these proposals. The announcement also included a 1m to help student nurses and midwives experiencing financial hardship, and 3million to train 500 advanced nurse practitioners. We are in discussions with the Chief Nursing Officer about the details of the outcomes required and the timescales for this. More details can be found at : Mental Health services On 12 th January 2016, Nicola Sturgeon announced that the government would provide 24.6m over four years for workforce development to improve workforce supply and train existing staff to deliver children and young people services as well as psychological therapies for all ages. This will include funding to backfill staff who are released for training and for salaries for new staff as part of a wider 54 million package. 5 DIGITAL 5.1 NES as a Digital Leader Our reputation as an organisation that has the capability to deliver on digital projects continues to grow. On 9 th February, Paul Grey, Director General Health and Social Care and the Chief Executive of NHS Scotland visited NES to meet with key members of our digital team and to lean about what we are doing, and the agile development methodology that we have been using. His interest was undoubtedly sparked by the on-going investigation of the Public Audit Committee into the IT issues at NHS24. Paul met with Caroline Lamb, Christopher Wroath, David McColl (Scrum Master), Anne Dickson (General Manager, Medicine) and Joanna Cuthbert (Product Owner for Turas). He was very Chief Executive s Report to the NES Board March

4 interested in the development process and in the technical aspects of the build and went away extremely happy with what he had seen. On Tuesday 16 th February, Caroline Lamb and Christopher Wroath met with Eddy Turnbull (Head of ehealth and SGHSCD). We discussed the progress that we had made with our digital implementation, the methodology and the capability that we have built internally. We also touched on the opportunities to exploit the NES Digital Platform (NDP) more widely across the public sector. Since that meeting Christopher Wroath and Caroline Lamb have been invited to meet with Mike Neilson (Head of Digital at Scottish Government) in April to take forward these discussions. Caroline Lamb has also been invited to join a task and finish group established by the Scottish Leaders Forum to consider what more is needed beyond current plans to position Scotland as the place that people come to see digital excellence in practice. On Thursday 18 th February, Christopher Wroath presented to the Senior Team of NSS at their awayday which was considering the adoption of agile. Christopher has subsequently met with staff at NSS who are developing their plans for a Digital Transformation. 5.2 Development of the NES Digital Platform (NDP) Meanwhile we have continued to deliver the build of the NES Digital Platform (NDP) to plan. Sprint 12 of the new Scottish Foundation Portfolio development completed on time and successfully delivered all the required functionality. Delivery remains on track for the agreed minimum viable product by 31 st March Sprint 9 of the proof of concept Virtual Learning Environment completed on time on 19 th February and successfully delivered all the required functionality. Work remains on track for the agreed Family Nurse Partnership delivery by 31 st March. These two on time developments mean the go live date for the NDP remains on target for 1 st April. NMAHP work on the Version 3 Nurse Portfolio has continued with the population of the product backlog in combination with core forms engine coding by the development team. Questions pertaining to the scope of a minimum viable product (MVP) continue; this centres around whether support of revalidation alone should constitute a MVP or whether a full set of Portfolio forms is required. This question is not impeding or delaying development work and a nursing Portfolio will be available by August Commercialisation of the NDP The NES/PA partnership submitted a costed proposal to the Welsh medical training group at the end of February. This proposal is structured around a Welsh uptake of the NDP with Turas and V3 Portfolio by August 2016 meaning that the Welsh would adopt V3 Porfolio at the same time as Scottish Foundation. Christopher Wroath and PA, visited the Royal College of Physicians of Ireland and the Northern Ireland Medical and Dental Training Agency in February to gauge the interest in Turas / v3 e-portfolio. Both visits generated positive engagement and PA will be following up these initial visits in April. 5.4 Corporate Digital The Office 365 migration is on target for go live on Tuesday 29 th March. This date has been chosen taking account of the Easter public holidays which will mean the NES offices will be closed from the evening of Thursday 24 th March, thus allowing maximum opportunity for full testing of the systems. Alfresco migration is on target with SharePoint sites being tested Chief Executive s Report to the NES Board March

5 now. The working group have commenced super user training and Executive and Digital group staff have commenced their pilots. 6 DENTAL 6.1 Recruitment for Dental Core Trianing Recruitment for Dental Core Training (DCT) posts is underway for DCT2 and will open on 3 rd March for DCT1. Specialty training posts in Restorative Dentistry and Paediatric Dentistry have been advertised with recruitment to specialty training posts in Oral Surgery, Oral Medicine and Orthodontics organised for Spring Dental core training posts were included in the Scottish Trainee Survey (STS) which was launched on 18 th January. 6.2 Launch of Online Assessments for Dental Nurses On 12 th February, many of the Dental Nurse Tutors and Graham Orr attended the launch of online assessment for dental nurses at the Royal College of Physicians and Surgeons of Glasgow. This is the product of a year-long collaboration between NES and SQA. Tommy MacGregor from NES co-ordinated the authoring and review of around 700 questions that are now available on SQA's SOLAR system. This streamlines assessment of candidates' progress, giving them much earlier and more focussed feedback. This collaborative project will benefit all Dental Nurse training providers who deliver the SVQ in Dental Nursing. 6.3 Mouth Matters - An Educational Event to Support Oral Health Improvement in Prisons A national educational event hosted and organised by NES Dental Directorate was held on 4 th February The aim of the event was to support the implementation of Mouth Matters, an evidence-informed oral health promotion resource developed by the Dental Health Services Research Unit, in prisons across Scotland. Prisoners have been identified as one of the target groups for oral health improvement by the Scottish government as prisoners' oral health is generally considerably worse than that of the general population. Seventy delegates attended and came from oral health promotion and health promotion staff from Health Boards and the Prison Service. Also in attendance were representatives from several relevant Third Sector organisations. An introduction to the day was given by Tom Ferris, Deputy Chief Dental Officer for Scotland. The emphasis for the event was sharing examples of practice from those who had begun to use the resource. Presentations were given by a wide variety of individuals including members of Health Board Oral Health Improvement Teams, Prison Health Promotion staff, a Deputy Governor, representatives from two Third Sector organisations and a serving prisoner. The prisoner delivered his own patient story about his experience of the Oral Health Programme using a presentation he had produced himself with the help of members of an Oral Health Improvement Team. He also described how he had become involved in a small working group within the prison whose aim was to find the most effective ways of tackling the oral health challenges. The presentations stimulated much discussion and exchange of ideas which will be further supported and developed by an online community of practice, set up and maintained by the Priority Groups work stream and accessible to all interested parties. Chief Executive s Report to the NES Board March

6 7 PHARMACY 7.1 Common Clinical Conditions and Minor Ailments A resource on `Common Clinical Conditions and Minor Ailments` has been developed by the NES Pharmacy team to support the Out-of-Hours agenda in NHS Scotland. The resource will update community pharmacists and their teams, in order that they can effectively respond to patients who present both in the out of hours setting and during normal working hours. The resource includes an overview of the most common clinical conditions (including signs, symptoms and alarm symptoms), and advice on how to respond to these conditions, be that through provision of advice or medication, or to refer to another profession/ service. It is hoped that by up skilling and using community pharmacists to deal with such conditions, this may help reduce the burden on GPs and out-of-hours services. A hard copy of this resource has been sent to all community pharmacies (22 nd February 2016) and an electronic version is available via the NES website. s.pdf 7.2 Urinary Tract Infection (UTI): e-learning In relation to the support for Common Clinical Conditions and following specific recommendations in the National Review of Primary Care Out of Hours Services Report there is a gradual implementation of Patient Group Directions (PGDs), across Community Pharmacy in Scotland. At present a PGD allowing the supply of Trimethoprim from community pharmacies without a prescription, for the treatment of uncomplicated UTIs is being rolled out nationally. To support this, NES Pharmacy have commissioned the development of an e-learning module on `Urinary Tract Infections` which is being made available to all community pharmacists. This module covers pathophysiology, assessment, diagnosis and the clinical management of UTIs - NHS Boards are using the module as core learning material for any pharmacist who will be involved in providing this service through this PGD. 8 MEDICINE 8.1 Medical Recruitment March is peak season for recruitment to medical training posts, and as always this activity is a source of enormous effort and considerable political interest. The activity is co-ordinated at a UK level, and is in three phases. (i) The first phase is recruitment of new medical graduates into the foundation programme. As in previous years, the programme is oversubscribed but this year for the first time the extent of over-subscription is sufficiently low that we do not anticipate fully filling the foundation programmes in Scotland. Primary list allocation is on 3 March. (ii) The second phase (so-called Round 1) is recruitment of applicants to year 1 of specialty training in core and run-through programmes. Across the UK, approximately 7,500 doctors complete foundation training, however, there are some 8,500 ST1 vacancies and therefore once more we do not anticipate filling all ST1 places. Round 1 offers will be complete by 24 March - fill rates will vary by specialty and geography. (iii) The third phase Round 2 is recruitment to higher specialty training posts. Applications opened on 16 February and will close on 9 March, with offers being complete by 20 May. Chief Executive s Report to the NES Board March

7 8.2 6 th Scottish Medical Education Conference The 6th Scottish Medical Education Conference incorporating the Annual Medical Appraisal Conference, Annual Practice Managers Conference and the Annual Practice Nurse Conference will be held at the Edinburgh International Conference Centre on Thursday 5 and Friday 6 May A significant effort has gone into the design of this congress and will include keynote plenary talks by Dr Catherine Calderwood (CMO, Scotland), Professor Terence Stevenson (Chair, GMC), Professor Brian Hodges (University of Toronto, Canada), Dr Julian Archer (Chief Investigator on a study analysing the regulatory impact of Medical Revalidation) and Mr Chris Lubbe (Past bodyguard of Nelson Mandela). In addition, there will be over 30 workshops and parallel sessions for delegates to choose from, including topics for those with an interest in undergraduate medical education, postgraduate training and medical appraisal. There is currently a call for abstracts that already has attracted significant interest. The highest scored abstracts will be presented orally during one of the plenary sessions with others presented as posters during the course of the meeting. A dinner and awards ceremony will be held on the Thursday evening when we plan to recognise outstanding contributions to medical education and training in Scotland. Full details of the event (#NESSME16) are available at : th Ottawa Conference 2016 The "Ottawa" conference is the major international medical and clinical education conference of Taking its name from the initial meeting in Canada, it rotates round the world biennially, and each year there is participation by NES staff as invited speakers, and presenters of current work. This year the meeting is in Perth, Western Australia. NES has taken a more coordinated view of its participation this time, and in addition to those staff presenting work from Scotland, we have sponsored a stand, and are sending two additional delegates. Our purpose is a) to raise the profile of Scotland as a source of cutting edge clinical education to emphasise our leadership in the field, b) to raise the profile of NES as an organisation c) in collaboration with government, to actively promote Scotland as a place to live and work, and d) to meet and encourage trained GPs to travel to Scotland to work. A social media campaign and a series of career clinics are planned for the duration of the conference and senior NES staff attending will be leading these in Perth. A comprehensive communications handling plan has been prepared and SG are fully supportive of the venture. There will also be opportunities to talk to attendees from around the world about our digital offering (e portfolio, Turas). 8.4 Sharing Information for Health and Care Group (SIHCG) The above group has now been in formal operation for one year, and will shortly be publishing its first annual report. Jointly Chaired by Healthcare Improvement Scotland and NHS Education for Scotland, the group includes Audit Scotland, the Care Inspectorate, the Mental Welfare Commission, and Public Health Intelligence from National Services Scotland. The group meets bimonthly, and considers data from all partner organisations currently in respect of each NHS Board in Scotland which provides patient care. 8.5 Junior Doctors Contract : England Board members will be aware through the national media that, following a period of inconclusive negotiation in England, the Secretary of State announced his intention to impose a new contract for doctors in training in England. Subsequently, the BMA in England has announced further industrial action on 9-11 March, 6-8 April and April In Chief Executive s Report to the NES Board March

8 addition the BMA have launched a judicial review of the decision by the Secretary of State. The Scottish Government have issued a position statement f.aspx 9. HEALTHCARE SUPPORT WORKERS 9.1 How Can We Make a Difference? Second National Health Care Support Worker Learning and Development Event On 3 rd February NES hosted an all day Learning Event for Health Care Support Workers at the University of Stirling. The overall aim of the event was to raise awareness of learning and development opportunities and value the contribution healthcare support workers make to the delivery of safe, effective, person centred care. The key note address was given by Shona Robison, Cabinet Secretary for Health, Wellbeing and Sport. Shirley Rogers Director of Health Workforce played a full part in event and gave the closing address. Over 140 staff and exhibitors attended the event. There was the opportunity to discuss effective Personal Development Planning & Review conversations and explore how to use the recently published Education Pathways for Business and Administration, Estates & Facilities and Clinical Support Workers. Workshops were available on a range of subjects including 'Support Workers are Leaders too' and 'Supporting colleagues to learn in the Workplace'. The feedback has been very positive with a number of attendees having their first opportunity to attend such an event. 10. PSYCHOLOGY 10.1 Ministerial Visit Psychology of Parenting (PoPP) On 9 th February 2016, NES Psychology of Parenting (PoPP) team co-hosted a ministerial visit with one of their 14 CPP partners, City of Edinburgh. Mr Jamie Hepburn, Minister for Sport, Health Improvement and Mental Health, and Ms Aileen Campbell, Minister for Children and Young People were first given a brief overview of the roll out of PoPP across Scotland by Judy Thomson (Director of Training for Psychology Services) and Brenda Renz (Programme Director Psychology of Parenting). The aims of PoPP are to train the multi-sector Early Years workforce to deliver evidencebased parenting programmes to parents of pre-schoolers with elevated levels of behaviour problems, and to ensure that these group-based programmes are delivered to scale and embedded as part of routine service delivery. Mr Hepburn noted the positive outcomes reported in relation to the 275 PoPP groups that have run to date and specifically the finding that at least 80% of parents who have completed pre and post- standardised measures on their children s behaviour, having attended one of these groups, have recorded improvements. He appreciated how this contributed to the preventive mental health agenda. Following a further brief account of how the programmes have been implemented in Edinburgh, the ministers enjoyed contributing to a guided discussion led by a PoPP champion in Edinburgh City. The parents spoke very positively about their experiences in the groups and about how they, their children and others in their families have benefited. They highlighted their appreciation of the non-judgemental approach of the group leaders and learning from other parents and wished that this form of support lasted longer and could be made more widely available. The ministers listened attentively to this feedback, and to that Chief Executive s Report to the NES Board March

9 of other local representatives from Edinburgh Council and NHS Lothian, including the Child Health Commissioner Computer based Cognitive Behavioural Therapy (ccbt) and Therapy via Video Conferencing Geraldine Bienkowski (Associate Director Psychological Therapies) was invited, as an expert in implementing Psychological Therapies policy through education and training, to give a presentation to a Maximising Uptake and Impact seminar for the European Commission Mastermind project in Treviso on the 9 th February Mastermind is a large EU project aiming to make high quality and easily accessible treatment for depression, in particular staff-supported computer-based CBT (ccbt) and psychological therapy delivered through Video Conferencing (ccvc). Among the 10 EU countries involved in the project, uptake of ccbt is highest in Scotland by several orders of magnitude. GB presented some of the factors which enable the roll-out of psychological interventions to scale across the country, including current SG policy and implementation strategy, and the national infrastructure provide by NES and other national boards. The output from the seminar will be an EU white paper on maximising the uptake of technology-supported psychological therapies. Geraldine s attendance was funded by the EU. CALENDAR 14 th January: Scottish Government I met with Anne Aitken, Head of Workforce Development, Health Workforce Directorate, as part of our regular 121 s and we discussed a number of workforce issues, including the challenges around creating an additional 100 GP Training Places Scottish Government I met with Colin Brown, Deputy Director, Office of the Director General and Chief Executive NHSScotland, Health and Social Care Directorates to discuss the developing agenda in relation to leadership and talent management for the NHS Top Table. 15 th January: Frontline Consultants I met with John Deffenbaugh, Director, Frontline, who shared his insights on primary care, and leadership, particularly focussed on some of the work that Frontline have been doing in England to support these areas. Nursing & Midwifery Council I met with Jackie Smith, Chief Executive and & Registrar or the Nursing and Midwifery Council and we discussed NES & NMC and continuing working together effectively 18 th January: NHS Education for Scotland/Scottish Social Services Council Partnership Group Chief Executive s Report to the NES Board March

10 I attended the Partnership Group, which is jointly chaired by Dr Lindsay Burley and Professor Jim McGoldrick. Items for discussion included the Primary Care Leadership programme for developing primary care and social care professionals to work together more effectively to deliver integrated models of care, an update on the work being undertaken to integrate and align planning around Self Directed Support, an update on joint work and future direction for NES and SSSC as well as an update report on the aims and delivery outcomes from April 2015 March th January: The Royal College of General Practitioners of Scotland I met with Miles Mack, Chair, RCGP Scotland and we discussed the challenges around recruitment to GP training posts, and the joint initiative between RCGP, SSSC and NES for Primary Care Leadership. 20 th January: Healthcare Improvement Scotland I met with Angiolina Foster, Chief Executive, Healthcare Improvement Scotland and we discussed the joint work between NES and HIS, particularly in relation to the QI Hub. 22 nd January: NHS Highland I met with Elaine Mead, Chief Executive, NHS Highland and we discussed the particular workforce challenges for NHS Highland and some of the innovative approaches that they are adopting. 25 th January: Leadership & Talent Management Meeting I attended this meeting, which was chaired by Shirley Rogers. The group has been pulled together to consider leadership and talent management for the NHS Top Table which is focussed on Chief Executives, direct reports to Chief Executives, Chairs and Non Executive Board Directors. Scottish Government I met with Billy McKenzie, the newly appointed Head of Workforce Policy to discuss workforce planning, integration and future work 28 th January: Health & Care Professions Council (HCPC) The Chair and I, along with colleagues, met with Marc Seale, Chief Executive HCPC and Elaine Buckley, Chair HCPC along with colleagues from HCPC. Items for discussion included podiatric surgery, standards of conduct, performance and ethics, review of the standards of education and training, Continuing Professional Development, Physician Associates, information sharing and Paramedic Education. 3 rd February: Scottish National Healthcare Support Worker Event I attended this event (see 9.1) and was delighted to see the level of enthusiasm and commitment, particularly from so many staff who very rarely get the chance to attend conferences and events. 4 th February: Institute for Healthcare Improvement (IHI) Strategic Review Chief Executive s Report to the NES Board March

11 I attended the Capacity and Capability session on day two, of the three day Strategic Review which was lead by IHI President and Chief Executive, Derek Feeley. The session outlined how Quality Improvement and capacity building is continuing to evolve in Scotland. The session also highlighted the progress made over the past year and key areas still to be developed, where strategic guidance would be welcomed. I provided an update for NES on the Quality Improvement Programme, including the framework, learning resources, taught programmes and future plans and challenges. 5 th February: Healthcare Science Postgraduate Scientist Trainees in NHSScotland - Quality management of your training - why does it matter? I was invited to the fourth National Healthcare Science Postgraduate Scientist Training and Supervisors event to give a keynote speech on the challenges facing the NHS in Scotland. The focus of this year s event was the quality management of postgraduate training for our diverse postgraduate scientist community and the contribution that healthcare science makes to patients and the public, set in the context of the real challenges faced by the NHS. 9 th February: NHS Board Chief Executives Private Meeting I attended the NHS Board Chief Executives private meeting and items for discussion included; effective prescribing, genomics, Transformational Change Programme Board, recruitment and retention and the Scottish Partnership Forum. 10 th February: NHS Board Chief Executives Strategic Session I attended the NHS Board Chief Executives Strategic Session and items for discussion included finance strategy and direction, shared services and staff experience. 16 th February: Everyone Matters Implementation Group Meeting I attended the Everyone Matters Implementation Group meeting and matters for discussion included an update on the progress with the National Conversation, Leadership and Management and the NHSScotland Event E-health I attended a meeting with Eddy Turnbull, Head of ehealth at SGHSCD, as outlined at 5.1. above. 17 th February: Transformational Change Programme Board I attended the Transformational Change Programme Board and items for discussion included social care, primary care and workforce (NHS and Social Care) 22 nd February: NHSScotland Senior Leaders Forum The Vice Chair, Caroline Wilkinson and I, attended the NHSScotland Senior Leaders Forum, which was held at The Royal College of Surgeons of Edinburgh. The forum is attended by Chairs and CEOs from across NHSScotland Boards. The meeting included two strategic sessions on communications and budgets. Chief Executive s Report to the NES Board March

12 RISK REGISTER The narrative relating to a number of the risks has been updated and one risk rating has been revised: Risk 2: The narrative has been updated to reflect the stage we have got to with agreeing budgets, however the rating remains unchanged reflecting the degree of uncertainty and challenge beyond 2016/17. Risk 17: The heading for this has been amended to reflect the focus of this risk around stresses in the UK consensus. Risk 7: The narrative has been updated to reflect progress with organisational change. Risk 9: The heading for this has been amended to reflect the fact that, going forwards we are at risk of not meeting financial targets, either through over or underspend. The narrative has been updated to reflect our anticipated year end position. Risk 10: The rating for this risk has been slightly reduced (lower likelihood) to reflect the increased confidence that we can deliver a balanced position for 2016/17. Chief Executive s Report to the NES Board March

13 Key Corporate Risks - March 2016 Currrent Period Last Period Brief Description I x L Inherent Risk I x L Residual Risk Notes Appetite I x L Residual Risk 1 2 Strategic/Policy Risks Uncertainty and upheaval in the external environment Signififcant pressure on budgets for 2016/17 and beyond 4 x 4 Primary 1 3 x 4 Primary 2 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 external environment remains uncertain with a Scottish election in May 2016 and developments such as the formal establishment of IJBs and the development of the National Clinical Strategy and the National Conversation which may impact on the future shape of health and care services and on workforce requirements. We cannot manage this uncertainty, but we can seek to manage the impact of change. We are well placed to remain a stable and successful organisation as other HBs are impacted by H&SCI and this could be an opportunity for us to offer more to the service. The Scottish Budget was published in December 2015, from this we have clarity with regards to a 1% uplift on our baseline against which we need to manage pay pressures amounting to 3%. We do not yet have any clarity around the level of reduction to be made to elements of our non recurrent and earmarked funding, or indeed which elements are included here. We continue discussions with SG to gain clarity on this. 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. High inherent risk due to size of England as compared to other nations and extent of cost 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. This includes our ability to work positively with NHSBoards around concerns about training & education; with the new IJBs, with the 3rd sector and with the SFC and Universities in relation to developments in UG education. We continue to experience pressures in maintaining core business in the face of increasing regulator requirements; whilst at the same time being able to respond to new requirements. We continually seek to manage this position through improved systems and processes and sharing of capability and capacity. Over the last year we have experienced some considerable turnover in senior roles and we have demonstrated our resilieance in managing this. We are also now moving forwards with the development of our 'Potential and Career Management Strategy'. The Finance and Dental transformation programmes are now through the approvals processes and have moved into implementation. This inevitably creates some anxiety for staff but this is being managed we continue to assess the overall position and will slow down planned changes where pressure points emerge. 3 x 4 Primary 2 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

14 Key Corporate Risks - March 2016 Currrent Period Last Period Brief Description I x L Inherent Risk I x L Residual Risk Notes Appetite I x L Residual Risk Challenges in workforce supply in some areas We lose the integrity of some of our reporting systems as a result of the introduction of e:ess Major adverse incident - impacting on business continuity Finance Risks Risk of underspends & resulting negative perception 4 x 4 Primary 1 3 x 4 Primary 2 5 x 5 Primary 2 3 x 2 Contingency 4 x 4 Primary 1 2 x 4 Housekeeping 4 x 5 Primary 1 3 x 3 Contingency We are experiencing difficulties in recruitment to a number of key 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 about the contribution of other groups. There are also some indications that we are experiencing challenges in filling some posts in our own workforce and we are doing further work to understand this. Due to ongoing issues with data transfer we have taken the decision to pause our implementation of e:ess until April NES has a fully functioning workforce system and does not have any operational requirement to implement a new system. We have significantly improved our resilience in this area through roll out of more agile working but still need to retain a focus on this. We have now agreed an appropriate level of drawdown of funding from SG for expansion posts - taking into account the gaps in some programmes, this has reduced the risk of a signficiant variance from our anticipated year end position. We are experiencing difficulties in filling some of our payroll vacancies and will need to carefully monitor the slippage that may emerge as a result. 3 x 4 Primary 2 3 x 2 Contingency 2 x 4 Housekeeping 3 x 3 Contingency 10 Reduction of resources puts NES into deficit 4 x 5 Primary 1 4 x 4 Primary 1 11 Reputational/Credibility Risks 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 We are confident that we will deliver a balanced position for 2015/16 but have significant concerns about the financial position beyond that. It likely that we may need to balance the budget for 2016/17 with an assumption that we will identify further efficiency savings as the year progresses. 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. The Executive Team is also giving consideration as to how we can better promote the successes and the contributions of NES. 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. Need to ensure that we are not complacent in relation to this and to seek means of external benchmarking our processes. Strong data security processes in place. Very positive recent internal audit report. Averse 4 x 3 Primary 2 3 x 4 Primary 2 Cautious 3 x 2 Contingency 2 x 2 Negligible Averse 3 x 2 Contingency