BERKSHIRE WEST CLINICAL COMMISSIONING GROUPS 2017/18 Corporate Risk Register (February 2018)

Transcription

1 Risk Ref. No. GBAF Strategic Objective CATEGORY: Quality Risk description, source and owner Lead: Nurse Director Q6 SO2 There is a collective risk to provider workforce management, total establishment staffing levels. All provider organisations with the local health economy have detailed risk regarding workforce. More specifically this is with reference to patient facing staff at a variety of AfC bands, within a number of clinical specialities. Therefore, there is increased reliability on bank and agency staff which pose a risk to the continuity of patient care and have a financial impact. Inherent risk score Required controls and actions to reduce/mitigate risk (with dates) Review Dates: (monthly, quarterly) Monitor/ Review body Residual Risk Score and Rating Is risk/ rating acceptable L I RR L I RRR Yes/No There are a number of methods of monitoring the workforce key performance indicators, this is completed on a monthly basis as per contractual requirement. These included: Turnover Sickness Agency spend Within the Clinical Quality Review Meetings provider commissioner interface, there are requested for deep dives relating to Human Resource issues and provider actions to mitigate significant risk. Quarterly Quality Committee Source: CCG Quality Team New risk added December 2017 Additionally vacancy rate, recruitment and retention plans are discussed during Quality assurance Visits. More recently there is the Accountable Care System workforce steering group which has been recently launched in order to address some of these issues collectively. This could include the exploration of working differently across the system in order to maintain safety and meet patient demand. Last reviewed: February 2018 AF Next review: March 2018 Quality Committee CATEGORY: Finance Lead: Chief Finance Officer (RC) 1

2 Risk Ref. No. GBAF Strategic Objective Risk description, source and owner F1 S03 The financial plan contains significant risk to delivery of agreed financial position particularly in relation to: acute contract over-performance, mental health placements CHC NCAs Impact of IR rules Source: CFO Inherent risk score Required controls and actions to reduce/mitigate risk (with dates) Review Dates: (monthly, quarterly) Monitor/ Review body Residual Risk Score and Rating Is risk/ rating acceptable L I RR L I RRR Yes/No ACS CFO Group established and meeting ACS Weekly weekly. System Efficiency Plan developed meetings for discussion with ACS groups including ACS CFO actions around 6m QIPP gap associated meetings with ACS programme. Every week CCG and RBHFT outturn position now fully aligned and over performance mitigated as at month 10. Over performance appears to be closer to CCG assumptions but this will need to be kept under review as we receive further data from RBH. A budget holder accountability framework and strengthened financial reporting are being rolled out. This will be fully implemented from m2 81/19. Recovery plan has been finalised and immediate action taken around discretionary spend FOT underspend on running costs. Regular discussion with NHS England with further mitigations being identified. Attention has shifted to the development of the 18/19 plan including system efficiency schemes. FRG QIPP and Finance Committee FRG Month end calls Twice per month NO Actions in train but need time to impact and benefits of ACS still in developm ent Last reviewed: February 2018 Acting CFO Next review: March 2018 F2 S /18 QIPP programme will not deliver as planned, resulting in reduced surplus at year end and greater financial pressure in Financial Recovery Group Risk assessed QIPP programme. QIPP group established. QIPP & Finance Committee NO (Schemes still being 2

3 Risk Ref. No. GBAF Strategic Objective Risk description, source and owner 2017/18. Source: CFO Inherent risk score Required controls and actions to reduce/mitigate risk (with dates) Review Dates: (monthly, quarterly) Monitor/ Review body Residual Risk Score and Rating Is risk/ rating acceptable L I RR L I RRR Yes/No QIPP process and documentation Programme strengthened for agreement at Q&F. Boards review at Q&F Committee. scrutiny at GBs Weekly FRG meetings Phasing of plan shared with NHS England. Deloittes report on 4 opportunities now Finance team with finalised and additional resource from NHSE input from to help with implementation. Further relevant resource from NHSE from m10. programme managers CCG risks and mitigations are being reviewed on a monthly basis and take account of potential further slippage. implanted with some back end loading of activity) F3 S03 Increased demand, and therefore acute and independent sector contract overperformance in the system, may be unaffordable and adversely affect CCG financial position Source: CFO CATEGORY: Children s, Mental Health (inc. LD), Voluntary Services Last reviewed: February 2018 Acting CFO Next review: March 2018 Marginal rate contract agreed with RBH to support cost reduction model. Discussions on fixing outturn and changing behaviour in the context of ACS working. Improved scrutiny of non-local contracts (dependent on capability of CSU staff). Raised as an ongoing issue with CSU. Over performance to date not significant but contracts do not reflect QIPP delivery. Last reviewed:february 2018 Acting CFO Next review: March2018 Contract Performance Meetings QIPP and Finance Committee GBs UCPB BCF FSG Lead: Director of Joint Commissioning (SG) NO (still seeing over performan ce in nonelective and elective activity albeit reduced M4) 3

4 CMM V 12 SO2, SO3 BHFT specialist community children s nursing BHFT has served notice on the day care elements of this service from end of April 2018, with some services stopping from November for safe staffing reasons. Overnight respite will no longer be provided for children at Ryeish Green CHC packages with complex health needs continue to be provided in schools, at weekends and in homes. The special school nursing service also continues. There are risks to children with very complex health needs, and their families, resulting from the lack of specialist community children s nursing workforce, leading to reduction in respite and support packages, with potential impact on the health of the child and the resilience of the family. There is associated financial risk arising from a potential need to find alternative providers to meet the CHC packages Contracts have confirmed that this was removed from the list of commissioner requested services. The circumstances around this decision are still being investigated. The service has been requested to be put back on ( ) Contractual process being followed regards notice period and contract variation in the short term CHC & BHFT have completed a risk assessment process on all 11 children currently using the service. 9 of the 11 children alternative arrangements have been put into place which will meet the needs. Additional services are required to meet the needs of the other 2 higher needs young people. (Risk assessment process completed and signed off ) Packages have been delivered as requested and agreed and this is in place for the next 2 months till end of March. However there have been further resignations and BHFT are reviewing the impact on staffing and will be discussing these operational matters at the project board meeting on ( ) CMV Together for Child Health NO (solution not yet identified and interim actions actions not yet taking effect) Identified CCG project manager support for long term options appraisal. Project brief signed off by project board and initial draft of the service specification has been created by the Task and Finish group to be reviewed by Project board on Proactive recruitment campaign continues Last reviewed: January 2018 AF Next Review: February

5 CMV 13 (MH) SO1, SO2, S03 Mental Health and Learning Disabilities Quality Assurance There is a risk that not all people with Mental Health and Learning Disabilities have had a post discharge review. From a case load of a 146 CCG and local authority funded cases, the data showed that 55 patients have a date that indicates a review has taken place. However, the analysis showed that 43 people had no date or BHFT had not provided the information as this may not have been available on RIO. A further 48 of the 55 are out of date or older than 12 months. RISK ADDED DECEMBER 2017 The CCG has requested a recovery plan from BHFT. The 3 local authorities have been asked to provide data related to cases with split health and social care funding that they have reviewed and these records may only be available on their patient management systems and not therefore available on RIO. The CCG is also looking to develop a robust process for updating information related to patient reviews on all CCG funded cases. 27 of the 146 cases are 100% funded by the CCG and will require a review. Last reviewed: December 2017 MH Commissioning Manager Next Review: December 2017 CMMV PB CMMV Programme Board QIPP & Finance Committee NO CATEGORY: Primary Care Commissioning Committee (PCCC) Lead: ACO (HC) PrC2a S01, S02 Viability of existing providers and ability to deliver new service models described in Primary Care Strategy may be affected by capacity and staffing constraints. Source: PCCC Workforce workstream of GPFV underway and linked with broader ACS workforce strategy. Practices continue to report difficulties with staffing and GP recruitment and retention in particular. Ongoing risk assessment processes in place and staffing discussions taking place with practices identified as particularly vulnerable. Increasing reliance on locums particularly amongst APMS practices is creating financial pressures as locum fees are rising. This together with rising indemnity costs is being discussed with national primary care lead through ACS programme. Quarterly JPCCC No actions are being taken as set out in GPFV Programm e Report. Last reviewed: December 2017 PCCC Next review: March 2017 PCCC 5

6 PrC2c iii S02 High number of special measures practices indicates that quality improvements are required and may affect viability of these practices going forward. Source: JPCCC iii) NWR CCG Special measures practices (Circuit Lane and Priory Avenue surgeries) Practices re-inspected, reports awaited. Ongoing dialogue underway with the provider with regard to staffing levels and the financial impact of high vacancy levels/locum costs. Patient complaints are also currently rising and there is a level of concern regarding access and continued management of administrative tasks. CCG continues to provide support to these practices and progress is being monitored by Nurse Director and Director of Primary Care. Should the issues not be resolved there remains a risk of contract failure resulting in approximately 16,000 patients for whom alternative provision would be required. Many of the practices potentially affected have limited capacity and/or are already predicting significant growth. General points: All other practices have now been inspected. 1 is rated Requires Improvement, others Good Quality Framework and Dashboard incorporating risk indicators is now in place and will support proactive conversations with practices facing particular challenge. Feeds into consolidated Primary Care Quality Report. As reported previously have also provided guidance to practices on preparing for CQC visits. Further work to be undertaken to agree support to be provided to Requires Improvement practices (of which there is 1 in NWR). Quarterly JPCCC No CCG continuing to work with provider to stabilise these surgeries and considerin g options should financial/s taffing models issues not be resolved. Last reviewed: December 2017 PCCC Next review: March 2017 PCCC 6

7 PrC6 SO1, SO2 Lack of effective Primary Care Support Services through Primary Care Support England (PCSE, provided by Capita) will have adverse impact on GMS/PMS/APMS service delivery including availability of medical records, list management, registrar and pension payments, availability of clinical supplies and timely completion of changes to the performers list Capita contract is managed by NHSE at a national level. Rectification plan currently in place and regular updates being received through TV Primary Care Forum showing progress made. PCSE updates also going to practices directly. CCG Primary Care Contracts Manager also monitoring issues. NHSE TV local team liaising with local NET (National Engagement Team) manager around practice specific issues. CATEGORY: A&E Delivery Board Lead: Operations Director (MM) Last reviewed: December 2017 PCCC Next review: March 2017 PCCC PCCC No but to be reviewed following next PCSE presentati on to Primary Care Forum and any further feedback from practices. UC1 S01, S02 There is a risk that A&E 4 hour performance at RBFT may not be sustainable with potential resulting breach of national constitutional performance target. Source: Directors meeting YTD performance (as at w/e 11th February) is 91.2% therefore the 95% target remains at risk. Top three reasons for breaches in w/e 11th February were Bed Management, A&E Assessment and Waiting for Specialist Opinion Acute. The A&E Delivery Board meet monthly. The work plan for 2017/18 is monitored by the A&EDB and the UCOG. UCOG continue to focus on operational delivery. There are 3 times weekly (increased to daily in times of increased pressure) system resilience calls focusing on supporting patient flow. Urgent Care Programme Board Urgent Care Ops Group QIPP & Finance NHS E / NHS I YES (Performance is above average for the South Central Region and supporting actions and firm controls are in place.) A&E performance now routinely includes WBCH MIU and Reading Walk in Centre. The A&E Delivery Board also monitor sole type 1 performance at the RBH (76.53% w/e 11th February) Last reviewed: February 2018 AW Next review: March

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9 Risk Assessment Tool (Risk Matrix) The CCG has adopted a risk assessment tool, which is based on a 5 x 5 matrix (Used by Risk Management AS/NZS 4360:1999, revised 2004). The risk matrix shown below is drawn from the National Patient Safety Agency A Risk Matrix for Risk Managers guidance published in January Risk assessment involves assessing the possible consequences of a risk should it be realised, against the likelihood of the realisation (i.e. the possibility of an adverse event, incident or other element occurring which has the potential to damage or threaten the achievement of objectives or of service delivery). Risks are measured according to the following formula: Likelihood x Impact All risks need to be rated on two scales - Likelihood and Impact (consequences), using the scales below. Likelihood To establish the Likelihood score go to the Likelihood definition scale below. Choose the most appropriate likelihood of the event occurring again from the five rows. The likelihood score is the number at the left hand end of the row. Level Detail Description examples 1 Rare: May occur only in exceptional circumstances 2 Unlikely: Could occur at some time 3 Possible: Might occur at some time 4 Likely: Will probably occur in most circumstances 5 Almost certain: Is expected to occur in most circumstances 9

10 Impact (consequences, severity) To establish the Impact score use the Impact definition scale below. For the risk/issue you have identified, consider what would happen if this risk were to be realised and choose the most appropriate row. The Impact score is the number at the top left-hand end of the selected row Descriptor Negligible/Insignificant Low (Green) Moderate High Very High Objectives/Projects Insignificant cost increase / schedule slippage. Barely noticeable reduction in scope or quality < 5% over budget / schedule slippage or minor reduction in quality / scope 5-10% over budget /schedule slippage or reduction in scope or quality % over budget / schedule slippage or failure to meet secondary objectives > 25% over budget / Schedule slippage or doesn't meet primary objectives Injury (Physical/Psychological) Minor injury not requiring first aid or no apparent injury Minor injury or illness, first aid treatment needed RIDDOR / Agency reportable Major injuries, or long term incapacity / disability (loss of limb Death or major permanent incapacity Patient Experience /Outcome Unsatisfactory patient experience not directly related to patient care Unsatisfactory patient experience - readily resolvable Complaints/Claims Locally resolved complaint Justified complaint peripheral to clinical care Service Business/Interruption Loss / interruption > 1 hour HR /Organisational Short term low staffing level development Temporarily reduces service quality (< 1 day) Staffing and Competence Loss / interruption > 8 Hours Ongoing low staffing level reduces service quality Mismanagement of patient care, short term effects (less than a week) Below excess claim. Justified Complaint involving lack of appropriate care Loss / interruption > 1 day Late delivery of key objective / service due to lack of staff. Minor error due to ineffective training. Ongoing unsafe staffing level Financial Small loss Loss > 0.1% of budget Loss > 0.25% of budget Inspection/Audit Minor recommendations. Recommendations given. Reduced rating. Challenging Minor noncompliance with Noncompliance with Recommendations. standards standards Noncompliance with core standards Adverse Publicity/Reputation Rumours Local Media - short term. Minor effect on staff morale. Local Media - long term. Significant effect on staff morale Serious mismanagement of patient care, long term effects (more than a week) Claim above excess level. Multiple justified complaint Loss / interruption > 1 week Uncertain delivery of key objective / service due to lack of staff. Serious error due to ineffective training Loss > 0.5% of budget Enforcement Action. Low rating. Critical report. Major non compliance with core standards National Media < 3 Days Totally unsatisfactory patient outcome or experience Multiple claims or single major claim Permanent loss of service or facility Non delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to insufficient training Loss > 1% of budget Prosecution. Zero Rating. Severely critical report National Media > 3 Days. MP Concern (Questions in House) 10

11 Likelihood Risk Score/Rating To calculate the inherent risk score/rating: Select the appropriate row for Likelihood and the appropriate column for Impact. The square where the rows intersect represent the risk score/rating, e.g. a risk with a likelihood of 2 and an impact of 3 would be scored as 6 and rated YELLOW (M = Medium). The colour codings categorise risk as follows: Low (Green), Medium (Yellow), High (Amber), Very high (Red). [This table may not be applicable for all situations. If this is the case, the table sets out a scale of parameters which can be used as comparable measures.] Please note: The inherent risk score/rating should not take into account the controls and assurances already in place to manage the risk. These should be taken into account when calculating the residual risk score. Risk Scoring Matrix The 'Impact' and 'Likelihood' scores are multiplied together to calculate the inherent risk score see example above. Impact L L L L L 2 L L M M H 3 L M H H VH 4 L M H VH VH 5 L H VH VH VH 11