Corporate Risk Register

Corporate Risk Register Item No 10/16 Meeting Title and ate Joint Governing Body for Horsham and Mid Sussex and Crawley 17 th November 016 Paper Author Alison Hempstead Lead Executive ate paper completed th November 016 Time required in 10 minutes meeting Paper summary For Information For discussion For ecision Audit Committee requested that the full corporate risk register is at the Joint Governing Body. This risk register has not been, it will be at the elivery Group (8 th Nov) and Executive Group (10 th Nov). Risks to note in particular: Current Risks: 059 Updated with additional actions around Brighton Hospital and referral to treatment (RTT) 068 Patient transport service (PTS) risk updated and new action added. 061 Finance risk, actions closed, new action of formal recovery plan Purpose Associated papers Associated Committees Closed Risks: Suggested that 060 SMSKP collaboration is closed and will be monitored on the Planned Care Risk register 075 on CSU mobilisation is closed as Go Live 1 st Nov. To give the Governing body a complete overview of the Risk Register that is presented to the Audit Committee on a quarterly basis. N/A Audit Committee, Executive and elivery Groups How does this work link to the Operating /Strategic plans? How does this work support the NHS Constitution/NHS Outcomes framework /KPIs Patient and Public Engagement to date Equality and iversity Assessment Legal Implications Risk Register implications Risk management of s Operating/Strategic plans Risk management of s duties under the NHS Constitution and NHS Outcomes Not at present Not at present Supports the in meeting its statutory duties None www.crawleyccg.nhs.uk www.horshamandmidsussexccg.nhs.uk

6/07/016 avid King 01/0/016 ) Barry Young ate risk entered Risk Owner () Total Risk Action Target ate Crawley & Horsham and Mid Sussex Combined Strategic Risk Register V6 016-17 Exec/el Nov 016 - monthly Owners: GB Assurance Crawley : 1 - Negligible 1 - Rare elivery 1 - Minor - Unlikely Financial Balance HMS : - Moderate - Possible NOF NHS Outcomes - Major - Likely PPE Patient and Public Engagement 5 - Catastrophic 5 - Certain uality 5 S NHS Constitution / Statutory uties 6 s Promote physical and mental wellbeing of our populations and workforce Ensure population has accessible, equitable and high quality integrated care Fully empower people and clinicians across all commissioning Improve value we achieve from the services we commission Achieve sustainable finances Recognised as effective and efficient organisation, with strong membership engagement and local leadership Changes made from V5 016-17 Risk escription 061 B 5 Financial Performance 016/17 There is a risk that the s will fail to contain spend within the budget approved by the Governing Body. Overspending against the budget will result in a recovery plan, NHS England (NHS E) intervention into local financial flexibilities, loss of financial credibility and an underlying deficit carried forward into 017/18. The budgets include uality, Innovation, Productivity and Prevention savings of 9.8m (.7%) for HMS and 5.1m (.%) for Crawley. 16 8) s have submitted a YT deficit at month 6 and NHSE have asked us to produce a formal recovery plan by end October 8) Barry Young ) 0/11/016 Action closed: ) Right care. ocobo opportunities - Programmes have scoped opportunities. Action closed: 6) Recovery plan framework is in place and details of risks/mitigations have been identified. Finalisation of recovery plan for programmes for IPP & stretch, including milestones to be signed off by Exec/el 071 S, Workforce risk to transformational change If commissioned providers are unable to recruit staff in the right numbers and with the right skills then the s' ability to deliver transformational change and business as usual, will be severely affected. Risk exacerbated by European Referendum result and potential staff choosing not to come to England due to uncertainty ahead. SECAmb are moving into Crawley; will recruit to Band workforce thus competing with social care agencies, scft responsive services etc 16 1) Programme of work in primary care locum chambers initiation meeting ) Programme of work in primary care primary care workforce tutors pulling together primary care ) Sustainability Transformation Plan (STP) plan to address wider workforce issues secondary and tertiary 1) Wendy Young 1) 0/11/016 ) Clare Allcock ) 0//016 ) Gerladine Hoban and ) 0/11/016 ) Health and Wellbeing Board actions on workforce need to be shared more widely with teams for input ) Minesh Patel and ) 0/11/016 5) Programme of work in primary care Skill mixing pharmacist 5) Clare Allcock 5) 0//016 appointments 6) Programme of work in primary care Skill mixing South East Coast Ambulance Community practitioner pilot 7) Engagement with Kent Surrey and Sussed Health Education England? 8) Two year planning process to incorporate local workforce plans complementary to STP workforce. 6) Clare Allcock 6) 0//016 7) and 7) 0/11/016 8) Wendy Young 8) 1/0/017 Action closed: 7) As a result of a judicial review, NHSE have advised that Funded Nursing Care rates will increase by 0% from 1 April 016. Action ) ) 7) target date 10b 016-17 Risk Register for Nov16 Joint GB (same as for Exec & el) 1

9/0/016 Geraldine Hoban Julia Layzell 09/05/016 avid King Kim Rickard 7/07/016 avid King 7/07/016 avid King 7/07/016 avid King ate risk entered Risk Owner () Total Risk Action Target ate Changes made from V5 016-17 Risk escription 07 B C, Provider Engagement Risk to Transformational change If commissioned providers are not engaged and supportive of the new models of care then progress in implementation will be jeopardised or incompletely implemented. 1) Communities of practice Governance structure 1) Clare Allcock 1) 01//016 ) STP to clearly outline the new models of care for the footprint (ACO/Communities of practice/acute configuration) ) and ) 0/11/016 ) Clear sign off and governance of STP to gain provider 'buy in' ) Gerladine Hoban and ) 0/11/016 16 to the solutions Risk target dates ) & ) ) Primary Care engagement via the Ben Gowland work ) Clare Allcock ) 1/11/016 5) Communication / engagment plan with providers 5) and 5) 0/0/017 07 Sustainable Transformational Plan (STP) If the STP is not adopted by all the relevant s and providers then there will be a negative impact on finances, reputation, patient quality and safety 1,,, 6 16 1) Attend STP meetings engage with s and providers 1) and ) Feedback through elivery and Executive, Governing Body and Audit Committee ) and 1) 1//016 ) 1//016 Risk target dates ) Identify plan for place based model of care ) and ) 1//016 07 NOF S,, Co-commissioning If the members do not vote to take on cocommissioning, NHS England may make the adopt joint or delegated co-commissioning then reputational damage, membership disempowered, governance implications 1. Co-commissioning to be scoped at Joint Governing Body 1) Alan Kennedy and 1) 0/11/016 Minesh Patel Ketan Kansagra and Simon ean/ Stephen Bellamy. Co-commissioning to be discussed at Locality and CRG ) Alan Kennedy and Minesh Patel Ketan Kansagra and Simon ean/ Stephen Bellamy ) 0/11/016 9 Risk target dates 068 NOF PPE S Patient Transport Service (PTS) If the current operational difficulties experienced in the initial mobilisation and delivery of the new Patient Transport Service continue then there will be continued and significant adverse impact on service quality, patient safety and patient experience. This in turn will impact patient flows across the Local Health Economy (LHE) increasing operational pressures in our acute and community services and in renal and oncology units across and outside of Sussex. Adverse media coverage is impacting patient and public confidence in the service with risks of reputational damage. There is the risk that the current operational difficulties experienced in the delivery of the new Patient Transport Service will continue. 5) TIAA (internal audit) report released, High Weald Lewes and Haven (HWLH) & Sussex s acting on recommendations pertaining to current PTS contract. A separate in-depth investigation is on-going. HWLH are organising a PTS lessons learned 8) The lead event commissioner for the 1 November is supporting and TIAA Coperforma will be present. to source increased clinical governance expertise 10) Patient Safety group has been established to oversee safety and patient experience. uarter1 uality report pending. 11) Coperforma contractual performance reporting reflects improved performance. ata validation exercise underway and awaiting output. 5) Kim Rickard 1/11/016 8) Kim Rickard 8) TBC with lead commissioner 10 ) Lead 11) Lead 10) TBC with lead commissioner 11) 0/11/016 5 0 ) Subcontractors - HWLH/ Sussex s working closely with ) Lead ) 0/11/016 16 Coperforma to understand issue relating to ocklands (MS) and are utilising the powers available within the NHS standard contract. 1) HWLH continues to monitor the PTS situation closely 1) Lead and have / are developing contingency plans based on scenario planning to enact should anything happen that may adversely 1) 0/11/016 impact on service delivery. Action 5) updated and target date given. Action 6) A service improvement plan for each Trust is with the Provider for action is now closed Actions updated & new target dates. Action 1) new 1) 15 CPN in place and original RAP closed on the /07/016 has been reopened on the /10/016 following identification of anomalies in Coperforma performance reporting. Three RAP areas of focus: 1. ue diligence.. Call handling. Transport timeliness. Action plans due to be received by HWLH by 1.10.016 but still currently outstanding. 1) Lead 1) /11/016 057 SECAmb There is a risk that the failings identified and highlighted via the published forensic report from eloittes March 016 may have an impact on finance, governance, performance, reputation and constitution. 16 ) Secamb are now in special measures and are being scrutinised by NHSE/NHSI/CC on a weekly basis. They have an action plan inplace. There is a new irector of Nursing in place. Secamb are working closely as a 'buddy' to South central Ambulance Service who have a positive CC report. Continue to monitor and review. ) Sue Moody ) 0/11/016 Action closed. New action added 10b 016-17 Risk Register for Nov16 Joint GB (same as for Exec & el)

HMS 6/0/016 Karen Eastman i Gilmour 7/0/016 Jacqui Nettleton 8/0/015 Paul Vinson Karen Eastman i Gilmour ate risk entered Risk Owner () Total Risk Action Target ate Changes made from V5 016-17 Risk escription 01 5 MSK Service delivery There is a risk that the commissioned integrated MSK service provided by Sussex MSK Partnership (SMSKP) will not deliver the service as per the specification. Implications; 1. Financial (GPs and patients may opt to refer directly to an acute Trust adding cost to and therefore not meeting IPP target). Reputational (GPs and patients may express concerns and dissatisfaction with the service). 16 ) Finance discussion on year at full Joint Partnership Single Performance Conference (SPC) - discussed at June SPC - task group set up to discuss further options for July SPC - update 01/08/016: Finance discussions ongoing with task/finish group. Feedback to SPC in Sept. ) Penalties for remedial action plan local quality requirement 18, referral to treatment applied from 8th October. Agreeing reinvestment milestones ) i Gilmour 7) 0/11/016 ) i Gilmour ) 0/11/016 Action 7 closed @SMSKP will develop multidiscplinary teams in community asap. Continue monthly monitoring - update 01/08/016: Crawley and Horsham MSK premises work complete by end July. Co-location to start in Aug/Sept' New actions & 5. 5) Options paper being developed for discussion on 15th November at Joint Single Performance Conference 5) i Gilmour 5) 0/11/016 Stroke Services If the current assumptions on tariff within the new service specification lead to arbitration then there is a risk the service specification will not be achieved or will be compromised on affordability criteria. 1) Central Sussex Board have the modelling, and a Commissioner to commissioner () meeting has been organised, to agree a strategy to finalise the projected costs. The Trust will be informed formally in November. 1) Jacqui Nettleton 1) 0/11/016 Target dates 065 PPE 16 ) Formal approval for co-location and centralising of Stroke Services at RSCH has been achieved. A wider engagement strategy with Loclaity Groups and the HOSC has been completed with no opposition boosting confidence within the Provider organsiation that Commissioners are supportive and that the reconfiguration is moving towards its final stages. ) Jacqui Nettleton ) 0/11/016 Brighton University Hospitals Trust (BSUH) Performance If BSUH do not improve their performance against RTT (referral to treatment) waiting times, then this will have a even greater detrimental affect on patient care and could compromise patient safety and quality. 1) Collaborative working with other s to consider procuring additional capacity. External stakeholder event held June - outcome being developed ) Increase discussions with Independent Sector and alternative providers to secure more capacity 1) iane Gilmour 1) 0/11/015 ) iane Gilmour ) 0/11/016 Risk and no changes this month ) Implement actions from workstreams arising from planned care programme board - Irritable Bowel Syndrome service, Ear Nose and Throat microsuction, headache pathway. ) iane Gilmour ) 0/11/016 5) Regular attendance at RTT Patient Treatment Liaison (PTL) 5) iane Gilmour 5) 0/11/016 059 S 16 6) Contract signed with orking Healthcare 6) iane Gilmour 6) 0/11/016 9 7) Headache pathway aiming go live Nov 016 to include direct access MRI 7) iane Gilmour 7) 0/11/016 8) Meeting ear, nose and throat (ENT) clinicians to build on clinic communication and repatriation microsuction patients to communict ENT if appropriate 8) iane Gilmour 8) 0/11/016 9) pathways for diagestive diseases to be launched. BSUH working on straight to test pathways 9) iane Gilmour 9) 0/11/016 10) Reviewing with other s additional diagnostic capcity 10) iane Gilmour 10) 0/11/016 111 Service If the planning data for the reprocurement of the 111 service is not recieved within the next month then there is a risk that the mobilisation timeline and 1) Receive adequate 111 planning data that will enable the financial and activity planning 1) Colin Simmons (Coastal - lead commissioners for the re-procurement) 1) 0/11/016 Action target dates 10b 016-17 Risk Register for Nov16 Joint GB (same as for Exec & el)

7/07/016 avid King 6/0/016 Paul Vinson i Gilmour 8/09/016 Wendy Young sarah Weston ate risk entered Risk Owner () Total Risk Action Target ate Changes made from V5 016-17 Risk escription 058 NOF,,5 there is a risk that the mobilisation timeline and service specification for the transformed 111 service will not meet the procurement timelines. There will be an impact on the development of the Local Clinical Hub for HMS & Crawley and on the procurement process for the Contact, Hub and Technology elements to deliver the Urgent & Emergency Care model for HMS & Crawley. There is also a risk that the A spine footprint s potential will agree to undertaking a seperate technology procurement, CHMS do not have the subject manager expertise as well as timescale not fully being understood ) Scope alternative data options enabling some element of planning to take place )Actions taken at the clinical hub programme board to fully understand the timescales and onwership of a separate technology procurement ) Sarah Weston ) Minesh Patel ) 0/11/016 ) 0/11/016 16 ) 111 reprocurment governance to be developed and agreed )Colin Simmons ) 0/11/016 9 Closed 060 SMSKP collaboration If SASH do not collaborate with SMSKP to develop co-location to the community for the integrated MSK service then this will: a) Result in efficiencies to be made by SMSKP with possible financial consequences for the. b) Cause an inability for SMSKP to hold a full suite of clinics in the community serving local patient needs. c) Mean SMSKP need to bring in other providers to support the activity in the community clinics which may delay full clinic activity. d) Lead to a delay in establishing collaboration with community based clinics 1) Establish programme board in a timely way to ensure progress to delivery. Met with Surrey and Sussex Hsopital (SASH); Programme Board to be established monthly from July ) Establish sub groups to support programme board which deal with operational, admin, IT issues. 1) iane Gilmour (SMSKP/SASH) 1) 1/10/016 ) i Gilmour ) 1/10/016 ) Programme Board to have oversight and decision making ) i Gilmour ) 1/10/016 16 authority to agree and support progress. 6 Risk and residual risk reduced. Suggested to close on corporate risk register and keep on programme risk register 075 S,,5 CSU mobilisation If Business Intelligence, contracts, finance, corporate service and IT do not successfully mobilise in September/October 016 and go live November 016 then there will be an impact on all services and ability to continue with business 1) Mobilisation plan for September/October 1) and avid King ) 0/10/016 ) Monitor through procurement committee/executive and ) ) 0/10/016 16 elivery and avid King Mobilisation occurred 1st Nov therefore close risk. 10b 016-17 Risk Register for Nov16 Joint GB (same as for Exec & el)