Gs) Health&Social CareREPORT North Lanarkshire..0Item No: 14

SUBJECT: Risk Management

TO: Integration Joint Board

Lead Officer Chief Accountable Officerfor Report:

Author(s) of Head of Planning, Performance and Quality AssuranceReportDATE: 27 October 2017

1. PURPOSE OF REPORT

This paper is coming to the Board:

For approval For endorsement E − To note

2. ROUTE TO THE SUB−COMMITTEEThis paper has been:

Prepared Reviewed Endorsed

2.1 The paper was prepared by the Head of Planning, Performance and Quality Assurance andreviewed at the Core Senior Leadership Team meeting.

3. RECOMMENDATION

3.1 The sub−committee is asked to approve the content of the report.

4. BACKGROUND/SUMMARY OF KEY ISSUES

4.1 New, closed or emerging risks and current risk profile

4.1.1 There are currently 10 live risks identified on the IJB register.4.1.2 The current risk profile and scoring template are set out below:

IMPACT

_______Low Minor Moderate Major Extreme

IScore 1 2 3 4 5Almost 5CertainLIkel 4Possible 3Unlikely 2Rare 1

Risk Score Number of RisksLow (1−3) 1Moderate (4−9) 5High (10−15) 4Very High (16+) 0

4.2 Very High Graded Risks

4.2.1 Following meetings to jointly review risks across the range of registers in place within health(e.g. corporate, acute, North and South), one risk has been increased to very high, ensuringconsistency of reporting with South and the Corporate register.

ID Title Risk Type Risk Owner

IJB9 Availability of GPs Strategic Janice Hewitt

4.2.3 This risk will be reviewed at least monthly, with mitigating actions being coordinated via thePrimary Care Strategy Board and Primary Care Transformation Fund Board.

4.3 High Graded Risks and Risks Exceeding Tolerance

4.3.1 From the 10 risks identified, three have an assessed level of risk as high, and a further onehas an assessed level of risk higher than the tolerance set. Members are asked to focus onthe key actions identified to ensure mitigation to tolerance level.

HSCNL Description of Risk Risk − Key actions AssuranceID Owner − a Source

(Da'Qi

a'

Impact of in year Janice 3HIGH 2MED 1. JIB Finance and Audit CommitteeIJB1 budget pressures Hewitt 2. HSCP Budget monitoring meetings SLT,

3. Budget monitoring and oversight Finance4. Prescribing Action Plans and Audit5. Capacity plans to maximise efficiency sub, JIB

Future budget Janice 3HIGH 2MED 1. JIB Finance and Audit CommitteeIJB2 settlements Hewitt 2. HSCP Budget monitoring meetings SLT,

3. Budget monitoring and oversight Finance4. Prescribing Action Plans and Audit5. Capacity plans to maximise efficiency sub, JIB6. Regular budget meetings with ChiefExecutives and Directors of Finance

Failure of strategic Janice 2MED 1. Joint Strategic Needs AssessmentIJB3 commissioning plan Hewitt 2. Locality Profiles SLT, PS&A

3. Strategic Planning Group Sub, JIB4. Locality engagement events5. Commissioning Plan ProgrammeBoard and workstreams6. Communication and engagementstrategy

HSCNL Description of Risk Risk − − Key actions AssuranceLn

ID Owner − 2 − Source− −(D

−0.)

−−(0

Sustainability of Janice 1. NL Carers Strategy ImplementationIJB10 Carer Support Hewitt Group SLT, JIB

Services in 2017/18 2. Working Group for roll out of CarersAct3. NL reps on key national workinggroups for Carers Act4. Carer representation on Integrated

3HIGH

ServiceReview Board

4.3.2 Risks within this category are reviewed at least every 2−3 months.

5. CONCLUSIONS

5.1 The IJB Risk Register (appendix 1) has been reviewed in line with NHS Lanarkshire's newself−assessmentapproach, which aims to ensure the risk management process is effective. A

copy of the tool is included in appendix 2.

5.2 NHS Lanarkshire has reviewed its risk appetite to medium and has introduced a newself−assessmenttool to support officers to more accurately rate risks, review more thoroughly

and ensure the risk register is a genuinely active tool used to support decision making.

5.3 The operational health risk register has also gone through the self−assessment processduring the month of October.

5.4 The operational social work register is being finalised in line with the developing risk strategywithin North Lanarkshire Council. Further meetings are taking place with NLC risk leads onweek beginning 30th October and the full register will be completed before the end of thecalendar year.

6. IMPLICATIONS

6.1 NATIONAL OUTCOMESThe risk management strategy will assist the identification, recording and mitigation of risks,thereby supporting the achievement of organisational outcomes by prioritising andmanaging risks which may threaten them.

6.2 ASSOCIATED MEASURE(S)No further measures.

6.3 FINANCIALThe risk management strategy will support the identification, prioritisation and managementof risks which may threaten financial balance and governance.

6.4 PEOPLEThe risk management strategy will support the identification, prioritisation and managementof risks which may threaten the safety of staff and patients/service users.

6.5 INEQUALITIESThe risk management strategy will support the identification, prioritisation and managementof risks which may impact on inequality.

7. BACKGROUND PAPERSNil

8. APPENDICESAppendix 1: Self−assessment toolAppendix 2: JIB Risk Register

CHIEF ACCOUNTABLE OFFICER (or Depute)

Members seeking further information about any aspect of this report, please contact Ross McGuffieon telephone number 01698 858 119.

NHS LANARKSHIRE

How Effective Is Your Risk Register?Self − Assessment

Effective Risk Management Today Prevents Crisis Management TomorrowThere are certain essential characteristics that can demonstrate that you have an effective riskregister ie; one that informs senior decision−making and enables best value for the use of finite

resources whilst minimising harm. Consider the following when reviewing your risk(s):

Are your risks really risks?

NHSLanarkshire

Some risks described on a risk register are really an issue or a problem, and can be resolved and managedoperationally. Not everything is a risk!

C•1

w

CC

I−C.

0

Issue Problem Risk

A Matter of concern or A Matter that is difficult to manage −A known escalating mattercontention and can create a dilemma or in emerging unepected event

Management on a day−to−day Senior management decisions are Requires a quantification of the risk,basis and can be resolved required to support day−to−day levc−( of risk recording of mitigating

management with action planning controls and actions to be takento manage safely and effectively for improvement and rubsequent

monitoring citric sflectiveness ofthe controls and actions

A serious incidentSignificant complaintBreach of a performance target

Cluster of seriousincidents /complaintsIncreasing Trendof incidentsNo sustainable performance

Resolution is difficult andthe matter is persistentUnexpected occurrenceChange in legislation

SG Directive

If the 'risk' is more of an issue or a problem and operational management is complete, consider closing the risk,noting reason why in the notepad.

If there are too many risks it becomes more difficult to manage and there is less focus on risk based actions andeffective resource allocation.Do the descriptions of the risks follow the NHSL Standard in the Policy?For example;

"There is a risk that..." What event could happen that creates uncertainty as to the achievement of the statedobjective?"because..." Why and/or how could this event occur?"leading to..." What would the consequence be if the event occurred

If not, update and record changes in the notepad.

Do the assessments of the risks reflect the overarching primary objectives of NHSL?For example;

SAFETY EFFECTIVENESS

Are any risks overstated and does the register reflect the actual position?

PERSON−CENTRED

Check against the matrix if your risk is assessed as high or very high to confirm the assessment taking intoconsideration the effectiveness of the mitigating controls.

Carol McGhee, Version 1, June 2017.

NHSNHS LANARKSHIRE Lanarkshire

How Effective Is Your Risk Register?Self − Assessment

Effective Risk Management Today Prevents Crisis Management TomorrowWhen was the risk first opened?

<lyear 1−2year 2−3year 3−4year >5 year

Consider why any risk is opened >4−5 years and if it still reflects the current position, including how effectivethe mitigating controls have been. Consider closure if the risk is no longer current and mitigation has beenas effective as it could be.

Are the mitigating controls out of date or current?

Update if necessary.

Are the mitigating controls working and evidenced through eg:

External Inspection Internal! External Audit Performance Trajectory Performance Indicators

Are more actions required to reduce the assessed level of risk?

NB − Some actions may be incorporated into other action plans (egfrom external inspection reports) and theyshould be referenced within the notepad and attached as a document i f they can support your mitigation ofthe risk.

Have you managed the risk to an acceptable level of tolerance and sustained this?

If yes, consider how long this level of risk! tolerance has been sustained and close the risk if there is goodevidence of effective mitigation.Do you have a good documented history of review, changes to the risk within the notepad?

If no, it is essential that you commence good record keeping within the notepadAre your risk review dates commensurate with the assessed level of risk and tolerance?Examples:

• Very High graded risk reviewed monthly• High graded risk reviewed 2−3 months• Medium graded risk reviewed 5−6 months• Low graded risks reviewed no longer than 1 year (if continues low consider closing)

Are your risks part of a risk register that is reviewed by Management Teams?

If NO, consider why and enable a more focused approach to review.., remember too many 'risks' becomeunmanageable forcing a 'tick box' exercise that could compromising your effective good governance.Do you have an identified assurance source (not the immediate management team) for the risk..., how isthe risk register governed?

Example: Site! Unit ! Service governance groups! Committees . This could range from being presented atevery governance meeting to at least a minimum of twice per year.

Carol McGhee, Version 1, June 2017.

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