LDP 2011-12 250311 risk management plan - NHS …€¦ · Web viewProperty market conditions deteriorate leading to disposal losses or inability to sell with consequential risks attached

Final 25th March 2011

LDP Risk Management Plan

Health Board: NHS GRAMPIAN

Use of Risk Management Plan

Please insert in the space provided for each target, the Health Board Lead responsible for the target.

Boards should, as in previous years, use the LDP Risk Management Plan to provide contextual information on key risks to delivery of each target and how risks are being managed. Within the template, the description of the key risk should be provided in the first column and detail on how the risk is being managed should be provided in the second column. Cross-reference to local plans should be made where necessary.

o Delivery: briefly highlight local issues and risks that may impact on the achievement of targets and/or the planned performance trajectories towards targets and how these risks will be managed.

o Workforce: brief narrative on the workforce implications of each of the HEAT targets where appropriate and relevant. This should include an assessment of staff availability to deliver the target, the need for any training and development to ensure staff have the competency levels required, and consideration of affordability cross referenced to the Financial Plan.

o Finance: Where applicable boards should identify and explain any specific issues, e.g. cost pressures or financial dependencies specifically related to achieving the target. There is no need to repeat generic financial risks that apply to all targets.

o Improvement: Where applicable, boards should outline any risks to sustainable improvement, particularly in respect of their national improvement programmes and implementation of lean methodology, required to deliver and sustain targets and how these are being managed.

o Equalities: Where applicable, boards should outline any risks that the delivery of the target could create unequal health outcomes for the six equalities groups, and/or for people living in socio-economic disadvantage; and how these risks are being managed.


Health Improvement for the People of Scotland

Health Improvement

Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines during 2011/12.

Achieve agreed number of inequalities targeted cardiovascular Health Checks during 2011/12.

Reduce suicide rate between 2002 and 2013 by 20%

Achieve agreed completion rates for child healthy weight intervention programme over the three years ending March 2014.

NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014.

At least 60% of 3 and 4 year olds in each SIMD quintile to have fluoride varnishing twice a year by March 2014.


Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention (ABI), in line with SIGN 74 guidelines during 2011/12.

NHS BOARD LEAD: Dr Lesley Wilkie, Director of Public Health and Planning

DeliveryRisk Management of Risk90% practice uptake of ABI Local Enhanced Service (LES) contract not maintained.

Practices will be asked to sign up to slightly revised LES for 1st April. Target contributions will be lower than 2010/11 therefore will be more manageable.

Actual ABI delivery rate in General Practice is variable across practices.

High ABI uptake was incentivised in 2010/11 and this is planned to continue (funding permitting) through the LES.We will offer a support visit to those not achieving the expected rate of delivery. We will continue to offer on-site refresher training to practitioners.

Accident and Emergency (A&E) based ABI delivery not embedded resulting in low levels of activity.

We will increase support to A&E at Aberdeen Royal Infirmary.

Maintaining levels of ABI activity in Sexual Health Services without dedicated nurse resource.

ABI delivery is currently boosted by 0.8 whole time equivalent (WTE) nurse resource and the need for this is being re-assessed. We will ensure that a funding source is identified.

Waiting times for alcohol specialist services may lengthen

ADPs and services are aware of possible increase in need and services have been re-commissioned with this in mind.

Monthly ABI uptake data is not available.

We will ensure that the requirement for monthly returns is considered for inclusion in the 2011/12 LES.

Low number of ABIs delivered in year 1 of 3 year cycle mean repeat ABIs will contribute little.

We will include repeat ABIs delivered at any point after 1 year in 2011/12 target.

Insufficient General Practice staff time to undertake and report ABIs

We will work with practices that require support to embed ABI into clinical routine.


WorkforceRisk Management of RiskABI facilitator post vacant since December 2010 with funding ceasing March 2011.

We will explore the possibility of continued funding from Health Scotland and will also explore funding options with the 3 Alcohol and Drugs Partnerships (ADP). Redesign of post options will be considered.

FinanceRisk Management of RiskPrimary Care LES funding is reliant on Grampian alcohol allocation which is not yet secured.

ABI delivery will continue to be prioritised by Grampian Director of Public Health and 3 Grampian ADP Chairs.

Specialist services reliant on Grampian alcohol allocation which is not yet secured.

Grampian allocation not yet determined. Continuation of current allocation between 3 ADPs is likely.

ABI Facilitator post funding source for 2011/12 not secured yet.

See workforce section.

ImprovementRisk Management of RiskInability to sustain ABI delivery at levels required to achieve target.

Due to delay in performance within previous 3 year cycle, we will ensure that the further one year target will be monitored closely, with particular regard to LES sign-up in Primary Care.

EqualitiesRisk Management of RiskVariable implementation and prioritisation of ABI roll-out at General Practice level may lead to inequality in alcohol-related harm reduction for population.

We will continue to manage performance and ensure practice visits to support front-line delivery where required.


Achieve agreed number of inequalities targeted cardiovascular Health Checks during 2011/12.NHS BOARD LEAD: Dr Lesley Wilkie, Director of Public Health and

Planning

Risk Management of RiskFailure to recruit additional GP Practices and/or pharmacies to participate in Keep Well (including existing Well North components) (KW)

We will continue the active recruitment of GP practices in Aberdeen City, Aberdeenshire and MorayWe will maximise opportunities to develop delivery models for practices with low numbers, or other challenges, to ensure eligible patients can access health checks.We will ensure revised age range is an incentive for early adopter practices who have worked through their patient lists.We will continue phased Community Pharmacy development in City and Aberdeenshire

Withdrawal from Keep Well of one or more pharmacies or practices

We will maintain close connection with each deliverer to ensuring necessary action from ‘early warning’ through practice and pharmacy monthly monitoring report s and follow up.

Failure of practices or pharmacies to meet monthly targets for Health Checks.

We will agree monthly targets with every deliverer and monitoring and management processThe Pharmacy Group will continue to oversee development and implementation of Grampian protocols and solutions We will focus work on ensuring robust systems and processes are in place to address any outstanding issues. in pharmacies in Moray.We will Incorporate learning from City and Aberdeenshire in revised protocols.We will use KW Learning Network to share local and national evaluation and solution based approaches to systems, processes, workforce, and progress.

Failure to sustain infrastructure of support for KW patients, pharmacies and practices

We will continue to align existing staff to mainstream some of this work and ensure relevant training to enhance delivery and capacity. Where appropriate, bank or other staffing, and alternative venues will be introduced to provide additional flexibility.We will ensure shared understanding of targeted primary prevention and need informs our Health and Care Framework, Aberdeen City Primary Care Redesign Programme and the Health Promotion Strategy.

WorkforceRisk Management of RiskRecruitment constraints impact We will prioritise staff input and support for the


on capacity to support KW development and extension.

extension phase..We will nurture and shape existing good practice e.g. case management for the Community Pharmacy Pilots in Aberdeenshire. We will seek support to pilot training of Community Pharmacy Assistants and capitalise on related work of other programmes e.g. long Term ConditionsWe will support the aims of the Primary Care Redesign Programme in Aberdeen City, configuring relevant services to support anticipatory care.

Staff receive appropriate training to ensure competence .

We will use relevant national and local training and streamline training and delivery as appropriate

Initial Health Behaviour Change (HBC) development work is not sustained

We will ensure dedicated professional support to maintain initial cascade model.We will develop implement and sustain Health Coach pilot

FinanceRisk Management of RiskFailure of formal and informal agreements to sustain and increase infrastructure to support timely extension of KW.

We will ensure implementation of fully costed action plans for each component of service to support development, sequencing and timescales for extension.

Failure to take account of recurrent,and relative resource use, in development of KW delivery models.

We will ensure local evaluation informs extension plans, consistent with fulfilling national government guidelines.

Insufficient resources secured to sustain the Community Pharmacy LES.

We will reduce service in line with resource.

ImprovementRisk Management of RiskInsufficient preparation is made for Keep Well extension in 2012

We will ensure progressive introduction of KW is supported by the continued development of flexible , quality models of delivery including use of bank staff where appropriate and use of alternative venues such as Health Village. Progressive engagement of relevant workforce at all levels is factored into CHP development plans.

Failure to contribute learning from KW as a pathfinder for our strategic theme to reduce health inequalities and improve health .

We will Use KW as a pathfinder for targeted intervention, within our evolving Health & Care Framework and ensure KW learning is a key driver in the sustainable development of Health Promotion

KW fails to address perceived inequalities in access to and use of anticipatory care.

We will influence the primary care redesign stakeholders, by collaborating on challenges and sharing solutions.


EqualitiesRisk Management of RiskFailure to engage the target population.

We will ensure implementation of formal and flexible patient engagement mechanisms.We will establish a Learning Disabilities pilot. .We will monitor patient engagement data and ensure performance management includes development of alternative engagement mechanisms as required.We will ensure revised engagement component within the LES

Programme creates unequal outcomes.

We will manage risk through Health Impact Assessment screening of specific components of programme. (eg Community Pharmacy)


Reduce suicide rate between 2002 and 2013 by 20%

NHS BOARD LEAD: Dr Pauline Strachan, Chief Operating Officer

DeliveryRisk Management of RiskAchievement of the target is affected by demographic changes and by lack of influence on other stakeholder agencies and the general public.

We will encourage each Choose Life Steering Group (aligned to local authority areas) to develop its own action plan for the revised Choose Life Strategy.We will ensure effective links between our Towards a Mentally Flourishing Scotland Group, Mental Health Improvement Group and the Choose Life groups. There will be close monitoring of impact.

WorkforceRisk Management of RiskTraining time for suicide prevention is seen as excessive and primary care cannot release staff for this.

We will continue to deliver Suicide Prevention Training to front-line staff and will offer Protected Learning Time sessions for primary care staff.

FinanceRisk Management of RiskUnknown costs for Choose Life initiatives.

We will influence local Choose Life action plans and links to Community Planning Groups.

ImprovementRisk Management of RiskThe Reduction in suicide rate continues to fluctuate due to demographic factors.

We will continue to work with partners on the refreshed “Towards a Mentally Flourishing Scotland” report.

EqualitiesRisk Management of RiskThere is variation in suicide rates within different local authority areas.

This will be defined within local Choose Life Action Plans and reported to the Joint Planning committee for Mental Health for appropriate action to be agreed.


Achieve agreed completion rates for child healthy weight intervention programme over the three years ending March 2014.


DeliveryRisk Management of RiskTime required to embed referral and delivery mechanisms into routine practice through the new child healthy weight pathway may compromise performance of targeted interventions.

We will develop an action plan to embed the child healthy weight pathway into routine practice and ensure progress is performance managed closely.

There are a lower number of eligible participants due to potential lower rate of child overweight compared to national average of 20.9% which increases challenge of target.

Local data will be reported in Summer 2011. This will be used to inform local programme delivery.

Failure to meet the requirement for 40% completions in two most deprived SIMD quintiles, 1 and 2, by local SIMD datazone in more remote and rural areas.

We will use available local intelligence and learning from implementation of other programmes and will work with Community Planning Partners to target the programme and monitor progress through existing performance mechanisms.

Uptake of targeted interventions is low.

We will implement an effective marketing, publicity and awareness-raising campaign with the general public, families in the target group, health professionals, voluntary and public sector partners. We will benchmark current uptake with other Health Board areas and identify and implement best practice from elsewhere.

Potential resistance from partners to taking universal height and weight measurements.

We will continue to work with our Local Authority partners, in particular Education, to overcome the significant barriers to this requirement and establish a practical but effective approach to measurement.

Time required to develop, test and agree a range of effective age-appropriate interventions is likely to delay programme delivery.

We have allowed a 6 month turn-around time for our planning process that ties in with increased delivery from academic year 11/12.

WorkforceRisk Management of RiskExtension of age range to 2 years will require additional capacity and skills development of community nursing and dietetic services.

A nurse lead has been identified to contribute to the strategic planning of the programme to ensure competing demands are taken into account in determining contribution to the


programme. We will develop and implement a training programme.

Insufficient staff capacity as well as knowledge and skills to provide flexible approach required to meet target

Existing staff will be used flexibly through reprioritising staff time and additional hours.Staff will be recruited to new posts should funding be available. We will develop a training and mentorship support programme.

Delivery of the target is reliant on partnership working at a time when budgets and staff are being reviewed in all organisations.

We will ensure continued communication and joint planning internally, and with community planning partners.

FinanceRisk Management of RiskBudget confirmed for 2011/12 only. Time limited contracts will be issued for new

posts if required.We will develop a project plan based on assumptions and review this as national guidance/funding is confirmed.

ImprovementRisk Management of RiskDelivery is dependent on ring-fenced resource and there are service capacity limitations which means mainstreaming will be a considerable challenge.

We will continue to embed the Child Healthy Weight Pathway into routine practice. We will provide mentorship/practice development support where possible. There will be strong nursing and AHP leadership to encourage delivery.We will work with community planning partnerships to continue delivery of non targeted interventions.

EqualitiesRisk Management of RiskExisting materials/approaches have the potential to exclude minority ethnic groups and those with literacy problems.

We will equality impact assess our new programme.

Achieving 40% completions in two most deprived SIMD quintiles is a challenge given the sensitivities of this issue combined with reaching this hard to reach group. Added to this is the challenge of directing resources to these areas whilst taking a pan-Grampian approach to funding allocation (urban/rural issues/datazone distribution). This could increase health inequality if not modelled carefully.

We will work with families in these target groups to ensure that approaches meet their needs.We will model how to apportion target across Grampian for maximum impact.

We will discuss potential proxy measures for deprivation/inequality with the Scottish Government as appropriate.


NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014.


DeliveryRisk Management of Risk Failure to engage the target population and those from disadvantaged areas

We will ensure that our level of service is delivering the 7.5% required. We will ensure that efforts to meet the inequalities aspect of the target do not compromise delivery of this target.Performance Management will continue through our Smoking Cessation Steering Group (SCSG) and performance management structure

Failure to maximise the benefit of prescribed smoking cessation medication.

We will ensure that 60% of 4-week quits come from the 40% most deprived datazones.Work to gather target data from Stroke, Cardiac, Respiratory and Diabetes MCNs will increase the proportion of our client group drawn from areas of deprivation Measures will be taken to capture data from Primary Care prescribing:A programme of structured practice visits by Smoking Advice Service staff will be undertaken to build working relationships with GP practices‘Just Five Minutes’ web-based support will gather target data from GP patientsWe will continue to review prescribing data as part of performance management.The SCSG will ensure partnership working with CHPs so that services are delivered to address local needs

Period of reduced functionality as new PMS implemented.

We will ensure business continuity arrangements are in place.

WorkforceRisk Management of RiskReduced staffing levels across organisations may reduce engagement with programme.

Performance management arrangements are in place across Community Planning Partnerships to identify falls in performance.

Our workforce may not be equipped to engage people from deprived data zones in stopping smoking

We will ensure that Specialist Smoking Cessation Support staff receive enhanced training in engaging hard to reach clients.

There is a risk that efforts to build smoking cessation capacity in partner

Appropriate smoking cessation training will be made available to meet the needs of staff from partner organisations.


organisations will be ineffective.The Smoking Cessation Training model has a limited emphasis on behaviour change competencies and prevention. This may present a risk to actual prevalence in the population.

Smoking Cessation training will be improved to enhance levels of health behaviour change competence this year.

FinanceRisk Management of RiskIndicative budget is for 2011/12 only although target continues through to 2014.

We will develop a project plan based on assumptions and review this as national guidance/funding is confirmed.

ImprovementRisk Management of RiskThere is a risk that the overall number of successful quits will fall as we attempt to tackle hard to reach clients in areas of deprivation.

We will aim to deliver the maximum number of quits from Chronic Disease MCNs, Community Pharmacy and Primary Care to maintain a high baseline numbers of quits.We will use our Specialist Service to tackle the “deprivation” aspect of the target

EqualitiesRisk Management of RiskProgramme delivery may result in unequal outcomes.

Alternative engagement mechanisms will be developed if evidence suggests this is the case.


At least 60% of 3 and 4 year olds in each SIMD quintile to have fluoride varnishing twice a year by March 2014.


DeliveryRisk Management of RiskLack of accurate data to inform planning and performance management of the programme.

National data system to support implementation of programme is still in development. We will continue to use robust local monitoring until national system operating effectively.

Unable to recruit practices to deliver programme

We will continue to undertaker practice visits to discuss and encourage recruitment to the programme and will provide support where required.

Failure to deliver target of 80% registration of 3-5 year olds with an NHS Dentist

Childsmile nursery component is targeted to areas of low NHS Dentist registration.Workforce and Premises planning will continue to address areas of identified need.

WorkforceRisk Management of RiskTime delay in recruitment of key staff.

Our Dental Transition Management Team will continue to monitor the situation closely, taking action as required.

FinanceRisk Management of RiskIndicative budget for 11/12 only whilst target is until 2014.

We will develop a project plan based on assumptions and review this as national guidance/funding is confirmed.

ImprovementRisk Management of Risk

EqualitiesRisk Management of RiskInability to reach hard to reach groups e.g. rural, disadvantaged and special needs

We will work with Community Planning Partners to identify problems and develop solutions including the utilisation of technology. There will be close monitoring and performance management of service to identify issues.

Efficiency and Governance


Efficiency and Governance

NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement.

NHS Boards to deliver a 3% efficiency saving to reinvest in frontline services

NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009.


NHS Boards to operate within their agreed revenue resource limit; operate within their capital resource limit; meet their cash requirement.

NHS BOARD LEAD: Mr Alan Gall, Director of Finance

DeliveryRisk Management of RiskMeeting and sustaining 18 week RTT standards from December 2011. Significant outpatient and inpatient backlogs to be cleared and sufficient human and physical capacity to maintain access times to be put in place

We will review performance daily including patient tracking. We will maximise the use of alternative facilities such as GJH and Stracathro. We will focus continuous service improvement efforts around working practices, use of theatre capacity and DNA reduction throughout patient pathways. Improved information flows and communication will prevent unnecessary delays.

Meeting all HEAT targets with trimmed workforce

We will focus attention on priorities on a continuous basis and ensure effective performance monitoring and management.

Meeting HEI standards continuously in all premises, particularly older premises where lack of capital funding precludes modernisation

We will direct available resources on a priority basis to areas of greatest need in terms of repair and maintenance and cleaning. We will continue to reinforce “ward manager” status and responsibility to improve ability to manage the ward environment. We are developing and implementing effective equipment cleaning standards.

Property asset base not fit for purpose as a result of low level of continuous maintenance budget and insufficient capital investment to replace ageing premises

We will prioritise available funds to maximise elimination or reduction of highest risk backlog maintenance. We await details on availability of revenue streams to support NPD and hubco type investments.

Patient safety compromised by having to take short cuts driven by financial demands

We will monitor staffing levels continuously throughout the organisation. We will implement e-rostering to maximise effectiveness of rota management and match demand and supply of skilled mixed staffing complements.

Insufficient financial resources available to fund potential increases in SMC approved drugs. Example – Warfarin replacement drug

We will ensure our local medicines management group continues to recognise the need to drive through efficiency of drug usage including minimising waste to ensure maximum investment available for drug demand. We will continue to review variation in drug prescribing patterns across the region to encourage best practice prescribing.

Demand for new and refurbished GP premises unable to be met from premises budgets already over committed for several years ahead.

We will look for innovative ways of funding premises development including opportunities arising from hub and similar vehicles. We will investigate options to share developments with


Risk of practitioners unable or unwilling to work from inadequate accommodation

public partners including local authorities and police.

Much reduced investment in new and replacement medical equipment will hamper progress in better patient care and potentially put staff and patients at risk from equipment that is beyond reasonable lifespan

There will be continuous risk assessment to ensure available resources are prioritised to eliminate highest risks. We will maximise opportunities arising from charitable contributions where appropriate to do so.

WorkforceRisk Management of RiskStaff numbers and skill mix restricted to fit in to reduced staffing budgets

Budget managers will continue to be responsible for staffing profiles and therefore must balance cost with service requirements. Inherent safety warnings within the system exist as staff themselves point out risks if they are likely to arise.

Partnership working put under intolerable strain as a result of imposed vacancy control

We will continue to have monthly meetings of our local partnership forum. The Employee Director remains a member of the executive team with continuous access to chief executive and other colleagues.

Staff safety compromised by lack of investment in health and safety management and practice

We will ensure that regular health and safety assessments are carried out. There are regular meetings of health and safety and risk management groups at both local and executive level. Staff will continue to be encouraged to record incidents via electronic Datix incident management system.

Inability to provide one year guaranteed job placement for graduates of the staff nurse programme. Relatively high number in Grampian because of local college output

We will continue efforts to find places as vacancies arise. Opportunities will be offered to join the nurse bank. We will encourage the seeking of opportunities beyond Grampian and locally elsewhere within care sector.

Requirement to reduce senior manager complement by 25% over 4 years. Risk of natural turnover being insufficient to meet targets and potential for financial compensation required to facilitate required change

Some progress has already been made through voluntary severance and retirement. Additional voluntary scheme currently underway may offer further opportunity.

In a very complex environment and one that increases in complexity year on year, the need for continuous staff training is paramount. There is a risk that training budgets are cut to the point

We will ensure budgets are set to cover all mandatory training. More will be done to make use of internal cross-training thereby avoiding additional external cost. We will explore opportunities to use internet based learning where possible.


that staff competence is compromisedContinuing to comply with the demands of EWTD and to manage the fundamental changes to junior doctor training

Efforts will continue to redesign services where possible that limit the need for complex rotas and where on call rotas are considered to be unnecessary.

Equal pay claims. Risk receding perhaps but not removed as yet

Risk being managed on a national based through Central Legal Office

FinanceRisk Management of RiskProgress in reaching NRAC parity hampered by general economic conditions

Current financial plans assume no additional movement towards parity.

Potential unplanned shortfall in GMS and GDS funding identified late in the financial year, leading to inability to reverse commitments or make compensatory savings elsewhere in the organisation

We will ensure careful monitoring of additional commitments undertaken at all stages so that decisions are based on current reality as opposed to expectation.

Large increase in GP prescribing volumes and use of high cost hospital drugs, particularly in treating cancer patients

Prescribing volumes have been steady for some years and national pricing negotiation is helping to stabilise costs. Medicine management groups and others will continue to review prescribing variation to allow practice to be standardised where possible. We will continue efforts, led by Pharmacy Director, to introduce working practices that will reduce costs and eliminate waste to help release funds for genuine need for drug technologies.

Potential reduction in “targeted” funding from SGHD programmes where NHS Grampian has invested resources recurrently

Risk arises where staff have been employed on a permanent basis or have established permanent rights. We will ensure exit strategies are built into such projects and applied where required or redeployment instigated where possible.

Business rates increases unaffordable

All rates assessments have been appealed. We await response from authorities and will deploy rating specialists to maximise chances of successful appeal.

National pay awards across all staff groupings are excessive and unaffordable

We will further review staff numbers, skill mix and service provision in the event of any material increase in pay terms.

Property market conditions deteriorate leading to disposal losses or inability to sell with consequential risks attached to surplus, empty premises

We review market conditions continuously with regular input from property specialists. There is regular review of premises awaiting disposal to ensure that they continue to pose no risk to the public or staff.

Improvement


Risk Management of RiskFailing to improve quality of care on a continuous basis

Improvement is not dependent solely on financial resources. We will focus on human behaviours and attitudes leading to an improved patient experience.

Lack of investment in staff training and development on continuous improvement methodologies

We will share knowledge and involve staff in practical improvement opportunities, thereby avoiding expensive input from external tutors and advisers.

Lack of investment in protected time allowing management and staff to take part in continuous improvement activity planning and implementation

We will support staff supervisors to recognise the value to the organisation as a whole of staff being given the opportunity to take part in activities that will lead to better ways of working and also act as a learning and development process for staff.

Progress in making significant strategic change in the way that services are delivered including Care of the Elderly is hampered by lack of revenue and capital funds to plan and implement required changes

We will ensure careful planning and strong leadership so that changes in care delivery are effected timeously and efficiently. Effective use of elements of the Change Fund will be essential to bridge any double running costs during transition periods.

Frustration amongst clinical staff in being unable to invest in “state of the art” technology as a result of restricted funds. Example, robotic minimally invasive surgery

We will communicate with and educate staff on financial conditions and future economic prospects to drive behaviour towards making savings by stopping “old technology” to allow investment in the future.

Inability to engage fully with public and other stakeholders in planning and implementing fundamental change in service delivery eg, reducing care of elderly people in hospital beds/stays and focusing efforts on care at home and in the community

We will continue to engage with key stakeholders when proposing material change. This approach will be cascaded down through the organisation.

Collaborative working across Grampian in making most effective use of our Change Fund share is less than effective leading to poor outcomes

We have appointed a senior manager to take the lead in bringing our three local authority partners and voluntary organisations together to ensure that plans are developed in partnership for the benefit of the region’s elderly population.

EqualitiesRisk Management of RiskLack of financial resource to support investment in health improvement and disease prevention in more deprived areas while continuing to treat illness for the whole population

We will make best possible use of targeted funding by identifying investment opportunities in both short term and medium/long term initiatives. We will collaborate with public sector and private sector partners in pooling resources to ensure maximum impact and synergy.


Insufficient investment in GP premises in more deprived areas where there is greatest need to increase NHS presence and involvement of clinical staff

We will ensure that strategic planning within the NHS and in conjunction with partners focuses on the importance of locating developments where the greatest need exists rather than on where providers would wish to be located.


NHS Boards to deliver a 3% efficiency saving to reinvest in frontline services

NHS BOARD LEAD: Mr Alan Gall, Director of Finance

DeliveryRisk Management of RiskShort term expediency measures taken that may compromise service quality

Our strategic budget steering group will review all efficiency proposals to consider impact prior to agreeing to proceed.

Proposals to make efficiencies through service redesign do not receive Government/political/public approval leading to requirement to make short term financial cuts to compensate

We will ensure effective planning, continuous engagement with stakeholders and clear benefits and impact analyses leading to orderly change in partnership.

WorkforceRisk Management of RiskStaff numbers fall below safe levels Budget managers are also responsible for

staffing profiles and therefore must balance cost with safety requirements. There are inherent safety warnings within the system as staff themselves point out risks if they are likely to arise.

Remaining staff faced with excessive workloads as a result of budget restrictions leading to posts being removed or vacancies being unfilled temporarily or permanently

We will review continuously how work is performed to identify what can be stopped or reduced or performed more efficiently through use of technology or by using different staff grades.

Staff absence rates increase reflective of pressure and excessive staff reductions created by budget cuts

Managers continue to be trained on effective absence management techniques and processes. Absence rates remaining steady and in some cases falling as a result.

Continuing ban on compulsory redundancy creates an ever increasing redeployment scenario where posts/staff removed through efficient reorganisation remain on payroll, demanding that cash efficiencies are made elsewhere and in other ways

This is not within the organisation’s control. Decision will be made on whether it is sensible to disrupt the organisation by continuing with service redesign when there are limited exit routes for displaced staff.

FinanceRisk Management of RiskEfficiency savings of 3% of estimated RRL for 2011/12 equates to around £24 million. While we will

The need to maximise efficiency in everything we do in the organisation is now ingrained in the psyche. There are various processes in place


be permitted to retain and reinvest these savings, we will in reality require to achieve them in cash terms to remain in revenue balance. Dependent on any additional unplanned cost pressures arising during the year, the target may increase beyond £24 million. There is a risk that the required savings will not be achieved in full or not fully on a recurrent basis

that are targeted at reducing costs including the dedicated Efficiency and Productivity Programme Office (EPPMO); Continuous Service Improvement (LEAN) initiatives; the “productive” series including wards, community and theatres; and local initiatives being discussed and implemented throughout the organisation.

ImprovementRisk Management of RiskPressure applied to reduce specialist “management” staff numbers dedicated to supporting operational units to plan and implement changes leading to improved efficiency and productivity

Essential that investment in this facility is supported by evidence of benefit in terms of cost savings, cost avoidance, increased productivity and arrange of non-financial benefits including a better patient experience. With such evidence in the public domain, justifying the investment is not difficult.

Staff numbers throughout the organisation reduced to such an extent that there is capacity only to deliver day to day services with no capacity remaining to develop and implement improvement plans

Job planning, appraisal and effective time management are essential components in freeing up time from day to day activities to focus on development. Efforts will continue to improve all of these skills throughout the organisation.

EqualitiesRisk Management of RiskTargeting of “soft targets” such as health promotion and initiatives designed to deliver health improvement in the longer term

Our developing Health & Care Framework in support of the strategic NHS Grampian Health Plan coupled with the complementary “Resource Allocation Framework” should ensure that rational resource allocation decisions are made in allowing the organisation to meet its wide range of objectives in an equitable fashion.

More vocal affluent lobby groups have excessive influence on NHS Grampian in terms of where investment should be reduced, leading to lack of redirection of resources to deprived areas as required

The same risk management process as noted above applies. It also requires open engagement with a wide range of stakeholders to avoid specific lobby groups having an undue influence on strategy and delivery.


NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009.


DeliveryRisk Management of RiskNon delivery as a consequence of poor housekeeping, technical failures and fluctuations in weather and through the continued use of fossil fuels (i.e. oil, gas, butane and propane);

Energy consumption and emissions are a direct function of service delivery. We will reinforce to all staff that they are responsible for ensuring, through prudent housekeeping, the proper management of simple measures such as control of windows, doors, heating, cooling and lighting with respect to time and temperature. We will continue to manage Building Energy Management System (BEMS) controls according to NHS Encode standards.Our two Environmental Managers will continue to monitor energy consumption and emissions on an ongoing basis, and any deviations to performance will be brought to the attention of both functional users and estates staff concerned, to mitigate risk.To compensate for weather variations, energy consumption is benchmarked against national Degree Day targets.

Absence of a Board-wide sustainable development plan to map out site specific migration from fossil fuel to non-carbon alternatives and energy conservation measures.

Use and changes to fossil fuels are a function of availability and sustainable investment strategy. (See Improvement Risk below)

WorkforceRisk Management of RiskMaintaining management awareness and resource capacity on managing the Phase 2 Targets across the whole estate, through lack of sufficient appropriate technical and support staff to address the Climate Change Act.

We are reviewing arrangements for dedicated technical and clerical support through our Safe and Affordable Workforce process.Currently E 8 Phase 2 energy data for returns are subject to unplanned work due to errors and estimating of the energy data – and resource issues are monitored monthly.

[Insert extra rows for extra risks as required]

Finance


Risk Management of RiskCapital funding allocations may be used to deliver buildings and assets to budget and timeline, but disregard a sustainable life cycle approach to Phase 2 Targets, Climate Change Act, energy efficiency and specification to NHS standards.

Carbon and Energy inefficient Buildings and assets have been procured in the past and have led to increased consumption, emissions and recurring revenue costs.We will continue to promote risk reduction through using approved Building and Asset performance standards for all new and refurbishment procurement projects. This includes for energy efficiency certification and carbon rating by Simplified Building Energy Model (SBEM) calculation and carbon management specifically to Building Research Establishment - Environmental Assessment Method (BREEAM) Healthcare – excellent rating for new projects and very good rating for refurbishment projects.

To address the identified Delivery Risks, we are taking steps to develop a Board-wide sustainable investment strategy to map out site specific migration from fossil fuel to non-carbon alternatives and energy conservation measures to meet E 8 Phase 2 Targets and Climate Change Act. (See Improvement Risk below)

CO2 Reduction Grant Scheme applications may be unsuccessful.

An application to install a Biomass Facility at Royal Cornhill Hospital has been lodged. Further future applications may be lodged where the Board-wide sustainable asset and investment strategy identifies a need and as applicable national grant schemes become available. (See Improvement Risk below)

ImprovementRisk Management of RiskThe quantity of CO2 produced by NHS Grampian will vary according to the type of fuel used and its carbon content. Although consumption may increase as sites develop, migrating to a fuel with a lower carbon impact will reduce carbon emissions.

We have developed and approved a Carbon Management Implementation Plan (CMIP) with targets and objectives to address changing energy use and the resulting carbon emissions.

A new Energy Centre at the Foresterhill Campus is under construction. The original design has been reviewed and adjusted to provide additional energy to University of Aberdeen Buildings. The design incorporates Combined Heat and Power, Biomass steam plant and conventional energy sources. The revised design will now contribute to CO2 estimated savings of 9570 Tonnes per annum, ensuring a reduction of at least 4% on the current CMIP for 2011/12 and 15% on the first full years use in 2012/13.


A new Emergency Care Centre at the Foresterhill Campus is also under construction and has an indicative energy performance of 46 GJ/100m3.

We are taking steps to review the NHS Grampian wide Carbon Management Implementation Plan to map out site specific migration from fossil fuel to non-carbon alternatives and further energy conservation measures to meet E 8 Phase 2 Targets and Climate Change Act.

The NHS Grampian property portfolio contains a high number of at risk, aged and poor performing stock (with high and unnecessary heated volumes and inefficient and poorly controlled energy systems) which, without major changes to construction or infrastructure, limit scope for achieving Phase 2 Targets at local site level. Grampian rates remain above the Scottish average.

Our property performance standards and new construction procurement standards (including for energy efficiency certification and carbon management to BREEAM Healthcare) are identified in the annual Property Strategy updates and this influences decision making on disposal, refurbishment and provision of new buildings to NHS standards.

To address the identified Delivery and Finance Risks, we are taking steps to develop a Board-wide sustainable asset and investment strategy to review the Carbon Management Implementation Plan (CMIP), and to map out site specific migration from fossil fuel to non-carbon alternatives, on-site renewables, new technologies and energy conservation measures to meet E 8 Phase 2 Targets and Climate Change Act.

EqualitiesRisk Management of RiskNone


Access to ServicesAccess to Services

From the quarter ending December 2011, 95 per cent of all patients diagnosed with cancer to begin treatment within 31 days of decision to treat, and 95 per cent of those referred urgently with a suspicion of cancer to begin treatment within 62 days of receipt of referral.

Deliver 18 weeks referral to treatment from 31 December 2011.

By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery.

Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013; and 18 weeks referral to treatment for Psychological Therapies from December 2014.


From the quarter ending December 2011, 95 per cent of all patients diagnosed with cancer to begin treatment within 31 days of decision to treat, and 95 per cent of those referred urgently with a suspicion of cancer to begin treatment within 62 days of receipt of referral.


DeliveryRisk Management of RiskInsufficient theatre capacity particularly for Breast and Urology 31 day cases

Theatre capacity and demand is being reviewed using Continuous Service Improvement/Lean methodologies. We will take action where scope for improvement is identified. We continue to allocate additional theatre sessions where available. We will give consideration to weekend working where appropriate and an additional mobile theatre.

Difficulty in clearing a backlog of patients requiring scoping.

We will seek additional staff from both internal and external sources. Additional hours are being worked.We will undertake a further review of capacity and demand to ensure full utilisation of all endoscopy sessions.

WorkforceRisk Management of RiskHigh turnover of patient trackers and difficulty filling the vacant posts.

We will utilise Bank staff/redeployed staff in the short term. We will make continued efforts to retain trained staff.

Lack of endoscopy capacity due to insufficient qualified nurses.

We will offer additional hours to qualified staff.Bank staff from theatres/ other ward areas and agency staff with relevant experience will also be utilised where appropriate.

FinanceRisk Management of RiskNo high or very high risks

ImprovementRisk Management of RiskNo high or very high risks

EqualitiesRisk Management of RiskNo high or very high risks


Deliver 18 weeks referral to treatment from 31 December 2011.


DeliveryRisk Management of RiskInsufficient theatre capacity to fully deliver target.

We will complete an option appraisal (currently underway) to identify cost effective solutions to increase theatre capacity.The National Productive Theatre Programme is being implemented to identify areas for improvement and increased efficiency.OPERA – the national theatre system was introduced in January 2011 and will ensure robust monitoring and performance management of utilisation.

Cancellation of elective activity due to emergency bed pressures.

We will ensure robust cross sector bed management measures continue to minimise cancellations. There is considerable focus on ensuring effective discharge planning, admission on day of procedure and pre-assessment to ensure effective bed use. We will continue to monitor and performance manage these closely.

Potential for referral rates to increase in some specialties.

We will continue to work cross system developing patient pathways to ensure referral to the right place at the right time. There will be ongoing engagement with primary and secondary care to determine solutions.

Delay in development of electronic pathways and monitoring due to focus on implementing base functionality of new Patient Management System

Local service improvement teams will continue to provide support to develop pathways.There is ongoing work with Intersystems to develop patient administration system to support pathway development

Increasing backlog of patients with unavailability status who require treatment.

We will continue to review the position through our Better Care Without Delay project and ensure appropriate action is taken.

WorkforceRisk Management of RiskNurse staffing levels reduced in line with efficiency targets

We are reviewing shift patterns to ensure an efficient utilisation of available staff across NHS Grampian. Through the Safe and Affordable Workforce initiative staff numbers and grades have been reviewed and changes will be implemented.

FinanceRisk Management of Risk


Current financial plans inadequate to meet increased demands upon service.

We will continue to negotiate with Access Support Team to secure appropriate funding. We will continue to ensure available resource (external and internal) is used efficiently and effectively. We will use available intelligence to deliver improvements that are sustainable without the use of waiting list initiatives.

ImprovementRisk Management of RiskAging population puts additional pressure on specific services at time of resource constraint.

We will monitor referral rates and activity closely.

Continued growing expenditure on hospital based acute services inconsistent with Board’s overall strategic plan to shift the balance of care.

We will continue to support improvement activity that shifts the balance of care away from hospital. We will continue to develop patient pathways which ensure care is provided by the right person in the right place.

EqualitiesRisk Management of RiskNo high/very high risks identified


By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery.


DeliveryRisk Management of RiskCompliance with target not delivered equitably across Grampian. Aberdeenshire is at particular risk of not delivering in full.

We will continue with the joint redesign work across all areas to improve patient pathways. The Aberdeenshire redesign, due for completion by June 2011, will benefit from the experience of Aberdeen City and Moray.

WorkforceRisk Management of RiskRecruitment and vacancy management processes lead to delay in filling key posts

Vacancy control is managed locally and action will continue to be taken timeously once approval to recruit is given.

Lack of applicants to fill key posts in North Aberdeenshire.

We will readvertise post with more flexible terms to attract wider field of candidate.

Staff focus on access for new patients.

We will continue to ensure that the redesign model supports routes out of treatment towards long term recovery. All staff will be recovery orientated.

FinanceRisk Management of RiskNo high/very high risks identified.

ImprovementRisk Management of RiskNo high/very high risks identified.

EqualitiesRisk Management of RiskRisk of inequitable service accessibility if targets not met.

Action will focus on ensuring geographic equity.Work is underway with partners to raise awareness of services available to hard to reach groups such as those from ethnic population and sex industry workers. NHS Grampian managers are members of the ADPs, of sub-committees thereof and undertake work on behalf of the ADPs.


Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) services from March 2013; and 18 weeks referral to treatment for Psychological Therapies from December 2014.


DeliveryRisk Management of RiskNon delivery of target in full. (CAMHS)

A waiting time steering group has been established to ensure compliance in all sectors of NHS Grampian. We will explore the current issues and develop an action plan to address them at a Waiting Times Workshop in early March 2011. The CAMHs Clinical Management Group will oversee the work and will hold the group accountable for ensuring target times are met and trajectories adhered to.We will agree a trajectory by September 2011.

New target being introduced during period of implementation of new PMS system may impact on data availability. (Psychological Therapies)

Close liaison with Patient Management System project team to minimise impact

WorkforceRisk Management of RiskAdequate staff available to deliver the improvement required. (CAMHS).

We will continue to ensure all vacancies in CAMHs are approved for appointment by vacancy management procedures. New resource has been allocated to increase staffing to maximum benefit. An appraisal of all services offered by CAMHs will take place in 2011 and, where required, redesign of services will ensure that access targets are met by ensuring resource is appropriately deployed.

Inadequate staff to meet the demands of the target. (Psychological Therapies)

NHS Grampian’s Psychological Therapies Steering Group (PTSG) has undertaken work to record workforce data across Mental Health Services, relating to staff groups, the modalities of psychological therapies delivered and supervision/training arrangements for those practitioners involved. Governance information for formally accredited practitioners in Psychological Therapies and for those staff members who are currently working towards accreditation has also been collected.


We are reviewing the skill mix of Community Mental Health Teams and the provision of varying Psychological Therapies across all areas of our service in line with locally developed guidance.Integrated Care Pathways (ICP) work has been focused towards IT infrastructure and the recording of information for the ICP Generic Pathway. This work has been inclusive of data recording for each standard and in particular standard 15 for Psychological Therapies. There is an ongoing training package which is underway to allow clinical staff to record the required information and planning has commenced in relation to our future Patient Management System (PMS) to be implemented by November 2011.

FinanceRisk Management of RiskNew resource is being invested in CAMHs at the same time as the service must contribute to meeting the organisation’s cost saving targets. (CAMHS)

We will comply fully with the vacancy management process and will develop initiatives to deliver efficiencies overall to ensure resource is utilised efficiently and effectively. The position will be performance managed closely.

The requirement for cost efficiencies will impact on resource required for development work. (Psychological Therapies)

We will seek support with development work from Scottish Government.

ImprovementRisk Management of RiskUnavailability of dedicated continuous service improvement resource to support clinical services to meet target. (currently provided by Mental Health Collaborative)

We will explore alternatives to Mental Health Collaborative resourced Continuous Service Improvement provision.

EqualitiesRisk Management of RiskThere may be under-provision for older people.(Psychological Therapies)

We are scoping the impact of the new target and will address with our Dementia ICP Group in first instance.

Treatment Appropriate to Patient


Treatment

Reducing the need for emergency hospital care, NHS Boards will achieve agreed reductions in emergency inpatient bed days rates for people aged 75 and over between 2009/10 and 2011/12 through improved partnership working between the acute, primary and community care sectors.

To improve stroke care, 90% of all patients admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013.

Further reduce healthcare associated infections so that by March 2013 NHS Boards’ staphylococcus aureus bacteraemia (including MRSA) cases are 0.26 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 65 and over is 0.39 cases or less per 1000 total occupied bed days.

To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14.


Reducing the need for emergency hospital care, NHS Boards will achieve agreed reductions in emergency inpatient bed days rates for people aged 75 and over between 2009/10 and 2011/12 through improved partnership working between the acute, primary and community care sectors.


DeliveryRisk Management of RiskCurrent trend of reducing bed days may not continue.

The Grampian Integrated Strategic Monitoring Performance Group (ISMPG), which has both local authority and health representation, will performance manage closely using local health Intelligence data. Action will be initiated where required.

Continued levels of unplanned community care eg. anticipatory and personalised care, unplanned admissions and extended length of stays as a consequence of inconsistency of approach to managing acute situations in the community.

We are reviewing delivery models across Grampian to assist transformation. Discussions and work continues to focus on the contributions of health, local authorities and third sector partners to improve the delivery of care with the aim of reducing unnecessary admissions and length of stay, alongside supporting self management and independence.The ISPMG will also monitor progress on this work, alongside local CHP joint planning and management structures.We will continue to apply Releasing Time To Care as an enabler across Grampian with Community Teams to support this. In Aberdeen City a demonstrator project has commenced to apply this methodology across joint teams, with a focus on the elderly population. The other Local Authorities are keen to progress this type of work also and are linked into the demonstrator.An outcomes framework for nursing is being developed across Grampian to further focus the key interventions required from nursing to support this target. Again we are seeking to align this to partners’ roles, responsibilities and contributions to a future pro-active model of care.

WorkforceRisk Management of RiskTeams currently working in a particular way. Variance in the delivery of care and clarity on the skills set required for the future.

We will continue to develop workforce plans using the 6 steps model. This is being developed alongside work on the future safe, affordable workforce plans.


The Releasing Time To Care approach locally has implemented a workload analysis tool and is developing a caseload management tool which will assist in organising workload and being clearer about the resource required and competency levels. The information is being shared for planning purposes at CHP and organisational level to assist in ensuring we transform the workforce to meet future needs.

FinanceRisk Management of RiskBudget constraints may compromise the quality of care.

Releasing time to care work has a focus on ensuring best value and examining existing workload and opportunities to remove waste, re-prioritise workloads and increase capacity. We will also examine the roles of other partners.

ImprovementRisk Management of RiskEnsuring consistency and support to embed continuous service improvement approaches in existing practice

We will ensure staff involvement in change and provide support to embed with day to day business. Improvement activity across NHS Grampian is significant and continues to aim to establish a consistent and systematic approach throughout the organisation.

EqualitiesRisk Management of RiskIdentifying people and the type of help they require to prevent deterioration and management of their ailments or conditions. Equity of access to suit need and retention in treatment are a key focus.

We will use risk prediction tools alongside local intelligence to identify those at risk and actively facilitate management plans, including other options for support eg. peer support, local self help mechanisms Managing equalities is a key objective across Grampian and the links are well established to support this.


To improve stroke care, 90% of all patients admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013.


DeliveryRisk Management of RiskPatients ready for discharge cannot leave the stroke unit because the care they require is not available at the required time. This then impacts on the admission of new patients to the unit.

We will identify beds outwith the stroke unit for the post stroke palliative and interim care required by c10% of patients.We will ensure facilities such as community hospitals and community rehabilitation teams are available and appropriately integrated for rehabilitation post stroke.

Post stroke palliative and interim care beds are not protected and are utilised for other patients.

These beds will be managed by the stroke physicians and their use will be closely monitored. We will ensure that Rehabilitation Teams are integrated and working across the system to ensure timely and appropriate discharge.

Length of stay in stroke unit and specialist rehabilitation beds is longer than required which impacts on availability for others.

Within the limitations of multi site working we will encourage early supported discharge to reduce length of stay and will work with key stakeholders to make this happen. Rehabilitation teams will play a key role in ensuring a seamless patient journey through Stroke Unit.

WorkforceRisk Management of RiskExpertise and confidence of community hospital staff to care for stroke patients may require further development.

We will ensure staff are supported across the system with their training needs met as appropriate. This will be facilitated through E-KSF and PDP activity and will encompass support from external partners (CHSS) and national competency frameworks. The Stroke Training Co-ordinator will be tasked with ensuring staff are at a competency level appropriate for the demand on their locality/unit/service.

FinanceRisk Management of RiskBudget constraints may prevent the required changes taking place.

We will continue to progress service redesign which delivers improved efficiency and through this facilitate change within available resources.


ImprovementRisk Management of RiskThe development of the different approach is not supported by behavioural change.

We will apply consistent improvement methodologies to ensure success. We will ensure that there is a clear communication strategy keeping stakeholders updated on progress towards attainment of target.

EqualitiesRisk Management of RiskDifferent facilities will be provided in different locations across Grampian

We will ensure a cross system approach and monitor service provision closely to minimise differences. We will ensure that there are appropriate pathways and protocols so that flow is sustained but also that the patient is being treated in the most appropriate location/site/facility.


Further reduce healthcare associated infections so that by March 2013 NHS Boards’ staphylococcus aureus bacteraemia (including MRSA) cases are 0.26 or less per 1000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 65 and over is 0.39 cases or less per 1000 total occupied bed days.

NHS BOARD LEAD: Dr Roelf Dijkhuizen, Medical Director

DeliveryRisk Management of RiskEffective measurement of compliance with infection prevention and control policy may not take place

Plans are in place to ensure that the system of Healthcare Environmental Inspection (HEI) audits taking place across NHS Grampian raise awareness of infection prevention and control policy and procedures and monitor their implementation.

Risk assessment of patients in terms of risk of cross transmission should take place on admission and be documented.

We will incorporate risk assessment in mandatory standard infection control precaution training for all clinical staff and a risk assessment tool has been piloted and will be rolled out.

Clear allocation of cleaning duties with a sign-off system at ward level

We will implement the findings of a review of the current allocation of cleaning duties to domestic and nursing staff to ensure adequate resource for cleaning. A new system for allocation and sign off of domestic cleaning duties was successfully implemented in Royal Aberdeen Children’s Hospital. We will roll this out to other sites.

Systems in place for identifying cleaned equipment

A clean equipment tagging method (record card in plastic pocket) was trialled by short life working group and found to work well. This is being rolled out across NHS Grampian. We are investigating the feasibility of identifying clean and dirty areas for patient equipment at ward level.

There may be misunderstanding of the correct method for cleaning patient equipment

Although there are instructions in the Decontamination of Medical Devices protocol, a group has been set up to provide detailed instructions on how to clean the 5 most commonly used pieces of patient equipment.

WorkforceRisk Management of RiskLack of decision making around the We will develop an annual work plan which


National Hand Hygiene Campaign and the MRSA Screening Programme at national level, combined with ongoing pressures due to HEI visits and pressures to increase Infection Prevention and Control Team (IPCT) knowledge of improvement methodology threaten to overwhelm the Team

mirrors the Healthcare Associated Infection Task Force Delivery Plan for the year 2011-12. The IPCT will continue to work closely with Scottish Patient Safety Programme colleagues to ensure work is aligned and not duplicated.

Ensuring effective communication flows

The Communication and Information Strategies have been reviewed and relaunched and there is now an HAI Communication and Involvement Framework in place. The IPCT will continue to use a range of communication methods including global emails, newsletters, team brief, awareness sessions, teaching sessions, the intranet and posters to communicate key infection prevention and control messages.

Service pressures may impact on delivery of the mandatory programme of HAI education

We will continue to reinforce the importance of supporting the release of staff for mandatory and statutory training. The IPCT will continue to develop alternative training packages that do not require staff to be away from the clinical setting for long periods.

FinanceRisk Management of RiskCurrent funds for parts of the service are “ring-fenced” and non-recurring.

Current practice is under constant review and redesign of services will take place to ensure continuity once funding comes to an end.

ImprovementRisk Management of RiskThere should be consistent environmental audit and domestic monitoring systems

We will ensure full implementation of robust external accreditation of the domestic monitoring process across all sites.

Ward staff are unable to make the necessary changes to their practice to reduce SABs.

A SAB action plan is in place which aims to provide support to clinical teams in implementing safer practices around device insertion and the taking of blood cultures. We will provide support from the IPCT, SPSP and executive leads for HAI and patient safety. External support from NES, HPS and NHS QIS is already in place.

EqualitiesRisk Management of RiskStaff, patients and visitors will have different levels of literacy and English may not be their first language.

We will ensure communication is available in formats that meet individual needs to ensure effective communication flows.


To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14.


DeliveryRisk Management of RiskLack of public understanding of unscheduled care choices.

We will continue to promote and develop our Know Who to Turn To campaign

Lack of knowledge and understanding across NHS system about A&E attendances.

We will ensure information is available to GPs and others on A&E attendances in a format that is relevant to them.

WorkforceRisk Management of RiskTraining to ensure required skill set is available in community may not be achieved within current funding levels.

We will identify required skills and agree prioritisation or alternative provision

FinanceRisk Management of RiskProvision or access may need to be increased beyond that which is currently funded. An example would be for increases in access to GP appointments.

We will be focus on redirection, de-escalation of current activity and on ensuring that patients are accessing the most appropriate level of unscheduled care currently available, rather than looking to increase capacity.

Uncertainty over funding availability for dedicated Health Intelligence support for unscheduled care project.

We will progress with Emergency Access Delivery Team and local Health Intelligence department.

ImprovementRisk Management of RiskCurrent trends may not be maintained and more members of the public may self present to Accident and Emergency (A&E)

We will ensure ongoing reminders to the public about when they should and shouldn’t use A&E. The ‘Know Who To Turn To’ campaign continues.

Financial position of Local Authorities may result in the reduction or withdrawal of services with impact on A&E attendance

We will continue to discuss changes with our partners to mitigate any risks.

Rate of attendance may reach a lower limit below which it cannot be further reduced

We will review performance regularly and ensure realistic target setting

Equalities


Risk Management of RiskWe are an area of both urban and rural geography with the main A&E department based within Aberdeen. As we encourage the public to use lower level services, there may be a perceived risk that only those living in the city centre have access to unscheduled care.

The recent Know Who To Turn To campaign highlighted unscheduled care services available across the Grampian area including at Dr Gray’s in Elgin (with telehealth links to Aberdeen and communications with Raigmore Hospital in Inverness) and the minor injuries units at 14 Community Hospitals.

Shifting demand away from Level 1, 2 emergency care departments includes the promotion of lower level minor injury units in community hospitals, which are available only in Shire and Moray. In Aberdeen City the minor injury service is run from the main A&E department with fewer options for residents to ‘de-escalate’ their choice of care.

We will ensure better promotion of pharmacist services through the Pharmore pilot and through Know Who To Turn To. Also better promotion of extended hours availability at general practices.

Documents

LDP 2011-12 250311 risk management plan - NHS …€¦ · Web viewProperty market conditions deteriorate leading to disposal losses or inability to sell with consequential risks attached