NHS HIGHLAND STRATEGIC RISK REGISTER ADULT SOCIAL CARE SERVICES AND CHILDREN S SERVICES

Transcription

1 Highland NHS Board 14 August Item 4.3 NHS HIGHLAND STRATEGIC RISK REGISTER ADULT SOCIAL CARE SERVICES AND CHILDREN S SERVICES Report by Jan Baird, Care and Lesley Anne Smith, Quality on behalf of Elaine Mead, Chief Executive The Board is asked to: Approve the NHS Highland Strategic Register for Services and Children s Services. Agree the management and assurance arrangements for NHS Highland s Strategic s relating to Services and Children s Services. 1. Background 1.1 The Board approved the NHS Highland Strategic Register at its on 3 April. It was recognised at that that although the Register identified a risk in relation to Planning for Integration it did not capture all risks relating the or Children s Services. 1.2 It was agreed that the would work with colleagues to ensure that any risks identified in the Highland Council Strategic Register relating to Services are reflected in NHS Highland s risk register documents from the 1 April and that this would be presented to a future of the NHS Board. 1.3 The risks relating to Services fall into three main types: Specific risks relating to Services transferring from the Highland Council on 1 April both Strategic and Operational s relating to the integration of both and Children s Services reflecting delivery of the Partnership Agreement and implementation of future service models s in respect of technical issues relating to integration which remain to be finalised over the coming year part of the Integrating Care in the Highlands programme 1.4 This paper captures the risks identified above and describes the management and assurance process relating to them. 2. Identification 2.1 NHS Highland s Corporate Register is made up of the following: strategic risks linked to corporate objectives and delivery of the local delivery plan, operational risks which have an organisation-wide impact on the provision of safe, effective patient care significant risks escalated from the Operational Units on account of their significance for the organisation and the requirement for the organisation to be involved in the management of the risk

2 This can be shown diagrammatically as follows: COMPONENTS OF CORPORATE RISK REGISTER STRATEGIC RISKS s associated with the strategic direction of an organisation. Strategic risks are often a function of uncertainties that may be driven by government policy, competition, court decisions or a change in stakeholder requirements. OPERATIONAL RISKS pertaining to the delivery of services. These would include risks involving human resources, controls and processes. Organisation-wide s s which have an organisation-wide impact on the provision of safe, effective patient care Unit specific s Significant risks escalated from the Operational Units on account of their significance for the organisation and the requirement for the organisation to be involved in the management of the risk 2.2 s relating to and Children s Services were identified from a number of documents as detailed below. An assessment has been made as to whether these risks are Strategic, Operational or relating specifically to the technical aspects of integration. 2.3 The risk rating system used by the Highland Council is similar to that used by NHS Highland and this information has been used to apply the appropriate NHS Highland risk rating to each of the identified risks. 2.4 The Highland Council Social Work Service Plan contained a section on s which contained the following: Ref Rating Type SW1 Inability to manage budget pressures HIGH Operational SW2 Not shifting the balance of care MEDIUM Strategic SW3 High levels of staff absence MEDIUM Operational SW4 Not responsibilities under mental HIGH Strategic health legislation for adults at risk SW5 Inability to recruit and retain qualified staff and managers HIGH Operational SW6 Poor transition management of service users MEDIUM Strategic into young adulthood SW7 Failure of planning for integration HIGH Integrating Care in Highland programme

3 2.5 The Highland Council Corporate Register at March contained several risks relevant to social care services: Ref Rating Type THC2 Property Assets HIGH Strategic THC6 Business Continuity & Emergency Planning HIGH Operational THC7 Poor transition management of service users HIGH Strategic into young adulthood (also SW6) THC26 Failure of planning for integration (also SW7) HIGH Integrating Care in the Highlands 2.6 In May NHS Highland s Internal Auditors prepared a paper outlining their assessment of the high level risks to NHS Highland as a result of Integrating Care in the Highlands together with a proposed two year audit plan which will provide the Audit Committee of NHS Highland with assurance that robust and effective arrangements are in place to mitigate these risks. In the paper they identified three new key risks areas to the achievement of NHS Highland s objectives as a direct result of Integrating Care in the Highlands: Ref Rating Type IA1 NHS Highland fails to deliver on its statutory HIGH Strategic responsibility of providing safe and effective children s services to the Highland population IA2 social care expenditure is in excess of the transferred budget, which could result in HIGH Strategic NHS Highland failing its statutory responsibility of retaining financial balance IA3 NHS Highland fails to deliver safe and HIGH Strategic effective adult services to the Highland population in a fair and consistent manner 2.7 Two Gateway Reviews conducted in line with programme management expectations identified IM&T as an area of significant risk. This was in relation to the ability to share information and communicate across and within the new services. Whilst this specific issue is included within the forward plan for Integrating Care in the Highlands, it is considered to be of such significance strategically that it has been included as a separate risk on the Strategic Register. 2.8 Following review by the Care the risks identified above have been described more fully, been subject to risk assessment and the assurance source has been determined. The Strategic s have been transferred to the NHS Highland Strategic Register and are attached as Appendix The Directors of Operations for North & West and South & Mid have been notified of the operational risks included above and asked to include these in their Operational Unit Registers. In addition they have been asked to consider any other risks relating to integrating care and update their Register accordingly The forward plan of Integrating Care in the Highlands is the subject of a separate Board paper which identifies issues relating to integration which remain to be finalised over the coming year and beyond.

4 3. Arrangements 3.1 For the risk management framework to be fully effective, robust monitoring arrangements and clear lines of responsibility and accountability must be in place for the management of risk registers. 3.2 The NHS Board has delegated the function of risk governance to the Committees. Each has a responsibility to provide assurance to the NHS Board in respect of the risks that fall within its specific remit. Each has further responsibility to encourage managers to ensure the dissemination of learning across NHS Highland from adverse events and near misses. In some cases the NHS Board itself is the assurance source. 3.3 This requires each Committee to use the Corporate Register and Management Reports issued by the Management Steering Group to consider risks that may require further scrutiny (for example, risks evaluated as very high) and seek assurance from individual risk owners regarding the management of these risks including the adequacy of existing control measures and progress against any actions required for improvement. 3.4 The primary assurance source for the risks included on the Strategic Register relating to and Children s Services is the Health & Committee. The first of this is due to be held on 7 th September. The Strategic Register will be considered at this and responsibilities allocated to ensure robust action plans are in place to address the risks identified. Update reports on these actions will be considered by the on regular basis. 4. Contribution to Board Objectives management is about the culture, processes and structures that are directed towards realising objectives and potential opportunities whilst managing adverse events. The risk management system and its associated risk registers supports the NHS Highland Strategic Framework and the Highland Quality approach, driving forward quality improvement in all aspects of the healthcare agenda. It supports the achievement of NHS Highland s objectives through effective risk management and consistent application of risk management methodologies. 5. Implications NHS Highland recognises that risk is inherent in the delivery of healthcare and that risk management should be part of an organisation s culture. This Strategy is based on the philosophy that the management of risk should be holistic, supporting clinical, corporate, public and staff governance. The Board, managers and staff have a duty of care to integrate risk management in their activities to enhance the quality of service and drive risk management effectively. 6. Assessment The Strategic Register is a risk based approach which will ensure than any implementation plans are prioritised using the agreed risk management assessment process.

5 . 7. Planning for Fairness The Strategic Register is a component part of the NHS Highland risk management system. This latter is currently under review and the resulting Management Strategy and Procedures will be subject to the Planning for Fairness Process. 8. Engagement and Communication The Board has a number of engagement mechanisms through which this work can be communicated, as detailed above in this report. Jan Baird Care 1 August Lesley Anne Smith Quality

6 ID Title Serv Char. Corp Obj. NHS HIGHLAND STRATEGIC RISK REGISTER ADULT SOCIAL CARE SERVICES AND CHILDREN S SERVICES Description Owner Consequence Acceptable Consequence Assurance Source Appendix 1 Last Review 19 Failure to deliver on statutory obligations on relation to Children s services 20 social care expenditure is in excess of transferred budget 21 s social care services are not delivered in a fair and consistent manner 22 Not shifting the balance of care 23 Not responsibilities under mental health legislation for adults at risk 4 7,8 There is a risk that NHS Highland (NHSH) fails to deliver on its statutory responsibility of providing safe and effective children s services, which are now being delivered by Highland Council (THC) 7 10 There is a risk that adult social care expenditure is in excess of the transferred budget, which could result in NHSH failing in its statutory responsibility of retaining financial balance 2,4 7,8,9 There is a risk that NHSH fails to deliver safe and effective adult services to the Highland population in a fair and consistent manner, which will also result on a failure to deliver on NHSH s contractual agreement with THC 3,4 7 The national and local strategic direction to meet the needs of the changing population is to reduce dependency on institutional care care homes, hospitals, and increase opportunity for care at home and community based care. This will require a shift in resource as the provision changes, to ensure sustainability of the developing community services. 2,4 7,8 Current legislation includes Mental Health Care & Treatment Act, Support & Protection Act, s with Incapacity Act. Statutory responsibility lies across both THC and NHSH with delivery shared according to the legislative context as the functions within MHC&T Act, for example, cannot be delegated out with THC. Public Health Directors of Operations/ Care/ Directors of Operations/ Health and ( THC) / Major Possible HIGH Major Unlikely MEDIUM Children and Committee ( THC)/ H&SC Major Unlikely MEDIUM Major Unlikely MEDIUM H&SC

7 ID Title Serv Char. 24 Poor transition management of service users into young adulthood Corp Obj. Description Owner Consequence 1,4 7,8,9 Due to the importance of transitions from children s services to adult services, the Highland Partnership Agreement places responsibility for smooth and effective transitions in the hands of both the and Children s Services. Existing policies and procedures are being reviewed to reflect the lead agency model but both organisations will be accountable. 25 Property Assets 4,6 10 The (council) needs to rationalise its property assets effectively such that it can afford to maintain them in good condition and suitable for their required use. This includes those delivering services which have transferred to the NHS. Work continues to agree long term arrangements recognising that the initial licences to occupy Council premises can only be regarded as interim. NHS HIGHLAND STRATEGIC RISK REGISTER ADULT SOCIAL CARE SERVICES Directors of Operations/ Health and ( THC) Housing and Property ( THC) / Estates Acceptable Consequence Assurance Source Major Possible HIGH Major Possible HIGH Children and Committee ( THC)/ H&SC Major Possible HIGH Major Possible HIGH Housing and Property Committee ( THC)/ H&SC Last Review 26 IM&T is not sufficiently developed and fit for purpose post integration 4,6 7,9,10 There is a risk that the inability to share information and communicate across and within the new services will impact on the ability to deliver the new models of care ehealth/ e- Government (THC) Committee/ ehealth Steering Group