BOARD ASSURANCE FRAMEWORK & SIGNIFICANT RISK REGISTER Trust Board in public
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1 BOARD ASSURANCE FRAMEWORK & SIGNIFICANT RISK REGISTER Trust Board in public Date: 22 February 2018 Agenda item: 1.7 Executive sponsor Report author(s) Report discussed previously: (name of sub-committee/group and date) Gillian Francis-Musanu, Director of Corporate Affairs Colin Pink, Head of Corporate Governance Executive Leads (Feb 2018) Executive Committee ( ) Action required: Approval ( ) Discussion ( ) Assurance ( ) Purpose of report: The 2017/18 Board Assurance Framework (BAF) highlights potential risks to the Trust s strategic objectives, mitigating actions and the implementation of its programme of objectives of the five year plan. The Significant Risk Register (SRR) details risks on the Trust risk register system that are recorded as significant which have been considered by the Executive Team and the links to the Board Assurance Framework. Summary of key issues The BAF details 14 risks to the Trust s strategic objectives, six of which are recorded as significant risks to delivery of strategy. There are nine significant risks recorded on the Trust risk register. The BAF and SRR have been reviewed throughout February. In particular the following two risks on the SRR have been escalated to a score of 20: Ambulance Handover Delays 1838 Failure to maintain Emergency Department performance 1491 Page 1 of 9
2 Recommendation: The Board is asked to discuss and approve the report and consider the following: Delivery of Trust strategy and annual priorities, assurance, risk, mitigation and action. Does the Board agree with the recorded controls and assurances listed in the BAF? The Board is asked to note the risks as recorded on the SRR including the two escalated risk scores. Relationship to Trust strategic objectives and assurance framework: SO1: Safe Deliver safe, high quality care and improving services which pursue perfection and be in the top 25% of our peers SO2: Effective As a teaching hospital, deliver effective and improving sustainable clinical services within the local health economy SO3: Caring Work with compassion in partnership with patients, staff, families, carers and community partners SO4: Responsive To continue to be the secondary care provider of choice for the people of our community SO5: Well led To be a high quality employer of choice and deliver financial and clinical sustainability around a patient centred, clinically led leadership model Corporate impact assessment Legal and regulatory impact Financial impact Patient experience/engagement Risk and performance management NHS Constitution/equality and diversity/communication The report is a requirement for all NHS organisations. As discussed in sections 5 (Income generation linked to activity referred to throughout the document) Patient experience and engagement is one of the Trusts strategic objectives.. These are highlighted throughout the report. Discussed throughout the report but with the greatest detail in objective 3. Page 2 of 9
3 Attachments February 2018 Board Assurance Framework tables February 2018 Significant Risk Register Page 3 of 9
4 Trust Board in public Board Assurance Framework & Significant Risk Register Date: 22 February Board Assurance Framework The Board Assurance Framework (BAF) describes the principal risks that relate to the organisation s strategic objectives and priorities. It is intended to provide assurances to the Board in relation to the management of risks that threaten the ability of the organisation to achieve these objectives. The strategic objectives are broken down into specific areas and the BAF details the key risks that the Trust faces to the delivery of these priorities. Each risk details the controls that are in place, the sources and effects of assurance and mitigating actions to reduce the likelihood of the impact of the risk materialising. The Significant Risk Register (SRR) supports the BAF and details the highest rated operational risks that have been raised by the Executive Team and Divisional Management. The SRR is regularly reviewed and moderated by the Executive Team to ensure alignment with the BAF and other key risks to the Trust. 2. Current status The BAF was reviewed by the Executive team throughout February and updated to reflect current position. In particular the Executive team considered the risk scores recorded on the SRR relating to the risks relating to ambulance handover and emergency department access standard, these risks have been increased to a score of Overview One of the purposes of the BAF is to ensure that all risks are mitigated to an appropriate or acceptable level. It is expected that not all risks will be able to have mitigating controls that reduce the risk to green (low impact, low likelihood). The 17/18 BAF (attached) details a total of 14 risks to the 5 Trust strategic objectives which are scored as follows: Objective 1. Safe Deliver safe, high quality care and improving services which pursue perfection and be in the top 25% of our peers 2.Effective As a teaching hospital, deliver effective and improving sustainable clinical services within the local health economy 3.Caring Work with compassion in partnership with patients, staff, families, carers and community Red (15-25) Amber (8-12) Green (1-6) Page 4 of 9
5 Objective partners 4. Responsive To continue to be the secondary care provider of choice for the people of our community 5. Well led - To be a high quality employer of choice and deliver financial and clinical sustainability around a patient centred, clinically led leadership model Red (15-25) Amber (8-12) Green (1-6) Total Headline information by objective (BAF) SO1: Safe Deliver safe, high quality care and improving services which pursue perfection and be in the top 25% of our peers 1.1 There is a risk that the Trust will not be in the top quartile 25% for safety and continue to improve beyond this benchmark if opportunities to innovate and learn from benchmarked outcome data/peer review are not adopted and implemented S4 x L3 = 12 S4 x L2 = 8 S4 x L1 = 4 SO2: Effective As a teaching hospital, deliver effective and improving sustainable clinical services within the local health economy 2.1 There is a risk that the Trust will not meet its objective of delivering effective and sustainable care if it does not embed relevant research and education programmes that support the development of local services with the best outcomes. 2.2 There is a risk that the Trust will not meet its annual priority to improve discharge planning if suitable plans are not developed and delivered within year. S4 x L3 = 12 S3 x L3 = 9 S3 x L2 = 6 S3 x L3 = 9 S3 x L3 = 9 S3 x L1 = 3 Page 5 of 9
6 SO3: Caring Work with compassion in partnership with patients, staff, families, carers and community partners 3.1 There is a risk that the Trust will not meet its annual priority to promote the conditions that create the best environment for patients if it does not seek to shape patient centered clinical services and learn from all sources of patient feedback. S3 x L3 = 9 S3 x L3 = 9 S3 x L2 = 6 SO4: Responsive To continue to be the secondary care provider of choice for the people of our community 4.1 There is a risk that the Trust will not meet its objective of becoming the secondary provider of choice for our catchment area if it does not deliver all national standards including seven day working. 4.2 There is a risk that if the Trust does not deliver the planned efficiencies it will be unable to create the necessary capacity, which will have an adverse impact on elective care, income, expenditure and ultimately quality objectives. S4 x L4 = 16 S4 x L3 = 12 S4 x L2 = 8 S5 x L3 = 15 S5 x L3 = 15 S5 x L2 = 10 SO5: Well led - To be a high quality employer of choice and deliver financial and clinical sustainability around a patient centred, clinically led leadership model 5. There is a chance that the Trust may not meet its priority to benefit from the opportunities of strengthening partnerships, collaboration and developing high quality safe and sustainable systems that emerge from the solutions within the STP. 5.1 There is a risk to the Trust s short term financial stability if the annual income plan is not delivered There is a risk to the Trust s short term financial stability if in-year divisional spending exceeds budget S4 x L3 = 12 S4 x L3 = 12 S3 x L3 = 9 S5 x L3 = 15 S5 x L3 = 15 S4 x L2 = 8 S5 x L3 = 15 S5 x L3 = 15 S3 x L2 = 6 Page 6 of 9
7 SO5: Well led - To be a high quality employer of choice and deliver financial and clinical sustainability around a patient centred, clinically led leadership model 5. 3 There is a risk to the Trust s longer term financial stability if it is unable to deliver its medium term financial plan There is a risk to the Trust s ability to operate if its historic liquidity position restricts its ability to physically pay for expenditure. 5.5 There is a risk that the Trust will not meet its objective of becoming an employer of choice if it does not deliver a workforce strategy that drives the recruitment and retention of talent, provides the relevant skill-mix for operational delivery and supports on-going professional education, training and development across all staff groups. 5.6 There is a risk that the Trust will not meet its objective of becoming an employer of choice if it does not deliver a workforce strategy that seeks to prioritise staff health, safety, well-being, engagement and inclusion There is a risk that the Trust will not fully realise the benefits available from well embedded IT systems. S5 x L3 = 15 S5 x L3 = 15 S4 x L2 = 8 S5 x L3 = 15 S5 x L3 = 15 S4 x L3 = 12 S5 x L3 = 15 S5 x L3 = 15 S3 x L2 = 6 S3 x L3 = 9 S3 x L3 = 9 S3 x L2 = 6 S5 x L3 = 15 S4 x L3 = 12 S3 x L3 = Key risks Strategic risks Identified The BAF highlights the following six key red risks to the Trust objectives that have been identified at time of updating the framework. As follows: Risk description Initial rating Current rating Target risk 4.2 There is a risk that if the Trust does not deliver the planned efficiencies it will be unable to create the necessary capacity, which will have an adverse impact S5 x L3 = 15 S5 x L3 = 15 S5 x L2 = 10 on elective care, income, expenditure and ultimately quality objectives. 5.1 There is a risk to the Trust s short term financial stability if the annual income plan is not delivered. S5 x L3 = 15 S5 x L3 = 15 S4 x L2 = There is a risk to the Trust s short term financial stability if in-year divisional spending exceeds budget S5 x L3 = 15 S5 x L3 = 15 S3 x L2 = 6 Page 7 of 9
8 Risk description Initial rating Current rating Target risk 5.3 There is a risk to the Trust s longer term financial stability if it is unable to deliver its medium term financial S5 x L3 = 15 S5 x L3 = 15 S4 x L2 = 8 plan. 5.4 There is a risk to the Trust s ability to operate if its historic liquidity position restricts its ability to physically pay for expenditure. S5 x L3 = 15 S5 x L3 = 15 S4 x L3 = There is a risk that the Trust will not meet its objective of becoming an employer of choice if it does not deliver a workforce strategy that drives the recruitment and retention of talent, provides the relevant skill-mix for operational delivery and supports on-going professional education, training and development across all staff groups. S5 x L3 = 15 S5 x L3 = 15 S3 x L2 = 6 3. Significant Risk Register There are nine risks on the Trust significant risk register. Each risk is in date and has mitigating actions to reduce the level of risk to an acceptable level. Risk 1491: Failure to maintain Emergency Department performance has an escalated risk score from 15 to 20. Risk 1838: Ambulance handover delays has an escalated risk score from 15 to SRR Breakdown ID Title Failure to maintain Emergency Department performance Unable to deliver realistic medium term financial plan Liquidity: Inability to pay creditors/staff resulting from insufficient cash due to poor liquid position Risk of not achieving Cost Improvement Plan Initial Rating Current Rating Residual Rating Next Review /04/ /02/ /02/ /02/ RTT Access Standards /02/ Risk of potential overspending from operational pressures /02/ Risk of Contract income below plan /02/ Delay to Trust strategy to implement an electronic patient record /02/ Ambulance Handover Delays /04/2018 Page 8 of 9
9 4. Discussion/Action/Recommendation The Board is asked to discuss and approve the report and consider the following: Delivery of Trust strategy and annual priorities, assurance, risk, mitigation and action. Does the Board agree with the recorded controls and assurances listed in the BAF? The Board is asked to note the risks as recorded on the SRR and the two risk scores which have increased. Gillian Francis-Musanu Director of Corporate Affairs February 2018 Page 9 of 9
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