Risk Register

Date Risk Status Risk Area

05/01/2012 Open Kingston Borough Team

Kingston Borough Team

Risk Ref Risk Title Cause & Effect Inherent Risk Priority 5 3 Extreme (15) Existing Controls Residual Risk Priority 5 3 Extreme (15) Action Required

160

Risk of failure to achieve 1.5% control total

Risk Owner: Yarlini Roberts Last Updated: 05/01/2012

Cause: Reduced funding due to top slicing by NHS London, unfavourable distribution of budgets at Cluster and practice levels - Increase in acute activity due to rise in unscheduled care; increased referrals; increased conversion rate from OPA to procedure. - Significant increase / demand in Healthcare - Ineffective contract management framework - Insufficient investment in primary care - Loss of local control re. acute activity now moved to Cluster

Escalation process with cluster in place should overspend and/or non-delivery of QIPP arise Practice level reports run manually until live system go live QIPP reporting to Local QIPP Committee on monthly basis Robust monthly monitoring of acute activity performance against plans Sollis Clarity reporting and analysis at practice level for acute activity Access available to clinical & non-clinical commissioning groups. Regular reports to KCC

Establish detailed analysis of underlying causes of KHT over-performance and set robust plans for 2012/13 SLAs
Person Responsible: Tonia Michaelides To be implemented by: 31/03/2012

Disaggregation of financial & performance information by consortia and practice basis as appropriate
Person Responsible: Yarlini Roberts To be implemented by: 31/01/2012

Effect: Failure to achieve 1.5% control total

Develop information infrastructure (systems & processes) to enable intelligent reporting of activity levels and costs.
Person Responsible: Yarlini Roberts To be implemented by: 31/03/2012

161

Failure to deliver Vital Signs and Operating Plan targets - areas of responsibility delegated to KCC
Risk Owner: Tonia Michaelides Last Updated: 05/01/2012

Cause: -Insufficient performance data to assess delivery of all areas of responsibility delegated to Kingston pathfinder, as identified delegation of Measures list - Failure to take remedial action if we are not aware that we are failing to deliver in any area. - Need to balance financial pressures with delivery of performance targets may mean that

3 3 High (9)

Read access to Performance Accelerator available Performance reports in place Approved delegation with cluster defined processes

3 3 High (9)

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Kingston Borough Team

some targets are not achieved due to lack of funding Effect: Pathfinder does not get authorisation as a clinical commissioning

Effect: 162 Risk to Service Development and quality of future patient care services
Risk Owner: Annette Pautz Last Updated: 04/01/2012

Cause: Lack of shared vision between commissioners and Your Healthcare Effect: Service development and quality of patient care is compromised.

2 3 Moderate (6)

5yr Block contract in place (4yrs to run) Agreed set of KPIs Monthly Performance Review & Qtrly Quality Review

2 2 Moderate (4)

Develop costed activity plans for 2012/13 with more sensitive and benchmarked performance measures
Person Responsible: Julia Gosden To be implemented by: 29/02/2012

Update and review current service specifications to include clear and specific outcomes in line with KCC vision for community services
Person Responsible: Annette Pautz To be implemented by: 31/03/2013

163

Failure to meet CQC Essential Standards for quality & safety and Inadequate follow-up of SIs in Mental Health Commissioned Services
Risk Owner: Phil Moore Last Updated: 05/01/2012

Cause: Lack of effective delivery of the Mental Health Services by SWL&StG due to failure to meet CQC essential standards and inadequate follow-up of serious incidents (SIs)

5 3 Extreme (15)

Mental Health Contract in place with key performance indicators and performance management processes and in built financial penalty clauses Performance management framework at cluster and borough levels SWL&StG action plans in place.

4 3 High (12)

Performance to be Reviewed and risk re-assessed

Person Responsible: Sylvie Ford To be implemented by: 10/10/2011

Review whether Performance Notice can be lifted

Person Responsible: Sylvie Ford To be implemented by: 10/10/2011

Effect:

Summary report to KCC

Person Responsible: Phil Moore To be implemented by: 14/02/2012

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Kingston Borough Team

164 Underperformance of Pathfinder contract interventions are not adequately addressed
Risk Owner: Tonia Michaelides Last Updated: 01/11/2011

Cause: Lack of ownership by Pathfinders Effect: The quality of patient care is compromised

4 3 High (12)

Regular reports to KCC to include SIs, Complaints etc

4 3 High (12)

-Pathfinder OD work to include areas where there are identified gaps in knowledge / experience
Person Responsible: Tonia Michaelides To be implemented by: 31/12/2011

-Regular review of provider governance reporting at KCC

Person Responsible: Tonia Michaelides To be implemented by: 30/03/2012

165

Over-activity issues are not adequately addressed

Risk Owner: Tonia Michaelides Last Updated: 01/11/2011

Cause: Financial forcasting lack robustness Focus of responsibility requires clarification Lack of joint working with ACU Effect: The quality of patient care is compromised Cause: Lack of effective systems and procedures Effect: Adult death or serious injury occurs

4 4 Extreme (16)

ACU management Board KHT Clinical Quality Meetings Regular Acute Performance reports

4 4 Extreme (16)

Review of memorandum of understanding with the ACU

Person Responsible: Tonia Michaelides To be implemented by: 30/11/2011

166

Risk to patient safety and Safeguarding Adults

Risk Owner: David Smith Last Updated: 21/10/2011

5 3 Extreme (15)

Joint Health & Social Care Service Adult Safeguarding team in place Safeguarding Adults Partnership Board in place (Chaired by David Smith)

5 2 High (10)

Agree formal escalation processes for Safeguarding Adults

Person Responsible: David Smith To be implemented by: 25/11/2011

Undertake stock-take of safeguarding arrangements ensuring consolidated Board assurance process.

Person Responsible: Tonia Michaelides To be implemented by: 31/10/2011

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Kingston Borough Team

167 Failure to ensure patient safety and Safeguarding children agenda
Risk Owner: Christine Robjohn Last Updated: 01/12/2011

Cause: Lack of capacity (Designated Nurse: 0.4) Organisational changes lead to lack of clarity around reporting systems Effect: Child death or serious injury occurs Financial liability Reputational damage Cause: - Lack of action and learning from previous serious incident occurences and deaths Effect: - Risk of further preventable SIs and deaths occuring - Reputational damage - Financial liability Cause: -Lack of readily available robust data and over optimistic planning assumptions -Demand management: New pathways do not effectively reduce/ replace acute activity -delayed start to Urology, Gynaecology, Falls & Neurology projects -straight line trajectories for delivering savings Effect: - Expected savings not achieved - Failure to achieve financial balance

5 3 Extreme (15)

- Established Framework and Child Protection Team within the Kingston Health Economy.

5 2 High (10)

Secure clarity re. capacity of Named/ Designated Nurse roles/structures within Kingston and across cluster.
Person Responsible: Christine Robjohn To be implemented by: 31/10/2011

168

Failure to learn from serious incidents

Risk Owner: Jill Pearse Last Updated: 05/01/2012

5 2 High (10)

Incident and Serious Incident Policies in place. SWL Risk Management Committee and Strategy in place

5 1 Moderate (5)

Review reporting arrangements to KCC

Person Responsible: Jill Pearse To be implemented by: 30/03/2012

169

New Patient pathways fail to achieve expected savings

Risk Owner: Tonia Michaelides Last Updated: 05/01/2012

3 4 High (12)

Monitoring of KPIs Review of Flash reports (includes project specific risks)at QIPP meetings Regular project specific meetings with project managers Review of QIPP programme by KCC Performance review meeting with providers

3 4 High (12)

Commence planning for 2012/13 QIPP programme.

Person Responsible: Tonia Michaelides To be implemented by: 31/10/2011

Develop Plan B for delivery of QIPP programme savings

Person Responsible: Julia Gosden To be implemented by: 31/10/2011

Review options for central QIPP performance monitoring system

Person Responsible: Tonia Michaelides To be implemented by: 31/10/2011

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Kingston Borough Team

170 Failure to deliver the Better Services, Better Value programme
Risk Owner: Tonia Michaelides Last Updated: 25/09/2011

Cause: -Failure to engage and take account of the views of patients and the public shape service planning and improvements in quality of care, including hard to reach groups. - Lack of engagement with clinicians in primary and secondary care may compromise ability to deliver new models of care.

4 2 High (8)

Better Services Better Value initiative Cluster level PPI and Comms team Deliberative events held (July 2011)

4 2 High (8)

Implement Better Services Better Value initiative

Person Responsible: Tonia Michaelides To be implemented by: 31/03/2012

Support cluster initiatives e.g. engagement with local stakeholders

Person Responsible: Tonia Michaelides To be implemented by: 31/12/2011

Support Cluster to draw up list of options & criteria

Person Responsible: Tonia Michaelides To be implemented by: 31/01/2012

171

Lack of a robust and co-ordinated response to a major incident

Risk Owner: Jonathan Hildebrand - Director of PH Last Updated: 05/01/2012

CauseFailure in disaster management and emergency planning EffectCommunity safety is compromised

5 3 Extreme (15)

Cluster Emergency Planning Cabinet EPLO Network -NHS London Emergency planning network -RBK Contingency planning forum (multi-agency) -Business Continuity Plan; Major Incident Plan; Severe Weather (snow) Plan; Communications Plan Heatwave Plan; Flood plan; Flu Plan; and Fuel Plan all in place.

4 3 High (12)

Arrange and hold emergency exercises -6 mthly Communications exercise -Annual table top exercise -3yrly live exercise
Person Responsible: Taryn Milton To be implemented by: 31/12/2011

Develop further training for on-call managers

Person Responsible: Taryn Milton To be implemented by: 30/09/2011

Develop training plan for all staff

Person Responsible: Taryn Milton To be implemented by: 31/10/2011

Implement action plan agreed with NHSL

Person Responsible: Taryn Milton

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Kingston Borough Team

To be implemented by: 30/09/2011

Review plans in line with scheduled dates

Person Responsible: Taryn Milton To be implemented by: 31/10/2011

172

Failure to maintain effective functioning and robust governance for Kingston as a PCT statutory body operating within a Cluster arrangement
Risk Owner: Jill Pearse Last Updated: 05/01/2012

Cause: Potential for making decisions that are ultra-vires or for not adequately maintaining a statutory function, with potential for legal challenge or financial penalty Effect: Reputational damage due to confusion about functioning or decision making

4 4 Extreme (16)

SOs & SFIs agreed by Joint Board, July 2011

4 3 High (12)

Review Governance arrangements following receipt of external report.

Person Responsible: Junaid Syed To be implemented by: 28/02/2012

173

Breaches of Confidentiality and Data Protection Act (Information Governance requirements compliance)
Risk Owner: Jill Pearse Last Updated: 04/01/2012

Cause:

4 3 High (12)

Completion of Information Governance Toolkit (IGT) Local Information Governance Steering Group (IGSG) Mandatory IG Training

4 3 High (12)

Effect: loss of public confidence and fines of up to 500,000

Ensure all Kingston staff complete IG training: - Monitor training status for individual staff - issue reminders and - report to senior management.
Person Responsible: Jill Pearse To be implemented by: 31/03/2012

Review IG Toolkit Submission arrangements with Cluster - i.e. whether to submit Kingston specific submission in March 2012 or complete as part of Cluster wide submission
Person Responsible: Jill Pearse To be implemented by: 29/02/2012

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Kingston Borough Team

194 Individual funding request process
Risk Owner: Jonathan Hildebrand - Director of PH Last Updated: 21/10/2011

Cause: Inadequate input from ACU to support IFR process Effect: IFR process runs risk of not being robust. Patients may not get care that is appropriate or vice versa

4 3 High (12)

Local IFR process in place

4 3 High (12)

Establish collaborative working arrangements with Public Health Teams in Wandsworth and Merton & Sutton. Secure GP input into IFR process
Person Responsible: Jonathan Hildebrand - Director of PH To be implemented by: 31/01/2012

Raise concerns with ACU

Person Responsible: Jonathan Hildebrand - Director of PH To be implemented by: 30/11/2011

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