strategic risk report 1 march 2018 - haringeyccg.nhs.uk papers/20180315/item 6.… · haringey ccg...

Strategic Risk Report

1 March 2018

Haringey CCG Risk Register HARINGEY CCG STRATEGIC OBJECTIVES:

1) To commission high quality, valued and responsive services, w orking in partnership w ith the public to make the best use of available resources; 2) To promote w ellbeing, reduce health inequalities and improve health outcomes for local people; 3) To improve the health and quality of life for people by commissioning integrated health and social care delivered closer to home.

2 1.3.18

Introduction The Strategic Risk Report (historically known as the Board Assurance Framework) evidences Haringey Clinical Commissioning Group’s control over the delivery of its strategic objectives listed above. This report directly underpins the Annual Governance Statement (AGS) and is the subject of annual enquiry by Internal and External Audit.

Function of the Strategic Risk Report This report is a tool for the Governing Body corporately to assure itself (gain confidence, based on evidence) about successful delivery of the organisation’s strategic objectives. The framework is designed to focus the Governing Body on controlling principal risks threatening the delivery of those objectives. It aligns principal risks, key controls and assurances on controls alongside each objective. Oversight of the management of individual risks is assigned to relevant Governing Body Committees. Where gaps are identified and key controls and assurances are insufficient to reduce the risk of non-delivery of objectives, action plans will be created where appropriate and overseen by the responsible committee. The Senior Management Team and the Audit Committee routinely review all risk on the Risk Register, whereas the Governing Body receives a more high-level Strategic Risk Report, containing risks rated 12 and above. The purpose of the Strategic Risk Report may be summarised as: To provide:

a comprehensive method for the effective and focused management of the principal risks to achieving strategic objectives; and

a basis for the preparation of a fair and representative Annual Governance Statement.

Governing Body responsibility for the Strategic Risk Report

It is the responsibility of the Governing Body as the corporate head of the CCG to: Establish strategic objectives. Identify the principal risks that threaten the achievement of these objectives. Identify and evaluate the design of key controls intended to manage these principal risks. Set out the arrangement for obtaining assurance on the effectiveness of key controls across all areas of principal risk Evaluate the assurance across all areas of principal risk. Identify positive assurances and areas where there are gaps in controls and / or assurances Ensure that plans are put in place to take corrective action where gaps have been identified in relation to principal risks and receive

assurance Maintain dynamic risk management arrangements including, crucially, a well-founded risk register. Open risks and recently closed risks are set out in pages 6-17.



3 1.3.18

Strategic Risk Heat Map

Imp

act

5

4

3

2

1

1 2 3 4 5

Likelihood

10

26

=

40

41

42



4 1.3.18

Strategic Risk Summary – Open Risks

Ref Risk Residual Priority

Key changes since last review

10

There is a risk that the performance against the A&E target at NMUH will not improve in line with the trajectory for 2017/18 agreed with NHS England, NHS Improvement and the A&E Delivery Board. The trajectory outlines a sustained improvement in the achievement of the target of 95% of patients being seen within 4 hours, with the 95% target being achieved by the end of March 2018.

15

There have been no changes in this review.

26 There is a risk that BEHMHT will fail to deliver the required ‘must do’ and ‘should do’ improvements required, after the Trust was rated as ‘requires improvement’ following an inspection by the CQC in December 2015.

12 There have been no changes in this review.

38 There is a risk of failing to deliver a balanced Financial Plan in 2017/18. This risk has been CLOSED as financial pressures in Acute and Continuing Care Services are likely to result in the CCG not meeting the control total. The CCG will work to mitigate pressures locally to achieve financial balance across North Central London. A new risk (risk 41) has been opened to ensure the CCG manages the financial position reported to NHS England in order to achieve financial balance across North Central London.

16

40 There is a risk of quality and access to dermatology care deteriorating as a result of cessation of North Middlesex to provide dermatology from March 2018.

12

Progress against actions has been updated.

41 There is a risk of the financial position worsening before the 2017/18 year-end.

6 This is a new risk.

42 There is a risk is of continued overspend on the Continuing Healthcare (CHC) budgets, resulting in the CCG being unable to meet its financial duty to deliver services within its resources.

16 This is a new risk.



5 1.3.18

Risk Ref:

SO(s) Risk Description Risk Owner

Lead Committee

Cause and Effects Why could this risk occur

and what could be the effects if the risk

materialised?

Inherent Risk

Score (Without

Controls)

Existing Mitigation / Controls

How are we managing this risk? What are the Key Controls in place

to prevent this risk from occurring?

Assurance / Evidence

Who / Where can we gain evidence that these

controls are working effectively?

(All assurances are positive unless stated

otherwise).

Residual Risk

Score (Current)

Planned Actions: Is the action a Gap in

Control (C) or a Gap in Assurance (A)

Progress on Action At what stage are we at

with the current action?

10

1,2,3 (Background: NHS England‘s expectation is that all NHS Trust’s performance against the

4 hour target will show month on month improvement).

There is a risk that the performance against the A&E

target at NMUH will not improve in line with the trajectory for 2017/18 agreed with NHS

England, NHS Improvement and the A&E Delivery Board. The

trajectory outlines a sustained improvement in the achievement

of the target of 95% of patients being seen within 4 hours, with

the 95% target being achieved by the end of March 2018.

Risk Owner

Tony Hoolaghan, Chief Operating Officer

Lead Committee Finance and Performance

Committee and Quality Committee

Risk reworded in its current form

4.4.17

Causes

Poor patient flow throughout the Trust and back in to the

community

Too much reliance on inpatient beds and

admitting patients.

Inconsistent

implementation of agreed new ways of working in the

department.

Lack of senior clinical

leadership within the Emergency

Department (ED).

Consultant and middle grade vacancies

leading to inconsistent senior cover for ED

Workforce challenges within the A&E department are

impacting on the trust’s ability to deliver high

quality care.

Effects

Too many patients waiting an unacceptably long time

for assessment and

I = 4

L = 5

20

1. The Trust is acting on

recommendations from the Emergency Care Improvement

Programme to improve streaming and patient flow through the

department, particularly at times of pressure.

2. Embedding of the “ Safer, Faster Better” (SFB) work via four

workstreams.

3. Refresh of A&E Delivery Board governance in October 2017. The

Trust CEO now chairs the Delivery Board.

4. Use of the quality surveillance process to escalate emerging

concerns about quality and safety and ensure a single shared view of

risks to quality and safety in the A&E department.

5. In 2017/18 a programme of CCG led Insight Visits to NMUH

will be informed by CQC recommendations and the Trust

Improvement Plan.

1/2. CCG (and partners) to continue to review

SFB programme progress at monthly A&E

Delivery Board meetings. The Director of

Performance, Planning and Delivery attends Safer, Faster, Better

steering group.

1/2. Bespoke programme

governance created to oversee the programme

and link to wider Trust improvement

programme.

1/2. Dedicated

Programme resource in place.

3. A&E Delivery Board minutes provide

evidence that performance

improvement and target recovery are overseen effectively and

appropriate challenge is made.

I = 5

L = 3

15

Actions

1. CCG acting as convenor and lead for

Out of Hospital workstream of the SFB

programme. Weekly project team

meetings set up and partner organisation

membership agreed.

Action owner Marco Inzani,

Head of Integrated Commissioning (Adults)

Implementation date

From 30.5.16

2. Recovery target

agreed and managed as part of the STF

(Sustainability and Transformation Fund) arrangements for

2017/18.

1/2.

Haringey CCG priorities are:

1. Preventing people from being admitted to

the Trust.

Primary care hub appointments available 7

days a week and blocked appointments held

specifically for patients being redirected form the

acute Trust.

Additional winter resilience funding for additional staff

to support admission avoidance activity.

A senior CCG nurse has

been based in the Trust four days a week since

September 2017 to support the discharge work.

2. Moving patients out of the hospital as soon as

they are well enough to be discharged.

Haringey and Enfield have

increased the number of patients going through our



6 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





treatment within the department.

Patients do not receive timely assessment and clinically appropriate,

high quality care

Potential for

unforeseen patient harm caused by

extended waits in ED.

Unforeseen pressure on nursing resource in

ED caused by department congestion.

Failure to achieve associated unscheduled care Key

Performance Indicators (KPIs)

Ineffective and inefficient use of GP capacity

Failure to reduce unwarranted A&E activity

Damage to CCG reputation

Impact on waiting times

for planned treatment.

4. Quality Stocktake meeting convened by

NHSE on 28.9.17.

5. The CCG will ensure

regular visits to the ED

department to seek assurance that safety is

being protected.

CQRG minutes will record the outcome of

Insight Visits and evidence that Trust is

acting on the recommendations.

Action owner

Tony Hoolaghan, Chief

Operating Officer

Implementation date

From 1.4.17

Discharge to Assess (D2A) pathways.

The senior CCG nurse is chairing the MO/DToC

meeting and discharge pathway, working with the Trust discharge team and

community teams to ‘pull’ patients out of the Trust.

This is through identifying and unblocking any

challenges to achieving earlier discharges

Identification of issues and actions agreed in Haringey

to increase patients being discharged through discharge to assess (D2A)

pathway 3 for Haringey patients.

The out of hospital

workstream was set up from May 2016 and weekly

project meetings are in place, alternating between steering group discussions

and wider group meeting with local health and social

care partner organisations. Local partners are working

together to implement priority actions identified to

support urgent care improvements.

New governance agreed



7 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





3. The NCL Accountable Officer and Director of

Nursing and Quality to work with regulators and the Trust to ensure the

safety concerns which led to a quality stock take

meeting in September 2017 are addressed.

Action owner

Jennie Williams Director of Nursing and Quality

Implementation date

From 28.9.17

4. CCG to ensure that

quality and safety within A&E are being protected

during this period of

and implemented for the SFB programme in

2017/18, with oversight continuing to be part of the

A&E Delivery Board responsibilities.

This includes development

of a steering group where work stream leads from the

4 areas ensure the system is working together to

deliver key priorities.

3. There is a robust approach in place to

ensure improvements required by the GMC are evidenced, which includes

oversight by the CCG at a weekly meeting.

It is anticipated that a further quality stocktake

meeting will be convened in January 2018 to provide

the system with assurance that the broader quality issues have been

addressed.

4. The NMUH Medical Director provides a near-

time brief on the protection



8 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





increased risk and enhanced surveillance.

Action owner

Jennie Williams Director

of Nursing and Quality

Implementation date

From February 2018

5. The CCG to ensure

that quality and safety within A&E are being protected during this

period of increased risk and enhanced

surveillance.

of quality and safety at every CQRG meeting.

The CCG undertook an assurance visit on 7.12.17

with NHS England and NHS Improvement to review progress with the

implementation of the quality and safety checklist.

The Emergency Care

Improvement Plan (ECIP) has reported that it

continues to support the Trust to embed the

checklist. The CCG Director of

Nursing and Quality and the Trust Medical Director

will work to develop an ED dashboard which the ED

team will embed. This will be used for

assurance at CQRG. The estimated time for

production of the dashboard is 6 weeks.

5. The Director of Nursing and Quality undertakes

regular visits to ED during the week and weekends.

The primary purpose is to ensure safety is being

protected and safe staffing is in place.



9 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





Action owner

Jennie Williams Director of Nursing and Quality

Implementation date

From February 2018

The Chair of the CCG will undertake a visit to ED on

19.02.18 accompanied by the Assistant Direction of

Quality and Patient Safety.

26 1,2 There is a risk that BEHMHT will fail to deliver the required ‘must do’ and ‘should do’

improvements required, after the Trust was rated as ‘requires

improvement’ following an inspection by the CQC in

December 2015.

Risk Owner

Jennie Williams – Director of Nursing and Quality

Lead Committee

Quality Committee

Risk reworded in its current

form 15.6.15

Causes

Lack of capacity/ capability to deliver the required

improvements

The Trust is unable to make the

necessary improvements to

services provided out of the St Anne’s site

due to unsatisfactory environment.

Effect

There will be a further

deterioration in the quality and safety of services and

BEHMHT will be deemed not to meet regulatory

standards in respect of CQC outcomes.

I = 4

L = 4

16

1. The delivery of the BEHMHT CQC improvement action plan will

be overseen by the Clinical Quality Review Group (CQRG) bimonthly

from April 2017.

2. Haringey CCG will ensure the

CQC improvement plan gives appropriate focus to improved

outcomes for patients accessing services in Haringey.

3. Appropriate escalation to CCG

Quality Committee and Commissioning and Finance and

Performance meetings where funding issues impact on quality.

1. CQRG minutes will provide evidence of

review of the Trust’s quality and delivery plan

and the quality and safety dashboard, with

specific focus on safeguarding, patient

complaints and serious incidents.

2. The performance against key patient safety and experience metrics

for services delivered in Haringey will

demonstrate month on month improvements.

3. The CCG Quality Committee and Finance

and Performance Committee minutes

demonstrate escalation of concerns to

commissioning and finance colleagues where

I = 4

L = 3

12

Action

1. Commissioners to receive CQC improvement plan full

update 6-monthly at the CQRG meeting, with

bimonthly exception reporting of key risks and

remedial actions.

Action Owner

Jennie Williams, Director

of Nursing and Quality

Implementation date

By end of September

2016

1. In September 2017 the

CQC undertook a comprehensive inspection

of eight core mental health services and one

community service, with a return visit to inspect three

further areas.

On 12.1.18 the CQC published the inspection

report which gave the Trust an overall rating of

‘Requires Improvement’ with ‘Good ‘for caring,

responsive and well-led. The safe and effective

domains were rated as ‘Requires Improvement’

Immediately after the inspection in September

2017 the Trust was asked to take actions to address

issues relating to risk



10 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





delivery of CQC actions is at risk.

2. To ensure the CCG

executive management team and CCG Finance

and Performance and Quality Committee are

kept briefed on the progress made by the

Trust to deliver the CQC improvement plan and

the Chief Officer and Chair are informed of any

emerging concerns relating to quality and safety. (C)

Action Owner

Jennie Williams, Director of Nursing and Quality

Implementation date

From June 2016

management .Haringey community based services

(adults) in Haringey were rated as ‘Requires

Improvement’.

The CQC will convene a Quality Summit to present

the findings to stakeholders and provide the Trust with

an opportunity to respond.

2. The Director of Nursing

provides regular briefings to the Accountable Officer and the Executive

Management Team. Regular updates are also

provided at Quality Committee meetings.



11 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





38 1 There is a risk of failing to deliver a balanced Financial

Plan in 2017/18.

Risk Owner

Simon Goodwin – Chief Finance

Officer

Lead Committee

Finance and Performance

Committee

Risk added to Register

17.1.17

This risk has been CLOSED as

financial pressures in Acute and Continuing Care Services are

likely to result in the CCG not meeting the control total. The

CCG will work to mitigate pressures locally to achieve

financial balance across North Central London.

Causes

1 Significant level of QIPP

required in financial plan.

2 Work needed to implement STP

interventions.

3 Limited capacity in CCG budget to mitigate financial

issues in 2017/18.

4 Impact of HRG+4.

I = 5

L= 4

20

1. Appropriate financial

governance systems in place

2. Review and ongoing scrutiny of

the CCG’s financial performance

by Finance and Performance Committee and Governing Body.

3. Review and identification of 2017/18 QIPP Plan at QIPP

Delivery Group and Finance and Performance Committee meetings.

4. 2017/18 budget setting process.

5. Approval of Financial Plan by Finance and Performance Committee and Governing Body.

6. Pan-NCL work to implement and

deliver the STP interventions.

1. Internal Audit reports

produced by Internal Audit which cover

financial procedures within the CCG.

2. Papers and minutes of

Finance and Performance Committee

and CCG Governing Body.

3. Papers and minutes of QIPP Delivery Group and

Finance and Performance Committee.

4. Budget holders to sign off their 2017/18 budgets

by March 2017.

5. Financial Plan to be

reviewed regularly by the Finance and

Performance Committee, following approval by the


and the Governing Body.

6. Discussion of NCL

financial position at Financial and Activity

Modelling Group.

I = 4

L= 4

16

1. Implement STP interventions. (C)

Action owner:

Simon Goodwin – Chief Finance Officer

Implementation date:

March 2017.

2. Identify additional QIPP projects, both CCG

and NCL-wide. (C)

Action owner:

Simon Goodwin – Chief

Finance Officer


Ongoing 2017/18.

3. Discussions with NHS

England and NHS Improvement regarding

overall NCL financial gap. (C)

Action owner:



Ongoing 2017/18.

1. STP QIPP interventions currently being delivered

and developed in conjunction with providers.

Updated Project Initiation Documents being produced with

implementation and delivery timelines agreed

with CCG commissioners.

2. Work is continuing to identify additional QIPP.

3. Ongoing monthly calls held with NHSE to ensure

`CCG and NCL plans remain on target. Financial

Strategy being developed for NCL CCGs to allow

some future mitigation in the event plans do not balance.

The control totals are now managed collectively

across NCL CCGs. The expectation is that the

NCL-wide control total will be achieved.



12 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





4. Pan-NCL Risk Share agreement to mitigate

risk of NCL CCGs failing to meet control totals in 17/18. (C)

Action owner:

Simon Goodwin –Chief Finance Officer


August/Sept 2017/18

5. Development of a

Financial Recovery Plan for the CCG in order to

manage system pressures and create

headroom/reserves. (C)

Action owner:

Anthony Browne –

Deputy Chief Finance Officer


August 2017/18 (ongoing).

4. This was agreed at the

GB meeting held on 9.11.17.

5. Finance & Performance

update report on financial management plan is being

presented to the Finance and Performance Committee on 14.7.17.

Relaunch of plan to Commissioning Senior

Management Team (CSMT) in November

2017.



13 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





40 1,2, 3 There is a risk of quality and access to dermatology care

deteriorating as a result of cessation of North Middlesex

Hospital (NMUH) to provide dermatology from March 2018.

Risk Owner

Clare Henderson, Director of Commissioning, Haringey CCG

Lead Committee

Quality Committee and Finance and Performance Committee.

Risk added to register

22.9.17

Causes

Ongoing failure to recruit to Consultant

dermatology posts at NMUH, leading to non-

viability of this service continuing to be

provided by the Trust.

Effects

NMUH is unable to treat patients.

I – 4

L – 5

20

1. Establishment of joint task-and-finish group with NMUH to develop

and evaluate options.

2. Clinical partnership with Royal

Free Hospital (RFH) dermatology department is being explored

3. Performance is routinely monitored at Contract Review

Group meetings.

1. Updates at CQRG and Contract Review Group

2. Regular progress review through Task and Finish Group

3. Minutes of Contract Review Group meetings.

L – 4

I – 3

12

1. Director of

Commissioning to oversee development of

longer-term approach, including one which mitigates risks at RFH.

Action owner

Clare Henderson, Director of

Commissioning

Implementation date

July 2018

2. NMUH to subcontract

service to Concordia from 8.1.18 for 12 months.

Action owner

Clare Henderson, Director of

Commissioning

Implementation date

8.1.18

1. Commissioners are taking an options paper to

the Joint Commissioning Committee on 1.3.18.

Commissioners continue to

meet regularly to oversee progress and development

of future model

2. The Concordia service has now been commissioned and is

delivering services from NMUH.



14 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





41 1 There is a risk of the financial position worsening before year

end 17/18.

Risk Owner

Simon Goodwin – Chief Finance

Officer

Lead Committee


Committee

Risk added to Register

19.2.18

Causes

1. Financial Pressures with

Acute Contracting, national pressures on Prescribing

stock availability and Continuing Health Care cost and volume pressures

2. Lack of CCG reserves /

contingency to stabilise financial position should

costs increase over contract value

3. Significant level of QIPP required in financial plan.

4. Impact of HRG+4 tariff increases and changes to

responsible commissioner identification rules.

I = 4

L= 3

12

1. Appropriate financial

governance systems in place

2. Review and ongoing scrutiny of

the CCG’s financial performance

by Finance and Performance Committee and Governing Body.

3. Review and identification of 2017/18 QIPP Plan at QIPP

Delivery Group and Finance and Performance Committee meetings.

4. Pan-NCL work to implement and deliver the STP interventions.

1. Internal Audit reports

produced by Internal Audit which cover

financial procedures within the CCG.

2. Papers and minutes of


and CCG Governing Body.

3. Papers and minutes of QIPP Delivery Group and

Finance and Performance Committee.

4. Financial Plan to be reviewed regularly by the

Finance and Performance Committee,

following approval by the Finance and

Performance Committee and the Governing Body.

5. Discussion of NCL financial position at

Financial and Activity Modelling Group.

I = 3

L= 2

6

1. Financial Management Plan in place (C)

Action owner:

Anthony Browne – Deputy Chief Finance

Officer


Ongoing 2017/18

2. Increased QIPP governance and

monitoring to identify and mitigate slippage, both

CCG and NCL-wide. (C)

Action owner:



Ongoing 2017/18.

3. Discussions with NHS

England and NHS Improvement regarding

overall NCL financial gap. (C)

Action owner:



Ongoing 2017/18.

1. F&P Committee approved Finance

Management Plan. Review of actions on a monthly

basis.

2. Senior level finance, executive and clinical

engagement through QIPP Leads meeting Work is

continuing to identify areas of slippage and begin

18/19 QIPP schemes in Q4 1718 where appropriate.

3. Ongoing monthly calls held with NHSE to assure

CCG and NCL plans. Control totals are now

managed collectively across NCL CCGs. The

expectation is that the NCL-wide control total will

be achieved.



15 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





4. Pan-NCL Risk Share

agreement to mitigate Delegated Primary Care

pressures (C)

Action owner:

Simon Goodwin –Chief

Finance Officer


Sept 2017/18

4. This was agreed at the

GB meeting held on 9.11.17.

42 1,2,3 There is a risk is of continued

overspend on the Continuing Healthcare (CHC) budgets,

resulting in the CCG being unable to meet its financial duty

to deliver services within its resources.

These budgets include expenditure on the female

Psychological Intensive Care Unit (PICU), inpatient

rehabilitation, patients to whom the CCG has a Section 117 duty

and people with learning disabilities.

Risk owner:

Clare Henderson, Director of Commissioning

Causes:

Demographic

changes in the frail elderly population

Bed pressures in

acute and mental health services.

Limited care homes/domiciliary care market

Lack of preventative work at an early stage with vulnerable

children and young people to ensure

packages are appropriate when

they transition to adulthood

Poor pathways for LD and mental health

L = 5

I = 4

20

1. Review of higher cost packages

to ensure that they are still required to meet needs, provide

value for money and to review CHC eligibility where this is

assessed as appropriate.

2. Domiciliary Care tracking to

ensure CCG is only funding care delivered by the provider.

3. A female PICU opened by

Camden and Islington Foundation

Trust (CIFT).

4. NCL wide-work on identifying value for money and sustainable

rates for care homes.

1, 2, 3. Monthly CHC

budget monitoring meetings to ensure

accuracy of forecast and reports to Finance and

Performance Committee.

4. Regular reports received by Joint

CCG/Haringey Council Commissioning and

Finance Management

L = 4

I = 4

16

1. NCL-wide review of

CHC considering brokerage and market

management options

Action owner:

Kay Matthews –Chief

Operating Officer, Barnet CCG


To be confirmed.

2. Procurement of domiciliary care project

with Haringey Council to improve the market.

1. This review is currently

being considered by the NCL Senior Management

Team.

2. The CCG is currently

considering an options paper on whether this is a

viable option.



16 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





Lead committee:


Committee

Risk added to register:

1.3.18

patients resulting in delays for patients in

services that are higher cost

Lack of reviews of CHC patients resulting in patients

who are not eligible remaining on CHC

Discharges from forensic units results in increased demand

Haringey Council also ensuring that

reviews are up to date and that clients

are given CHC eligibility where appropriate.

Effects

Continued increase

in CHC budget costs.

Lack of opportunities to invest in

developing improved pathways that will

result in reduced costs in the longer

term.

Group, and the Finance and Performance

Partnership Board.

Action owner:

Temmy Fasegha, - Vulnerable Adults

Commissioning Manager


To be confirmed.

3. Review of budget

structure to bring mental health and learning

disabilities budgets under the responsibility of lead

commissioners to improve strategic

pathway development.

Action owners:

Shelley Shenker -

Assistant Director, Mental Health

Commissioning/ Temmy Fasegha, -

Vulnerable Adults Commissioning Manager


To be confirmed.

4. Recruitment of 5 WTE clinical reviewers to clear

the backlog of 300 reviews.

3. Initial review meeting to

take place on 6.3.18, as part of a wider review of

the recovery plan.

4. Proposal to be

considered by Finance and Performance Committee

on 25.4.18.



17 1.3.18

Risk Ref:


Lead Committee



materialised?

Inherent Risk

Score (Without

Controls)








otherwise).

Residual Risk

Score (Current)





Action owner:

Temmy Fasegha, - Vulnerable Adults

Commissioning Manager


April 2018.

5. Development of

commissioning plans to ensure the delivery of

interventions that are early as possible,

maximise independence and reduce delays in moving on to the next

appropriate provision.

Action owners:

Shelley Shenker - Assistant Director,

Mental Health Commissioning


June 2018.