16: Completion of Phase 2 of the redevelopment is not approved by NHS London and delivered in line with the agreed project schedule

Transcription

1 Introduction The Board Assurance Framework aims to identify the main risks to the delivery of the CCG s strategic objectives. It sets out the controls that have been put in place to manage the risks and the assurances that have been received that show if the controls are having the desired impact. It includes an action plan to further reduce the risks and an assessment of current performance. The table below sets out the strategic objectives and lists the various risks that relate to them. The Board Assurance Framework is made up of two parts; the first risks shown (1-8) are shared across the collaborative (Central London, West London, Hammersmith & Fulham, Hounslow CCGs), the other risks (10 onwards) are unique to NHS West London CCG. The collaborative risks have been drawn up following a review of the NHS North West London Cluster Board Assurance Framework to ensure that the most important risks are being addressed by the CCGs. Strategic Objective (Collaborative) Deliver improved quality of services to patients Risk identified Initial Score Current Score Risk appetite 1: Failure of Imperial College Healthcare Trust to provide quality and timely treatment of patients : Failure to deliver maternity services to desired standards due to lack of staff : Failure to meet standards in safeguarding adults : CCG is unable to monitor commissioned community services, due to lack of reporting against, and review of, contract KPIs for commissioned community services Last Review : Not delivering KPIs especially Public Health targets Commissioning Plans: Deliver Shaping a Healthier Future and the Out of Hospital Strategy Delivering financial obligations and other statutory duties Achieving authorisation and setting up an effective organisation 4: Commissioning Support Unit (CSU) lacks the capacity to deliver contract with the Clinical Commissioning Group : Implementation of Out of Hospital Strategies fails to deliver desired outcomes : New care pathways and QIPP plans do not deliver new models of care and related savings Jan 16: Completion of Phase 2 of the redevelopment is not approved by NHS London and delivered in line with the agreed project schedule Jan 3: Failure to meet standards in safeguarding children : Failure of CWHH Collaborative to maintain financial control during remainder of year and implement robust systems for subsequent years : Over performance of acute, CNWL and CLCH contracts, therefore financial and QIPP targets may not be met Jan 5: Failure to meet Information Governance requirements within the CCG : Limited opportunity for organisational development, impacting on engagement and succession planning : Integration of Queen s Park & Paddington (QPP) into CCG may not be achieved effectively Page 1 of 16

2 Objective: Deliver improved quality of services to patients Risk: Failure of Imperial College Healthcare Trust to provide quality and timely treatment of patients. Director lead: Chief Officer (Daniel Elkeles) Date last reviewed: 25 th ruary 20 Initial: 5 x 5 = 25 Current: 4 x 4 = 16 Appetite: 1 x 4 = 4 The principle risks are 18 week waits, urgent cancer waits, and pathology results. Aim is to substantially reduce the likelihood that this will happen. Controls: (What are we currently doing about the risk?) Mitigating actions: (What more should we do?): Imperial have set up an Intensive Support Team which reports to their Board. A new Chief Operating Officer is now in post. A series of independent reviews have been set up, most notably by NHS London. Regular updates are being provided to the Cluster Board and Quality & Clinical Risk Committee. A mini Board Assurance Framework has been produced, setting out controls and actions, and was reviewed by Cluster and local committees in January. First meeting of quarterly governance meeting took place in ruary. Seeking assurance through CQG meetings including pathology review and clinical governance review. March meeting to look at the Hammersmith Hospital emergency department review. March Assurances: (How do we know if the things we are doing are having an impact?) Minutes of CCG and Collaborative Quality committees reported to the governing body monthly. A full update on quality issues at Imperial was presented to the collaborative quality committee in January and has been circulated to governing body members. Gaps in assurance: (What additional assurances should we seek?) Need to gain a more complete understanding of risks associated with pathology results and latest reported incidents. We need further assurance that they are delivering agreed clinical governance action plans. Current performance: (With these actions taken, how serious is the problem?) The issues at Imperial remain of serious concern. Performance is improving but it will take a number of months for Imperial to establish a track record of delivery. Of the 9 contractual Cancer targets, at month 7, ICHT are failing 4. Of the 3 contractual 18 Weeks (RTT) targets, ICHT, at Trust level, are only failing the admitted target. However, the RTT target is a specialty-level targets, and ICHT have specialties failing both the admitted and nonadmitted target. : We wrote to Imperial in Dec and Jan regarding ICHT s performance against 18 Weeks RTT and Cancer contractual targets. The Trust has taken action to improve performance, and this is supported by trend analysis. However, ICHT is still failing key Cancer and 18 Weeks targets, and the Trust has not yet provided sufficient assurance that performance against all targets will come back in line in a timely and sustainable basis. We are requesting further information and instructing the CSU to issue a Contract Query, which will mandate agreement of a Remedial Action Plan with associated milestones and penalties for non-delivery. 1 Page 2 of 16

3 Objective: Deliver improved quality of services to patients Director lead: Director of Patient Safety & Quality (Jonathan Webster) Risk: Failure to deliver maternity services to desired standards due to lack of staff Date last reviewed: 25 th ruary 20 Initial: 4 x 5 = 20 Current: 3 x 5 = 15 Appetite: 1 x 5 = 5 Controls: (What are we currently doing about the risk?) Monitoring of Maternity Quality is included in commissioning standards and minimum datasets. Serious Incidents with contributory factors pertaining to staffing levels are monitored via NHS London. A North West London maternity provider network has been established. Maternity Serious Incidents are monitored. Standards for staff numbers and ratios (birth to midwife, consultant cover) in contracts are required in contracts. Reports are given to the Cluster Quality and Clinical Risk Committee. Risk reviewed at last Cluster Quality & Clinical Risk Committee. Assurances: (How do we know if the things we are doing are having an impact?) Minutes of Cluster Quality & Clinical Risk Committee, Minutes of Maternity Network. Failure in this area would have a large impact on patients. The risk score reduced in October after action plans were prepared by ICHT. Plans have not yet been delivered. While the impact of failures could have a major impact on patients, the aim is to substantially reduce the likelihood of this happening. Mitigating actions: (What more should we do?): Implement Clinical Governance frameworks and minimum datasets. Part of /14 contracting round Work with ACV on workforce strategy/plan for staff through contracting rounds Ensure there is an item on maternity on all Provider CQG agendas Long term mitigation through implementation of Shaping a Healthier Future Gaps in assurance: (What additional assurances should we seek?) Mar 12 The Director of Patient Safety and Quality and the Company Secretary are looking at maternity risks across all the main providers of maternity services to our residents to ensure local issues are adequately captured. DE Current performance: (With these actions taken, how serious is the problem?) We still have serious concerns about this issue. Figures for Imperial are: Midwife to birth ratio is 1:33 against a target of 1:30. Consultant hours present on labour ward are 60 against a target of 98. West Middlesex University Hospital NHS Trust have are currently rated as amber in relation to consultant cover (92 hours against target of 98) on labour ward. Reds relate to non-elective C- sections and first bookings within 12 weeks and 6 days. 2 Page 3 of 16

4 Objective: Delivering financial obligations and other statutory duties Director lead: Director of Patient Safety & Quality (Jonathan Webster) Risk: Failure to meet standards in safeguarding children Date last reviewed: 25 th ruary 20 Initial: 4 x 5 = 20 Current: 3 x 5 = 15 Appetite: 1 x 5 = 5 Controls: (What are we currently doing about the risk?) A Safeguarding Children Improvement Team and Designated Professionals are in place. An aide-memoir for commissioning Safeguarding Children Services has been completed and considered by the Migration Board and Cluster Quality Committee. An update on Safeguarding arrangements has been presented to the Cluster and Collaboration Quality Committees. A lead GP has been identified for the CCG and will become a member of the Local Safeguarding Commissioning Board. Safeguarding is a standing item on CCGs Quality & Patient Safety Committees. Review of Provider safeguarding arrangements carried out in light of Savile allegations submitted to NCB (January 20). Assurances: (How do we know if the things we are doing are having an impact?) Minutes of Collaborative and CCG Quality Committees. Current performance: (With these actions taken, how serious is the problem?) Outcomes framework is being across triborough. Hounslow CCG is reviewing it prior to implementation. Failure in this area would have an impact on vulnerable members of the community and is therefore very serious. Steps have been taken to reduce the likelihood of problems occurring. While the impact of failures could have a major impact on patients, the aim is to reduce the likelihood of this occurring. Mitigating actions: (What more should we do?): An outcomes framework is now being piloted Quarterly safeguarding reports to go to CCG Quality committees with standard reporting format Annual Safeguarding Children report to CCG Quality Committees and Governing bodies Understand the risk associated with multiple commissioning organisations for Children s services Gaps in assurance: (What additional assurances should we seek?) None. Mar None. 3 Page 4 of 16

5 Objective: Commissioning Plans: Deliver Shaping a Healthier Future and the Out of Hospital Strategy Risk: Commissioning Support Unit (CSU) lacks the capacity to deliver contract with the Clinical Commissioning Group. Director lead: Chief Officer (Daniel Elkeles) Date last reviewed: 8 th ruary 20 (likelihood x consequence): Initial: 4 x 4 = 16 Current: 3 x 4 = 12 Appetite: 1 x 3 = 3 Recruitment is underway in the CSU and a number of important posts, particularly in acute commissioning remain unfilled. Good management of the CSU should ensure that it delivers to the agreed specification. Controls: (What are we currently doing about the risk?) CSU Customer Survey completed and results made into an action plan. Monthly meetings of the Collaborative Commissioning Support Committee are held to discuss the Service Level Agreement and Key Performance Indicators and to review CSU progress. Service Level Agreement has been signed (subject to governing body approval) Mitigating actions: (What have we done /what more should we do?): A detailed service specification is being finalised Key Performance Indicators to be agreed as part of the Service Level Agreement Risk wording to be reviewed for March update DE/ CL CL DE/ BW Assurances: (How do we know if the things we are doing are having an impact?) Commissioning Support Committee will monitor performance and report to CCGs. The Service Level Agreement is on the agenda for this governing body meeting. Gaps in assurance: (What additional assurances should we seek?) Commissioning Support Committee minutes to be presented to the governing body. Current performance: (With these actions taken, how serious is the problem?) This remains a concern, however it is hoped that the mitigating actions will ensure the risk is adequately controlled. The CSU has recruited to 70% of posts. None. 4 Page 5 of 16

6 Objective: Achieving Authorisation and setting up an effective organisation Director lead: Chief Officer (Daniel Elkeles) Risk: Failure to meet Information Governance requirements within the CCG. Date last reviewed: 8 th ruary 20 Initial: 4 x 3 = 12 Current: 3 x 3 = 9 Appetite: 1 x 3 = 3 Controls: (What are we currently doing about the risk?) A Joint Information Governance Committee has been formed at Cluster level. A London-wide group for records management has been set up. The CCG has completed the Information Governance Toolkit and a locally agreed action plan to fill gaps. Assessment of information governance requirements completed and plan to meet requirement agreed. A training programme for staff is in place and is being promoted. All CCG staff to have received training by March 20. Failure in this area could lead to breach of legal requirements or reputational damage. Although significant controls are in place, more is required prior to 1 st April 20. Resources and procedures must be put in place to allow this risk to be properly controlled. Mitigating actions: (What have we done /what more should we do?): Set up an Information Governance Working Group, that reports to the collaborative quality committee, to review toolkit submissions and action plans and hold first meeting. Establish contractual mechanism to meet information governance requirements post 1 st April. Write and agree local policies and procedures BW Complete and review an information asset register for the CCGs BW BW BW ½ day records management tidy-up supported by expert advisors. BW Assurances: (How do we know if the things we are doing are having an impact?) CCG governing bodies submitted the information governance toolkit findings as part of the authorisation process. Report to the Quality and Patient Safety Committee on progress. Current performance: (With these actions taken, how serious is the problem?) We are on-track to meet our Information Governance responsibilities as outlined in the Information Governance toolkit. We are at levels 0-2 for all criteria with a plan to be at level 2 for the majority of criteria by March. Gaps in assurance: (What additional assurances should we seek?) Minutes of the collaborative quality committee to be presented to governing body. None. 5 Page 6 of 16

7 Objective: Commissioning Plans: Deliver Shaping and Healthier Future and the Out of Hospital Strategy Director lead: Director of Strategy (Thirza Sawtell) Risk: Implementation of Out of Hospital Strategies fails to deliver desired outcomes Date last reviewed: 8 th ruary 20 Initial: 4 x 5 = 20 Current: 3 x 5 = 15 Appetite: 2 x 5 = 10 Failure in this area would have a significant impact on the ability of CCGs to deliver high standards of care within the budget allowed. Work is underway to ensure that the objectives of this strategy are realised. Controls: (What are we currently doing about the risk?) Acute Reconfiguration Programme across North West London is underway. Each CCG has developed an Out of Hospital strategy. An Out of Hospital Delivery Group has been established to oversee delivery of the strategy. Mitigating actions: (What have we done /what more should we do?): Out of Hospital Workforce strategy being developed. Deliver Primary Care Transformation Project TS TS Joint Committee of PCTs meeting to discuss the outcomes of the Shaping a Healthier Future consultation. TS Assurances: (How do we know if the things we are doing are having an impact?) Reports on Out of Hospital strategy implementation to CCG governing bodies. Current performance: (With these actions taken, how serious is the problem?) Good progress is being made, but a lot of work remains to be done if delivery is to be successful. Gaps in assurance: (What additional assurances should we seek?) None. Out of Hospital Programme Manager has been appointed and commenced in January. 6 Page 7 of 16

8 Objective: Delivering financial obligations and other statutory duties Risk: Failure of CWHH Collaborative to maintain financial control during remainder of year and implement robust systems for subsequent years. Director lead: Chief Financial Officer (Clare Parker) Date last reviewed: 8 th ruary 20 Initial: 4 x 4 = 16 Current: 2 x 4 = 8 Appetite: 1 x 3 = 3 The Collaborative is on track to meet or exceed its control total. Financial systems are within the control of the CCG. Controls: (What are we currently doing about the risk?) Operating plans and budgets were signed off at the beginning of the year. Finance & Performance and Audit Committees working at Cluster, Collaborative and CCG level. Chief Finance Officer is in place across the four CCGs. Acute Commissioning Vehicle (CSU) provides regular reports to the CCG governing body on financial and activity performance. QIPP plans signed-off and are being implemented. A high level plan for managing the upside risk has been developed. Assurances: (How do we know if the things we are doing are having an impact?) Minutes of Finance & Performance Committees, finance reports to the governing body. Mitigating actions: (What have we done /what more should we do?): An upside risk has been identified. Local detailed plans are being worked through and will be reviewed by the CCG. Gaps in assurance: (What additional assurances should we seek?) None. CP Current performance: (With these actions taken, how serious is the problem?) Across the four CCGs in the collaborative, current performance shows a strong likelihood of control totals being met. None. 7 Page 8 of 16

9 Objective: Deliver improved quality of services to patients Director lead: Director of Patient Safety & Quality (Jonathan Webster) Risk: Failure to meet standards in safeguarding adults Date last reviewed: 25 th ruary : (likelihood x consequence) Initial: 4 x 5 = 20 Current: 4 x 5 = 20 Risk appetite: 1 x 5 = 5 Controls: (What are we currently doing about the risk?) From a commissioning perspective, our responsibilities are principally two-fold: Commissioning high-quality care for those in the most vulnerable circumstances Addressing failures in care with providers, in line with multi agency procedures. The Director of Patient Safety & Quality will take responsibility for safeguarding issues, and will ensure dedicated resource is available. A policy is now in place. Safeguarding adults will be integrated with the current Safeguarding Children s team with the creation of an adult lead post. This will enable consistency of monitoring of safeguarding outcomes across CWHH. The DH response to Winterbourne has been published and this is being reviewed to ensure there is a clear action plan in place for the CCGs to achieve the deadlines set by the DH. This will be monitored as part of Safeguarding Adults quarterly report for the CCG s Quality & Patient Safety Committees. Safeguarding Adults will become a statutory responsibility of the CCGs. We have a policy in place and are implementing other structures to exercise this function. We want to reduce the likelihood to low. Mitigating actions: (What have we done /what more should we do?): Appoint a new staff member with oversight of adult safeguarding and the Mental Capacity Act gone to advert Quarterly reporting into CCG Quality Committees Review of arrangements for vulnerable adults placements in light of Winterbourne View. Mar Jan Mar Assurances: (How do we know if the things we are doing are having an impact?) Commissioners will review individual performance at regular quality meetings Commissioners will review the trends behind formal and informal quality reports Commissioners will review the impact of its commissioning decisions, including on vulnerable adults, through the planning round Self-Assessment Assurance Framework completed for local Safeguarding Board and action plans fed into Provide Clinical Quality Groups. Current performance: (With these actions taken, how serious is the problem?) Performance measures to be defined. Page 9 of 16 Gaps in assurance: (What additional assurances should we seek?) The CCG do not have a member of staff dedicated to adult safeguarding (Previously INWL had a clinical governance lead). The CCG do not have a formal policy for safeguarding adults in place : None. Risk 9: [INTENTIONALLY LEFT BLANK] 8

10 Objective: Delivering financial obligations and other statutory duties NHS West London CCG: Board Assurance Framework Risk: Over performance of C&W, CNWL and CLCH contracts, therefore financial and QIPP targets may not be met Initial: 4 x 4 = 16 Current: 4 x 3 = 12 Risk appetite: 2 x 3 = 6 Controls (What are we currently doing about the risk?) Robust service level agreements and performance targets are in place. Commissioning Support Unit is responsible for managing delivery under memorandum of understanding. Action plan in place to recover delivery of QIPP plans and regular reporting to QIPP board. Assurances (How do we know if the things we are doing are having an impact?) Finance & Performance sub-committee monitor provider performance, finance and QIPP, and the CSU will monitor delivery against agreed contracts. Finance & Performance sub-committee reports to the Governing Board. Current performance (With these actions taken, how serious is the problem?) The current financial position is showing a year-end forecast of.3m Director lead: Managing Director (Carolyn Regan) (F&P) Date last reviewed: January 20 Failure in this area would have a significant impact on the ability of CCGs to deliver care in the appropriate setting and remain within budget. Performance and contract management systems are within the control of the CCG through active participation in contract management meetings and commissioning the CSU to work on CCG s behalf. Mitigating actions (What have we done /what more should we do?) Implement action plan for at risk projects Jan Preparation for 20/14 contracting round includes controls Dec 12 Gaps in assurance (What additional assurances should we seek?) Review service level agreements, with monthly monitoring of outcomes. 10 Page 10 of 16

11 Objective: Achieving Authorisation and setting up an effective organisation Risk: Limited opportunity for organisational development, impacting on engagement and succession planning Director lead: Managing Director (Carolyn Regan) (Exec Team) Date last reviewed: ruary 20 Initial: 3 x 4 = 12 Current: 3 x 4 = 12 Risk appetite: 2 x 3 = 6 Controls (What are we currently doing about the risk?) Commissioning Learning Set and plenary meeting content are informed by member feedback. Progress against organisational development plan written by external provider is monitored by Governing Board. Monthly Governing Board development sessions include assessment of the CCG s organisational development. Assurances (How do we know if the things we are doing are having an impact?) Governing Board development sessions include opportunity to reflect on organisational development and agree actions to support the CCG s development. Feedback from Commissioning Learning Sets indicates engagement in wider CCG membership. Time constraints and clinical practice commitments may result in CCG members being unable to participate in CCG development. Transition of services and key personnel may lead to loss of corporate memory. We want the organisation to succeed through engaging with members and retaining valuable knowledge and skills. Mitigating actions (What have we done /what more should we do?) Joint Commissioning Learning Set meeting increased awareness Governing Board skills audit Development support for leaders & future leaders Jan Plenary meetings being developed in line with member feedback Recruitment to the CCG is underway Nov 12 Ongoing Gaps in assurance (What additional assurances should we seek?) Objective assessment of the CCG s performance against the agreed organisational development plan to be commissioned. Current performance (With these actions taken, how serious is the problem?) Attendance at Joint CLS meeting good, interest in work of CCG and Provider Networks strong. There is strong commitment from the Governing Board. However, member practices have started to comment that CCG meetings do not relate to their work. External support for development in place (Jan ). Attendance at CCG meetings remains high. Feedback from Commissioning Learning Set attendees positive overall. Resources needed to support commitment. 11 Page 11 of 16

12 Objective 4: Deliver improved quality of services to patients Risk: CCG is unable to monitor commissioned community services, due to lack of reporting against, and review of, contract KPIs for commissioned community services Director lead: Managing Director (Carolyn Regan) Out of Hospital Lead (Dr Fiona Butler) (F&P/ QPSR/ OOH) Date last reviewed: ruary 20 (QPSR) Initial: 5 x 4 = 20 Current: 5 x 4 = 20 Risk appetite: 2 x 3 = 6 Controls (What are we currently doing about the risk?) QPSR and F&P sub-committees monitor progress. Managing Director attends CLCH monthly contract meetings. The CCG is not able to monitor performance against KPIs, therefore is not in a position to assess the quality of service offered to patients. Performance and contract management systems are within the control of the CCG through active participation in contract management meetings and commissioning the CSU to work on CCG s behalf. Mitigating actions (What have we done /what more should we do?) Review of performance by CLCH Ongoing Agree commissioning intentions for 20/14 Dec 12 Assurances (How do we know if the things we are doing are having an impact?) Health & Wellbeing Boards provide feedback on performance. Improved reporting to CCG though Finance & Performance sub-committee. Gaps in assurance (What additional assurances should we seek?) QPSR and OOH to develop remedial action plan, with progress monitored by QPSR. Current performance (With these actions taken, how serious is the problem?) Performance in this area remains a concern. District nursing performance good. CLCH being invited to attend QPSR meeting. 12 Page 12 of 16

13 Objective: Commissioning Plans: Deliver Shaping a Healthier Future and the Out of Hospital Strategy Delivering financial obligations and other statutory duties Director lead: Managing Director (Carolyn Regan) Out of Hospital Lead (Dr Fiona Butler) (F&P/ OOH) Risk: New care pathways and QIPP plans do not deliver new models of care and related savings Date last reviewed: January 20 Initial: 3 x 4 = 12 Current: 3 x 4 = 12 Risk appetite: 2 x 3 = 6 Controls (What are we currently doing about the risk?) The Commissioning Support Unit is monitoring progress against agreed targets. The CCG is integrating QPP into service delivery models. Assurances (How do we know if the things we are doing are having an impact?) Out of Hospital steering group will monitor progress against agreed commissioning targets. Commissioning Learning Sets are responsible for feedback to and from practices. It is likely that if new models of care are not delivered, quality of care for patient will be reduced, and savings will not be made. This relates to three of our four strategic objectives, therefore it is essential to reduce the likelihood of this occurring. Mitigating actions (What have we done /what more should we do?) PMO being established in CCG Jan OOH steering group working with CLSs to implement agreed targets Ongoing Gaps in assurance (What additional assurances should we seek?) Commissioning Learning Sets will audit referral patterns and use audits to inform changes in referrals. Current performance (With these actions taken, how serious is the problem?) Currently there is significant variation in referral management. PMO being established in CCG to ensure our plans are implemented Page of 16

14 Objective: Achieving Authorisation and setting up an effective organisation Delivering financial obligations and other statutory duties Director lead: Managing Director (Carolyn Regan) (F&P) Risk: Integration of Queen s Park & Paddington (QPP) into CCG may not be achieved effectively Date last reviewed: January 20 Initial: 3 x 3 = 9 Current: 3 x 3 = 9 Risk appetite: 2 x 3 = 6 Controls (What are we currently doing about the risk?) The CCG is represented at Health & Wellbeing Boards in Westminster and Kensington & Chelsea. Representatives of both Health & Wellbeing Boards have attended and participated in meetings of the Governing Board. The CCG s Integrated Plan and Commissioning Intentions are aligned with the current draft JSNAs. Assurances (How do we know if the things we are doing are having an impact?) Finance & Performance sub-committee is monitoring the transition of budget allocation for QPP. Feedback from Health & Wellbeing Boards and CLSs provides assurance. Due to the complexities of integrating work from two PCTs and working with two Local Authorities, the CCG faces additional pressures to meet its responsibilities for integrated working. Integration of QPP is central to the organisation s commitment to reduce health inequalities, and maintain financial balance. Mitigating actions (What have we done /what more should we do?) Health & Wellbeing Boards are writing Joint Strategic Needs Assessments (JSNAs) in collaboration with CCG CCG representation at both OSCS and HWBs consistent Appointment of Provider Network Lead for North of CCG will include QPP in its role Mar Ongoing Jan Gaps in assurance (What additional assurances should we seek?) Further monitoring of integration of QPP budget required. Current performance (With these actions taken, how serious is the problem?) Joint working with Health & Wellbeing Boards is strong. The CCG has appointed a Network Provider Lead for the North of the CCG (January 20). 14 Page 14 of 16

15 Objective: Deliver improved quality of services to patients Director lead: Vice Chair (Dr Iain Blake) (QPSR/ F&P) Risk: Not delivering KPIs especially Public Health targets Date last reviewed: ruary 20 Initial: 2 x 3 = 6 Current: 2 x 3 = 6 Appetite: 1 x 4 = 4 There is a risk that General Practice does not achieve its public health targets linked to health improvement. This would result in the health status and longer term outcomes of the WLCCG registered population not improving Controls (What are we currently doing about the risk?) Finance and Performance committee scrutinises provider performance including primary care performance. Mitigating actions (What have we done /what more should we do?) Paper on public health spend and outcomes presented to Board 18 December /12 Assurances (How do we know if the things we are doing are having an impact?) Finance and Performance committee scrutinises provider performance including primary care performance. Feedback from Health & Wellbeing Boards provides assurance. Gaps in assurance (What additional assurances should we seek?) Performance in mental health to be monitored. Process for reporting Public Health targets to CCG April 20. Current performance (With these actions taken, how serious is the problem?) Performance remains constant. However, progress against public health targets must continue to be maintained. Generally, the CCG performs well in terms of spend and outcome for many of the major disease types such as cancer, circulation, musculoskeletal and respiratory. Disease burden overall in the CCG tends to be low and acute and prescribing spend tends also to be very low (December 2012). 15 Page 15 of 16

16 Objective: Deliver Shaping a Healthier Future and the Out of Hospital Strategy Risk: Completion of Phase 2 of the ST Charles redevelopment is not approved by NHS London and delivered in line with the agreed project schedule Director lead: Carolyn Regan (St Charles/ OOH) Date last reviewed: 14 January 20 Initial: 3 x 4 = 12 Current: 3 x 4 = 12 Appetite: 3 x 3 = 9 Controls (What are we currently doing about the risk?) Formal governance structure is in place with reporting mechanism to Governing Board and expansion of membership of Project Board Structure of the Business Case will meet DH requirements in terms of robustness and detail Links to the key approving bodies are being identified in order to ensure smooth progress Assurances (How do we know if the things we are doing are having an impact?) Ongoing confirmation of support from key bodies Regular progress reports to relevant bodies Direct involvement of NCB and NHS Property Services Ltd in development Proactive PPE programme to maintain local support Project is in initial approval stages and faces a number of key challenges (changes in NHS structure and limited clarity of impact of proposed service changes and delivery) Likelihood is affected by the level of unknowns (changing NHS structure and appetite for decision making during transition). Impact reflects the reputational and financial impact of delays across a wide range of stakeholders Mitigating actions (What have we done /what more should we do?) Action date Soft market test of developer appetite 31/12/12 Revisit financial appraisal and availability of the CIs 31/01/ Quantifying impact of commissioning intentions 31/01/ Clarify links with SAHF Estates Implications 31/01/ Gaps in assurance (What additional assurances should we seek?) Need clarity of the decision making processes, criteria and appetite of the new approving bodies post April 20 Current performance (With these actions taken, how serious is the problem?) Risk of delay due to transition uncertainties but proactive management and investigation of policy planning will assist to minimise this 16 Page 16 of 16