Final 16th March 2012
LDP Risk Management Plan
Health Board: NHS Grampian
Use of Risk Management Plan
Boards should, as in previous years, use the LDP Risk Management Plan to provide contextual information on key risks to delivery of each target and how risks are being managed. Within the template, the description of the key risk should be provided in the first column and detail on how the risk is being managed should be provided in the second column. Cross-reference to local plans should be made where necessary.
oDelivery and Improvement: briefly highlight local issues and risks that may impact on the achievement of targets and/or the planned performance trajectories towards targets and how these risks will be managed.
oWorkforce: brief narrative on the workforce implications of each of the HEAT targets where appropriate and relevant. This should include an assessment of staff availability to deliver the target, the need for any training and development to ensure staff have the competency levels required, and consideration of affordability cross referenced to the Financial Plan.
oFinance: Where applicable boards should identify and explain any specific issues, e.g. cost pressures or financial dependencies specifically related to achieving the target. There is no need to repeat generic financial risks that apply to all targets.
- Equalities: Where applicable, boards should outline any risks that the delivery of the target could create unequal health outcomes for the six equalities groups, and/or for people living in socio-economic disadvantage; and how these risks are being managed.
HEATS TARGETS FOR 2012/13
To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25%, by 2014/15At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours
Reduce suicide rate between 2002 and 2013 by 20%
To achieve 14,910 completed child health weight interventions over the three years ending March 2014
NHSScotland to deliver universal smoking cessation services to achieve at least 80,000 successful quits (at one month post quit) including 48,000 in the 40% most-deprived within-Board SIMD areas over the three years ending March 2014
At least 60% of 3 and 4 year old children in each SIMD quintile to receive at least two applications of fluoride varnish (FV) per year by March 2014
NHSScotland to reduce energy-based carbon emissions and to continue a reduction in energy consumption to contribute to the greenhouse gas emissions reduction targets set in the Climate Change (Scotland) Act 2009
By March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery
Deliver faster access to mental health services by delivering 26 weeks referral to treatment for specialist Child and Adolescent Mental Health Services (CAMHS) from March 2013; reducing to 18 weeks by December 2014; and 18 weeks referral to treatment for Psychological Therapies from December 2014
Reduce the rate of emergency inpatient bed days for people aged 75 and over per 1,000 population, by at least 12% between 2009/10 and 2014/15
No people will wait more than 28 days to be discharged from hospital into a more appropriate care setting, once treatment is complete from April 2013, followed by a 14 day maximum wait from April 2015
To improve stroke care, 90% of all patient admitted with a diagnosis of stroke will be admitted to a stroke unit on the day of admission, or the day following presentation by March 2013
Further reduce healthcare associated infections so that by 2012/13 NHS Boards’ staphylococcus aureus bacteriamia (including MRSA) cases are 0.26 or less per 1,000 acute occupied bed days; and the rate of Clostridium difficile infections in patients aged 65 and over is 0.39 cases or less per 1,000 total occupied bed days
To support shifting the balance of care, NHS Boards will achieve agreed reductions in the rates of attendance at A&E between 2009/10 and 2013/14
To increase the proportion of people diagnosed and treated in the first stage of breast, colorectal and lung cancer by 25%, by 2014/15
Executive Lead:Board Lead: / Sir Lewis Ritchie: Director of Public Health
Dr William Moore: Consultant in Public Health Medicine
Delivery and Improvement
Risk / Management of RiskTarget Uncertainties and Unknowns:
Detect Cancer Early (DCE) baseline estimates and individual NHS Board performance targets are not finalised - revisions are planned within next 12 months.
Limited evidence for the effectiveness of specific local interventions or pathway redesign to achieve the target.
Stochastic health outcome events - probabilistic random variation in frequency of occurrence (denominators) for calendar years.
Biological variation - differences in rate of progression for individual tumours (numerators). / There will be effective communication links with the DCE Scottish Government Performance Team.
The NHS Grampian implementation plan for DCE will have sufficient flexibility to adapt to a different planning context. It is anticipated that the current baseline estimate for Grampian ( 12.6% ) will change.
Agreed NHS Grampian actions will be reviewed and revised based on local monitoring and evaluation, emerging evidence, and reported learning from early diagnosis and treatment initiatives elsewhere.
Planning and Delivery:
Non-adoption of an integrated cross-boundary and whole system approach across Grampian.
Non-representative processes with insufficient engagement by clinicians and other key stakeholders. / A time-limited steering group is responsible for co-ordination, development and implementation of the DCE programme within Grampian. This function will transfer to the NHS Grampian Cancer Services Managed Clinical Network (MCN) before summer 2012
NHS Grampian DCE working groups are aligned to discrete steps within the cancer care pathway :
- Community Engagement (Public Awareness and Influencing Behaviour)
- Primary Care (Symptom Management and Referral)
- Diagnostics (Capacity and Managing Demand)
Duplication at national, North of Scotland Cancer Network (NOSCAN) and NHS Grampian levels. / There will be effective communication links with the DCE Scottish Government Team, Regional Cancer Networks and other NHS Scotland Boards.
Public Awareness & Individual Decisions:
No increase in ‘positive view’ of cancer treatment and prognosis.
No increase in individual awareness and identification of symptoms and signs that may be related to breast, colorectal or lung cancer.
No reduction in individual delay to seek medical advice.
No increase ( or reduction ) in screening programme participation - it is expected that most ‘early stage’ breast and colorectal cancer cases will be detected by the Screening Programmes.
- NHSG Bowel Screening Uptake - 59.1% (May 2011 KPIs)
- NHSG Breast Screening Uptake - 81.1% (2007-10 KC62)
There will be consistency with the national-level campaign content and timetable. Population profiling will be used to identify high priority groups.
There will be integration with existing local primary prevention activities, and utilisation of existing links to organisations and communities.
A cross-sectoral approach will be adopted in partnership with cancer charities, local authorities, voluntary organisations / services, and ‘Healthy Working Lives’ employers.
It will be ensured that information on screening benefits and potential harms is readily available within Grampian. NHSG DCE working groups will further examine specific options, such as General Practitioner involvement in the bowel screening programme.
Patient Care Pathway:
Non-specific clinical features which have a low positive predictive value (probability of disease given clinical features).
Increased ‘false positive’ patient flows through the diagnostic pathway - potential harm for these ‘true negative disease’ patients and inefficient use of scare resources.
Delay due to process barriers for referral or direct access investigations.
Inequity of access to cancer diagnostics due to misclassification of clinical need for Urgent Suspected Cancer Referral.
Increased identification of breast, colorectal or lung cancer at all stages of disease.
Minimal increase in proportion of colorectal cancer cases diagnosed and treated in first stage - improvement expected to compensate for smaller potential gains for Breast and Lung Cancer. / There are conflicts between certain identified risks.
As a principle, NHS Grampian DCE working groups will focus on ‘clinically appropriate’ thresholds for further investigation and / or referral. Diagnostic pathways will be reviewed and redesign options further examined in terms of:
- structure and process barriers
- optimal productivity
- reducible variation and waste
- referral guidance and clinical guidelines
- support for GP clinical suspicion and clinical judgement
- models for risk categorisation and ‘risk sharing’ between primary and secondary care for individual patients and patient sub groups
- open access imaging and direct referral for diagnostics
- alternative diagnostic modalities
- alternative models for diagnostic clinics
Demand and capacity mismatch due to increased patient numbers and patient flows.
Performance against cancer access standards not sustained. / NHS Grampian DCE working groups will review diagnostic capacity provision (imaging, endoscopy and pathology services ) and treatment capacity provision ( surgery and oncology services ).
Data Collection and Reporting:
Non-standardised data fields.
Insufficient validation checks.
Incomplete dataset collection.
Separate information systems with no direct communication links.
Delays in report generation. / DCE ‘Data and Reporting’ working group will review current cancer audit data process, MDT data collection, data storage, data validation, and data extraction.
NHS Scotland standardised definitions and measures will be applied for all DCE processes in Grampian.
Workforce
Risk / Management of RiskOptimal diagnostic and treatment pathways in the Grampian context that require changes to workforce capacity, processes and patterns of working to meet clinical needs - anticipated high impact for imaging, endoscopy and pathology diagnostic services. / Predicted necessary changes will be incorporated into workforce planning processes.
Targeted training support will be provided.
Processes for benchmarking and dissemination of learning will be supported within Grampian, such as practice referral profiling.
Finance
Risk / Management of RiskUnpredictable peaks or patterns in service use.
Level of DCE funding available insufficient to meet net resources requirement. / Notification of national-level and local marketing campaign phases will be widely disseminated within Grampian.
Available DCE funding, and other resources to support cancer services modernisation, will be subject to a prioritisation process by the NHS Grampian Cancer Services MCN.
Equalities
Risk / Management of RiskPoor impact for individuals and communities in relative and absolute deprivation or disadvantage.
Poor impact for the Grampian population who reside in accessible or remote rural areas (> 30% ). / A proportionate and whole population approach will be adopted. Communication and marketing resources will be prioritised towards local high-risk target groups.
An asset-based approach will be adopted - working with individuals and communities to identify and strengthen skills, knowledge, resources, and networks - to build resilience and a sense of coherence to effect positive change.
Specific actions to mitigate the identified risks are included within the previous Public Awareness & Individual Decisions section.
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NHS Grampian February 2012
Final 16th March 2012
At least 80% of pregnant women in each SIMD quintile will have booked for antenatal care by the 12th week of gestation by March 2015 so as to ensure improvements in breast feeding rates and other important health behaviours
Executive Lead:Board Lead: / Dr Pauline Strachan: Chief Operating Officer
Mr Andrew Fowlie: General Manager Moray CHP
Delivery and Improvement
Risk / Management of RiskHigh midwifery caseloads and workload may diminish ability to attain target fully. / A Grampian review has been conducted and a new workforce plan proposed.
Our full understanding of the needs of the target group is at an early stage. / Public Health will analyse available data to identify priority groups so that interventions can be shaped appropriately.
Workforce
Risk / Management of RiskThe spread of midwifery services is historical rather than planned on a needs-based service approach. / We will work to re-allocate resources based on need. Our Maternity Review has been comprehensive.
The social context of antenatal care delivery is not fully integrated into our model of delivery. / We will take forward a training and development plan with NHS Education Scotland and other stakeholders. We have expressed an interest to take part in the Family Nurse Partnership programme.
Finance
Risk / Management of RiskThe redistribution of resources to areas of greatest need will take time. / The NHSGrampian Maternity Review is in process and will guide resource allocation.
Equalities
Risk / Management of RiskOur approach may be based on incomplete needs assessment and data analysis. / The full analysis will be completed in 2012. We have involved local ethnic and diversity communities in the Maternity Review and impact assessed the consultation document.
We have appointed 3 bi/tri-lingual Health Link Workers to reach out to non-English speaking communities and feed back on healthcare needs.
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NHS Grampian February 2012
Final 16th March 2012
Reduce suicide rate between 2002 and 2013 by 20%
Executive Lead:Board Lead: / Sir Lewis Ritchie: Director of Public Health
Mr Bill Harrison: General Manager Mental Health
Delivery and Improvement
Risk / Management of RiskAchievement of the target is affected by demographic changes and by NHSGrampian’s lack of influence on other stakeholder agencies and the general public. / We will continue to influence and encourage each Choose Life Steering Group (aligned to local authority areas), and their newly revised and agreed local Choose Life action plans which also take account of self harm aspects.
We will ensure effective links between our Grampian Mental Health Collaborative and Towards a Mentally Flourishing Scotland Group, Mental Health Improvement Group and the Choose Life groups. There will be close monitoring of impact of those action plans.
The reduction in the suicide rate continues to fluctuate due to small numbers and demographic factors. / We will ensure detailed analysis of available data to ensure comprehensive understanding of the number and rate and will work with partners on developing an overarching implementation plan for the Mental Health Strategy for Scotland.
Workforce
Risk / Management of RiskTraining time for suicide prevention may be seen as excessive beyond the immediate needs of staff. In particular staff in primary care might not be released for this. / We will continue to deliver Suicide Prevention Training to front-line staff and will offer Protected Learning Time sessions for primary care staff. Community and Primary Care staff will be supported in such training.
Finance
Risk / Management of RiskNo high or very high risks.
Equalities
Risk / Management of RiskThere is variation in suicide rates within different local authority areas. / This has been defined within local Choose Life Action Plans and is regularly reported to the Grampian Mental Health Collaborative for appropriate action to be agreed.
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NHS Grampian February 2012
Final 16th March 2012
To achieve 1,556 completed child health weight interventions (CHW) over the three years ending March 2014
Executive Lead:Board Lead: / Sir Lewis Ritchie: Director of Public Health
Mrs Caroline Comerford: Nutrition Co-ordinator
Delivery and Improvement
Risk / Management of RiskThere is a lower number of eligible completions (above the 91st centile) due to lower rates of children overweight compared to national average which increases challenge of target. / We will monitor emerging prevalence rates and, if necessary, increase coverage of school based intervention and manage resource implications accordingly.
Failure to meet the requirement for 40% completions in two most deprived SIMD quintiles, 1 and 2, by local SIMD datazone in more remote and rural areas. / We will use available local intelligence and learning from the implementation of other programmes and work with Community Planning Partners to target the programme and monitor progress through existing performance mechanisms.
Delivery of Child Healthy Weight services is currently dependent on ring-fenced, time limited resource. This factor, combined with service capacity limitations, poses a challenge for mainstreaming targeted interventions within clinical services and the school based intervention into school settings. / We will continue to embed the Child Healthy Weight Pathway into routine practice. There will be strong Nursing, Allied Health Profession leadership to encourage delivery.
We will work with Education partners to discuss the viability of the long term sustainability of the school-based intervention.
We will be reporting through the national database for all interventions from April 2012. This is a new system that will inevitably need time to bed in and could present challenges with reporting as it does so. We do not have a local database for our school-based programme. / Systems and key staff will be put in place to input and quality assure monitoring data.
The collection of accurate and verifiable data, provided in a timely fashion is critical to the success of our CHW programme. Data will be collected via the Child Health Surveillance Programme and the worthiness of the collected data will be dependent on the performance of data providers. Potential risks include; inaccurate data entry errors, incomplete data and data corruption during translation. The data collected for the programme must also relate to the correct time period and be available when required, in a form that can be subsequently analysed. / We will monitor the data collection processes and tools continuously through statistical analysis and by revisitingthe quality and completeness of data received. This will be done through a regular contact with all data providers in Grampian by the public health intelligence unit. Similarly all data received will be testedto determine the amount of variation induced by the measurement system.
Workforce