Dec 15 20 15 10

SR Strategic Objectives

Strategic Risk Description and change in Current Risk Rating Inherent Risk

Current Risk Aug 2019

Target Risk

SR1 (AN)

Deliver targeted improvements in clinical excellence

The Trust faces increasing challenges recruiting and retaining medical staff.

Sep 8

Oct8

Nov 8

Dec8

Jan 8

Feb 8

Mar 12

Apr 12

May 12

June 12

July 12

16 12 4

SR2a (PF)

Deliver targeted improvements in High Quality Care

Capability and capacity of clinical and non-clinical staff to undertake improvement in the quality of care.

Sep 12

Oct12

Nov12

Dec12

Jan 12

Feb 12

Mar 12

Apr 12

May 12

June 12

July 12

12 12 6

SR2b (PF)

Deliver targeted improvements in High Quality Care

National, regional and local workforce pressures in relation to recruitment, retention and development of clinical professionals, including nurses, doctors and allied health professionals.

Sep 15

Oct15

Nov15

Dec15

Jan 15

Feb 15

Mar 15

Apr 15

May 15

June 15

July 15

20 15 10

SR3 (LD)

Deliver targeted improvements in activity levels, access and unlocking capacity Insufficient theatre, bed or clinic capacity to achieve planned activity

levels.

Sep 12

Oct12

Nov12

Dec12

Jan 16

Feb 16

Mar 16

Apr 16

May 16

June 12

July 12

20 12 8

SR4 (TN)

Deliver a culture of improvement

Staff lack confidence, motivation, resource and capacity to embrace opportunities for improvement.

Sep 9

Oct9

Nov9

Dec9

Jan 9

Feb 9

Mar 9

Apr 9

May 9

June 9

July 9

12 9 6

SR5 (TN)

Deliver the VAL-YOU (organisational development) programme to improve retention and staff experience

Failure to improve staff experience as a result of capacity and resource in relation to bullying and harassment and equality, diversity and inclusion will result in increased staff turnover, challenges recruiting staff, failure to raise concerns and reduce ability of staff to perform thus impacting on quality of care.

Sep 12

Oct12

Nov12

Dec12

Jan 12

Feb 12

Mar 16

Apr 16

May 16

June 16

July 16

20 16 4

SR6 (TN)

Deliver the Recruitment and Retention programme to recruit and develop a workforce of appropriately skilled and engaged staff

Failure to recruit and retain the workforce, as a result of capacity and resource and available workforce, will result in increased staff turnover, challenges recruiting staff, failure to raise concerns and reduce ability of staff to perform thus impacting on quality of care.

Sep Oct Nov Dec Jan Feb Mar Apr May June July

NEW

RIS

K

20 12 8

SR7 (MM)

Enable the site redevelopment

Failure or delay in completing WDZ land sale by August 2021.

Sep 20

Oct20

Nov20

Dec20

Jan 20

Feb 20

Mar 20

Apr 20

May 20

June 20

July 20

25 20 10

SR8 (MM)

Deliver the site redevelopment projects

Awaiting approval of Accommodation OBC from NHSi.

Sep 9

Oct9

Nov8

Dec8

Jan 8

Feb 8

Mar 8

Apr 8

May 16

June 12

July 12

12 20 3

SR Strategic Objectives

Strategic Risk Description and change in Current Risk Rating Inherent Risk

Current Risk Aug 2019

Target Risk

SR9 (SP)

Implement Digital Strategy

Inability to implement the objectives set out in the Trust’s digital strategy.


NEW

RIS

K

20 16 12

SR10 (HW)

Exploit equipment provision to enhance care and Trust operations Lack of sufficient funding for the ongoing delivery of the annual

Diagnostic Imaging Replacement Programme (DIRP) and the development of imaging capacity and capability, thereby creating the risk of sub-standard service to our patients with potentially unreliable and technically inferior diagnostic imaging equipment.

Sep 16

Oct16

Nov16

Dec16

Jan 16

Feb 16

Mar 16

Apr 16

May 16

June 16

July 16

9 9 2

SR11 (HW)

Achieve financial stability

The national tariff, based on average reference costs, does not adequately recompense RNOH for the complexity of NHS work undertaken resulting in a significant underlying deficit.

Sep 12

Oct12

Nov12

Dec12

Jan 12

Feb 12

Mar 12

Apr 12

May 12

June 12

July 12

20 16 8

SR12 (TN)

To deliver world class musculoskeletal research and education Failure to deliver a strategic review will prevent the RNOH delivering

world class neuro musculoskeletal research and education.

Sep 16

Oct16

Nov16

Dec16

Jan 16

Feb 16

Mar 16

Apr16

May 16

June 16

July 16

15 12 3

SR13 (RH)

Lead national programmes to improve NHS sustainability NHS Improvement, NHS England and other stakeholder funding bodies

do not continue to support (through funding and contractual arrangements) the RNOH as a provider of clinical improvement programmes run through the Stanmore Health Consulting Directorate of RNOH.


NEW

RIS

K

12 9 6

SR14 (RH)

Undertake a leadership role where appropriate and relevant in regional setting of Sustainability and Transformation Programmes

STP unable to approve pre-consultation business case process.


NEW

RIS

K

12 8 6

SR15 (TN)

Coordinate RNOH and RNOH Charity strategies

Failure of sufficient executive leadership, integration and coordination with RNOH Charity CEO and Trustees will result in aims and objectives of Trust strategy.


NEW

RIS

K

8 6 2

The Royal National Orthopaedic Hospital NHS Trust. Board Assurance Framework (2018 - 19)

The Royal National Orthopaedic Hospital NHS Trust Board Assurance Framework

2019-20

Extreme Risk 15-25High Risk 8-12Medium 4-6Low Risk 1-3

Source of Risk: (External Environment, Risk Register, Strategic Objective, Board or Committee, etc.)

Strategic Objective BAF REF No:

SR1

Risk Open Date: Oct-18

Executive Lead/ Risk OwnerAresh Nejad

Risk Review Date: Sep-19

Lead Committee:

Effects: Risk Rating Consequence Likelihood Total Score: Risk Movement

Inherent Risk:4 4 16

Residual/ Current Risk: 4 3 12

Target Risk: 2 2 4

Assurances on Control (Positive Assurance: Reports, Audits, Dashboards, Minutes, Positive Surveys, External evidence etc.) (Negative Assurance: Incidence Reports & Investigations, Complaints, Negative Surveys, External Borrowing, Regulatory intervention, Legal challenges, etc.)

Gaps in Assurance:Where effectiveness of control is yet to be ascertained or negative assurance on control received.

Green

AmberRed

Lead: Due date Status: Not Yet Started/In Progress/Complete

Mr Aresh Hashemi-Nejad

01-Oct-19

In progress

Mr Aresh Hashemi-Nejad01-Oct-19

In progress

Mr Aresh Hashemi-Nejad 01-Oct-19 In progressMr Aresh Hashemi-Nejad

01-Oct-19In progress

Mr Aresh Hashemi-Nejad Oct-19 In progress

Progress Update

Positive Assurance (1st, 2nd or 3rd line)Controls: (Preventative, Corrective, Directive or Detective) Positive Assurance Review Date

i) Mr Aresh Nejad - risk owner (1) ii) Staffing number in WOD Report (2)iii) SSIP Programme and Project KPIs

Gaps in control: Where are we failing to put controls/systems in place. Where are we failing in making them effective

e) CCIO involvement in procurement of novel technologies for clinical / staffing issues New CCIO appointed (Deputy MD). To lead a group of clinicians who will work closely with the Chief Digital & Innovation Officer. Discussions underway to identify group of people and to clarify how this will work. Meetings to commence after the summer holidays and once new MD in post.

The Royal National Orthopaedic Hospital NHS Trust Board Assurance Framework 2019-20

Best patient care in the NHSAnnual Objectives(a) Develop clinical leadership and more systematic use of the use of clinical outcome data at RNOH driven by local clinical leadership within clinical services(b) Continue the development of critical mass in RNOH Children’s Services – The RNOH Children’s Hospital(c) Medicines safety optimisation – Reducing medication errors with potential for harm by x%

Strategic Risk Description:The Trust faces increasing challengings recruiting and retaining medical staff.RNOH has experienced difficulty recruiting to non-consultant posts in orthopaedics, anaesthetics, paediatrics and urology. National trainee numbers have declined. Individual Units have struggled to recruit to posts, which has negatively impacted on night time cover and out of hours care. Current arrangements to manage this do not deliver robust operational control for the Trust. Budgetary pressures have increased as a result of agency and bank staff utilisation. Historical contractual arrangements require updating. These circumstances combine to apply significant challenges to the effective delivery of a safer clinical workforce.

Risk Key

Strategic Aim: Strategic Objective: Deliver targeted improvements in clinical excellence

Causes:

a) Reduced number of Doctors in Training (Orthopaedic SPRs, Core Trainee SHOs, Paediatric SPRs, Anaesthetic SPRs, Urology SPR)b) Reduced appeal of Trust doctor SHO postsc) Failure of departmental recruitment to research fellow SHO posts (inc. contribution to night on-call team)d) External factors: Changing NHS workforce culture, New Terms and conditions of service 2016

a) Reduced surety and operational control of on-call teamb) Increasing utilisation of temporary staff means decreased continuity of care and increased risk for patientsc) Potential reduction in service provision leading to reduced number of patients treated at the hospitald) Long term challenge to clinical staff sustainability

a) Safer Staffing Improvement Programme - Wide range of projects addressing the range of issuesb) Increased governance/oversight of NCHD workforcec) Increased governance over new and existing provider and commissioned supplementary clinical servicesd) Increase utilisation of assitive tools and technologies for temporary staff management and information flow to assist continuity and clinical handover

a) MD (Responsible Officer) report to Trust Board re: Staffing and Training requirementsb) WOD report to Trust Board re: Non-Consultants. Safer Staffing Strategy Meeting to consider other models (physicians, prescribing pharmacists, specialist nurses etc.)c) GMC Guidance re: staffing for emergenciesd) SSIP SG report to IPB

c) Enable divisional autonomy for alternative staffing models (e.g Independent / )

Advertised Advanced Nurse Practitioner post but no suitable applicants applied. Reviewing alternative options.d) Reviewing SLAs with other Trusts to ensure RNOH can access the full range of required supplementary clinical services

Reference directory now published on Grapevine to improve access to existing services. Clinical Working Group being set up to review ongoing requirements. Master SLA list is now comprehensive. The Clinical Advisory Group is in the process of being set up and the first meeting will take place later this year.

b) Procure Managed Resident Medical Officer (RMO) Service OJEU selection completed, preferred supplier selected. No legal challenge received during standstill period. Next meeting 25th July to establish mobilisation timeframes. Contract will be live from 4th November 2019.

Effective control thought to be in place but assurances are uncertain and/or insufficient.

Effective control is in place and Board satisfied that appropriate assurances are available.

a) Creating a foundational platform to enable further staffing model changes in the future by providing core services centrally i.e. MET/Outreach/On-call

MET - completeOutreach/AIT - completeRMO - In progress and on track with outlined timeframes

Safer Staffing Improvement ProgrammeMonthly Steering Group meetings reporting to IPB

Action: Action Plan to Address Gaps

Effective controls may not be in place and assurances are not available to the Board.




SR2a

Risk Open Date: Oct-18 Executive Lead/ Risk Owner Paul FishRisk Review Date: Oct-19 Lead Committee: Quality Committee


Inherent Risk: 3 4 12


Target Risk: 3 2 6



Green

AmberRed

Lead: Due date Status: Not Yet Started/In Progress/ John Bateson

John BatesonIntroduce an improvement recognition award at the annual staff awards






Progress UpdateExternal provider to be comissioned to provide introduction to QI training programme on the RNOH site

Funding agreed for programme at improvement programme board in September 2019

a) Increasing numbers of staff trained in QI methodology

a) Access to training based on external capacity to provide b) Limited finance available to support rapid roll out of QI training c) recognition and reward system for QI to be developed

Positive Assurance (1st, 2nd or 3rd line)Controls: (Preventative, Corrective, Directive or Detective)


Best patient care in the NHSAnnual Objectives(a) Improve shared learning from incidents through the introduction of safety huddles into all clinical departments by January 2020.(b) Improve consistency in ward outcomes through the introduction of ward accreditation in all in-patient areas by March 2020.(c) Improve retention and career progression for Healthcare Assistants via the introduction of a Registered Nurse apprentice route into the trust by March 2020.(d) Improve staff to patient communication via the introduction of a communication tool by October 2019.

a) Monthly

Strategic Risk Description:Capacity and capability of clinical and non-clinical staff to undertake improvement in the quality of care.

Risk Key

Strategic Aim: Strategic Objective:Deliver targeted improvements in High Quality Care

Causes:

a) Lack of knowledge and skills in improvement methodology b) Lack of confidence to undertake improvement activity c) Lack of time within work schedule to undertake improvement activity d) Lack of motivation to undertake improvement activity e) Perception that staff 'need permission' to undertake improvement activity f) Lack of recognition of improvement activity

a) Inadequate improvement activity to improve quality of care b) Poorly designed or executed improvement activity

a) Access to improvement training for staff (external and e-learning) b) Improvement training included in staff induction c) Central improvement resource to support staff d) Standardised improvement methodology e) Resources to support staff undertaking improvement (Life QI etc)f) Improvement programme board

a) Outcomes data (measurement for improvement over time)b) Improvement KPI's as measured and reported via the Improvement programme board

Positive Assurance Review Date




SR2b

Risk Open Date: Oct-18 Executive Lead/ Risk Owner Paul Fish

Risk Review Date: Oct-19 Lead Committee: Quality Committee



Residual/Current Risk: 5 3 15

Target Risk: 5 2 10



Green

Amber

Red

Lead: Due date Status: Not Yet Started/In Progress/ Dr Julie-Anne Dowie-Baker on-going in-progress

Positive Assurance Review Date Positive Assurance (1st, 2nd or 3rd line)Controls: (Preventative, Corrective, Directive or Detective)


Best patient care in the NHSAnnual Objectives(a) Improve shared learning from incidents through the introduction of safety huddles into all clinical departments by January 2020.(b) Improve consistency in ward outcomes through the introduction of ward accreditation in all in-patient areas by March 2020.(c) Improve retention and career progression for Healthcare Assistants via the introduction of a Registered Nurse apprentice route into the trust by March 2020.(d) Improve staff to patient communication via the introduction of a communication tool by October 2019.

Strategic Risk Description:National, regional and local workforce pressures in relation to the recruitment, retention and development of clinical professionals including nurses, doctors and allied health professionals.

Risk Key

Strategic Aim: Strategic Objective:Deliver targeted improvements in High Quality Care

Causes:

a) In excess of 40,000 vacancies for Registered Nurses in the NHS in England b) Uncertainty in relation to Brexit and the supply and retention of EU nurses c) Increased demand across the NHS for RN posts in the aftermath of the Francis report d) Reduced applications for undergraduate nursing programmes with the removal of the nursing bursary e) Reduced number of HCA's being trained as nurses with the removal of financial support from HEE f) Challenges recruiting to NCHD posts at the RNOH

a) Nursing vacancy rate of circa 18% b) Particular pressure in relation to band 5 nursing posts c) Increased agency costs to maintain safe staffing levels d) High use of locum NCHD to support medical rotas e) Focus on delivery of clinical services resulting in less focus on quality improvement

a) CQC inspection improvement from requires improvement to good b) National in-patient survey improvement - 3rd best in London c) CRAB data - strong performacne in relation to morbidity and mortality data d) Other outcomes data - HAPU, falls, infection rates, FFT e) CHPPD and planned Vs actual staffing levels

a) e-rostering policy compliance None

Action Plan to Address GapsEffective controls may not be in place and assurances are not available to the Board.

a) As per CQC regime b) Annually c) Monthlyd) Monthly e) Monthly

a) Retention & recruitment action plan b) e-rostering c) Daily staffing controls and escalation process d) Medical staffing improvement group

a) Outcomes data (1)b) FFT & other patient feedback (1)c) Ward accreditation process (2) d) Internal audit (2) e) CQC inspection (3) f) National in-patient survey (3)

Progress Updatee-rostering compliance monitored weekly via bank and agency meeting and monthly via divisional performance reviews




Action:




SR3

Risk Open Date: 17/10/2018 Executive Lead/Risk Owner Lucy DaviesRisk Review Date: 05/09/2019 Lead Committee: Executive Committee



Current Risk:

4 3 12

Target Risk:

4 2 8


Gaps in Assurance:Where effectiveness of control is yet to be ascertained or negative assurance on control received. G

Green

AmberRed

Lead: Due date Status: Not yet Started/In Progress/ Complete

Lucy Davies, COO / Luke Martin, GM Apr-20 In progress

Lucy Davies, COO / Luke Martin, GM Dec-19 Complete


Best patient care in the NHS

Annual Objectives(a) Deliver agreed clinical service activity plans, ensuring that they provide timely access to care for patients and help deliver the financial plan.(b) Explore opportunities to improve outpatient models of care, including digital opportunities, for the benefit of patients and staff by delivering communications to engage stakeholders, identify clinical leadership, deliver a Project Initiation Document by 31/3/20. (c) Commence programme to improve effectiveness of pre operative preparation for the benefit of patients and staff, including ePOA. This will be achieved through delivery of business case for investment in staff and technology to (1) address backlog and (2) provide appropriate levels of POA for identified demand, taking into account recommendations from April 2019 NHSI Theatre Review, signed off by Exec Committee, by November 2019.

Sep-19

Strategic Risk Description: Insufficient theatre, bed or clinic capacity to achieve planned activity levels.

Risk Key

Strategic Aim:

Strategic Objective:Deliver targeted improvements in activity levels, access and unlocking capacity

Causes:

a) Clinical workforce shortages, particulalrly in Pain Management consultant teamb) Infrastructure failuresc) Increasing demand, particulalrly in Sarcoma service d) Higher LoS than peerse) High levels of FU OP actvityf) Improved tracking of clock starts from tertiary referralsg) inadequate pre operative preparation of patients

a) Temporary or long-term bed, theatre or clinic closures; inability to extend theatre template to 3-session dayb) Temporary theatre or ward or clinic room closuresc) Demand / capacity mismatch; growth in waiting timesd) Reduced opportunity to maximise IP activity through fixed bed capacitye) Reduced opportunity to maximise new OP activity through existing clinic templates; wasted travel and time for patients for limited clinical inputf) Increased proportion of inherited waitsg) Pathway delays, short notice cancellations and wasted theatre time

Controls: (Preventive, Corrective, Directive or Detective)

a) Workforce Dashboard; monthly monitoring of Care Hours Per Patient Day (CHPPD) (2); monitoring via AITFb) 6 Facet Survey (3); CaPSAG spending review (2)c) AITF d) AITF reporting (1)e) Model Hospital (3)f) Model Hospital (3)


CHPPD within expected range; quarterly capital backlog maintenance reports demonstrate programme focussed on key patient areas and infrastructure; level 2 assurance on referral criteria, Directories of Service, scheduling and SOPs training; level 2 assurance on theatre productivity. May 2019: impact of increasing number of inherited waits has slightly increased risk of wait time growth, particularly growth in tip-ins to backlog. Annual RTT trajectory modified for May 2019 submission.

b) POA case for investment to address backlog and provide sufficient capacity going forward

Case in draft

Action Plan to Address GapsProgress Update

a) Develop programme to review and address FU:New OP ratios

Action:

Scoping meetings underway

a) Detailed nursing recruitment and retention action plan; Safer Staffing programme (medical staff); review of pain management jpb plans and potential reduction in anaesthetic sessions by pain consultants in short term as easier to backfillb) Stanmore Building; backlog maintenance programmec) Regular review of referral criteria and Directory of Serviced) Scheduling training and implementation of SOPse) Outpatient model of care improvement programme f) POA improvement plan

Positive Assurance (1st, 2nd or 3rd line)

Reasonable Assurance Rating: G, A, R

Effective controls may not be in place and assurances are not available to the Board. Effective control thought to be in place but assurances are uncertain and/or insufficient.






SR4

Risk Open Date: Sep-19 Executive Lead/ Risk Owner Tom NettelRisk Review Date: Nov-19 Lead Committee: Improvement Strategy Sub-

Committee reporting to Quality Committee




Target Risk: 3 2 6



Green

Amber

Red

Lead: Due date Status: Not Yet Started/In Progress/


Best patient care in the NHSAnnual Objectives(a) Deliver Motivate and Mobilise Programme of Improvement Strategy by March 2020.(b) Deliver Build Confidence Programme of Improvement Strategy by March 2020.

Strategic Risk Description:Staff lack confidence, motivation, resource and capacity to embrace opportunities for improvement.

Risk Key

Strategic Aim: Strategic Objective:Deliver a culture of improvement

Causes:

a) Lack of resources - funding or staff within Improvement function to deliver annual objectives b) Lack of knowledge and skills in improvement methodology c) Lack of confidence to undertake improvement activityd) Lack of time within work schedule to undertake improvement activitye) Lack of motivation to undertake improvement activity f) Perception that staff 'need permission' to undertake improvement activity g) Lack of recognition of improvement activity

a) Inability to achieve ‘Outstanding’ ratingb) Inadequate improvement activity to improve quality of care, quality of staff experience, financial savings and infrastructure improvementsc) Poorly designed or executed improvement activity

a) Access to improvement training for staff (internal, external and e-learning) b) Improvement training included in staff induction c) Central improvement resource to support staff d) Standardised improvement methodology e) Resources to support staff undertaking improvement (Life QI etc)f) Improvement Strategy Sub Committeeg) Organisational conversation led by Improvement with support from Valyou/Staff Experience:h) Ongoing work to raise the profile of Improvement approaches and the Improvement Team in the Trust i) Develop and utilise regular communications channels – Articulate, Improvement Community, Twitter, Grapevine, key Trust consultative meetingsj) Have Trust level priority projects all using Improvement methodology where appropriatek) Development and Implementation of RNOH Improvement Toolsl) Development and Establishment of Improvement Champions

Progress UpdateAction:



Controls: (Preventative, Corrective, Directive or Detective)

a) Access to training based on internal and external capacity to provide b) Access to training based on funding c) Capacity within Improvement team to lead and deliver the objectivesd) Recognition and reward system for QI to be developed

Strategy KPIs are in their infancy and wil always be limited in scope and ability to give a fully detailed understanding of improvement culture progress.

Action Plan to Address Gaps


a) Increasing numbers of staff trained in QI methodology b) Higher than benchmarked number of live improvement projectsc) NHS leading staff survey scores in relation to improvement

a) Improvement Strategy KPIs including staff trained in improvement b) Improvement Strategy KPIs including number of improvement projects including assessment of quality, design and execution of improvement activityc) Staff Survey results re improvement







SR5

Risk Open Date: Executive Lead/ Risk Owner Tom Nettel

Risk Review Date: Lead Committee:




Target Risk: 2 2 4



GreenAmberRed

Lead: Due date Status: Not Yet Started/In Progress/ Complete


a) Access to training based on funding and internal/external capacity to provide b) Capacity within WOD team to lead and deliver the objectives



(a) Improving Staff Survey results (3rd in London and UK)(b) Improving vacancy and turnover rates

(a) Staff Experience Strategy KPIs (b) Staff Survey results (c) WOD Committee oversight

Progress Update

See above controls

Action:







Best staff experience in the NHSAnnual Objectives(a) Deliver Phase 2 of the Conflict Resolution project by 31st March 2020.(b) Deliver the agreed Equality Achievement projects by 31st March 2020.(c) Delivery of the Leadership Development Programme Phase 3 – including OLT and use of Apprenticeship Levy – by 31st March 2020.(d) Delivery of Management Skills Programme for all first line managers by 31st March 2020.

Next month

Strategic Risk Description:Failure to improve staff experience as a result of capacity and resource in relation to bullying and harassment and equality, diversity and inclusion will result in increased staff turnover, challenges recruiting staff, failure to raise concerns and reduce ability of staff to perform thus impacting on quality of care.

Risk Key

Strategic Aim: Strategic Objective:Deliver the VAL-YOU (organisational development) programme to improve retention and staff experience

Causes:

a) Lack of resources - funding or staff within WOD function to deliver annual objectives b) Lack of commitment, knowledge and skills from staff including Trust Board, senior leadership team and amongst staff to improve staff experience c) Lack of time within work schedule to undertake staff experience improvement

a) Quality of care, quality of staff experience, financial savings and infrastructure improvements will not be deliveredb) Increased incidents of perceived bullying, harassment and discriminationc) Increased vacancy, sickness and turnover ratesd) Inability to achieve ‘Outstanding’ ratinge) Loss of ‘Good’ rating

(a) Review of planned activities and prioritisation dependent on available resource(b) Deliver Phase 2 of the Conflict Resolution project by 31st March 2020(c) Deliver the agreed Equality Achievement projects by 31st March 2020(d) Delivery of the Leadership Development Programme Phase 3 – including OLT and use of Apprenticeship Levy – by 31st March 2020(e) Delivery of Management Skills Programme for all first line managers by 31st March 2020




SR6

Risk Open Date: Executive Lead/ Risk Owner Tom Nettel

Risk Review Date: Lead Committee:




Target Risk: 4 2 8



GreenAmberRed


(a) Staff Experience Strategy KPIs (b) Balanced Scorecard KPIs(c) WOD Committee and Executive Committee oversight



Progress Update


Best staff experience in the NHSAnnual Objectives(a) Deliver the Recruitment Process Improvement Project by 31 March 2020.(b) Deliver Phase 2 of the Safer Staffing Programme by 31 March 2020.(c) Deliver Nursing Recruitment and Retention Project Phase 2 by 31 March 2020.(d) Deliver Agency Reduction Project by 31 March 2020.

Strategic Risk Description:Failure to recruit and retain the workforce, as a result of capacity and resource and available workforce, will result in increased staff turnover, challenges recruiting staff, failure to raise concerns and reduce ability of staff to perform thus impacting on quality of care.

Risk Key

Strategic Aim: Strategic Objective:Deliver the Recruitment and Retention programme to recruit and develop a workforce of appropriately skilled and engaged staff.

Causes:

a) Lack of resources - funding, systems or staff within WOD function to deliver annual objectives b) Lack of commitment, knowledge and skills from staff including Trust Board, senior leadership team and amongst staff to improve recruitment and retentionc) Lack of time within work schedule to undertake recruitment and retention

a) Quality of care, quality of staff experience, financial savings and infrastructure improvements will not be deliveredb) Increased incidents of perceived bullying, harassment and discriminationc) Increased vacancy, sickness and turnover ratesd) Inability to achieve ‘Outstanding’ rating and loss of 'Good' ratinge) Increased clinical incidents

(a) Draft and submit business case for investment in medical resourcing, resourcing function, e-rostering for medical staff and AHPs, investment in commercial partner for provision of bank staff and direct engagement models(b) Deliver the Recruitment Process Improvement Project by 31 March 2020.(c) Deliver Phase 2 of the Safer Staffing Programme by 31 March 2020.(d) Deliver Nursing Recruitment and Retention Project Phase 2 by 31 March 2020.(e) Deliver Agency Reduction Project by 31 March 2020.



See controlsAction:




Effective control is in place and Board satisfied that appropriate assurances are available.(a) Funding to implement business case (b) National and international lack of supply of workforce

a)Supply of workforce

Extreme Risk 15-25

High Risk 8-12

Medium 4-6

Low Risk 1-3

Source of Risk: (External Environment, Risk Register, Strategic Objective, Board

or Committee, etc.)


SR7

Risk Open Date: 23.10.19 Executive Lead/ Risk Owner Mark Masters

Risk Review Date: Mar-20

Lead Committee: Redevelopment Programme Board




Target Risk: 5 2 10

Assurances on Control

(Positive Assurance: Reports, Audits, Dashboards, Minutes,

Positive Surveys, External evidence etc.)

(Negative Assurance: Incidence Reports & Investigations,

Complaints, Negative Surveys, External Borrowing, Regulatory

intervention, Legal challenges, etc.)

Gaps in Assurance:Where effectiveness of control is yet to be

ascertained or negative assurance on control received.

Green

Amber

Red


CompleteM Masters Monthly In progress

M Masters Monthly Monthly


i) Monitor and review risk register

ii) Monitor progress of providing vacant possession


Monthly




Progress UpdateAction:

a) Where appropriate de-risking activities have been carried out, such as vendor due

diligence to provide more certainty and improve the attractiveness of the site to

potential purchasers

b) Obtain prescriptive rights over Warren lane access

a) Value provided by Deloitte Sale being monitored by land

Sale short life working Group and Redevelopment Programme

Board

Trust Board


Gaps in control: Where are we failing to put controls/systems in place. Where are we

failing in making them effective


Improved infrastructure

Annual Objectives

Disposal of western development zone by August 2021

Strategic Risk Description:

Failure or delay in completing WDZ land sale by August 2021.

Risk Key

Strategic Aim:

Strategic Objective:

Enable the site redevelopment

Causes:

a) Lack of Market appetite

b) Land value not achieved

c) Brexit

d) Deal complicated by trying to meet accounting treatment test

e) Business Cases to enable vacant possession not approved (MSCP and Staff Accommodation)

a) Inability to repay loan




SR8

Risk Open Date: Executive Lead/ Risk Mark Masters

Risk Review Date: 04-Sep-19

Lead Committee: Redevelopment Programme Board



Current Risk: 4 5 20

Target Risk: 3 1 3

Assurances on Control(Positive Assurance: Reports, Audits, Dashboards, Minutes, Positive Surveys, External evidence etc.)(Negative Assurance: Incidence Reports & Investigations, Complaints, Negative Surveys, External Borrowing, Regulatory intervention, Legal challenges, etc.)


GreenAmber

Red

Lead: Due date Status: Not yet Started/In

Controls: (Preventive, Corrective, Directive or Detective) Positive Assurance (1st, 2nd or 3rd line)

Review Date

Risk Key


Strategic Aim: Infrastructure DevelopmentStrategic Objective: Deliver the site redevelopment projects

Annual Objective. i) Have an approved business case for staff accommodation ii) Have an approved full business case for the multi-story carpark iii) Agree a development provider for Patient Step Down Facility iv) Complete the P&O building enabling infrastructure work

Strategic Risk Description: Awaiting approval of Accommodation OBC from NHSi.

Causes:

NHSI have stated that our business case is robust however it would be on balance sheet and NHSI wish to see it off balance sheet. NHSI have insisted that we pursue a 'land-lease' model and obtain accounting treatment advice from auditors, which has been done however does not achieve an off balance sheet position. NHSI are now persuing this with DH and HMT. NHSI wish to identify a model for providing staff accommodation which is off balance sheet which they may then roll out nationally, unfortunately the RNOH are test case. The RNOH OBC has now been with NHSI for 15 months.

Until the staff accommodation can be located away from the WDZ, the WDZ cannot be sold with vacant posession. The Trust are due to repay the short term loan for the construction of the TSB by August 2021 and is to use the capital receipt from the WDZ sale for this purpose. The Trust cannot commence procurement of the staff accommodation until the OBC is approved. The procurement process, design, planning, construction will take approx 30 months to complete and we are currently 23 months away from August 2021. This project can therefore no longer be accomplished within the necessery timeframe.


We are in very regular communication with NHSI. Raised at STP Estates Board. DoF written to NHSI.

NHSI recognise their involvement in this delay. 04-Sep-19

Gaps in control: Where are we failing to putcontrols/systems in place. Where are we failing in making them effective

Reasonable Assurance Rating: G, A, R

We have no direct control of NHSI. Effective control is in place and Board satisfied that appropriate assurances are available.Effective control thought to be in place but assurances are uncertain and/or insufficient.


Action: Progress Update




SR9

Risk Open Date: Sep-19 Executive Lead/ Risk Owner Saroj PatelRisk Review Date: Oct-19 Lead Committee: Digital Committee


Inherent Risk:

4 5 20

Residual/ Current Risk:

4 4 16

Target Risk:

4 3 12



GreenAmberRed

Lead: Due date Status: Not Yet Started/In Progress/ In progressNot startedIn progress


Improved infrastructureAnnual Objectives(a) Deliver Year 1 Programme of Work (within the resource constraints already highlighted) – March 2020.(b) Develop Digital capability.(c) Deliver Responsive, Secure & Resilient Digital Services.

Monthly/Quarterly

Strategic Risk Description:Inability to implement the objectives set out in the Trust's digital strategy.

Risk Key

Strategic Aim: Strategic Objective:Implement Digital Strategy

Causes:

(a) Deliver Year 1 Programme of Work (within the resource constraints already highlighted) – March 2020.i) Resources are not allocated to enable the outlined work schedule to be delivered.ii) That projects are added to the work schedule that were not part of the original programme of workiii) Organisational priorities are changed(b) Develop Digital capabilityi) Materials to improve the adoption of any digital capability are not developed to meet the demands of the Trustii) Resources do not adapt to the training provided(c) Deliver Responsive, Secure & Resilient Digital Servicesi) Hightened risk of cyber attacks makes for a high likelihood of an attack taking placeiii) Staff inadvertently responding to any cyber attack and infecting the Trustiv) Continuously changing nature of the attacks

(a) Deliver Year 1 Programme of Work (within the resource constraints already highlighted) – March 2020i) If appropriate resources are not allocated the implementation of the programme of work will be delayedii) Unprioritised work will cause delays to the prioritised programme of work(b) Develop Digital capabilityi)The move towards paperless care will be impactedii) Intended efficiencies to be gained within the provision of patient care will not be realised(c) Deliver Responsive, Secure & Resilient Digital Servicesi) The Trust would be seriously impacted by an attack being successful ii) Safe, efficient and effective patient care would be compromised

(a) Deliver Year 1 Programme of Work (within the resource constraints already highlighted) – March 2020.i) Programme plan for the Digital Programme of Work(b) Develop Digital capabilityPlans created to deliver capability improvements(c) Deliver Responsive, Secure & Resilient Digital Servicesi) Cyber security action planii) Independent Cyber security assessmentsiii) CareCERT monitoring alerts

(a) Deliver Year 1 Programme of Work (within the resource constraints already highlighted) – March 2020.Digital Strategy Delivery Board, Digital Committee and Executive Committee(b) Develop Digital capabilityDigital Strategy Delivery Board(c) Deliver Responsive, Secure & Resilient Digital Servicesi) Progress against the action plan and report from the external assessment is monitored by the Digital Committee and the Senior Leadership and Executive Teamsii) Investigating and actioning the alerts provided from CareCERTiii) On track to achieve CareCERT Cyber Essential accreditation by Q4 2019/20


Reports to the Executive and Digital Committee and the minutes of these meetings (2nd)



A number of requests for unprioritised but essential work have been received which have delayed the Year 1 Programme of Work




Progress Update

The Cyber Security Action plan is being prgressed to ensure that we meet the plan to Cyber Essential Accreditation by Q4 2019/20No action has yet been taken towards the provision of materials and training to deliver appropriate Digital Capability





SR10

Risk Open Date: 01.09.19 Executive Lead/ Risk Owner Hannah Witty

Risk Review Date: Lead Committee: STRIDE (Strategic Imaging Development) Governance Group

Effects: Risk Rating Consequence LikelihoodTotal Score:

Risk Movement



Target Risk: 1 2 2



GreenAmber

Red



Improved infrastructureAnnual Objectives(a) Deliver annual Diagnostic Imaging replacement programme (DIRP) to ensure existing services are maintained and upgraded with current technology in line with Imaging Strategy.(b) Deliver and finalise additional opportunities for developing imaging capacity and capability to meet current demand, reduce out-sourcing and support NLP Diagnostic Imaging provision.

1st October 2019

Principal Risk Decription:Lack of sufficient funding for the ongoing delivery of the annual Diagnostic Imaging Replacement Programme (DIRP) and the development of imaging capacity and capability, thereby creating the risk of a sub-standard service to our patients with potentially unreliable and technically inferior diagnostic imaging equipment.

Risk Key

Strategic Aim: Strategic Objective:Exploit equipment provision to enhance care and Trust operations

Causes:

Insuffiicient confidence of year-on-year funding in the context of the overall investment needs the Trust has.

Inability to fund the DIRP and the development of imaging capacity and capability which will continue to increase the potential for equipment failure and possibility of sub-optimal patient diagnosis.

The lack of assured funding also impacts on the confidence of the Trust to depend on a range of suitable and relaible foundational imaging services that will enable it to lead and position itself as a centere of excellence MSK Imaging Hub.


a) The STRIDE Group will continue to meet throughout the year and funding will be identified as an agenda item.b) NED involvement has begun with an infiormal review of the STRIDE Options paper written by Mike Giles and Luke Martin. This will be formally presented to the Board in October where ongoing NED involvement and support will be officially invited. From this a strategy in line with postive assurance will be developed.

It is also an annual/ongoing agenda consideration and challenge for CAPSAG in consideration and context of the Trust's broader priorities.




a) Ensuring preventative maintenance is undertaken at the appropriate times to maximise imaging equipment reliabilility, safety and accuracy/clarity of images.b) Seeking partnerhsips and/or sympathetic financing solutions to provide greater ongoing assurance of ongoing funding.

a) Part of the STRIDE Group's work is to seek funds through partnership or direct funding opportunities and this will continue throughout this financial year. b) Involvement of Non-Executive Directors (NED): thier contacts, experience and influence to polarise opportunities potentially attractive to suppliers.c) CAPSAG is constantly challenged as to how to fund imaging equipment.




Progress Update



Strategic objective BAF REF No:

SR11

Risk Open Date: Sep-19 Executive Lead/ Risk Owner Hannah Witty

Risk Review Date: Monthly Lead Committee: Finance Committee




Target Risk: 4 2 8



Green

Amber

Red

Lead: Due date Status: Not Yet Started/In Director of Finance 30-Dec-19 In progress

Director of Finance 30-Nov-19 In progress

Director of Finance, PCD GM 30-Dec-19 In progressDirector of Finance 30-Sep-19 In progress

Progress UpdateSupport and drive NOA tariff engagement to ensure shared objectives with EWG to influence tariff change

PCD refresh of growth strategy, including risks and opportunities

Update of top loss moaking procuedures underway to inform NOA-EWG discussions. CEO attendance at EWG-NHSE&I tariff meetings.

MTFP Board review 18 Sept, plan for sustainability including effieicy plans to follow (end Nov 19)

Action:

Medium Term Financial Plan, plan for sustainability and five year efficiency planModelling underway, inlcuding case for additional theatre. Possible external support needed.

Model Hospital training to SLT to aid identification of effiency opportunities through benchmarking data

Sessions booked with RJAH MH specialist to provide traning and share learning

a) NHSE&I acknowledgement that tariff is not fit for purpose for complex orthopaedics, but there has been limited action to correctb) Medium term plan for sustainability. Internal bandwith to identify and deliver efficency savingsc) Failure to persuade consultants to move external private practice to RNOH

RNOH expects to reforecast to not fit financial plan in 2019/20




Outcome of internal audit review of controls (3)Unqualified external audit opinion, including VfM (3)





Financial SustainabilityAnnual Objectives(a) Influence national payment mechanisms in conjunction with the National Orthopaedic Alliance to ensure complexity is factored into agreed payment mechanisms by 31 March 2020.(b) Delivery of £7.6m Private Care income target within budgeted resource by 31 March 2020. (c) Facilitate identification and delivery of efficiency and productivity schemes to ensure RNOH meets its CIP target by 31 March 2020, and develop a medium term plan detailing priority areas for efficiencies over the next five years by 30 September 2019.(d) Development of a Board approved Medium Term Financial Plan including a financial strategy for sustainability by 30 September 2019.

Internal audit - agreed points during the yearExternal audit - annual

Strategic Risk Description:The national tariff, based on average reference costs, does not adequately recompense RNOH for the complexity of NHS work undertaken resulting in a significant underlying deficit. RNOH does not have sufficent mitigations in place in the form of non-NHS income growth or efficiency plans to address this deficit.

Risk Key

Strategic Aim: Strategic Objective:Achieve financial stability

Causes:

a) The national tariff does not cover the cost of the complexity of NHS activity undertaken at RNOHb) RNOH is dependent on a very small number of PP consultants resulting in limited growth of non-NHS incomec) Easy efficiency opportunities have been delivered; investment now needed to realise cashable savings

RNOH continues to run with an unsustainable underlying deficit, control totals are not met and revenue support loans continue to be required to fund NHS activity.

a) Trust financial control framework including Standing Financial Instructions, business planning, budget setting and delgation, authorised signatories, monthly financial reporting, divisional adn operational performance reviewsb) Private Patient growth strategy, annually agreed financial targets, monthly reporting, PPSDC oversightc) Board agreed efficiency targets, monthly monitoring and escalation processd) RNOH is working with wider NOA partners and also seeking to establish stronger links to the Expert Working Group to ensure changes are made to the national tariff to properly fund complex orthopaedic activity going forward

a) Annual business planning and budget setting processesb) Monthly financial reportingc) Internal audit of control environmentd) External audit of financial outturn and control environmente) NOA Board agreement on tariff approachf) RNOH membership of EWG





SR12

Risk Open Date: Sep-19 Executive Lead/ Risk Owner Tom NettelRisk Review Date: Next month Lead Committee: Research, Education and

Innovation CommitteeEffects: Risk Rating Consequence Likelihood Total Score: Risk Movement



Target Risk: 3 1 3



GreenAmberRed

Lead: Due date Status: Not Yet Started/In


World leading research, education and innovationAnnual ObjectivesDelivery of the RNOH Research, Education and Innovation Strategic review:(a) A Trust Board agreed vision and objectives for future RNOH Research, Education and Innovation strategy by November 2019.(b) A programme plan to deliver strategy, vision and objectives agreed by Trust Board by 31 January 2020.(c) Delivery of agreed programme plan milestones by 31 March 2020.

Strategic Risk Description:Failure to deliver a strategic review will prevent the RNOH delivering world class neuro musculoskeletal research and education.

Risk Key

Strategic Aim: Strategic Objective:To deliver world class neuro musculoskeletal research and education

Causes:

a) Lack of resources - funding, systems or staff within RNOH develop a vision and objectives, programme plan and milestonesb) Lack of commitment, knowledge and skills from staff including Trust Board, senior leadership team and amongst staff c) Lack of time within work schedule to undertake annual objectives

a) Improvements in quality of care will not be deliveredb) Loss of academic partnerships and potential further academic partnersc) Loss of funding and inability to take advantage of funding opportunities for research and educationd) Inability to achieve ‘Outstanding’ rating and loss of 'Good' rating; sustainability/viability of organisation as national and international specialist centre questionede) Increased vacancies and turnover

Delivery of the RNOH Research, Education and Innovation Strategic review:a) A Trust Board agreed vision and objectives for future RNOH Research, Education and Innovation strategy by November 2019b) A programme plan to deliver strategy, vision and objectives agreed by Trust Board by 31 January 2020c) Delivery of agreed programme plan milestones by 31 March 2020

a) Establishment of REI Committeeb) Monthly updates at Trust Board



Progress UpdateSee controlsAction:





a) Significant ongoing progress w Nursing and AHP researchb) Effective management and oversight of education funds via Ed ti C itt

a) REI governance structure is not fully establishedb) Understandable lack of buy in to overall plan c)Absence of agreed funding and programme/project management resource




SR13

Risk Open Date: Apr-19 Executive Lead/ Risk Owner Rob Hurd

Risk Review Date: Nov-19 Lead Committee: Strategy & Sustainability Committee


Inherent Risk:

4 3 12

Residual/ Current Risk:

3 3 9

Target Risk:

3 2 6



Green

AmberRed




a) SHC Sub-Committee of the Board is still developing and so fully effective assurance to Board is not yet in place.b) Difficulties in achieving clear agreement with NHS I on future leadership, governance, structures and funding, particularly from April 2021.

a) Lack of clear agreement on clear aim / purpose for SHC.b) Uncertainty of longer term support and funding for major SHC project - GIRFT England from April 2021.

a) Strenghtening of RNOH Governance 2019/20: Inclusion of SHC in Strategy, Aims, Objectives and BAF monitoring; Establishment of Stanmore Health Consulting Sub-Committee of Strategy & Sustainability Committee to agree clear purpose, aims, objectives and delivery plans for SHC.b) NHS I / RNOH joint review and investigation of GIRFT Leadership , Governance & Culture - Reporting to September GIRFT Board and September RNOH Strategy & Sustainability Committee.c) Internal Audit of GIRFT recruitment processes and expenses.

a) Major SHC Projects (e.g. GIRFT England) are delivering on Key Performance Indicators as at September 2019 - e.g. numbers of front line visits, national specialty reports produced, data and information feed into Model Hospital, evidence of improvements in GIRFT identified quality of care outomes metrics across all GIRFT specialties with significant associated financial benefits to NHS.b) External Reviews and Reports of key "think tanks" (Kings Fund and NHS Providers) of GIRFT methodology very positive and in the public domain.c) Many examples of Trust by Trust, Specialty by Specialty improvements facilitated by GIRFT methodology leading to large numbers of requests for additional support.d) 2018 NHS I Internal Audit Report (Green) and 2019 GIRFT RNOH Internal Audit Report (Partial Assurance) give examples of positive assurance and practice on GIRFT internal controls processes including governance and recruitment processes. e) NHS I/RNOH Joint Review / Investigation into governance and culture May - September 2019 identified need to invest in leadership development and organisational development within GIRFT and enhanced NHS I oversight arrangements.f) RNOH Internal Audit Report 2019 (Partial Assurance) gives examples of weaknesses in internal controls on GIRFT expenses which are being rectified.


Effective controls may not be in place and assurances are not available to the Board. Effective control thought to be in place but assurances are uncertain and/or insufficient.


World leading external roleAnnual Objectives(a) Agreement of strategy and financially sustainable long term plan and associated governance for Stanmore Health Consulting Directorate (incorporating all projects and programmes within this) by RNOH Trust Board by 31 March 2020.(b) Agreement of funding and programme milestones and KPIs for translating GIRFT into new areas not currently in GIRFT England Programme by 30 September 2019.(c) GIRFT funding and structures longer term (from April 2021) agreed as part of NHS I /E restructure and NHS Long Term Plan implementation plan by 31 March 2020.

Strategic Risk Description:NHS Improvement, NHS England and other stakeholder funding bodies do not continue to support (through funding and contractual arrangements) the RNOH as a provider of clinical improvement programmes run through the Stanmore Health Consulting Directorate of RNOH - of particular note the main SHC programme/project (GIRFT England) is formally funded until March 2021 and so there is particular uncertainty beyond that point as to the scale of SHC activities.

Risk Key

Strategic Aim: Strategic Objective:Lead national programmes to improve NHS sustainability

Causes:

a) External: As part of the "coming together" nationally of NHS Improvement and NHS England they have been reviewing their aims , objectives and operating models over the last 18 months and this is continuing over the months ahead (currently in "Phase 3" scheduled to complete later this calendar year) - NHS Improvement are now more clearly seeing their role as supporting Quality Improvement rather than regulation and, as such, have indicated the need to integrate GIRFT more closely with their regional structures - including the potential for the transfer of GIRFT resources and staff in the longer term into NHS I/E Regions, rather than utilising RNOH as a GIRFT partner.

b) Internal: Combined with the uncertainties caused by environmental factors described above, the rapid expansion of the GIRFT England Programme over the last 2 years (5 staff to 200 staff from 2017 to 2019) and the focus on the operational delivery of the programme has meant that leadership development and organisational development has been less well developed than elsewhere in RNOH.

If these risks are not managed there is a potential that the delivery of SHC objectives and GIRFT operational delivery is adversely impacted and therefore the likelihood of RNOH contributing to national programmes will be reduced.

Lead: Due date Status: Not Yet Started/In Progress/ Complete

Rob Hurd and Rachel Yates 31st December 2019 In Progress

Rob Hurd and Tim Briggs 31st March 2020 In Progress

a) A clear purpose/aim and underpinning objectives and plans need to be agreed for Stanmore Health Consulting to provide assurance that these are aligned to the Strategic Aims of the RNOH.b) Agreement needs to be reached with NHS I on the proposed arrangements from the end of the current GIRFT England programme from April 2021.

SHC Sub Committee now evolving with monthly meetings - Board engagement session to be scheduled in the Autumn.

Action:

In dialogue with NHS I - agreement to agree by 31st March 2020.

Action Plan to Adress GapsProgress Update




SR14

Risk Open Date: Apr-19 Executive Lead/ Risk Owner Rob HurdRisk Review Date: Mar-19 Lead Committee: Strategy & Sustainability


Inherent Risk: 4 3 12Residual/ Current Risk: 4 2 8Target Risk: 3 2 6

Assurances on Control (Positive Assurance: Reports, Audits, Dashboards, Minutes, Positive Surveys, External evidence etc.) (Negative Assurance: Incidence Reports & Investigations, Complaints, Negative Surveys, External Borrowing, Regulatory

Gaps in Assurance: Where effectiveness of control is yet to be ascertained or negative assurance on control received.

Green

Amber

Red

Lead: Due date Status: Not Yet Started/In Rob Hurd 01-Mar-20 In progress


World leading external roleAnnual Objectives(a) North London Partners Adult Elective Orthopaedic Review Pre Consultation Business Case agreed by NCL CCGs JCC by 31 March 2020.(b) Annual Report on lessons learned from NCL STP pilot of GIRFT enabling system change to GIRFT and RNOH Board by 31 March 2020.(c) Contribute to leading relevant elements of STP including workforce, nursing, finance, estates and digital by 31 March 2020.

Strategic Risk Description:STP unable to approve pre-consultation business case process.

Risk Key

Strategic Aim: Strategic ObjectivesUndertake a leadership role where appropriate and relevant in regional setting of Sustainability and Transformation Programmes

Causes:

Lack of financial resources of the scale of support / implementation resources required to realise the patient care, staff experience, teaching, training, research and financial benefits of the NCL Adult Elective Orthopaedics review.

Inability to progress with recommendations for the new clinical service model for orthopaedics in the NCL STP.

High quality engagement process and associated patient and clinical staff engagement supported by high quality business case.

The Joint Commissioning Committee of North Central London Commissioners has supported every step of the process to date. The Joint Health Overview and Scrutiny Committee has minuted that this review process has been an exemplar in terms of engagement with patients, clinicians, the public and organisations affected.




Progress UpdateEngagement events have been arranged targeting specific concerns raised around AHP involvement and transport issues raised.

Events scheduled as part of Autumn engagement and consultation eventsAction:





Patients and staff continue to raise concerns around impact on transport if some local hospital sites no longer provide inpatient elective orthopaedics.

Some Allied Health Professional Staff have indicated at engagement events that they have not felt sufficiently engaged to date.




SR15

Risk Open Date: Sep-19 Executive Lead/ Risk Owner Tom Nettel

Risk Review Date: Next month Lead Committee: Executive CommitteeEffects: Risk Rating Consequence Likelihood Total Score: Risk Movement

Inherent Risk:2 4 8


Target Risk: 2 1 2

Assurances on Control (Positive Assurance: Reports, Audits, Dashboards, Minutes, Positive Surveys, External evidence etc.) (Negative Assurance: Incidence Reports & Investigations, Complaints, Negative Surveys, External Borrowing, Regulatory


GreenAmberRed

Lead: Due date Status: Not Yet Started/In P / C l t





Effective use of charitable funds to deliver key research, quality and staff experience projects

Support delivery of relevant Trust Strategic Aims and Objectives through Charity support and grants by 31 March 2020 not yet delivered.


Progress UpdateSee controls.Action:


World leading external roleAnnual Objectives(a) Share and agree Trust Strategic Aims and Objectives that will be supported by the RNOH Charity’s Strategy by 1 November 2019.(b) Support delivery of relevant Trust Strategic Aims and Objectives through Charity support and grants by 31 March 2020.

Next month

Strategic Risk Description:Failure of sufficient executive leadership, integration and coordination with RNOH Charity CEO and Trustees will result in aims and objectives of Trust strategy.

Risk Key

Strategic Aim: Strategic Objective:Coordinate RNOH and RNOH Charity strategies

Causes:

a) Lack of resources and time within executive team to deliver annual objectives b) Lack of commitment, knowledge and skills from staff including Trust Board, senior leadership team and amongst staff to work with Charityc) Lack of time, resources or commitment from Trust Charity leadership to support delivery of annual objectives

a) Quality of care, quality of staff experience, financial savings and infrastructure improvements may not be delivered without charitable fundingb) Increased incidents of perceived bullying, harassment and discriminationc) Increased vacancy, sickness and turnover ratesd) Inability to achieve ‘Outstanding’ ratinge) Loss of ‘Good’ rating

a) Share and agree Trust Strategic Aims and Objectives that will be supported by the RNOH Charity’s Strategy by 1 November 2019b) Support delivery of relevant Trust Strategic Aims and Objectives through Charity support and grants by 31 March 2020

a) Executive Committee oversightb) RNOH Trust Board serve as Trustees on RNOH Charityc) Overview of charity funding against trust strategy and aligned requests for funding via Executive Commitee and Charity Trustee Board meetingd) Establishment of joint RNOH Trustee and Trust Executive meetings


Dec 15 20 15 10

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