CCG: BOARD ASSURANCE FRAMEWORK
INTRODUCTION
1.
As a Clinical Commissioning Group (CCG) we have identified various risks. Many of these are low level and are managed at an operational level. This document
highlights the top strategic risks facing us as an organisation therefore the scores for these risks are high, at least at the start of the year.
2.
The CCG is part of a collaborative arrangement with other CCGs in North West London comprising Central London, West London, Hammersmith & Fulham, Hounslow
and Ealing CCGs. The CCGs have worked together to identify a common set of risks and to develop common approaches to their management, as appropriate.
3.
Workshops have taken place with each CCG governing body to identify the key risks to achieving our objectives for the year. The outputs were mapped and discussed
with the chairs of the CCGs to reach a common set of 20 risks and subsequently discussed by Governing Bodies. The Board Assurance Framework takes those key
risks to the delivery of the CCG’s strategic objectives and 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.
CCG Objective
Objective 1: Empowering patients to
take more control of their health and
wellbeing through delivery of the
‘whole systems integrated care’
programme.
Objective 2: Securing high quality
services and improved outcomes for
patients
Initial
Score
Current
Score
Last
Review
1 – Engagement with patients is not adequate to enable them to make informed choices about
their care.
16
16
May 14
2 - Inability to specify outcomes that we want to see providers deliver leading to reduced impact of
commissioning.
16
16
May 14
3 - Safeguarding Children – failure to meet statutory responsibilities leading to poor quality care
15
15
May 14
4 - Safeguarding Adults – failure to meet statutory responsibilities leading to poor quality care
primarily in care homes but also other providers
20
20
May 14
5 – Imperial not delivering services to the agreed standard and lack of alignment between their
strategy and our operational delivery
20
16
May 14
6 –Chelsea & Westminster do not deliver services to agreed standard
12
12
May 14
7 – Inability of West Middlesex to deliver services to agreed standard and impact of the transaction
with Chelsea and Westminster
16
16
May 14
8 – Inability of Ealing Hospital to deliver services to agreed standard
20
20
May 14
Description of risk identified
1
CCG: BOARD ASSURANCE FRAMEWORK
Objective 3: Putting in place the
infrastructure to deliver high quality
commissioning.
Objective 4: Building relationships with
local authorities and Health and
Wellbeing Boards to deliver the Better
Care Fund plan, and developing and
delivering joint plans with other CCGs
across North West London.
Objective 5: Delivering the Out of
Hospital Strategy and acute hospital
changes as set out in the Shaping a
Healthier Future Strategy.
Objective 6: Delivering our statutory
and organisational duties
9 – Inability of Central London Community Healthcare to deliver services to agreed standard
12
12
May 14
10 – Inability of West London Mental Health Trust to deliver services to agreed standard and to
deliver elements of the out of hospital strategy
16
12
May 14
11 – Inability of Central & North West London Trust to deliver services to agreed standard and to
deliver elements of the out of hospital strategy
20
20
May 14
12 – Failure to put systems in place to deliver improvements in commissioning support.
20
16
May 14
13 – Not managing the relationship between CCGs and member practices effectively
20
20
May 14
20
20
May 14
15 - Through unsustainable demand, uncontrolled delays to the delivery timelines and an inability
to deliver the required clinical workforce Shaping a Healthier Future delivers precipitate, poorly
planned change, which adversely impacts quality and safety
16
12
May 14
16 – Through an inability to meet the clinical standards, deliver the requisite workforce, deliver
behavioural change, sustain expected patient experience and unsustainable demand on the system
Shaping a Healthier Future does not deliver the planned benefits to improve quality and safety of
health and care across NW London
16
16
May 14
17 - Primary care and community care providers are not able (due to organisational and workforce
issues) to deliver the increase in activity required to deliver services as described in the Out of
Hospital Strategy
16
16
May 14
18 - Failure to deliver IT systems which can deliver data CCGs need
16
16
May 14
19 - Failure to operate in a way that meets required Information Governance standards
12
12
May 14
20 - Failure to meet in year financial targets and to deliver the planned underlying surplus that
underpins longer term financial sustainability
16
16
May 14
14 - Lack of alignment between approaches taken by CCGs and Local Authorities means that the
benefits set out in the Better Care Fund workstreams are not realised and unmanageable cost
pressures in 2015/16.
2
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Empowering patients to take more control of their health and wellbeing
Director lead: Director of Quality & Patient Safety
Risk: Engagement with patients is not adequate to enable them to make informed choices about their care. This
leads to a lessening of our ability to move activity from acute to community settings.
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Risk
Appetite
Rationale for current score:
Enabling patients to make the right choices is central to the CCG’s plans and will
require significant behavioural change to achieve.
Rationale for risk appetite:
We want to reduce the likelihood of this risk through greater awareness of
patients of their health and healthcare options.
Controls: (What are we currently doing about the risk?)
Mitigating actions: (What more should we do?):
New quality schedules included in provider contracts will lead to
 Patient engagement strategies in place across the five CCGs which was informed by
production of quarterly patient experience integrated reports.
patients.
Access to patient records via handheld devices
 A range of programmes being put in place as part of the Better Care Fund.
 Better Care Fund programme has identified resources to capture patient experience Using the Prime Minister’s Challenge Fund to support online
appointment booking and ePrescription services
across Health & Social Care which will be used to drive action.
Assurances: (How do we know if the things we are doing are having an impact?)


Each CCG has system in place for capturing patient experience and reported through PPE
and Quality committee.
Quarterly reports from providers will be reported to Care Quality Group meetings and given
to each CCG Quality Committee.
Regular reports from Healthwatch to Quality committee.

Current performance: (With these actions taken, how serious is the problem?)
JW
Dec 15
FF
Dec 15
FF
Co-design of care pathways and Out of Hospital Services
On-going
TSaw
Improving the effectiveness of 111 service
On-going
tbc
Extended access to primary care through redesigned LES services
including care planning and care navigators.
Summer
2014
TSan
Gaps in assurance: (What additional assurances should we seek?)
 Analysis of trends and themes across providers relating to patient feedback.
Additional Comments
3
July 14
1
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Chief Finance Officer
Risk: Inability to specify outcomes that we want to see providers deliver leading to reduced impact of
commissioning.
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Risk
Appetite
Controls: (What are we currently doing about the risk?)
 Review of commissioning intentions and contract reviews led to development of
consistent strategy for implementing data quality and service delivery improvement
programmes in our 2014/15 contracts with Providers.
Rationale for current score:
If we are unable to specify outcomes and measure performance accurately,
desired quality improvements will not be delivered.
Rationale for risk appetite:
Obtaining the right data is difficult, but by improving collection and analysis
of data, the risk this is should be reduced.
Mitigating actions: (What more should we do?):
Lessons learned workshop from contracting round
leading to actions for improvement.
June
14
OW
Action plan to be developed and agreed
June
14
OW
Assurances: (How do we know if the things we are doing are having an impact?)
 Acute/Community Information Schedule Trackers used to inform Quality and
Performance reports which go to Governing Bodies and committees.
Gaps in assurance: (What additional assurances should we seek?)
We have not yet identified learning from the 2014/15 contracting round.
Current performance: (With these actions taken, how serious is the problem?)
There is an acknowledged gap in our data quality standards
Additional Comments
4
2
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Director of Patient Safety & Quality
Risk: Safeguarding Children – failure to meet statutory responsibilities leading to poor quality care
Date last reviewed: May 2014
Rationale for current score:
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 3 x 5 = 15
Current: 3 x 5 = 15
Appetite: 2 x 5 = 10
Risk
Appetite
Controls: (What are we currently doing about the risk?)





Failure in this area would have an impact on vulnerable members of the community
and is therefore very serious. This is a challenging control environment in the
context of multi-agency working and the wider commissioning environment. Steps
have been taken to reduce the likelihood of problems occurring.
Rationale for risk appetite:
While the impact of failures could have a major impact on patients, the aim is to
reduce the likelihood of this occurring. Risks can never be completely eliminated.
Mitigating actions: (What more should we do?):
Leadership roles for safeguarding clearly defined within key providers and CCG. Designated
Nurses sit on each CCG Quality Committee.
Established working relationships with the Safeguarding Children’s Boards.
Reporting systems for serious incidents and framework to CCGs that identifies assurances.
Reporting framework has been strengthened for providers via internal review, CQG scrutiny and
CCG assurance using the outcomes framework. There are quarterly agenda reports by providers
at CQG with exceptions as required monthly.
Lead for health on serious case reviews as they occur.
Multi Agency Safeguarding Hubs in place.
Strengthen reporting of outcomes of Female Genital
Mutilation work by providers
Sept 14
Jonathan
Webster
Develop a consistent approach for CCGs to Looked After
Children with improved reporting.
July 14
Jonathan
Webster
Develop a robust contract for healthcare Out of Borough
Looked After Children placements
July 14
Jonathan
Webster
Sept 14
Jonathan
Webster
Sept 14
Jonathan
Webster
Review transition of care from children’s to adult services
Recruit named GP (Central London)
Assurances: (How do we know if the things we are doing are having an impact?)
 Quarterly written reports to CCG Quality committees with monthly verbal updates for
exceptional issues. Minutes presented to governing body meetings.
 Reports to NHS England assurance meeting and Local Safeguarding Children’s Board.
Gaps in assurance: (What additional assurances should we seek?)
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments
All main trusts are reporting in on a quarterly basis but this needs to be more effectively aligned to
CQG agendas. Key risk factors are: FGM/ ensuring the CCGs are compliant re LAC responsibilities.
Risks around systems to monitor mobile families.
5
 Risks due to multiple commissioning organisations have not been resolved.
Particular risk in relation to CAMHS tier 4 beds – commissioned by NHS England
but a lack of beds nationally/ concerns re the quality of the provision. Impact on
local children & young people placed on adult wards or general paediatric wards.
 No. children placed out of Borough/changes to payment systems.
3
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Director of Patient Safety & Quality
Risk: Safeguarding Adults – failure to meet statutory responsibilities leading to poor quality care primarily in
care homes but also other providers
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 5 = 20
Current: 4 x 5 = 20
Appetite: 2 x 5 = 10
Risk
Appetite
Rationale for current score:
CCGs have implemented governance structures to exercise this function.
However risk remains high as systems are largely untested and legislative
changes create new challenges in the system.
Rationale for risk appetite:
The aim is to reduce the likelihood to low, but the consequences of failure
remain high.
Controls: (What are we currently doing about the risk?)
 Leadership roles for Safeguarding Adults clearly defined within CCG and key providers.
 Establishment of systems in line with multi-agency working eg Continuing Healthcare
Quality Assurance Group and Care Quality Group meetings.
 Established working relationship with Local Safeguarding Adults Board.
 Clear relationships with local authorities in relation to safeguarding and continuing
healthcare.
 Reporting systems have been developed to provide a framework for assurance to the
CCGs.
Mitigating actions: (What more should we do?):
Assurances: (How do we know if the things we are doing are having an impact?)
 CCG Quality & Safety Committee minutes showing quarterly Safeguarding Adults
reports.
 Quality Assurance Group for Continuing Healthcare.
Current performance: (With these actions taken, how serious is the problem?)
Gaps in assurance: (What additional assurances should we seek?)
 Governing Bodies do not yet know if these new systems and processes
are sufficiently robust and embedded in multi-agency working.
 Better reporting of causes of pressure ulcers.
Additional Comments
All trusts are aware of the need to report on a quarterly basis but not all are submitting using the
framework developed by the safeguarding team. However, this needs to be better aligned with the
CQG agenda.
There is a concern that the complexity of the commissioning
environment and public sector financial constraints lead to
insufficient focus on quality.
6
Strengthen work with local authorities to develop services
for learning disability following Winterbourne view report.
Sept 14
Jonathan
Webster
Improve health response to Mental Capacity Act utilising
NHS England funding.
Dec 14
Jonathan
Webster
Commence implementing the findings from Quality
dashboard to improve continuing healthcare provision in
care homes and other units.
June
14
Jonathan
Webster
Facilitate completion of Safeguarding Adults audit tool and
use to improve the system across health economy
June
14
Jonathan
Webster
4
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Managing Director, Hammersmith & Fulham
Risk: Imperial not delivering services to the agreed standard and lack of alignment between their strategy and
Date last reviewed: May 2014
our operational delivery
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 5 x 4 = 20
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Risk
Appetite
Controls: (What are we currently doing about the risk?)




Rationale for current score:
Imperial is a major provider to the CCGs and therefore its performance has a
big impact on patients in the area. There have been performance issues in
the past.
Rationale for risk appetite:
Contract management and other process aim to ensure that problems do
not arise.
Mitigating actions: (What more should we do?):
Imperial executive team attend CWHHE executive meetings every 6 weeks to discuss
and agree strategy and explicit arrangements for CCGs to be involved in strategy
development. Performance issues also discussed.
Account Manager in place to lead on contract monitoring with Imperial.
Clinical Quality Group meetings take place regularly.
Local Transformation Incentive Scheme in place for 2014/15 to incentivise the Trust to
implement change-behaviour and activity reductions consistent with Shaping a
Healthier Future.
We will issue contract query notices in line with the
agreed national contract if performance falls below
expected standards
Development and approval of the Outline Business Case
tbc
Oct 14
CL
TSaw
Assurances: (How do we know if the things we are doing are having an impact?)
 Performance reports to governing bodies.
 Quality Committee minutes and Finance and Performance Committee minutes to the
governing body.
Gaps in assurance: (What additional assurances should we seek?)
Information systems do not provide complete and up-to-date information on
which to base commissioning decisions.
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments
Foundation Trust application and the delivery of the
transformational elements in the contract to be monitored
in-year.
7
5
CCG: BOARD ASSURANCE FRAMEWORK
Director lead: Managing Director, West London
Objective: Securing high quality services and improved outcomes for patients
Date last reviewed: May 2014
Rationale for current score:
There have been concerns about reporting processes. The Trust is
currently working with the CCGs to address these concerns.
Rationale for risk appetite:
Contract management and other process aim to ensure that problems
do not arise.
Controls: (What are we currently doing about the risk?)
Mitigating actions: (What more should we do?):
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk: Chelsea & Westminster do not deliver services to agreed standard
Risk Rating
25
(likelihood x
20
Risk
15
consequence):
Score
10
Initial: 3 x 4 = 12
5
Risk
Current: 3 x 4 = 12
0
Appetite
Appetite: 2 x 4 = 8
 Contract review meetings.
 Clinical Quality Group meetings.
 Performance & Contracting Executive meeting responsible for oversight of contract inyear, assessing risks and identifying these for Finance & Performance and Quality
meetings.
 Transformation Board: second year for urgent care, and first year for planned care.
Continue to work through the Account Manager and the
CSU to drive improvements
Review communication flow between CQG and CCG Quality
meeting
Review of 2013/14 risk log to reduce likelihood of same
risks appearing again
Re-investment of RTT fines to support the Trust
Ongoing
June
2014
June
2014
Ongoing
LP
LP
CP
Assurances: (How do we know if the things we are doing are having an impact?)
Gaps in assurance: (What additional assurances should we seek?)




 C&W to develop rigorous serious incident management programme to align with
national standards
 Evidence to demonstrate progress against agreed plans to improve serious
incident reporting and management required
Quality and Performance reports to Committees and Governing Bodies
Quality Committee and Finance and Performance Committee report into Governing Bodies
Draft commissioner response to 2014/15 Quality Accounts being reviewed (April 2014)
Reports to Care Quality Group
Current performance: (With these actions taken, how serious is the problem?)
 C-section rates improving at month 11 (February 2014)
 18 week RTT (referral to treatment) for subspecialty capacity (Trauma & Orthopaedics;
Ophthalmology; Gastro; General Surgery; Plastic Surgery; Rheumatology) below target and will
remain so until Q2, 2014/15
8
Additional Comments
 Should non-performance in serious incident reporting/
management continue, a Board to Board session may be
considered
6
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Managing Director, Hounslow
Risk: Inability of West Middlesex to deliver services to agreed standard and impact of the transaction with
Chelsea & Westminster
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Risk
Appetite
Rationale for current score:
There are uncertainties around the future of West Middlesex Hospital in the
context of its proposed partnership with Chelsea & Westminster Hospital.
Rationale for risk appetite:
Contract management and other process aim to ensure that problems
arising from uncertainty do not arise.
Controls: (What are we currently doing about the risk?)
Mitigating actions: (What more should we do?):
 Contract review meetings.
Hounslow CCG to become a member of the Trust’s
 Clinical Quality Group meetings.
Transformation Board.
 Representation from the Trust on the Urgent Care Board
 Contract with the Trust includes provision for a transformation programme
management office
June
2014
SJ
Assurances: (How do we know if the things we are doing are having an impact?)
 Quality and Performance report to the governing body
Gaps in assurance: (What additional assurances should we seek?)
 We will need to receive the minutes and reports from the Transformation
Board
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments
9
7
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Managing Director, Ealing
Risk: Inability of Ealing Hospital to deliver services to agreed standard
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 5 x 4 = 20
Current: 5 x 4 = 20
Appetite: 2 x 4 = 8
Risk
Appetite
Rationale for current score:
There are serious concerns with the sustainability of the Trust and the
quality of care provided.
Rationale for risk appetite:
Contract management and other process aim to ensure that problems do
not arise.
Controls: (What are we currently doing about the risk?)
 Contract review meetings.
 Clinical Quality Group meetings.
 Quality measures agreed as part of the 2014/5 contract
 Board to Board and PCE meetings.
Mitigating actions: (What more should we do?):
Assurances: (How do we know if the things we are doing are having an impact?)
 Quality and Performance report
 Monitoring performance and quality via contract meetings and the Clinical Quality
Group meetings.
Current performance: (With these actions taken, how serious is the problem?)
Gaps in assurance: (What additional assurances should we seek?)
 We need a comprehensive plan for addressing identified quality issues
10
Proposed merger is a key mitigation We are expecting
an update in the summer.
Aug 14
Special quality committee set up to review recent quality
information and to agree next steps.
June
14
Additional Comments
KM
JWeb
8
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Managing Director, Central London
Risk: Inability of Central London Community Healthcare (CLCH) to deliver services to agreed standard
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 3 x 4 = 12
Current: 3 x 4 = 12
Appetite: 2 x 4 = 8
Risk
Appetite
Controls: (What are we currently doing about the risk?)
 A new contract will be in place for 2014/15 to include a number of agreed approaches
to improving models of care.
 Community Nursing review underway.
 Central London Community Healthcare agreed to adopt an IT single system.
 A programme to oversee delivery of the improvement plan has been established which
reports to the CLCH contract performance committee.
 CLCH have agreed with the principle that we pass day to day management of
community nurses to GP localities.
Assurances: (How do we know if the things we are doing are having an impact?)
 Quality and Performance report.
 Feedback from CCG Chairs, Governing Bodies, members and patients.
Current performance: (With these actions taken, how serious is the problem?)
11
Rationale for current score:
Delivery of Out of Hospital strategy is dependent on the community nursing
model being implemented. Plans in place reduce the risk score achievement
of milestones but improved outcomes need to be seen before the risk can be
reduced.
Rationale for risk appetite:
Successful design and implementation will potentially deliver improvements
to patient experience and outcomes.
Mitigating actions: (What more should we do?):
Expansion of use of common IT system across multiple
community services in tri-Borough CCGs
Service Delivery Improvement Plan to be agreed
Dec 14
MB
June
14
MB
Gaps in assurance: (What additional assurances should we seek?)

To be confirmed based on implementation of 2014/15 contact.
Additional Comments
9
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Managing Director, Ealing
Risk: Inability of West London Mental Health Trust to deliver services to agreed standard and to deliver
elements of the out of hospital strategy
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 3 x 4 = 12
Appetite: 2 x 4 = 8
Risk
Appetite
Rationale for current score:
West London Mental Health Trust has a significant role to play in the
successful delivery of out of hospital strategy. Agreement of priorities
reduced the risk score in May.
Rationale for risk appetite:
Measures are being put in place aiming to reduce the likelihood of problems
with service levels.
Controls: (What are we currently doing about the risk?)
 Transformation Board is in place and co-chaired by a Hounslow GP Governing Body
Member and West London Mental Health Trust Medical Director. Board has agreed
priorities including psychiatric liaison and shifting settings of care.
Mitigating actions: (What more should we do?):
Assurances: (How do we know if the things we are doing are having an impact?)
 Updates and mental health issues presented to governing bodies by the lead
commissioner.
Current performance: (With these actions taken, how serious is the problem?)
Gaps in assurance: (What additional assurances should we seek?)
 Structured and systematic reporting process not in place. Concerns
about the ability of WLMHT management to deliver actions.
Additional Comments
Action plan to be developed.
Jun 14
KM
10
12
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Securing high quality services and improved outcomes for patients
Director lead: Managing Director, West London
Risk: Inability of Central & North West London Trust to deliver services to agreed standard and to deliver
elements of the out of hospital strategy
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 5 x 4 = 20
Current: 5 x 4 = 20
Appetite: 2 x 4 = 8
Risk
Appetite
Controls: (What are we currently doing about the risk?)
 Contract review meetings
 Quality Improvement Group established in responses to CQC conditions
 Clinical Quality Group
 NHS England Clinical Quality Summit with CCG input
Rationale for current score:
There are serious concerns that the quality of services provided by the Trust
is currently not meeting expectations as evidenced by the Care Quality
Commission reviews and Monitor investigation.
Rationale for risk appetite:
Measures are being put in place aiming to reduce likelihood of problems
with service levels.
Mitigating actions: (What more should we do?):
Continue to work through the Account Manager and the CSU
to drive improvements
Continued leadership of QIG
Review communication flow between CQG/CCG Quality
meeting
CQG focussing on how the new CQC regime will operate to
understand provider and commissioner responses
On-going
LP
On-going
LP
June 2014
LP
CQG
Assurances: (How do we know if the things we are doing are having an impact?)
Gaps in assurance: (What additional assurances should we seek?)
 Quality & Performance reports to Committees and Governing Bodies
 Quality and Finance & Performance Committee report into Governing Bodies
 Updates on action plans and accelerated service improvement plans to Quality Improvement
Group and CQG
 Reports to Care Quality Group
 Draft 2014/15 Quality Accounts, presented to West London CCG Quality, Patient
Safety & Risk Committee in April 2014, did not demonstrate how the trust would
be responding to CQC conditions
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments
 In April 2014, Monitor announced it has launched an investigation into the way Central North
West London NHS Foundation Trust is run.
 Given the expansion to provide services at Milton Keynes and the current two enforcement
notices, concerns remain.
13
 Greater input to North West London Mental Health Transformation Programme
Board
11
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Putting in place the infrastructure to deliver high quality commissioning.
Director lead: Chief Officer
Risk: Failure to put systems in place to deliver improvements in commissioning support
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 5 x 4 = 20
Current: 4 x 4 = 16
Appetite: 2 x 3 = 6
Risk
Appetite
Controls: (What are we currently doing about the risk?)
Rationale for current score:
A decision has been taken to change how commissioning support is secured
and transition arrangements need to be put in place to achieve this. Risk
reduced followed approval from NHS England to in-house services.
Rationale for risk appetite:
Systems are being put in place to ensure that commissioning support
functions meet the needs of the CCGs more closely.
Mitigating actions: (What more should we do?):
 Joint approach agreed by all eight CCGs across North West London to in-house services.
 Business case produced and approved by NHS England to demonstrate how we can inhouse functions.
 Communications plan now in place.
 Paper on transition governance going to July Governing Body meetings.
Assurances: (How do we know if the things we are doing are having an impact?)
 NHS England have assured themselves that the business case is robust
 Reports to each governing body via Chair and Chief Officer at each meeting
Current performance: (With these actions taken, how serious is the problem?)
An engagement event for CSU staff took place on 23rd June.
New structures to be developed and being consulted on.
Describe the future governance arrangements for
overseeing the effectiveness of ‘in-housing’ of
commissioning support services
Jun/
July 14
BW
July 14
BW
Gaps in assurance: (What additional assurances should we seek?)

Regular updates are required on progress of the business case, plans to
operationalize it and any slippage in timeframes.
Additional Comments
14
12
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Putting in place the infrastructure to deliver high quality commissioning.
Director lead: Chief Officer
Risk: Not managing the relationship between CCGs and member practices effectively
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Risk
Appetite
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 5 = 20
Current: 4 x 5 = 20
Appetite: 2 x 5 = 10
Controls: (What are we currently doing about the risk?)
 Members meetings set up and in the diary
 meetings with LMC reps in place and LMC involvement in the CCG’s activities.
Mitigating actions: (What more should we do?):
Assurances: (How do we know if the things we are doing are having an impact?)


Rationale for current score:
Implementation of contracts to replace LESs, exploration of co-commissioning
primary care with NHS England and the development of networks to deliver
different services all carry a risk. A risk that is heightened given that we are a
membership organisation with GP practices as embers.
Rationale for risk appetite:
By engaging with our members and the LMC we aim to reduce the likelihood of
this risk materialising.
Implementing new contracts for out of hospital services
July 14
TSan
Bid for co-commissioning of primary care services to be
submitted to NHS England by 20 June
June 14
TSaw
Meeting being set up with the LMC to explore how we
can identify common goals and work together to achieve
them, particularly across the eight CCGs in NW London
Jul 14
BW
Implementing learning from the 360 degree stakeholder
survey results.
Sept 14
DE
Gaps in assurance: (What additional assurances should we seek?)
Need to strengthen reporting of member engagement and feedback to
governing bodies.
reports to governing bodies from members meetings.
360 degree stakeholder feedback survey
Current performance: (With these actions taken, how serious is the problem?)
Risk remains high at start of year as arrangements are being put in place.
Additional Comments:
15
13
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Building relationships with local authorities and Health and Wellbeing Boards to deliver the Better
Director lead: Chief Officer
Care Fund plan, and developing and delivering joint plans with other CCGs across North West London.
Risk: Lack of alignment between approaches taken by CCGs and Local Authorities means that the benefits set
out in the Better Care Fund workstreams are not realised and unmanageable cost pressures in 2015/16
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 5 x 4 = 20
Current: 5 x 4 = 20
Appetite: 2 x 4 = 8
Risk
Appetite
Controls: (What are we currently doing about the risk?)
Date last reviewed: May 2014
Rationale for current score:
Close working between CCGs and local authorities is increasingly important
to the achievement of CCG plans. The financial impact of the BCF is
significant, with around 3% of budget included within the BCF. If the
identified schemes do not generate savings within health and social care,
this will be unaffordable. There are a number of schemes that require work
to deliver and implement them and the governance of the Fund is complex.
Rationale for risk appetite:
By putting robust governance arrangements and joint plans in place the risks
can be minimised.
Mitigating actions: (What more should we do?):
 Health & Wellbeing Boards in place with representation from CCG Governing Body.
 Joint Health & Wellbeing Strategy has been agreed.
 Tri-Borough: Integration Partnership Board brings parties together to develop agreed approaches
and Joint Executive Team in place for each of tri-borough, Hounslow and Ealing.
 BCF has been agreed for each borough. Tri-borough, Hounslow and Ealing
 Project areas identified and leads assigned.
 Resource plans being put in place.
 Greater internal governance of the tri borough plan is being considered
 BCF plans rated as ‘green’ by NHS England
Confirm with accountable authorities how the BCF
contributes to the delivery of their corporate agendas, to
ensure commitment to the programme.
Jun 14
CA/MDs
Develop wider communications and engagement
programme to embed BCF in practice for both NHS and
Local Authorities, commissioners and providers, customers
and communities
Sept 14
CA/MDs
Further work in progress to revise Terms of Reference for
Health and Wellbeing Boards
Sept 14
CA/MDs
Develop project support to implement the programme
June 14
CA/MDs
Assurances: (How do we know if the things we are doing are having an impact?)
Reports on joint projects brought to governing body on an ad hoc basis.
Current performance: (With these actions taken, how serious is the problem?)
Gaps in assurance: (What additional assurances should we seek?)
Change of administration in Hammersmith & Fulham means new relationships need to be built.
Need to develop clear reporting lines to the Governing Bodies
On-going assurance that Health & Wellbeing Strategy is being implemented.
Additional Comments
16
14
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Delivering the Out of Hospital Strategy and acute hospital changes as set out in the Shaping a
Director lead: Chief Officer
Healthier Future Strategy.
Risk: Through unsustainable demand, uncontrolled delays to the delivery timelines and an inability to deliver
the required clinical workforce Shaping a Healthier Future delivers precipitate, poorly planned change, which
adversely impacts quality and safety
Rationale for current score:
25
20
15
10
5
0
This is one of the largest reconfigurations programmes in the country and is in the
initial phases of implementation.
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 3 x 4 = 12
Appetite: 2 x 4 = 8
Rationale for risk appetite:
Risk
Appetite
Controls: (What are we currently doing about the risk?)




Date last reviewed: May 2014
If these changes are delivered in an uncontrolled manner it will quickly impact
quality and safety of services across NWL
Mitigating actions: (What more should we do?):
Clinical Board - brings together all of NW London’s medical leaders to ensure transition is
being safely planned and managed and will coordinate collective action to address any
issues as required.
Monitoring - Clinical Board and Programme board continue to review monitor key metrics
on activity, quality and shape change.
Stakeholder Engagement – The Programme Board is engaging with the NTDA, NHSE and DH
capture all assurance requirements and ensure external support is maintained
Maternity Contingency Plan now in place.
Continue to review programme governance structures as we
progress through implementation
June 14
TSa
Central Middlesex and Hammersmith A&E Closure impact and
mitigating actions.
Sept 14
TSw
Assurances: (How do we know if the things we are doing are having an impact?)
 Implementations decisions are being monitored through a CCG assurance framework
Gaps in assurance: (What additional assurances should we seek?)
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments
 These will (if any) be identified through the external review that is underway
and managed through the programmes governance structures in place
The governance process in place is well supported by all organisations indicating all organisation are
working together to mitigate this risk. Dates have now been proposed for the closure of
Hammersmith and Central Middlesex A&E in September.
17
15
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Delivering the Out of Hospital Strategy and acute hospital changes as set out in the Shaping a
Director lead: Director of Strategy & Transformation
Healthier Future Strategy.
Risk: Through an inability to meet the clinical standards, deliver the requisite workforce, deliver behavioural
change, sustain expected patient experience and unsustainable demand on the system Shaping a Healthier
Future does not deliver the planned benefits to improve quality and safety of health and care across NW
London
Rationale for current score:
25
20
15
10
5
0
This is one of the largest reconfigurations programmes in the country and is in the
initial phases of implementation
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Date last reviewed: May 2014
Rationale for risk appetite:
Risk
Appetite
Controls: (What are we currently doing about the risk?)
If these changes are delivered in an uncontrolled manner it will quickly impact
quality and safety of services across NWL
Mitigating actions: (What more should we do?):
 Clinical standards were approved in the DMBC and all providers are now creating plans which
support the delivery of these standards
 Clinical Workforce – a steering group for the development of a NW London wide workforce has
been implemented, working with HE NWL. A baseline of all acute, community and primary care
workers has been defined.
 Unsustainable demand – All provider CIP and commissioner QIPP plans have been designed in
support of the activity shift and system wide shape change. A finance and activity modelling
group consisting of all commissioner and provider Finance Directors has been established to
ensure a common view for the creation of all business cases. A programme wide tracker to
review activity, quality and shape change is reviewed by the programme quarterly.
Assurances: (How do we know if the things we are doing are having an impact?)
 Benefits framework –DMBC included a benefits framework to ensure that the programme was
designed to deliver the specified benefits and this will continue to be reviewed
Current performance: (With these actions taken, how serious is the problem?)
 The programme is continuing to develop to deliver two services transitions this year and
complete the Outline Business Cases
18
Continue to review programme governance structures as we
progress through implementation
June 14
TSaw
Gaps in assurance: (What additional assurances should we seek?)
 These will (if any) be identified through the external review that is underway
and managed through the programmes governance structures in place
Additional Comments
16
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Delivering the Out of Hospital Strategy and acute hospital changes as set out in the Shaping a Healthier
Director lead: Managing Director for each CCG
Future Strategy.
Risk: Primary care and community care providers are not able (due to organisational and workforce issues)
to deliver the increase in activity required to deliver services as described in the Out of Hospital Strategy
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Controls: (What are we currently doing about the risk?)
 An approach Local Enhanced Services and Local Incentive Schemes
has been agreed.
 An application to the Prime Minister’s Challenge Fund has been
approved and forms part of a £10m investment across CWHHE CCGs.
 Whole systems strategy has been agreed.
 Network development programme in all CCGs underway
 IT investments underway
 Each CCG has an Out of Hospital Strategy and staff in post to deliver.
 Workforce strategy in the Shaping a Healthier Future programme
Risk
Appetite
Date last reviewed: May 2014
Rationale for current score:
Changes to Primary Care services are vital to the delivery of strategies but face
challenges to deliver.
Rationale for risk appetite:
By investing in Primary Care the risk of failure will be reduced.
Mitigating actions: (What more should we do?):
Service models and supporting infrastructure for 7-day access are being developed
14/15
TSaw
Services previously commissioned as Local Enhanced Schemes are being commissioned
July 2014
TSan
Need to define how we will work with NHSE to improve quality of primary care services
July 2014
DE
Sept 14
EY
Implement the recommendations of Community Services Review
We will review community services and commission in a different way so as to help
make roles more attractive and improve recruitment and retention of staff.
June
2014
EY
Setting up a new health education network.
July 2014
TSaw
Plan being developed to improve practice nursing
July 2014
JWeb
Assurances: (How do we know if the things we are doing are having an impact?)
Gaps in assurance: (What additional assurances should we seek?)
 We don’t have a mechanism for understanding the relative impacts of the
various schemes in place to develop primary care e.g. Prime Minister’s
Challenge Fund, whole systems integrated care, and network development.
 Out of Hospital group to monitor progress; minutes go to governing body meetings.
 Urgent care board minutes go to governing body meetings
 Shaping a Healthier Future delivery tracker
 Performance report showing progress with delivering local priorities
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments
Vacancies in key staff groups such as health visitors.
Productive General Practice programme being rolled out in Hounslow.
19
17
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Delivering our statutory and organisational duties
Director lead: Chief Information Officer
Risk: Failure to deliver IT systems which can deliver data CCGs need
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 2 x 4 = 8
Risk
Appetite
Controls: (What are we currently doing about the risk?)
 Collaborative Information Strategy & Information Governance committee in place and
meeting regularly.
 CQUIN agreed with Providers on the use of information.
Assurances: (How do we know if the things we are doing are having an impact?)
 Highlight reports to Information Strategy & Information Governance committee and by
exception to Governing Bodies.
Current performance: (With these actions taken, how serious is the problem?)
20
Rationale for current score:
There are a large number of stakeholders with varying priorities making
consensus difficult to achieve and not getting the required value from the
Hitachi contract for the data warehouse.
Rationale for risk appetite:
Information Strategy currently being developed with the aim of bringing
parties together and securing the data that the CCGs require.
Mitigating actions: (What more should we do?):
Agree Information Strategy
July 14
AG
June
14
BW
IT governance structure being strengthened
July 14
BW
Benefits realisation plan for SystmOne-Health being put
in place.
July 14
AG
SystmOne support team looking at use of strategic reporting
module to feed direct GP data to CSU to allow better reporting
on out of hospital contracts/ developments.
Sept
14
AG
Assurances being sought from GP practices and risk
stratification tool providers that data is being used safely
and lawfully to produce care plans
Gaps in assurance: (What additional assurances should we seek?)
Additional Comments
18
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Delivering our statutory and organisational duties
Director lead: Director of Compliance
Risk: Failure to operate in a way that meets required Information Governance standards
Date last reviewed: May 2014
25
20
15
10
5
0
Risk
Score
Risk
Appetite
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 3 x 4 = 12
Current: 3 x 4 = 12
Appetite: 2 x 4 = 8
Rationale for current score:
Failure in this area could lead to breach of legal requirements or reputational
damage. It could also lead to prevention of delivering strategic change e.g. risk
stratification for care planning.
Rationale for risk appetite:
Resources and procedures will be put in place to allow the risk to be properly
controlled.
Controls: (What are we currently doing about the risk?)




Mitigating actions: (What more should we do?):
Each CCG has a dedicated Information Governance lead. Information Governance NHS England reviewing a sample of Practice
working group is in place. Independent Information Governance advice contract in compliance
place.
Plan to be developed for increasing CCG compliance
Information Governance policies approved and circulated.
Training plan to be developed to ensure 100% staff
Information Strategy & Information Governance Committee in place to oversee IG compliance
compliance and progress.
All practices to become level 2 IG compliant. Memorandum of understanding near
finalisation. With regard to risk stratification, we are working with HSCIC and TPP to
get risk stratification incorporated within SystmOne as quickly as possible.
June 14
BW
June 14
BW
June 14
BW
Assurances: (How do we know if the things we are doing are having an impact?)
Gaps in assurance: (What additional assurances should we seek?)


Once the training plan is in place, will need updates
The CCGs have achieved level 2 against the Information Governance toolkit (v11).
Internal Audit Report produced (April 2014).
Current performance: (With these actions taken, how serious is the problem?)
Additional Comments:
21
19
CCG: BOARD ASSURANCE FRAMEWORK
Objective: Delivering our statutory and organisational duties
Director lead: Chief Finance Officer
Risk: Failure to meet in year financial targets and to deliver the planned underlying surplus that underpins longer term
financial sustainability
Date last reviewed: May 2014
Rationale for current score:
25
20
15
10
5
0
Risk
Score
Risk
Appetite
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Risk Rating
(likelihood x
consequence):
Initial: 4 x 4 = 16
Current: 4 x 4 = 16
Appetite: 1 x 4 = 4
Rationale for risk appetite:
By systematically identifying and addressing financial risks, we aim to reduce the
likelihood of problems occurring.
Controls: (What are we currently doing about the risk?)
Mitigating actions: (What more should we do?):

Budgets approved by governing bodies.

Contracts agreed with all but one key provider, with transformation outcomes explicit

Local CCG Finance & Performance committees are scrutinising finance reports and
monitor QIPP and investment plans.
Risk pooling across the CCG’s in CWHHE is in place.

The 5 CCGs have strong plans for 2014/15 and many in year risks have been mitigated by
the agreement of contracts with little or no activity related element. However, the focus
in year is on transformation of both acute and out of hospital services, through contracts
and the Better Care Fund, and delivering this transformation will be critical to ensuring
that the underlying surplus at the end of March 2015 is in line with plans and promotes
future financial sustainability. This requires whole systems working and is high risk.
Assurances: (How do we know if the things we are doing are having an impact?)
 Governing Bodies receive regular finance reports including investment and QIPP plans.
Audit committee receives reports from internal audit on the operation of system controls.
Current performance: (With these actions taken, how serious is the problem?)
Risk remains high at start of year as arrangements are being put into place.
Implement the agreed governance and oversight arrangements
with each provider to ensure joint working is delivered
June
2014
MDs
Increase reporting within the CCGs of the delivery against the
contract transformation elements
June
2014
OW
July 2014
MDs
Increase clinical leadership and support to transformation
programmes
Gaps in assurance: (What additional assurances should we seek?)
Need to strengthen the governance links from contract monitoring through
committees to the governing body.
Additional Comments:
NHS England have now asked the CCGs in North West London to increase
their surplus by £5, of which £3.1m is for CWHHE.
22
20
CCG: BOARD ASSURANCE FRAMEWORK
23
CCG: BOARD ASSURANCE FRAMEWORK
Risk Scoring Matrix
(Source – National Patient Safety Agency)
Consequence scores
Choose the most appropriate domain for the identified risk from the left hand side of the table Then work along the columns in same row to assess the severity
of the risk on the scale of 1 to 5 to determine the consequence score, which is the number given at the top of the column.
Consequence score (severity levels) and examples of descriptors
1
2
3
4
5
Domains
Negligible
Minor
Moderate
Major
Catastrophic
Impact on the
safety of patients,
staff or public
(physical/
psychological
harm)
Minimal injury
requiring
no/minimal
intervention or
treatment.
Minor injury or illness, requiring
minor intervention
Moderate injury requiring
professional intervention
Major injury leading to long-term
incapacity/disability
Incident leading to death
Requiring time off work for >3 days
Requiring time off work for 4-14
days
Requiring time off work for >14 days
Multiple permanent injuries or irreversible
health effects
Increase in length of hospital stay by >15
days
An event which impacts on a large number of
patients
No time off work
Increase in length of hospital stay
by 1-3 days
Increase in length of hospital stay
by 4-15 days
RIDDOR/agency reportable incident
Mismanagement of patient care with longterm effects
An event which impacts on a small
number of patients
Quality/complaint
s/ audit
Peripheral
element of
treatment or
service
suboptimal
Overall treatment or service
suboptimal
Treatment or service has
significantly reduced effectiveness
Non-compliance with national standards with
significant risk to patients if unresolved
Totally unacceptable level or quality of
treatment/service
Formal complaint (stage 1) / Local
resolution
Formal complaint (stage 2)
complaint
Multiple complaints/ independent review
Gross failure of patient safety if findings not
acted on
Informal
complaint/inquiry
Single failure to meet internal
standards
Local resolution (with potential to go
to independent review)
Minor implications for patient safety
if unresolved
Repeated failure to meet internal
standards
Reduced performance rating if
unresolved
Major patient safety implications if
findings are not acted on
Low performance rating
Inquest/ombudsman inquiry
Critical report
Gross failure to meet national standards
24
CCG: BOARD ASSURANCE FRAMEWORK
Human resources/
organisational
development/staff
ing/ competence
Statutory duty/
inspections
Adverse publicity/
reputation
Short-term low
staffing level that
temporarily
reduces service
quality (< 1 day)
No or minimal
impact or breech
of guidance/
statutory duty
Rumours
Potential for
public concern
Low staffing level that reduces the
service quality
Late delivery of key objective/
service due to lack of staff
Uncertain delivery of key objective/service
due to lack of staff
Non-delivery of key objective/service due to
lack of staff
Unsafe staffing level or competence
(>1 day)
Unsafe staffing level or competence (>5
days)
Ongoing unsafe staffing levels or competence
/ Loss of several key staff
Low staff morale / Poor staff
attendance for mandatory/key
training
Loss of key staff /Very low staff morale
No staff attending mandatory training /key
training on an ongoing basis
Breech of statutory legislation
Single breech in statutory duty
Reduced performance rating if
unresolved
Challenging external
recommendations/ improvement
notice
Local media coverage –
short-term reduction in public
confidence
Local media coverage –
long-term reduction in public
confidence
No staff attending mandatory/ key training
Enforcement action
Multiple breeches in statutory duty
Multiple breeches in statutory duty
Prosecution
Improvement notices
Complete systems change required
Low performance rating
Zero performance rating
Critical report
National media coverage with <3 days
service well below reasonable public
expectation
Severely critical report
National media coverage with >3 days service
well below reasonable public expectation. MP
concerned (questions in the House)
Total loss of public confidence
Elements of public expectation not
being met
Business
objectives/
projects
Finance including
claims
Service/ business
interruption
Environmental
impact
Insignificant cost
increase/
schedule slippage
Small loss Risk of
claim remote
Loss/interruption
of >1 hour/
Minimal or no
impact on the
environment
<5 per cent over project budget
5–10 per cent over project budget
Schedule slippage
Schedule slippage
Loss of 0.1–0.25 per cent of budget
Loss of 0.25–0.5 per cent of budget
Claim less than £10,000
Claim(s) between £10,000 and
£100,000
Non-compliance with national 10–25 per cent
over project budget
Incident leading >25 per cent over project
budget
Schedule slippage
Schedule slippage
Key objectives not met
Uncertain delivery of key objective/Loss of
0.5–1.0 per cent of budget
Key objectives not met
Non-delivery of key objective/ Loss of >1 per
cent of budget
Claim(s) between £100,000 and £1 million
Failure to meet specification/ slippage
Purchasers failing to pay on time
Loss of contract / payment by results
Loss/interruption of >8 hours
Loss/interruption of >1 day
Loss/interruption of >1 week
Claim(s) >£1 million
Permanent loss of service or facility
Minor impact on environment
Moderate impact on environment
Major impact on environment
Catastrophic impact on environment
25
CCG: BOARD ASSURANCE FRAMEWORK
Table 2 Likelihood score (L)
What is the likelihood of the consequence occurring?
used whenever it is possible to identify a frequency.
The frequency-based score is appropriate in most circumstances and is easier to identify. It should be
Likelihood score
1
2
3
4
5
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably
never happen/recur
Do not expect it to
happen/recur but it
is possible it may do
so
Might happen or
recur occasionally
Will probably
happen/recur but it
is not a persisting
issue
Will undoubtedly
happen/recur, possibly
frequently
How often might
it/does it happen
Table 3 Risk scoring = consequence x likelihood ( C x L )
Likelihood
Likelihood score
1
2
3
4
5
Rare
Unlikely
Possible
Likely
Almost certain
5 Catastrophic
5
10
15
20
25
4 Major
4
8
12
16
20
3 Moderate
3
6
9
12
15
2 Minor
2
4
6
8
10
1 Negligible
1
2
3
4
5
For grading risk, the scores obtained from the risk matrix are assigned grades as follows
1-3
Low risk
4-6
Moderate risk
8 - 12
High risk
15 - 25
Extreme risk
26