Final 19th March 2010
Annex 2: LDP Risk Narrative
Health Board: NHS GRAMPIAN
Use of Narrative
Boards should, as in previous years, use the LDP Risk Narrative to provide contextual information on key risks to delivery of each target and how risks are being managed. Within the template, the description of the key risk should be provided in the first column and detail on how the risk is being managed should be provided in the second column. Cross-reference to local plans should be made where necessary.
oDelivery: briefly highlight local issues and risks that may impact on the achievement of targets and/or the planned performance trajectories towards targets and how these risks will be managed.
oWorkforce: brief narrative on the workforce implications of each of the HEAT targets where appropriate and relevant. This should include an assessment of staff availability to deliver the target, the need for any training and development to ensure staff have the competency levels required, and consideration of affordability cross referenced to the Financial Plan.
oFinance: Where applicable boards should identify and explain any specific issues, e.g. cost pressures or financial dependencies specifically related to achieving the target. There is no need to repeat generic financial risks that apply to all targets.
oImprovement: Where applicable, boards should outline any risks to sustainable improvement, particularly in respect of their national improvement programmes and implementation of lean methodology, required to deliver and sustain targets and how these are being managed.
- Equalities: Where applicable, boards should outline any risks that the delivery of the target could create unequal health outcomes for the six equalities groups, and/or for people living in socio-economic disadvantage; and how these risks are being managed.
Health Improvement for the People of Scotland
Health ImprovementH3: Achieve agreed completion rates for child healthy weight intervention programme by 2010/11.
H4: Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11.
H5: Reduce suicide rate between 2002 and 2013 by 20%, supported by 50% of key frontline staff in mental health and substance misuse services, primary care, and accident and emergency being educated and trained in using suicide assessment tools/ suicide prevention training programmes by 2010.
H6: Through smoking cessation services, support 8% of your Board’s smoking population in successfully quitting (at one month post quit) over the period 2008/09–2010/11
H7: Increase the proportion of new-born children exclusively breastfed at 6–8 weeks from 26.6% in 2006/07 to 33.3% in 2010/11.
H8: Achieve agreed number of inequalities targeted cardiovascular Health Checks during 2010/11
H9: At least 60% of 3 and 4 year olds in each SIMD quintile to have fluoride varnishing twice a year by March 2014.
H3: Achieve agreed completion rates for child healthy weight intervention programme by 2010/11.
NHS BOARD LEAD: / Dr Lesley Wilkie, Director of Public HealthDelivery
Risk / Management of RiskClient identification:
Baseline data is available through routine assessment for Primary 1 only from 2009. No additional formal mechanisms exist for height and weight measurements for other age groups.
Children identified through referral mechanisms (particularly self referral) who are outwith the specified centile range may not receive an intervention.
The actual prevalence of child overweight is uncertain due to the lack of retrospective data. / The measurement programme will be extended to Primary 5 on a phased basis. Plans are being developedfor a Primary 7 pilot to link measurement with other measurement/survey activity within the School setting through theNational Dental Inspection Programmeto reduce the impact for schools and children. If successful this will be rolled out. Referral routes will be expanded to include health and other professionals and self referral. Referral pathways will be clarified through the development of Child Obesity Pathway.
Prevalence will be monitored from 2009.Work is underway with AberdeenUniversity to establish retrospective 20 year data for the prevalence of overweight in AberdeenCity and Aberdeenshire primary schools.
Level of client uptake, engagement and commitment to interventions. / We will ensure effective marketing, publicity and awareness-raising with both the target group, health professionals and voluntary and public sector partners. We will develop publicity materials (posters, generic publicity leaflet, pop up displays) to promote Eat Play and Grow Well (EPGW).
Additional activities will be undertaken (e.g. one off taster sessions) and delivery will be flexible to incentivise compliance with programme.
There will be proactive involvement with development of Health Scotland “Raising the Issue of Child Healthy Weight” training.
Activities to meet target place additional demands on all staff involved. There may be a lack of capacity to provide face to face engagement with clients prior to the programme. There is limited capacity to train and support the programme and ensure quality assurance of delivery. / We will recruit to dietetic and other public health posts with a specific remit for this work in line with current recruitment procedures.
We will strengthen partnership links with key professional groups and maximise available engagement mechanisms (e.g. quality of pre-engagement materials that are sent to families).
Knowledge and expertise of health and other professionals in this area may need development. / We will develop and deliver training. There will be proactive involvement with the development of Health Scotland “Raising the Issue of Child Healthy Weight” training.
There may be limited availability of suitable resources and supporting materials. / We will develop local resources for promotion and delivery of intervention and use Department of Health materials.We will Participate in the development of Health Scotland materials.
There is potential for a fragmented approach to delivery across our 3 Community Health Partnerships. / We will develop and maintain a Grampian-wide monitoring system.
Non-attainment of target overall due to low level of client uptake, engagement and commitment to interventions. / We are developing and implementing a diverse and tiered range of interventions in addition to the core evidence based programme. We anticipate that these interventions will increase the scale and pace of delivery during 2010/11. This work is being taken forward with support from both the Scottish Government and NHS Health Scotland.
Workforce
Risk / Management of RiskThere is limited capacity to provide support for the work involved in delivering this target. / Where appropriate we will reprioritise core staff time and use additional hours payments for permanent staff.We will recruit new staff to key posts with time dedicated to the target in line with current recruitment procedures.
There is limited capacity to develop interventions adhering to specific programme criteria.
The quality assurance of intervention content and delivery has yet to be determined – linked to lack of planning time and capacity. / Core intervention will be developed with additional hours that adheres to specified programme criteria. Complementary activities will be developed and existing activities used to supplement core intervention and achieve agreed outcomes.
Delivery of the target is reliant on partnership working at a time when budgets and staff are being reviewed in all organisations. / We will ensure continued communication and joint planninginternally and with community planningpartners and overall project monitoring.
Establishment of local data monitoring and collection mechanisms may take time and resources away from the delivery of the target interventions. / We will develop a simple database for monitoring and evaluation.
Finance
Risk / Management of RiskThere is uncertainty about ability to carry forward ring fenced funding which is essential for the achievement of the target. / We will continue to deliver dependent on carry forward of ring-fenced funding.
Delivery to small and likely dispersed population (particularly in Moray may not be cost effective / We will monitor and review unit costs on an ongoing basis
Improvement
Risk / Management of RiskIt may not be possible to sustain activities beyond the life of the target. Delivery of interventions rely on ring-fenced resource being available with lack of system capacity to mainstream this activity / We will work to gain support, agreement and protocols for a Child Obesity Pathway and to embed approaches through community planning partnership activities.
Equalities
Risk / Management of RiskThe opt in approach to participation in intervention could exacerbate rather than improve health inequalities. / We will take a proactive approach to co-delivery with Community Learning and Development in disadvantaged areas.
There may be Inequitable provision as a result of differing approaches to capacity and resource allocation within local Community Learning and Development services. / We will ensure continued communication and joint planning with Local Authority colleagues through the community planning process.
We will ensure a diverse approach to delivery of the interventions
Existing materials available in English have the potential to exclude minority ethnic groups (particularly Eastern European migrants). / We will carry out an Equality Impact Assessment and develop an action plan.
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Final 19th March 2010
H4: Achieve agreed number of screenings using the setting-appropriate screening tool and appropriate alcohol brief intervention, in line with SIGN 74 guidelines by 2010/11.
NHS BOARD LEAD: / Dr Lesley Wilkie, Director of Public HealthDelivery
Risk / Management of RiskFocus on the delivery of the Alcohol Brief Interventions (ABI) standard continues to be variable across the area. / We have identified ABI leads in each Community Health Partnership and within each priority area.
An ABI Co-ordinator has been recruited to increase the profile, focus and to support delivery within priority settings. We will continue to engage with Scottish Government on an ongoing basis on overall performance.
Accurate and timely reporting on quarterly basis to Scottish Government reflecting actual activity by each priority area in line with trajectory. / ABI Co-ordinator will work closely with ABI leads in each priority area, CHP and relevant others to ensure accurate activity is received ahead of submission. Performance will be overseen by Substance Misuse Group.
The recording method for Locally Enhance Service Contract inhibits the recording of data for ABI in General Practice. / The data collection method has been reviewed and amendments made to simplify current recording process. Retrospective data will continue to be collected through the Primary Care Contracts Team.
Implementation of data collection and recording methods for ABI in antenatal setting. / The data collection method has been reviewed and developed and is part of antenatal ABI training. Work has been undertaken to review retrospective activity to ensure this is accurate.
Recording of ABI delivery within the sexual health setting is dependent on an amendment to the current database. / Changes to current system have been agreed and the amended system is planned to be in place for 1stMarch 2010.
There is a requirement to ensure only activity by doctors, nurses and midwives are recorded for delivery of the target. / We will continue to reinforce the national criteria and undertake quality assurance checks to satisfy that data submitted meets criteria and does not include duplication of activity.
Patient intoxication in A&E making ABI inappropriate. / It has been agreed that the model of delivery for ABI within the A&E setting will be focussed within the A&E ward. Those individuals who attend the A&E department in ARI and who are intoxicated receive a ‘custody card’.
The development and implementation of two Alcohol Liaison Nurse posts will provide other opportunities for ABI for those admitted to hospital and referred by A&E.
There is effective joint working with Alcohol and Drug Partnerships (ADPs).
We will develop and implement client pathways in Moray.
Pressure of workload on doctors, nurses and midwivesprelude time to deliver ABI. / We will review and simplify pathway and tools to support staff in busy work environments where appropriate. The position will be monitored.
Workforce
Risk / Management of RiskStaff are available and able to participate in local ABI training / Training programmes have been condensed and designed to meet each priority area’s work capacity.Training programmes will be delivered at a time and location to fit priority area’s work capacity.
Champions in each area have/are being developed to encourage staff training as appropriate.
Backfill funding is available and prioritised, in order to release staff in the three priority areas so they can attend training.
Sufficient trained staff available to deliver target. / A full time ABI Co-ordinator has been recruited to co-ordinate and deliver training to the Grampian workforce.Six others are trained to deliver training to the Grampian workforce which includes antenatal and A&E. Plans are in place to ensure a number of trainers undergo the national A&E and antenatal training due to take place in spring 2010.
Securing staff engagement in delivering ABI. / We will incentivise practices through LES.
We will educate staff in the evidence of effectiveness of ABI in reducing alcohol consumption to encourage delivery and overall benefit for Grampian population.
Finance
Risk / Management of RiskAvailability of sufficient resource to deliver target number of interventions. / A budget of £125k per annum will be allocated from earmarked alcohol funding to cover ABI delivery in General Practice over 3 years.
Funding has also been provided to other priority areas to support backfill/capacity.
Unconfirmed resource for 2010/11 to deliver local training. / We will clarify with Health Scotland the allocated budget for 2010/11 to support training and revise plans accordingly for ABI Co-ordinator, backfill of trainers, administrative support, backfill of priority staff and associated training costs.
Availability of sufficient resource to meet demands of those individuals who require referral onto counselling/support services and specialist services. / Each of the three ADPs have been allocated funding to support the increase in service capacity required to meet the increased demand within their local areas.
Short-term funding of posts poses an increased risk for inappropriate completion and negates impact of projects. / We will confirm continuation of any posts and developments, based on appropriate evidence well in advance of termination date of posts.
Improvement
Risk / Management of RiskContinued development of IT systems for non-mandatory data collection and recording of ABI data set from Information Services Division. / We are assessing needs and options are under discussion.
Maintaining a pool of trained staff in areas of high turnover. / A training plan will be reviewed to address the training of new staff.
Impact of delivery of ABI is understood and is linked to the delivery of the HEAT A11 standard. / A Grampian Substance Misuse Performance Report is produced which incorporates both ABI activity, referral-on and alcohol waiting times for both NHS and non-NHS alcohol/substance misuse services. This information is used to support planning of the HEAT A11 standard.
Equalities
Risk / Management of RiskThere may be inequity in access as not all General Practices have signed-up to the Locally Enhanced Service. / Each CHP is developing alternative plans to support population/geographical reach. Some alternative models may not however be counted towards delivery of this target.
Areas have been identified where specific populations may benefit from ABI but do not generally access their General Practice or antenatal or A&E settings. / Alternative models for reaching specific populations who are at risk and would benefit from screening and ABI have been implemented. E.g. Sexual Health, Keep Well, Well North, Healthy Hoose, Homelessness Practice and the Grampian Pharmacy Pilot.
Inequitable access to NHS and non-NHS alcohol/substance misuse services is available across Grampian. / NHS Grampian continues to work closely with ADPs to review and ensure equitable access and outcomes to alcohol/substance misuse services for populations across Grampian, as part of the HEAT A11 and H4 standards.
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Final 19th March 2010
H5: Reduce suicide rate between 2002 and 2013 by 20%, supported by 50% of key frontline staff in mental health and substance misuse services, primary care, and accident and emergency being educated and trained in using suicide assessment tools/ suicide prevention training programmes by 2010.
NHS BOARD LEAD: / Mr Jack Stuart, General Manager, Aberdeenshire CHPDelivery
Risk / Management of RiskLow uptake of training by GPs impacting on delivery / We continue to be proactive in seeking attendance at training by an appropriate mix of professions.We have been able to release primary care nurses to attend Applied Suicide Intervention Skills Training (ASIST) and are confident the target for this staff group will be met.
We await the outcome for RCGP accreditation of STORM training. Once agreed we will engage with the GPs, with the support of their aligned multi-disciplinary mental health teams, by taking the training to them locally.
We will Meet with members of the National Choose Life Teamand with key primary care personnel to highlight the target and find local solutions, whilst learning from other Boards.
We will link training to Protected Learning Time
Workforce
Risk / Management of RiskStaff turnover, long term sickness and competing demands impacts on the availability of trainers / Training is an agreed priority for STORM trainers and we have employed two STORM trainers. The pool of ASIST trainers has increased to 12 across NHS Grampian from health, local authority and voluntary sector organisations.
Finance
Risk / Management of RiskGPs may require backfilling arrangements to attend training / Links are being made with protected learning time where appropriate. Course duration will be kept to minimum while still enabling learning and skills development. Where appropriate, links are being made to protected learning time, which is available for all primary care staff. Course duration will be re-examined in light of any prior learning agreement where appropriate.
Improvement
Risk / Management of RiskUnknown socio and economic factors may impact on suicide rates/attempts / We will continue to work closely with the three local Choose Life co-ordinators across Grampian to create preventative measures. Self Harm training has been rolled out with significant demand for places.
Equalities