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							NHS FORTH VALLEY                                                                                                                                                                                                          Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National Issues
                          Description                                        Quantification Impact Likelihood Risk Rating                                     Actions to manage financial risk
                                                                                £'000       of Risk  of Risk Product
National Policies and Strategies

Implications of review into free personal and                                    NYK          5      3        15            Lord Sutherland Review Report due March 2008
nursing care

Towards a Mentally Flourishing Scotland                                         under                                       Published November 2007
                                                                                review

National Strategy to tackle Alcohol Misuse                                        nyk                                       Publication Spring 2008

National Strategy and Delivery framework for Drugs                                nyk                                       Publication Spring 2008

Food and Health Delivery Plan                                                     nyk                                       Publication 2008

Getting it Right for Every Child                                                 under                                      Published 2007
                                                                                review

Updated National Maternity Policy                                                 nyk                                       Currently under review nationally

Mental Health of Children and Young People Framework for Promotion                 see                                      Timeframe by 2015 - local issues identified in later section
Prevention and Care                                                          local services

Delivering a Healthy Future : Action Framework for Children and Young              see                                      Published in 2007 - local issues identified in later section
People's Health in Scotland (2007)                                           local services

National Delivery Plan for Childrens Services                                     nyk                                       To be published in 2008

Task Force Report on Inequalities                                                 nyk                                       To be published in May 2008

Framework for Adult Rehabilitation                                                nyk                                       Clear Action Plan to be prepared by end of 2008 to identify how NHS Boards
                                                                                                                            can contribute

Better Together                                                                   nyk         1      1        1             Launched January 2008

Better Cancer Care                                                                                                          Report launched October 2008 : local Cancer Strategy Group reviewing
- Smoking Prevention Action Plan to be published                                  nyk         3      3        9
- Develop regional managed public health networks                                 nyk         1      1        1
- Potential Future screening programmes : Spiral CT screening in high risk       future       1      1        1
                                        ovarian screening                        future       1      1        1             Results from trial not expected until 2012
- Impact of genetics - re-cancer genetics service                                 nyk         1      1        1
- New cancer clinical standards to be published by QIS                            nyk         1      1        1             To be published during 2008
- improve rehabilitation for people with cancer                                   nyk         1      1        1

Managed Knowledge Network                                                         nyk                                       To be launched April 2008

National Health Information and Support Service                                   nyk                                       To be launched by April 2009

Carers Information Strategy                                                       265         4      3        12            Confirmation received of 3 year funding : confirmation required beyond 2011

National Palliative Care Plan                                                    under                                      Publication in October 2008 : under review by local Palliative Care Strategy Group
                                                                                review

Implications of Waste Management in NHSScotland                                  under        3      3        9             Published in 2007 : checking any implications
                                                                                review

Prison Health Advisory Board Report : health services transfer to health       awaiting       5      3        15            Transfer to health agreed but requires primary legislation change
                                                                                 info                                       Forth Valley higher number of prisons than population share : unmet need also risk
                                                                                                                            Well structured planning in advance of transfer will help to highlight issues and mitigate risk




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                                       1                                                                                                              8:12 PM11/24/2011
NHS FORTH VALLEY                                                                                                                                                                                     Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National Issues
                          Description                                  Quantification Impact Likelihood Risk Rating                                    Actions to manage financial risk
                                                                          £'000       of Risk  of Risk Product
Better Health Better Care

Cost of Independent Scrutiny                                               NYK           2     3        6             Under national debate

Elections to Health Boards                                                  266          4     2        8             Under national debate

Implications of Patient Bill of Rights                                     NYK           2     3        6

Integrated Resource Framework for CHPs                                      nyk          nyk   nyk     nyk            Para 1.3 but no further information provided - reference to Strategic
                                                                                                                      Partnership Group

Expansion of Managed Clinical Networks                                      nyk          nyk   nyk     nyk            Indicates national leadership and resource(?) for respiratory and
                                                                                                                      neurological conditions

Workforce Planning - new roles                                              nyk          nyk   nyk     nyk            Should be resourced from redesign
                                                                                                                      Examples given rehabilitation co-ordinators, physician assistants and
                                                                                                                      Assistant Practitioners in Child Health

Roll out of new approach to community nursing                               nyk          nyk   nyk     nyk            Awaiting results from Pilot Boards : Spring 2009 timeframe

Require NHS Boards to achieve the Investing in                              nyk          nyk   nyk     nyk            Guarantees a quality experience for volunteers
Volunteers Standard

2008 National Staff Survey                                                  n/a          1     1        1             Actioned

Ensuring progress towards Health and Homelessness standards                 nyk          nyk   nyk     nyk            To be reviewed

Evidenced based interventions for wellbeing of children in                  nyk          nyk   nyk     nyk            Summer 2009
deprived areas

Continue to implement Education (Additional Support for Learning)      within existing   3     3        9             recurrent resource provided once national non-recurrent resource ceased
(Scotland) Act 2004 - healthcare support for schools to be increased     resources                                    No further local funding will be provided : assume within existing resources
                                                                                                                      Spending review does not identify additional resource specifically for this

Abolition of Prescription Charges                                          £ 3m          5     2        10            Phased funding received in 2008/09 : await confirmation about future years

Meet the Health Needs of serving and former armed forces personnel        under          3     3        9             Need to assess likely demand beyond current levels
                                                                          review

NHS Boards to publish operational travel plans by April 2008                nyk          3     3        9

Healthcare Associated Infection - new priorities for action                 851          4     2        8             National funding available




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                                 2                                                                                               8:12 PM11/24/2011
NHS FORTH VALLEY                                                                                                                                                                                       Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National Issues
                          Description                         Quantification Impact Likelihood Risk Rating                                     Actions to manage financial risk
                                                                 £'000       of Risk  of Risk Product
Non-Recurrent Allocations

Eye Care - Adult Low Vision Clinic                                 20        1        4        4             Non-Recurrent Funding from SGHD - awaiting confirmation of Exit Strategy

Eye Care - Childrens Low Vision Clinic                             94        2        4        8             Non-Recurrent Funding from SGHD - awaiting confirmation of Exit Strategy

Palliative Care Model Schemes                                      25        1        1        1             Funding now received

Sexual Health Strategy                                            237        1        1        1             Funding now received

Audiology Services                                                 38        1        5        5             National funding distributed in 2007/08 was less than had previously been
                                                                                                             received : unless received choice will be to deduct from local service or seek
                                                                                                             funds from another source e.g. Access

Emergency Dental Service                                           88        2        1        2             Funds received non-recurrently - risk remains that in any particular year
                                                                                                             funding will be withdrawn. Board does not receive uplift funding so has to
                                                                                                             absorb costs

NSD Transfers : QMAS / ETB                                        125        3        5        15            No funding identified within Financial Plan : Funds top sliced from Boards
                                                                                                             but no permanent agreement to this : discussion on NSD efficiencies
                                                                                                             Solution - would have to find locally efficiency savings to fund - not subject to local
                                                                                                             scrutiny on same basis as other services




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                        3                                                                                                          8:12 PM11/24/2011
NHS FORTH VALLEY                                                                                                                                                                                         Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National Issues
                          Description                                    Quantification Impact Likelihood Risk Rating                                      Actions to manage financial risk
                                                                            £'000       of Risk  of Risk Product
HEAT Targets

Reduce mortality from Coronary Heart Disease among
under 75s in deprived areas

80% of all 3 to 5 year old children to be registered with
an NHS dentist by 2010/11

Achieve agreed completion rates for child healthy weight
programme by 2010/11

Achieve agreed number of screenings using the appropriate
screening tool and appropriate alcohol brief intervention
in line with SIGN 74 guidelines by 2010/11

Through smoking cessation services support 8% of each NHS
Board's smoking population in successfully quitting (at one month
post-quit) over the period 2008/09 - 2010/11

Reduce suicide rate between 2002 and 2013 by 20% supported by                                                           Assess funding required to release staff for training if beyond existing funds
50% of key frontline staff in mental health and substance misuse
being trained in using suicide assessment tools/suicide prevention
training programmes by 2010

Increase in the proportion of newborn children exclusively breastfed
at 6-8 weeks from 26.6% in 2006/07 to 33.3% in 2010/11

Achieve a sickness absence rate of 4% from March 2009                        under      5        5        25            Local assessment of opportunity and real cost to organisation of non-
                                                                            review                                      achievement of target to be completed

Meet national 2% cash efficiency target                                     £ 7m        5        5        25            Efficiency Plan under monthly review
                                                                          per annum                                     "Real" cash savings totalling £14.5m required by end of year 3

Improved efficiencies for first outpatient attendance DNA, non-routine       under                                      Efficiencies currently being quantified
inpatient average length of stay, review to new outpatient attendance     assessment
ratio and day case rate by March 2011

Ensure all employees covered by Agenda for Change have an agreed             N/A        1        4        4             Ability to confirm gateway progression
KSF personal development plan by March 2009

Universal utilisation of CHI                                                 N/A        1        1        1             No financial risk - operational efficiency risk

Increase percentage of new GP outpatient referrals into consultant-led       N/A        1        1        1             No financial risk - operational efficiency risk
secondary care services that are triaged online for clinical priority
and appropriate recipient service to 90% from December 2010

Scottish Ambulance Service to respond to 75% of Category A calls             nyk        3        3        9             May be local issues regarding ambulance turnaround time - requires review
within 8 minutes from April 2009

Ensure that anyone contacting their GP Surgery has guaranteed                nyk        1        1        1             Currently achieved
access to a GP, Nurse or other healthcare professional within 48 hours




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                                   4                                                                                                 8:12 PM11/24/2011
NHS FORTH VALLEY                                                                                                                                                                                               Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National Issues
                          Description                                         Quantification Impact Likelihood Risk Rating                                     Actions to manage financial risk
                                                                                 £'000       of Risk  of Risk Product
HEAT Targets cntd
Maximum wait from urgent referral to treatment for all cancers is two             N/A        1        3        3             Currently achieved
months

No patient will wait longer than 15 weeks from GP referral to a first            £ 2.3m      5        5        25
outpatient appointment from 31 March 2009


No patient will wait longer than 15 weeks for inpatient or day case               inc in     5        5        25
treatment from 31 March 2009                                                  £ 2.3m above


No patients will wait for longer than 6 weeks for one of 8 key diagnostic         inc in     5        5        25
tests from 31 March 2009                                                      £ 2.3m above


Agree reductions in rates of attendances at A & E from 2006/07 to                no info     3        3        9
2010/11                                                                         available

No patient will wait for more than 4 hours from arrival to admission,             N/A        1        3        3             Currently achieved
discharge or transfer from accident and emergency treatment

Reduce proportion of older people (aged 65+) who are admitted as an               cost       3        3        9             In theory cost saving but given increasing population in particular elderly
emergency inpatient two or more times in a single year by 20%                   saving ?                                     will need to be tested in reality
compared with 2004/05 and reduce by 10% inpatient bed days for
people aged 65 or over by 2008

Achieve agreed reductions in rates of hospital admissions and bed days            cost       3        3        9             Test reality of potential cost implications during the next two years
of patients with primary diagnosis of COPD (Chronic Obstructive                 saving ?
Pulmonary Disease), Asthma, Diabetes or CHD from 2006/07 to 2010/11

Reduce the annual rate of defined daily dose per capita of anti-depressants      under       3        3        9             In theory cost saving but given increasing population will need to be tested
to zero by 2009/10 and put in place the required support framework to            review                                       in reality
achieve a 10% reduction in future years

Reduce the number of readmissions (within one year for those that have            N/A        1        1        1             Currently achieved
had a psychiatric hospital admission of over 7 days by 10% by end of
December 2009)

Achieve agreed improvements in the early diagnosis and management of               nyk       3        3        9             Awaiting information regarding improvements envisaged
patients with dementia by March 2011

Improvements in QIS (Quality Improvement Scotland) clinical governance           existing    2        2        4
and risk management standard                                                    resources

To reduce all staphylococcus aureus bacteraemia (including MRSA) by             £ 0.851m     4        2        8             National funding available - clarity about recurrent nature of funding required
30% by 2011                                                                      (in part)

Increase the level of older people with complex care needs receiving care          nyk       4        4        16            Experience to date with complex care suggests significant cost
at home

Improvement in the quality of health care experience                               nyk       1        1        1


New Target - 2009 onwards : patient experience                                    NYK        nyk     nyk      nyk




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                                        5                                                                                                  8:12 PM11/24/2011
NHS FORTH VALLEY                                                                                                                                                                                          Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National Issues
                          Description                               Quantification Impact Likelihood Risk Rating                                       Actions to manage financial risk
                                                                       £'000       of Risk  of Risk Product

Introduction of International Accountancy Standards                    under       5        3        15            Treasury announced delay in introduction for public sector until 2009/10
                                                                       review                                      Issues - re-statement of accounts : minimal financial impact
                                                                                                                          review of leases : under review
                                                                                                                          PFI/PPP Schemes - awaiting output if work commissioned from PWC


Arbuthnott Funding increase in timescale planned                       £ 1.7m      5        5        25            Previously received approximately £ 3m per annum for Arbuthnott
                                                                                                                   2008/09 received £ 1.27m with no indication of future years
                                                                                                                   Imperative for Healthcare Strategy implementation : given population increase FV
                                                                                                                   continues to fall further behind parity - efficiency impact therefore even greater
                                                                                                                   Assumed step-up of rate of implementation in 2011/12


New UK Emissions Standard                                               nyk        3        3        9             Scheduled for introduction in 2010 - impact as yet unknown but considerable
                                                                                                                   cost potential : confirm where risk lies re-new Acute Hospital

- Carbon Reduction Commitment Scheme                                    204        3        3        9             Notification received 22.7.08 : spend not included in Financial Plan
                                                                                                                   Funds could be refunded up to 90% dependent on performance within 12-18 months


VAT Bill for agency doctors - change in Treasury guidance               500        4        4        16            VAT to be paid on full cost of employing agency doctors and other medical professionals
                                                                                                                   Change in Treasury rule in March budget - applicable from 1.4.09 : under appeal with HMRC


Introduction of National Tariffs                                     in progress   3        1        3             Tariff likely to be focussed on benchmarking in future but final confirmation
                                                                                                                   awaited


Receipt of funding for accelerated depreciation /                       6342       5        4        20            Dependent on Treasury agreement : amount quoted year 1 only
impairments / loss on sales


Future years uplift lower than 3.15%                                    3146       5        5        25            Pay and Price increase exceeds uplift - cash efficiency required to meet gap
                                                                       per 1%


SEHD retention of Bellsdyke profit                                      7933       5        1        5             Confirmation in 2007 Annual Review Briefing
                                                                                                                   Funding included within NHS FV Financial Plan : estimated timescale only


Modernising Medical Careers

Junior Doctors - funding transfer expected from NES                     592        5        3        15            Verbal indication only from NES : also timescales may vary : National issue

Junior Doctors - removal expenses & excess travel                    £ 0.250m -    5        4        20            Final quantification under review
                                                                      £ 0.500m

NES : Use of ACT to fund travel and subsistence costs of students       tbc        3        3        9



Immunisation

Human Papilloma Virus (HPV)                                             300        3        1        3             Resourced within Financial Plan




     5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                               6                                                                                                       8:12 PM11/24/2011
NHS FORTH VALLEY                                                                                                                                                                                                    Annex 2
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
National and Regional Issues
                             Description                                   Quantification Impact Likelihood Risk Rating                                    Actions to manage financial risk
                                                                              £'000       of Risk  of Risk Product

National Services Division
- Recombinant Factor VII risk sharing

- Risk Sharing for High Cost Drugs                                             NYK        3        3        9             Risk Sharing agreed at Chief Executive Meeting 16.1.08 and reviewed 21.5.08 .
                                                                                                                          Chief Executives Meeting reviewing November 2008


- Transition to Digital Mammography                                                                                       See local issues : Imaging Section

- Usage of paediatric HDU                                                                                                 FV activity broadly comparable with Arbuthnott share : low risk at present

- Transport of critically injured children                                                                                Review scheduled Spring 2008.

- Proposed future funding arrangements for the procurement and financing        74        2        4        8             Proposal to be considered at August Chief Executive Meeting
  of plasma products                                                                                                      Proposal is that NSS transfer funding to Boards and charge on usage basis
                                                                                                                          National gap £ 1.4m at present. Whilst Boards can action future controls suggest that
                                                                                                                          response is that existing gap should not be transferred to Boards


Regional Planning

Eating Disorders : Inpatient Provision                                         NYK        3        4        12            NHS Forth Valley part of Option Appraisal Exercise within SEAT
                                                                                                                          Risk that outcome/future demand exceeds current cost
                                                                                                                          See Local Services : Mental Health Section

Increase in use of Children and Adolescent Mental Health Services                                                         SEAT : part of Sick Childrens Hospital reprovision : information on
                                                                                                                          consortium funding under review

Regional Forensic Unit for Learning Disabilities                                2         1        5        5             SEAT : Capital increase from £ 2.6m to £ 3.7m : work underway in Fife
                                                                                                                                to reduce capital costs and thereby reduce revenue impact

Bariatric Surgery                                                              nyk        3        3        9             SEAT : see Local Services : General Surgery Section
                                                                                                                                SEAT estimate £ 0.620m
West of Scotland - Gynaecology Cancer                                          171        3        4        12            Need to establish reasons for costs : what activity is transferring from local system
                                                                                                                          Need to transfer funding from local service to fund

Home Ventilation Service                                                       nyk        3        3        9             SEAT : review of service underway - outcome awaited

NHS Lothian SLA                                                                750        4        4        16            Significant increase in emergency cardiology activity
                                                                                                                          Under review as to impact on local service and potential to transfer funding

NHS Glasgow SLA                                                                238        3        5        15            Glasgow Costing information received early November : under local review

Introduction of Primary PCI                                                    up to      2        4        8             Cost of SEAT provision to be included in 2009/10 Financial Plan
                                                                                100

Wheelchair and Seating Services : Initial Agreement May 2008                   207        3        3        9             National Funding based on NRAC share £ 0.319m
                                                                                                                          West Initial Agreement FV 11% share of service based on population £ 0.526m
                                                                                                                          Risk that NRAC distribution versus West costs result in uneven distribution across West




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                                     7                                                                                                          8:12 PM11/24/2011
NHS FORTH VALLEY
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008

                                                 Description   Quantification Impact Likelihood Risk Rating                                      Actions to manage financial risk
                                                                  £'000       of Risk  of Risk Product
Pay Modernisation / Pay Awards

Pay Awards differ from 2.5%                                       956 per     4        3        12            Pay review Body Reports still awaited
                                                                0.5 percent

Agenda for Change Incremental Drift                                1352       5        5        25            Significant financial cost : monitor monthly - see workforce profile
                                                                                                              and turnover rate

New Dental Contract                                               as yet      3        3        9
                                                                 unknown


Equal Pay                                                         as yet      5        3        15            National Issue : Legal guidance : Unquantified Contingent Liability
                                                                 unknown


Energy Costs                                                     £1.266m      5        5        25            National utilities paper circulated 31 July 2008 identifying options
                                                                 full year                                    Public sector -wide contract from September 2009 for electricity and from March
                                                                                                              2010 for gas. Interim 1 year contract required for NHS : potential for 50% increase in cost
                                                                                                              Move to flexible contract also brings additional uncertainty. Limited mitigation available
                                                                                                              however need to stress energy awareness through the organisation

Healthcare Strategy
Fees and Project Team costs differ from budgeted amount            200        1        1        1             Currently under review

Stenhousemuir Health Centre                                        240        3        3        9             Impact of On Balance Sheet asset : potential cost if asset revalued
                                                                                                              Under review at present : impact 2009/10 - cover by capital charge increase

Prescribing
Changes to cost and volume projections                             1200       5        4        20            Cost and Volume increases reported

Top-slicing of Category M Savings                                  700        5        5        25            Savings of £ 54m top-sliced nationally

Impact of SMC recommendations exceed                             estimate     2        2        4             Current funding likely to be sufficient this financial year
funds available                                                  awaited

External Boards

High Cost / Low Volume cases including priority /                  358        4        3        12            Estimate if demand increases beyond funded levels
community                                                                                                     Need to ensure meeting existing protocols

Bids submitted without Exit Strategies

Asthma UK                                                                         3        3         9        2 year funding for childhood asthma project inc a part time paediatric nurse for G/mouth
                                                                                                              community : includes "case of need for continuing paediatric asthma nursing in FV"
                                                                                                              Funding not yet confirmed




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                           8                                                                                                  8:12 PM11/24/2011
NHS FORTH VALLEY
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008
Local
                          Description                         Quantification Impact Likelihood Risk Rating                                    Actions to manage financial risk
                                                                 £'000       of Risk  of Risk Product

Local Services
Women and Children

Reprovision of Childrens Hospitals in East and West               700        5        4        20            Clinical Work complete aligning FV Child Health sub specialties with East or
result in more repatriation / earlier repatriation to                                                        West - majority aligned with West / Yorkhill
local services                                                                                               Risk greater in East of re-patriation : funds should transfer accordingly but
                                                                                                             - need to ensure Regional Financial Plans fully take account of this

CAMHS - Staffing issues                                           under      4        5        20            Maternity Leave / sick leave in very small department already under pressure
                                                               assessment

Increase in number of HIV/AIDS patients                          under       2        3        6             Reported increase in number of patients. To be reviewed as part of Sexual Health
                                                                 review                                      Strategy Review

MHRA Laboratory Accreditation                                     100        2        4        8             Business Case reviewed by Strategic Planning Group February 2008
                                                                                                             Scoring and initial assessment to be considered at March Meeting


Local Services
Surgical

Staffing issues within critical care                              432        4        2        8


Oncology Nursing                                                   55        2        5        10            Posts approved within Acute Services and in post. No funding agreed

Prostate Cancer Nurse                                              40        1        5        5             Post funded by charity : Awaiting confirmed exit strategy from Department

Introduction of vacuupumps                                         50        1        5        5             Service change without assessment of likely implications
                                                                                                             Awaiting confirmation of action plan to address

Increase in oncology drugs                                         350       3        4        12            Plans on how to manage / identify change in service provision awaited
                                                                estimated

ENT Consultant retiral                                            under      3        3        9             No Case for replacement consultant yet received - to be approved by Executive
                                                                 review                                      Group.

Transitional Arrangement Savings                                  220        3        4        12            Recurrent Plans required

Local Services
Medicine, Emergency Care and Rehabilitation Unit

Rheumatology Nurse post                                            35        1        5        5             Post funded by drugs company - funding ceased 30.9.07
                                                                                                             Confirm Department's exit strategy

AHP Consultant                                                     50        1        5        5             Post funded by SGHD for 1 year (2006/07)
                                                                                                             Confirm Department's exit strategy

Smoking Cessation Service                                          60        2        3        6             Fixed term funding via Smoking Cessation Group : national funding
                                                                                                             confirmation awaited thereafter local group decision

Transitional Arrangements Savings                                 240        3        4        12            Recurrent Plans required




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                        9                                                                                         8:12 PM11/24/2011
NHS FORTH VALLEY
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008

                                                 Description              Quantification Impact Likelihood Risk Rating                                    Actions to manage financial risk
                                                                             £'000       of Risk  of Risk Product

Local Services
CHPs

Cessation of Big Lottery Funding for Stirling Healthy Living Centre       under review      2     5        10            Assessment over future funding in conjunction with Stirling Council
                                                                                                                         National funding of £ 2.5m available to sustain HLCs during 2008/09 until
                                                                                                                         local decisions about their future

Cessation of Jointly Funded Projects such as Changing Children Services        900          4     4        16            Awaiting final confirmation from Local Authorities : consider application of
and Delayed Discharges                                                                                                   resource transfer uplift


Local Services - Complex Care

SGHD intention to uprate care home payments                                    NYK          3     3        9             Notification within Spending Review of intention to uprate payment rates

SGHD - 2007/08 overspend less 2008/09 funding                                  100          2     4        8


Local Services - Corporate

Impact of non-domestic rates increases                                    under review      3     3        9             Non-Domestic rates inflation average of 4%

Water Rates increases                                                          NYK          3     3        9             Water rates increase estimated at 3.41%

Increase in cost of interpretation services                                     35          1     5        5             Joint contract with 3 Local Authorities : NHS Forth Valley usage has
                                                                                                                         increased substantially - increase charge confirmed as part of contract review

Procurement - transfer to National Distribution Centre                         150          3     4        12            Current price reduction estimated between 4% and 6% : 2009/10 Management
                                                                                                                         charge will increase from 2.75% to 9% - cost estimate under review

Renal Services
Ability to accommodate local service change                                  awaiting       1     3        3
within funds transferred from Glasgow                                     activity update

Increase in dialysis demand                                                   125           3     3        9             included in High cost / low volume estimates
                                                                           per annum




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                                   10                                                                                       8:12 PM11/24/2011
NHS FORTH VALLEY
FINANCIAL RISK ASSESSMENT 2008/09 - 2012/13 : December 2008

                                                 Description   Quantification Impact Likelihood Risk Rating                                     Actions to manage financial risk
                                                                  £'000       of Risk  of Risk Product
Waiting Times
Ability to meet waiting times plan in 2008/09                  full estimate    5      3        15            Sustainability Plan required : future year risk
                                                                  in plans


Revenue consequences of Primary Care                               under        3      3        9             Awaiting draft options around premises projects
Modernisation Programme contained within                          review

Information and Management Technology
Introduction of Picture Archiving and                               240         2      3        6             Invest to save scheme : checking if initial cost can be capitalised
Communications System                                                                                         Savings in future years : costing in progress

Additional Costs of implementing IM & T Strategy                    800         5      4        20            Estimated cost beyond that in Financial Plan : national discussion

Clinical and other Legal Claims

New Claims received                                            not quantified   5      2        10            Ongoing monitoring

Cancer Services
Increase in recruitment rate to clinical trials                not available    2      2        4

Activity impact of cancer awareness campaigns                  not available    2      2        4

Local impact of services transferring from Glasgow             under review     5      3        15            Under review

Revaluation/Capital Charges

Ensure capital charge position across the area is                  cost         3      3        9             Under review
resourced following the completion of the revaluation             neutral
exercise


Additional Time Out Allowance : Nursing                        under review     5      3        15            Under review




      5df6cbd3-905b-4b5e-a7d3-938cf7ca2c02.xls                                                        11                                                                            8:12 PM11/24/2011

						
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