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
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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
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
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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
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
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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
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
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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
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
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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
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
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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
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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
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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
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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
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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
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