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					                                                                                                                               NHS Haringey Board Assurance Framework

                              Risk                                                      Controls in Place                                   Sources of Assurance                       Gaps in control/assurances                                                                               Target Risk
                                                                                                                                                                                                                                                                                                                                Lead
                                                   Inherent Risk                                                    Current Risk                                                                                                            Risk Appetite and Actions                                              Goal
                                                                                                                                                                                                                                                                                                                               Director
No                  Description                   C    L    Total                 Description                     C     L    Total                  Description                                     Description                                                                             C      L    Total


1.1   Failure to address the major Public         4    4     16     • Operating plan (Commissioning Strategy      4    3     12      • Public health Targets reports go to PCT      • Immunisation: RIO transfer outside of PCT      RISK APETITE: TREAT                                    3      3      9      1 - Healthy   Susan Otiti
      Health and LAA targets will have                                    Plan -CSP) and most LCPs (care                             Board, Wellbeing Partnership Board, CEC and    control. IT training.                                                                                                       Communities
      adverse impact on the health                                                  pathways)                                        Commissioning Committee                        • Smoking: The database is not set up to         ACTIONS: Implementing key strategies and action
      inequalities agenda, organisational                            • Immunisation: All GP practices audited                        • Immunisations: Immunisation Performance      enable detailed monitioring/interrogation to     plans that will contribute towards the overall aim
      reputation and the outcome of WCC                                and immunisation action plan in place                         Groups, Imm and Vacc Committee in place        support service improvement (it iwas             of reducing health inequalities.
      and CAA. Priorities where risk has                                          and monitored.                                     and links to pan London IT forum. Regular      designed for the DH quarterly returns). The      • Immunisations actions: Strategic & Operational
      been highlighted includes:                                        • Sexual health/Chlamydia/Teenage                            meetings with performance colleagues. Ad       DH quarterly returns are sent to the DH by       Action Plan is being progressed with assistance
      National screening programmes                                     pregnancy: Revised action plan with                          hoc reports to the PCT Board.                  the providers. The PCT has no preview and        from NHS London. Monitoring the performance
      (cervical, breast and bowel)                                    strengthened focus informed by better                          • Sexual health/Chlamydia/Teenage              therefore no control of what data is sent and    improvement programme designed to support GP
      • immunisation                                                  data and evidence of what’s worked in                          pregnancy: Performance management and          when (to date this has not been an issue,        practices to deliver effective immunisation
      • sexual health/Chlamydia/teenage                               other boroughs (as advised by National                         progress report goes to the Sexual Health      but could bcome of concern in the future)        programmes. RiO implementation due Autumn 09.
      pregnancy                                                                   Support Team)                                      Partnership Board, Chlamydia Screening         • NHS health checks programme/CVD:               • Alcohol: Needs assessment to be updated
      • alcohol                                                     • Alcohol: An Alcohol Strategy is in place.                      Group, Teenage Pregnancy Board.                Currently, no Project management support.        • Smoking: Commissioning arrangements require
      • smoking cessation                                            A plan (developed from the Strategy) is                         • Alcohol: The Strategy is monitored by the    Further costs and activity modelling of the      review
      • NHS health checks programme/CVD                                          updated annuallly.                                  Alocohol Strategy Group (this is led by the    core programme and the impact on other           • NHS health checks programme/CVD:
                                                                     • Smoking cessation: SLAs witjh various                         Council - DAAT)                                services. Continued funding of LES for March     implementation of the NHS Health Checks
                                                                     providers are in place, based on the DH                         • Smoking: There aer monitoring meetings       2010/11                                          Programme in Haringey including the Locally
                                                                             10 high impact outcomes.                                with providers e.g. the Stop Smoking Service                                                    Enhanced Service
                                                                      • NHS health checks programme/CVD:                             and Innovision. Quality reportes are sent to
                                                                      Launch of the programme is imminent                            the DH quarterly.                                                                               CURRENT STATUS November 2009:
                                                                     subject to launch of the LES. The LES is                        • NHS health checks programme/CVD:                                                              • Immunisations: RiO implementation imminent. All
                                                                        accompanied by a detailed Standard                           vascular checks steering group accountable                                                      GP practices audited. All children with incomplete
                                                                     Operating Procedure (SOP) for Haringey                          to CEC. (Nominated PCT lead Dr Fiona Wright                                                     vaccinations are followed up. Immunisation action
                                                                                                                                     Associate Director of Public Health).                                                           plan in lace and monitored by NHS London.
                                                                                                                                     • All the above public health strands have                                                      • Sexual health/Chlamydia/Teenage pregnancy:
                                                                                                                                     strategies, action plans and performance                                                        Teenage Pregnancy strategy has been reviewed.
                                                                                                                                     returns attached.                                                                               Task and finish groups established to address data
                                                                                                                                     • NHS London monitors by receiving monthly                                                      and other issues. Sexual health needs assessment
                                                                                                                                     returns.                                                                                        completed.
                                                                                                                                                                                                                                     • Alcohol: The needs assessment is being
                                                                                                                                                                                                                                     updated and will be complete by the end
                                                                                                                                                                                                                                     of December 09.
                                                                                                                                                                                                                                     • Smoking: The commissioning arrangements
                                                                                                                                                                                                                                     are currently being reviewed and revised
                                                                                                                                                                                                                                     • NHS health checks programme/CVD:
                                                                                                                                                                                                                                     NHS Health Checks Programme Update
                                                                                                                                                                                                                                     to CEC November 2009. NHS Health checks
                                                                                                                                                                                                                                     is an agreed priority for NHS Haringey LES
                                                                                                                                                                                                                                     development. The LES has been developed
                                                                                                                                                                                                                                     and was discussed at the LMC 6th November.
                                                                                                                                                                                                                                     IT infrastructure for data collation, risk
                                                                                                                                                                                                                                     calculation and calling patients is being
                                                                                                                                                                                                                                     developed as a matter of urgency. A Standard
                                                                                                                                                                                                                                     Operating Procedure and Care Pathway to
                                                                                                                                                                                                                                     guide primary care delivery is in final draft.




1.2   The expected spread in pandemic flu         5    4     20     • Business continuity plans                   5    3     15      • Swine flu: Influenza Pandemic Committee      • Business continuity plans: Business            RISK APPETITE: TREAT                                   4      2      8      1 - Healthy   Susan Otiti
      will be a risk re capacity and resilience                     • Major incident plan                                            has been in place since February 2008.         continuity plans (directorates) are not all in                                                                              Communities
      of the organisation fails to support the                      • Flu and winter resilience planning and                         Updated detailed plan reflecting current       place and have not been signed off at Board      ACTIONS:
      current statutory, mandatory and                              response                                                         arrangements for Flu Response was              level                                            • Business continuity plans: Business continuity
      organisational requirements resulting                         • Sickness absence monitoring                                    submitted to Board in July 2009.               • Major incident plans: Major incident plans     plans to be signed off by the Board and made
      from competing financial issues and                           • Epidemiological reports                                        • Bronze and Silver flu pandemic meetings      (directorates) need review                       available on the intranet
      the impact on time resources of other                         • SITREP reports                                                 • Winter resilience operations meetings        • A coherent overarching plan is needed          • Major incident plans: to be reviewed and signed
      issues.                                                       • Emergency funding                                              • Directors group meetings                     pulling together the signed off directorate      off
                                                                                                                                                                                    plans                                            • Monitor increased H1N1 activity locally closely in
                                                                                                                                                                                                                                     order to implement business continuity/initiate
                                                                                                                                                                                                                                     trigger points.
                                                                                                                                                                                                                                     • Emergency planning Officer to be recruited to
                                                                                                                                                                                                                                     lead on the above.

                                                                                                                                                                                                                                     CURRENT STATUS November 2009:
                                                                                                                                                                                                                                     • Emergency Planning officer to take up post on
                                                                                                                                                                                                                                     16th November and the priority is to progress the
                                                                                                                                                                                                                                     completion, sign off and coordination of business
                                                                                                                                                                                                                                     continuity and major incident plans.




                                                                                                                                                          Page 1 of 14
                                                                                                                               NHS Haringey Board Assurance Framework

                             Risk                                                       Controls in Place                                    Sources of Assurance                        Gaps in control/assurances                                                                           Target Risk
                                                                                                                                                                                                                                                                                                                                  Lead
                                                  Inherent Risk                                                     Current Risk                                                                                                            Risk Appetite and Actions                                              Goal
                                                                                                                                                                                                                                                                                                                                 Director
No                 Description                   C    L    Total                  Description                     C     L    Total                    Description                                     Description                                                                         C      L    Total


1.1
2.1   Failure to address the major Public
                 have robust and well defined    4    4
                                                      3     16
                                                            12     • Operating plan (Commissioning Strategy
                                                                   Organisational development plan                4
                                                                                                                  3    3     12
                                                                                                                             9       • Public health Targets reports go to PCT
                                                                                                                                     APO diagnostics                                  • Immunisation: RIO transfer outsidefor a
                                                                                                                                                                                      Not all functions have been mapped of PCT       RISK APETITE: TREAT
                                                                                                                                                                                                                                           APPETITE: TREAT                                3
                                                                                                                                                                                                                                                                                          2      3
                                                                                                                                                                                                                                                                                                 2      9
                                                                                                                                                                                                                                                                                                        4       1 - Healthy     Susan Otiti
                                                                                                                                                                                                                                                                                                              5 - world class Arshiya Khan
      governance LAA targets willfor the
      Health and arrangements have                                        Plan -CSP) and most LCPs (care                             Board, Wellbeing Partnership Board, CEC and      control. IT training.
                                                                                                                                                                                      better fit with APO or NHSH.                                                                                             Communities
                                                                                                                                                                                                                                                                                                              primary care
      adverse impact APO into an
      transition of theon the healtharms                                            pathways)
                                                                   Joint provider board in shadow form with                          Commissioning Committee
                                                                                                                                     Transforming Community Services (TCS)            • Smoking: The database is not set up to        ACTIONS: Implementing key strategies and action
      inequalities agenda,will impact on
      length organisation organisational                            • Immunisation: All GP practices audited
                                                                   NEDs from the commissioning PCT                                   • Immunisations: Immunisation Performance
                                                                                                                                     scheduled monitoring by NHSL                     enable detailed monitioring/interrogation to    • Process will contribute towards the overall aim
                                                                                                                                                                                                                                      plans thatmapping and gap analysis to identify
      reputation and the outcome of WCC
      service provision, and may have                                 and immunisation action plan in place                          Groups, Imm and Vacc Committee in place          Not all functionsimprovement (it iwas
                                                                                                                                                                                      support service have been clearly divided or    of reducingeach organisation.
                                                                                                                                                                                                                                      best fit for health inequalities.
      and CAA. Priorities where
      financial and reputational risk has                                         and monitored.
                                                                   Audit & Governance Committee agenda                               and links to pan London PCT board
                                                                                                                                     Regular reporting to the IT forum. Regular       identified for the DH quarterly returns). The
                                                                                                                                                                                      designed       SLA arrangements.                  Immunisations actions: Strategic & Operational
                                                                                                                                                                                                                                      • Agree SLAs where required.
      been highlighted the PCT due to:
      consequences to includes:                                        • Sexual health/Chlamydia/Teenage
                                                                   split into APO and NHSH sections with the                         meetings with performance colleagues. Ad         DH quarterly returns are sent to the DH by      • Clear audit being progressed with assistance
                                                                                                                                                                                                                                      Action Plan isplan for APO.
      National screening programmes                                    pregnancy: Revised a Haringey NED
                                                                   APO section chaired by action plan with                           hoc reports to the PCT Board.                    Estates SLAs lacking. has no preview and
                                                                                                                                                                                      the providers. The PCT                          from NHS London. Monitoring the performance
      (cervical, breast and bowel)
      -Uncertainty of roles/functions                                 strengthened focus informed
                                                                   from the Joint provider board. by better                          • Sexual health/Chlamydia/Teenage                therefore no control of what data is sent and   CURRENT STATUS November 2009:to support GP
                                                                                                                                                                                                                                      improvement programme designed New Risk
      • immunisation
      Including duplication of roles in                               data and evidence of what’s worked in                          pregnancy: Performance management and            Finance and audit has not been an issue,
                                                                                                                                                                                      when (to date this activity has not been        practices to deliver effective immunisation
      • sexual health/Chlamydia/teenage
      HCS/Commissio ning PCT                                         other boroughs (as advised by National                          progress report goes to the Sexual Health        divided between theconcern in NHSH.
                                                                                                                                                                                      but could bcome of APO and the future)          programmes. RiO implementation due Autumn 09.
      pregnancy
      -Unclear SLAs                                                               Support Team)                                      Partnership Board, Chlamydia Screening           • NHS health checks programme/CVD:              • Alcohol: Needs assessment to be updated
      • alcohol
      - Weak governance structures in APO                           • Alcohol: An Alcohol Strategy is in place.                      Group, Teenage Pregnancy Board.                  Currently, no Project management support.       • Smoking: Commissioning arrangements require
      • smoking cessation
      and/or Commissioning PCT                                       A plan (developed from the Strategy) is                         • Alcohol: The Strategy is monitored by the      Further costs and activity modelling of the     review
      -Lack of Resource programme/CVD
      • NHS health checks                                                        updated annuallly.                                  Alocohol Strategy Group (this is led by the      core programme and the impact on other          • NHS health checks programme/CVD:
      -Unclear reporting/monitoring                                  • Smoking cessation: SLAs witjh various                         Council - DAAT)                                  services. Continued funding of LES for March    implementation of the NHS Health Checks
      processes                                                      providers are in place, based on the DH                         • Smoking: There aer monitoring meetings         2010/11                                         Programme in Haringey including the Locally
                                                                             10 high impact outcomes.                                with providers e.g. the Stop Smoking Service                                                     Enhanced Service
                                                                      • NHS health checks programme/CVD:                             and Innovision. Quality reportes are sent to
                                                                      Launch of the programme is imminent                            the DH quarterly.                                                                            CURRENT STATUS November 2009:
                                                                     subject to launch of the LES. The LES is                        • NHS health checks programme/CVD:                                                           • Immunisations: RiO implementation imminent. All
                                                                       accompanied by a detailed Standard                            vascular checks steering group accountable                                                   GP practices audited. All children with incomplete
                                                                    Operating Procedure (SOP) for Haringey                           to CEC. (Nominated PCT lead Dr Fiona Wright                                                  vaccinations are followed up. Immunisation action
                                                                                                                                     Associate Director of Public Health).                                                        plan in lace and monitored by NHS London.
                                                                                                                                     • All the above public health strands have                                                   • Sexual health/Chlamydia/Teenage pregnancy:
                                                                                                                                     strategies, action plans and performance                                                     Teenage Pregnancy strategy has been reviewed.
                                                                                                                                     returns attached.                                                                            Task and finish groups established to address data
                                                                                                                                     • NHS London monitors by receiving monthly                                                   and other issues. Sexual health needs assessment
2.2   The PCT does not have a clear and          5    4     20     Clinical quality monitoring meetings with      4    4     16      CQUINs agreed with NMUH
                                                                                                                                     returns.
                                                                                                                                                                                   Quality framework as required for WCC for      RISK APPETITE: TREAT
                                                                                                                                                                                                                                  completed.
                                                                                                                                                                                                                                                                                          3      3      6     5 - world class Arshiya Khan
      streamlined process for the                                  NMUH and GOSH in place.                                                                                         quality is not in place.                                                                                                   primary care
                                                                                                                                                                                                                                  • Alcohol: The needs assessment is being
      commissioning of high quality services                                                                                         Action plans from NMUH being monitored.                                                      ACTIONS:
                                                                                                                                                                                                                                  updated and will be complete by the end
                                                                                                                                                                                   Quality monitoring meetings only with NMUH • Develop and agree a quality framework in time
                                                                                                                                                                                                                                  of December 09.
                                                                   Director of Professional Standards                                                                              and GOSH.                                      for WCC assessments
                                                                                                                                                                                                                                  • Smoking: The commissioning arrangements
                                                                   recruited to the position                                                                                                                                      • Develop more robust quality assurance processes
                                                                                                                                                                                                                                  are currently being reviewed and revised
                                                                                                                                                                                   No quality schedule agreed with WIC, HCS, with NMUH and GOSH.
                                                                                                                                                                                                                                  • NHS health checks programme/CVD:
                                                                                                                                                                                   BEHMHT, GPs
                                                                                                                                                                                                                                  NHS Health Checks Programme Update
                                                                                                                                                                                                                                  • Agree quality schedules with other providers.
                                                                                                                                                                                                                                  to CEC November 2009. NHS Health checks
                                                                                                                                                                                                                                  • Quality reports to the board.
                                                                                                                                                                                                                                  is an agreed priority for NHS Haringey LES
                                                                                                                                                                                                                                  development. The LES has been developed
                                                                                                                                                                                                                                  CURRENT STATUS November 2009: New Risk
                                                                                                                                                                                                                                  and was discussed at the LMC 6th November.
                                                                                                                                                                                                                                  IT infrastructure for data collation, risk
                                                                                                                                                                                                                                  calculation and calling patients is being
                                                                                                                                                                                                                                  developed as a matter of urgency. A Standard
                                                                                                                                                                                                                                  Operating Procedure and Care Pathway to
2.3   Inadequate governance arrangements         4    4     16     Joint Committees of the PCTs in place.         3    3      9      • CQUINs driven by the Acute Commissioning Time lines are not adhered to.                    RISK APPETITE: TREAT
                                                                                                                                                                                                                                  guide primary care delivery is in final draft.
                                                                                                                                                                                                                                                                                          2      2      4     5 - world class Arshiya Khan
      with the Acute Commissioning Agency                                                                                            Agency agreed with acute providers and                                                                                                                                   primary care
      during the transition period will have                       Timelines for transition agreed.                                  commissioners.                                Lack of clarity on roles and responsibilities. ACTIONS:
      adverse impact on quality of care, the                                                                                         • Assurance and Governance Committee                                                         • Meetings with the governance and assurance
      validation process and budgetary                             External audit commissioned by NHS                                reporting to the Joint Committees of the PCTs Lack of clarity re performance and quality     lead at acute commissioning agency due in
      controls leading to poor patient                             Haringey to provide further assurance.                            established.                                  monitoring.                                    November 09
      experience, over payments, failure to                                                                                                                                                                                       • Handover to be completed by December 09
      meet agreed saving targets and failure                       Internal audit by BJ to take place during                                                                       Lack of properly developed and officially      •
      to plan properly for 2010/11                                 Oct 2009 – Feb 2010 to look into the gov                                                                        agreed and signed SLAs.                        CURRENT STATUS November 2009: New Risk
      commissioning cycle.                                         arrangements.




3.1   BAF 001.5: Failure to achieve good         3    3     9      The PCT has undertaken a GP patient            3    2      6      CQC results. Reports are taken to the CEC        NONE                                                                                                2      2      4     1,2,3,4 and 5   Duncan Stroud
      response rate to national survey on                          survey in 2009. The results are being                             and Commissioning Team. Commissioning                                                            RISK APPETITE: TREAT
      patient experience indicators leading                        analysed and compared. Reports based                              Committee for patient and public feedback
      to limited picture of patient experience                     on CQC data have gone to the Board in                             around commissioned services and Joint                                                           ACTIONS:
      of Haringey services. The risk is                            May and July 2009.                                                Provider Board in relation to specific patient                                                   • The PCT will undertake a new patient survey in
      damage to the TPCT's reputation and                                                                                            feedback about community services.                                                               January 2010
      not being able to demonstrate that                                                                                                                                                                                              • The PCT will work with Haringey LINks to agree
      local services meet patient needs.                                                                                                                                                                                              the questions for the survey

                                                                                                                                                                                                                                      CURRENT STATUS November 2009: Controls,
                                                                                                                                                                                                                                      assurances and actions updated




                                                                                                                                                            Page 2 of 14
                                                                                                                                 NHS Haringey Board Assurance Framework

                              Risk                                                        Controls in Place                                   Sources of Assurance                         Gaps in control/assurances                                                                              Target Risk
                                                                                                                                                                                                                                                                                                                                      Lead
                                                    Inherent Risk                                                     Current Risk                                                                                                             Risk Appetite and Actions                                               Goal
                                                                                                                                                                                                                                                                                                                                     Director
No                  Description                    C    L    Total                  Description                     C     L    Total                   Description                                      Description                                                                            C      L    Total


1.1
4.1           of address the major not
      Failure to new arrangements Public           4    4
                                                        3     16
                                                              12     • Operating plan (Commissioning Strategy
                                                                        SLA                                         4
                                                                                                                    3    3     12
                                                                                                                               9         Fortnightly steering group in go to PCTs
                                                                                                                                       • Public health Targets reports which PCT        • Immunisation: RIO transfer outside of PCT
                                                                                                                                                                                        NONE                                            RISK APETITE: TREAT
                                                                                                                                                                                                                                             APPETITE: TREAT                                   3      3
                                                                                                                                                                                                                                                                                                      2      9
                                                                                                                                                                                                                                                                                                             6       1 - Healthy     Susan Otiti
                                                                                                                                                                                                                                                                                                                   5 - World class Harry Turner &
      Health and LAA targets will have
      delivering required health outcomes as                         • SLAPlan -CSP) and most LCPs (care
                                                                             monitoring currently by PCTs                              Directors of Finance and Directors of CEC and
                                                                                                                                       Board, Wellbeing Partnership Board,              control. IT training.                                                                                                       Communities David Maloney
                                                                                                                                                                                                                                                                                                                   primary care
      adverse impact in the health
      a result of gaps on contracts as acute                         • Acute agency pathways) interim form,
                                                                                      currently in                                                      Committee
                                                                                                                                       Commissioning participate; led by Rachel         • Smoking: The database is not set up to        ACTIONS: Implementing key strategies and action
      inequalities agenda, organisational
      commissioning is transferred outside                            • Immunisation: All GP practices audited
                                                                     staffed mainly by existing PCT staff,                             • Immunisations: Immunisation Performance
                                                                                                                                       Tyndall, sector SRO.                             enable detailed monitioring/interrogation to    Development contribute towards staffing of
                                                                                                                                                                                                                                        plans that willof detailed plans for the overall aim
      the PCT. and the outcome of WCC
      reputation                                                        and immunisation action plan in
                                                                     ensuring continuity and knowledgeplace                            Groups, Imm and Vacc Committee in place
                                                                                                                                       • Commissioning Committee                        support service improvement (it iwas            permanent health inequalities.
                                                                                                                                                                                                                                        of reducing acute agency, with associated
      and CAA. Priorities where risk has                             transfer       and monitored.                                     and links to pan London IT forum. Regular        designed for the DH quarterly returns). The     • Immunisations actions: Strategic & Operational
                                                                                                                                                                                                                                        governance regime - Rachel Tyndall/Harry Turner
      been highlighted includes:                                         • Sexual health/Chlamydia/Teenage                             meetings with performance colleagues. Ad         DH quarterly returns are sent to the DH by      Action Plan is being progressed with assistance
      National screening programmes                                      pregnancy: Revised action plan with                           hoc reports to the PCT Board.                    the providers. The PCT has no preview and       from NHS STATUS November the performance
                                                                                                                                                                                                                                        CURRENT London. Monitoring 2009:
      (cervical, breast and bowel)                                      strengthened focus informed by better                          • Sexual health/Chlamydia/Teenage                therefore no control of what data is sent and   improvement programme designed to support GP
                                                                                                                                                                                                                                        • Acute Commissioning Agency is recruiting senior
      • immunisation                                                    data and evidence of what’s worked in                          pregnancy: Performance management and            when (to date this has not been an issue,       practices to deliver effective immunisation
                                                                                                                                                                                                                                        staff to address capacity issues that underpin this
      • sexual health/Chlamydia/teenage                                other boroughs (as advised by National                          progress report goes to the Sexual Health        but could bcome of concern in the future)       programmes. RiO implementation due Autumn 09.
                                                                                                                                                                                                                                        risk.
      pregnancy                                                                     Support Team)                                      Partnership Board, Chlamydia Screening           • NHS health checks programme/CVD:                Alcohol: Needs assessment to be updated
                                                                                                                                                                                                                                        • Corporate Finance Director is spending 2 days a
      • alcohol                                                       • Alcohol: An Alcohol Strategy is in place.                      Group, Teenage Pregnancy Board.                  Currently, no Project management support.       • Smoking: Commissioning arrangements require
                                                                                                                                                                                                                                        week until the end of Dec 09 to support the ACA
      • smoking cessation                                              A plan (developed from the Strategy) is                         • Alcohol: The Strategy is monitored by the      Further costs and activity modelling of the     review
      • NHS health checks programme/CVD                                           updated annuallly.                                   Alocohol Strategy Group (this is led by the      core programme and the impact on other          • NHS health checks programme/CVD:
                                                                       • Smoking cessation: SLAs witjh various                         Council - DAAT)                                  services. Continued funding of LES for March    implementation of the NHS Health Checks
4.2   Failure to break even (Finance).             4    3     12        Monthly are in place, based on the DH
                                                                     • providerscontract monitoring meetings        3    3      9      • Smoking: There aer CEC/Board with
                                                                                                                                       • Monthly reporting to monitoring meetings       2010/11
                                                                                                                                                                                        Lack of direct control over providers and       Programme in Haringey including the Locally            3      2      6     5 - World Class Harry Turner &
      Overspend will result in failure to meet                       with key10 high impact outcomes.
                                                                               providers to ensure enforcement                         with providers e.g. the Stop Smoking Service
                                                                                                                                       minutes of the committee.                        dependency on the effectiveness of the          Enhanced Service
                                                                                                                                                                                                                                        RISK APPETITE: TREAT                                                       Primary Care    David Maloney
      statutory duties, UoR score of 1, and                               NHS health checks programme/CVD:
                                                                     of•contract terms                                                 • Bi-monthly reporting reportes are sent to
                                                                                                                                       and Innovision. Qualityto the commissioning      Acute Commissioning Agency.
      qualified opinion from the auditors.                              Launch senior management imminent
                                                                     • Monthly of the programme is team                                the DH quarterly.
                                                                                                                                       Committee                                                                                        CURRENT STATUS November 2009:
                                                                                                                                                                                                                                        ACTIONS:
                                                                       subject financial of the LES. mitigating
                                                                     review ofto launch position andThe LES is                         • NHS health checks programme/CVD:
                                                                                                                                       • Internal review. Already had an internal                                                       • Immunisations: RiO implementation imminent. All
                                                                                                                                                                                                                                        • Demand management plans agreed with GPs
                                                                         accompanied by a detailed Standard
                                                                     actions                                                           vascular checks steering group accountable
                                                                                                                                       audit report and an External Audit is planned.                                                   GP practices audited. All children with incomplete
                                                                                                                                                                                                                                        and providers.
                                                                      Operating Procedure (SOP) for Haringey                           to CEC. (Nominated PCT lead Dr Fiona Wright                                                      vaccinationsSLA meetings up. Immunisation action
                                                                                                                                                                                                                                        • Quarterly are followed with Providers and
                                                                                                                                       Associate Director of Public Health).                                                            plan in lace and monitored by NHS London.
                                                                                                                                                                                                                                        quarterly performance meetings.
                                                                                                                                       • All the above public health strands have                                                       • Sexual health/Chlamydia/Teenage pregnancy:
                                                                                                                                                                                                                                        • This risk should be linked to a corresponding risk
                                                                                                                                       strategies, action plans and performance                                                         Teenage Pregnancy strategy has been reviewed.
                                                                                                                                                                                                                                        on the Agency’s BAF.
                                                                                                                                       returns attached.                                                                                Task and finish groups established to address data
                                                                                                                                       • NHS London monitors by receiving monthly                                                       CURRENT STATUS November 2009: assessment
                                                                                                                                                                                                                                        and other issues. Sexual health needs
                                                                                                                                       returns.                                                                                         completed.
                                                                                                                                                                                                                                        • NHS London has imposed an out-patients scale
                                                                                                                                                                                                                                        • Alcohol: The needs assessment is and hospitals
                                                                                                                                                                                                                                        back agreement between the PCTs being
                                                                                                                                                                                                                                        updated and Outpatients are by the end
                                                                                                                                                                                                                                        for this year. will be complete now being treated as
                                                                                                                                                                                                                                        of December 09.
                                                                                                                                                                                                                                        block contracts.
                                                                                                                                                                                                                                        • Currently The commissioning arrangements
                                                                                                                                                                                                                                        • Smoking: breaking even with assistance from the
                                                                                                                                                                                                                                        are currently being reviewed and revised
                                                                                                                                                                                                                                        scale back agreement.
                                                                                                                                                                                                                                        • NHS health checks programme/CVD:
                                                                                                                                                                                                                                        NHS Health Checks Programme Update
                                                                                                                                                                                                                                        to CEC November 2009. NHS Health checks
                                                                                                                                                                                                                                        is an agreed priority for NHS Haringey LES
4.3   Continued growth in acute activity/cost      5    4     20                                                    3    3      9      • GRIP                                           • Recent growth in acute activity and cost      RISK APPETITE: TREAT
                                                                                                                                                                                                                                        development. The LES has been developed                              6     5 - World Class Harry Turner &
      preventing investment in locality                              • CSP. NHS London will performance                                • Commissioning Committee                        has exceeded expectation                        and was discussed at the LMC 6th November.                                 Primary Care    David Maloney
      services. This risk is linked to risks 4.1                     manage the key indicators.                                        • CEC                                            • NCL Acute Agency is still in its infancy      ACTIONS:
                                                                                                                                                                                                                                        IT infrastructure for data collation, risk
      and 5.4 (the Director lead tbc)                                • CEC (clinical – demand management                               • PCT Board.                                                                                     • 5 year demand management strategy/plan
                                                                                                                                                                                                                                        calculation and calling patients is being
                                                                     and PBC) Commissioning Committee.                                 • NCL Acute Agency Board                                                                         developed as a matter of urgency. A Standard
                                                                     Within the CSP there are targets /                                • Within the CSP there are targets /                                                             Operating STATUS November 2009:
                                                                                                                                                                                                                                        CURRENT Procedure and Care Pathway to
                                                                     indicators.                                                       indicators.                                                                                      guide time secondment of is Corporate Finance
                                                                                                                                                                                                                                        • Part primary care deliverythein final draft.
                                                                     • Enforcement of acute SLAs including                                                                                                                              Director to the NCL Acute Commissioning Agency
                                                                     performance targets                                                                                                                                                • Liaison with NHS London to support/implement
                                                                     • Demand management strategy/plans                                                                                                                                 measures to mitigate this risk
                                                                     • Primary care development plans and
                                                                     agreed budget
                                                                     • NCL Acute Commissioning Agency local
                                                                     policies and procedures
                                                                     • NHS London local policies and
                                                                     procedures




5.1   Business interruption risk: Failure to       4    3     12     Commissioners Investment and Asset             3    3      9      • Board meeting                                  Local Commissioning Plan                        RISK APPETITE: TREAT                                   2      2      4     5 - World class James Slater
      identify location for Central                                  Management Strategy and Local                                     • Commissioning Committee                                                                                                                                                   primary care
      Neighbourhood Development Centre                               Commissioning Plan                                                • ELEVATE (Strategy Partnership Board)                                                           ACTIONS:
      (hub).                                                                                                                                                                                                                            Outcome of options appraisal will produce further
                                                                                                                                                                                                                                        actions

                                                                                                                                                                                                                                        CURRENT STATUS November 2009: Options
                                                                                                                                                                                                                                        appraisal underway




                                                                                                                                                             Page 3 of 14
                                                                                                                                 NHS Haringey Board Assurance Framework

                              Risk                                                        Controls in Place                                   Sources of Assurance                         Gaps in control/assurances                                                                              Target Risk
                                                                                                                                                                                                                                                                                                                                        Lead
                                                    Inherent Risk                                                     Current Risk                                                                                                              Risk Appetite and Actions                                               Goal
                                                                                                                                                                                                                                                                                                                                       Director
No                  Description                    C    L    Total                  Description                     C     L    Total                   Description                                      Description                                                                            C      L    Total


1.1
5.2   Failure to address the major Public
                 deliver locality plans on time.   4
                                                   5    4
                                                        3     16
                                                              15     • Operating plan (Commissioning Strategy
                                                                     Local Commissioning plan for West              4
                                                                                                                    3    3     12
                                                                                                                               9       • Public health Targets reports go to PCT
                                                                                                                                         GRIP                                           • Immunisation: RIO transfer outside of PCT
                                                                                                                                                                                        None                                             RISK APETITE: TREAT
                                                                                                                                                                                                                                              APPETITE: TREAT                                  3      3
                                                                                                                                                                                                                                                                                                      1      9
                                                                                                                                                                                                                                                                                                             3       1 - Healthy     Susan Otiti
                                                                                                                                                                                                                                                                                                                   5 - World class James Slater
      Health and LAA targets will have
      Impacting on WCC, reputation and                                      Plan reported to the LCPs (care
                                                                     Haringey, -CSP) and most Commissioning                            • Local Wellbeing Partnership Board, CEC and
                                                                                                                                       Board, Commissioning Plan Coordinating           control. IT training.                                                                                                       Communities
                                                                                                                                                                                                                                                                                                                   primary care
      businessimpact on the health
      adverse interruption (new for                                  Committee        pathways)                                        Commissioning Committee
                                                                                                                                       Group                                            • Smoking: The database is not set up to         ACTIONS: Implementing key strategies and action
      November agenda, organisational
      inequalities09)                                                 • Immunisation: All GP practices audited                           Commissioning Immunisation Performance
                                                                                                                                       • Immunisations: Committee                       enable detailed monitioring/interrogation to     Work that will contribute progress against plans
                                                                                                                                                                                                                                         plans to plan and monitortowards the overall aim
      reputation and the outcome of WCC                                 and immunisation action plan in place                          Groups, Imm and Vacc Committee in place          support service improvement (it iwas             of reducing health inequalities.
      and CAA. Priorities where risk has                                            and monitored.                                     and links to pan London IT forum. Regular        designed for the DH quarterly returns). The      • Immunisations actions: Strategic & Operational
                                                                                                                                                                                                                                         CURRENT STATUS November 2009: New risk, as
      been highlighted includes:                                         • Sexual health/Chlamydia/Teenage                             meetings with performance colleagues. Ad         DH quarterly returns are sent to the DH by       Action Plan is being progressed with assistance
                                                                                                                                                                                                                                         above
      National screening programmes                                      pregnancy: Revised action plan with                           hoc reports to the PCT Board.                    the providers. The PCT has no preview and        from NHS London. Monitoring the performance
      (cervical, breast and bowel)                                      strengthened focus informed by better                          • Sexual health/Chlamydia/Teenage                therefore no control of what data is sent and    improvement programme designed to support GP
      • immunisation                                                    data and evidence of what’s worked in                          pregnancy: Performance management and            when (to date this has not been an issue,        practices to deliver effective immunisation
      • sexual health/Chlamydia/teenage                                other boroughs (as advised by National                          progress report goes to the Sexual Health        but could bcome of concern in the future)        programmes. RiO implementation due Autumn 09.
5.3   Locality plans fail to deliver
      pregnancy
                                                   5    4     20     Local Commissioning plan for West
                                                                                    Support Team)
                                                                                                                    5    3     15      • GRIP
                                                                                                                                       Partnership Board, Chlamydia Screening
                                                                                                                                                                                        None
                                                                                                                                                                                        • NHS health checks programme/CVD:
                                                                                                                                                                                                                                         RISK APPETITE: TREAT
                                                                                                                                                                                                                                         • Alcohol: Needs assessment to be updated
                                                                                                                                                                                                                                                                                               3      2      6     5 - World class James Slater
      transformation and predicted savings                           Haringey, reported to the Commissioning                           • Commissioning Committee                                                                                                                                                   primary care
      • alcohol                                                       • Alcohol: An Alcohol Strategy is in place.                      Group, Teenage Pregnancy Board.                  Currently, no Project management support.        • Smoking: Commissioning arrangements require
      identified in the business case (the                           Committee                                                         • Board                                                                                           ACTIONS:
      • smoking cessation                                              A plan (developed from the Strategy) is                         • Alcohol: The Strategy is monitored by the      Further costs and activity modelling of the      review
      lead time is 1-5 years, the impact is                                                                                            • NCL reconfiguration programme                                                                   Plans are being developed that maps the way
      • NHS health checks programme/CVD                                            updated annuallly.                                  Alocohol Strategy Group (this is led by the      core programme and the impact on other           • NHS health checks programme/CVD:
      that the status quo is unaffordable)                                                                                                                                                                                               forward for gaps in services
                                                                       • Smoking cessation: SLAs witjh various                         Council - DAAT)                                  services. Continued funding of LES for March     implementation of the NHS Health Checks
      (new for November 09)
                                                                       providers are in place, based on the DH                         • Smoking: There aer monitoring meetings         2010/11                                          Programme in Haringey including the Locally
                                                                                                                                                                                                                                         CURRENT STATUS November 2009: New risk, as
                                                                               10 high impact outcomes.                                with providers e.g. the Stop Smoking Service                                                      Enhanced Service
                                                                                                                                                                                                                                         above
                                                                        • NHS health checks programme/CVD:                             and Innovision. Quality reportes are sent to
                                                                        Launch of the programme is imminent                            the DH quarterly.                                                                                 CURRENT STATUS November 2009:
                                                                       subject to launch of the LES. The LES is                        • NHS health checks programme/CVD:                                                                • Immunisations: RiO implementation imminent. All
                                                                         accompanied by a detailed Standard                            vascular checks steering group accountable                                                        GP practices audited. All children with incomplete
6.1   Safeguarding children: Failure to meet       5    4     20     • Assurance Framework For Safeguarding
                                                                      Operating Procedure (SOP) for Haringey
                                                                                                                    4    4     16      • JAR meetings / action plan
                                                                                                                                       to CEC. (Nominated PCT lead Dr Fiona Wright
                                                                                                                                                                                                                                         RISK APPETITE: TREAT
                                                                                                                                                                                                                                         vaccinations are followed up. Immunisation action
                                                                                                                                                                                                                                                                                               3      3      9     2 - Healthy      Julie Quinn
      the safeguarding children standards in                         Children                                                          • Health Leads meetings / action plan            • The number of actions still in progress. NB:                                                                             starts for all
                                                                                                                                       Associate Director of Public Health).                                                             plan in lace and monitored by NHS London.
      view of Haringey's accountability and                          • Safeguarding policies, procedures and                           • CEC (re: primary care and GP training)         This is a 3 year work programme and pace of      ACTIONS:                                                                  children and
                                                                                                                                       • All the above public health strands have                                                        • Sexual health/Chlamydia/Teenage pregnancy:
      responsibility as commissioner for                             training                                                          • SIG (re: serious incidents relating to         change is in line with progress against          • GOSH audit tool to be finalised (draft has been                         young people
                                                                                                                                       strategies, action plans and performance                                                          Teenage Pregnancy strategy has been reviewed.
      health in Haringey. This impacts on a                          • JAR action plan                                                 safeguarding children)                           actions.                                         piloted)                                                                  in Haringey
                                                                                                                                       returns attached.                                                                                 Task and finish groups established to address data
      range of statutory and inspection                              • Training figures                                                • Commissioning Committee (re: looked after      • CQC inspection and the interface with NHS      • Quality Framework in development
                                                                                                                                       • NHS London monitors by receiving monthly                                                        and other issues. Sexual health needs assessment
      requirements, quality and reputation.                                                                                            children and performance monitoring)             London has impacted on the PCT’s                 • Quality reports to go to the Board
                                                                                                                                       returns.                                                                                          completed.
                                                                                                                                       • Board reports                                  reputation. PCT has reduced confidence in        • Annual CEC reports to include safeguarding
                                                                                                                                                                                                                                         • Alcohol: The needs assessment is being
                                                                                                                                       • LSCB                                           ability to articulate progress in safeguarding   initiatives and assurances
                                                                                                                                                                                                                                         updated and will be complete by the end
                                                                                                                                       • NHS London                                     against unknown criteria and the lack off        • Balanced scorecard being populated to support
                                                                                                                                                                                                                                         of December 09.
                                                                                                                                       • CQC (re: registration, self-assessments etc)   accurate benchmarked standards from other        development of a dashboard
                                                                                                                                                                                                                                         • Smoking: The commissioning arrangements
                                                                                                                                                                                        services against which Haringey PCT is           • Outcomes to be agreed and included in the
                                                                                                                                                                                                                                         are currently being reviewed and revised
                                                                                                                                                                                        assessed. PCT is concerned that opportunity      scorecard for perf/quality monitoring
                                                                                                                                                                                                                                         • NHS health checks programme/CVD:
                                                                                                                                                                                        to demonstrate improvement may be limited        • Monthly core brief document to go to SMG
                                                                                                                                                                                                                                         NHS Health Checks Programme Update
                                                                                                                                                                                        as part of the forth coming CQC evaluation       • Interagency audit tool in development
                                                                                                                                                                                                                                         to CEC November 2009. NHS Health checks
                                                                                                                                                                                        making it more difficult for the CQC to
                                                                                                                                                                                                                                         is an agreed priority for NHS Haringey LES
                                                                                                                                                                                        recognise progress made by NHS Haringey          CURRENT STATUS November 2009:
                                                                                                                                                                                                                                         development. The LES has been developed
                                                                                                                                                                                        compared with national progress.                 • Of 77 action on the JAR action plan 44 have
                                                                                                                                                                                                                                         and was discussed at the LMC 6th November.
                                                                                                                                                                                                                                         been achieved with 9 on track for delivery.
                                                                                                                                                                                                                                         IT infrastructure for data collation, risk
                                                                                                                                                                                                                                         • All Haringey providers are declaring fully met on
                                                                                                                                                                                                                                         calculation and calling patients is being
                                                                                                                                                                                                                                         core standard 2.
                                                                                                                                                                                                                                         developed as a matter of urgency. A Standard
                                                                                                                                                                                                                                         • Senior clinical representation are now on all the
                                                                                                                                                                                                                                         Operating Procedure and Care Pathway to
                                                                                                                                                                                                                                         relevant safeguarding children sub-groups, to
                                                                                                                                                                                                                                         guide primary care delivery is in final draft.
                                                                                                                                                                                                                                         enable the PCT to track assurance from those
                                                                                                                                                                                                                                         work streams.
                                                                                                                                                                                                                                         • The PCT is working closely with the Local
                                                                                                                                                                                                                                         Authority, who is supportive of progress being
                                                                                                                                                                                                                                         made.
                                                                                                                                                                                                                                         • The CEO is working with NHS London to bolster
                                                                                                                                                                                                                                         confidence regarding the monitoring mechanisms
                                                                                                                                                                                                                                         at the PCT/SHA interface.




7.1   Failure to progress Mental Health            4    3     12     • Sector level reorganisation/North            3    3      9              • KPMG review (08/09) supports the       • Implementation group yet to be set up          RISK APPETITE: TREAT                                  3      2      6     3 - Good         Liz Rahim
      strategy and modernise mental health                           Central London sector review looking at                           strategy                                         • Strategy is in the process of being agreed                                                                               mental health
      services (relates to the overarching                           the mental health work stream                                     • Strategy has been through the Board            by the Borough (i.e. not agreed as yet).         ACTIONS:                                                                  and wellbeing
      and local borough strategy and                                 • Transition plan with the Trust                                  • Mental Health Partnership Board                                                                 • Implementation group is being set up                                    for all
      realignment of resources)                                                                                                        • Mental Health Executive
                                                                                                                                                                                                                                         CURRENT STATUS November 2009:
                                                                                                                                                                                                                                         Implementation group is being set up that will
                                                                                                                                                                                                                                         monitor progress against the strategy




                                                                                                                                                             Page 4 of 14
                                                                                                                               NHS Haringey Board Assurance Framework

                             Risk                                                      Controls in Place                                    Sources of Assurance                        Gaps in control/assurances                                                                            Target Risk
                                                                                                                                                                                                                                                                                                                                 Lead
                                                 Inherent Risk                                                      Current Risk                                                                                                           Risk Appetite and Actions                                              Goal
                                                                                                                                                                                                                                                                                                                                Director
No                 Description                  C    L    Total                  Description                      C     L    Total                   Description                                     Description                                                                          C      L    Total


1.1
7.2   Failure to address theof quality of
                 be assured major Public        4
                                                5    4     16
                                                           20     • Operating plan (Commissioning Strategy
                                                                     Contract monitoring                          4
                                                                                                                  5    3     12
                                                                                                                             15      • Public healthand discussion atgo to 2 Board
                                                                                                                                       Information Targets reports Part PCT          • Immunisation: RIO transfer outside of PCT
                                                                                                                                                                                     Quality issues surfaced via the CQC during a    RISK APETITE: TREAT
                                                                                                                                                                                                                                          APPETITE: TREAT                                 3      3      9       1 - Healthy LizSusan Otiti
                                                                                                                                                                                                                                                                                                              3 - Good          Rahim
      mental and LAA targetsin Haringey
      Health health services will have                                   Plan to invoke performance alert
                                                                  • Potential-CSP) and most LCPs (care                               Board, Wellbeing Partnership Board, CEC and
                                                                                                                                     meeting                                         control. IT training.
                                                                                                                                                                                     period of change within BEHMHT. It was not                                                                                Communities
                                                                                                                                                                                                                                                                                                              mental health
      resultingimpact on the health health
      adverse in suboptimal mental                                                  pathways)                                        • Monitoring at Committee
                                                                                                                                     Commissioning JCIGG                             possible to pick up the issues viaset up to
                                                                                                                                                                                     • Smoking: The database is not the usual        ACTIONS: Implementing key strategies and action                          and wellbeing
      well being agenda, organisational
      inequalitiesfor all. E.g. recent BEHMHT                      • Immunisation: All GP practices audited                          • Immunisations: Immunisation Performance
                                                                                                                                       CQC visits                                    enable detailed monitioring/interrogation to
                                                                                                                                                                                     contract monitoring mechanisms.                 plans that will contribute towards the overall aim
                                                                                                                                                                                                                                     • BEHMHT action plan                                                     for all
      reputation and the and the BEHMHT
      improvement noticeoutcome of WCC                               and immunisation action plan in place                           Groups, Imm and meetings
                                                                                                                                     • LR visits and SP Vacc Committee in place      support service improvement (it iwas            of reducing health inequalities.
      and CAA. Priorities where risk has
      response to it.                                                             and monitored.                                     and links to pan London IT forum. Regular       designed for the DH quarterly returns). The     • Immunisations actions: Strategic & Operational
                                                                                                                                                                                                                                     CURRENT STATUS November 2009: Action plan
      been highlighted includes:                                      • Sexual health/Chlamydia/Teenage                              meetings with performance colleagues. Ad        DH quarterly returns are sent to the DH by      being Plan is monitored at JCIGG and all actions
                                                                                                                                                                                                                                     Actionactively being progressed with assistance
      National screening programmes                                   pregnancy: Revised action plan with                            hoc reports to the PCT Board.                   the providers. The PCT has no preview and       from NHS London. Monitoring the performance
                                                                                                                                                                                                                                     are assigned as completed. The CQC is due to
      (cervical, breast and bowel)                                   strengthened focus informed by better                           • Sexual health/Chlamydia/Teenage               therefore no control of what data is sent and   revisit and confirm so thatdesigned to support GP
                                                                                                                                                                                                                                     improvement programme the Improvement Notice
      • immunisation                                                 data and evidence of what’s worked in                           pregnancy: Performance management and           when (to date this has not been an issue,       practices to deliver effective immunisation
                                                                                                                                                                                                                                     can be lifted.
      • sexual health/Chlamydia/teenage                             other boroughs (as advised by National                           progress report goes to the Sexual Health       but could bcome of concern in the future)       programmes. RiO implementation due Autumn 09.
      pregnancy                                                                   Support Team)                                      Partnership Board, Chlamydia Screening          • NHS health checks programme/CVD:              • Alcohol: Needs assessment to be updated
8.1   • alcohol achieve at a minimum, level
      Failure to                                5    4     20      • Alcohol: An Alcohol place
                                                                  • A tight process is in Strategy is in place.   5    3     15      Group, Teenage Pregnancy place
                                                                                                                                     • Board to Board session in Board.              Currently, no Project management support.
                                                                                                                                                                                     • Robust quality assurance mechanism for        • Smoking: Commissioning arrangements require
                                                                                                                                                                                                                                     RISK APPETITE: TREAT                                 5      2     10     4-preventing  Stephen Deitch
      • smoking cessation
      2 of the WCC requirements (new for                          • A plan (developed from the Strategy) is
                                                                     Project plan                                                      Commissioning support monitored
                                                                                                                                     • Alcohol: The Strategy isfor London by the     Further costs andsubmitted
                                                                                                                                                                                     documents to be activity modelling of the       review                                                                   and managing
      • NHS health checks programme/CVD
      November 09)                                                              updated annuallly.
                                                                  • Regular WCC coordinating group                                   Alocohol Strategy Group (this is led by the
                                                                                                                                     • NHS London stock take session                 • Coherent presentation impact on Haringey
                                                                                                                                                                                     core programme and theof the NHS other          • NHS health checks programme/CVD:
                                                                                                                                                                                                                                     ACTIONS:                                                                 long term
                                                                    • Smoking
                                                                  meetings cessation: SLAs witjh various                             Council - DAAT)                                 services. Continued funding of LES for March
                                                                                                                                                                                     story/golden thread                             implementation of the NHS Health Checks
                                                                                                                                                                                                                                     • Meetings every 2 weeks with the Sector                                 conditions in
                                                                  • providers are in place, based on the DH
                                                                     Board Development Programme                                     • Smoking: There aer monitoring meetings        2010/11 component of WCC not fully worked
                                                                                                                                                                                     • Sector                                        • Capacity gaps being addressed the Locally
                                                                                                                                                                                                                                     Programme in Haringey including by external                              adults
                                                                  • KPMG 10 high impact outcomes.
                                                                            enlisted to address capacity                             with providers e.g. the Stop Smoking Service    up                                              Enhanced Service
                                                                                                                                                                                                                                     consultancy
                                                                     • NHS
                                                                  issues health checks programme/CVD:                                and Innovision. Quality reportes are sent to                                                    • Weekly updates at GRIP and regular updates to
                                                                     Launch of the programme is imminent                             the DH quarterly.                                                                               CURRENT STATUS November 2009:
                                                                                                                                                                                                                                     the Board
                                                                    subject to launch of the LES. The LES is                         • NHS health checks programme/CVD:                                                              • Immunisations: RiO implementation imminent. All
                                                                                                                                                                                                                                       CSL used for QA
                                                                      accompanied by a detailed Standard                             vascular checks steering group accountable                                                      GP practices audited. All children with incomplete
                                                                   Operating Procedure (SOP) for Haringey                            to CEC. (Nominated PCT lead Dr Fiona Wright                                                     vaccinations are followed up. Immunisation action
                                                                                                                                                                                                                                     CURRENT STATUS November 2009: New risk, as
                                                                                                                                     Associate Director of Public Health).                                                           plan in lace and monitored by NHS London.
                                                                                                                                                                                                                                     above
                                                                                                                                     • All the above public health strands have                                                      • Sexual health/Chlamydia/Teenage pregnancy:
                                                                                                                                     strategies, action plans and performance                                                        Teenage Pregnancy strategy has been reviewed.
                                                                                                                                     returns attached.                                                                               Task and finish groups established to address data
                                                                                                                                     • NHS London monitors by receiving monthly                                                      and other issues. Sexual health needs assessment
                                                                                                                                     returns.                                                                                        completed.
                                                                                                                                                                                                                                     • Alcohol: The needs assessment is being
                                                                                                                                                                                                                                     updated and will be complete by the end
                                                                                                                                                                                                                                     of December 09.
                                                                                                                                                                                                                                     • Smoking: The commissioning arrangements
                                                                                                                                                                                                                                     are currently being reviewed and revised
                                                                                                                                                                                                                                     • NHS health checks programme/CVD:
                                                                                                                                                                                                                                     NHS Health Checks Programme Update
                                                                                                                                                                                                                                     to CEC November 2009. NHS Health checks
                                                                                                                                                                                                                                     is an agreed priority for NHS Haringey LES
                                                                                                                                                                                                                                     development. The LES has been developed
                                                                                                                                                                                                                                     and was discussed at the LMC 6th November.
                                                                                                                                                                                                                                     IT infrastructure for data collation, risk
                                                                                                                                                                                                                                     calculation and calling patients is being
                                                                                                                                                                                                                                     developed as a matter of urgency. A Standard
                                                                                                                                                                                                                                     Operating Procedure and Care Pathway to
                                                                                                                                                                                                                                     guide primary care delivery is in final draft.




                                                                                                                                                           Page 5 of 14
                                                                                                     NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




                             Risk                                                   Controls in Place                                Sources of Assurance                          Gaps in control/assurances
                                                                                                                                                                                                                                                                            Target Score                       Lead
                                            Inherent Risk                                                Current Score                                                                                                                      Actions                                             Goal
             Description                                                   Description                                                     Description                                     Description                                                                                                        Director
                                            C   L    Total                                               C   L    Total                                                                                                                                                 C      L    Total
BAF 003.1: Population of Haringey are       3   3      9     PPI Forum and CIDA involved in drawing      3   2      6     Consultation Group, Equality Impact          Yes, no external authority or mechanism for         Resources have been secured and              3      2      6     5 - World class Duncan Stroud
not aware of the PC Strategy and not                         up the EIA and key members on the EIA                        Assessment Panel and Group including PPI     verifying the process meets best practice in        additional support purchased via                                 primary care
fully engaged, the patients, public and                      panel. Overview and Scrutiny Committee.                      members. Consultation budget agreed,         terms of consultation, other than OSC               Stakeholder Project plan. A range of
stakeholders feel that there is lack of                      TPCT Board. Internal Audit report on PPI                     proactive work with Enfield Communications                                                       products and processes have been put in
consultation. RISK CLOSED.                                   in 2007provided assurances and                               team. 010909 update: NHS Haringey works                                                          place as well as running media campaigns
Superseded by the NDPs                                       Partnerships Internal Audit report                           closely with the OSC to ensure that the PCT                                                      in September through to March. A
                                                             undertaken in 2007. Copies available.                        follows correct consultation and substantial                                                     stakeholder engagement strategy is being
                                                                                                                          variations guidance. as managed by the                                                           produced and new investment identified for
                                                                                                                          Centre for Public Scrutiny. We also work                                                         2008/09 with new publicity materials ,
                                                                                                                          closely with LINKs to ensure that key                                                            community survey, employing Health Link
                                                                                                                          messages around consultation are followed                                                        for Hornsey etc.      CURRENT STATUS
                                                                                                                          through and policies adhered to. We are open                                                     November 2009: Closed
                                                                                                                          to audit by LINKs.




BAF 007.1: Financial risks around loss      5   4     20     Reports and financial analysis to the       3   2      6     Financial Planning Process , projections and      Analysis not complete                          Changed from 20 to 12 - Analysis             3      2      6     5 - World class James Slater
of revenue due to delay in opening of                        Commissioning committee                                      financial analysis                                                                               underway. CURRENT STATUS November                                primary care
Hornsey Central. RISK CLOSED.                                                                                                                                                                                              2009: Closed
Hornsey Central now open




BAF 001.5: Failure to achieve good          3   3      9     The PCT has undertaken a GP patient         3   2      6     CQC results. Reports are taken to the CEC         NONE                                                                                        2      2      4     1,2,3,4 and 5   Duncan Stroud
response rate to national survey on                          survey in 2009. The results are being                        and Commissioning Team. Commissioning                                                            RISK APPETITE: TREAT
patient experience indicators leading                        analysed and compared. Reports based                         Committee for patient and public feedback
to limited picture of patient experience                     on CQC data have gone to the Board in                        around commissioned services and Joint                                                           ACTIONS:
of Haringey services. The risk is                            May and July 2009.                                           Provider Board in relation to specific patient                                                   • The PCT will undertake a new patient
damage to the TPCT's reputation and                                                                                       feedback about community services.                                                               survey in January 2010
not being able to demonstrate that                                                                                                                                                                                         • The PCT will work with Haringey LINks to
local services meet patient needs.                                                                                                                                                                                         agree the questions for the survey
RISK CLOSED as not perceived to
be any different from any other                                                                                                                                                                                            CURRENT STATUS November 2009: Closed
organisation - risk out of our
direct control to manage.


Lack of capacity across the joint           3   3     9      • Adult MH targets: update with Suicide,    2   2      4     • Mental Health Executive (joint health, social   • Partnership arrangements are being           RISK APPETITE: TREAT                         2      2      4     3 - Good        Liz Rahim
commissioning of mental health                               Drug misusers, indicators drug users                         services forum). Dates?                           reviewed.                                                                                                       mental health
services and therefore failure to deliver                    within treatment (AMBER) and drug users                      • Quarterly performance meetings with the         • 3 Borough SLA management needs tighter       ACTIONS:                                                         and wellbeing
improvement across the system.                               sustained in treatment (RED) . CAMHs                         mental health trust, Dates?                       focus. Feeds into the Performance              • Will to be reviewing commissioning                             for all
COMPLETED AND CLOSED ALL                                     collect once a year (GREEN), Crisis                          • Three borough SLA meetings. Dates?              Committee and reports to the Board. The        arrangements and considering alternative
MONITORING MEETINGS ARE IN                                   Resolution (AMBER),                                                                                            mental health executive feeds into the Well-   providers
PLACE                                                        • Older People Mental Health collected                                                                         being Partnership Board and through to         • Well be undertaking some work around
                                                             once a year, TBC.                                                                                              HSP.                                           patient satisfaction with mental health
                                                                                                                                                                                                                           services in primary and secondary care.
                                                                                                                                                                                                                           • Action plan in progress.

                                                                                                                                                                                                                           CURRENT STATUS November 2009: closed




                                                                                                                                                        Page 6 of 15
                                                                                                  NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




                             Risk                                                  Controls in Place                               Sources of Assurance                       Gaps in control/assurances
                                                                                                                                                                                                                                                                          Target Score                       Lead
                                           Inherent Risk                                               Current Score                                                                                                                     Actions                                              Goal
             Description                                                  Description                                                    Description                                   Description                                                                                                          Director
                                           C   L    Total                                              C   L    Total                                                                                                                                                 C      L    Total
As a result of existing MH resources       3   3     9      • CPA 7 day follow-up (green)              3   3      9     • Mental Health Executive (joint health, social Specific elements within SLA (see controls     RISK APPETITE: TREAT                           3      3      9     3 - Good        Liz Rahim
tied up in services challenging re-                         • Crisis resolution (red)                                   services forum)                                 section)                                                                                                          mental health
commissioning agenda, moving                                • Mental Health Executive (joint health,                    • 3 borough service agreement in place with                                                    ACTIONS:                                                           and wellbeing
inpatient to community based services.                      social services forum)                                      specific commissioning intentions for HTPCT                                                    • Action plan in progress.( Provide overview                       for all
CLOSED. CONSOLIDATED WITH                                                                                               across all care groups. Where and when is                                                      of key actions)
FAILURE TO PROGRESS MH                                                                                                  this monitored?
STRATEGY RISK                                                                                                           • There are specific elements in the SLA for                                                   CURRENT STATUS November 2009: Closed
                                                                                                                        Haringey to achieve these targets. Where
                                                                                                                        and when is this monitored?

                                                                                                                        • quarterly performance meetings with MH



Failure to meet Maternity scoring in       3   4     12     Tbc                                        3   2      6     Tbc                                            Tbc                                             CURRENT STATUS November 2009: Closed           3      2      6     4-preventing  Stephen
2009/10 (low ranking compared with                                                                                                                                                                                                                                                        and managing Deitch
London PCTs). DH/SHA target not                                                                                                                                                                                                                                                           long term
reached and a reputational risk. RISK                                                                                                                                                                                                                                                     conditions in
CLOSED. PERFORMANCE                                                                                                                                                                                                                                                                       adults
SIGNIFICANTLY IMPROVED




Failure to manage and maintain the         4   3     12     • The Commissioning Committee, Trust       3   3      9      Monthly reports to finance committee and      NONE                                            RISK APPETITE: TREAT                           3      2      6     5 - World class Harry Turner
Commissioning expenditure within the                        Board, and senior management team are                       Board.                                                                                                                                                            primary care
total contract value and resource limit.                    monitoring the performance.                                                                                                                                ACTIONS:
That acute commissioning providers                          • Acute Commissioning stock take is                                                                                                                        • The PCT is arranging Director level
continue at a high level of over                            produced monthly for monitoring                                                                                                                            meetings with each Hospital. The purpose
performance for the remainder of the                        purposes.                                                                                                                                                  of these meetings is to agree mechanisms
year. RISK CLOSED.                                                                                                                                                                                                     to enable activity to be managed within the
CONSOLIDATED WITH 4.3                                                                                                                                                                                                  planned levels set out in the SLAs.
(FAILURE TO BREAK EVEN)                                                                                                                                                                                                • An internal Commissioning spend review
                                                                                                                                                                                                                       group was set up to consider options
                                                                                                                                                                                                                       available.
                                                                                                                                                                                                                       • The PCT's DOF has been assigned to the
                                                                                                                                                                                                                       NCLCA 2 days per week to work with the
                                                                                                                                                                                                                       agency on influencing the acute spend.

                                                                                                                                                                                                                       CURRENT STATUS November 2009: Closed




Failure to negotiate the Alcohol LES       3   5     15     Objective H2 as outlined in the Alcohol    3   2      6     • Minutes of the alcohol brief interventions   • Funding.                                      RISK APPETITE: TREAT                           3      2      6     4-preventing  Stephen
(Local Enhanced Services) -awaiting                         Strategy.                                                   meeting. Dates please?                         • The existing Brief Interventions work on                                                                         and managing Deitch
outcome of funding and for the                                                                                          • SBI Evaluation Report                        the hospital wards and minimal work in          ACTIONS:                                                           long term
extension of work at hospital as per                                                                                                                                   Primary Care will continue - but this will be   • DAAT to project manage.                                          conditions in
Business Case put to the PCT by the                                                                                                                                    limited and would not be in line with           • The Action plan is the alcohol strategy                          adults
DAAT Manager. Resulting in higher                                                                                                                                      objective H2 in the Alcohol Strategy.           specifically H2 however this requires
A&E admission rates, increased crime                                                                                                                                                                                   resources to implement.
and higher mortality rates. CLOSED.                                                                                                                                                                                    • 01/07/09. This risk will need to move
ALCOHOL LES NOT TAKEN UP BY                                                                                                                                                                                            from ‘TREAT’ to 'TOLERATE' if the
THE PCT. DES IN PLACE                                                                                                                                                                                                  interventions do not receive funding from
(NATIONAL STANDARD)                                                                                                                                                                                                    the investment plan. The risk is high at the
                                                                                                                                                                                                                       moment however this may change one the
                                                                                                                                                                                                                       investment plan discussions have been
                                                                                                                                                                                                                       concluded.

                                                                                                                                                                                                                       CURRENT STATUS November 2009: Closed




                                                                                                                                                     Page 7 of 15
                                                                                                   NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




                             Risk                                                   Controls in Place                                  Sources of Assurance                       Gaps in control/assurances
                                                                                                                                                                                                                                                                        Target Score                        Lead
                                            Inherent Risk                                                  Current Score                                                                                                                 Actions                                             Goal
             Description                                                    Description                                                     Description                                    Description                                                                                                     Director
                                            C   L    Total                                                 C   L    Total                                                                                                                                           C      L    Total
Safeguarding children: Failure to           5   4     20     • Mechanisms identified for assurance         4   4     16     • Contingency arrangements focussing           • Impact of Trial and Inspection has had an RISK APPETITE: TREAT                         3      3      9     2 - Healthy      Julie Quinn
resource the service adequately:                             and control are in place. what are they?                       provision on agreed priorities in place        adverse effect on recruitment                                                                                starts for all
Health Visitor (HV) caseloads not                            • Regular review of assurance and                              (monitored where and when ?)                                                               ACTIONS:                                                         children and
meeting the 400 children/300 families                        control. How/when?                                             • Fortnightly review (where and dates?)                                                    • Fortnightly review                                             young people
per HV ratio. Potentially placing                                                                                           • Audit 6 weekly contacts between HVs and                                                  • Consider commissioning options                                 in Haringey
vulnerable children/families at risk. -                                                                                     GPS (monitored where and when ?)                                                           • Implementation of JAR Action Plan –
number of HV vacancies was 11.28                                                                                            • Feedback from children’s centres and                                                     including a Haringey – due dates ongoing.
now 12.9/33.14. Is this is a GOSH risk                                                                                      maternity services (monitored where and                                                    Ensure concerns are escalated/other
to be monitored by NHS Haringey                                                                                             when ?)                                                                                    services are aware of the continuing
(tbc). CLOSED. NEW RISK OPENED                                                                                              • Analysis of incidents (monitored where and                                               pressure that the HV service is working
THAT OVERARCHES THE                                                                                                         when ?)                                                                                    under.
ASSURANCE FRAMEWORK FOR                                                                                                                                                                                                • Continuing efforts are being made to
SAFEGUARDING CHILDREN                                                                                                                                                                                                  recruit HVs.
                                                                                                                                                                                                                       • Staffing skill mix introduced where each
                                                                                                                                                                                                                       team has an RGN, Nursery Nurse, 2 HV
                                                                                                                                                                                                                       Assistants. Each team is also to have team
                                                                                                                                                                                                                       secretaries. 8 candidate have been given
                                                                                                                                                                                                                       offers.

                                                                                                                                                                                                                         CURRENT STATUS November 2009: Closed


Failure to provide a universal HV           4   4     16     TBC                                           4   3     12     TBC                                            TBC                                           CURRENT STATUS November 2009: Closed       4      2      8     2 - Healthy      Julie Quinn
programme whilst the PCT’s resources                                                                                                                                                                                                                                                    starts for all
are focused on safeguarding. This                                                                                                                                                                                                                                                       children and
includes identifying potential                                                                                                                                                                                                                                                          young people
safeguarding concerns where thee are                                                                                                                                                                                                                                                    in Haringey
atypical risk factors (i.e. family
profile/social/educational). Is this is a
GOSH risk to be monitored by NHS
Haringey (tbc) CLOSED. NEW RISK
OPENED THAT OVERARCHES THE
ASSURANCE FRAMEWORK FOR
SAFEGUARDING CHILDREN


Failure to forecast unplanned               4   3     12     • Monthly contract monitoring meetings        3   3      9     • Monthly reporting to CEC/Board with          Lack of direct control over providers.        RISK APPETITE: TREAT                       3      2      6     5 - World Class Harry Turner &
expenditure arising from activity                            with key providers to ensure enforcement                       minutes of the committee. ? dates                                                                                                                           Primary Care    David Maloney
variance after implementing PBR and                          of contract terms                                              • Bi-monthly reporting to the commissioning                                                  ACTIONS:
lack of clarity of the costs of non-PBR                      • Monthly senior management team                               Committee ? dates                                                                            • Demand management plans agreed with
activity and Commissioning SLAs                              review of financial position and mitigating                    • Internal review. Already had an internal                                                   GPs and providers.
resulting in considerable unplanned                          actions                                                        audit report and an External Audit is planned.                                               • Quarterly SLA meetings with Providers
expenditure leading to what? What is                                                                                        ? dates                                                                                      and quarterly performance meetings.
the risk? CLOSED AND FAILURE TO
BREAK EVEN RISK OPENED                                                                                                                                                                                                   CURRENT STATUS November 2009: Closed




Failure to deliver to plan demand           3   3     9      • Monthly reports to finance committee        3   3      9     • 1:1 meetings with Directors who are          • Internal and External Audit.                RISK APPETITE: TREAT                       2      2      4     5 - World Class Harry Turner &
management, performance metrics                              and Board.                                                     accountable for the directorate budgets.       • Locality structure not in place presently                                                                  Primary Care    David Maloney
savings and service changes and                              • Budget holder reports on a regular basis                     • Monthly reports to commissioning             and therefore demand management by            ACTIONS:
adding to financial burden. CLOSED                           and discussed at team meetings.                                committee and Board                            locality not commenced.                       • tbc
AND FAILURE TO BREAK EVEN                                    • Monthly contract meetings and
RISK OPENED                                                  performance review meetings with                                                                                                                            CURRENT STATUS November 2009: Closed
                                                             providers.




                                                                                                                                                         Page 8 of 15
                                                                                              NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




                             Risk                                                Controls in Place                              Sources of Assurance                       Gaps in control/assurances
                                                                                                                                                                                                                                                                    Target Score                        Lead
                                          Inherent Risk                                              Current Score                                                                                                                  Actions                                             Goal
             Description                                                 Description                                                  Description                                  Description                                                                                                         Director
                                          C   L    Total                                             C   L    Total                                                                                                                                             C      L    Total
Failure to identify internal savings to   3   3     9      Monthly finance reports                   3   2      6     • GRIP minutes,                               GRIP receives reports on the forecast          RISK APPETITE: TREAT                         2      2      4     5 - World Class Harry Turner &
fund its ‘must do’ investments.                                                                                       • Board minutes,                              outturn and this is used to mitigate this risk                                                                  Primary Care    David Maloney
CLOSED AND FAILURE TO BREAK                                                                                           • Commissioning Committee (monitor SLAs)                                                     ACTIONS:
EVEN RISK OPENED                                                                                                                                                                                                   • we have limited flexibilities in budgets
                                                                                                                                                                                                                   and PCT unable to provide coverage for
                                                                                                                                                                                                                   unforeseen overspends.
                                                                                                                                                                                                                   • Balanced budget at present. Ref to Core
                                                                                                                                                                                                                   brief 300709.

                                                                                                                                                                                                                  CURRENT STATUS November 2009: Closed



Failure to achieve LAA targets due to     4   3     12     • Mapping of current options and          4   2      8     • Obesity steering group.                     Funding required to develop infrastructure    RISK APPETITE: TREAT                          4      2      8     1 - Healthy     Susan Otiti
inadequate behaviour change                                resource pack developed.                                   • CSPAN steering group.                       and options for behaviour change                                                                                Communities
programmes relating to obesity,                            • Other documents/guidance/policies?                                                                                                                   ACTIONS:
exercise and motivational behaviour                                                                                   ? meeting dates and what has gone there for                                                 • Prioritise for PCT funding
change and achieve the CVD, cancer                                                                                    assurance?                                                                                  • Continue to seek outside sources of
mortality, vascular checks vital sign                                                                                                                                                                             funding
targets and life expectancy targets (as
above). If incompletely delivered the                                                                                                                                                                             CURRENT STATUS November 2009: Closed
programme unlikely to reduce
inequalities. CLOSED.
CONSOLIDATE WITH 1.1:
FAILURE TO ADDRESS PUBLIC
HEALTH TARGETS

CAMH: Failure to be effective in          4   3     12     • CAMHS Priority Action Plan              4   2      8     Commissioning Committee, through to CEC       None                                          RISK APPETITE: TREAT                          3      2      6     3 - Good        Liz Rahim
managing contract with MHT to deliver                      • CAMHS performance meeting feeds into                     and Board.                                                                                                                                                    mental health
strategic aims – to focus service on                       the overall Mental Health Performance                                                                                                                  ACTIONS:                                                          and wellbeing
early intervention. November 09.                           meeting.                                                                                                                                               • We are planning to invest additional                            for all
CLOSED. CONSOLIDATE WITH 6.1:                                                                                                                                                                                     resources - on tiers one and two of CAMHS.
SAFEGUARDING CHILREN. This is                                                                                                                                                                                     • Action plan in progress.
a children related risk and being
addressed in the JAR action plan                                                                                                                                                                                  CURRENT STATUS November 2009:
                                                                                                                                                                                                                  consolidated with BAF 6.1, as this risk
                                                                                                                                                                                                                  relates to children and is reflected in the
                                                                                                                                                                                                                  JAR action plan.




                                                                                                                                                  Page 9 of 15
                                                         NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




              Risk                           Controls in Place                    Sources of Assurance         Gaps in control/assurances
                                                                                                                                                          Target Score            Lead
                     Inherent Risk                               Current Score                                                              Actions                       Goal
Description                           Description                                     Description                     Description                                                Director
                     C   L    Total                              C   L    Total                                                                       C      L    Total




                                                                                               Page 10 of 15
                                                         NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




              Risk                           Controls in Place                    Sources of Assurance         Gaps in control/assurances
                                                                                                                                                          Target Score            Lead
                     Inherent Risk                               Current Score                                                              Actions                       Goal
Description                           Description                                     Description                     Description                                                Director
                     C   L    Total                              C   L    Total                                                                       C      L    Total




                                                                                               Page 11 of 15
                                                         NHS Haringey Board Assurance Framework - Closed Risks (November 2009)




              Risk                           Controls in Place                    Sources of Assurance         Gaps in control/assurances
                                                                                                                                                          Target Score            Lead
                     Inherent Risk                               Current Score                                                              Actions                       Goal
Description                           Description                                     Description                     Description                                                Director
                     C   L    Total                              C   L    Total                                                                       C      L    Total




                                                                                               Page 12 of 15
            NHS Haringey Board Assurance Framework


           Initial   Current   Target
  NO                                    Lead

1 (1.1)     16         12        9      Susan Otiti



2 (1.2)     20         15        8      Susan Otiti



3 (2.1)     12         9         4      Arshiya Khan



4 (2.2)     20         16        6      Arshiya Khan



5 (2.3)     16         9         4      Arshiya Khan



6 (3.1)      9         6         4      Duncan Stroud



7 (4.1)     12         9         6      Harry Turner & David Maloney



8 (4.2)     12         9         6      Harry Turner & David Maloney



9 (4.3)     20         9         6      Harry Turner & David Maloney



10 (5.1)    12         9         4      James Slater



11 (5.2)    15         9         3      James Slater



12 (5.3)    20         15        6      James Slater



13 (6.1)    20         16        9      Julie Quinn



14 (7.1)    12         9         6      Liz Rahim



15 (7.2)    20         15        9      Liz Rahim



16 (8.1)    20         15       10      Stephen Deitch



17 (9.1)    20         15        6      Ian Fuller




                               Page 13 of 15
                  Graph showing individual risk according to the Current RAG rating


             18

             16
                                                4 (2.2)                                                                  13 (6.1)
             14             2 (1.2)                                                                                12 (5.3)                 1       1
                                                                                                                                     15 (7.2) 6 (8.1) 7 (9.1)


             12
RAG Rating




                  1 (1.1)
             10

             8                        3 (2.1)             5 (2.3)                                           1
                                                                              7 (4.1) 8 (4.2) 9 (4.3)10 (5.1) 1 (5.2)          14 (7.1)


             6
                                                                    6 (3.1)
             4

             2

             0
                                                                                              RISK
                                                (Numbers in the brackets refer to the risk register number)

				
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