Nurses Day! - Birmingham Children's Hospital

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Major Risks
Table 33: Major Organisational Risks
Risk
Failure to ensure the staff
culture is aligned to the Trust’s
strategic objectives could impact
on achievement of the Trust’s
strategic objectives and on the
delivery of high quality care and
patient experience.
Planned reductions in funding
could impact on the delivery
of the Trust’s services, affect
the quality of care and patient
experience and impact on
achievement of the Trust’s
strategic objectives.
Under developed workforce
plans could impact on the
delivery of the Trust’s services,
affect the quality of care and
patient experience and impact
on achievement of the Trust’s
strategic objectives.
Failure to deliver our Cost
Improvement Plans could
impact on the delivery of the
Trust’s services, affect the
quality of care and patient
experience and impact on
achievement of the Trust’s
strategic objectives.
A delay in delivery of the
strategic outline case for the
new hospital project could
impact on achievement of the
Trust’s strategic objectives.
Management & Mitigation
l Seek feedback from staff through a range of means and embed
the output and associated actions into Trust reporting systems
l Embed results from local surveys and staff polls into performance
indicators and leadership appraisals with a goal of 10%
improvement each year
l Develop a cultural barometer for use across all parts of the
organisation
l Improve the regularity and quality of staff briefing
l Work with the Birmingham Director of Public Health to develop a
health impact assessment of proposed funding changes
l Engage with staff, patients and families on the potential solutions
to reduction in resources
l Identify and develop alternative service scenarios that will better
use public resources across the whole of the children’s mental
health budget
l Deliver improved workforce productivity through more efficient
use of the temporary workforce and re-profiling of the total
workforce
l Shift from junior medics to advanced practitioners
l Shift in WTE from nurses to support workers
l Review the medical administration function
l Improve experience and quality of clinical education placements
for all clinical staff
l Improvement in students and juniors recommending BCH as a
place to train by 10%
l Set a financial plan for 2013/14 that requires an achievable
CIP target
l Review legacy CIPs carried forward from 2012/13
l Strengthen PMO function and its monitoring mechanisms
l Revise focus on CIP at performance reviews
l Enhance the CIP Governance framework especially with regards
to Quality Impact Assessments
l Regular formal engagement with key stakeholders
l Board level review of progress and barriers to moving the project
forward
l Programme board with key partners re-established
l Project infrastructure of key partners being established
l Development of detailed plan with key milestones
During 2012/13 some internal control issues
emerged relating to the management of junior
doctor rotas. These issues created risks in relation
to the Trust’s ability to demonstrate full compliance
with the Working Time Regulations and the New
Deal arrangements. The issues also created
financial risks. A detailed risk analysis provided
assurance that the risk to patient safety was low.
Management of these risks and the processes
put in place to address the internal control issues
were closely monitored by the Board of Directors
and its committees, including the Audit Committee.
Support and leadership was provided by Executive
and Non-Executive Directors.
A review by the West Midlands Deanery in March
2013 provided assurance on the quality of the new
processes and systems. An independent review
has been commissioned by the Audit Committee to
provide additional assurance that these processes
and systems are embedded and sustainable.
The Board of Directors is satisfied that the actions
taken have addressed the internal control issues.
Review of economy, efficiency and
effectiveness of the use of resources
The Trust has a range of processes embedded
throughout the organisation to ensure that
resources are used economically, efficiently and
effectively.
In reviewing the key risks of the organisation
through the Board Assurance Framework the
Board considers the effectiveness of the internal
controls compared with the risks. On a regular
basis it also reviews progress against the annual
service plans and the financial plan that results
from this. The Board is supported in the process
by a regular, in-depth review by the Finance and
Resources Committee of the Trust’s financial
position, business cases for significant revenue
and capital investments, and the investment of
cash balances.
Table 34: Internal Audit limited assurance opinion
Clinical Coding: Outpatient &
Emergency
The review found weaknesses
in the coding processes,
including validation and audit.
The Audit Committee supports the delivery of
effective, efficient and economic services through:
l Undertaking a range of thematic reviews,
including workforce, financial standing,
arrangements to deliver quality services and the
effectiveness of the assurance process.
l Considering the coverage of external
and internal audit and reviewing progress
on implementing internal and external audit
recommendations.
The Trust uses a comprehensive internal audit
service as part of its assurance process. An annual
internal audit work programme is risk based and
progress and amendments are reported to the
Audit Committee.
A new Internal Auditor was appointed in 2012/13,
which provided the opportunity for a fresh, in depth
review of the Trust’s risk and quality governance
processes. Significant assurance was given in the
following reviews:
1. Board Assurance Framework
2. Risk Management
3. CQC compliance
4. CAS alerts
5. Clinical Audit
6. SIRI process
7. Quality Governance
8. Directorate Governance
The Internal Auditor gave limited assurance as
follows in table 34 below.
Review Control weakness Action
Programme of formal audit
and regular spot checks to
be established. Longer-term
adoption of automated process.