NHS Shetland: Proposed Ambulatory Care Development RISK CHAMPION: Kathleen Carolan (DN&AS) REVISION NUMBER: DATE: 16th October 2017

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1 RISK REGISTER PROJECT: NHS Shetland: Proposed Ambulatory Care Development RISK CHAMPION: Kathleen Carolan (DN&AS) REVISION NUMBER: DATE: 16th October 217 Identification Assessment Prior To Mitigation Mitigation Likliehood (1- Impact (1- Value (1- Risk Ref Description 5) 5) 25) Impact On? Mitigation Action Taken BUSINESS RISKS: Strategic risks which remain (1%) with the public sector organisation regardless of the sourcing method for the proposed investment. They include political risks. The project's objectives are not clearly defined Different stakeholders have different expectations of the outcome of the project Set out clear objectives for the project as Clear aims and benefits described in the briefing part of the Initial Agreement, linking them and design development stages. Work continuing to to clearly defined & measurable benefits and outcomes profile demand increases impacting on DSU utilisation Consult with all stakeholders to gain a consensus on the strategic brief for the project at IA stage and project brief at OBC stage Stakeholders have been involved in every decision making stage including ruling out the need for a separate endoscopy suite.will continue to work with staff and service users through next stage of the design phase and be clear about the strategic aims of the Directorate in terms of benefits Poor stakeholder involvement will result in a lack of support for project The anticipated benefits from the project are not achieved following project completion Prepare and implement an appropriate project communication plan which includes engaging with all appropriate The PPF, clinical/non clinical stakeholders, management teams and the Board have been involved in the design process good engagement stakeholders at appropriate stages of the and input provided to date. Working with PPF/SHC project to ensure that ongoing input to the design process is maintained Set out a realistically achievable benefits realisation plan as part of the Initial Agreement Benefits realisation is included in design option selection process.financial savings target will be attributed to the project (revenue savings) as part of the wider efficiency programme for Acute & Specialist Services. The desire to improve ambulatory care has a negative effect on in-patient services, journey times and/or pathways The hospital lift accessing theatres, remains a single point of failure, although his risk is heightened as some eqpt also now requires its use Map the impact of all proposed changes on all existing/future "clinical journeys" Ensure that scheduled maintenance on the lift is carried out pro-actively as required. Have in place an emergency response in the event of lift failure. All current and future journeys have been mapped and will be reviewed in the context of any plans developed. Scheduled maintenance is planned. An established emergency response is in place.

2 Work to improve the ambulatory care facility compromises the secondary function of the unit as the Board's pandemic contingency location Funding is not available for backlog maintemnance and lifecycle with a subsequent impact on facility availability and sustainability Consider the unit's secondary function in Plans in place to review as/when a facility option is all developing proposals. Ensure that it is finalised. able to fulfill this function Undertake detailed assessments based on PAMS reporting to secure timely funding and investment Discussion have taken place with HFS to confirm the accuracy of existing PAMS data including lifecycle and backlog maintenance costs. SERVICE RISKS: Risks associated with the design, build, financing and operational phases of the proposed investment. Dependant on procurement route they can be shared with business partners and service providers. NHS Shetland doesn't have the capacity or capability to deliver the project Develop appropriate governance arrangements for the project including resource planning and individual skills review External advisors have been utilised through all stages of the project development and will continue to be insitu through further design/construction phases. Need to agree local project management support for the construction phase in 216. The available accommodation/space is unable to support the proposed service model The proposal developed disperses eqpt storage areas away from the operating theatre environmnet. The available space requires derrogations from relevant design and technical guidance in key areas, e.g. Bed spacing. Risk is that these may reflect unacceptable compromises. Required levels of business continuity are not maintained during project development New service model arrangements should be considered and properly tested at the early design planning stages of a project and then further tested throughout the development of the project Ensure operational plans are in place to deal with the less desireable compromises associayted with shifting storage areas.discuss with relevant clinical sub-specialties Develop a clear list of derrogations for sign-off by all relevant stakeholders before progression. (Including clinical, management, infection control, FM and estates) Consider space "mock-ups" Develop a detailed risk treatment / mitigation plan throughout the life of the project to ensure that business continuity is maintained The ability to refurbish and extend the size of the unit and how that would impact on patient flow was central to the design process Eqpt implications considered on a service by service basis. List of derrogations developed. Phasing requirements have been identified as part of the initial design development and construction costs. Stakeholder discussions about service continuity have been central to the design process.

3 Programming and phasing is complex, with all activities on the "critical path". Any challenges to any element will have an impact on the duration and cost of the project A decant plan should be developed that aligns with any construction plan and is regularly updated as timetables change. A detailed decant plan has already been developed. The tender will include specific details on phasing of the construction work, decanting and continuity of service throughout the construction phases of the build Successful completion is dependent upon space being made available by Shetland Islands Council for a service moving from GBH. Demand for the service does not match the levels planned, projected or presumed (Either exceeds antyicipated demand or falls substantially below this) Space transfer to be discussed extensively with SIC and agreed along with timescales Carry out sensitivity testing of assumptions behind service demand projections to understand and manage any underlying risks Space transfer has (and continues) to be discussed extensively with SIC. Programme has been agreed. Will start to test assumptions with the phasing in of the O&G service in EXTERNAL ENVIRONMENTAL RISKS: Risks that affect all organisations regardless of whether they are public or private sector including secondary legislation and general inflation. Wider facility becomes wholly unsuitable for the global model of care, rendering the proposed investment redundant or reducing its payback period. Currently accepted functional suitability compromises, e.g. relating to in-patient wards become unacceptable, resulting in the need for more widespread change earlier than anticipated. Adverse publicity occurs due to an operational issue Review proposals in the context of current NHS Shetland scenario planning activity Review proposals in the context of current NHS Shetland scenario planning activity. Provisional discussions have taken place with HFS regarding this. Provisional discussions have taken place with HFS regarding this Review ongoing operational Media communication about phasing of building arrangements associated with the project works will take place before and during the and ensure that any specific risks are construction phase to minimise the impact of encapsulated into the project risk register potential operational issues Communication strategy does not consider public perception / consultation feedback / media interest / parliamentary interest / organisational reputation The anticipated date for a complete replacement facility (23) is missed, meaning that lifecycle costs utilised in the business case are wrong Ensure that the project communication plan covers these issues Early discussion with Govt and all key stakeholders regarding timescales for replacement of the Gilbert Bain Hospital. Working closely with SHC and PPF on mechanisms for consultation/feedback Provisional discussions have taken place with HFS regarding this.

4 Risk categories Description Service risks These are the risks associated with the design, build, financing and operational phases of the proposed investment. Dependant on procurement route they can be shared with business partners and service providers. External environmental risks These risks affect all organisations regardless of whether they are public or private sector. They include secondary legislation and general inflation.

5 Risk Register RISK ACTION PLAN Ref No: Risk Owner: Ranking: Risk Manager: Action Date: Risk Description: Impact of Risk Score: Probability of Occurrence: Current Management of Risk Leading Practices GAPS Cost of Risk Minimum: Most Likely Maximum 5% Percentile Action Plan & Timeline App E Project Risk Matrix.xlsx 5 Risk Action Plan

6 PROBABILITY / LIKELIHOOD OF OCCURRENCE IMPACT / CONSEQUENCE OF OCCURRENCE 1 Rare Will occur only in exceptional circumstances 1 Insignificant No risk to the project No impact on services No impact on the environment 2 Remote Unlikely to occur 2 Minor Minor risk to project Minor impact on services Minor impact on the environment 3 Possible Reasonable chance of occurring/ may occur occasionally. 3 Moderate Some impact on project Some service disruption Moderate impact on the environment 4 Likely Likely to occur 4 Major Significant impact on the project Cost implications with a value of between 2%-4% of Target Cost on a Frameworks Scotland scheme Major impact on the environment 5 Almost certain More likely to occur than not 5 Catastrophic Stops or delays project Cost implications with a value in excess of 4% of Target Cost on a Frameworks Scotland scheme RISK PRIORITISATION The product of likelihood x impact identifies the seriousness of the risk exposure and therefore it s priority. There are three categories: Risk Rating High risk (Red) High Medium risk 6-14 (Amber) Medium Low risk 1-5 (Green) Low