Patrick Keady

HSJ Conference: NHS Risk Management



I chaired NHS Risk Management today. Organised by the Health Service Journal, NHS Risk Management was their first conference that focussed exclusively on risk management.



Birmingham’s Centennial Centre was oozing with energy and attendees including clinical governance managers (10%), safety and health practitioners (15%), risk managers (35%) and directors (40%). And the delegates came from the full spectrum of healthcare organisations: SHA/other (5%), Foundation Trusts (10%), Independent Healthcare (20%), Trusts (30%) and PCTs (35%).


While I’ve been practicing in risk management for 20 years, I had mixed expectations of the conference …… and thankfully it was an enjoyable and informative conference. Here were some of the highlights for me.



Mark Burns, the Safety and Security Adviser at Blackpool, Fylde and Wyre Hospitals NHS Foundation Trust reminded us of how risk management is now directly linked with Corporate Objectives. Trusts are more aware of their risk appetite – the level of risk that they are happy with. And he reflected on how reactions to incidents have improved – senior managers today ask ‘what happened?’ In the past, they would have asked ‘who did it?’


Linda Handley-Wright, the Risk Manager at Derby City PCT expanded on the theme of culture. The key is to make risk management interesting, using LEAN principles and engaging the right people. Linda added that organisations need to address different learning styles – including scenarios, what if’s and linking risk management with other initiatives via training needs analysis. In Derby, they’ve taken Standards for Better Health as the basis of something much better – they’ve produced the Healthy Derby 10-year plan aimed at improving health, commissioning and engagement.



And engagement was a key message from Dr Anne Dyas, a Consultant Microbiologist at Worcestershire Acute Hospitals NHS Trust. Dr Dyas urged that ‘we (people involved in managing risks) must get out there and teach. To be prepared to defend changes in practice with robust evidence’. She warned that changes introduced simply for public relations reasons will not be sustainable. Jobs done in haste will probably be done badly. Dr Dyas added that data is only as good as those that gather it – she warned against multiple data sources. Most extra tasks need extra hands and extra equipment. New initiatives must support the task (of infection prevention and control) and not add to it. And do Dr Dyas’s views work in practice? Definately. Dr Dyas’s team oversaw a significant reduction in MRSA and CDiff at their Trust and this helped them win the 2008 Oxoid Infection Control Team Award.



Anne Cleminson (Trust Secretary) and Steve Bradbury (Risk Manager) from Mersey Care NHS Trust described the key elements of Assurance at their Trust – getting buy-in from key stakeholders, Committees that are fit-for-purpose, an effective Assurance Framework and good communication. And the Trust’s biggest champions are the Non-Executive Directors because of their creativity and innovation.



Ian Strudley, Head of the Health and Social Care Services, Health and Safety Executive, reminded delegates that HSE is all about reducing the real risks – upto 250 people die every year at work in the UK and many more have serious injuries and ill health. HSE reduces the real risks, by balancing risks and benefits. He gave examples of how HSE is working in partnership with organisations such as the Healthcare Commission – agreeing the Concordat for joint working between regulatory and inspecting bodies. HSE works with the NHS Litigation Authority – workshops on stress management standards. And with respect to managing violence and aggression, it works with the NHS Counter Fraud and Security Management Service.



Stephen Williamson, the Corporate Health, Safety and Risk Adviser at University Hospital of South Manchester NHS Foundation Trust reminded us of what the ideal health and safety management system looks like – setting the policy, organizing, planning for action, measuring performance, auditing compliance and review. Steve reflected the views of many delegates with respect to NHS Patient Safety First – that it will succeed with Executive ownership, and clear commitment from clinicians, managers, corporate and support functions.



Gary Hay and David Firth, partners at Capsticks, gave an overview of key legal compliance and regulation. They described the risk-related legislation in place, CNST claims, the NHSLA risk management standards, employment legislation and stress at work. No real surprises there. And then they introduced a case-study about a patient scalded in a bath – and delegates faces lit up. The case study renewed the energy of the audience. The case study felt real and it gave the delegates and opportunity to contribute.



And then the controversial (and most thought-provoking) presentation – on World Class Commissioning. Controversial because it was close to home for many of the delegates. Roger Hymas from Humana, had recently completed a secondment as Director of Commissioning with Hampshire PCT. And he reminded us that on 4th July, the Financial Times proposed that the PCTs be turned into one giant health insurer. Roger highlighted eight ‘tests’ for insurers – and PCTs meet three of the tests, don’t meet another three and possibly meet the remaining two.


Roger identified his top-10 risks facing the NHS. And in reverse order they were:

10. The NHS will run out of money in the longterm, and not before the next general election (possibly June 2010). 2008 is the year when demand is running ahead of budgets and at the same time, PCTs are spending just 15% of what the private sector spends on managing Commissioning – the suggestion here is that PCT Commissioning functions need to be better funded and by implication, they need a greater range of skills in their teams.


9. Practice-based commissioning will not gain traction. While it is estimated that only a third of GPs will be willing and able to make practice-based commissioning deliver in the way that PBC advocates suggest, by increasing PBC activity, the NHS has the potential to redistribute significant amounts of money – with GPs switching patients from one Acute Trust to another.


8. Block contracts remain impenetrable to PCT scrutiny and validation, including mental health block contracts – see Risk 10 above about PCT Commissioning functions.


7. PCTs need to invest more in management systems. In other words if PCTS don’t put aside money to invest in management systems, they’re unlikely to get control of their PCT finances – links with Risk 10 !


6. The supply side will shrink – reducing competition and choice. This will be a consequence of Trust mergers and some of the private sector providers (including ISTCs) retreating from NHS provison


5. Patients need more encouragement to play their role in re-shaping the market. Consumer surveys consistently show that consumers want choice. Patient Choice has much more to do, if it is to achieve its potential.


4,3 and 2 – Is Monitor encouraging Foundation Trusts to be too aggressive in developing their financial strategies (?) through:
– the pursuit of earnings before interest, tax, depreciation and amortisation as a key measure of success.
– the building of significant capital reserves on FT balance sheets
– service line analysis which could lead to huge distortions in provision


PCTs that transfer money to their local FT and other providers are transferring the financial risk to themselves! They are also in danger of losing control of Commissioning. Armed with the management tools developed by Monitor, FTs may choose to cherry-pick the more financially profitable specialties and procedures. And FTs could choose to unilaterally decommission services, putting patients at risk.

1. WCC will not move fast enough – or fail.


What a thought-provoking presentation to end the day. And it suggests that provided PCTs implement robust risk management processes and they invest in management systems, then World Class Commissioning is likely to become a reality.


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