Challenging risk management norms

Senior consultant Mason Fitzgerald highlights the latest developments in system risk management, arguing that it is an increasingly important tool for ICS leaders.

Almost exactly a year ago, we wrote about our emerging work on system risk management, setting out a framework for developing system risk in a way that supports ICS objectives and promotes collaborative working.

One year on, this framework still holds true, and we have developed it further with ICS colleagues up and down the country. Since ICBs became authorised in July, newly constituted boards have, quite rightly, been considering their risk appetite and identifying key strategic risks as a system.

NHS trusts have also stepped up, with trust boards eager to consider the degree of alignment of their board assurance frameworks with local partners, as well as the system, and the greater role they can play in delivering better health outcomes and addressing inequalities.

Similar to other systems work, every ICS needs to develop arrangements which best work in their system, and a variety of approaches are being used. There are, however, a number of developments that should apply everywhere:

• System risk management is now a necessity of operating in the new legislative and regulatory framework, and should be on the agenda of every ICB and trust board.
• Many of the key risks to ICS objectives will lie outside the control of the NHS, driven by the social and economic conditions that affect our local communities.
• As such, a wide range of partners need to be involved, including local authorities and the VCSE sector.
• Traditional norms of risk management need to be challenged and adapted, i.e. owners of specific risks and assurance groups may sit across a range of different organisations.

Done well, system risk management will identify and focus on ‘upstream’ causes of ill health and demand for health and care services. It will bring a range of partners together to consider how those risks can be collectively managed. It will challenge leaders and boards to consider where resources need to be allocated for the long-term benefit of current and future generations. And it will help leaders to stay aligned and on course to deliver for their local communities.

System risk management will continue to develop as a concept and a practice, linked to the development of the initial integrated care strategies and joint five-year forward plans, which should result in greater alignment and integration.

Development of system operating models will also drive discussions on aspects of risk, clinical, financial and otherwise, as well as models of risk sharing arrangements.