Hertfordshire
Appendix 12a
Strategic Risk Assessment
Reason for Completing Risk
Assessment
Assessment Undertaken by
Directorate Mental Health ......................
Assessment Review
Name
Proposed Mental Health
Consultation Service Changes
Location Hertfordshire ..........................
Signed ......................................
Date
Step 1
Step 2
..................................
Review Date
3 Months
......................................................
......................................................
...................................................... Incident Form Ref .............................
Step 3 /4
Risk Rating
(to be agreed with line
manager )
List significant
hazards here:
Closure of St Julian’s
No local bed.
Loss of contact with
local networks.
Potential delay in
admission.
Increased Travel/
Costs.
Reductions to Direct
Access Psychology
Some Referrals
stay in Primary
Care
List groups of
people who are at
risk
Service User
Carer
CATT
Acute Beds
Watford & 3
Rivers PCT
PopulationService users not
accepted by
CMHT and not
List existing controls in place
Consequences
Likelihood
Risk
Score
Additional Actions Required
HPT Bed Management Policy- within
JCT Commissioned bed.
3
3
9
Monitor threshold for
admission across all In
Patient Units,
Bed Management & Placement Team
If not available bed will be purchased
from another provider, although will
increase £ pressure on HPT.
Daily Bed Occupancy
Monitoring and remedial
action to ensure best use of
all resources.
Crisis Assessment and Home
Treatment Teams temporarily hold
care.
Reinvestment of 400k, in
community and Inpatient
services.
2
CMHT operational criteria.
NSF Mental Health Herts County
guidelines for depression, anxiety,
2
4
Review arrangements for
Watford and Bushey and
Three Rivers CMHTs and
consider transitional
arrangements in order that
Comp
Date
Residual
Risk
Score
managed by
primary care,
Carers
inexperienced
primary care
staff;
(Some referrals
from Hertsmere)
schizophrenia and post natal
depression.
GPs have a clear referral
pathway to treatment.
Short-term counselling provision in
primary care - other provider for this
could be sought to replace DAS
provision for this group of patients.
Plan needed for
management of patients in
treatment and for those
which have been referred.
Ensure practices which
currently use DAS service for
short –term counselling can
access another provider for
in-house service.
Increase primary care team
staffing and competencies
e.g. pilot project in W3R ;
Development of Primary
Care Mental Health team
(including psychological
therapies).
Day Services
Reduction
Increased demand
for acute services.
Person may receive
reduced or no day
service.
Social Isolation.
Reduction in
therapy.
Greater pressure on
Carers.
User
Carer
CMHTs
GP
Acute Beds
Vol Orgs
2
Primary Care Mental Health Services.
3
6
Greater use of the Voluntary
sector.
Community Mental Health Teams.
Crisis Assessment and Home
Treatment Team.
Full benefit from new GMS
Contract.
Primary Mental Health Care
Hospital Admission.
Carers Assessments.
Carers Respite.
Review the overall provision
including Models of delivery.
Closure of EIP Service
Non Specialist
Team providing this
service.
Increased reliance
on secondary
services.
Risk of
disengagement
from service.
Increased Pressure
on Carers.
Reductions in CMHT
Staffing
Less availability of
specialist
community mental
health care.
Greater reliance on
primary care.
Higher referral
Threshold.
Reduced capacity,
leading to less
contact with staff.
Longer Waiting
User
Carers
CMHT’s
CATT
Other Community
Teams
CAMHS
Existence of range of generic
community teams able to cater for
persons with psychotic symptoms.
2
5
10
Learning from the challenges
presenting the current EI
team, develop plan for future
provision of this service.
2
3
6
Full benefit from new GMS
Carers Assessments.
Carers Respite.
User
Carers
CMHT
GPs
Other Community
Teams
Vol Orgs
Acute Beds
Primary Care Pilots.
Voluntary/ Non Stat Provision.
PCTs Demand Management
Strategies.
Primary Mental Health Care.
Development of Graduate/
Gateway roles.
Revision of CATT care
pathways to include access
via voluntary organisations,
of persons presenting to
them in crisis.
Lists.
Increased Pressure
on Carers.
Closure of ADTU
Users
Greater pressure on Carers
acute care including Acute Beds
CATT
in patient beds and
crisis team.
Increased pressure
on carers.
Mental Health Therapy
Reductions
Person may receive
reduced or no
service.
Take longer to
recover.
Longer Admissions
and increased
pressure on acute
beds.
Users
Carers
Acute Beds
CATT
Crisis Assessment and Home
Treatment Teams.
4
2
8
Full 24hr CATT Service.
1
4
4
Consider Model and
reinvestment when funding
available.
Carers Assessments.
Carers Respite.
No In patient facility will be left without
therapy input in totality.
Closure of Seward
Lodge Day Unit
No day service,
potentially leading
to continuing care
or care home
placement for life.
Loss of social
networks and
supports.
Increased pressure
on Carers.
Reduction in Alcohol
Services
Some people with
this identified need
will not get a
service as current
threshold will need
to be raised as will
waiting times.
Higher levels of
Disengagement.
CAMHS Conduct
Disorder Service
reduction
The referral criteria
for CAMHS have
been amended so
that referrals of
simple challenging
behaviour of children
younger than 12
years of age will no
longer be accepted.
There is likely to be
an increased
workload for other
services working with
Users
Carers
MHSOPCommunity
Teams
Continuing CareBeds
EPD
GPs
Specialist MHSOP Teams for older
People.
Users
Carers
GPs
Police
Non Stat and Voluntary Sector
Provision and Support.
Children and
young People
Carers
GPs
Schools
CSF
Other agencies
working with
Children, such as
health visitors
and YOT’s
Multi Agency sign up to new referral
criteria.
5
4
20
Consider Model and
reinvestment when funding
available. However this will
not be of benefit to those
currently in the service.
3
4
12
Better demand management
strategies and signposting of
services at a primary care
level..
1
3
3
Carers Assessments.
Carers Respite.
Community Drug and Alcohol Teams
Multi Agency monitoring of impacts of
new referral criteria.
Waiting List monitoring.
Regular monitoring of
impacts will enable any
additional measures needed
to be promptly put in place.
this group of children.
Possible increase in
waiting times for
other service users if
number of referrals
are not reduced by
5% with
implementation of
new criteria.
LD Reductions in
Therapy Staff
Delays in access to
‘Mainstream’ Physio/
Diatetic services.
Possible
unavailability of
“specialised”
treatments.
Reduced outreach 7
follow up support.
Loss of Specialist
Skills/Expertise.
Increased Pressure
on Primary Care.
Deterioration in
health/additional
physical health
problems.
Impact on Health
Target re meeting
health inequalities.
Service Users
Carers
Primary Carers
SLDS Maintenance of links/networks
with mainstream physio/diatetics.
Establishment of Technical Instructor
Posts who will support access to
above.
Re-configured SLD service to meet
priority areas of need- eg; Dysphagia
needs.
3
4
12
Primary Care demand
management