Orkney Integration Joint Board Risk Register
1. Objectives
The objectives of the Risk Register are to:
- Identify key risks that could prevent the achievement of the IJB's objectives.
- Evaluate the significance of the risks.
- Identify any mitigating controls.
- Identify the owner of each risk.
- Act as a basis by which the risks can be monitored and reported upon.
2. Risk Assessment
Identified risks are assessed and the following is determined:
- The likelihood of the risk materialising.
- The impact/potential consequences if it does occur.
3. Risk Evaluation
Risks are evaluated on a sliding scale of 1-30 with 30 being the highest value i.e. highest likelihood / most severe impact / consequences. The risk evaluation tables have been used in order to assess specific risks and to introduce a measure of consistency into the risk assessment process. The overall rating for each risk is calculated by multiplying the likelihood value against the impact value to give the total score.
IMAGE: The page includes the Orkney Health and Care logo, consisting of a blue oval emblem with two circular figures above the words “OHAC orkney health and care”.
Risk Evaluation Criteria
| Likelihood | Description |
|---|---|
| 1 | Extremely unlikely – will only occur in exceptional circumstances (likely to occur every 5 to 10 years). |
| 2 | Not expected to happen, but potential exists – unlikely to occur (likely to occur every 2 to 5 years). |
| 3 | May occur occasionally; has happened on occasions – reasonable chance of occurring (likely to occur annually). |
| 4 | Strong possibility that this could occur – likely to occur (likely to occur quarterly). |
| 5 | This is expected to occur frequently and, in most circumstances, – more likely to occur than not (likely to occur daily / weekly / monthly). |
| Impact | Description |
|---|---|
| 1 | Negligible never happened but is theoretically possible |
| 2 | Minor – Potential to cause some damage in the short and medium term |
| 3 | Moderate – Potential to cause significant damage in the short and medium term |
| 4 | Major – Could seriously threaten reputation or weaken service delivery |
| 5 | Catastrophic – Will seriously threaten reputation or weaken service delivery |
Risk Matrix
| Likelihood (L) \ Impact (I) | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|
| 5 | 5 | 10 | 15 | 20 | 25 |
| 4 | 4 | 8 | 12 | 16 | 20 |
| 3 | 3 | 6 | 9 | 12 | 15 |
| 2 | 2 | 4 | 6 | 8 | 10 |
| 1 | 1 | 2 | 3 | 4 | 5 |
IMAGE: The risk matrix shows likelihood values from 1 to 5 vertically and impact values from 1 to 5 horizontally. The products range from 1 to 25. The matrix uses green for low risks, yellow for medium risks, orange for high risks, and red for very high risks.
Key
- Very High: Senior manager action to confirm the level of risk identified and produce an action plan to elimiate, reduce, or transfer the risk.
- High: Service manager action to confirm the level of risk identified and produce an action plan to eliminate, reduce or transfer the risk.
- Medium: Department action to continue the level of risk identified and produce an action plan to eliminate, reduce, or transfer the risk.
- Low: Department action to confirm the level of risk identified and manage using routine procedures.
Summary of Risks
| Risk Ranking | Risk Theme | Risk | Risk Rating |
|---|---|---|---|
| 1 | Financial | Savings Targets: Unable to deliver upon existing savings targets or any new savings imposed by either party. | 20 |
| 2 | Financial | Funding Resources: Uncertainty around the level and terms of future funding settlements and funding allocations. | 15 |
| 3 | Financial | Inflationary Pressures: Inflationary pressures driving up costs, in turn wage pressures | 20 |
| 4 | Financial | Commissioned Services: Economies of scale, lack of competition, choice or financial stability for tendered contracts. | 15 |
| 5 | Financial | Annual Budget: Failure to set a balanced budget by 1 April each year. | 12 |
| 6 | Financial | Budget Control: Failure of budgetary control processes | 25 |
| 7 | Financial | Future Demographics: Ageing population, more children with complex needs, increase in demand. | 20 |
| 11 | Strategic | Public Protection: Potential ineffective processes and joint working arrangements around identifying, investigating, sharing information and protective action. | 15 |
| 12 | Strategic | Public Protection: Findings of the Children and Young People in Need of Care and Protection report. Findings of the Adult Support and Protection Inspection in 2023. | 4 |
| 13 | Strategic | Public Protection: Vacancies in suitably qualified and experienced staff. | 4 |
| 14 | Strategic | Implications of National Care Service: The Scottish Government’s intention to create a National Care Service and to amend the functions of Integration Joint Boards may affect the provision of care in Orkney. | 12 |
| 15 | Strategic | Isles Primary Care Model: There is a risk that the IJB will fail to commission services to deliver and meet the population needs of the Isles. | 9 |
| 16 | Strategic | Unpaid Carers: Non-self-identification of people providing care as being unpaid career themselves. | 16 |
| 17 | Strategic | Young Carers: External pressure on unpaid carers such as financial pressures from the cost-of-living crisis and educational pressures. | 16 |
| 18 | Strategic | Unpaid Carers: Support for unpaid carers is not effectively planned for and managed. | 16 |
| 21 | Operational | Insufficient workforce planning: Failure to recruit and retain appropriately skilled workforce. | 20 |
| 22 | Operational | Recruitment, Development and Retention of Workforce: Difficulties in recruiting to Social Care posts. | 20 |
| 23 | Operational | Recruitment, Development and Retention of Workforce: Difficulties in recruiting to Social Work posts. | 20 |
| 24 | Operational | Analogue to Digital Switchover: Cost implications delaying progress of an accelerated switch from analogue to digital phone lines. Switch from analogue to digital planned for 31 January 2027 in Scotland. | 15 |
| 25 | Operational | Additional Investment Posts: There is a risk that the IJB will fail to identify the funding to commission the four additional investment posts as agreed in August 2023. | 4 |
IJB - Financial Risks
| No | Risk Owner | Risk | Impact | L | I | Score | Prior | Target | Controls in Place | Actions to be Taken | Target Date |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Chief Finance Officer | Savings Targets: Unable to deliver upon existing savings targets or any new savings imposed by either party. | NHS Orkney being put in special measures. | 5 | 4 | 20 | 16 | Budget setting process. | Review where £2.4m recurring savings can be taken from. | 31.12.2025 | |
| 2 | Chief Finance Officer | Funding Resources: Uncertainty around the level and terms of future funding settlements and funding allocations. | Less funding from NHS Orkney and Orkney Island Council, reduction in ability to provide services, take on of other agencies' responsibilities. | 5 | 3 | 15 | 9 | Medium Term Financial Plan highlights reliance on funding from NHS Orkney and Orkney Island Council. Estimate of reducing resources built into a Long Term Financial Plan | 31.03.2026 | ||
| 3 | Chief Finance Officer | Inflationary Pressures: Inflationary pressures driving up costs, in turn wage pressures | Budget overspends, service reduction, or cuts | 5 | 4 | 20 | 20 | 15 | The Medium Term Financial Plan 2025-2028 includes assumptions on pay and inflation increases | Service review to determine areas requiring further funding. | 31.12.2025 |
| 4 | NHSO and OIC Procurement Teams | Commissioned Services: Economies of scale, lack of competition, choice or financial stability for tendered contracts. | Increased cost to IJB. | 5 | 3 | 15 | 9 | Contract Standing Orders, Procurement and Financial Regulations | Review Service Level Agreements and ensure current and relevant. | Ongoing | |
| 5 | Chief Finance Officer | Annual Budget: Failure to set a balanced budget by 1 April each year. | Breach of statutory provision. Unable to commission/decommission services with financial resources attached. | 3 | 4 | 12 | 12 | 6 | The IJB is advised annually of the delegated budgets provided by each partner. Budget for 2025/26 approved in April 2025. | Ongoing discussions with partner bodies on more joined up working. Budget allocations should be sent by the IJB to both the Partners for the services they deliver. The budget should detail: service pressures, saving initiatives, and change initiatives. | 01.04.2026 |
| 6 | Chief Finance Officer | Budget Control: Failure of budgetary control processes | Unexpected overspends against budgets requiring additional funding from NHS Orkney and/or Orkney Islands Council. | 5 | 5 | 25 | 20 | Budget monitoring, budget setting process | Create a Financial Recovery Plan to bring spend in line with budgets. | 30.09.2025 | |
| 7 | Chief Finance Officer | Future Demographics: Ageing population, more children with complex needs, increase in demand. | Additional costs | 5 | 4 | 20 | 12 | Medium Term Financial Plan assumptions include inflationary increases to help mitigate demographic pressures. | Ongoing |
IJB - Strategic Risks
| No | Risk Owner | Risk | Impact | L | I | Score | Prior | Target | Controls in Place | Actions to be Taken | Target Date |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 11 | Chief Officer. | Public Protection: Potential ineffective processes and joint working arrangements around identifying, investigating, sharing information and protective action. | A failure in providing effective public protection could lead to a child or vulnerable adult experiencing or being at risk of significant harm. | 3 | 5 | 15 | 15 | 6 | Public Protection committee and Child protection Sub-committees. Children’s Services Strategic Partnership. Suicide Prevention Task Force. | NHS Orkney to propose updated pathway, procedures and training to ensure that Paediatric child protection assessments are robust enough. | 31.03.2025 |
| 12 | Head of Children, Families and Justice Services and Chief Social Work Officer. | Public Protection: Findings of the Children and Young People in Need of Care and Protection report. Findings of the Adult Support and Protection Inspection in 2023. | Reputational damage to Orkney Health and Social Care Partnership. | 2 | 2 | 4 | 4 | 4 | Improvement Plan from the joint Children and Young People in Need of Care and Protection inspection. The Adult Support and Protection Improvement Plan is now in place. | To update child protection procedures in line with national guidance. | 30.09.2024 |
| 13 | Head of Children, Families and Justice Services and Chief Social Work Office. | Public Protection: Vacancies in suitably qualified and experienced staff. | Multi-Agency Practitioners not confident in the policies and procedures in place. | 2 | 2 | 4 | 4 | 4 | Public Protection Lead Officer and Public Protection Learning and Development Officer in post. Analysed learning reviews, subsequent action plans and training and development for the partnership. | Training and Development Schedule to follow updated procedures and support identified areas for improvement in the improvement plans. | 30.11.2024 |
| 14 | Chief Officer. | Implications of National Care Service: The Scottish Government’s intention to create a National Care Service and to amend the functions of Integration Joint Boards may affect the provision of care in Orkney. | National developments relating to the redesign of adult care services may not take account of the unique requirements of delivering effective care services in remote and rural areas, and the higher costs of care required for small provision in rural areas may not be recognised and funded appropriately. | 4 | 3 | 12 | 12 | 6 | Engagement with the Scottish Government through COSLA, the Chairs’ and Vice Chairs’ national meetings, and through the Chief Officers’ Group to ensure there is a full understanding of Orkney’s challenges. | To be reviewed | Ongoing |
| 15 | Head of Primary Care Services. | Isles Primary Care Model: There is a risk that the IJB will fail to commission services to deliver and meet the population needs of the Isles. | Model does not fully support Working Time Directive which has consequential recruitment challenges. High cost of model delivery. | 3 | 3 | 9 | 9 | 4 | Risk assess working patterns and operate against HR advice. | Commission Long term review of Primary Care service delivery model. | 31.03.2025 |
| 16 | Head of Health and Community Care. | Unpaid Carers: Non-self-identification of people providing care as being unpaid career themselves. | Potential failure to meet legislation and impact on the valuable service unpaid carers are providing within the community. Increasing reliance on unpaid carers may become unsustainable. | 4 | 4 | 16 | 16 | 9 | Established an unpaid Carers Conference. | Investigate opportunities to work with employers (initially NHS Orkney and Orkney Islands Council) to develop carer-friendly employment policies. | 31.12.2025 |
| No | Risk Owner | Risk | Impact | L | I | Score | Prior | Target | Controls in Place | Actions to be Taken | Target Date |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 17 | Head of Health and Community Care. | Young Carers: External pressure on unpaid carers such as financial pressures from the cost-of-living crisis and educational pressures. | Reduced educational opportunities for young carers. | 4 | 4 | 16 | 16 | 9 | Working with Partners in communications to identify unpaid carers. | Develop specific strategies to identify and support young carers. | 31.03.2025 |
| 18 | Head of Health and Community Care. | Unpaid Carers: Support for unpaid carers is not effectively planned for and managed. | Increased levels of stress placed upon unpaid carers leading to carer burnout. Increased need for statutory care services, placing greater demands on services. | 4 | 4 | 16 | 16 | 9 | Social workers have recently tried a different approach to traditional break provision of a bed in a care home. The impact of these approaches will be assessed for their efficacy. Furthermore, a more formal approach to tackling the current short break/respite situation is being considered, with some ideas explored at the Unpaid Carer Conference, in November 2025. | Maximise innovative respite care/short breaks options and opportunities. | 31.03.2026 |
IJB - Operational Risks
| No | Risk Owner | Risk | Impact | L | I | Score | Prior | Target | Controls in Place | Actions to be Taken | Target Date |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 21 | Chief Officer | Insufficient workforce planning: Failure to recruit and retain appropriately skilled workforce. | Existing workforce becomes overstretched. | 5 | 4 | 20 | 20 | 9 | The Health and Social Care Three Year Workforce Plan submitted to Scottish Government on 31 July 2022. Quarterly meetings with the Council, Health Board and Third Sector Interface to discuss workforce planning as a whole system approach. | Updated Three Year Workforce Plan to be submitted to Scottish Government | 31.12.2025 |
| 22 | Head of Community Health and Care | Recruitment, Development and Retention of Workforce: Difficulties in recruiting to Social Care posts. | Service staff become overstretched. Service cannot manage within its resources. Increased levels of stress related absence. | 5 | 4 | 20 | 20 | 9 | Recruitment incentives in Social Care running. | Evaluate recruitment incentives. | 31.12.2025 |
| 23 | Head of Children, Families and Justice Services and Chief Social Work Officer. | Recruitment, Development and Retention of Workforce: Difficulties in recruiting to Social Work posts. | Key pieces of work are not able to be undertaken. Service standards drop and vulnerable people are placed at risk. Service is reactive rather than proactive. | 5 | 4 | 20 | 20 | 9 | Launched of a Sponsorship and Trainee Social Work Partnership with Open University to produce qualified Social Workers over next 2,4, 6 and 10 years. | Social Worker ‘Grow Our Own Scheme’ will continue to aim for two trainee intakes per year. | 31.03.2026 |
| 24 | Head of Health and Community Care. | Analogue to Digital Switchover: Cost implications delaying progress of an accelerated switch from analogue to digital phone lines. Switch from analogue to digital planned for 31 January 2027 in Scotland. | Vulnerable adults could be left without a means to contact someone if they are in need of help which could result in not getting appropriate treatment in a timely fashion. Significant increase in cost of service provision once appropriate kit has been identified. | 5 | 3 | 15 | 15 | 5 | Funding of £71,400 is available from the Scottish Government to test new equipment now available both in terms of efficacy and connectivity issues. All service users have been written to by the Telecare team advising them to be in touch if there is a change to their existing telephone package. | The project team continues to test the capabilities of alternative kit in an Orkney environment. A paper is to be prepared and presented to a future meeting of the Board to detail the estimated cost of transition and in future service provision. | 31.03.2025 |
| 25 | Chief Officer | Additional Investment Posts: There is a risk that the IJB will fail to identify the funding to commission the four additional investment posts as agreed in August 2023. | Redundancies required and consequential costs. Also impacts on service provision. | 4 | 1 | 4 | 6 | 6 | Operational arrangements relating to AHPs has been altered to mitigate the impact whilst the Primary Care team continues to review structures within existing resources, This leaves two posts - Commissioning Officer and Community Led Support Officer. | Further work is required relating to the cost/benefit analysis for both of these posts. Although there is a strong sense of spend to save, further work is underway to quantify and evidence this before a decision can be put to IJB. | 31.12.2025 |