COMMENT
Risk management in the NHS – and across the public sector – is changing as Trusts have increasingly developed in-house business continuity expertise. But the impact of efficiency savings and cuts could reverse some of that progress, argues Richard Mackie, director of the Centre of Risk for Health Care Research & Practice.
B
usiness continuity managers can have a bit of a thankless time of it – theirs
is the sort of job that when they are doing well, nobody notices.
That would not matter as such, except that when managers dealing with the need to make savings start to comb their back of- fices, someone whose job they pay little at- tention to can be a target.
But that sort of thinking is leaving organi- sations open to far greater potential risks and losses, according to business continu- ity expert Richard Mackie, who has spent a long career dealing with these issues and is now director of the Centre of Risk for Health Care Research & Practice, based at Barts and The London School of Medicine and Dentistry.
He said: “In the past, there were a lot of consultants brought in, who helped to de- sign the various policies and procedures and practices, but over the last few years there’s been a change, with public sector organisations taking this on board them- selves.
“It isn’t a difficult thing to do as such. The risk manager, or business continuity man- ager, becomes almost like a conductor of an orchestra – they cannot tell the IT de- partment how to go and do their business continuity plan, but rather they will say to IT that in the event of something taking place, we need to have the right infrastruc- ture there to deal with it. They will tell that department to ensure the organisation has that technical capability, and to come back with the plan. Then you need to know that HR know what to do, and so on. Local au- thorities and NHS trusts are realising they can do this themselves. It’s all about liaison between the departments.
“External companies offer back-up facili- ties, but a number of organisations have a lot of empty properties, or some used not to their full capacity. If you have one set aside with PCs that’s still quite capable of functioning, you can do it yourself at very little cost.
“In the past, people were very consumed with the mega-events, which were very
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low-risk, but very high-impact. We tended to find that smaller risks, that were quite likely to occur, could really blindside peo- ple, despite their smaller impact.
“If you’re too focused on the mega-events, you can forget the smaller events, and be- fore you know it you haven’t got any plans, and that can catch you out.
“Particularly in the last two or three years, I have noticed in the public sector a change towards thinking about these smaller events and ensuring structures are in place to mitigate against them.”
The efficiency savings in the NHS, and rapid organisational change, have obvious implications for business continuity. But those decisions remain ultimately the re- sponsibility of senior executives.
Mackie said: “They would be the ones mak- ing the cuts and decisions, which can im- pact upon business continuity and service levels. It’s up to the business continuity manager to pick up the pieces and mop up the mess, while ensuring they’re not affect- ed by the cuts themselves.
“Unless an event actually happens, it can be difficult to show your worth. If you’re good, the risks should not materialise – and if they do, they will have minimal impact – so business should continue.
“If your plans work successfully, no-one will notice your good work! It’s only when you don’t have that individual there and something does go wrong that you have a serious interruption to service, you’re not able to meet demands, and it’s at that point, when problems are occurring that can cost into the millions of pounds, that senior managers will realise it was not worth sav- ing a small amount of money.”
Business continuity in the NHS has a spe- cial relevance, since its staff will be directly responsible for helping dealing with disas- ters and ‘mega-events’, not just considering their own welfare and facilities.
Mackie explained: “A common event peo- ple have to plan for is pandemic flu. In the fire service, say, you have to weigh up how
many motor vehicle accidents there are on an average day, and how many instances of fire and so on there are; and then, if there is a pandemic outbreak, schools will be closed, offices will be closed, a lot of people will be at home. So the likelihood of car ac- cidents will go down, so in terms of service levels and resources, you won’t necessarily need 100% anyway.
“But in healthcare, it’s a different story. If there is a pandemic illness, staff will be dealing with those people coming in, put- ting staff at risk, then you’ve got to think about the staff you can depend on.
“There are legality issues, but you have to identify staff you can depend on, who would tend to be younger staff, those less likely to have family, those less likely to have very elderly parents who need looking after. Their general fitness and wellbeing will generally be better.
“But you also need to look at things that can be delayed. If there is a pandemic event, it may last for a few weeks or months, but if someone’s awaiting a hip operation, or non-life threatening surgery, that can be postponed. Those facilities and resources can then be transferred to the frontline.
“Looking at terrorist events and similar, again it’s all about having back-up plans: can non life-threatening operations be cancelled? Most hospitals do have empty floors they don’t use – if there is a shortage of beds, there’s still no shortage of space, in which temporary beds could be set up.
“It’s also possible to set up emergency tri- age units on site for people whose injuries do not require hospitalisation, to stop them coming in and using up resources. Think- ing about it logically, planning becomes straightforward.”
That depends on the experts still being in their jobs to do the planning, Mackie added.
Visit
www.smd.qmul.ac.uk/risk/ Richard Mackie
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