Trust Policy

Hereford & Worcester Abdominal Aortic Aneurysm (AAA) Screening Programme

Risk Management of AAA Screening Procedures Policy AAA Screening Department / Service: Originator: Catherine Schorah

Accountable Director: Mr Eric Grocott (Clinical Director) Approved by: Mr Eric Grocott and The Vascular Clinical Governance Date of approval: First Revision Due: Target Organisation(s) Target Departments Target staff categories

Meeting February 2015 February 2017 Worcestershire Acute Hospitals NHS Trust AAA Screening AAA Screening team

Policy Overview: To define and document an organisation-wide local management process for AAA Screening Procedures in order to manage the risks associated, and to demonstrate implementation, compliance and monitoring.

Key amendments to this policy Date Amendment

By

February 2013 February 2013

4.5-5.4cm aneurysms are now classed as “medium”

C Schorah

Section 7 (Monitoring and Compliance) amended to include monitoring table

C Schorah

January 2015

Section 4 (Responsibilities and duties) description of AAA Screening Board updated to reflect current membership Section 5:1 “Special needs” altered to “special requirements” to reflect current wording in invitation letter Section 5:3 A “medium” aneurysm leaflet is now available

C Schorah

January 2015 January 2015

C Schorah

C Schorah

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Trust Policy Contents page: 1. Introduction 2. Scope of this document 3. Definitions 4. Responsibility and Duties 5. Policy detail 6. Implementation of key document 6.1 Plan for implementation 6.2 Dissemination 6.3 Training and awareness 7. Monitoring and compliance 8. Policy review 9. References 10. Background 10.1

Equality requirements

10.2

Financial Risk Assessment

10.3

Consultation Process

10.4

Approval Process

10.5

Version Control

Appendices Supporting Documents Supporting Document 1 Supporting Document 2

Equality Impact Assessment Financial Risk Assessment

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Trust Policy 1. Introduction This policy accurately describes and documents the management of The Hereford and Worcester AAA Screening Procedures in order to manage the risks associated, and to demonstrate implementation, compliance and monitoring.

2. Scope of this document                

Purpose Definitions Local duties Duties within the organisation Duties external to the organisation Education and Training Development and content of local procedural documentation Process for inviting/requesting screening procedures Process for the receipt of the results of a screening test Process for taking action on screening results Process for the communication of screening results Monitoring compliance with the document Process for monitoring compliance Standards/key performance indicators References Associated documentation; NHS AAA Screening Programme (NAAASP) Standard Operating Procedures, Hereford and Worcester AAA Screening Board terms of Reference

3. Definitions AAA Screening; all men in their 65th year who are registered with a General Practice in Hereford and Worcester are invited for AAA Screening locally (Men over 65 can self refer into the Programme). The screening (ultrasound examination) is carried out by an accredited Screener, who will measure the subject’s abdominal aorta. The successful measurement and size of the aorta is fundamental in providing results of screening to the patient and their GP. NAAASP National Abdominal Aortic Aneurysm Screening Programme QA Quality Assurance WAHT Worcestershire Acute Hospitals NHS Trust SOP Standard Operating Procedures NHS National Health Service CST Clinical Skills Trainer H&W Hereford and Worcester SCR Summary Care Record PAS Patient Administration System PID Patient identifiable data GP General Practitioner Northgate IT subcontractors CPD Continual Professional Development ST Screening Technician

4. Responsibility and Duties The Programme Director/Clinical Lead, a Consultant Vascular Surgeon is responsible to NAAASP and WAHT having overall accountability and responsibility for the operational processes and risk management of the Programme and for Clinical support to the Programme Manager/Co-ordinator.

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Trust Policy The Programme Manager/Co-ordinator is responsible to the Director/Clinical Lead, who delegates the task of operational and risk management of the screening programme to the Co-ordinator, but remains the responsible clinician for patients entered into the screening programme. The Manager/Co-ordinator is responsible for the development, implementation and dissemination of this Policy to AAA Screening Staff they manage and liaise with. She is also responsible for ensuring that all staff adhere to the NAAASP Standard Operating Procedures. The Clinical Skills Trainer/Lead Ultrasound Clinician, a Vascular Scientist is responsible to the Programme Director. As CST she is the first line clinical supervisor of the Screeners and is responsible for staff training and regular review of staff for quality assurance (QA) and risk management. In addition to undertaking routine equipment QA assessments and ensuring that regular maintenance of the ultrasound equipment is carried out. As Lead Ultrasound Clinician she has overall responsibility for QA of Staff and the risk management of the screening process. She is responsible for the screening equipment, staff accreditation, and monitoring of clinical performance (including review of scans from screening clinics). She is expected to report QA concerns to the Programme Director and Programme Manager. She will advise on which ultrasound equipment is to be purchased (subject to specifications of the National Screening Guidelines) and when it needs to be updated or replaced. All other AAA Screening Staff will be responsible in demonstrating their understanding of the Policy and will be monitored by the Manager/Co-ordinator, Ultrasound Lead/Clinical Skills Trainer, to ensure their compliance. AAA Screening Board (previously known as AAA Steering Group) meet quarterly to monitor the performance of the Programme against National Standards (NAAASP SOPs) and to identify and act on risks associated with the delivery of the AAA Screening Programme (AAA Screening Board Terms of Reference) Membership of the Board comprises of representatives from;  Public Health England , Herefordshire , Worcestershire and Arden Area Team  WAHT management team  Midlands and East QA team-UK National Screening Committee/NHS Screening Programmes, Public Health England The Programme Director, Manager and CST are expected to attend these meetings and provide accurate reports on operational activity. They are also expected to bring to the attention of the Board any risks/issues around screening.

5. AAA Screening Risk Management Process 5.1 Process for Inviting eligible cohort for Screening NAAASP IT subcontractors identify all men in their 65th year from Open Exeter. This is downloaded into the local H&W AAA Clinical System. Cohorts are subdivided into registered General Practice on the AAA Clinical System. NB Regular Open Exeter updates are applied to the AAA Clinical system by Northgate, ie, change of address, change of GP Practice. Screening Locations have been chosen after discussion with all stakeholders and comprise of General Practices and Community Hospitals in Hereford and Worcester. Clinics are planned according to size of cohort and set-up appropriately in the AAA Clinical System in advance (minimum of 3 weeks’ notice). Locality of clinics is evenly distributed throughout the screening year.

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Trust Policy The Daily Record Sheet is accessed daily by the Programme Administrator. Following the order of the Daily Record Sheet, as well as checking the AAA Clinical System, appointments (NAAASP standard invite letters) are generated and sent out, by post, to the subjects, by the Programme Administrator 3 weeks in advance of the planned clinic. This consists of an appointment detailing a specific date, time and location (address and postcode supplied) along with a NAAASP information leaflet. The standard invite letter asks men with special requirements (eg. Mobility, hearing or visual) to contact the screening centre in order to arrange an appointment at a dedicated clinic if applicable. The letter also includes the screening centre contact number for further information, queries or rescheduling of appointments. The date of appointment/s and amount sent is recorded on the Daily Record Sheet by the Administrator. This is monitored by the Programme Manager daily-fortnightly. There is also an audit trail on the AAA Clinical system.

5.2 Process for Self-referrals requesting screening Local presentations have been carried out to GP Practices. Press releases, ie Newspaper articles have been generated by NAAASP and H&W AAA Screening Programme detailing the self-referral opt in. Posters and leaflets are displayed in General Practices and Community Hospitals in H&W to encourage men over 65 to self-refer. The Screening Centre contact number is displayed and instructions are clearly set out for Men over 65 to contact the Screening Centre, by phone, if they would like to make an appointment to be screened. On receiving a request for self-referral, the subject’s NHS number is obtained if they know it, or from PAS or SCR and the subject is added to the registered GP Practice Cohort on the H&W AAA Clinical System. The subject is then offered a screening appointment locally and as soon as possible, with a choice of dates. An appointment letter is generated in exactly the same way as detailed above (invitations for screening).

5.3 Process for the receipt, taking action, documentation and communication of screening results As soon as the Screening Technician has completed the screening examination, all results are verbally communicated to the subject at the Screening Clinic. Possible Outcomes:Normal = < 3 cm The subject is verbally informed of the results at the end of the examination, reassured and discharged by the Screening Technician. The technician uses the tick boxes on the Clinical System to document that the patient has received the results of the scan. The subject is also verbally informed that a letter of results will be sent to his registered GP Practice (timescale of 1 day – 2 weeks). The result of the subject’s screening is recorded by the Screening Technician at the end of the screening examination on the AAA Clinical system and the outcome of discharge is recommended. NB: Failsafe: in the event of computer malfunction results are collected on a back-up paper proforma complete with PID by the Screening Technician. These are entered onto the AAA clinical system within 24-48 hours by the Screening Technician/Administrator. The Administrator/Programme Manager is alerted to patients without an outcome by the AAA Clinical system daily. Paper proformas are retained, securely, in the AAA office for at least one month after the clinic date.

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Trust Policy Using the Daily Record Sheet, and the AAA Clinical System the Administrator will generate and send (post out) the letter to the GP Practice (timescale of 1 day – 2 weeks). The date of the results letter/s and amount is recorded on the Daily Record Sheet by the Administrator. This is monitored by the Programme Manager daily-fortnightly. There is also an audit trail on the AAA Clinical system. Small aneurysm = 3 cm – 4.4 cm The subject is verbally informed of his results at the end of the examination and the findings and next steps are explained (the subject is also given a NAAASP small aneurysm leaflet – with the local screening centre contact number and Wendy Hayes, Vascular Consultant Nurse, contact number on the back). He is also informed that a results letter will be sent to the subject and his GP explaining the results and what happens next (as explained verbally and the timescale of 1 day – 2 weeks applied/given). The technician uses the tick boxes on the Clinical System to document that the patient has received the results of the scan. The result of the subject’s screening is recorded by the Screening Technician at the end of the screening examination on the AAA Clinical system and the outcome of a surveillance appointment in 1 year’s time is recommended. In addition, a request is made for a Vascular Nurse Consultant appointment. Images are automatically flagged as QA review on the AAA Clinical system. NB: Failsafe: in the event of computer malfunction results are collected on a back-up paper proforma complete with PID by the Screening Technician. These are entered onto the AAA clinical system within 24-48 hours by the Screening Technician/Administrator. The Administrator/Programme Manager is alerted to patients without an outcome by the AAA Clinical system daily. Using the Daily Record Sheet, and the AAA Clinical System the Administrator will generate and send (post out) the letter to the GP Practice and subject (timescale of 1 day – 2 weeks). The date of the results letter/s and amount is recorded on the Daily Record Sheet by the Administrator. This is monitored by the Programme Manager daily-fortnightly. There is also an audit trail on the AAA Clinical system. Weekly, the Programme Manager is responsible for informing the Vascular Nurse Consultant of AAA’s found during that week. The Vascular Nurse Consultant has access to the AAA Clinical system and is prompted by the system of patients requiring an appointment with her. Also, The Programme Manager/Administrator exports AAA subjects into a spreadsheet, which is recorded on the AAA Department M Drive to aid the Vascular Nurse in appointing subjects. The AAA Clinical system will remind the Administrator/Programme Manager when the patient’s surveillance scan is required/overdue. Alerts are reviewed daily by the Administrator and or Programme Manager. Medium aneurysm = 4.4 – 5.4 cm The subject is verbally informed of his results at the end of the examination and the findings and next steps are explained (the subject is also given a NAAASP medium aneurysm leaflet – with the local screening centre contact number and Wendy Hayes, Vascular Consultant Nurse, contact numbers on the back). He is also informed that a results letter will be sent to the subject and his GP explaining the results and what happens next (as explained verbally and the timescale of 1 day – 2 weeks applied/given). The technician uses the tick boxes on the Clinical System to document that the patient has received the results of the scan. Abdominal Aortic Aneurysm Screening Procedures Policy WAHT-CG-744 Version 2 Page 6 of 14

Trust Policy The result of the subject’s screening is recorded by the Screening Technician at the end of the screening examination on the AAA Clinical system and the outcome of a surveillance appointment in 3 months’ time is recommended. In addition a request is made for a Vascular Nurse Consultant appointment. Images are automatically flagged as QA review on the AAA Clinical system. NB: Failsafe: in the event of computer malfunction results are collected on a back-up paper proforma complete with PID by the Screening Technician. These are entered onto the AAA clinical system within 24-48 hours by the Screening Technician/Administrator. The Administrator/Programme Manager is alerted to patients without an outcome by the AAA Clinical system daily. Using the Daily Record Sheet, and the AAA Clinical System the Administrator/Screening Technician will generate and send (post out) the letter to the GP Practice and subject (timescale of 1 day – 2 weeks). The date of the results letter/s and amount is recorded on the Daily Record Sheet by the Administrator/Screening Technician. This is monitored by the Programme Manager daily-fortnightly. There is also an audit trail on the AAA Clinical system. Weekly, the Programme Manager is responsible for informing the Vascular Nurse Consultant of AAA’s found each week. The Vascular Nurse Consultant also has access to the AAA Clinical system and is also prompted by the system of patients requiring an appointment with her. Also, The Programme Manager/Administrator exports AAA subjects into a spreadsheet, which is recorded on the AAA Department M Drive to aid the Vascular Nurse in appointing subjects. The AAA Clinical system will remind the Administrator/Programme Manager when the patient’s surveillance scan is required/overdue. Alerts are reviewed daily by the Administrator and or Programme Manager. Large aneurysm = 5.5 cm or above The subject is verbally informed of his results at the end of the examination and the findings and referral to a Vascular Consultant and the next steps are explained (the subject is also given a NAAASP referral leaflet – with the local screening centre contact number and Wendy Hayes, Vascular Consultant Nurse, contact numbers on the back). He is also informed that a results letter will be sent to the subject and his GP explaining the results and what happens next (as explained verbally and the timescale of 24 hours applied/given). The technician uses the tick boxes on the Clinical System to document that the patient has received the results of the scan. The result of the subject’s screening is recorded by the Screening Technician at the end of the screening examination on the AAA Clinical system and the outcome of referral to Vascular Consultant is recommended. The Images are automatically flagged as QA review on the AAA Clinical system. The Screening Technician contacts the Screening Office by phone once the patient has left the clinic or at a suitable break in the clinic, informing the Programme Manager/Administrator verbally of the result. NB: Failsafe: in the event of computer malfunction results are collected on a back-up paper proforma complete with PID by the Screening Technician. These are entered onto the AAA clinical system within 24-48 hours by the Screening Technician/Administrator. The Administrator/Programme Manager is alerted to patients without an outcome by the AAA Clinical system daily. Abdominal Aortic Aneurysm Screening Procedures Policy WAHT-CG-744 Version 2 Page 7 of 14

Trust Policy The Programme Manager will refer the patient to an appropriate Vascular Surgeon on the AAA Clinical System. Using the Daily Record Sheet and the AAA Clinical System the Programme Manager or Administrator will generate and post out the referral to the Vascular Consultant and letter to the GP Practice. The subject’s letter is generated and posted out (timescale = 24 hours). The date of the results letters and referral are recorded on the Daily Record Sheet by the Programme Manager/Administrator. This is monitored by the Programme Manager dailyfortnightly. There is also an audit trail on the AAA Clinical system. The AAA Clinical system will remind (Alert) the Administrator/Programme Manager to chase response of the vascular referral. AAA Clinical System Alerts are reviewed daily by the Administrator and or Programme Manager. The Programme Manager/Administrator will update the AAA Clinical System with the response date received from the Vascular Team. Non-visualised - rescreen The examination is abandoned and the patient is informed and explained to verbally and a convenient appointment is arranged for re-screen by the Screening Technician or the patient is informed that he will receive an appointment for re-screen as soon as possible. It is also explained that his GP will receive a letter of non-visualisation (timescale 1 day – 2 weeks). The technician uses the tick boxes on the Clinical System to document that the patient has received the results of the scan. The result of the subject’s screening is recorded by the Screening Technician at the end of the screening examination on the AAA Clinical system and the outcome of re-screen is agreed. NB: Failsafe: in the event of computer malfunction results are collected on a back-up paper proforma complete with PID by the Screening Technician. These are entered onto the AAA clinical system within 24-48 hours by the Screening Technician/Administrator. The Administrator/Programme Manager is alerted to patients without an outcome by the AAA Clinical system daily. Using the Daily Record Sheet, and the AAA Clinical System the Administrator/Screening Technician will generate and send (post out) the letter to the GP Practice (timescale of 1 day – 2 weeks). The Administrator/Screening Technician will check whether an appointment has been made for re-screen and make one if necessary. The date of the non-vis letter/s and amount is recorded on the Daily Record Sheet by the Administrator/Screening Technician. This is monitored by the Programme Manager daily-fortnightly. There is also an audit trail on the AAA Clinical system. Non-visualised – refer to medical imaging The examination is abandoned and the patient is informed and explained to verbally by the Screening Technician. The patient is informed that he will receive an appointment for medical imaging at the local Vascular Lab as soon as possible. It is also explained that his GP will receive a letter of non-visualisation (timescale 1 day – 2 weeks). The technician uses the tick boxes on the Clinical System to document that the patient has received the results of the scan. The result of the subject’s screening is recorded by the Screening Technician at the end of the screening examination on the AAA Clinical system and the outcome of refer to medical imaging is agreed. NB: Failsafe: in the event of computer malfunction results are collected on Abdominal Aortic Aneurysm Screening Procedures Policy WAHT-CG-744 Version 2 Page 8 of 14

Trust Policy a back-up paper proforma complete with PID by the Screening Technician. These are entered onto the AAA clinical system within 24-48 hours by the Screening Technician/Administrator. The Administrator/Programme Manager is alerted to patients without an outcome by the AAA Clinical system daily. Using the Daily Record Sheet and the AAA Clinical System the Administrator/Screening Technician will generate and send a referral to medical imaging Department by fax or post and will generate and post out a non-vis refer to medical imaging letter to the GP Practice (timescale of 1 day – 2 weeks). The date of the non-vis letter/s and amount is recorded on the Daily Record Sheet by the Administrator/Screening Technician. This is monitored by the Administrator/Programme Manager daily-fortnightly by the Clinical system alerts. There is also an audit trail on the AAA Clinical system. If screening results are not entered in full an alert is generated by the system.

6. Implementation 6.1 Dissemination Included in Job Descriptions and Training given to AAA Staff by CST and Programme Manager. Policy produced in line with the NAAASP Standard Operating Procedures Policy distributed to AAA Staff on Department M Drive.

6.2 Training and awareness 3 months training for accreditation of Screening Technicians. Administrator is trained and inducted by the Screening Manager. Should any procedures change, the Screening Manager will make staff aware. Policy awareness sessions to be held in Admin duties for all Staff. All team members attend Trust mandatory Training according to Trusts Training Needs Analysis Appendix A of the Trusts Mandatory Training Policy

7. Monitoring and compliance The NHSLA requirements are – Organisations should measure, monitor and evaluate compliance with the minimum requirements within the NHSLA Risk Management Standards. This should include the use of audits and data related to the minimum requirements. The organisation should define the frequency and detail of the measurement, monitoring and evaluation processes. Monitoring demonstrates whether or not the process for managing risk, as described in the approved documentation, is working across the entire organisation. Where failings have been identified, action plans must have been drawn up and changes made to reduce the risks. Monitoring is normally proactive - designed to highlight issues before an incident occurs - and should consider both positive and negative aspects of a process.

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Trust Policy Page/ Section of Key Document

Key control:

Checks to be carried out to confirm compliance with the Policy:

How often the check will be carried out:

Responsible for carrying out the check:

Results of check reported to: (Responsible for also ensuring actions are developed to address any areas of non-compliance)

Frequency of reporting:

Page 4

Quality Assurance of ultrasound machines as recommended by NAAASP

Servicing and maintenance of machines and probes

Yearly

Servicing and maintenance reports retained for inspection and reported to AAA Steering Board

yearly

Page 4

ST’s maintain high standards in clinical performance, quality assurance and compliance with SOP’s or changes to local policy

Review of first 100 images of newly qualified technicians

Weekly

Monthly

NAAASP standard monitoring and clinical observation proforma used. Reported to AAA Screening Board

4 times a year

Review of all abnormal scans within 4 weeks

LUC/CST and Programme Manager as listed in duties and job description LUC/CST and Programme Manager as listed in duties and job description

Review of 4 random scans per month for each screening technician (post 100)

Monthly

Every screening technician is observed during one clinic at least every six months. Feedback and effective documentation is made to technicians and programme manager. Concerns or issues are flagged and a review /action plan initiated

Page 5

All men eligible for screening are invited

Six monthly

Team brief or team meetings/ inhouse CPD days are held regularlyto include policy awareness

Monthly

Staff appraisals undertaken in accordance with Trust Policy

Yearly

Revalidation of competency assessed by NAAASP every two years Search facility within the AAA Clinical

Every two years

Daily-fortnightly

Agendas and minutes taken and stored Reported to AAA Screening Board Appraisal notes taken and including recommendations and objectives for following year

Coordinator or

An audit trail on AAA clinical

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4 times a year

Trust Policy to attend an appointment in the correct screening year

System lists any eligible men yet to be invited for screening

Administrator as listed in duties and job description

system which is reported to AAA Screening Board

Daily to fortnightly

Coordinator or Administrator as listed in duties and job description

An audit trail on AAA clinical system which is reported to AAA Screening Board

4 times a year

Daily to fortnightly

Coordinator or Administrator as listed in duties and job description Coordinator as listed in duties and job description

An audit trail on AAA clinical system which is reported to AAA Screening Board

4 times a year

An audit trail on AAA clinical system which is reported to AAA Screening Board

4 times a year

Coordinator as listed in duties and job description

An audit trail on AAA clinical system which is reported to AAA Screening Board

4 times a year

An alert function within the AAA Clinical System highlights any cancelled appointments not rebooked

The clinician treating the patient (GP) is informed of the results within seven days of the scan Page 6

Page 6

The patient is informed of the results immediately on completion of scan

Page 8

Vascular referrals are made in a timely manner as per NAAASP guidelines

Page 9

The patient is followed up in the event of the aorta not visualised as per NAAASP guidelines

A Daily Record Sheet is kept to log each step of the call and recall process GP letters are automatically generated at the end of the clinic by the AAA Screening programme clinical system (database). Coordinator or Administrator monitor against clinic list and enter amount sent on the Daily Chart. There are “check boxes” on Clinical System. If not completed an ALERT is generated automatically.

The time from referral to out-patients appointment and time from referral to surgery is monitored and surgical outcomes (including mortality) are recorded AAA Clinical System Results of the initial scan are documented on the Clinical System and follow up monitored on a locally maintained spread sheet

Monthly

Daily-fortnightly

The Clinical System will show an alert against the patient until screening is successfully completed.

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Policy 8. Policy Review The Programme Manager, delegated by the Programme Director, is responsible for the review of this Policy every two years. 9. References Essential Elements in Developing an Abdominal Aortic Aneurysm (AAA) Screening and Surveillance Programme NAAASP July 2011 Version 3.0 Hereford and Worcester AAA Screening Board Terms of Reference 10. Background 10.1 Equality requirements The screening programme is for all those born male and aged 65+. Please see supporting document 1. 10.2 Financial risk assessment No financial risk identified – please see supporting document 2. 10.3 Consultation Contribution List This key document has been circulated to the following individuals for consultation; Designation Hereford and Worcester AAA Screening Board Wendy Hayes, Consultant Vascular Nurse (WAHT) Mel Williams, Principal Vascular Scientist (WAHT)

This key document has been circulated to the chair(s) of the following committee’s / groups for comments; Committee Vascular Department Clinical Governance Meeting AAA Screening Board

10.4 Approval Process This policy is approved by the Vascular Clinical Governance committee 10.5 Date

Version Control Amendment

WAHT-CG-744

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By:

Version 2

Policy Supporting Document 1 - Equality Impact Assessment Tool To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Yes/No 1.

Comments

Does the Policy/guidance affect one group less or more favourably than another on the basis of:  Race

No

 Ethnic origins (including gypsies and

No

travellers)  Nationality

No

 Gender

Yes

 Culture

No

 Religion or belief

No

 Sexual orientation including lesbian,

No

Only those born male are eligible under national screening policy

gay and bisexual people  Age

Yes

Only those aged 65+ are eligible under screening national policy

2.

Is there any evidence that some groups are affected differently?

Yes

Men are 6 times more likely to develop an aneurysm than women. UK Screening Committee assessed evidence and concluded that screening men in their 65th year could offer benefits at a reasonable cost.

3.

If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

Yes

4.

Is the impact of the Policy/guidance likely to be negative?

No

5.

If so can the impact be avoided?

N/A

6.

What alternatives are there to achieving the Policy/guidance without the impact?

N/A

7.

Can we reduce the impact by taking different action?

N/A

WAHT-CG-744

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Version 2

Policy Supporting Document 2 – Financial Impact Assessment To be completed by the key document author and attached to key document when submitted to the appropriate committee for consideration and approval. Title of document:

Yes/No

1.

Does the implementation of this document require any additional Capital resources

No

2.

Does the implementation of this document require additional revenue

No

3.

Does the implementation of this document require additional manpower

No

4.

Does the implementation of this document release any manpower costs through a change in practice

No

5.

Are there additional staff training costs associated with implementing this document which cannot be delivered through current training programmes or allocated training times for staff

No

Other comments:

None

If the response to any of the above is yes, please complete a business case and which is signed by your Finance Manager and Directorate Manager for consideration by the Accountable Director before progressing to the relevant committee for approval

WAHT-CG-744

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Version 2