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NHS NORTH OF ENGLAND – NORTH WEST COMMISSIONING DEVELOPMENT TEAM

DRAFT Section Major Themes

First Steps (Chapter 1)

Constitution (Chapter 2)

TOWARDS ESTABLISHMENT – CREATING RESPONSIVE & ACCOUNTABLE CCGs – SUMMARY (December 2011) DRAFT Summary of Issues need to be developed and agreed by the whole of the membership of the CCG, and not just by the CCG’s governing body; need to involve the membership of the CCG in decision-making; need to demonstrate probity and ensure openness, robustness and transparency – not just to the CCG but to local people and stakeholders the CCG is ALL the member practices - not just those in leadership positions, members of the Governing Body / Committees, or employees coming together as a CCG – work together to identify groups of practices. Risk Assessed (with SHA) identifying practice representatives – every practice need to identify a GP or other healthcare professional ensuring effective participation – shaping the culture; giving voice to patients, carers, local communities; driving forward improvements; enabling CCG to fulfil its duty of supporting continual improvement in the quality of primary care. Practice Agreement identifying clinical leaders – how many; eligibility; appointment process (select / elect); tenure; running appointment process (Nominations Committee) skills & competencies; equal opportunities & diversity; frequency leadership team will meet; how rest of CCG will be kept engaged, informed and empowered to participate. Includes 2 Lay Members and 2 other Clinical Members drawing up a Constitution Part 1 of Schedule 2 of the Health & Social Care Bill - as a minimum it should contain: Member practices to agree and sign off CCG Name – clear link to locality vision for commissioning and local health services – with other clinicians and stakeholders membership – the GP practices that make up the CCG the CCG’s key structures and how they will operate area of the CCG – a defined geographical area, the CCG will have overall make-up and processes for identifying governing responsibility for planning, developing and monitoring local services body / committees; any locality arrangements; arrangements to discharge functions delegation of function arrangements for securing effective participation of members identify how CCG will involve patients / public in functions of the CCG to be exercised on its behalf, by – commissioning decisions o any of its members or employees identify how will involve health & care professionals o its Governing Body in design of services o any committee or sub-committee of the group identify how, working with councils, will promote procedure to be followed by CCG / its Governing Body in making decisions partnership working and play role in H&WB how the CCG will deal with conflicts of interest shape culture, behaviours and relationships arrangements for securing transparency about decisions and the way they are put in place systems and processes that safeguard made – including holding public meetings of the Governing Body transparency, accountability & good governance appointment of an Audit Committee and Remuneration Committee by the consider processes for making the right decisions as Governing Body member-led organisations a description of the functions to be undertaken by the Governing Body and build CCG on foundation of effective local committees/ sub-committees relationships / communications anything else the CCG feels necessary – approach to NHS Constitution, public etc Need to meet requirements of the Public Sector Equality Duty (and describe in Constitution). Complete Equality Delivery System NOTE – Towards Excellence is subject to change to reflect changes to Health and Social Care Bill going through Parliament Key: Text in RED = Systems / Processes / Documents suggested in Towards Excellence Text in GREEN = Suggested Solution / Process

Version – Draft No 2 (19 December 2011)

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Andy Meadows, Governance Lead (andy.meadows@northwest.nhs.uk)


NHS NORTH OF ENGLAND – NORTH WEST COMMISSIONING DEVELOPMENT TEAM

DRAFT

TOWARDS ESTABLISHMENT – CREATING RESPONSIVE & ACCOUNTABLE CCGs – SUMMARY (December 2011) DRAFT

Section Importance of Good Governance (Chapter 3)

Summary of Issues good governance is about setting the right policy and procedures for ensuring things are done in a systematic and proper way – with transparency and public accountability built in. guidance references – The Good Governance Standard for Public Services, Committee on Standards in Public Life (Nolan Principles) suggested design principles for governance arrangements – true to vision; clinically-led; designed to fit new arrangements; securing maximum probity, transparency & accountability; rigorous to withstand challenge; bureaucracy light integrated governance – corporate (including strategic risk management); clinical; financial; information; research o corporate – overseen by governing body, including strategic and operation risk management Assurance Framework Standing Orders, Scheme of Reservation, Scheme of Delegation o clinical – securing continuous improvement (statutory duty). Includes – providing leadership for quality and safety; seeking views of patients / public / carers on services; encouraging reporting of errors / near misses for continuously learning; investigating complaints / concerns to improve quality; actively learning from patients’ experiences; promoting continuous improvement through contracts / monitoring; have systems / process that secure continuous learning throughout commissioning cycles. Establishing a Quality C’ tee o finance – an effective financial governance framework (financial reporting arrangements in place; procedures / policies to support meeting statutory financial duties; systems of internal control; effective Audit Committee) Standing Financial Instruction o information – systems to support effective use of information Senior Information Risk Officer o research – expected only in limited circumstances Demonstrating chapter stresses importance of accountability, probity and transparency as a statutory NHS body Accountability Accountability To demonstrate that the CCG is properly governed and that decisions have been made in an inclusive and open way & Probity & to their local community , for high quality health services Managing with H&WB, for Joint Health & Well Being Strategy and Joint Strategic Needs Assessment Conflicts of as commissioners, to the local council through its overview and scrutiny role Interest Probity integrity and honesty in all CCG operations (Chapter 4) clear safeguards re conflicts of interest Transparency As statutory NHS bodies, CCGs are expected to promote transparency at all times, e.g., ensuring early engagement on proposed commissioning plans publishing details of contracts held with the public and stakeholders publishing information about remuneration of staff setting out in the Constitution the way decisions are made having a Register of Interest holding key meetings in public, especially the Governing Body having systems to declare interests Conflicts of Guidance recognises that can’t avoid conflicts of interest but stresses importance of managing them effectively Interest openness engaging with providers Safeguards transparency creating clear and transparent commissioning specifications responsiveness and best practices following proper procurement processes securing expert advice ensuring sound record-keeping Register of Interests dispute resolution NOTE – Towards Excellence is subject to change to reflect changes to Health and Social Care Bill going through Parliament Key: Text in RED = Systems / Processes / Documents suggested in Towards Excellence Text in GREEN = Suggested Solution / Process Version – Draft No 2 (19 December 2011)

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Andy Meadows, Governance Lead (andy.meadows@northwest.nhs.uk)


NHS NORTH OF ENGLAND – NORTH WEST COMMISSIONING DEVELOPMENT TEAM

DRAFT Section Chapter 4 (continued) Governance Structures (Chapter 5)

Key Leadership Roles (Chapter 6)

TOWARDS ESTABLISHMENT – CREATING RESPONSIVE & ACCOUNTABLE CCGs – SUMMARY (December 2011) DRAFT Summary of Issues Additional Safeguards

Any Qualified Provider Primary Care Trust Procurement Guide (the basis for any future requirements) See also Technical Appendix 1: Managing Conflicts of Interest Member practices will need to describe these governance structures in their Constitution, discharged through a range of processes and structures Governing ensures that CCG has appropriate arrangements in place to exercise functions, effectively, efficiently, economically and in Body accordance with accepted principles of good governance determines the remuneration, fees and allowances payable to employees / persons providing services to CCG assurance, including audit and remuneration assuring the decision-making process oversight of arrangements for dealing with conflict of interest Governing GP Practices At the discretion of each CCG member practices to determine Body Others At least one registered nurse, one secondary care specialist doctor (if either of these 2 clinicians have a Membership conflict of interest, CCG must demonstrate how it will deal with this [in Chapter 6]) One lay member to oversee audit, remuneration and conflicts of interest One lay member to champion patient and public empowerment Accountable Officer and a Chief Finance Officer Audit functions to be determined by the Governing Body Committee Remuneration makes recommendations to the Governing Body on decisions of pay / remuneration of members and employees, together Committee with people who provide services (no usually healthcare services) to the CCG Quality recommendation, not stipulated by legislation (see clinical governance in Chapter 3 above) Committee Other C’tees at determination of the CCG or its Governing Body (including delegation to individuals / employees) Delegation to member practices to determine if have a locality structure for the Clinical Commissioning Group, but will need to be clear Localities about what locality can / cannot do will need to be referenced in their Constitution will require a Scheme of Delegation, Terms of Reference and be reflected in Standing Orders, Standing Financial Instructions delegation to locality brings additional responsibilities, will need an Accountability Agreement between locality & CCG Accountable ensures CCG complies with its legal duties / functions, i.e., exercises functions effectively, efficiently, economically; secures Officer continuous improvement in quality; delivers its financial duties; ensures accounting and auditing; providing information to NHS CB / Secretary of State ensures CCG provides good value for money in delivering duties Role may be shared across CCGs NOTE – Towards Excellence is subject to change to reflect changes to Health and Social Care Bill going through Parliament Key: Text in RED = Systems / Processes / Documents suggested in Towards Excellence Text in GREEN = Suggested Solution / Process

Version – Draft No 2 (19 December 2011)

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Andy Meadows, Governance Lead (andy.meadows@northwest.nhs.uk)


NHS NORTH OF ENGLAND – NORTH WEST COMMISSIONING DEVELOPMENT TEAM

DRAFT Section Chapter 6 (continued)

Collaborative Arrangements across CCGs (Chapter 7)

Next Steps (Chapter 8)

TOWARDS ESTABLISHMENT – CREATING RESPONSIVE & ACCOUNTABLE CCGs – SUMMARY (December 2011) DRAFT Summary of Issues Governing Role to be undertaken by a different GP (if Accountable Officer is a GP) or any other member of the Governing Body Body Chair Chair is selected by the Governing Body If Chair is a GP, the role of Deputy Chair should be undertaken by a Lay Member (in case of conflict of interest for the GP Chair) Same individual should not hold role of Accountable Officer and Chair of the Governing Body Chief Responsible for the provision of financial advice, supervision of financial control & accounting systems, including directions: Financial o implement CCG financial policies Officer o maintain effective systems of internal financial control o ensure sufficient records are maintained to show and explain CCGs transactions, o preparation of such accounts, certificates, estimates, reports required by CCG / external bodies Same individual should note hold role of Accountable Officer and Chief Financial Officer H&SC Bill encourages collaboration both with other CCGs and also with local authorities (the later through Section 75 agreements) Main risk with any such arrangement, keeping local accountability – the Collaboration Continuum (page 45) Types of to have a single representative voice - not ignored if ‘small’ Collaborative shared staff & expertise – share access to rare resource, improve cost efficiency, reduce bureaucracy Working support services – increase efficiency, reduce management / infrastructure costs risk pooling / sharing – improved resilience, improved response to major incident, reduce financial/ resource / staffing risks Good secure shared objectives - each CCG to understand how arrangement will help deliver its own objectives Governance explicit alignment of vision and values for the collaboration an agreement regarding the scope – agreeing Terms of Reference, Memo of Understanding Collaboration Agreement clarity regarding extent to which decisions can be taken – Scheme of Delegation, Terms of Reference Joint Committee process for taking decision – Terms of Reference, Collaboration Agreement how delegated body will report – Performance Criteria / Reporting Arrangements Collaboration Agreement clarity regarded any hosted / shared service arrangements – Service Level Agreement, Memo of Understanding Collaboration Agreement include a dispute resolution process – Terms of Reference, Collaboration Agreement MISSING – LIABILITY / RISK SHARING ARRANGEMENTS OF WORKING TOGETHER final guidance will be issued once the Health & Social Care Bill receives Royal Assent CCGs can use this guidance, supported by PCT Clusters, to take next steps on leadership and governance Local authorities should expect CCGs, supported by the PCT Clusters, to engage with them re: o the content of the Constitution o principles for involvement and engagement in commissioning decisions (also with overview & scrutiny committees) o joint commissioning opportunities o the development of H&WB, Joint Strategic Needs Assessments and Joint Health & Wellbeing Strategies NOTE – Towards Excellence is subject to change to reflect changes to Health and Social Care Bill going through Parliament Key: Text in RED = Systems / Processes / Documents suggested in Towards Excellence Text in GREEN = Suggested Solution / Process

Version – Draft No 2 (19 December 2011)

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Andy Meadows, Governance Lead (andy.meadows@northwest.nhs.uk)


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