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PROPOSED GOVERNANCE ARRANGEMENTS North of England Specialised Commissioning Transition Board

Purpose 1. The purpose of the paper is to outline the interim governance proposals for

the North of England Specialised Commissioning Transition Board. 2. This includes the establishment of a transitional Board and regional

operating groups that will oversee and manage the transition of specialised services to the NHS Commissioning Board. 3. This paper seeks agreement for the adoption of the new governance

arrangements from January 2012. Context 4. In July 2011, the Shared Operating Model for PCTs 1 confirmed that the 10

SCGs in England would be clustered into four larger groups along the same footprint as SHA clusters2. The aim of clusters is to support: a. Incremental progress towards national convergence of all specialised commissioning b. The move towards one operating model for specialised services c. A continued focus on convergence of contracts, policies and service specifications d. The need to maintain current performance and to implement existing Quality, Innovation, Productivity and Prevention (QIPP) schemes 5. In support of this, specialised commissioning groups and the National

Specialised Commissioning Team have agreed to create a single operating model, strategy and vision for specialised commissioning in order to continue with the trajectory of becoming a fully functional single national team by April 2013. 6. In August 2011, the Department of Health issued further guidance

outlining arrangements for the establishment of contract agreements between specialised services commissioning groups and providers. (Gateway Reference 16467). Single Operating Model Case for Change 1

See: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_128735 NSCT will continue working at a national level but increasingly linking with the SCG clusters as we move towards the single operating model. 2

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7. The programme of change will, over the next few months, increasingly

require specialised commissioning groups to work as one larger group within their clusters, agreeing priorities, sharing resources and converging policies and approaches as smoothly and as quickly as possible. 8. The progress of transition and the delivery of operational performance will

require significant adjustment within each cluster – this will result in the creation of a single senior management team and the development of regional operating groups. 9. These measures will enable the commissioning of specialised services in

the North of England to transfer as quickly and as effectively as possible into the new NHS Commissioning Board arrangements. Current Governance Arrangements 10. Specialised commissioning groups are joint sub-committees of the primary

care trusts within their region, with delegated responsibilities to commission specialised services on their behalf. 11. Specialised commissioning groups have board members with delegated

authority drawn from constituent primary care trusts. In some cases specialised commissioning group boards are enhanced with patient representation and other stakeholders. 12. Each specialised commissioning group is hosted by one primary care trust

on behalf of all member primary care trusts. 13. The development of a transitional board will not change the statutory

responsibilities of primary care trusts. Proposed Governance Arrangements 14. It is important to note at the outset that for the remainder of 2011/2012 and

throughout 2012/13, primary care trusts will remain accountable for the performance of specialised commissioning. 15. Financial flows, Schemes of Reservation and Delegation, Standing

Financial Instructions and risk sharing arrangements will remain at a regional level so as to provide the necessary assurances. 16. The management of ledger systems through the host primary care trust

and the reporting through the host primary care trust audit committee will not change.

17. However, as with primary care trust and strategic health authority

clustering, every opportunity to work in an integrated manner in order to 2 Final Version 21st November 2011


consolidate resources and skills and to help maintain resilience and momentum towards change should be seized upon. 18. A key enabler is agreeing the governance and accountability

arrangements that will deliver the right balance between helping primary care trusts and specialised commissioning boards maintain grip, whilst freeing up specialised commissioning teams to deliver the fundamental requirements of NHS modernisation. 19. In discussion with the host/lead primary care trust Cluster Chief Executives

it is proposed that a Single Specialised Commissioning Transition Board be established. 20. Each primary care trust Chief Executive from all the primary care trust

clusters across the three existing specialised commissioning groups will be members of the transition board. 21. This membership ensures that the statutory authorities are legally

represented on the North of England Specialised Commissioning Transition Board. 22. The Chair will be a primary care trust Cluster Chief Executive with the two

remaining lead specialised commissioning primary care trust Cluster Chief Executives becoming vice-chairs. 23. To ensure that the strategic health authority continues to be an integral

part of the assurance process, as per paragraph 6 of the Sir David Carter Review, the NHS North of England Chief Operating Officer and a nominated Non Executive SHA Board member will be non-voting members of the transition board. 24. The North of England Specialised Commissioning Transition Board may

also wish to consider other co-opted (non-voting) members if deemed necessary. 25. Following the appointment of an Interim Chief Officer, a senior leadership

team will be identified and be in attendance at the transition board. This leadership team will support the three regional groups who will maintain relationship and performance management at a local level. 26. Performance and operations of the regional operational groups (currently

the three specialised commissioning groups), will be reported to the transition Board on an aggregated level and within an agreed performance management framework.

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27. Existing specialised commissioning groups within the North of England

are: • • •

North West Specialised Commissioning Group. Five primary care trust clusters representing twenty four primary care trusts North East Specialised Commissioning Group. Four primary care trust clusters representing twelve primary care trusts Yorkshire and the Humber Specialised Commissioning Group. Six primary care trust clusters representing fourteen primary care trusts.

28. As specialised commissioning groups are formal sub committees of

primary care trust Boards the dissolution of the current regional specialised commissioning groups and development of a North of England Specialised Commissioning Transition Board requires the formal approval of primary care trust boards. . 29. In order to support the North of England Specialised Commissioning

Transition Board three regional operating groups will be established. This approach will provide regional issues to be managed appropriately and within existing Schemes of Reservation and Delegation of the primary care trusts hosting existing specialised commissioning groups. 30. This also provides a mechanism for regional reporting and performance

management and avoids in advance any conflict of interest with national reviews such as paediatric cardiac surgery. North of England Specialised Commissioning Transition Board 31. The North of England Specialised Commissioning Transition Board will be

comprised of the 15 Primary Care Trust Clusters across the North of England with membership and voting rights for each Primary Care Trust Cluster Chief Executive. 32. This approach avoids any issue of double delegation and ensures that

there is a synergy between sub-regional and regional priorities. 33. Quoracy will comprise of a minimum attendance of at least two Primary

Care Trust Cluster Chief Executives from each region, and either the Chair or one of the vice chairs. 34. Deputies to the primary care trust Cluster Chief Executive will be permitted

at the discretion of the Chair. In such circumstances deputies will need to be provided with formal delegated authority to make binding decisions on behalf of their primary care trust cluster board. 35. The strategic health authority will be represented by the Chief Operating

Officer but will not hold any voting powers.

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36. The North of England Specialised Commissioning Transition Board will

follow on from the NHS North of England management executive meetings, when the strategic health authority and Primary Care Trust Cluster Chief Executives are in attendance. This is felt to be the least disruptive way to accommodate North of England meetings, avoiding the need for additional travel. 37. For the avoidance of any doubt, the North of England interim

arrangements will not impinge upon or alter the arrangements for the National Joint Committee of Primary Care Trusts (JCPCT) conducting the review of children’s congenital heart services. Delegation arrangements have been directly made by all primary care trusts for the JCPCT and these will remain unchanged Establishment Agreement 38. A national model for the development of an Establishment Agreement is

currently being prepared which as a minimum will include: • • • • • •

Terms of reference Roles and responsibility of members Quoracy and voting rights Roles and responsibility of the Interim Chief Officer including the development of specific schemes of reservation and delegation Conflict resolution processes, and Schemes of reservation and delegation in relation to future procurement issues.

39. The Establishment Agreement will also outline accountabilities and the

objectives of the Board during the transitional period including: • • • •

The development of the North of England strategy for specialised commissioning The oversight of transition within the North of England The assurance process for the convergence of policy and approach during the transitional period The statutory responsibilities of primary care trusts for specialised commissioning including the budget throughout 2011/12 and 2012/13 and until responsibility transfers to the NHS Commissioning Board.

40. As an interim measure prior to the receipt of the national guidance the

governance and hosting principles outlined within the current Establishment Agreements will be consolidated into the North of England Establishment Agreement. Once the national guidance is available primary care trusts will be asked to adopt the revised documentation and principles therein.

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41. Existing specialised commissioning group hosting arrangements will

remain (as outlined in paragraph 40 above) until the transfer of functions to the NHS Commissioning Board including the hosting of separate specialised commissioning group contracts and budgets. 42. Governance structures will from the outset seek to provide for and

encourage clinical and clinical commissioning group engagement as much as possible. Performance and accountability 43. Clearly, accountability for performance and delivery must be maintained

through this transitional period. The North of England Specialised Commissioning Transition Board will have overall responsibility and oversight of performance within each regional operating group. 44. The respective responsibilities of the North of England Specialised

Commissioning Transition Board and the regional operating groups are set out below:

North of England Specialised Commissioning Transition Board

• • • • • • • •

Regional Operating Groups

• • • •

Strategy and policy implementation Transition and convergence Commissioning intentions Financial and performance oversight of the delivery within the three regional operating groups QIPP Strategic oversight for the agreement of any local developments. Business planning process Performance and financial monitoring at regional level (including management of local cost pressures) Relationship/provider management Regional strategic projects (e.g. major trauma) Local engagement (CCG, clinical, PPE) Quality and clinical governance

45. It is envisaged that the regional operating groups will oversee local

business planning, negotiating and setting of budgets at regional level; ensuring effective engagement with stakeholders and providing the detailed performance reports to the transition board. 46. As these groups will focus on operational matters it is suggested that

membership should be drawn from cluster primary care trust directors although this will be a matter for local discussion.

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Timescales 47. Each primary care trust should ratify the new arrangements in time for the

inaugural meeting of the North of England Specialised Commissioning Transition Board in January 2012. Recommendations Primary Care Trusts should: 1. Endorse the proposed governance arrangements that replace the

existing governance of specialised commissioning across the North of England. That is the development of a single North of England Specialised Commissioning Transition Board with a single supporting Establishment Agreement. It is proposed that this will be enacted through the primary care trust Cluster Chief Executives on behalf of their constituent primary care trust Boards. 2. Note the intention to appoint an interim Chief Officer and a North of England Senior Leadership Team so as to support both the transition Board and the three regional operational groups. 3. Note that, for financial governance and audit purposes, the use of resources will remain with the current governance arrangements via the three host primary care trust audit committees. 4. Note that staff will continue to be employed by the host primary care trust – until such time as these responsibilities transfer to the NHS Commissioning Board.

North of England Specialised Commissioning Transition Board

Membership All Primary Care Trust Cluster Chief Executives

North of England Senior leadership team including an Interim Chief Officer

North West Region Operating Group

North East Regional Operating Group

Yorkshire and Humber Regional Operating Group

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