Equity and Excellence: Liberating the NHS – an Update on Transition in Kirklees
Introduction This report gives the Board an update on three key elements of the current NHS reforms, namely: The creation of clinical commissioning groups (formerly GP Consortia) The creation of the Kirklees Health and Well Being Board The implementation of the Transforming Community Services agenda, and in particular the formation of the social enterprise, Locala Community Partnerships CIC. The Board has already received an update on the recommendations of the NHS Future Forum and the Government’s response to it under the Chief Executive’s report. All transition work programmes will need to take into account the implications of any consequent changes to the Health and Social Care Bill arising from this work.
Clinical Commissioning Groups There are two clinical commissioning groups (CCGs) in Kirklees – the North Kirklees Health Alliance, and the Greater Huddersfield Commissioning Consortium. Both CCGs are making good progress and developing at a similar rate. Plans are now underway for the CCG Executive meetings, with the first GHCC meeting planned for 23 June, with NKHA on the 27 July. Each CCG executive committee will meet on the fourth Wednesday of every month thereafter. The main areas of CCG development to draw to the PCT Board’s attention are: Both CCGs have held initial development sessions, with further organisational development being planned; Both CCGs have reviewed their ways of working and streamlined their meetings schedule, moving to fortnightly meetings (one of which is the Executive Committee). This makes better use of time limited clinical expertise; Significant attention is being paid by each CCG to practice engagement, and communication between shadow board members and their constituent practices is a priority; and Dialogue is continuing between the CCGs and other key stakeholders such as the local authority and providers. In addition to this work focussing on organisational development and infrastructure establishment, the CCGs have also begun work on their commissioning plans and priorities, including their responsibilities on the delivery of QIPP. Both groups recognise the importance of building on what is already underway, while allowing any change to evolve, and the work of the two CCG executive committees will help provide assurance to the PCT Board around QIPP ownership and delivery. In summary, much work has already been undertaken but there is obviously still a lot to do. The key next steps for both CCGs are:
To strengthen the focus on finance, performance issues through their executive committees; To initiate practice visits and practice cluster meetings; To produce and initial commissioning plan; To engage with management teams to share work to date and ‘get to know each other’; and To address any issues arising from changes to the Health Bill and prepare for authorisation Assignment and staffing capacity to Support Clinical Commissioning Groups Following engagement with teams in NHS Kirklees, and the local CCG leadership, we are now in a position to begin assignment of a number of relevant staff to the Clinical Commissioning groups, in line with the latest guidance on implementing transition of staff to the new arrangements (Gateway 15864 – March 2011). In doing so, we will be following the Organisational Change policy for Kirklees; we have advised staff of the principles underpinning the process during the June staff briefings, this being undertaken consistently across the cluster. All arrangements remain transitional and we have not yet worked through the impact of the latest government response to ‘Future Forum’ recommendations and any consequent changes and revised implementation. Staff whose functions will transfer to CCGs will be assigned in the first instance. In the case of Kirklees, some staff may be dedicated to one CCG, others may be shared across the two. However, in the case of some functions, where staff may be assigned to consortia, it could be that it is more appropriate to deliver this support though a service that then brings staff groups together across several CCGs, forming in some instances, embryonic commissioning support services. For some functions, this can happen almost straight away, for others, more consideration is required. For those staff whose functions do not transfer to CCGs but which will move to other bodies eg NHS Commissioning Board or the local authority, then they will either be managed either through a cluster level or local management structure until such times as new arrangements can be put in place. A challenge remains for us to reduce running costs and therefore we continue to keep oversight of the need to reduce posts overall. We have made provision in the accounts for redundancy costs if necessary and will deal with such issues in a transparent way, overseen by the Remuneration and Terms of Service Committee. Any such decision is likely to be made after June 2011 following the initial phase of assignment
Transforming Community Services Overseen by the TCS Board, the transition of NHS Kirklees’ Provider Services Directorate to its new social enterprise form is on target for 1 October 2011. The social enterprise, Locala Community Partnerships CIC, has been created. Managing Director Robert Flack has been seconded in to Locala in order to manage the necessary contractual and transition elements with NHS Kirklees on behalf of Locala. 2
The transition has a number of projects which are coordinated. Progress and risks are reported through the TCS governance structure. A recent report to the PCTâ€™s Audit Committee validated the programmes approach and governance. The project areas, progress and risks are highlighted below: HR Commissioner staff working in support of KCHS were identified during a process that commenced in autumn 2010. All identified staff have now been successfully transferred to KCHS. Comprehensive TUPE consultation has taken place with trade union partners and KCHS staff over the past 3 months. This has included a range of 1:1 and group meetings, written feedback and the production of a comprehensive new set of Frequently Asked Questions for staff. The procurement of a pension scheme for new staff is well underway. A preferred broker was selected in May and is working with KCHS to secure the new scheme; as well as additional elements including an Injury Benefit Scheme for all Locala staff and the required insurances, negligence schemes and indemnities common with all providers of NHS services. KCHS continues to await the outcome of its Direction Status application, made in February 2011, which will secure the NHS pensions of transferring staff. The NHS Pension Scheme is being actively pursued to expedite their response. Affected KCHS staff will be sent their formal Notification of TUPE Transfer at the end of June 2011. The purpose of the Notification is to formally advise staff on an individual basis that their contract of employment will transfer automatically to Locala at midnight on 30 September 2011. Business Set up Locala has sourced a bank account and is currently procuring a ledger. A permanent finance team will be appointed. Budgets have been set and during the transition and beyond the organisation is working to deliver is cost improvements. The Business Transfer Agreement is scheduled for signature by NHS Kirklees and Locala on 1 July 2011. There has been additional staff from the cluster identified to support the BTA process. In addition work continues on developing a new contract for October between the NHS Kirklees and Locala. Membership Locala is currently inviting the public to be members of Locala. In addition all staff, unless they opt out will become members of Locala. From the pool of members a members council will be created. Members can nominate themselves to be elected onto the members council. We will be using the Electoral Reform Service for this process to ensure probity and transparency. The members council will consist of 10 staff members, six public members and four co-opted members likely to be councillors and GPs. There role will be to appoint the 3
Chair, NEDs, help shape and define the strategic and financial plans and appoint an auditor. Initially the members council will be supported by an induction process. The appointment of the Chair and NEDs is supported by Odgers recruitment. Odgers will advertise and identify suitable candidates. The Members Council will appoint those candidates. Estates There are two simultaneous pieces of work ongoing in the Estates transition project. 1. Potential for rationalisation of estate. Led by EC Harris, reporting 23rd June. 2. Preparation for tenure including licences, terms of agreements, landlord tenant relationships, costs efficient approaches to VAT, Health & Safety etc. Led by Community Solutions. Work area one will conclude on the 23rd June and give the foundation for an estate strategy. The agreement of tenure aspect to work area two will conclude and lead into creation and delivery of an estates strategy. This will be concurrent with ongoing estates management led by Community Solutions. The terms and conditions of working with Community Solutions needs to be agreed and formalised. IT KCHS have requested that BT Engage provide a stocktake of the current IT provision and the potential opportunities and developments for the future. This will form the basis of an IT strategy. In the meantime we are working with the HIS on a programme of rationalising the IT hardware and replacing hardware that is out of date. For the transition specifically we are following the regional template for transition into a social enterprise. All actions have an owner and timeline. 4
Health and Well-Being Board Discussions are ongoing between the PCT and Council Directors in respect of remit, membership and governance. Given the NHS Futures Forum proposals and the Government response regarding this Board, then some of the points under discussion could be clarified once the governments final proposals are published in detail. At present the Government proposals are: We will give Health and Wellbeing Boards a new duty to involve users and the public. The Bill will make clear that HWBs should be involved throughout the process as clinical commissioning groups develop their commissioning plans, and there will be a stronger expectation, set out in statutory guidance, for the plans to be in line with the health and wellbeing strategy. Though they will not have a veto, HWBs will have a clear right to refer plans back to the group or to the NHS Commissioning Board for further consideration. 4
HWBs will have a stronger role in promoting joint commissioning and integrated provision between health, public health and social care. They will be given a formal role in authorising clinical commissioning groups and the NHS Commissioning Board will have to take HWBs views into account in their annual assessment of commissioning groups. Health and Wellbeing boards discharge executive functions of local authorities, and should operate as equivalent executive bodies do in local government. It will be for local authorities to determine the precise number of elected members on a Health and Wellbeing Board, and they will be free to insist upon having a majority of elected councillors. HWBs will be subject to oversight and scrutiny by the existing statutory structures for the overview and scrutiny of local authority executive functions. The existing statutory powers of local authority overview and scrutiny functions will continue to apply. In the line with the principles of the Localism Bill, local authorities will have greater discretion over how to exercise these powers. Local authorities will still be able to challenge any proposals for the substantial reconfiguration of services, and we will retain the Governmentâ€™s four tests for assessing service reconfigurations. So the present early draft of the remit will be tabled at the Board as well as the options for membership. This will be subject to change as the DH releases the command papers in July. The next meeting of the potential Shadow Board is on the 20th July, at which we hope to clarify these matters. 5
Conclusions As will be apparent from the updates above, work on NHS transition is progressing in NHS Kirklees at a strong pace. Inevitably, many elements could not be moved on until the conclusions of the listening exercise emerged, but we are now in a position to assess the impact of the Governmentâ€™s response to the Future Forum and make necessary changes where required.