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Agenda Item 11 Enclosure KPCT/11/27


NHS Kirklees Board


Proposed governance arrangements for the NHS Calderdale, NHS Kirklees and NHS Wakefield District Cluster Board

FOI Exemption Category


Lead Director:

Sue Cannon, Executive Director of Quality and Governance (Nursing


Victoria Pickles, Head of Corporate Affairs, NHS Calderdale

Key Points to Note:

 

From 1 October 2011, there will be a single Cluster Board for NHS Calderdale, NHS Kirklees and NHS Wakefield District. As part of the handover process to the new single Board, a Legacy Report has been produced and presented to this Board setting out the key areas of performance and delivery and the issues and actions to be addressed by the Cluster Board and its subcommittees. The Cluster Board will require revised standing orders (incorporating the standing financial instructions and scheme of delegation). These will also set out the new governance arrangements to be implemented across the cluster. Part of these arrangements will include a subcommittee which provides a governance vehicle for the development of Clinical Commissioning Groups and delegation of decision making powers.

Budget Implications:


Risk Assessment:


Legal Implications:

NHS Kirklees will remain a statutory organisation. The governance arrangements have been developed in line with the national guidance

Health Benefits:



Staffing Implications:

The appointment process for Non Executive Directors and Non Executive Associates is described in the paper.

Equality Impact:


Environmental Impact:


Sub Group/Committee:

Consultation has been undertaken with the Clinical Commissioning Executive and the Audit Committee


i. ii. iii. iv.


Receive the report setting out the proposed governance arrangements for the Cluster. Note that the Cluster Board will become the Board for NHS Kirklees from 1 October 2011. Note the appointment of the Non Executive Directors to the Cluster Board Approve the appointment of the Non Executive Associates.




Purpose of Report 1.1.

The report provides a description of the governance arrangements being developed to support a single Cluster Board for NHS Calderdale, NHS Kirklees and NHS Wakefield District. This follows the national model of governance being implemented, under guidance from the Strategic Health Authority (SHA). The Board is asked to note these arrangements.


Two Non Executive Associates are required to support the Clinical Commissioning Executive governance arrangements. The Board is asked to approve the appointments to these Associate roles.

Current Position 2.1.

In July 2011 the Strategic Health Authority wrote to the Chairs and Chief Executive of the Calderdale, Kirklees and Wakefield Cluster setting out the requirement to move to a single board arrangement.


Discussion was held at the informal boards in early August describing the proposed future governance arrangements and the timetable for completing this work. It set out the request from the SHA to move to this model of governance. The letter from the SHA is attached at appendix 1. The governance diagram is attached at appendix 2.


An update on the progress against this work was presented at the Cluster Partnership on 6 September 2011.


The new Board will be referred to as the NHS Calderdale, Kirklees and Wakefield District Cluster Board. Documentation will be changed appropriately to reflect this change.

Single Cluster Board 3.1.

The Cluster Board will be the Board for NHS Calderdale, NHS Kirklees and NHS Wakefield District, replacing the existing boards in each area. As a result, the Cluster Partnership, which was a subcommittee of all three existing boards will be closed.


The Cluster Board has a single set of executive and non executive directors. Appointments to the Directors were completed in April. The Appointments Commission confirmed the appointment of the Chair, the Audit Chair and six other non executives to the Cluster Board at its meeting on 13 September. These are: Angela Monaghan, Chair Keith Wright, Chair of the Cluster Audit Committee Sandra Cheseldine Roy Coldwell Tony Gerrard Roger Grasby


Mehboob Khan Ann Liston 3.3.

To support the Cluster Board, a single set of subcommittees is required. This reflects the reduced executive and non executive resource available to support a subcommittee structure. The existing subcommittees were grouped into four categories: 

Transfer to new arrangements unchanged

Transfer to new arrangement with some amendments

Responsibilities transfer in the new governance but with a new arrangement.

Subcommittee closed

An appendix setting out the subcommittees for each area and where they sit in the four categories is attached at appendix 3. 3.4.

Draft terms of reference for the new committees have been developed. They are currently out for discussion and consultation with appropriate individuals and groups, and will be presented to the first meeting of the Cluster Board on 4 October 2011 for approval.


As part of the agreement of the new governance arrangements, a legacy report has been produced for any of the subcommittees being amended or closed. This is to provide assurance to the Cluster Board that existing governance arrangements have been reviewed and covered in the new arrangements where required. The legacy reports will be presented at the first subcommittee meetings along with the action sheets from the predecessor committee minutes.


Amended standing orders (incorporating the standing financial instructions, scheme of delegation and authorised limits) will also be presented to the Cluster Board for approval. A key element of these still to be finalised is if and how the Chief Executive and Director of Finance will delegate their accountabilities and responsibilities and who these will be delegated to. This is important to ensure that there can be local decision making and that key governance actions can be taken. For example signing of contracts, sealing of documents, approval of quotations.


The Cluster Board will meet monthly, with every other meeting being in public. The meetings will continue on a rotation around the three areas. In line with the requirement for each area to produce its own Report and Accounts, the Annual General Meetings will be held separately in each area.


The Directors of Public Health (DsPH) of each PCT will remain as the statutory DPH for that PCT/Local Authority area. The DsPH will remain managerially accountable to the Chief Executive and professionally accountable to the Cluster Board. Each DPH will be a member of the new Board, will receive all the papers of formal Board meetings and contribute to the agenda. They will share one single vote on the Board on occasions when the Board votes on decisions.


To ensure effective handover, the letter from the SHA set out the need for the Chief Executive to produce a legacy report for each area covering patient safety, quality, finance, performance, QIPP and governance as well as the main risks affecting each area. These reports, along with the up to date risk register and Board Assurance Framework, are presented at this Board meeting.


3.10. A single Board Assurance Framework and risk reporting process is being developed for the Cluster Board and will be presented to the Cluster Board at its meeting in November. The Board Assurance Framework and risk register for each organisation is being signed off at the existing boards as part of the handover arrangements to the Cluster Board and will form the starting point for the Cluster assurance. The existing risk register and escalation arrangements in each organisation will continue until such time as any cluster arrangements are put in place. 3.11. The agenda for the Cluster Board is to be agreed. It is likely that this will include standing items on quality and patient safety, finance and performance, QIPP, governance and transition (commissioning and provider development, Health and Wellbeing Boards, Commissioning Support etc). Finance and Performance Committee minutes will also continue to be presented to the Cluster Board until the new subgroup arrangements have been signed off. 3.12. It is expected that there may also be further guidance from the Department of Health around governance of Clusters and the Clinical Commissioning Groups. Updates on any changes will be provided to the Cluster Audit Committee. 4. Clinical Commissioning Groups, Board subcommittee arrangements 4.1.

Each of the current boards has a subcommittee arrangement with its local Clinical Commissioning Group(s). This provides a mechanism for having executives and non executives working alongside Clinical Commissioning Group members and a route for future delegation of responsibilities.


Each area has a director responsible for the development of the CCG: 

Calderdale – Dr Matt Walsh

Kirklees – Carol McKenna

Wakefield – Jo Webster


In addition Ann Ballarini as Executive Director of Commissioning is responsible for ensuring that CCGs are prepared for the Authorisation Process, with the appropriate skills and knowledge in place.


In Calderdale and Kirklees there is a Clinical Commissioning Executive (CCE) for each of the Clinical Commissioning Groups (CCG), including membership from the CCG Board alongside executive and non executives and other partner representatives. Wakefield District has a similar Clinical Executive Committee (CEC) which is a federated model, with membership on the one committee from all the local CCGs. This will be reviewed by December.


The existing terms of reference for these board subcommittees have been reviewed and brought together where possible. The membership has been amended to reflect the proposals set out in the NHS Future Forum report.


To reflect the need for lay membership on the CCE / CEC, it is proposed that the membership of the CCE includes two Non Executive Associates (NEAs). These roles need to be appointed by the Board and the Board is asked to approve the appointment of Rob Millington and Vanessa Stirum as the NEAs for Greater Huddersfield and Valerie Aguirregoicoa and Imran Patel as the NEAs for North Kirklees.



A copy of the NEA role description is attached at appendix 4. In addition, one NED from the Cluster Board and one Executive Director will be appointed to the CCE / CEC by the Cluster Board. Other members will be agreed locally by the CCE / CEC.


The CCEs / CEC will be supported by strengthened governance arrangements as described below:

Clinical Commissioning Group Proposed Governance Structure

Clinical Senates (to be developed)

Quality Group

Clinical Governance: Quality Boards Patient Safety Infection Control Clinical Incidents Medicines Management Clinical Effectiveness Patient Experience

Cluster Board

Clinical Commissioning Executives (Greater Huddersfield & North Kirklees)

Finance and Performance Group

Audit and Governance Group

Finance Performance QIPP Contract Management

Audit Risk Information Governance Equality & Diversity



The terms of reference for these sub groups* will be approved by the CCEs / CEC. The Cluster Board will be asked for a view on these arrangements to ensure that they are assured that they represented robust and supportive governance. [* There cannot be double delegation therefore these will be sub groups set up to support the CCE / CEC to discharge its responsibilities, but responsibility will remain with the CCE / CEC.]

4.10. Each sub group will have a work plan for the year. There will be a self assessment and assurance process, through the Audit Committee, that the CCE and its subgroups are meeting their terms of reference and work plan. 4.11. The intention is that these arrangements will enable the delegation of decision making powers and responsibility for local commissioning to the Board subcommittee. Within the Scheme of Delegation (set out as part D to the Standing Orders), the terms of reference describe the responsibilities that the CCE / CEC are being given by the Cluster Board. This is supported by delegation of responsibilities to individual executives. 4.12. The future decision making requires CCGs to be authorised and therefore accountability and responsibility to be delegated to them from the Cluster Board. The arrangements described in this paper do not allow delegation of 6

responsibilities to the Clinical Commissioning Groups. The Board subcommittee is a way of developing the skills and experience of CCG Board members to undertake commissioning and become the local decision making body in a safe way supported by the responsible and accountable executive and non executives with a clear route of accountability to the Board. 4.13. On 6 September 2011, the SHA sent out a draft plan for delegation of responsibilities to Pathfinders, including the development of a number of documents in addition to agreed clinical outcomes and budgets:



A Pathfinder Constitution

Pathfinder Development Plan

Establishment Agreement

Delivery agreement between pathfinder and PCT Cluster Board

All of these documents are in development and will be shared with the Cluster Board. The current development plan will be refreshed as a result of the outputs of the diagnostic tool, currently being completed in each of the areas, which identifies the knowledge and skills requirements for the CCG.

Recommendations It is recommended that the Board: v. Receive the report setting out the proposed governance arrangements for the Cluster. vi. Note that the Cluster Board will become the Board for NHS Kirklees from 1 October 2011. vii. Note the appointment of the Non Executive Directors to the Cluster Board viii. Approve the appointment of the Non Executive Associates.