NHS HALTON CLINICAL COMMISSIONING GROUP CONSTITUTION. Version: 4

Transcription

1 NHS HALTON CLINICAL COMMISSIONING GROUP CONSTITUTION Version: 4 Approved by NHS Halton Clinical Commissioning Group Members Forum and Governing Body on 5 th November 2015 NHS England Effective Date: 16 th May 2016

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3 CONTENTS Part Description Foreword 5 1 Introduction and Commencement Name Statutory framework Status of this Constitution Amendment and variation of this Constitution 7 2 Area Covered 8 3 Membership Membership of the Clinical Commissioning Group Eligibility Leaving the Clinical Commissioning Group 10 4 Vision, Purpose, Values and Strategic Objectives Vision and Purpose Values Strategic Objectives Principles of good governance Accountability 13 5 Functions and General Duties Functions General duties General financial duties Other relevant regulations, directions and documents 25 6 Decision Making: The Governing Structure Authority to act Scheme of Reservation and Delegation General Committees of the CCG Joint arrangements The Governing Body Committees: Audit Committee Executive Partnership Board Human Resource and Organisational Development Committee Integrated Governance Committee Performance and Finance Committee Primary Care Commissioning Committee Quality Committee Remuneration Committee Service Development Committee Urgent Issues Committee 34 7 Roles and Responsibilities Practice representatives Other GPs or primary care health professionals 38 Page

4 Part Description Page 7.3 All members of the CCG s Governing Body The Chair of the Governing Body The Deputy Chair of the Governing Body Role of the Role of the Chief Finance Officer Role of the Chief Nurse Role of the Director of Transformation Role of the Director of Public Health Role of the Practice Manager Member of the Governing Body Role of the Secondary Care Doctor Member Role of the Registered Nurse Member Role of Lay Members Joint appointments with other organisations Indemnity 43 8 Standards of Business Conduct and Managing Conflicts of Interest Standards of business conduct Conflicts of interest Declaring and registering interests Managing conflicts of interest: general Managing conflicts of interest: contractors and people who 50 provide services to the CCG 8.6 Transparency in procuring services 50 9 The CCG as Employer Transparency, Ways of Working and Standing Orders General Standing orders 53 Appendices Description Page A Definitions of Key Descriptions used in this Constitution 54 B List of Member Practices 56 C Standing Orders 57 D Scheme of Reservation and Delegation including Summary Matrix 71 E Prime Financial Policies 81 F The Nolan Principles 90 G The Seven Key Principles of the NHS Constitution 91

5 FOREWORD This Constitution sets out NHS Halton Clinical Commissioning Group s (CCG) responsibilities for commissioning care for local people. It describes the governing principles, rules and procedures that we will establish to ensure probity and accountability in the day to day running of NHS Halton CCG; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to our goals. It confirms: the legal status of the CCG the CCG s vision, values and strategic objectives membership of the CCG and the decisions reserved to the membership how the membership relates to the CCG s Governing Body the CCG s leaders, their roles and how they are selected and are expected to behave the powers of the Governing Body, Committees and individuals the CCG s meeting arrangements the CCG s prime financial policies The Constitution applies to all of the Member Practices; CCG employees, individuals working on behalf of the CCG and to anyone who is a member of the CCG Governing Body (including the audit and remuneration Committees) and any Committee(s) established by the CCG or its Governing Body. Every Member Practice, employee or other person working on behalf of the CCG, or member of the Governing Body or any Committees is responsible for knowing, complying with and for upholding the arrangements for the governance and operation of the CCG as described in this Constitution. Page 5

6 1 INTRODUCTION AND COMMENCEMENT 1.1. Name The name of the CCG is NHS Halton Clinical Commissioning Group Statutory Framework Clinical commissioning groups are established under the Health and Social Care Act 2012 ( the 2012 Act ). 1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 ( the 2006 Act ). 2 The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision The NHS Commissioning Board (all future references in this document refer to NHS England, the operational name for the NHS Commissioning Board) is responsible for determining applications from prospective groups to be established as clinical commissioning groups 4 and undertakes an annual assessment of each established group. 5 It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so Clinical commissioning groups are clinically led membership organisations made up of providers of essential primary medical services to registered patients during core hours 7. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a Constitution Status of this Constitution This version of the Constitution is made between the Members Practices of the CCG and will be effective from the date of approval The Constitution is published on the CCG s website at See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act See section 275 of the 2006 Act, as am ended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as am ended by section 13 of the 2012 Act See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act See section 14Z16 of the 2006 Act, inserted b y section 26 of the 2012 Act See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act As defined by Regulation of the National Health Service (Clinical Commissioning Groups) Regulations 2012 (SI 2012/1631) See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and an y regulations issued Page 6

7 1.4. Amendment and Variation of this Constitution This Constitution can only be varied in two circumstances 9 a) where the CCG applies to NHS England and that application is granted b) where in the circumstances set out in legislation NHS England varies the CCG s Constitution other than on application by the CCG. Page 7

8 2 AREA COVERED 2.1 The geographical area covered by the CCG is fully coterminous with the local authority boundary of Halton Borough Council. 2.2 This CCG's geographical area is made up of 79 Lower Super Output Areas (LSOAs), which have a total population of 125,970. The total population registered with Member Practices within the CCG is 129,078. This difference in population is due to patients being registered with a Member Practice within Halton but living within another Local Authority boundary. (The LSOA population estimates are mid-2013 estimates from the Office of National Statistics, and the Member Practices population estimates are correct as at March 2014 from Health and Social Care information Centre indicator portal) 2.3 All Member Practices are located within this local authority boundary. 2.4 The map below shows practices with different symbols/colours according to the clinical commissioning group to which they belong. NHS Halton CCG's practices are shown as dark red circles. Practices are located according to the centroid of their postcode recorded by the Organisation Data Service (branch practices are not shown). Local Authority boundaries are shown as yellow lines and the geographical boundaries of clinical commissioning groups as thick red lines (mixed red/yellow lines indicate shared LA/clinical commissioning group boundaries). Page 8

9 3 MEMBERSHIP 3.1 Membership of the CCG The following practices comprise the Members Practices of the CCG. Practice Name Appleton Village Surgery Beaconsfield Surgery Beeches Medical Centre Brookvale Practice Castlefields Health Centre Grove House Practice Heath Road Hough Green Health Park Murdishaw Health Centre Newtown Health Care Centre Oaks Place Surgery Peelhouse Medical Plaza Tower House Practice Upton Rocks Primary Care Weavervale Practice West Bank Medical Centre W indmill Hill Medical Centre Address 2 6 Appleton Village, W idnes, W A8 6DZ Bevan W ay, W idnes, W A8 6TR 20 Ditchfield Road, W idnes, W A8 8QS Hallwood Health Centre, Hospital W ay, Runcorn, W A7 2UT The Village Square, Castlefields, Runcorn, W A7 2HY St Paul s Health Centre, High Street, Runcorn, W A7 1AB Heath Road, Runcorn, W A7 5TJ Hough Green Road, Widnes, W A8 4NJ Gorsewood Road, Murdishaw, Runcorn, W A7 6ES W idnes HCRC, Oaks Place, Caldwell Road, W idnes, W A8 7GD W idnes HCRC, Oaks Place, Caldwell Road, W idnes, W A8 7GD Peelhouse Lane, W idnes, W A8 6TN St Paul s Health Centre, High Street, Runcorn, W A7 1AB W idnes RUFC Car Park, Heath Road, W idnes, W A8 7NU Hallwood Health Centre, Hospital W ay, Runcorn, W A7 2UT 2 Lower Church Street, W est Bank, W idnes, W A8 0NG Norton Hill, W indmill Hill, Runcorn, W A7 6QE Page 9

10 3.1.2 Appendix B of this Constitution contains the list of Member Practices, together with the signatures of the Member Practice Representatives confirming their agreement to this Constitution. 3.2 Eligibility Providers of essential primary medical services to registered patients during core hours 10 from locations within the boundary of Halton Borough Council will be eligible to apply for membership of the CCG Leaving the CCG Subject to the agreement of NHS England a member practice may resign from the CCG to join another Clinical Commissioning Group after giving a minimum number of three months notice The only ground on which the CCG would terminate a membership of an individual practice is when the practice ceases to hold a contract for the provision of primary medical services As defined by Regulation 2 of the National Health Service (Clinical Commissioning Groups) Regulations 2012 (SI 2012/1631) See section 14A(4) of the 2006 Act, inserted by section 25 of the Regulations to be made Page 10

11 4 VISION, VALUES AND STRATEGIC OBJECTIVES 4.1 Vision and Purpose The vision of the CCG is: Involving everybody in improving the health and well-being of the people of Halton The purpose of the CCG is: To improve the health and well-being of the population of Halton by preventing ill-health, promoting self-care and independence, arranging local, community-based support whenever possible and ensuring high quality hospital services for those who need it. In doing so, we aim to empower and support local people from the start to the end of their life. We intend to support people to keep well and supported in their homes, particularly avoiding crises of care that result in hospital admission. Practices will be the building blocks around which we will support and empower individuals and communities, promoting prevention, self-care, independence and resilience. We will work with local people and organisations, including Halton Borough Council, healthcare providers and the voluntary sector to ensure that the people of Halton experience smooth, coordinated, integrated and high quality services to improve their health and well-being. We will ensure sustainability principles are embedded across our commissioned services thus preserving resources for future generations and ensuring public money is spent in the most effective and sustainable way possible The CCG plans only to commission services from providers who can demonstrate a commitment to their social responsibilities and to sustainability principles The CCG will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. 4.2 Values Good corporate governance arrangements are critical to achieving the CCG s objectives. Page 11

12 4.2.2 The key values and behaviours that lie at the heart of the CCG s work are: a) Partnership- by which we mean we will work in a collaborative manner across our member practices, with local people and communities and with organisations with whom we share a common purpose b) Openness- by which we mean we will undertake to deliver all business within the public domain unless there is a legitimate reason for us not to do so c) Caring- by which we mean we will place the local people, patients carers and their families at the heart of everything we do d) Honesty- by which we mean we will be clear in what we are able to do and what we are not able to do as a commissioning organisation e) Leadership- by which we mean we will be role models and champions for health in the local community f) Quality- by which we mean we will commission the services we ourselves would want to access; and g) Transformational- by which we mean we will work to deliver improvement and real change in care. 4.3 Strategic Objectives The CCG s strategic objectives are: Strategic Objective 1: To commission services which continually improve the health and wellbeing of the people of Halton. Strategic Objective 2: To continually improve and innovate in our engagement with local people and communities to secure their participation in improving their own health outcomes. Strategic Objective 3: To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations. Strategic Objective 4: To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Strategic Objective 5: To develop the skills, knowledge and competence of the people who are working with us to create a high performing organisation that will allow us to build effective partnerships with other organisations and develop leadership from within. Page 12

13 4.3.2 The strategic objectives are measured by the five domains of the NHS Outcomes Framework: a) Preventing people from dying prematurely b) Enhancing the quality of life for people with long-term conditions c) Helping people recover from episodes of ill health or following injury d) Ensuring that people have a positive experience of care; and e) Treating and caring for people in a safe environment and protecting them from avoidable harm. 4.4 Principles of Good Governance In accordance with section 14L (2)(b) of the 2006 Act, 12 the CCG will at all times observe such generally accepted principles of good governance as are relevant to it in the way it conducts its business. These include: a) the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business; b) The Good Governance Standard for Public Services; 13 c) Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England 14 d) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles ; 15 e) the seven key principles of the NHS Constitution; 16 and f) the Equality Act Accountability The CCG will demonstrate its accountability to the Member Practices, local people, stakeholders and NHS England in a number of ways, including by: a) publishing its Constitution Inserted by section 25 of the 2012 Act The Good Governance Standard for Public Services, The Independent Commission on Good Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance and Accountability (CIPFA), 2004 As published by the Professional Standards Authority for Health and Social Care in Novem ber 2012 See Appendix F See Appendix G See Page 13

14 b) appointing independent Lay Members and non GP clinicians to its Governing Body c) holding meetings of its Governing Body in public (except where the CCG considers that it would not be in the public interest in relation to all or part of a meeting) d) publishing annually a commissioning plan e) complying with local authority health overview and scrutiny requirements f) meeting annually in public to publish and present its annual report (which must be published) g) producing annual accounts in respect of each financial year which must be externally audited h) having a published and clear complaints process i) complying with the Freedom of Information Act 2000; and j) providing information to NHS England as required In addition to these statutory requirements, the CCG will demonstrate its accountability by: a) being a strategic member of the Halton Health and W ell Being Board, Halton Strategic Partnership Board and Halton Children s Trust, including their affiliated Committees and Sub-Committees b) establishing a Halton People s Health Forum for local people and patients and organisations who represent them to meet with clinical commissioners and CCG staff c) establishing a CCG Members Forum for staff from practices to discuss areas of mutual interest in regard to clinical commissioning d) establishing a NHS Halton CCG Practice Manager s Forum for practice managers to receive information about and feed into the work of the CCG e) establishing a NHS Halton CCG Practice Nurse Forum to receive information and ensure engagement in the work of the CCG; and f) participating in the Mersey Clinical Commissioning Group Network The Governing Body will throughout each year have an on-going role in reviewing the CCG s governance arrangements to ensure that the CCG continues to reflect the principles of good governance. Page 14

15 5 FUNCTIONS AND GENERAL DUTIES 5.1 Functions The functions that the CCG is responsible for exercising are largely set out in the 2006 Act (as amended by the 2012 Act), the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations and the National Health Service (Clinical Commissioning Groups Disapplication of Responsibility) Regulations 19. An outline of these appears in the Department of Health s Functions of clinical commissioning groups: a working document. They relate to: a) Commissioning certain health services (where NHS England is not under a duty to do so) 20 that meet the reasonable needs of: i) All people registered with Member Practices, and ii) People who are usually resident within the area and are not registered with a Member Practice b) commissioning emergency care for anyone present in the CCG s area c) paying its employees remuneration, fees and allowances in accordance with the determinations made by its Governing Body and determining any other terms and conditions of service of the CCG s employees d) determining the remuneration and travelling or other allowances of Governing Body Members In discharging its functions the CCG will: a) act 21, when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and NHS England of their duty to promote a comprehensive health service 22 and with the objectives and requirements placed on NHS England through the mandate 23 published by the Secretary of State before the start of each financial year by: i) Preparing and Publishing a Commissioning Plan Statutory Instrum ent 2012/2996. Statutory Instrum ent 2013/350. See further section 3(1A) of the 2006 Act and Regulation 4 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act Page 15

16 The CCG shall prepare a Commissioning Plan in accordance with the guidance published by NHS England. The Commissioning Plan will set out how the CCG proposes to exercise its functions during the relevant Financial Year. The CCG shall publish the Commissioning Strategy and 2 year plan and supply a copy to NHS England before any date specified by NHS England in a direction and to any relevant Health and W ellbeing Board. The CCG may revise the Commissioning Plan after it has been published. W here the CCG revises the Plan in a way which it considers to be significant it must publish the revised plan, give a copy of the plan to NHS England before any date specified by NHS England in a direction and also provide a copy to any relevant Health and W ellbeing Board. W here the CCG revises the Plan in a way which it does not consider to be significant it must publish a document setting out the changes it has made to the Plan and give a copy of the document to NHS England and each relevant Health and W ellbeing Board. 24 A copy of the Commissioning Plan as amended from time to time shall be available at the CCG s place of business 25 and shall be published on the CCG s website ii) Consulting on Commissioning Plans W here the CCG is preparing a Commissioning Plan or revising a Commissioning Plan in a way which the CCG considers significant, the CCG will: a) consult individuals for whom it has responsibility for the purposes of Section 3 of the NHS Act 2006; and b) involve any relevant Health and W ellbeing Board in preparing or revising the Commissioning Plan. iii) Procurement In drafting the Commissioning Plan, the CCG will have regard to: a) the NHS (Procurement, Patient Choice and Competition) (No. 2) Regulations 2013) b) Part 8 of the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 (Choice of Health Service Provider); and See section s.14z12 of the 2006 Act First Floor, Runcorn Town Hall, Heath Road, Runcorn, Cheshire W A7 5TD Page 16

17 c) any other guidance from NHS England in respect of procurement, patient choice and competition W hen commissioning services the CCG will ensure that providers meet relevant requirements, namely that they: a) are registered with the Care Quality Commission and licensed by Monitor where required, or meet equivalent assurance requirements b) will meet the Terms and Conditions of the NHS Standard Contract which includes a requirement to have regard to the NHS Constitution, relevant guidance and law c) accept NHS prices d) can provide assurances that they are capable of delivering the agreed service requirements and comply with referral protocols; and e) reach agreement with local commissioners on supporting schedules to the standard contract including any local referral thresholds or patient protocols b) meet the public sector equality duty 26 by: i) affirming the CCG commitment to having an effective Equality Delivery System (EDS) and to mainstream equality issues within all our commissioning decisions and will ensure compliance with the Equality Act 2010 ii) publishing an annual statement of priorities and action plan demonstrating how it will deliver the NHS EDS iii) nominating a lead manager to oversee delivery of the EDS iv) delegating responsibility to the Human Resources and Organisational Development Committee to ensure compliance with statutory equality duties c) working in partnership with its local authority to develop joint strategic needs assessments 27 and joint health and wellbeing strategies 28 by: See section 149 of the Equality Act 2010, as am ended by paragraphs 184 and 186 of Schedule 5 of the 2012 Act See section 116 of the Local Government and Public Involvement in Health Act 2007, as am ended by section 192 of the 2012 Act See section 116A of the Local Government and Public Involvem ent in Health Act 2007, as inserted b y section 191 of the 2012 Act Page 17

18 i) giving each relevant Health and W ellbeing Board a draft of the Commissioning Plan or, as the case may be, a copy of the revised Commissioning Plan ii) consulting each relevant Health and W ellbeing Board on whether the draft Commissioning Plan takes proper account of each Joint Health and W ellbeing Strategy published by the relevant Health and Wellbeing Board which relates to the period (or any part of the period) to which the Commissioning Plan relates iii) including in the published Commissioning Plan or, in circumstances where the CCG revises a published plan in a way in which the CCG considers significant, the revised Commissioning Plan, a summary of the views expressed by individuals consulted, an explanation of how the CCG took account of those views; and a statement of the final opinion of each relevant Health and W ellbeing Board consulted in relation to the Commissioning Plan; and iv) having regard to any guidance published by NHS England in relation to drafting, revising and consulting on the contents of the Commissioning Plan. 5.2 General Duties - in discharging its functions the CCG will: make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements 29 by: a) securing public involvement at all stages of the commissioning cycle and in particular: i) strategic planning: engaging with communities to identify health needs and aspirations; and engaging the public in decisions about priorities and strategies. ii) iii) iv) specifying outcomes and procuring services: Engaging patients in service design and improvement; and patient centred procurement and contracting. managing demand and performance: patient centred monitoring and performance management. establishing and approving a Communication and Engagement Strategy that details the approach to communication and engagement. 29 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act Page 18

19 5.2.2 Facilitate Communication and Engagement by: a) Building continuous and meaningful engagement with our public, patients and carers to influence the shaping of services and improve the health and wellbeing of people in Halton. b) Increasing confidence, with patients, public, provider and partner organisations in the CCG as an effective and responsive commissioning organisation. c) Developing a culture within the CCG that promotes open communication and engagement within and outside the organisation Promote awareness of, and act with a view to ensuring that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 30 by: a) requiring all officers to demonstrate regard for the NHS Constitution through their reports and recommendations to the Governing Body and sub Committees b) ensuring that there is a robust communication and engagement strategy that clearly articulates the CCG s commitment to the NHS Constitution. c) requiring that all decisions taken by the Governing Body and its sub Committees shall be considered alongside the relevant provisions of the NHS Constitution d) declaring the extent of compliance with the NHS Constitution annually Act effectively, efficiently and economically 31 by: a) delegating authority to the Governing Body to ensure that the CCG complies with its obligations under the Act. b) delegating responsibility to the Audit Committee to provide assurances to the Governing Body through appropriate reporting that the CCG is acting appropriately and in accordance with the Act. c) delegating responsibility to the Performance and Finance Committee to ensure compliance with this provision. d) nominating the Chief Finance Officer as the executive officer responsible for ensuring appropriate mechanisms are in place Act with a view to securing continuous improvement to the quality of services 32 by: See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as am ended by 2012 Act) See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act Page 19

20 a) establishing a Quality Committee as a Sub-Committee of the Governing Body that has specific delegated responsibility to ensure commissioned services are of high quality and that they are regularly reviewed in the context of continuous improvement. b) requiring providers, through Commissioning for Quality and Innovation (CQUINs), quality schedules and other quality improvement processes, to continue to improve services. c) nominating the Chief Nurse as the Governing Body lead for quality. d) requiring the Chief Nurse to submit an annual report to the Governing Body following an assessment by the Quality Committee setting out the quality improvements and any issues within provided services for the preceding year. e) establishing and approving of a Quality Strategy Assist and support NHS England as appropriate in relation to its duty to improve the quality of primary medical services 33 and ensure appropriate specialist commissioning by: a) establishing a Primary Care commissioning and Quality Committees that have specific delegated responsibilities to deliver this function and to support NHS England in this regard b) nominating a Clinical Lead to support NHS England in this role c) ensuring links to NHS England Specialist Commissioning Systems d) supporting NHS England with co-commissioning of primary care Have regard to the need to reduce inequalities 34 by: a) establishing this requirement as a key purpose of the CCG that will be monitored by the Governing Body through assurance provided via the Quality Committee. b) nominating the Public Health lead as the Governing Body lead for ensuring discharge of this duty c) ensuring proper representation of the CCG on the Health and W ellbeing Board d) making arrangements for the Local Authority and HealthW atch input into the development of plans e) monitoring progress against targets at every public meeting See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act Page 20

21 5.2.8 Promote the involvement of patients, their carers and representatives in decisions about their healthcare 35 by: a) having HealthWatch representation on the Governing Body b) establishing a Halton People s Health Forum for local people and patients and organisations who represent them to meet with clinical commissioners and CCG staff c) ensuring all Lay Members have a responsibility for Public and Patient Involvement and identifying one lay member as a lead for patient and public involvement and engagement d) nominating a Clinical Lead to lead on this work Act with a view to enabling patients to make choices 36 by: a) establishing and approving a Procurement Policy that details plans in respect of procurements so that patients are able to choose between providers where this will secure the needs of the people who use the relevant services, improve the quality of those services and improve efficiency in the provision of services. b) establishment of Patient Education Programmes c) ensuring Clinical Leaders develop and implement frameworks to enable patients to make informed choices d) requiring the Chief Nurse to provide regular updates to the Governing Body on progress with Choice Obtain appropriate advice 37 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: a) ensuring an appropriate and robust skill composition of the Governing Body and appointing members of the highest calibre b) having an identified Public Health lead on the Governing Body c) having an identified Local Authority lead on the Governing Body d) having a Secondary Care Doctor Governing Body Member e) having a Practice Manager Member on the Governing Body See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act Page 21

22 f) appointing appropriate members to each of the Sub Committees so that the Governing Body and the CCG can be assured that all decisions are fully informed g) ensuring there is representation on Health and W ellbeing Board and that there are feedback mechanisms in place h) establishing a Members Forum to work closely with operational managers to ensure delivery of the commissioning plans i) ensuring that all clinical and officer members are able to access high quality education and training programmes to support them in their advisory and decision making roles j) contributing to the development of a CCG Network so that additional multi-disciplinary advice can be sourced from that forum k) contributing to and engaging with Clinical Networks and Clinical Senates to ensure appropriate clinical advice is accessed and utilised l) establishing Clinical Fora for clinicians from Member Practices and, where appropriate from community and secondary care providers, to discuss areas of mutual interest in regard to clinical commissioning m) communicate and consult with all appropriate professional bodies including the Local Medical Committee n) ensure appropriate advice to support decision making in relation to individual funding requests Promote innovation 38 by supporting innovative approaches to service redesign, service delivery, health improvement and quality where there is sufficient evidence to do so Promote research and the use of research 39 by engaging with appropriately authorised and approved programmes of research where those programmes contribute to the delivery of the CCG s strategic and operational objectives Have regard to the need to promote education and training 40 for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty 41 by: See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act See section 14Z of the 2006 Act, inserted b y section 26 of the 2012 Act See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act Page 22

23 a) establishing an appropriate Human Resources and Organisational Development Committee that will have delegated responsibility for ensuring there are robust training and education opportunities b) nominating the HR Lead () of the Governing Body as the Officer responsible for ensuring there are appropriate arrangements in place c) developing and approving a Training and Education Programme for the CCG, Governing Body and Sub Committee members Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the CCG considers that this would improve the quality of services or reduce inequalities 42 by: a) working to align the vision of the CCG and Halton Borough Council to enable integration b) working to develop an effective Health and Wellbeing Board and sustaining effective membership c) working with the Local Authority to identify opportunities for integration and establishing Section 75 Partnership Arrangements d) having Local Authority representation on the Governing Body e) encouraging providers to collaborate and co-operate to ensure patients are able to access seamless services 5.3 General Financial Duties the CCG will perform its functions so as to: Ensure its expenditure does not exceed the aggregate of its allotments for the financial year 43 by: a) nominating the Chief Finance Officer as the executive officer with responsibility to ensure appropriate mechanisms, including policies and procedures are in place b) delegating responsibility to the Performance and Finance Committee to oversee the discharge of this duty c) delegating responsibility to the Audit Committee to receive, review and approve prime financial policies and procedures d) requiring the Governing Body to receive regular reports from the Performance and Finance Committee on financial performance. Those report shall also detail any risk and associated mitigation plans See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act Page 23

24 e) delegating responsibility to the Audit Committee to assure the Governing Body that the Chief Finance Officer and the Performance and Finance Committee are effectively discharging their responsibilities in this regard f) the establishment and monitoring of Cost Improvement Plans by the Performance and Finance Committee Ensure its use of resources (both its capital resource use and revenue resource use) does not exceed the amount specified by NHS England for the financial year 44 by: a) nominating the Chief Finance Officer as the executive officer with responsibility for this requirement b) delegating responsibility to the Performance and Finance Committee to oversee the discharge of this duty c) requiring the Governing Body to receive regular reports from the Performance and Finance Committee on financial performance. Those report shall also detail any risk and associated mitigation plans d) delegating responsibility to the Audit Committee to assure the Governing Body that the Chief Finance Officer and the Performance and Finance Committee are effectively discharging their responsibilities in this regard e) the establishment and monitoring of Cost Improvement Plans by the Performance and Finance Committee Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by NHS England 45 by: a) nominating the Chief Finance Officer as the executive officer with responsibility for this requirement b) delegating responsibility to the Performance and Finance Committee to oversee the discharge of this duty c) requiring the Governing Body to receive regular reports from the Performance and Finance Committee on Financial Performance. Those reports shall also detail any risk and associated mitigation plans d) delegating responsibility to the Audit Committee to assure the Governing Body that the Chief Finance Officer and the Performance and Finance Committee are effectively discharging their responsibilities in this regard See sections 223I(2) and 223I(3) of the 2006 Act, inserted b y section 27 of the 2012 Act See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act Page 24

25 e) the establishment and monitoring of Cost Improvement Plans by the Performance and Finance Committee Publish an explanation of how the CCG spent any payment in respect of quality made to it by NHS England 46 by publishing this information in the CCG annual report that will be made available to the public. 5.4 Other Relevant Regulations, Directions and Documents The CCG will: a) comply with all relevant regulations; b) comply with directions issued by the Secretary of State for Health or NHS England; c) take account, as appropriate, of documents issued by NHS England; and d) provide assurance in relation to Caldicott / information officer roles and functions The CCG will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this Constitution, its Scheme of Reservation and Delegation and other relevant group policies and procedures. 46 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act Page 25

26 6 DECISION MAKING: THE GOVERNING STRUCTURE 6.1 Authority to act The CCG is accountable for exercising the statutory functions conferred on it. It may grant authority to act on its behalf to: a) its Governing Body b) employees c) a Committee or Sub-Committee of the CCG The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the CCG as expressed through: a) the CCG s Scheme of Reservation and Delegation; and b) for Committees, their Terms of Reference 6.2 Scheme of Reservation and Delegation The CCG s Scheme of Reservation and Delegation sets out: a) those decisions that are reserved for the membership as a whole acting through the Members Forum b) those decisions that are the responsibilities of its Governing Body (and its Committees), the CCG s Committees and Sub-Committees, individual members and employees The CCG remains accountable for all of its functions, including those that it has delegated 6.3 General In discharging functions of the CCG that have been delegated to its Governing Body (and its Committees) individuals must: a) comply with the CCG s principles of good governance 48 b) operate in accordance with the CCG s Scheme of Reservation and Delegation 49 c) comply with the CCG s standing orders 50 d) comply with the CCG s arrangements for discharging its statutory duties See Appendix D See section 4.4 on Principles of Good Governance above See appendix D See appendix C See Section 5 above Page 26

27 e) where appropriate, ensure that Member Practices and the public have had appropriate opportunities to contribute to the CCG s decision making process W hen discharging their delegated functions, Committees must also operate in accordance with their approved Terms of Reference W here delegated responsibilities are being discharged collaboratively, the joint (collaborative) arrangements must: a) identify the roles and responsibilities of those clinical commissioning groups who are working together b) identify any pooled budgets and how these will be managed and reported in annual accounts c) specify under which clinical commissioning group s Scheme of Reservation and Delegation and supporting policies the collaborative working arrangements will operate d) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties e) identify how disputes will be resolved and the steps required to terminate the working arrangements f) specify how decisions are communicated to the collaborative partners 6.4 Committees of the CCG The following Committees have been established by the CCG: a) Audit Committee b) Executive Partnership Board c) Human Resources and Organisational Development Committee d) Integrated Governance Committee e) Performance and Finance Committee f) Primary Care Commissioning Committee g) Quality Committee Page 27

28 h) Remuneration Committee i) Service Development Committee j) Urgent Issues Committee Committees will only be able to establish their own Sub-Committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the CCG or the Committee they are accountable to. 6.5 Joint Arrangements The Clinical Commissioning Croup (CCG) can work together with other CCGs in the exercise of its commissioning functions. The CCG may make arrangements with one or more CCG in respect of: delegating any of the CCG s commissioning functions to another CCG; exercising any of the commissioning functions of another CCG; or exercising jointly the commissioning functions of the CCG and another CCG For the purposes of the arrangements described above, the CCG may: make payments to another CCG; receive payments from another CCG; make the services of its employees or any other resources available to another CCG; or receive the services of the employees or the resources available to another CCG. Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions. For the purposes of the arrangements described above, the CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. Where the CCG makes arrangements with another CCG as described above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of: Page 28

29 How the parties will work together to carry out their commissioning functions; The duties and responsibilities of the parties; How risk will be managed and apportioned between the parties; Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; Contributions from the parties, including details around assets, employees and equipment, to be used under the joint working arrangements. The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to the above. The CCG will act in accordance with any further guidance issued by NHS England. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body. The Governing Body of the CCG shall require, in all joint commissioning arrangements that the lead clinician and lead manager of the lead CCG make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives. Should a joint commissioning arrangement prove to be unsatisfactory the Governing Body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year Joint commissioning arrangements with NHS England for the exercise of CCG functions The CCG may wish to work together with NHS England in the exercise of its commissioning functions. The CCG and NHS England may make arrangements to exercise any of the CCG s commissioning functions jointly. These arrangements may include other CCGs. Where joint commissioning arrangements pursuant to above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question. Arrangements made may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG. Where the CCG makes arrangements with NHS England (and another CCG if relevant), the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of: Page 29

30 How the parties will work together to carry out their commissioning functions; The duties and responsibilities of the parties; How risk will be managed and apportioned between the parties; Financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund; Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements; and The liability of the CCG to carry out its functions will not be affected where the CCG enters into such arrangements. The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body. The Governing Body of the CCG shall require, in all joint commissioning arrangements that Accountable Officer of the CCG make a quarterly written report to the Governing Body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives. Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months notice period Joint commissioning arrangements with NHS England for the exercise of NHS England s functions The CCG may wish to work with NHS England and, where applicable, other CCGs, to exercise specified NHS England functions. The CCG may enter into arrangements with NHS England and, where applicable, other CCGs to: Exercise such functions as specified by NHS England under delegated arrangements; Jointly exercise such functions as specified with NHS England. Where arrangements are made for the CCG and, where applicable, other CCGs to exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question. Arrangements made between NHS England and the CCG may be on such terms and conditions (including terms as to payment) as may be agreed between the parties. For the purposes of the arrangements described, NHS England and the CCG may establish and maintain a pooled fund made up of Page 30

31 contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made. Where the CCG enters into arrangements with NHS England, the parties will develop and agree a framework setting out the arrangements for joint working, including details of: How the parties will work together to carry out their commissioning functions; The duties and responsibilities of the parties; How risk will be managed and apportioned between the parties; Financial arrangements, including payments towards a pooled fund and management of that fund; Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements. The liability of NHS England to carry out its functions will not be affected where it and the CCG enter into joint arrangements. The CCG will act in accordance with any further guidance issued by NHS England on cocommissioning. Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body. The Governing Body of the CCG shall require, in all joint commissioning arrangements that the Accountable Officer of the CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives. Should a joint commissioning arrangement prove to be unsatisfactory the governing body of the CCG can decide to withdraw from the arrangement, but has to give six months notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months notice period The CCG has entered into joint arrangements with the following: a) Mersey Network with NHS Knowsley CCG, NHS Liverpool CCG, NHS South Sefton CCG, NHS Southport and Formby CCG, NHS St Helens CCG, NHS W arrington CCG and NHS W est Lancashire CCG b) The CCG has joint Committees with Halton Borough Council, governed through the section 75 partnership agreement c) The CCG works jointly with Halton Borough Council to commission services and secure better outcomes for the people of Halton d) The CCG may enter into further joint arrangements with the approval of the Governing Body Page 31

32 6.6 The Governing Body Functions - the Governing Body has the following functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this Constitution. 52 The Governing Body has responsibility for: a) ensuring that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the CCGs principles of good governance 53 (its main function) b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act c) approving any functions of the CCG that are specified in regulations 54 d) additional delegated matters: i) managing demand and performance: patient centred monitoring and performance management. This includes monitoring performance against plans and national targets, including monitoring progress on targets related to reducing inequalities ii) leading the setting of vision and strategy iii) approving Commissioning Plans iv) providing assurance of strategic risk v) receiving reports, including: a) Financial and Performance Reports from the Performance and Finance Committee b) Reports in respect of Quality including the Annual Quality Report c) Key Issues and Risk reports from all accountable Sub- Committees See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act See section 4.4 on Principles of Good Governance above See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act Page 32

33 vi) approving the CCG Equality Delivery Objectives for the relevant year vii) approving arrangements for service integration e.g. Section 75 Agreements Composition of the Governing Body - the Governing Body shall not have less than fifteen voting members and comprises of: a) the Chair who will be a GP or primary care health professional from a Member Practice b) four other GPs or other primary care health professionals from Member Practices to be known as Clinical Members c) four Lay Members, d) two Registered Nurses, one of whom will be the Chief Nurse (an employee of the CCG) and one of whom will be the Independent Registered Nurse e) one Secondary Care Specialist Doctor f) the g) the Chief Finance Officer h) the Director of Transformation i) the Director of Public Health j) one Practice Manager Member k) The Governing Body will invite the following individuals to attend all of its meetings and participate in debate, but they will not have voting rights: HealthWatch representative Children s Trust Representative Local Authority (Health and W ellbeing Board) representative CCG and commissioning support staff as required for agenda items The Governing Body may invite such other person(s) to attend all or any of its meetings, or part(s) of a meeting, in order to assist it in its decision making and in its discharge of its functions as it sees fit. Any such person may speak and participate in debate, but may not vote. Page 33

34 6.7 Committees of the Governing Body - the Governing Body has appointed the following Committees: a) Audit Committee The Audit Committee, which is accountable to the Governing Body, provides an independent and objective view of the CCG s systems for managing risk, governance and internal control with regard to financial systems, financial information and compliance with laws, regulations and directions. The Governing Body approves and keeps under review the Terms of Reference for the Audit Committee, which includes information on the membership of the Audit Committee. The Audit Committee membership is appointed by the Governing Body from amongst its Lay and non-executive Members and shall consist of not less than three members. A quorum shall be two members. One of the members shall be the Audit Committee Chair who will be the Lay Member of the Governing Body who has qualifications, expertise or experience in financial management and audit matters. The Chair of the CCG shall not be a member. The and Chief Finance Officer shall not be members of the Audit Committee. The Audit Committee Chair may ask for any officer to attend an Audit Committee meeting, such officer will not be entitled to vote. The Audit Committee Chair may require any officer of the CCG to answer questions or make documents available to the Audit Committee. b) Executive Partnership Board - The purpose of this Board is to ensure that an integrated system is developed and appropriately managed to ensure that the resources available to both Health and Social Care, including the Better Care Fund, are effectively used in the delivery of personalised, responsive and holistic care to those who are most in need within our community. This Board reviews its, Terms of Reference which includes information on its membership. The Board will act as a multi-agency group of lead officers and key representatives, which takes strategic decisions aimed at:- Determining the strategic direction and policy for the provision of services to those with identified care and support needs to improve quality, productivity and prevention. Promoting inter-agency cooperation, via appropriate joint working agreements/ arrangements, to encourage and help develop effective working relationships between different services and agencies, based on mutual understanding and trust. Exercising financial control over budgets, including the Better Care Fund, associated with the running of the Services supporting those with identified care and support needs, ensuring financial probity. Page 34

35 Driving forward the continued implementation of achieving a whole system coordinated approach, including the strategic aims outlined in Halton s Better Care Plan by overseeing the associated work of Partner organisations, monitoring performance, reviewing and evaluating services and taking assertive action where performance is not satisfactory. c) Human Resources and Organisational Development Committee The Committee, which is accountable to the CCG s Governing Body is accountable for all human resources and organisational development matters including staff salaries (those not on very senior management framework), education and training and Public Sector Equality duty. The Governing Body approves and keeps under review the Terms of Reference for the Committee, which includes information on the membership of the Committee. d) Integrated Governance Committee - The Committee will report to the Governing Body on the development, implementation and monitoring of all areas of integrated governance by providing assurance on: the systems and processes by which the CCG leads, directs and controls its functions in order to achieve organisational objectives, and in which they relate to the wider community and partner organisations. The Committee is established in accordance with the CCG s Constitution, Standing Orders and Scheme of Reservation/Delegation. The Terms of Reference set out the membership, remit responsibilities and reporting arrangements of the Committee and shall have effect as incorporated into the CCG s Constitution and Scheme of Reservation. The Committee is accountable to the Governing Body for providing assurance in relation to all areas of governance. The Governing Body approves and keeps under review the Terms of Reference for the Integrated Governance Committee which includes information on the membership. e) Performance and Finance Committee The Committee will advise the Governing Body on all financial matters and provide assurance in relation to the discharge of statutory functions in line with the Standing Financial Instructions (SFIs). The Committee will ensure that the performance of commissioned services is monitored. The Committee will also be responsible for monitoring the performance of CCG key performance indicators, for example as outlined in the NHS Operating Framework. The Performance and Finance Committee will also work to support the Audit Committee. The Governing Body has approved and keeps under review the Terms of Referencefor the Performance and Finance Committee which includes information on the membership. Page 35

36 f) Primary Care Commissioning Committee- The CCG has established the NHS Halton CCG Primary Care Commissioning Committee ( Committee ). The Committee will function as a corporate decisionmaking body for the management of the delegated functions and the exercise of the delegated powers. The Committee is established in accordance with NHS Halton Clinical Commissioning Group s (the CCG) Constitution, Standing Orders and Scheme of Reservation & Delegation. These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee. The Committee will act to review and assure the Governing Body in relation to effective commissioning of primary care. The Committee has been established in accordance with the above statutory provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in Halton, under delegated authority from NHS England. In performing its role the Committee will exercise its management of the functions in accordance with the agreement entered into between NHS England and NHS Halton CCG, which will sit alongside the delegation and Terms of Reference. The functions of the Committee are undertaken in the context of a desire to promote increased cocommissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers. The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act. g) Quality Committee The Committee will report to the Governing Body on the development, implementation and monitoring of all areas of quality by providing assurance on: the systems and processes by which the CCG leads, directs and controls its functions in order to achieve organisational objectives, and in which they relate to the wider community and partner organisations. The Committee is established in accordance with the CCG s Constitution, Standing Orders and Scheme of Reservation/Delegation. The Terms of Reference set out the membership, remit responsibilities and reporting arrangements of the Committee and shall have effect as incorporated into the CCG s Constitution and Scheme of Reservation. The Committee is accountable to the Governing Body for ensuring the quality of services and the promoting the continuous improvement of services. The Governing Body approves and keeps under review the Terms of Reference for the Quality Committee which includes information on the membership. h) Remuneration Committee - The Committee makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for executive management employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The Governing Body approves and keeps under review the Terms of Reference for the Remuneration Committee which includes information on Page 36

37 the membership. i) Service Development Committee - The Committee will report to the Governing Body and the Members Forum on the development and implementation of the Commissioning Strategy for the CCG. The Committee will have a key role in ensuring the delivery of commissioning plans and through these plans improving the health of the population of Halton. The Committee is established in accordance with the CCG Constitution Standing Orders and Scheme of Reservation/Delegation. The Terms of Reference sets out the membership, remit responsibilities and reporting arrangements of the Committee and shall have effect as incorporated into the CCG s Constitution and Scheme of Reservation. The Committee is accountable to the Governing Body for providing assurance in relation to all areas of service development and delivery of the Commissioning Plan. The Governing Body approves and keeps under review the Terms of Reference for the Service Development Committee which includes information on the membership. j) Urgent Issues Committee - The Committee shall meet as required. A meeting will be called by a member of the Executive Management Team to enable decision making or management of specific key issues as outlined within the Terms of Reference. Page 37

38 7. ROLES AND RESPONSIBILITIES 7.1 Member Practice Representatives a) Each Member Practice is required to nominate and appoint internally a GP or other primary health care professional as a Member Practice Representative who will represent the relevant Member Practice in the CCG. b) The role of each Member Practice Representative is to: i) act on behalf of the relevant Member Practice as a member of key decision making processes ii) ensure the relevant Member Practice is actively engaged and involved with the work of the CCG iii) ensure that all Member Practice staff are fully informed and engaged via internal systems iv) attend appropriate meetings e.g. Members Forums and the Service Development Committee to enable engagement and involvement in decision making for the Member Practice in the CCG v) use his or her reasonable endeavours to identify and nominate in writing a deputy to attend on their behalf at any meeting of the CCG for which they cannot be present, wherever possible, this should be a clinician vi) work to support the CCG in discharging it duties effectively 7.2 Other GP and Primary Care Health Professionals In addition to the Member Practice Representatives identified in section 7.1 above, the CCG has identified a number of other GPs / other Primary Health Care Professionals to support the work of the CCG and / or represent the CCG as Clinical Leads Key clinical roles have been determined by the Governing Body and from time to time further roles may be required Clinical Lead roles will have clear role requirements and clear delivery outcomes. These will be agreed with the clinician as will managerial support, accountability and reporting arrangements. Page 38

39 7.3 All Members of the CCG s Governing Body Guidance on the roles of members of the Governing Body is set out in guidance from NHS England 55. In summary, each member of the Governing Body should share responsibility as part of a team to ensure that the CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this Constitution. Each brings their unique perspective, informed by their expertise and experience. 7.4 The Chair of the Governing Body The Chair of the Governing Body is responsible for: a) leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this Constitution b) building and developing the Governing Body and its individual members c) ensuring that the CCG has proper constitutional and governance arrangements in place d) ensuring that, through the appropriate support, information and evidence, the Governing Body is able to discharge its duties e) supporting the in discharging the responsibilities of the CCG f) contributing to building a shared vision of the aims, values and culture of the CCG g) leading and influencing to achieve clinical and organisational change to enable the CCG to deliver its commissioning responsibilities h) overseeing governance and particularly ensuring that the Governing Body and the wider CCG behaves with the utmost transparency and responsiveness at all times i) ensuring that public and patients views are heard and their expectations understood and, where appropriate as far as possible, met j) ensuring that the CCG is able to account to its local patients, stakeholders and NHS England k) ensuring that the CCG builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the relevant local authority. W here the Chair of the Governing Body is also the senior clinical voice of the CCG they will take the lead in interactions with stakeholders, including NHS England 55 Clinical Commissioning Group Governing Body Members Role outlines, Attributes and Skills, NHS England, October 2012 Page 39

40 7.5 The Deputy Chair of the Governing Body The Deputy Chair of the Governing Body deputises for the Chair of the Governing Body where he or she has a conflict of interest or is otherwise unable to act. 7.6 Role of the The of the CCG is a member of the Governing Body The role of has been set out in guidance from NHS England 56 and includes: a) being responsible for ensuring that the CCG fulfills its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money b) at all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems c) working closely with the Chair of the Governing Body, the will ensure that proper constitutional, governance and development arrangements are put in place to assure the Member Practices (through the Governing Body) of the CCG s on-going capability and capacity to meet its duties and responsibilities. This will include arrangements for the on-going developments of its officers and staff d) in addition to the s general duties, where the is also the senior clinical voice of the CCG they will take the lead in interactions with stakeholders, including NHS England 7.7 Role of the Chief Finance Officer The Chief Finance Officer is a member of the Governing Body and is responsible for providing financial advice to the CCG and for supervising financial control and accounting systems The role of Chief Finance Officer comprises, in summary: a) being the Governing Body s professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged 56 Clinical Commissioning Group Governing Body Members Role outlines, Attributes and Skills, NHS England, October 2012 Page 40

41 b) making appropriate arrangements to support and monitor the CCG s finances c) overseeing robust audit and governance arrangements leading to propriety in the use of the CCG s resources d) being able to advise the Governing Body on the effective, efficient and economic use of the CCG s allocation to remain within that allocation and deliver required financial targets and duties; and e) producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHS England 7.8 Role of the Chief Nurse The Chief Nurse is a member of the Governing Body and is responsible for providing professional nursing advice to the Governing Body Acting as lead for the Governing Body in relation to quality and early warning for quality issues Acting as lead for patient experience and engagement for the Governing Body Acting as lead for governance, including Information Governance, Risk and Equality and Diversity 7.9 Role of the Director of Transformation The Director of Transformation is a member of the Governing body and is responsible for providing the CCG and the Governing Body with clear advice and reports in relation to the delivery of the commissioning and transformation functions of the CCG. As a joint appointment with the Local Authority, the post holder will supported by other key officers from the Local Authority and the CCG to ensure the delivery of integrated commissioning functions Provide expert advice of commissioning and transformation, ensuring through robust systems and reporting that the integrated commissioning team delivers the strategic commissioning plans of the CCG Role of the Director of Public Health The Director of Public Health for Halton provides to the CCG clear advice on local health needs and local health inequalities through the development of local Joint Strategic Needs Assessment and advice on impacts of commissioning plans Providing to the CCG and Governing body through the Public Health team appropriate Public health advice across all areas of the Public health agenda, infection control, inequalities, outcomes, local health needs Providing guidance to the governing body were appropriate in relation to public health and impact of commissioning decisions made by the CCG Page 41

42 7.11 Role of the Practice Manager Member The Practice Manager Member of the Governing Body will provide a practice managerial view to the Governing Body and provide appropriate challenge on the delivery of functions and duties Role of the Secondary Care Doctor Member As well as sharing responsibility with the other members for all aspects of the CCG governing body business, the secondary care doctor will bring a broader view, on health and care issues to underpin the work of the CCG. In particular, they will bring to the governing body an understanding of patient care in the secondary care setting Role of the Registered Nurse Member As well as sharing responsibility with other members for all aspects of the CCG governing body business, the registered nurse will bring a broader view from their perspective as a registered nurse, on health and care issues to underpin the work of the CCG especially in regard to the contribution of nursing to patient care. In particular, they will work alongside the CCG s Chief Nurse Role of Lay Members As a member of the Governing Body each individual will share responsibility to ensure that the CCG exercises its functions effectively, efficiently, economically, with good governance and in accordance with the CCG Constitution. Each will bring their unique perspective, informed by their expertise and experience Each lay member will have responsibility for public engagement, ensuring that opportunities are created and protected for patient and public empowerment in the work of the CCG Additionally, members will take lead responsibility for one of the following: audit and conflict of interest matters, who will also act as Deputy Chair quality integrated governance remuneration, appointments and organisational development patient and public involvement and engagement primary care commissioning 7.15 Joint Appointments with other Organisations The CCG has the following joint appointment with other organisations: a) Chief Finance Officer is a joint appointment (with NHS Knowsley CCG and NHS St Helens CCG) This joint appointment is supported by a memorandum of understanding Page 42

43 between the organisations who are party to this joint appointment Indemnity As a membership organisation the CCG confers the following indemnity upon nominated practice representatives, clinical leaders, Lay Members, the independent Nurse and the Independent Secondary Care Doctor, and Practice Management representative (as defined in this Constitution) who are undertaking duties on behalf of the CCG as part of its governance arrangements Indemnity Statement such individuals, as specified in paragraph 7.1 and 7.2 above, who have acted honestly and in good faith will not have to meet out of his or her own personal resources any personal civil liability which is incurred in the execution of his or her governance functions, save where the person has acted recklessly Such individuals need to ensure they act in accordance with the CCGs Constitution (including the Standing Orders, Prime Financial Policies and Scheme of Reservation and Delegation), the CCGs policies and procedures, guidance issued by appropriate regulatory bodies, together with any appropriate statue or regulations The position of employees of the CCG is different to the individuals listed above as the CCG, as statutory body, is always liable for the actions of its employees in the course of their employment. 8 STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST 8.1 Standards of Business Conduct Employees, Member Practice Representatives, Clinical Leads, Committee and Sub-Committee members of the CCG and members of the Governing Body (and its Committees) will at all times comply with this Constitution and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the CCG and should follow the Seven Principles of Public Life, set out by the Committee on Standards in Public Life (the Nolan Principles). The Nolan Principles are incorporated into this Constitution at Appendix F Governing Body Members should also comply with Standards for members of NHS Boards and Clinical Commissioning Group governing bodies in England All persons referred to at Paragraph must comply with the CCG s standards on business conduct, including the requirements set out for managing conflicts of interest. This policy will be available on the CCG s website at 57 As published b y the Professional Standards Authority for Health and Social Care in Novem ber 2012 Page 43

44 8.1.4 Individuals contracted to work on behalf of the CCG or otherwise providing services or facilities to the CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services. 8.2 Conflicts of Interest As required by section 14O of the 2006 Act, as inserted by section 25 of the 2012 Act, the CCG will make arrangements to manage conflicts and potential conflicts of interest to ensure that the ability of any individual to exercise judgment or act in their role in support of the work of the CCG is not or could not be seen to be impaired or otherwise influenced by his or her other interests. The detailed requirements are set out in the guidance issued by Monitor (Substantive guidance on the Procurement, Patient Choice and Competition Regulations) and, in particular, section 7 of that statutory guidance. These are set out in the CCG s Standards of Business Conduct. The Audit Committee chair and the Accountable Officer will be required to provide direct formal attestation to NHS England that NHS Halton CCG has complied with this guidance. The Accountable Officer will also need to provide assurance to the Health and Wellbeing board that services are appropriately commissioned and conflicts managed W here an individual, i.e. an employee, Member Practice Representative, member of the Governing Body, Clinical Leads or a member of a Committee or a Sub-Committee of the CCG or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the CCG considering an action or decision in relation to that interest which must be considered as a potential conflict and is subject to the provisions of this, Constitution and the CCG s Standards of Business Conduct. A conflict of interest occurs where an individual s ability to exercise judgement, or act in a role, is or could be impaired or otherwise influenced by his or her involvement in another role or relationship. The individual does not need to exploit his or her position or obtain an actual benefit, financial or otherwise, for a conflict of interest to occur A conflict of interest will include: a) a direct pecuniary interest: where an individual may financially benefit from the consequences of a commissioning decision (for example, as a provider of services) b) an indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from the consequences of a commissioning decision c) a non-pecuniary interest: where an individual holds a non-remunerative or not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision (for example, where an Page 44

45 individual is a trustee of a voluntary provider that is bidding for a contract) d) a non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequence of a commissioning decision which cannot be given a monetary value (for example, a reconfiguration of hospital services which might result in the closure of a busy clinic next door to an individual s house) e) where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories; and If in doubt, the individual concerned should assume that a potential conflict of interest exists For a commissioner, a conflict of interest may therefore arise when their judgment as a commissioner could be, or be perceived to be, influenced and impaired by their own concerns and obligations as a provider. In the case of a GP involved in commissioning, an obvious example is the award of a new contract to a provider in which the individual GP has a financial stake. However, the same considerations apply when deciding whether to extend a contract Conflicts of interest can be managed by Doing business appropriately. If commissioners get their needs assessments, consultation mechanisms, commissioning strategies and procurement procedures right from the outset, then conflicts of interest become much easier to identify, avoid and/or manage, because the rationale for all decision- making will be clear and transparent and should withstand scrutiny; Being proactive, not reactive. Commissioners should seek to identify and minimise the risk of conflicts of interest at the earliest possible opportunity, for instance by: considering potential conflicts of interest when electing or selecting individuals to join the governing body or other decision-making bodies; ensuring individuals receive proper induction and training so that they understand their obligations to declare conflicts of interest. they should establish and maintain registers of interests, and agree in advance how a range of possible situations and scenarios will be handled, rather than waiting until they arise; Assuming that individuals will seek to act ethically and professionally, but may not always be sensitive to all conflicts of interest. Rules should assume people will volunteer information about conflicts and, where necessary, exclude themselves from decision-making, but there should also be prompts and checks to reinforce this; Being balanced and proportionate. Rules should be clear and robust but not overly prescriptive or restrictive. They should ensure that decision-making is transparent and fair, but not constrain people by making it overly complex or cumbersome; Page 45

46 Openness. Ensuring early engagement with patients, the public, clinicians and other stakeholders, including local Healthwatch and Health and Wellbeing Boards, in relation to proposed commissioning plans; Responsiveness and best practice. Ensuring that commissioning intentions are based on local health needs and reflect evidence of best practice securing buy in from local stakeholders to the clinical case for change; Transparency. Documenting clearly the approach taken at every stage in the commissioning cycle so that a clear audit trail is evident; Securing expert advice. Ensuring that plans take into account advice from appropriate health and social care professionals, e.g. through clinical senates and networks, and draw on commissioning support, for instance around formal consultations and for procurement processes; Engaging with providers. Early engagement with both incumbent and potential new providers over potential changes to the services commissioned for a local population; Creating clear and transparent commissioning specifications that reflect the depth of engagement and set out the basis on which any contract will be awarded; Following proper procurement processes and legal arrangements, including evenhanded approaches to providers; Ensuring sound record-keeping, including up to date registers of interests; and A clear, recognised and easily enacted system for dispute resolution. 8.3 Declaring and Registering Interests The CCG will maintain one or more registers of the interests of: a) the Member Practice clinicians and practice management Representatives b) the Governing Body Members c) the members of its Committees or Sub-Committees of the Governing Body d) the Clinical Leads e) its employees The CCG will ensure that, as a matter of course, declarations of interest are made and regularly confirmed or updated. This includes the following circumstances On appointment: Applicants for any appointment to the CCG or its governing body should be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests should again be made and recorded. At meetings: All attendees should be asked to declare any interest they have in any agenda item Page 46

47 before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interest should be recorded in minutes of meetings. Quarterly: CCGs should have systems in place to satisfy themselves on a quarterly basis that their register of interests is accurate and up to date. On changing role or responsibility: Where an individual changes role or responsibility within a CCG or its governing body, any change to the individual s interests should be declared. On any other change of circumstances: Wherever an individual s circumstances change in a way that affects the individual s interests (e.g. where an individual takes on a new role outside the CCG or sets up a new business or relationship), a further declaration should be made to reflect the change in circumstances. This could involve a conflict of interest ceasing to exist or a new one materialising The Registers of Interests of members of the Governing Body and of formal Committees of the Governing Body will be published on the CCG website A Register of Interests will be maintained for our employees and members practices which will be made available upon request Individuals will declare any interest that they have, in relation to a decision to be made in the exercise of the commissioning functions of the CCG, in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware W here an individual is unable to provide a declaration in writing, for example, if a conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter The will ensure that the registers of interest are reviewed regularly, and updated as necessary. 8.4 Managing Conflicts of Interest: general Member Practice Representatives, the Governing Body, the Committees or Sub- Committees of its Governing Body, Clinical Leads and employees will comply with the arrangements determined by the CCG for managing conflicts or potential conflicts of interest. They shall additionally have regard to the requirements of Managing Conflicts of Interest: Statutory Guidance for Clinical Commissioning Group s published December 2014 under sections 140 and 14Z8 of the National Health Services Act 2006 as amended by the Health and Social Care Act The will determine the arrangements for the management of conflicts of interest to ensure the integrity of the CCGs decision making process. Page 47

48 8.4.3 The Governance Lead (Chief Nurse) will ensure that arrangements (as determined by the ) are in place for managing conflicts of interest within one week of receiving declaration. The arrangements will detail the following: a) when an individual should withdraw from a specified activity, on a temporary or permanent basis b) monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual W here an interest has been declared, either in writing or verbally, the declarer will ensure that before participating in any activity connected with the CCG s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Governance Lead W here a Member Practice Representative, Clinical Lead, Governing Body Member, Committee or Sub-Committee member, employee or person providing services to the CCG is aware of an interest which: a) has not been declared, either in the register or orally, they will declare this at the start of the meeting; b) has previously been declared, in relation to the scheduled or likely business of the meeting, the individual concerned will bring this to the attention of the Chair of the meeting, together with details of arrangements which have been confirmed for the management of the conflict of interests or potential conflict of interests The Chair of the meeting will then determine how this should be managed and inform the member of their decision. W here no arrangements have been confirmed, the Chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual will then comply with these arrangements, which must be recorded in the minutes of the meeting W here the Chair of any meeting of the CCG, including Committees, Sub- Committees, or the Governing Body and the Governing Body s Committees and Sub-Committees or the Members Forum, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy Chair will act as Chair for the relevant part of the meeting. W here arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the Chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy Chair may require the Chair to withdraw from the meeting or part of it. W here there is no deputy Chair, those present and voting at the meeting will select one Any declarations of interests, and arrangements agreed in any meeting of the CCG, Committees or Sub-Committees, or the Governing Body, the Governing Body s Committees or Sub-Committees, or Membership Forum will be recorded Page 48

49 in the minutes W here more than 50% of those present and otherwise able to vote at a meeting are required to withdraw from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the Chair (or deputy) will determine whether or not the discussion can proceed In making this decision the Chair will consider whether the meeting is quorate, in accordance with the number and balance of membership set out in the CCG s standing orders. W here the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. W here a quorum cannot be convened from those eligible to be present and vote at the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the Chair of the meeting shall consult with the Governance Lead on the action to be taken Action which the Governance Lead may take for the purposes of resolving a failure to achieve a quorum at any meeting for reasons set out at paragraph may include: a) requesting another of the CCG s Committees, Members Forum, or Governing Body (as appropriate) which must be quorate to progress the item of business, or if this is not possible, b) inviting on a temporary basis one or more of the following to make up the quorum so that the CCG can progress the item of business: i) an appropriate Member Practice Representative ii) a member of a relevant Health and W ellbeing Board iii) a member of a Governing Body of another Clinical Commissioning Group where such an individual does not have a conflict of interest. These arrangements must be recorded in the minutes In any transaction undertaken in support of the CCG s exercise of its commissioning functions (including conversations between two or more individuals, s, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. W here an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Governance Lead of the transaction as soon as reasonably practicable The Governance Lead will take such steps as deemed appropriate, and request information deemed appropriate from individuals, to ensure that all conflicts of Page 49

50 interest and potential conflicts of interest are declared. 8.5 Managing Conflicts of Interest: contractors and people who provide services to the CCG Anyone seeking information in relation to procurement, or participating in procurement, or otherwise engaging with the CCG in relation to the potential provision of services or facilities to the CCG, will be required to make a declaration of any relevant conflict / potential conflict of interest Anyone contracted to provide services or facilities directly to the CCG will be subject to the same provisions of this Constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services. 8.6 Transparency in Procuring Services The CCG recognises the importance in making decisions about the services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers. The Procurement, Patient Choice and Competition Regulations place requirements on commissioners to ensure that they adhere to good practice in relation to procurement, do not engage in anti-competitive behavior that is against the interest of patients, and protect the right of patients to make choices about their healthcare. Monitor has a statutory duty under section 78 of the HSCA to produce guidance on compliance with any requirements imposed by the regulations and how it intends to exercise the powers conferred on it by these regulations. Monitor s Substantive guidance on the Procurement, Patient Choice and Competition Regulations is the relevant statutory guidance. NHS England works closely with Monitor with regard to these matters and has engaged with Monitor in developing this revised guidance The CCG will publish a Procurement Policy approved by its Governing Body which will ensure that: a) all relevant clinicians and potential providers, together with local members of the public, are engaged in the decision-making processes used to procure services b) service redesign and procurement processes are conducted in an open, transparent, non-discriminatory and fair way The CCG will maintain a register of procurement decisions taken which will include; Page 50

51 the details of the decision; who was involved in making the decision (i.e. governing body or committee members and others with decision-making responsibility); and a summary of any conflicts of interest in relation to the decision and how this was managed by the CCG The register will be updated whenever a procurement decision is made and in the interests of transparency the register of interests and the register if decisions will be made publically available an easily accessible to patients and the public via prominent place of the CCG website and making available for inspection on request either via public libraries and at the Headquarters of the CCG. The registers will form part of the CCG s annual accounts and will thus be signed off by external auditors. Copies of this Procurement Policy will be available on the CCG s website at Openness and transparency in decision making The CCG will evidence how it is fulfilling its duty in relation to public involvement by making evidence of its decision making publically available and this will provide further assurance that the CCG is seeking and encouraging scrutiny of its decision making process to Health and Wellbeing board, local Healthwatch and to local communities that the proposed service meets local needs and priorities; it will enable them to raise questions if they have concerns about the approach being taken; to audit committee, and where necessary, external auditors, that a robust process has been followed in deciding to commission the service, in selecting the appropriate procurement route, and in addressing potential conflicts; and to NHS England in their role as assurers of the co-commissioning arrangements. 9 THE CCG AS EMPLOYER 9.1 The CCG recognises that its most valuable asset is its people. It will seek to enhance their skills and experience and is committed to their development in all ways relevant to the work of the CCG. 9.2 The CCG will seek to set an example of best practice as an employer and is committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally. 9.3 The CCG will ensure that it employs suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected of staff employed by the CCG. All staff will be made aware of this Constitution, the commissioning strategy and the relevant internal management Page 51

52 and control systems which relate to their field of work. 9.4 The CCG will maintain and publish policies and procedures (as appropriate) on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCG will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters 9.5 The CCG will ensure that its rules for recruitment and management of staff provide for appointment and advancement on merit on the basis of equal opportunity for all applicants and staff. 9.6 The CCG will ensure that employees' behaviour reflects the vision, purpose, values and strategic objectives as set out above. 9.7 The CCG will ensure that it complies with all aspects of employment law. 9.8 The CCG will ensure that its employees have access to such expert advice and training opportunities as they may require in order to exercise their responsibilities effectively 9.9 The CCG recognises and confirms that nothing in or referred to in this Constitution (including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the CCG, any member of its Governing Body, any member of any of its Committees or Sub-Committees of its Governing Body, or an employee of the CCG or any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act Copies of this Code of Conduct, together with the other policies and procedures outlined in this Section, will be available on the CCG s website at 10 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS 10.1 General The CCG will publish annually a commissioning plan and an annual report, presenting the CCG s annual report to a public meeting Key communications issued by the CCG, including the notices of procurements, public consultations, Governing Body meeting dates, times, venues, and certain papers will be published on the CCG s website at The CCG may use other means of communication, including circulating information by post, by , or making information available in venues or services accessible to the public. Page 52

53 10.2 Standing Orders This Constitution is also informed by a number of documents which provide further details on how the CCG will operate. They are the CCG s: a) Standing orders (Appendix C) which sets out the arrangements for meetings and the appointment processes to elect the CCG s representatives and appoint to the CCG s Committees, including the Governing Body; b) Scheme of Reservation and Delegation (Appendix D) which sets out those decisions that are reserved for the Member Practices acting through the Members Forum and those decisions that are the responsibilities of the Governing Body, the Governing Body s Committees and Sub- Committees, the CCG s Committees and Sub-Committees and employees; c) Prime financial policies (Appendix E) which sets out the arrangements for managing the CCG s financial affairs. Page 53

54 APPENDIX A DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION 2006 Act National Health Service Act Act Health and Social Care Act 2012 (this Act amends the 2006 Act) Area CCG Chair of the Governing Body Chief Finance Officer Clinical Member a Governing Body Member, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by the NHS Commissioning Board, with responsibility for ensuring the CCG: complies with its obligations under: o sections 14Q and 14R of the 2006 Act (as inserted by section 26 of the 2012 Act), o sections 223H to 223J of the 2006 Act (as inserted by section 27 of the 2012 Act), o paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as inserted by Schedule 2 of the 2012 Act), and o any other provision of the 2006 Act (as amended by the 2012 Act) specified in a document published by the Board for that purpose; exercises its functions in a way which provides good value for money. and appointed in accordance with the provisions of paragraph of Appendix C the geographical area that the CCG has responsibility for, as defined in Section 2 of this Constitution NHS Halton Clinical Commissioning Group, a body corporate established by the NHS Commissioning Board in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act) a Governing Body Member appointed in accordance with the provisions of paragraph of Appendix C a Governing Body Member appointed in accordance with the provisions of of Appendix C a Governing Body Member appointed in accordance with the provisions of paragraph of Appendix C Clinical Lead those individuals referred to at paragraph Committee a Committee or Sub-Committee created and appointed by: the membership of the CCG a Committee / Sub-Committee created by a Committee created / appointed by the membership of the CCG a Committee / Sub-Committee created / appointed by the Governing Body Page 54

55 Financial year this usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a clinical commissioning group is established until the following 31 March Governing Body the body appointed under section 14L of the NHS Act 2006 (as inserted by section 25 of the 2012 Act), with the main function of ensuring that a clinical commissioning group has made appropriate arrangements for ensuring that it complies with: its obligations under section 14Q under the NHS Act 2006 (as inserted by section 26 of the 2012 Act), and such generally accepted principles of good governance as are relevant to it. Governing Body Member Independent Registered Nurse Lay Member Member Practice NHS England Member Practice Representatives Practice Manager Member Registers of interests Secondary Care Specialist Doctor any person appointed to the Governing Body a Governing Body Member appointed in accordance with the provisions of paragraph of Appendix C a Governing Body Member appointed in accordance with the provisions of paragraph of Appendix C a provider of essential primary medical services to registered patients during core hours 59 from locations within the boundary of Halton Borough Council, which is a member of the CCG (see tables in Section 3 and Appendix B) the NHS Commissioning Board an individual appointed by a Member Practice to act on its behalf in the dealings between it and the CCG, as required under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act) a Governing Body Member appointed in accordance with the provisions of paragraph of Appendix C registers a clinical commissioning group is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of: the members of the CCG; the members of its Governing Body; the members of its Committees or Sub-Committees and Committees or Sub-Committees of its Governing Body; and its employees. A Governing Body member appointed in accordance with the provisions of paragraph of Appendix C 59 As defined by Regulation of the National Health Service (Clinical Commissioning Groups) Regulations 2012 (SI 2012/1631) Page 55

56 APPENDIX B - LIST OF MEMBER PRACTICES Practice Name Address Signature Appleton Village Surgery Beaconsfield Surgery Beeches Medical Centre Brookvale Practice Castlefields Health Centre Grove House Practice Heath Road Hough Green Health Park Murdishaw Health Centre Newtown Health Care Centre Oaks Place Surgery Peelhouse Medical Plaza Tower House Practice Upton Rocks Primary Care Weavervale Practice West Bank Medical Centre W indmill Hill Medical Centre 2 6 Appleton Village, W idnes, W A8 6DZ Bevan W ay, W idnes, W A8 6TR 20 Ditchfield Road, W idnes, W A8 8QS Hallwood Health Centre, Hospital W ay, Runcorn, W A7 2UT The Village Square, Castlefields, Runcorn, W A7 2HY St Paul s Health Centre, High Street, Runcorn, W A7 1AB Heath Road, Runcorn, W A7 5TJ Hough Green Road, Widnes, W A8 4NJ Gorsewood Road, Murdishaw, Runcorn, W A7 6ES W idnes HCRC, Oaks Place, Caldwell Road, W idnes, W A8 7GD W idnes HCRC, Oaks Place, Caldwell Road, W idnes, W A8 7GD Peelhouse Lane, W idnes, W A8 6TN St Paul s Health Centre, High Street, Runcorn, W A7 1AB W idnes RUFC Car Park, Heath Road, W idnes, W A8 7NU Hallwood Health Centre, Hospital W ay, Runcorn, W A7 2UT 2 Lower Church Street, W est Bank, W idnes, W A8 0NG Norton Hill, W indmill Hill, Runcorn, W A7 6QE Page 56

57 APPENDIX C STANDING ORDERS 1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction These standing orders have been drawn up to regulate the proceedings of the CCG so that it can fulfill its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the CCG is established The standing orders, together with the CCG s Scheme of Reservation and Delegation 60 and the CCG s prime financial policies 61, provide a procedural framework within which the CCG discharges its business. They set out: a) the arrangements for conducting the business of the CCG b) the appointment of Practice Leads c) the procedure to be followed at meetings of the Members Forum the Governing Body and any Committees or Sub-Committees of the CCG or the Governing Body d) the process to delegate powers e) the declaration of interests and standards of conduct. These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate 62 of any relevant guidance The standing orders, Scheme of Reservation and Delegation and prime financial policies have effect as if incorporated into the CCG s Constitution. Group members, employees, members of the Governing Body, members of the Governing Body s Committees and Sub-Committees, members of the CCG s Committees and Sub-Committees and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders, Scheme of Reservation and Delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal or termination of any engagement of that individual by the CCG See Appendix D See Appendix E Under some legislative provisions the group is obliged to have regard to particular guidance but under other circumstances guidance is issued as best practice guidance. Page 57

58 1.2. Schedule of matters reserved to the clinical commissioning group and the Scheme of Reservation and Delegation The 2006 Act (as amended by the 2012 Act) provides the CCG with powers to delegate its functions and those of the Governing Body to certain bodies (such as Committees) and certain persons. Certain decisions may only be exercised by the Membership Forum in formal session. These decisions and also those delegated are contained in the CCG s Scheme of Reservation and Delegation (see Appendix D). A Decision Reservation and Delegation Summary Matrix is available (see Appendix D) 2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS 2.1. Composition of membership Section 3 of this Constitution provides details of the membership of the CCG (also see Appendix B) Section 6 of the this Constitution provides details of the governing structure used in the CCG s decision-making processes, whilst Section 7 of this Constitution outlines certain key roles and responsibilities within the CCG and its Governing Body, including the role of Member Practice Representatives (section 7.0 of the Constitution) Key Roles Paragraph of this Constitution sets out the composition of the CCG s Governing Body whilst Section 7 of this Constitution identifies certain key roles and responsibilities within the CCG and its Governing Body. These standing orders set out how the CCG appoints individuals to these key roles The appointment of the Chair is subject to the following process and criteria: a) Nominations self nomination or nomination by a Member Practice as a Governing Body Member b) Eligibility must be a clinician working in a Member Practice and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process election managed via Local Medical Committee by Member Practices through Practice Leads d) Term of office three years. A roll-over period of 12 months is allowable in the event that the CCG does not have a suitable replacement at the end of the three year tenure e) Eligibility for reappointment three yearly election f) Grounds for removal from office Page 58

59 i) failure to work within the standards of governance for the CCG as determined by Chair and ; or ii) Upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012; or iii) No longer a practicing clinician in a Member Practice; or iv) Subject to an interim suspension by the GMC or NMC as applicable for a period which exceeds 3 months. g) Grounds for temporary suspension i) Subject to an interim suspension by the GMC or NMC as applicable suspension from a Performers List if applicable ii) Notice period dependent on reason for notice The appointment of Clinical Members (may be a GP or any other primary care health professional), as listed in paragraph of the CCG s Constitution, is subject to the following process and criteria: a) Nominations self nomination or nomination by a Member Practice b) Eligibility must be a clinician working in a Member Practice and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process election by Member Practices through Practice leads, elections managed via Local Medical Committee d) Term of office three years. A roll-over period of 12 months is allowable in the event that the CCG does not have a suitable replacement at the end of the three year tenure e) Eligibility for reappointment three yearly election f) Grounds for removal from office i) failure to work within the standards of governance for the CCG; or ii) upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012; or iii) no longer a practicing clinician in a Member Practice; or iv) subject to an interim suspension by the GMC or NMC as applicable for a period which exceeds 3 months. g) Grounds for temporary suspension i) Subject to an interim suspension by the GMC or NMC as applicable suspension from a Performers List if applicable Page 59

60 h) Notice period dependent on reason for notice The appointment of Member Practice Representative (Practice Lead) is subject to the following process and criteria - a) Nominations Nomination by a Member Practice; b) Eligibility must be a clinician working in a Member Practice c) Appointment process by agreement with individual practice and CCG d) Term of office three years; e) Eligibility for reappointment effective delivery of role and function; f) Grounds for removal from office - i) failure to work within the standards of governance for the CCG; or ii) upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012; or iii) no longer a practicing clinician in a Member Practice; or iv) subject to an interim suspension by the GMC or NMC as applicable for a period which exceeds 3 months. g) Grounds for temporary suspension i) Subject to an interim suspension by the GMC or NMC as applicable suspension from a Performers List if applicable h) Notice period dependent on reason for notice The appointment of Clinical Lead roles, as listed in paragraph 7.1 of the CCG s Constitution, is subject to the following process and criteria: a) Nominations by application for role b) Eligibility must be a clinician working in a Member Practice or local service c) Appointment process application and interview by CCG Chair d) Term of office dependent on role e) Eligibility for reappointment delivery of role requirements and post still required Page 60

61 f) Grounds for removal from office - i) failure to work within the standards of governance for the CCG; or ii) upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012; or iii) No longer a practicing clinician in a Member Practice; or iv) subject to an interim suspension by the GMC or NMC as applicable for a period which exceeds 3 months. g) Grounds for temporary suspension i) Subject to an interim suspension by the GMC or NMC as applicable suspension from a Performers List if applicable h) Notice period dependent on reason for notice The appointment of the Chief Finance Officer, Director of Transformation and Chief Nurse is subject to the following process and criteria - a) Nominations application b) Eligibility must meet the role specification and complete appropriate assessment processes and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process by interview d) Term of office permanent e) Grounds for removal from office i) failure to work within the standards of governance or deliver functions of job role for the CCG; or ii) in the case of the Chief Finance Officer, upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012; or f) Grounds for temporary suspension i) Subject to an interim suspension by the NMC as applicable investigation or suspension by CCG g) Notice period 3 months or dependent on reason for notice Page 61

62 The appointment of the Lay Members including the Deputy Chair is subject to the following process and criteria: a) Nominations application b) Eligibility must be able to evidence appropriate skills in line with the role specifications outlined nationally and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process interview d) Term of office three years e) Eligibility for reappointment Lay Members will be eligible for reappointment, subject to the agreement of the Membership Forum, who will be advised by its advisory panel on Governing Body appointments. f) Grounds for removal from office i) Failure to work within the standards of governance for the CCG g) Grounds for temporary suspension i) Investigation or suspension by the CCG h) Notice period dependent on reason for notice The appointment of the Practice Manager Member as referred to at of the CCG s Constitution, is subject to the following process and criteria: a) Nominations application b) Eligibility working within a Member Practice and must be able to evidence appropriate skills and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process nomination and election d) Term of office three years. A roll-over period of 12 months is allowable in the event that the CCG does not have a suitable replacement at the end of the three year tenure e) Eligibility for reappointment by application f) Grounds for removal from office failure to work within the standards of governance for the CCG Page 62

63 g) Grounds for temporary suspension i) Investigation or suspension by the CCG h) Notice period dependent on reason for notice The appointment of the Secondary Care Specialist Doctor is subject to the following process and criteria: a) Nominations application b) Eligibility must be able to evidence appropriate skills in line with the role specifications outlined nationally and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process interview d) Term of office three years. A roll-over period of 12 months is allowable in the event that the CCG does not have a suitable replacement at the end of the three year tenure. e) Eligibility for reappointment by application f) Grounds for removal from office i) failure to work within the standards of governance for the CCG; ii) upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 g) Grounds for temporary suspension - i) Interim suspension by GMC as applicable ii) Investigation or suspension by the CCG h) Notice period dependent on reason for notice The appointment of the Independent Registered Nurse is subject to the following process and criteria: a) Nominations application b) Eligibility must be able to evidence appropriate skills in line with the role specifications outlined nationally and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 c) Appointment process interview Page 63

64 d) Term of office three years. A roll-over period of 12 months is allowable in the event that the CCG does not have a suitable replacement at the end of the three year tenure e) Eligibility for reappointment by application f) Grounds for removal from office i) failure to work within the standards of governance for the CCG; or ii) upon being identified as not meeting the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012 g) Grounds for temporary suspension i) Interim suspension by NMC as applicable ii) Investigation or suspension by the CCG h) Notice period dependent on reason for notice The identification of the individual to be proposed to NHS England for appointment as is subject to the national process and criteria The roles and responsibilities of each of these key roles are set out either in paragraph or Section 7 of the CCG s Constitution. 3. MEETINGS OF THE MEMBERS FORUM, CCG GOVERNING BODY AND AUDIT COMMITTEE 3.1. Calling meetings Ordinary meetings of the CCG shall be held at regular intervals at such times and places as the CCG may determine The Chair may call an extraordinary meeting of the CCG at any time Before each public meeting of the Governing Body, a notice specifying the proposed business authorised by the Chair, shall be advertised at so as to be available at least three clear days before the meeting Before each meeting of the Audit Committee a notice of the meeting, authorised by the Chair, shall be delivered to every member, so as to be available to them at least ten days in advance of the meeting Agenda, supporting papers and business to be transacted Items of business to be transacted for inclusion on the agenda of a meeting need to be notified to the Chair at least 14 working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least 10 working days before the meeting takes Page 64

65 place. The agenda and supporting papers will be circulated to all members of a meeting at least 5 working days before the date the meeting will take place Agendas and public papers for the CCG s Governing Body including details about meeting dates, times and venues - will be published on the CCG s website at Petitions W here a petition has been received by the CCG, the Chair of the Governing Body shall include the petition as an item for the agenda of the next meeting of the Governing Body Chair of a meeting At any meeting of the CCG or its Governing Body or of a Committee or Sub- Committee, the Chair of the Governing Body, Committee or Sub-Committee, if any and if present, shall preside. If the Chair is absent from the meeting, the deputy Chair, if any and if present, shall preside If the Chair is absent temporarily on the grounds of a declared conflict of interest the deputy Chair, if present, shall preside. If both the Chair and deputy Chair are absent, or are disqualified from participating, or there is neither a Chair or deputy a member of the CCG, Governing Body, Committee or Sub-Committee respectively shall be chosen by those persons present and entitled to vote, or by a majority of them, and shall preside Chair's ruling The decision of the Chair of the Governing Body or Chair of any Committee on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, Scheme of Reservation and Delegation and prime financial policies at the meeting, shall be final Quorum The Governing Body will be quorate if nine voting members are present. This must include the Chair or Deputy Chair, a minimum of two Clinicians, one Lay Member, one of the following -, Chief Finance Officer or Chief Nurse, and four others For all other of the CCG s Committees and Sub-Committees, including the Governing Body s Committees and Sub-Committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate Terms of Reference Decision making Every question put to a vote at a meeting shall be determined by a majority of the votes of members present and voting on the question. In the case of an equal vote, the Chair of the meeting shall have a second and casting vote. Page 65

66 At the discretion of the Chair, all questions put to the vote shall be determined by oral expression or by a show of hands, unless the Chair directs otherwise, or it is proposed, seconded and carried that a vote be taken by paper ballot If at least one third of those present and entitled to vote so request, the voting on any question may be recorded so as to show how each person present voted or did not vote (except when conducted by paper ballot). If a person present and entitled to vote so requests, their vote shall be requested by name In no circumstances may a person who is absent vote by proxy. Absence is defined as being absent at the time of the vote A Manager who has been appointed to act up for an Officer Member during a period of incapacity or temporary absence may exercise the voting rights of the Officer Member. A Manager s status when attending a meeting shall be recorded in the minutes Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting W here the Terms of Reference with regard to decision making for any of the CCG s Committees or Sub-Committees differ from these Standing Orders, those Terms of Reference shall prevail Emergency powers and urgent decisions W here decisions need to be taken as a matter of urgency the Chair may make decisions on behalf of the CCG or any Committee of the CCG after taking advice and securing agreement with two people from the following:- the Deputy Chair the Chair of the Remuneration Committee a Clinical Member Decisions taken pursuant to paragraph shall be reported to the next meeting of the Membership Council, the Governing Body and any relevant Committee Suspension of Standing Orders Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or NHS England, any part of these standing orders may be suspended at any meeting, provided the majority of persons present and entitled to vote are in agreement A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting. Page 66

67 A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Audit Committee for review of the reasonableness of the decision to suspend standing orders Record of Attendance The names of all present shall be recorded in the minutes of all meetings. The names of all Governing Body Members present shall be recorded in the minutes of the Governing Body meetings. The names of all present at meetings of the Governing Body s Committees / Sub-Committees shall be recorded in the minutes of the respective Governing Body Committee / Sub-Committee meetings Minutes Each meeting shall be supported by an appropriate secretary who will be responsible for administering the meeting in accordance with these Standing Orders and under the direction of the Chair of the meeting The secretary shall keep a record of attendance (both attendee names and where applicable the name of the Member Practice they represent) apologies, declarations of interest, action taken following declarations and take minutes of the proceedings The minutes of the proceedings of a meeting shall be drawn up and submitted for agreement at the next ensuing meeting where they shall be signed by the Chair of that meeting to confirm them as a true and accurate record No discussion shall take place upon the minutes except upon their accuracy or where the Chair considers discussion appropriate Minutes shall be circulated in accordance with the wishes of those present and entitled to vote at the relevant meeting. W here providing a record of a public meeting the minutes shall be made available to the public as required by the Code of Practice on Openness in the NHS Admission of public and the press to Governing Body meetings The public and representatives of the press may attend all meetings of the Governing Body but shall be required to withdraw in the event that the Chair of meeting determines that: That representatives of the press, and other members of the public, be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest Section 1 (2) Public Bodies (Admissions to Meetings) Act 1960 Guidance should be sought from the Chief Nurse to ensure correct procedure is followed on matters to be included in the exclusion. Page 67

68 General Disturbances The Chairperson or the person presiding over the meeting shall give such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press. This is to ensure that the CCG s business shall be conducted without interruption and disruption. The Chairperson or the person presiding over the meeting can request a member of the public or press to leave the meeting should their presence be detrimental to the work of that meeting. This action is without prejudice to the power to exclude on grounds of the confidential nature of the business to be transacted; the public will be required to withdraw upon the Governing Body resolving as follows: That in the interests of public order the meeting adjourn for (the period to be specified) to enable the CCG Board to complete its business without the presence of the public Business proposed to be transacted when the press and public have been excluded from a meeting Matters to be dealt with by the Governing Body following the exclusion of representatives of the press, and other members of the public as provided above shall be confidential to the members of the Governing Body. Any person in attendance at such a meeting shall not reveal or disclose the contents of papers marked In Confidence or minutes headed Items Taken in Private outside of the CCG, without the express permission of the. This prohibition shall apply equally to the content of any discussion during the Governing Body meeting which may take place on such reports or papers Observers at CCG Meetings The Governing Body will decide what arrangements and terms and conditions it feels are appropriate to offer in extending an invitation to observers to attend and address any of the Governing Body meetings and may change, alter or vary these terms and conditions as it deems fit. 4. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES 4.1. Appointment of Committees and Sub-Committees The Governing Body may appoint Committees and Sub-Committees of the CCG, subject to any regulations made by the Secretary of State 63, and make provision for the appointment of Committees and Sub-Committees of its Governing Body. W here such Committees and Sub-Committees of the CCG, or Committees and Sub-Committees of its Governing Body, are appointed they are included in Section 6 of the CCG s Constitution. 63 See section 14N of the 2006 Act, inserted b y section 25 of the 2012 Act Page 68

69 Other than where there are statutory requirements, such as in relation to the Governing Body s Audit Committee or remuneration Committee, the CCG shall determine the membership and Terms of Reference of Committees and Sub- Committees and shall, if it requires, receive and consider reports of such Committees at the next appropriate meeting of the CCG The provisions of these standing orders shall apply where relevant to the operation of the Governing Body, the Governing Body s Committees and Sub- Committee and all Committees and Sub-Committees unless stated otherwise in the Committee or Sub-Committee s Terms of Reference Terms of Reference Terms of Reference shall have effect once approved and will be available on request Delegation of Powers by Committees to Sub-Committees W here Committees are authorised to establish Sub-Committees they may not delegate executive powers to the Sub-Committee unless expressly authorised by the CCG Approval of Appointments to Committees and Sub-Committees The CCG shall approve the appointments to each of the Committees and Sub- Committees which it has formally constituted including those Committees and Sub-Committees of the Governing Body. The CCG shall agree such travelling or other allowances as it considers appropriate. 5. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES 5.1. If for any reason these standing orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the CCG and staff have a duty to disclose any non-compliance with these standing orders to the Chief Officer as soon as possible. 6. USE OF SEAL AND AUTHORISATION OF DOCUMENTS 6.1. Clinical Commissioning Group s seal The CCG may have a seal for executing documents where necessary. The following individuals or officers are authorised to authenticate its use by their signature: a) the Page 69

70 b) the Chair of the Governing Body c) the Chief Finance Officer d) the Chief Nurse 6.2. Execution of a document by signature The following individuals are authorised to execute a document on behalf of the CCG by their signature. a) the b) the Chair of the Governing Body c) the Chief Finance Officer d) the Chief Nurse 7. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS 7.1. Policy statements: general principles The CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by NHS Halton Clinical Commissioning Group. The decisions to approve such policies and procedures will be recorded in an appropriate group minute and will be deemed where appropriate to be an integral part of the CCG s standing orders. Page 70

71 APPENDIX D SCHEME OF RESERVATION AND DELEGATION 1. Schedule of matters Reserved to the Clinical Commissioning Group and Scheme of Delegation 1.1 The arrangements made by the CCG as set out in this Scheme of Reservation and Delegation of decisions shall have effect as if incorporated into the CCG s Constitution. 1.2 Nothing in the Scheme of Reservation and Delegation should impair the discharge of the direct accountability to the Membership Forum or Governing Body of the Chief Finance Officer (CFO). Outside of these requirements the Chief Finance Officer shall be accountable to the CCG s. 1.3 The Clinical Commissioning Group remains accountable for all of its functions, including those that it has delegated. 1.4 Unless stated in the CCG s Constitution or in its Scheme of Reservation and Delegation, the CCG s has responsibility for the operational management of the CCG. Page 71

72 SCHEME OF RESERVATION AND DELEGATION Ref Reserved or delegated matter Matter reserved to the Member ship Matter reserved to the Governing Body Delegated to Governing Body or Committee Individual Member or Officer Responsible for preparing or recommending a course of action Operational responsibility 1. Regulation and control 1.1 Determine the arrangements by which the members of the Group approve those decisions that are reserved for the membership Members Forum Chair 1.2 Consideration and approval of applications to the NHS England on matters concerning changes to the Group s constitution, including proposed changes to the appendices to the Constitution Members Forum Governing Body 1.3 Approval of the Group s overarching scheme of reservation and delegation, which sets out those decisions that are in statute the responsibility of the Group and that are reserved to the membership and those delegated to the Governing Bod y Committees, sub committees Its m embers or employees Members Forum 1.4 Final authority on interpretation of the Group s constitution and supporting appendices (i.e. standing orders, prim e financial policies and scheme of reservation and delegation) Chair 1.5 Disclosure of non-compliance with the Group s Constitution (incorporating the standing orders, prim e financial policies and scheme of reservation and Delegation) All Staff All Members 1.6 Suspension of provisions within the Constitution (incorporating the standing orders, prim e financial policies and Scheme of Reservation and Delegation) due to extreme cause or emergency. Chair and CFO and Chief Officer together Page 72

73 1.7 Review of any such suspensions of the Constitution Audit Committee Head of Internal Audit Head of Internal Audit 1.8 Approval of the Group s operational scheme of delegation that underpins the Group s Scheme of Reservation and Delegation within the Constitution. Governing Body Approval of the Group s detailed financial policies that are underpinned by the Prim e Financial Policies within the Constitution including thresholds above which quotations or form al tenders must 1.9 be obtained arrangements for seeking professional advice regarding the supply of goods and services delegated limits for the certification of invoices raising of orders 1.10 Executing a document by signature or use of the Group s seal Audit Committee Chair or CFO or or Chief Nurse Chief Finance Officer Chief Finance Officer 2. Practice M ember Representatives & M embers of the Governing Body Approve the arrangements for identifying practice representatives for the Members Forum Approve the arrangements for appointing clinical leaders to the Group s Governing Bod y Members Forum Members Forum Chair Chair 2.3 Approve the arrangements for appointing the non-gp members to the Group s Governing Body Members Forum Chair 3. Strategy and Planning 3.1 Approve the Group s vision, values and overall strategic direction Members Forum Chair 3.2 Approve the Group s Operating Structure Members 3.3 Approve the Group s Commissioning Plan Forum Approve the Group s Financial Strategy and Annual Budget which Governing CFO CFO meet the financial duties of the Group Body Page 73

74 3.5 Approve to the approved budgets where variation would impact on the overall levels of e and expenditure or the Group s to achieve its strategic s Governing CFO 3.6 Approve a plan where the CCG is faced with a deficit in excess of 1% or poor puts the Group s continued in doubt. Governing and CFO and CFO 4. Annual and Accounts 4.1 of the Group s Annual Accounts Audit Committee 4.2 of the Group s Annual Report Audit Committee 4.3 of of auditors and their annual audit plans Audit Committee 4.4 duties. of for the Group s financial 5. Human and Development Audit Committee CFO CFO CFO 5.1 Approve the s and and or other for bers and other staff, pensions and gratuities uneration Committee 5.2 Approve other em ployees. s and conditions of service for the Group s HR & OD Committee 5.3 Approve y ents for ployees, including the accountable officer (where he/she is an ployee or ber of the Group) and for other persons working on behalf of the Group. HR & OD Committee 5.4 Approve ents where the Group has joint appointm with another Group and the individuals are ployees of that Group HR & OD Committee Page 74