CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BODY MEETING

Transcription

1 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING Wednesday 7 th May 2014 at 1 pm in the Sacred Heart and St. Edward s Church Hall 370 Blackburn Road, Darwen BB3 0AA A G E N D A Item No: Agenda Item Member Responsible CLINICAL STRATEG 1. Mental Health and Dementia Mrs Debbie Nixon/ Dr Tom Phillips PUBLIC PARTICIPATION 2. Chairman s Welcome Mr Joe Slater Report Presentation 3. Apologies for Absence and Confirmation of Mr Joe Slater Quoracy 4. Declarations of Interest relating to items on the Mr Joe Slater agenda 5. Questions from Members of the Public Mr Joe Slater PART 1 BUSINESS (APPROXIMATEL 2 PM) Minutes of the Meeting Held on 5 th February 2014 Extract from Part 2 of the Minutes of the Meeting held on 5 th February Matters Arising 7.1 Action Matrix 8. End of ear Review 2013/ Clinical Chief Officer s Report Mr Joe Slater Attached Attached Mr Joe Slater Attached Dr Chris Clayton Presentation Attached 9. Finance Report Mr Roger Parr Attached 10. Contract Performance Report Mr Roger Parr Attached 11. Quality and Performance Report Dr Malcolm Ridgway Attached 12. Governing Body Assurance Framework Update Mr Roger Parr Attached 13. Blackburn with Darwen Outcomes Analysis Update Mrs Debbie Nixon/ Attached Mr Dominic Harrison 14. General Practitioner Out of Hours Service Mrs Debbie Nixon Attached 15. Revised Clinical Commissioning Group Constitution PART 1 FOR INFORMATION 16. Communications and Engagement Annual Report 16.1 Communications and Engagement Plan for 2014/ Governing Body Sub-Committees and Groups Summary Mr Iain Fletcher Mr Iain Fletcher Mr Iain Fletcher Attached Attached Attached Attached Page 1 of 2

2 18. Domestic Abuse Services Dr Chris Clayton Attached 19. Any Other Business All 20. Date and Time of Next Meeting: Wednesday 2 nd July 2014, in the Sacred Heart and St. Edward s Church Hall,370 Blackburn Road, Darwen BB3 0AA Mr Joe Slater RESOLUTION That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section1(2)Public Bodies(Admission to Meetings)Act 1960) PART 2 (APPROXIMATEL 3.15 PM) A/14 Minutes of Part 2 of the meeting held on 5 th February 2014 Mr Joe Slater B/14 Matters Arising Mr Joe Slater B/14.1 Action Matrix C/14 Any Other Business Mr Joe Slater Attached Attached Page 2 of 2

3 Subject to approval at the next meeting Item 6 CLINICAL COMMISSIONING GROUP (CCG) Minutes of the Governing Body Meeting held on Wednesday 5 th February at 1 pm in Meeting Rooms 1 & 2 Blackburn Central Library Town Hall Street, Blackburn BB2 1AG PRESENT: Mr Joe Slater Chairman (Chair) Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Mrs Anne Asher Lay Member Nurse Representative Dr Tom Phillips Executive Member Dr Pervez Muzaffar Executive Member Mr Dominic Harrison Director of Public Health Dr Penny Morris Executive Member Dr Nigel Horsfield Lay Member Secondary Care Doctor (Retired) Mrs Debbie Nixon Chief Operating Officer Dr Malcolm Ridgway Clinical Director for Quality and Effectiveness IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Dr Helen Lowey Consultant in Public Health (Item 1 only) Mrs Catherine Baron Business Support Officer (minutes) Min No: Blackburn with Darwen Draft Alcohol Strategy: Preventing harm, Improving Outcomes The Chair drew members attention to the presentation on the agenda in relation to the Blackburn with Darwen Draft Alcohol Strategy: Preventing Harm Improving Outcomes by Mr Dominic Harrison. The presentation highlighted the effects of alcohol related harm not only to the health of the individual who consumes alcohol above the recommended number of units, but also the significant adverse impact that alcohol has on crime, health and social care services within Blackburn with Darwen. The strategic aims of the Blackburn with Darwen Alcohol Strategy have been developed based on the national alcohol strategy whilst ensuring that they reflect the local needs based on the Alcohol Joint Strategic Needs Assessment. It strives to prevent and reduce alcohol related problems through greater partnership working, by utilising the best available evidence of the problems within the community and what is known to work. Questions and answers followed. Page 1 of 9

4 Members of the Governing Body (GB) commended the Public Health Team and Blackburn with Darwen Borough Council (BwD BC) for their work in supporting and lobbying for the Government s move to increase the minimum price per unit for alcohol throughout the country. It was considered that there needs to be more focus on educating the middle sector at home drinkers to assist them in understanding the long term health impact of alcohol. Dr Nigel Horsfield reported that he is in the process of investigating the possibility of a pilot study on some new liver function tests which will inform the medical practitioner and the patient if the patient is at risk of liver disease. Current liver function tests do not provide such detail; there will be a cost implication to each blood test. A member of the public asked if primary schools are being targeted as part of the consultation, to which Dr Helen Lowey, confirmed that they are, in particular around the children and young people pledges. However there is always more than can be done and if there are opportunities to work even closer between the different population groups then the Public Health Team would welcome those discussions to further promote this Strategy. A member of the public asked what level of influence the Public Health Team has over the Licencing and Planning Departments at the BwD BC on cutting down the number of outlets selling cheap alcohol. Dr Lowey confirmed that other partners are very much involved in ensuring that the correct data, relating to health is used to support the licencing process. RESOLVED: That the Governing Body approve and support the delivery of the Blackburn with Darwen Alcohol Strategy Chairman s Welcome The Chair opened the meeting by welcoming all attendees and members of the public. He introduced himself and gave a short briefing with regard to meeting protocol and housekeeping Apologies for Absence and Confirmation of Quoracy Mr Paul Hinnigan, Lay Member Governance Dr Zaki Patel, Executive Member The meeting was confirmed as quorate Declarations of Interest Relating to Items on the Agenda The Chair reminded GB members and members of the public that they should, if appropriate, make a declaration should a conflict emerge during the meeting. No declarations were made at this point in the meeting, however as discussions took place some members declared their interests as conflicts arose. These were recorded against the relevant agenda item. Page 2 of 9

5 Questions from Members of the Public The Chair informed the meeting that no questions from members of the public had been received prior to the meeting however an update was requested in relation to the approved plans to create a vascular centre which, as per the story in the Lancashire Telegraph had been thrown into doubt after health chiefs in Bolton objected to a partnership with the Royal Blackburn Hospital (RBH). Last year it was announced that Blackburn would become one of three centres for specialist vascular surgery, bringing an end to complex operations in Bolton. The aim was to create a centre of excellence for disorders of the veins and arteries with patients from Bolton being treated by East Lancashire Hospitals NHS Trust (ELHT) to increase the volume of work and maintain Consultants skills. Dr Chris Clayton commented that discussions are ongoing and are being led by the Specialised Commissioning Team, NHS England; however no decision has been reached to date. The CCG continues to support ELHT and believe the intent to bring an arterial centre to the RBH to be in the best interests of the Hospital and local residents Minutes of the Meeting held on 4 th December 2013 The minutes of the meeting were accepted as an accurate record. RESOLVED: That the Minutes of the Meeting held on 4 th approved as a correct record. December 2013 were Extract of Part 2 of the Minutes of the Meeting held on 4 th December 2013 The extract of Part 2 of the minutes of the meeting was accepted as an accurate record. RESOLVED: That the Extract of Part 2 of the Minutes of the Meeting held on 4 th December 2013 was approved as a correct record Matters Arising Action Matrix The following items were noted: Dr Malcolm Ridgway reported that the Quality Team is preparing the response to the recommendations from the Francis Report. Don Berwick s methodology and the Francis report joined together will form the basis of the Quality Strategy Mrs Debbie Nixon reported a reduction in waiting times for Cognitive Behavioural Therapy (CBT) which is now no more than 9 weeks and for counselling no more than 1 week. The services are delivered by Lancashire Care NHS Foundation Trust (LCFT) and the CCG has agreed a recovery plan with them in order to clear the backlog of patients. Although the target has been reached there is a need to ensure that this reduction is sustained through regular monitoring. Members noted that the non-recurrent funding to support this initiative is still being negotiated. Page 3 of 9

6 Clinical Chief Officers Report Dr Chris Clayton presented his report and highlighted key items of national and local interest. Items of note related to: Winterbourne View Progress Report The Department of Health published its latest update on the transforming care programme. Within BwD there has been a lot of development and support as part of the core work programme. The CCG/Local Authority have recently appointed a Service Transformation Manager which is a joint post between health and social care. Better Care Fund (BCF) The BCF will provide 3.8 billion to local services to give elderly and vulnerable an improved health and social system. The final submission of the CCG action plan is due 4 th April NHS England (NHSE) Mrs Celia Ingham Clark has been appointed as the National Director for reducing premature deaths, this links with the Health and Well-being Board Strategy on reducing premature deaths. Never Events NHSE has confirmed that the GB cannot discuss the detail of individual never events at their meetings in public as cases could become personally identifiable. The cases are reported through the Quality, Performance and Effectiveness Committee (QPEC). NHSE is collating all information on never events and the publishing of data will be monthly from April Leadership Forum A big challenge for the CCG is how it will reconfigure services across Lancashire. The Lancashire Leadership Forum is well represented by organisations including Healthwatch, BwD BC, ELHT and Public Health. The forum is in the process of developing a Health and Care Strategy for Lancashire. LCFT has appointed Mrs Sue Moore as Chief Operating Officer. Dr Clayton, on behalf of the GB, thanked Mr Jon Tomlinson for his support whilst in post as Chief Operating Officer. NHS Trust Development Agency has appointed Professor Eileen Fairhurst as the Chair of ELHT. Mr Jim Birrell has been appointed as the Interim Chief Executive of ELHT. Commissioning Support Unit (CSU) it is expected in that there will be between 8-10 CSUs. The Lancashire CSU has merged with Staffordshire CSU and is now known as Staffordshire and Lancashire CSU. Assurance Framework A Quarter 3 Assurance meeting has been arranged for the 10 th March The focus for the CCG will be how it plans to develop and improve its providers of care. Healthwatch the CCG continues to work closely with Healthwatch and has taken on an active role attending meetings of their Board. BwD Senate meeting took place on the 21 st January The role of the Locality Groupings was discussed and the ways practices can work together to improve the quality of care to patients were explored. Following a question from a member of the public, Dr Clayton confirmed that Professor Fairhurst is covering the whole of ELHT and therefore both the Blackburn and Burnley Hospitals committing the equivalent of 3 days per week. RESOLVED: That the Governing Body noted the content of the report. Page 4 of 9

7 Finance Report Mr Roger Parr presented the Finance Report which provided an update on the financial position of the CCG as at month 9 Quarter 3. The current revenue position remains on plan to deliver the planned year end surplus of 1,922k. ear to date the CCG is reporting a cumulative surplus of 1,462k. This is ahead of the planned surplus of 1,441k. In terms of the month 9 cumulative position there are some pressures with regards to the health care commissioned services which is forecasting an overspend of 2,234 however this is offset by under spends in other areas in the CCG. Members held a discussion which focussed on NHSEs programme to review Personal Medical Services (PMS) contracts which could result in premiums being reduced as the GMS Minimum Practice Income Guarantee is gradually phased out. Note: Dr Tom Phillips declared an interest in this discussion as Brownhill Surgery is a PMS practice. Dr Chris Clayton reported that in order to mitigate potential risks to local practices the CCG will be working with NHSE to establish a Local Medical Network which will begin to review the challenges at a local level. A member of the public expressed concern regarding the excessive amount of money that ELHT spend on agency staff and questioned if they have got any future plans to recruit permanent staff in order to reduce these costs. The GB was not in a position to answer this question on behalf of ELHT however it was highlighted that there is an issue nationally with regards to the recruitment of staff. ACTION: Following an enquiry from the Chair, Mr Roger Parr agreed to check if there are any financial implications following the introduction of the Think Well Campaign and the Minor Ailments Scheme. RESOLVED: That the Governing Body noted the content of the report, the risks and the detailed appendices Contract Performance Report Mr Roger Parr presented the Contract Performance Report, which gave the GB an update on the activity performance of the major commissioned services of the organisation as at Month 8. Mr Parr drew members attention to the key information: Referrals are down year on year by 0.39% which is an increase from previous month and on average continue to show a reduction based on working days (see detailed appendices) Contract performance points to note included that data shows Accident & Emergency (A&E) and non-elective are down in terms of activity and finance Non elective activity performance is starting to show a trend in terms of operating under plan Outpatient activity continues to be below plan for follow ups and over plan for Page 5 of 9

8 procedures Waiting lists at ELHT for inpatients and day cases has seen an increase in month of 167, mostly associated with general surgery and general medicine compared to an increase in the previous month of 343; one of the outliers is nephrology which showed a sharp increase at the start, however in December this returned to the usual expected level Inpatients waiting on an incomplete pathway over 36 weeks has reduced to 14 Regarding the General Practitioners with Special Interests (GPwSI) Services which operated on a block contract, review meetings will take place focussing on capacity and the future of these services, during GP Out of Hours (OOHs) Service The total activity remains around plan. Questions and answers followed. ACTION: Following a request from Mrs Anne Asher, Mr Roger Parr to consider including the maximum wait in relation to the number of patients on an incomplete pathway in future Contract Performance Reports. Mrs Debbie Nixon provided an update on the current position with regards to A&E and highlighted the high level of scrutiny which has taken place across the Health Economy so far over the Winter period, which has resulted in reducing demand over and above the national average. The GB noted that ELHT has improved its performance in the last week, and has delivered within the 95% target; however ELHT will not achieve its 95% target in this financial year. RESOLVED: That the Governing Body is requested to note the content of the report and the supporting appendices Quality and Performance Report Dr Malcolm Ridgway presented the GB with an update on the quality and performance exception report information about the main commissioned services as at November 2013, month 8. Key points were highlighted: With regards to the balanced scorecard amber status has been achieved for NHS constitution rights A&E targets will not be reached however progress is being made Cancer 62 day wait a letter of concern has been sent to the lead commissioner regarding breaches LCFT Performance against the 95% target regarding the number of patients under adult mental illness specialties on care plan approach who were followed up within 7 days of discharge from in-patient care has improved however this was variable across Lancashire and has been reported to the Lancashire Quality and Performance Group Memory Assessment Service the new service should deliver the target into the future Methicillin-resistant Staphylococcus aureus (MRSA) no reported cases in November however the forecast is rated red as there have been 3 cases year to date Clostridium difficile currently on target 18 week referral to treatment Regarding Ear, Nose and Throat a financial penalty has been incurred of 9.6k due to performance of only 76.56% Admission to stroke unit within 4 hours the target is not being met, however Page 6 of 9

9 there is a recovery plan in place and a letter of concern has been sent to the lead commissioner Friends and family test there has been an increase in patient satisfaction Keogh The Quality Surveillance Group has met and good progress is being made. A robust quality assessment framework is being led by EL CCG The CCG has successfully appointed to the role of Head of Quality Questions and answers followed. ACTION: Following an enquiry from Mr Roger Parr, Dr Malcolm Ridgway agreed to check if monthly reporting is available with regards to the Memory Assessment Service. RESOLVED: That the Governing Body noted the contents of the report Everyone Counts: Planning for Patients 2014/ /19 Mr Roger Parr, provided an update on progress with the Everybody Counts: Planning for Patients and 5 year Financial Plan and Detailed Budgets for 2014/15 and 2015/16 and highlighted key points: Submission date for the initial draft of the plan is the 14 th February Development of plans is currently underway Work is ongoing with the CSU regarding the five year strategic plan The selection of three Local Quality Premium Indicators is dealt with during the operational meetings, these will be presented to the Governing Body for final ratification Better Care Fund (BCF) submission is 14 th February 2014; the CCG is working closely with BwD BC colleagues There will be significant demands on CCG resources over the next few years CCGs are required to maintain an underlying surplus of 2.5% and will have to deliver a 1% surplus each year Providers will be expected to deliver at least a 4% efficiency The CCG will receive a minimum uplift of 2.14% which means that BwD will be under-funded by 2.21% The total revenue resources allocated in are over 205m The Commissioning for Quality and Innovation (CQUIN) uplift remains at 2.5% for those providers operating under NHS contracts The CCG is planning to put aside a 1% contingency which will be fully utilised during the financial year (due to the financial risks outlined) The BCF equates to 10.8m of CCG resources in ; the funding will be spent in partnership with BwD BC The CCG is required to set aside 5 per head of population for vulnerable older people The CCG will be managing risks and the cost pressures due to increased activity The contract with ELHT has not yet been signed; negotiations are ongoing The CCG plans to deliver 4m QIPP savings The CCG is awaiting confirmation from NHS England that the CCG is able to spend the 2.5% retained surplus; however this has been built into the financial plans Prescribing is being monitored Questions and answers followed. Page 7 of 9

10 A discussion took place regarding the distance from target during which members expressed their concerns relating to the allocations announced in December. Overall the CCG is around 4m below its target of a fair shares funding level had been applied. This will have the effect of increasing avoidable health inequalities due to the fact that the local health economy will have less money to spend on local health services compared with the average CCG in this country. RESOLVED: That the Governing Body; Noted the content of the Everybody Counts Report and progress being made Noted the assumptions made and the financial risks detailed in the Financial Plan Report and approve the levels of contingency reserves and planned annual surplus Approved the proposed budgets as shown in the Financial Plan Report Appendices 1-4 Would await further update on the financial position as the outstanding issues detailed in the Financial Plan Report are resolved Governing Body Assurance Framework Update Mr Roger Parr presented the report which provided an update on the risks held on the Governing Body Assurance Framework for the period October to December 2014; Quarter 3 (Q3) and drew members attention to points 3.2 and 3.3 which highlights the movement in risk score at the end of Q3 and the increased risk rating which occurred during the Q3 reporting period. Questions and answers followed. Following a question raised by the Chair, Dr Chris Clayton reported that the Compact Agreement between NHSE has been drafted and is in the process of becoming formalised. In relation to quality monitoring within Primary Care, Dr Malcolm Ridgway provided an update on how the CCG is taking steps towards managing and monitoring performance and quality within General Practice in BwD. Following a question raised by the Chair, Mr Roger Parr provided assurance to the GB that in July 2013 Klynveld Peat Marwick Goerdeler (KPMG) had produced a report of their evidence in relation to allocation issues. RESOLVED: That the Governing noted the contents of the report Clinical Presentation Programme for 2014 Governing Body Public Meetings Mr Iain Fletcher presented a forward plan of clinical presentation for the GB meetings throughout 2014/15 and highlighted that the Individual Personal Health Budgets and Children s Complex Cases may be brought forward. RESOLVED: That the Governing Body noted and approved the suggested clinical presentation programme for the year 2014/15. Page 8 of 9

11 Communications and Engagement Update Mr Iain Fletcher provided an update in relation to communication and engagement activity for the period October to December The Chair commented that the report does not make reference to the Ask Ellie Campaign and requested confirmation that there is a mechanism in place for public to be able to feedback their comments regarding the care they received. Mr Fletcher confirmed that the CSU are linking into the Ask Ellie Campaign and will feedback information to the CCG. RESOLVED: That the Governing Body: Noted the contents of the report Would feedback any comments or suggestions in relation to communications and engagement activity and comment on initial plans for the future Receive a further report at its meeting in April Governing Body Sub-Committees and Groups Summary The above report, which summarised each Committee Meeting for the GB and identified key decisions or actions and items of particular interest was noted for information. RESOLVED: That the Governing Body noted the content of the report Any Other Business There was no further business to discuss Date and Time of Next Meeting The next meeting will be held on at 7 May at 1 pm, Venue to be confirmed. Post meeting note: The next meeting will be held at in the Sacred Heart and St. Edward s Church Hall, 370 Blackburn Road, Darwen BB3 0AA. Signed. Chairman Date Page 9 of 9

12 Item 6.1 CLINICAL COMMISSIONING GROUP (CCG) PRESENT: Extract from Part 2 of the Minutes of the Governing Body Meeting held on Wednesday 5 th February at 3 pm in Meeting Rooms 1 & 2 Blackburn Central Library Town Hall Street, Blackburn BB2 1AG Mr Joe Slater Chairman (Chair) Dr Chris Clayton Clinical Chief Officer Mr Roger Parr Chief Finance Officer Mrs Anne Asher Lay Member Nurse Representative Dr Tom Phillips Executive Member Dr Pervez Muzaffar Executive Member Mr Dominic Harrison Director of Public Health Dr Penny Morris Executive Member Dr Nigel Horsfield Lay Member Secondary Care Doctor (Retired) Mrs Debbie Nixon Chief Operating Officer IN ATTENDANCE: Mr Iain Fletcher Head of Corporate Business Mrs Catherine Baron Business Support Officer (minutes) A/14 Minutes of Part 2 of the Meeting held on 4 th December 2013 The Minutes of Part 2 of the Meeting held on 4 th December 2013 were considered and accepted as an accurate record. RESOLVED: That the Minutes of Part 2 of the Meeting held on 4 th December 2013 were agreed as an accurate record. B/14 B/14.1 Matters Arising/ Action Matrix The following item was noted: Minute D/13 June Any Other Business Older Adults Mrs Debbie Nixon, Chief Operating Officer, reported that Mrs Jill Frame has been appointed as Adult Safeguarding champion and is conducting an external review of the safeguarding arrangements, looking at resource across Pennine Lancashire to ensure a robust system and assurance process that is fit for purpose. 1

13 GOVERNING BOD MEETING - ACTION MATRIX Item 7.1 Action Origin Board Ref Recommendations from the Francis Report The CCG will publish its response to the recommendations from the Francis Report following the publication of the Government s response. Action Owner Due Date Status IF February Meeting RECEIVED AT THE MARCH MEETING General Practitioner Acute Visiting Service Evaluation Report Mrs Debbie Nixon to ensure that an evaluation of the service is presented to the February meeting. DN March Meeting RECEIVED AT THE MARCH MEETING Finance Report Following an enquiry from the Chair, Mr Roger Parr agreed to check if there are any financial implications following the introduction of the Think Well Campaign and the Minor Ailments Scheme. RP May Meeting VERBAL UPDATE Contract Performance Report Following a request from Mrs Anne Asher, Nurse Representative, Mr Roger Parr to consider including the maximum wait in relation to the number of patients on an incomplete pathway in future Contract Performance Reports Quality and Performance Report Following an enquiry from Mr Roger Parr, Dr Malcolm Ridgway agreed to check if monthly reporting is available with regards to the Memory Assessment Service. RP MR May Meting May Meeting VERBAL UPDATE VERBAL UPDATE

14 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 8.1 REPORT TITLE: RESPONSIBLE OFFICER: CLINICAL CHIEF OFFICER S REPORT DR CHRIS CLATON, CLINICAL CHIEF OFFICER SUMMAR: This report provides an update on national and local issues of interest to Governing Body members not covered elsewhere on the agenda, and provides an indication of where the Clinical Chief Officer s efforts have been directed since the last meeting. GOVERNING BOD ACTION: The Governing Body is requested to receive this report and to note the items as detailed. EQUALIT ANALSIS: Has an Equality Analysis been completed in respect of this report/issue requiring decision? No COMMUNICATION: Communication and/or engagement undertaken or required? No RISKS: Have any risks been assessed? No RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified within the report) None Report of the Clinical Chief Officer 7 th May 2014 Page 1 of 12

15 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Report of the Clinical Chief Officer 7 th May 2014 Page 2 of 12

16 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 CLINICAL CHIEF OFFICER S REPORT 1) Introduction This report provides an update on national and local issues of interest to Governing Body (GB) members not covered elsewhere on the agenda, and also provides an indication of where the Clinical Chief Officer s efforts have been directed since the last meeting. 2) Department of Health 2.1 NHS Constitution The Expert Advisory Group to the NHS Constitution has published a paper setting out ten recommendations to the Department of Health (DoH) and national and local organisations for increasing the impact of the Constitution. These recommendations build on those made by the NHS Future Forum in October Since the introduction of the NHS Constitution in 2009, the health system has undergone significant reform. The changes made to the health and care system in England from 1st April 2013 gave the Constitution greater significance, providing a platform for shared values and a unifying approach among the many newly established health bodies. This was recognised in the Health and Social Care Act 2012, which reaffirmed the importance of the Constitution: the Secretary of State now has a duty to have regard to it, as do all NHS bodies. In addition, NHS England (NHSE) and Clinical Commissioning Groups (CCGs) are now required to promote it along with Health Education England. Local Authorities, in the exercise of their Public Health functions, also have a duty to have regard to the Constitution paving the way for further and better integration with health services. Blackburn with Darwen (BwD) CCG has been reviewing its Constitution in line with the agreement of the Membership that this should be undertaken annually. Further information is contained in Item 17 on today s agenda. Further information via: NHS Choice Framework 2014/15 This framework published by the DoH on the 1 st April brings together information about patients rights to choice about their health care, where to get more information to help make a choice, and how they can complain if they have not been offered choice. Report of the Clinical Chief Officer 7 th May 2014 Page 3 of 12

17 The 2014 to 2015 version reflects changes to expansions of patients rights to choice in the areas of: general practice mental health personal health budgets The NHS Choice Framework will be updated annually, as choice rights expand to new services and patient groups. Further information via: Transforming Primary Care Transforming Primary Care published by the DoH and NHSE on 14 th April sets out plans for more proactive, personalised and joined up care, including the Proactive Care Programme, providing the 800,000 patients with the most complex health and care needs with: a personal care and support plan a named accountable General Practitioner (GP) a professional to coordinate their care same-day telephone consultations The plan builds on the role of Primary Care (PC) in keeping patients well and independent. It explains how professionals across the healthcare system can work together to transform care to become more proactive and tailored to patients individual need. An emerging model for PC will be considered by the Membership of the CCG at a meeting of the Senate on 29 th April. This will continue to be developed throughout the coming year and assured with NHSE s Local Area Team (LAT). Further information via: 3) NHS England 3.1 Chief Executive Mr Simon Stevens started his new role as NHSE s Chief Executive on 1st April, with a visit to the north east of England. Mr Stevens first morning was spent meeting staff and patients at Shotley Bridge Hospital in County Durham where he started his career in the NHS as a trainee manager over a quarter of a century ago. 3.2 Putting Patients First NHS England s Business Plan 2014/ /17 A refreshed business plan was published by NHSE on 31 st March, describing its role in delivering high quality care for all, now and for future generations. It describes everything the organisation undertakes, both as a direct commissioner and as a leader, partner and enabler of the NHS commissioning system. There is a strong focus on maintaining and improving present NHS performance and looking to the future to secure a sustainable NHS. Report of the Clinical Chief Officer 7 th May 2014 Page 4 of 12

18 The business plan builds on Everyone Counts: Planning for Patients 2014/15 to 2018/19; earlier planning guidance for the system, which was published in December Within the business plan long-term ambitions are described, medium-term objectives and the specific deliverables NHSE expects to achieve over the next year. The plan outlines how NHSE will work as an organisation and how it will work with others; setting out the key intentions it will carry out as part of its role to improve outcomes for patients and how it will measure the impact of this. Further information via: Securing Excellence in GP IT (General Practitioner Information Technology) Services NHSE has outlined plans for how more than 230 million in funding will be used to ensure all GP practices across England have high-quality IT systems. Set out in an updated operating model for ,, the plans aim to improve the quality of GP care by enhancing patients experience of services, supporting and encouraging greater integration of care and providing efficiency benefits for practices by reducing paperwork, freeing up more time for patient care. GPs have led the way in the move from paper to digital record-keeping and this model lays the foundations for all GP practices to be able to offer online transactions to patients in the future, such as booking appointments, ordering repeat prescriptions and accessing their individual health records online. It also supports the aim of implementing integrated digital care records across the NHS, which will help make patients journeys seamless by giving health professionals in both hospitals and primary care access to the information they need, without patients having to constantly repeat themselves. Under these arrangements, GP IT funding will be distributed to CCGs based on patient population size, which is a significant change from previous models. This will ensure equity across all parts of England based on a core IT service offer. Alongside this, there will be a range of add-on IT services which can be tailored and implemented to fit with local service improvement strategies. Having frontline Clinicians at the forefront of this agenda will ensure GP IT services are designed in the best way to enable health and care professionals to do their jobs more effectively while providing better and more convenient services to patients. NHSE is also creating resources and networks to support practices, CCGs and other stakeholders to share with their peers what works for them, offer advice on best practice and collaborate on innovative ideas. Locally, these plans will inform the CCG s GP IT Strategy. Further information via: Report of the Clinical Chief Officer 7 th May 2014 Page 5 of 12

19 3.4 Personal Health Budgets People with complex health care needs now have the right to ask for a personal health budget. The scheme is being rolled out across the country after the budgets were trialled in a national pilot programme between 2009 and 2012 at sites all over the country. A personal health budget is an amount of NHS money available to some people with long term conditions to meet their healthcare and well-being needs. The budgets give people more independence over how their healthcare money is spent, be that on carers to provide intensive help at home, equipment to improve quality of life or therapies like counselling. From April 2014, people, who have significant health needs and are eligible for NHS Continuing Healthcare, can ask their NHS team to provide their care through a personal health budget. NHS Continuing Healthcare is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital but have complex ongoing healthcare needs. From April 2015, people will design and agree a plan with their healthcare team that shows how they will use the budget to meet their goals, which could include therapies, personal care and equipment. The budgets can be managed in the form of a notional budget, direct payments or a third party arrangement. This will mainly apply to people with long term conditions and complex health needs. Taking up a personal health budget will be optional, and anyone who does not want to manage their healthcare needs in this way can leave their care arrangements as they are now. The CCG will continue to work closely with the Commissioning Support Unit (CSU) in the development and delivery of Personal Health Budgets during 2014 and will participate in the Delivery Assurance Group across Lancashire for full implementation by Further information via: 4) Blackburn with Darwen Clinical Commissioning Group 4.1 Happy Birthday! The CCG celebrated its first year of operation this month with a special cake baked by a member of staff. I had the pleasure of addressing staff prior to the cake being cut and thanked them for their hard work over the last year to improve the health and well-being of the population of the Borough. Report of the Clinical Chief Officer 7 th May 2014 Page 6 of 12

20 At its Staff Away Day on 19 th March, the CCG reflected on progress and achievements during its first year of operation and discussed plans for the future. I have included some of these below: Progress and Achievements The CCG has continued to maintain a stable financial position. The CCG, as an Associate Commissioner, has continued to seek assurance in the delivery of the Action Plan produced following the Keogh Report, which highlighted a number of areas where improvements and actions were required within East Lancashire Hospitals NHS Trust (ELHT). The CCG s Winter Plan has continued to manage demand and its Unscheduled Care schemes have contributed to: o a reduction in attendances to the Accident and Emergency (A&E) Department at ELHT o a reduction in non-elective admissions o improved health related quality of life for people with long term conditions o an increase in the proportion of older adults living independently at home following hospital discharge The CCG has developed a strong leadership role for the Lancashire Care NHS Foundation Trust (LCFT) mental health contract. This work has involved: o a major service transformation programme o being one of only two level four Senior Responsible Officer roles in Lancashire o having two Clinical Leads associated with the contract o the sign off of a public consultation on Dementia following a review chaired by the CCG Chair. Report of the Clinical Chief Officer 7 th May 2014 Page 7 of 12

21 The CCG s local work within Mental Health Services has included: o the Attention Deficit Hyperactivity Disorder (ADHD) Service which went live in 2013 o a Consultant Psychiatrist led Single Point of Access (SPOA) service being commissioned o the Improving Access to Psychological Therapies (IAPT) 53 weeks waiting time being brought down to under 4 weeks (provision through third sector providers) o the Dementia Local Improvement Scheme (LIS) being approved by NHSE in February 2014 o an in-reach Memory Assessment Team (MAS) Team being established and rolled out in alignment to the Dementia LIS from April o a Dementia Intermediate Support Team (IST) team now being in operation seven days a week from 8am-8pm o the Nursing Home Liaison Team (NLHT) being recruited to and becoming operational The CCG is currently developing a PC Strategy and work within Primary and Community Care has involved: o the roll out of four integrated PC localities o the production of a Quality LIS o the development of Diabetes, Cardio-vascular Disease and Respiratory Local Enhanced Services (LESs) o an Advice and Navigation Scheme o the development of a Safeguarding Framework o the delivery of a Cancer LIS The CCG s work in Integrated Care has continued and this work has included: o the strengthening of its partnerships o complex under 65 s plans o an integrated recovery and treatment model for alcohol Future Plans Plans to build on the CCG s work within Unscheduled Care include: o an evaluation of the Winter Plan o developing the Early Action Police Liaison Role at the A&E Department at ELHT (which commenced 1 st April 2014) o a review of Children s Assessment and Observation Pathway o a step up pathway from PC to the Children s Community Nursing Service o an extension of the PC Pathway in Urgent Care o an extension of the Acute GP Visiting Scheme to include the East Lancashire (EL) CCG Paramedic Pathfinder o the development of an Urgent Care PC Model linking in with Integrated Care. Planned actions for Mental Health Services include a review and stock take of the whole system programme which will involve: o a Transition Plan for specialist Dementia teams o increased monitoring of inpatient capacity o a review of service specifications (all services) o a focus on re-design of the Community Mental Health Team (integrated with PC localities) and IAPT/ SPOA/ Crisis Pathways (including issues linked to A&E) Report of the Clinical Chief Officer 7 th May 2014 Page 8 of 12

22 Developments and plans for Primary and Community Care include: o further development of the four integrated PC localities in terms of commissioning functions o the emerging model to transform PC (see Item 2.3) Plans for the CCG to build on its work within Integrated Care, along with its partners, involve: o the Better Care Fund o an over 65 s/frail elderly scheme o developing a 0-25 complex needs strategy for children and young people o a review of children s emotional well-being and a Child and Adolescent Mental Health Service strategy 4.2 CCG Checkpoint Quarter 3 Assurance The CCG has been assessed against the original six domains for authorisation. Initial feedback has been received which indicated that the LAT were pleased with the CCG s submissions. However there were two areas of concern; namely the A&E 4 hour target and the 62 cancer wait target. The CCG s overall assessment is assured ; with support relating to ELHT. 4.3 Staff Changes The CCG has strengthened its Quality Team with two new members of staff, supported by the CSU. This will support the quality assurance of LCFT going forward. The Scheduled Care Team, shared with EL CCG, has been separated to form teams in each CCG which will concentrate on aspects of elective activity and developing cases for change. 4.4 LCFT Appointment The Trust has appointed Mr David Curtis MBE as Interim Deputy Director of Nursing for the next three months, following the retirement of Mr Colin Dugdale. Mr Curtis brings a wealth of experience to the role and will be responsible for supporting the continued development of the professional leadership agenda, the continual improvement of services and embedding compassionate care The Harbour The Trust recently held a Topping Out ceremony at The Harbour in Blackpool, the first of the Trust s new mental health inpatient units, to mark a milestone in the construction stages. A number of construction and design partners were in attendance along with the Expert Service User and Carer Group and to conclude the ceremony attendees were given the opportunity to visit one of the functional acute wards. The new facility, located in Blackpool, will provide a total of 154 beds functional mental health, advanced care and dementia care. The building is due to be completed later this year and will become operational by Spring Report of the Clinical Chief Officer 7 th May 2014 Page 9 of 12

23 4.4.3 Mental Health Inpatient Facility for EL 4.5 ELHT The Trust is in the very early stages of starting the process to develop the mental health inpatient facility for EL. The facility will be located in Blackburn, within the footprint of the Royal Blackburn Hospital site and will become operational during 2016/17. It will replace the existing mental health wards at Burnley and Blackburn which are no longer suitable for delivering modern mental health care. The unit will provide a much better standard of accommodation than what is currently available with en suite rooms, access to outdoor space and communal therapeutic areas. Service users and carers will be involved in the design process and the features will mirror the Trust s exemplar site at The Harbour in Blackpool which is also under development and due to complete in early The Trust will be in a position to provide more definitive information about the EL site during the summer months following the completion of formalities and briefings to local scrutiny officers and Members of Parliament. In the meantime, any queries can be ed to: communications@lancashirecare.nhs.uk The CCG attended a tripartite Board Meeting with members of ELHT and EL CCG prior to the Chief Inspector of Hospitals inspection visit to the Trust on 29 th April. Topics for discussion were quality and safety, assurance from the Trust from a CCG s perspective and partnership working in practice. 4.6 Commissioning Support Unit The CSU is going through a process of ensuring its status as a formal organisation on the national lead provider framework. This is to confirm its stability in the continuation of the delivery of services in the future. 5) Health and Well-Being Board Over the last year, the Health and Well-being Board (H&WBB) for BwD has met regularly at Blackburn Town Hall. Some of the meetings have been open to the public but, as this has been the first year of operation, there have also been some private meetings which have concentrated on the development of an effective Board. The Board held a very successful event at the end of October 2013, when King George s Hall was the venue for the launch of the report of the Director of Public Health and structured discussions with the public about Health and Well-being matters. A DVD recording of this event is available on the BwD Council s website. The Board has ensured that commissioners within the Council, the CCG and the LAT of NHSE have taken account of the Borough s Health and Well-being Strategy when drawing up their plans. The Board has five working groups considering how best to tackle certain of our problems and requires these groups to report back on progress made in implementing actions to deliver the aims contained in the strategy. The Board has also supported the work to plan for the introduction of the Better Care Fund and integrated working. There have been opportunities to consider how well we provide assistance for people with poor mental health and the need to consider outcomes for people with a learning disability and autism. The voluntary sector and the public and patient representatives have been encouraged to play a full part in the work of the Board and have made valuable contributions to the work. Report of the Clinical Chief Officer 7 th May 2014 Page 10 of 12

24 The ratified minutes of the meeting held on 20 th January 2014 are contained within the Governing Body Sub-Committees and Groups Summary. 6) Healthwatch Healthwatch has also had a year of operating and has now developed to become an independent organisation. It is now a community interest company, known as Healthwatch BwD CIC. The Chair of the group, Sir Bill Taylor, as well as overseeing the move to independence, has strengthened the Board bringing in expertise from the housing sector as well as the voice of younger people. Sir Bill has also been instrumental in bringing together Chairs from across the North West to enable shared learning and also recognising that hospitals such as the Royal Blackburn serve more than one community and therefore the Healthwatch voice will be stronger if it is a united one. The Board meets in public and has met in Darwen as well as Blackburn and is steadily growing in influence. There are various task groups which consider in depth particular aspects of health or social care. The organisation has joined with others at the our Support, our Choice Service in Town Hall Street, Blackburn and the staff and volunteers are increasingly working in partnership to support the public in having their say about local services. 7) VCS Voice VCS Voice is the new voluntary and community sector forum for people working or volunteering within the sector within BwD. It is open to any voluntary, community or faith organisation operating within the area. Participants come together to collectively discuss strategic issues with their representatives, exchange information, network with each other, lobby or campaign on particular topics, or co-ordinate joint action. The forum has agreed to meet on at least a quarterly basis. A process to elect a new Chair and Vice Chair was completed on 28 th March and Mr Abdul Mulla was appointed as Chair, with Mr aqoob Hussain MBE, appointed as Vice Chair. The new chair will be the VCS Representative on the BwD Local Strategic Partnership Board. 8) One Voice Local charity One Voice has received an award for Excellence in Public Health in recognition of the organisations work on the Baiter Sehat campaign. The awards, sponsored by the DoH highlight local efforts to raise awareness of public health and recognise the great number of people who are actively engaged in charitable or voluntary work within their local community The event was hosted by Lord Victor Adebowale and took place on 3rd April in the Terrace at the House of Lords. Also in attendance was Jane Ellison MP, Parliamentary Under Secretary of State for Public Health. One Voice is a community development charity that promotes greater civic engagement and social cohesion, particularly amongst the most deprived and disadvantaged people of BwD. One Voice, through the Baiter Sehat campaign, has launched numerous community education and key health initiatives in partnership with BwD Borough Council. These include organ donation, domestic violence, drug and alcohol abuse, forced marriage and shisha and tobacco smoking. Report of the Clinical Chief Officer 7 th May 2014 Page 11 of 12

25 9) Meetings Members may be interested to note the following meetings and events which have taken place during the course of the last three months: 3 rd February Future Models of Health and Care Delivery 5 th February GB Meeting in Public 5 th February Pennine Lancashire Clinical Transformation Board 6 th February Lancashire Network Development Day 7 th February St Ives Business and Training Centre Opening 11 th February NHS Medical Leaders Conference th February Commissioning Business Group 13 th February Local Medical Committee 24 th February Executive Joint Commissioning Group 24 th February Winter Planning Meeting 25 th February Future Hospital Partners Event 26 th February Hot Topics event 27 th February Lancashire CCG Network 28 th February Jack Straw Residents Meeting 3 rd March Healthcare and Innovation Expo 5 th March GB Discussion and Development 13 th March Local Medical Committee 17 th March BwD Plan for Prosperity Engagement Summit 20 th March Respiratory Event 20 th March Lancashire Leadership Forum 20 th March Board to Board with ELHT and EL CCG 24 th March Executive Joint Commissioning Group 24 th March Winter Planning Meeting 25 th March Reform/Shelford Group Conference with Mr Jeremy Hunt and Mr Andy Burnham 27 th March Lancashire CCG Network 28 th March Jack Straw Residents Meeting 1 st April Call to Action Event 2 nd April Team to Team with EL CCG 2 nd April GB Discussion and Development 2 nd April Pennine Lancashire Clinical Transformation Board 23 rd April ELHT Stakeholders Event 24 th April Lancashire CCG Network 10) Recommendation The Governing Body is requested to receive this report and to note the items as detailed. Dr. Chris Clayton Clinical Chief Officer 25 th April 2014 Report of the Clinical Chief Officer 7 th May 2014 Page 12 of 12

26 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 9 REPORT TITLE: RESPONSIBLE OFFICER: FINANCE REPORT MR ROGER PARR, CHIEF FINANCE OFFICER SUMMAR: This report provides details of the CCG s overall year end position at the end of its first year as a statutory NHS organisation. GOVERNING BOD ACTION: The Governing Body is asked to note the content of the report and the overall financial position of the CCG at the end of the financial year 2013/14. EQUALIT ANALSIS: Has an Equality Analysis been completed in respect of this report/issue requiring decision? N/A COMMUNICATION: Communication and/or engagement undertaken or required? N/A RISKS: Have any risks been assessed? ES RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified with the report) N/A Page 1 of 1

27 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven. We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate. NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Page 2 of 2

28 NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP 1. Introduction GOVERNING BOD MEETING 7 TH MA 2014 REPORT OF THE CHIEF FINANCE OFFICER MARCH 2014 This report provides details of the CCG s overall year end position at the end of its first year as a statutory NHS organisation. The figures remain provisional at this stage as the final position will be confirmed after the completion of the External Audit review of the CCG s Annual Accounts. The draft Annual Accounts were submitted on 22 nd April 2014, one day ahead of the national deadline. The CCG is reporting an overall provisional surplus of 1,924k. This is a favourable variance of 2k against the planned surplus of 1,922k. The overall surplus is made up of a surplus on programme budgets (commissioning and corporate) of 1,793k plus a surplus of 131k on running costs. The total revenue resources available to the CCG totalled 202,904k which was made up of revenue resources for programme costs of 198,924k and 3,980k for running costs. Total expenditure was 200,980k. The CCG achieved both of its financial duties ie for expenditure not to exceed resources and running costs to be maintained within the amount specified. Appendix 2 & 4 provide further details of the expenditure on healthcare and non healthcare commissioning costs. Appendix 3 shows the expenditure on the main healthcare contracts. 2. Financial Risks The year end position includes a small number of assumptions which have yet to be finalised and there remains an element of risk albeit relatively small. The main risk is that associated with prescribing costs. Notification of the actual year end prescribing expenditure comes from the NHS Business Services Authority (NHSBSA). The figures included in the report are based on the actual expenditure to January and include a prudent forecast for February and March. 3. Statement of Financial Position Appendix 5 shows the Statement of Financial Position at the end of March The payables balance of 9,614k includes NHS creditors and accruals of 2,098k and non NHS 7,516k. The Non NHS accruals includes a prescribing accrual of 4,200k. Page 3 of 3

29 During 2013/14, the CCG was given a maximum cash drawdown as shown in Appendix 1. At the financial year end, the CCG had a cash balance of Key Performance Indicators 5. Capital i. QIPP the QIPP target was fully achieved in 2013/14. ii. Better Payment Practice Code for NHS invoices, the CCG achieved the 95% target for both number and value of invoices. For Non NHS, the CCG achieved the 95% target for number of invoices and was slightly under target in terms of value. Capital funding of 104k was approved by NHS England for GP IT schemes for 2013/14. Funding was approved for EMIS web software upgrade and IT equipment replacement. At the end of the financial year, capital expenditure of 68k was charged back to NHS England. 6. Recommendation The Governing Body is asked to note the content of the report and the overall financial position of the CCG at the end of the financial year 2013/14. Roger Parr Chief Finance Officer 24 th April 2014 Page 4 of 4

30 Item 9 NHS Blackburn with Darwen CCG Appendix 1 Summary Governing Body Report March 2014 Expenditure to Date 000 Programme Costs 000 Running Costs 000 Revenue Resource Limit Confirmed (202,904) (198,924) (3,980) Anticipated 0 0 Total Revenue Resource Limit (202,904) (198,924) (3,980) Expenditure Commissioning (Page 2) 195, ,203 Corporate (Page 4) 1,928 1,928 Reserves (Page 4) 0 0 Healthcare Sub Total 197, ,131 0 Running Costs (Page 4) 3,849 3,849 Total Expenditure 200, ,131 3,849 Surplus/(Deficit) 1,924 1, Target Surplus/(Deficit) 1,922 Better Payment Practice Code TD Value (%) TD Number (%) Target (%) NHS Non NHS Cash Maximum Cash Drawdown 192,373,135 Actual Cash Drawdown 192,373,135 Bank Account and Petty Cash Float Balance at 31st March 324 Page 1

31 NHS Blackburn with Darwen CCG Appendix 2 Healthcare Commissioning Report March 2014 Expenditure to Date 000 Acute Services NHS contracts (includes Ambulance Services) 111,979 Non NHS Providers 4,854 NHS Contract Exclusions / Cost per Case 442 Non Contract Activity 995 Other (206) Sub Total Acute Contracts 118,064 Mental Health Services NHS contracts 15,652 Non NHS Providers 569 NHS Contract Exclusions / Cost per Case 138 Non Contract Activity 54 Other (220) Sub Total Mental Health Services 16,193 Community Health Services NHS contracts 14,800 Non NHS Providers 2,134 NHS Contract Exclusions / Cost per Case (7) Non Contract Activity 35 Hospices 1,045 Other 19 Sub Total Community Services 18,026 Total Healthcare Contracts 152,283 Continuing Care Services Continuing Care 6,545 Free Nursing Care 480 Sub Total Continuing Care Services 7,025 Primary Care services Prescribing 26,491 Enhanced Services 412 Out of Hours 1,135 Commissioning 2,345 Other 433 Sub total Primary Care services 30,816 Other Programme Services Other Non Acute (NHS) 198 Complex Cases & Individual Funding Requests 4,881 Sub Total Other Programme Services 5,079 Total Expenditure 195,203 Page 2

32 NHS Blackburn with Darwen CCG Appendix 3 Main Healthcare Contracts March 2014 Expenditure to Date 000 Acute Contracts Main Provider East Lancashire Hospitals NHS Trust 96,298 Other Lancashire Providers Lancashire Teaching Hospitals NHS FT 4,725 Blackpool Fylde & Wyre Hospitals NHS FT 432 University Hospitals Morecambe Bay NHS FT 72 North West Ambulance Service NHS Trust 6,499 Sub Total Other Lancashire Providers 11,728 Greater Manchester Providers University Hospital South Manchester NHS FT 435 Salford Royal NHS FT 336 Royal Bolton Hospitals NHS FT 247 Wrightington, Wigan & Leigh NHS FT 538 Central Manchester University Hospital NHS FT 1,287 Pennine Acute NHS Trust 299 Sub Total Greater Manchester Providers 3,142 Merseyside providers Alder Hey Childrens Hospital NHS FT 80 Royal Liverpool & Broadgreen NHS Trust 232 Sub Total Merseyside Providers 312 Independent Sector Contracts BMI Healthcare (Beardwood, Beaumont, Gisburne) 4,037 Ramsay 313 Sub Total 4,350 Total Acute Contracts 115,830 Mental Health Contracts Lancashire Care NHS FT 15,068 Calderstones Partnership NHS FT 439 Greater Manchester West NHS FT 29 Total Mental Health Contracts 15,536 Community Health Contracts Lancashire Care NHS FT 14,504 Total Community Health Contracts 14,504 Total Expenditure 145,870 Page 3

33 NHS Blackburn with Darwen CCG Appendix 4 Non Healthcare Commissioning Report March 2014 Expenditure to Date 000 Other Corporate Costs (Non Running Costs) CSU re charge 552 NHS Property Services re charge 1,133 Other 243 Sub Total Corporate Costs 1,928 Plan requirements & reserves Reserves 0 Sub Total Reserves 0 Running Costs CCG Pay 1,503 CSU re charge 1,464 NHS Property Services re charge 344 Other 538 Running Costs Reserve 0 Sub Total Running Costs 3,849 Total Expenditure 5,777 Page 4

34 NHS Blackburn with Darwen CCG Appendix 5 Statement of Financial Position March 2014 Statement of Financial Position March 000 Non Current Assets Property, Plant, Equipment 0 Total Non Current Assets 0 Current Assets Trade and Other Receivables 748 Financial Assets 0 Current Assets 0 Cash and Bank 0 Total Current Assets 748 Total Assets 748 Current Liabilities Trade and Other Payables (9,614) Other Liabilities 0 Provisions 0 Borrowings 0 Total Current Liabilities (9,614) Total Assets less Current Liabilities (8,866) Non Current Liabilities Trade and Other Payables 0 Provisions 0 Borrowings 0 Other Liabilities 0 Total Non Current Liabilities 0 Total Assets Employed (8,866) Financed By General Fund (8,866) Revaluation Reserve 0 Donated Asset Reserve 0 Government Grant Reserve 0 Other Reserves 0 Total Equity (8,866) Page 5

35 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 10 REPORT TITLE: RESPONSIBLE OFFICER: CONTRACT PERFORMANCE REPORT MR ROGER PARR, CHIEF FINANCE OFFFICER SUMMAR: This report provides the Clinical Commissioning Group (CCG) Governing Body with an update on the activity performance of the major commissioned services of the organisation. The report relies upon aggregated anonymised data supplied by the Staffordshire and Lancashire Commissioning Support Unit. GOVERNING BOD ACTION: The Governing Body is requested to note the content of the report and the supporting appendices. EQUALIT ANALSIS: Has an Equality Analysis been completed in respect of this report/issue requiring decision? N/A COMMUNICATION: Communication and/or engagement undertaken or required? N/A RISKS: Have any risks been assessed? ES RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified with the report) N/A

36 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Page 2 of 14

37 NHS Blackburn with Darwen Clinical Commissioning Group Governing Body Meeting 7 th May 2014 Contract Performance Report Month 11 February Introduction This report provides the Clinical Commissioning Group (CCG) Governing Body with an update on the activity performance of the major commissioned services of the organisation. The report relies upon aggregated anonymised data supplied by the Staffordshire and Lancashire Commissioning Support Unit. 2. Lancashire Care NHS Foundation Trust Mental Health 2.1 The CCG is the lead commissioner for mental health services from Lancashire Care NHS Foundation Trust (LCFT). The table below contains performance data for all of the Lancashire CCG s for inpatients services which are commissioned on a block contract basis. The activity is year to date (TD) as the end of month /14 TD Variance 13/14 12/13 Variance 12/13 Inpatient % TD Ward Occupied Bed % CCG Admissions Ward Occupied Bed Days Comparison Admissions Days Comparison NHS BLACKBURN WITH DARWEN CCG ,452 14, NHS BLACKPOOL CCG ,043 15, NHS CHORLE AND SOUTH RIBBLE CCG ,533 9, NHS EAST LANCASHIRE CCG ,591 27, NHS FLDE & WRE CCG ,215 13, NHS GREATER PRESTON CCG ,792 15, NHS LANCASHIRE NORTH CCG ,788 15, NHS WEST LANCASHIRE CCG ,380 5, TOTAL 2,788 2, , , There has been a noticeable reduction in the number of occupied bed days across Lancashire, however the reduction in admissions is not as great. 2.3 Blackburn with Darwen CCG commissions mental health services in the community and the table below monitors those services to which referrals have been made this financial year. These services are also commissioned on a block contract basis. Page 3 of 14

38 Teams Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Complex Care and Treatment Community Mental Health - Older Adult (Dementia) Community Mental Health - Older Adult (Functional) Intermediate Support Teams - Older Adult (Dementia) Intermediate Support Teams - Older Adult (Functional) Community Restart Crisis Resolution Home Treatment Eating Disorder Service Memory Assessment Service (MAS) Recovery Teams Older Adult Liaison Total Accepted Referrals The CCG continues to work with the provider in analysing the data. 3. Referrals to Secondary Care 3.1 The referrals for treatment to CCG s main provider, East Lancashire Hospitals NHS Trust (ELHT) are monitored monthly. From the table below it can be seen that year on year referrals have increased by 0.68% compared to an increase of 0.44% reported at the end of January. The referral activity measured on an average working day continues to show a reduction from the previous year (0.62%) albeit this figure is moving towards the total referrals. Referral Type Variance GP 24,860 25, % Other 7,480 7, % Sub total GP and Other 32,340 33, % Excluded 8,141 7, % Total 40,481 40, % Average / working day % Month 11 ear on ear Comparison: February The increase in other referrals is due to a change in recording of gynaecology referrals. Appendix 1 contains the details of GP referrals by specialty, and highlights those specialties in the advice and navigation initiative. The initiative was expanded in September to include a further four specialties. The year on year changes in referrals remains consistent with the previous month. 4. Contract Performance 4.1 The contract monitoring performance summary is detailed in appendix 2. The main points of delivery are summarised below with the negative figures indicating the variance is under plan. Page 4 of 14

39 Point of delivery Financial Variance Activity Variance k % % A and E , Elective Non Elective (inc non emergency) Outpatients , The elective pressure is due to casemix change in orthopaedics at ELHT and an increase in the medical specialty procedures. Endoscopic procedures in medical specialties are also creating a cost pressure of 174k to date in the specialty. 4.3 The non-elective activity has continued to perform under plan however at a much reduced rate. The month 10 activity is the highest month experienced in the year. There is a financial under performance against plan for trauma but this is offset by financial pressures in medical specialities. Month Total Plan 1,844 1,884 1,839 1,893 1,810 1,827 1,947 1,927 2,035 1,934 1,856 20,796 activity Actual 1,897 1,928 1,773 1,874 1,800 1,648 1,730 1,730 1,876 1,914 1,816 19,986 activity Variance Most specialties are close to the non-elective plan apart from General Surgery, General Medicine and Paediatrics, which are noticeably under plan. The Accident and Emergency attendances remain below plan. The detailed graph in appendix 3 shows the trend for non-elective activity. 4.5 Outpatient activity continues to be below plan for both first but follow up attendances and the more expensive outpatient procedures continue to be over plan, creating an overall financial pressure. 4.6 Direct access pathology activity is 16.3% above the activity plan and is due to tests in Blood Sciences and Vitamin D. 5. ELHT Waiting Lists 5.1 The detailed inpatient and daycase waiting list by specialty for the CCG s main provider is detailed in appendix 4. The total size of the waiting list has decreased by 148 patients at the end February compared to a decrease of 35 patients in January. The main areas of decrease are in general surgery and orthopaedic waiting lists. 5.2 The CCG has 15 patients on an incomplete patient pathway waiting over 36 weeks, compared to 14 at the end of January - 6 at Central Manchester University Hospitals and 6 at Lancashire Teaching Hospitals, 2 at Wrightington Wigan and Leigh and 1 at Royal Liverpool.2 of these patients have waited between 43 and 44 weeks. 5.3 The CCG continues to monitor and query the over 36 week waiters with the relevant providers. Page 5 of 14

40 6. Ambulance Contract 6.1 The All Incidents activity indicator of the ambulance service at month 11 remain on target. The year on year comparison shows a 0.7% reduction compared to a reduction of 1.5% last month. The table below shows performance to date for BwD. Blackburn with Darwen CCG February 2014 Performance Line Target Month Activity ear to Date Activity ear on ear Comparison Activity % Status Activity % Status 12/13 13/14 Variance % Variance R1 (% <8 mins) 75% % G % G % R2 (% <8 mins) 75% % G % G 7, % All Reds (%<19 mins) 95% % G % G 8, % Green , % AS % All Incidents , % Data Source: NWAS PES & HAS Reports CCG TD Trend 7. Community Services Lancashire Care NHS Foundation Trust 7.1 The detailed activity performance schedule is in appendix 5. The CCG is working with the lead commissioner to improve the reporting of data and has received an update on progress for each service. 7.2 LCFT have provided waiting time information for the first time on two of the service lines Podiatry and Paediatric Speech and Language Therapy (PSALT). In podiatry LCFT are reporting 98% compliance with the 18 week target and PSALT 93% compliance. 8. Other Community Services 8.1 The General Practitioners with Special Interests (GPwSI) work on a block contract basis. The activity performance against plan is in appendix 6 and show activity is generally above plan. The CCG is in discussion with the provider of anticoagulation service to understand the variance on domiciliary visits and updated data has been requested. 9. General Practice Out of Hours Service 9.1 The Out of Hours service is on a block contract with activity profiles based on a two year average of activity. Previous reports have reported on a Pennine Lancashire basis, however the report is now specifically for Blackburn with Darwen. PCC Attendances (Primary Care Centre) ear to date Activity Full ear Forecast Activity 2012/ /14 Variance Status 2012/ /14 Variance Status 9,905 10, % R 10,906 11, % R Dr Advice 3,229 2, % G 3,481 3, % G Home Visits 2,328 2, % A 2,556 2, % A Total 15,462 15, % G 16,943 17, % G Page 6 of 14

41 9.2 The total activity remains consistently around plan and the detailed monthly performance is contained in graphical form in appendix Recommendation 10.1 The Governing Body is requested to note the contents of the report and the supporting appendices. Mr Roger Parr Chief Finance Officer 25 th April 2014 Page 7 of 14

42 Appendix 1 BwD CCG GP Referrals to ELHT by Specialty February 2014 (ear to Date) Specialty GP Referrals Number of Referrals GP Referrals Variance Quantity Variance % Referrals per Working Day (210 days) (213 days) Variance % General Surgery group % % E.N.T % % Other Specialty group % % General Medicine group % % Obstetrics % % Urology % % Paediatrics % % Dermatology % % Cardiology % % Rheumatology % % T & O % % Ophthalmology % % Gynaecology % % Grand Total % % ellow - highlighted specialties are those that are part of the Advice and Navigation scheme. Green highlighted are those specialties entering the Advice and Navigation scheme in September. Definitions: GP Other Excluded Referrals into Consultant-led clinic from a GP Referrals into Consultant-led clinic from non-gp medical professional (e.g. Consultant, Nurse Specialist) Referrals into Consultant-led clinic from other sources (e.g. Self-Referral, A&E department, Midwifery) Specialty Groupings General Surgery Group General Medicine Group General Surgery, Breast Assessment, Vascular Surgery General Medicine, Gastroenterology, Diabetic and Thoracic Medicine Page 8 of 14

43 Appendix 2 All Providers Contract Monitoring for BwD CCG: February 2014 (ear to Date) Point of Delivery (POD) A and E Activity Plan Activity Actual Activity Variance Cost Plan Cost Actual Cost Variance Activity Variance % Cost Variance % Accident & Emergency 50,964 49,188 1,776 4,876,189 4,801,274 74, % 1.5% Accident & Emergency Minor Injuries Unit 1,746 1, , ,224 7, % 7.3% A and E Total 52,709 51,062 1,647 4,980,738 4,913,498 67, % 1.4% Pathology Total 1,027,525 1,195, ,796 2,273,388 2,638, , % 16.1% Block Block 10,910,157 10,910,157 CQUIN CQUIN 2,134,712 2,134,712 Critical Care Critical Care 2,387 2, , ,784 10, % 1.3% Radiology Direct Access 20,692 23,836 3, , , , % 16.3% Outpatients 24,379 27,123 2,743 1,749,075 2,034, , % 16.3% Radiology Total 45,071 50,959 5,888 2,561,779 2,979, , % 16.3% Elective In Patient Daycase 15,044 15, ,147,447 11,787, , % 5.7% In Patient Elective 3,306 3, ,990,352 7,951,276 39, % 0.5% Elective Total 18,350 19, ,137,800 19,739, , % 3.1% Excess Bed Days Elective Excess Bed Days , ,063 27, % 14.9% Non Elective Non Emergency Excess Bed Days 771 1, , , , % 53.2% Non Elective Excess Bed Days 7,104 8,724 1,620 1,603,281 1,977, , % 23.4% Excess Bed Days Total 8,667 10,968 2,301 2,016,864 2,540, , % 25.9% Rehabilitation 5,612 4,145 1,467 1,570,354 1,336, , % 14.9% Non Elective 14,984 14, ,026,015 22,989,441 36, % 0.2% Non Elective Same Non Day Emergency Elective Care 1,438 1, ,140,889 1,147,010 6, % 0.5% Non Elective Short Stay 1,507 1, ,028, ,900 28, % 2.8% Non Elective Total 17,930 17, ,195,441 25,136,351 59, % 0.2% Non Elective Non Emergency 2,866 2, ,207,643 3,855, , % 8.4% Outpatient First Outpatient Attendances 36,637 35, ,065,517 4,968,667 96, % 1.9% Outpatient Follow up Attendances 71,295 71, ,397,145 5,459,895 62, % 1.2% Outpatient Procedures 20,845 22,804 1,959 2,387,980 2,692, , % 12.7% Outpatient Total 128, ,348 1,570 12,850,642 13,120, , % 2.1% Total 88,659,753 90,114,333 1,454, % Other 9,334,371 10,124, , % Grand Total 97,994, ,238,449 2,244, % Page 9 of 14

44 Appendix 3 ELHT : NHS BwD NEL+NELST (All) (All) Cumulative Variance Plan Actual Variance M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M12 Cumulative Activity Volumes April to Feb consistent with and actuals : 16,528 spells : 16,630 spells : 17,436 spells : 16,619 spells Page 10 of 14

45 Page 11 of 14 Appendix 4

46 Appendix 5 LCFT: Service Line Activity Against Plan February 2014 Service Line ear to date Activity Full ear Forecast Activity Plan Actual Variance Status^ Plan Forecast Variance Status Adult LDS C&EL CITT (TR) CITNS 8,894 9,719 Children's LDS Chronic Fatigue Service Community Matrons 14,122 14, % 15,406 16, % R Community Stroke Service 4,164 5,680 1, % 4,542 6, % R Dermatology 3,277 4,517 1, % 3,575 4, % R Diabetes Specialist Nursing Service 7,380 10,968 3, % 8,051 11, % R District Nursing 103,498 86,411 17, % 112,907 94, % G Ear Care (TR) 1,560 5,101 3, % 1,702 5, % R Healthy Legs (TR) 1,001 1, % 1,092 1, % R Intermediate Care Services 8,708 9, % 9,500 10, % R Minor Injury (TR) 2,067 1, % 2,255 1, % G Out of Hours 10,483 7,190 3, % 11,436 7, % G Podiatry 27,601 26,495 1, % 30,110 28, % G Pulmonary Rehabilitation 2,276 4,382 2, % 2,483 4, % R Rapid Assessment Team 3,872 10,932 7, % 4,224 11, % R Safeguarding & oung People Tissue Viability Service 1,776 1, % 1,937 1, % G Treatment Room (TR) 73,333 53,197 20, % 80,000 58, % G Ulcer & Vascular (TR) 5,006 5, % 5,461 6, % R Vasectomy Service (CPC) % % G LDS = Learning Disability Service ^ Trend direction Reporting vs previous Tolerances month. = within 5% C&EL CITT = Central & East Lancs Community Intravenous Therapy Team Data Source: LCFT Community Schedule 6 Monitoring Contacts (both Under Face to Face Plan Over (F2F) Plan and Non F2F, First CITNS = Children's Integrated Therapy Nursing Services, comprising Children s and Follow Ups, including Group contacts) Nursing (formerly Complex Needs) and Children s Speech & Language Therapy TR = Treatment Room Page 12 of 14

47 Appendix 6 General Practitioners with Special Interest (GPwSI) February 2014 GPwSI Service Anticoagulation Cardiology Dermatology Diabetes Ophthalmology Activity Type ear to date Activity ear on ear Comparison Plan Actual Variance 12/13* 13/14 Variance Community Contacts 4,767 5, % 4,681 5, % Domiciliary Contacts 1,907 1, % 1,144 1, % First % % Follow Up % % First 1,100 1, % 1,067 1, % Follow Up % % First % 154 Follow Up % 457 First % % Follow Up % % Data Source: Spreadsheet data returns from individual GPwSI services. Page 13 of 14

48 GP Out of Hours Service Appendix 7 BwD PCC Attendance BwD Dr Advice Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar BwD Home Visit BwD Total Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Page 14 of 14

49 NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 11 REPORT TITLE: RESPONSIBLE OFFICER: NHS Blackburn with Darwen CCG Quality and Performance Exception Report Month 11 February 2014 data) Dr Malcolm Ridgway, Clinical Director for Quality and Effectiveness SUMMAR: This report provides the Clinical Commissioning Group (CCG) Governing Body with and update on the Quality and Performance exception report information of the main commissioned services as at February 2014, Month 11. GOVERNING BOD ACTION: The Governing Body is requested to note the contents of the report. EQUALIT IMPACT ASSESSMENT (EIA): Has an EIA been completed in respect of this report/issue requiring decision? N/A COMMUNICATION: Communication and/or engagement undertaken or required N/A RISKS: Have any risks been assessed? es RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified with the report) Nil Page 1 of 1

50 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate N N N NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. NHS Services must reflect the needs and preferences of patients, their families and their carers The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it services. Page 2 of 2

51 NHS Blackburn with Darwen Clinical Commissioning Group Governing Body Meeting 7 th May 2014 Quality and Performance Report Month 11 February 2014 data 1.0 Introduction The following report contains an executive summary of information on provider service performance against contractual obligations throughout the month of February 2014, focusing on exceptions. Progress against associated recovery plans is scrutinsed each month by the Quality, Performance and Effectiveness Committee. Attached at Appendix 1 is the CCG s balanced scorecard for February 2014, and Appendix 2 provides the year to date performance information for the NHS outcomes framework indicators. 2.0 Lancashire Care NHS Foundation (LCFT) Mental Health Services 2.1 Advancing Quality (AQ) - Early intervention psychosis and Dementia Appropriate Care Scores Due to the delay in receipt of data for AQ indicators of approximately 3 months, the most recent data available relates to April to November First episode psychosis performance has further improved in November following variable performance earlier in the year. Conversely, performance against the Dementia indicator has continued to deteriorate in November with under performance against both the Appropriate Care Scores (ACS) and Composite Process Score (CPS) targets reported. Performance has been inconsistent throughout the year on these indicators. 2.2 Improving Access to Psychological Therapies (IAPT) IAPT Recovery and Prevalence rates continue to fail to meet targets. LCFT are continuing to implement and develop the New Ways of Working model to address these failings. The Trust is also working with the Health and Social Care Information Centre (HSCIC) to ensure their data collections processes are to the standard necessary to support the new data standards required from July The locally reported position for February is an under performance for prevalence 0.78% against a target of 0.90%. Whilst there is still under performance for recovery of 33% against a target of 50%, this is a slight improvement on the January position, which was reported as 26%. 2.3 Care Quality Commission Visits There are currently no known inspection visits being undertaken at any sites for LCFT. 3.0 LCFT Community Services Concerns have been raised with LCFT regarding Podiatry and Children s Speech and Language Therapy (SALT) waiting times, which are reporting cases waiting over 52 weeks. A request has been made to the Trust by the host Commissioner, to validate numbers and provide reasons for any long waiters. Page 3 of 3

52 4.0 East Lancashire Hospitals NHS Trust (ELHT) 4.1 A&E 4 Hour Waiting Time Target ELHT met the A&E 4 hour maximum waiting time target in February 2014, with performance at 95.44% against a target of 95% (an improvement from 92.2% in January). However, the year to date position remains below the target of 95% at 93.47% and will not be met for 2013/14. Blackburn Emergency Department (ED) and Blackburn Urgent Care Centre (UCC) continue to be the main source of delays. Analysis of breaches shows that 50.3% relate to delays in 1 st Assessment. Recovery actions are in place to improve performance, full details of which are monitored through the Quality, Performance and Effectiveness Committee (QPEC). 4.2 Diagnostics The target for patients waiting 6 weeks or more for a diagnostic test has been met in February 2014 at 0.63%, following two consecutive months of exceeding the 1% target. In January 2014, 15 breaches were reported relating to DEXA Scans at Care UK, however this has improved in February 2014 with a reduction to 7 patients. 4.3 Cancer waits The percentage of patients receiving subsequent treatment for cancer within 31 days (radiotherapy treatment) has underperformed at 92.86% against a target of 94%, however remains over target year to date at 94.56%. The percentage of patients receiving treatment for cancer within 62 days of upgrade of their priority has also underperformed in February with performance of 75% against a target of 86%, year to date position for this indicator remains below target at 80.72%. The percentage of patients receiving 1 st definitive treatment for cancer within 2 months (62 days) is above target in February at 92% against a target of 85% and on track to achieve for Quarter 4, however, year to date position for this indicator is 82.05%, due to under performance in the first two quarters of the year. As previously reported, detailed proactive investigation of breaches is taking place between commissioners and provider and actions to improve performance are included on page 13 and 14 within this report. 4.4 Admission to Stroke Unit within 4 hours The most recent information relating to the admission to Stroke Unit within 4 hours target is for January 2014, with continued underperformance 46.27% against a target of 90%. The main reason for the decline in performance is reported to be bed flow and capacity to prevent A&E 4 hour breaches. The CQUIN Advancing Quality score for stroke had previously been met for the first time in October at 60.94% against a target of 50%; however this has deteriorated in November to 40% (there is a time delay for AQ data of approximately 3 months) and year to date performance remains below target at 46.42%. An exception report has been provided and is monitored through the QPEC Week Referral to Treatment Times The 18 week referral to treatment standard for admitted patients is 90%. Whilst cumulatively across all specialties this target is being met (91.7 % in February 2014), ELHT do have under performance in the following specialties: General Surgery % in February The backlog (number of patients on the elective waiting list for admission to hospital who have already breached Page 4 of 4

53 their 18 week date) for this speciality has reduced during the month of February and the current backlog position stands at 72 of which 30 are undated (awaiting an appointment date) the internal tolerance being 57. Trauma & Orthopeadics % in February The backlog has reduced significantly during the month of February, the current position stands at 75 against an internal tolerance of 57. The number of hip and knee replacements now accounts for approximately 32% of the backlog and tends to be more complex cases. Ophthalmology 90.08% in February Although this specialty achieved the above target for February the backlog remains a major concern and is significantly above the internal tolerance of 38, currently standing at 148. Pain Management 85.06% in February The Trust is reporting that Chronic Pain has consistently failed to achieve the 18-week standard over recent months but has been off-set by over-achievement in other specialties. On the 24 February, the wait for a consultant appointment is reported to be weeks. The host commissioner East Lancashire CCG, have issued performance notices and have met with the Trust to discuss recovery actions. 4.6 Ambulance Handover Hospital Arrival Screen (HAS) Data Entry Compliance ELHT reported 83.3% performance against a target of 95% for February with year to date performance standing at 82.2%. Staff capacity and patient flow is affecting compliance with delays of up to 30 minutes for triage. 4.7 Meticillin-Resistant Staphylococcus Aureusis (MRSA) & Clostridium Difficile There was one case of MRSA reported in February 2014, with three cases reported year to date involving BwD CCG patients. Four cases of Clostridium Difficile were reported in February The year to date position for the CCG is 21 cases against a year to date target of Friends & Family Test The response rate within A&E remains an issue with a slight improvement in performance in February of 6% against a target of 15%. As previously reported, the touchscreen kiosk is not attracting the number of responses anticipated and the Trust are looking at rolling out SMS texting as nationally this has led to increased response rates. 4.9 Workforce within ELHT Staff sickness absence was 4.47% for January 2014 and although above the threshold of 3.75% is an improvement on the previous two years performance for the same period (4.81% , 4.64% ). The year to date figure is 3.98%. Spending on temporary staffing in January was 1.8M which is 1M above the 80k threshold. 23% of this was spent on Middle grade Doctors and 26% on qualified bank and agency nurses. 75% of staff have had an annual appraisal against a target of 90%. Performance is being managed through the Executive Performance meetings with Divisions. Page 5 of 5

54 4.10 Keogh Review Following the publication of the Keogh Review Report in July 2013, BwD CCG and East Lancashire CCG in collaboration with ELHT and the Local Area Team of NHS England have developed a CCG Quality Assurance Framework (QAF). This Framework is designed to provide Commissioners with the level of assurance required to be confident that appropriate action is being taken by the Trust to address the issues and concerns raised by the Keogh Team. Evidence provided by the Trust during February 2014 was collated and reviewed against key lines of enquiry. It was noted that progress had been made against the Quality Assurance Framework; however, further evidence was required to support a number of indicators. In addition the Trust has been advised that the Chief Inspector of Hospitals Sir Mike Richards will be leading a full inspection of the Trust on 29 th April Calderstones Partnership NHS Foundation Trust (CPFT) 5.1 Monitor CPFT s governance rating is subject to enforcement action from Monitor. An action plan was submitted to Monitor on 6 th January 2014 and all actions are to be implemented by the 30 th October Recommendation The Governing Body is asked to note the contents of the report Dr Malcolm Ridgway Clinical Director for Quality and Effectiveness 25 th April 2014 Page 6 of 6

55 Page 7 of 7 Blackburn with Darwen CCG Balanced Scorecard February 2014 Appendix 1

56 OUTCOMES Compared to the England average at present QP CCG BALANCED SCORECARD Monthly review BLACKBURN WITH DARWEN CCG * Organisation: BWD CCG Organisation: BWD CCG OVERALL Dec 13 OVERALL Feb Preventing people from dying Financial performance FINANCE ears of life lost 2012 Recurrent surplus Feb Quality of life for LTC Plan TD 3. Helping people to Plan Full ear TD recover Q3 Q3 OUTCOMES * Combined measure * * * * * Unplanned Management of 2% Q3 hospitalisation NR funds Ambulatory care Jul '12 Jun '13 QIPP Asthma, diabet' + epilep' Jul '12 Jun '13 TD delivery Q3 F forecast Q3 EM admissions Activity Acute not normally requiring admission Jul '12 Jun '13 TD Feb 14 Children with LRTI Jul '12 Jun '13 Forecast Feb 14 < 30 days of discharge 2010/11 Running costs Q3 Id risks and 4. Positive experience ELHT mitigations Q3 Friends & Family test Feb 14 (combined) Financial 5. Safe environment management MRSA C Diff Local priorities Feb 14 TD Feb 14 TD Diabetes 9 care proc. Q3 2013/14 COPD pulmon rehab ref's Q3 2013/14 CCG 8pt safeguard'g f'wk Q3 2013/14 IAPT Quality premium (QP) * national measure, * local measure no data Overall domain RAG rating All KPIs on track for Quality Premium Not all KPIs on track for Quality Premium 1+ KPI statistically significantly off track All KPIs statistically significantly off track FINANCE Internal and external audit Balance sheet indicators Plan meets 2013 surplus requirements Overall domain RAG rating All primary indicators rated green Unclear Unclear 2+ red indicators Q3 Q3 Q3 Indicator RAG ratings available separately Page 8 of 8

57 NHS Constitution The overall position for BwD CCG has improved in February 2014 moving from Red to Amber. A & E - 4 hour Performance at ELHT is green in February at 95.44% against the 95% operational standard. ear to date position remains below the 95% standard however and is expected to underperform at year end. 6 Week Diagnostic Performance for 6 week diagnostics has moved from red to green in February Day Cancer Performance against the 31 day cancer wait indicator has moved from red to green in February Day Cancer TD performance against the 62 day cancer wait indicator is red with performance in February 2014 for the % of patients receiving subsequent treatment for cancer at 82.05%. Quality The overall position for BwD CCG remains Amber in February CQC Enforcement The position remains amber, as formal warnings to East Lancashire Hospitals NHS Trust are still in place. Monitor Quality Compliance The position remains Amber as a result of the Monitor enforcement notice at Calderstones Foundation Trust. Hospital Standardised Mortality Ratios (HSMR) outlier Monthly trend data for August to December 2013 shows ELHT in line with, or below, national levels of mortality for the 56 diagnosis groups. Friends and Family (FFT) at ELHT The position for the FFT has improved in February, with combined response rate of 27.6%. A&E response rates, whilst improving, remain a concern at 6.1% in February. Page 9 of 9

58 Blackburn With Darwen CCG - Performance Report Show Metric Reporting Level Information Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Trend Preventing People from Dying Prematurely Cancer Waiting Times 191: % Patients seen within two weeks for an urgent GP referral for suspected cancer (MONTHL) The percentage of patients first seen by a B'burn D'wen specialist within two weeks when urgently CCG referred by their GP or dentist with suspected cancer 1879: % Patients seen within two weeks for an urgent GP referral for suspected cancer (QUARTERL) The % of patients first seen by a specialist within two weeks when urgently referred by their GP or dentist with suspected cancer Metric Ref: : % of patients seen within 2 weeks for an urgent referral for breast symptoms (MONTHL) Two week wait standard for patients referred B'burn D'wen with 'breast symptoms' not currently covered CCG by two week waits for suspected breast cancer 1880: % of patients seen within 2 weeks for an urgent referral for breast symptoms (QUARTERL) Two week wait standard for patients referred B'burn D'wen with 'breast symptoms' not currently covered CCG by two week waits for suspected breast cancer 535: % of patients receiving definitive treatment within 1 month of a cancer diagnosis (MONTHL) The percentage of patients receiving their B'burn D'wen first definitive treatment within one month (31 CCG days) of a decision to treat (as a proxy for diagnosis) for cancer 1881: % of patients receiving definitive treatment within 1 month of a cancer diagnosis (QUARTERL) The percentage of patients receiving their B'burn D'wen first definitive treatment within one month (31 CCG days) of a decision to treat (as a proxy for diagnosis) for cancer 26: % of patients receiving subsequent treatment for cancer within 31 days (Surgery) (MONTHL) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Surgery) Metric Ref: 26 B'burn D'wen CCG B'burn D'wen CCG Last Updated: 09/04/2014 Last Updated: 06/03/2014 Last Updated: 09/04/2014 Last Updated: 06/03/2014 Last Updated: 09/04/2014 Last Updated: 06/03/2014 Last Updated: 09/04/2014 RAG G G G G G G G G G G G G Actual 95.76% % % % % % 94.78% % % % % % Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% T'Hold 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% RAG Actual Target T'Hold RAG G G % 93.00% 88.00% G G G G % 93.00% 88.00% G G G G % 93.00% 88.00% G G G 93.00% 88.00% G G % 93.00% 88.00% G Actual % % % % 93.75% % % % % % % % Target 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% T'Hold 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% 88.00% RAG Actual Target T'Hold RAG A G % 93.00% 88.00% G A G G % 93.00% 88.00% G G G G % 93.00% 88.00% G A G 93.00% 88.00% G G % 93.00% 88.00% G Actual % % % % % % % % % % % % Target 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% 96.00% T'Hold 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% 91.00% RAG Actual Target T'Hold A % 96.00% 91.00% G % 96.00% 91.00% G % 96.00% 91.00% 96.00% 91.00% G % 96.00% 91.00% RAG A G G G G G R G G R G G Actual 93.75% % % % % % % % % % % % Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% T'Hold 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% Library/Performance Monitoring Page Report.rdl 1 of 7 # - TD in development U - TD unavailable

59 Metric 1882: % of patients receiving subsequent treatment for cancer within 31 days (Surgery) (QUARTERL) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Surgery) Reporting Level B'burn D'wen CCG Information Last Updated: 06/03/2014 RAG Actual Target Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar G G G G 96.97% % % % 94.00% 94.00% 94.00% 94.00% 94.00% Trend Metric Ref: : % of patients receiving subsequent treatment for cancer within 31 days (Drug Treatments) (MONTHL) 31-Day Standard for Subsequent Cancer B'burn D'wen Treatments (Drug Treatments) CCG Last Updated: 09/04/2014 T'Hold RAG G 89.00% G G G 89.00% G G G 89.00% A G G 89.00% G 89.00% G Actual % % % % % % % % % % % % Target 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% 98.00% Metric Ref: 1170 T'Hold 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 93.00% 1883: % of patients receiving subsequent treatment for cancer within 31 days (Drug Treatments) (QUARTERL) 31-Day Standard for Subsequent Cancer Treatments (Drug Treatments) B'burn D'wen CCG Last Updated: 06/03/2014 RAG Actual Target G G G G % % % % 98.00% 98.00% 98.00% 98.00% 98.00% Metric Ref: 1883 T'Hold 93.00% 93.00% 93.00% 93.00% 93.00% 25: % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) (MONTHL) 31-Day Standard for Subsequent Cancer Treatments where the treatment function is (Radiotherapy) B'burn D'wen CCG Last Updated: 09/04/2014 RAG G R G R A G G A G G A G Actual % % % % 93.75% % % 90.00% % 95.00% % % Target 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% 94.00% Metric Ref: : % of patients receiving subsequent treatment for cancer within 31 days (Radiotherapy Treatments) (QUARTERL) 31-Day Standard for Subsequent Cancer B'burn D'wen Treatments where the treatment function is CCG (Radiotherapy) Last Updated: 06/03/2014 T'Hold 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% 89.00% RAG Actual Target G % 94.00% A % 94.00% G 96.97% 94.00% 94.00% G 96.97% 94.00% Metric Ref: : % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (MONTHL) The % of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer B'burn D'wen CCG Last Updated: 09/04/2014 T'Hold RAG R 89.00% A A A 89.00% A R R 89.00% G A G 89.00% G 89.00% A Actual % % % 80.00% 84.00% % % % % % 92.00% % Target 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% T'Hold 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 1885: % of patients receiving 1st definitive treatment for cancer within 2 months (62 days) (QUARTERL) The % of patients receiving their first definitive treatment for cancer within two months (62 days) of GP or dentist urgent referral for suspected cancer B'burn D'wen CCG Last Updated: 06/03/2014 RAG Actual Target T'Hold A % 85.00% 80.00% R A A % % % 85.00% 85.00% 85.00% 85.00% 80.00% 80.00% 80.00% 80.00% 540: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (MONTHL) Percentage of patients receiving first B'burn D'wen definitive treatment following referral from an CCG NHS Cancer Screening Service within 62 days. Last Updated: 09/04/2014 RAG G G G G G G G G G G G G Actual % % % % % % % % Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% T'Hold 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 1886: % of patients receiving treatment for cancer within 62 days from an NHS Cancer Screening Service (QUARTERL) Percentage of patients receiving first B'burn D'wen definitive treatment following referral from an CCG NHS Cancer Screening Service within 62 days. Last Updated: 06/03/2014 RAG G G G G Actual % % % % Target 90.00% 90.00% 90.00% 90.00% 90.00% T'Hold 85.00% 85.00% 85.00% 85.00% 85.00% Library/Performance Monitoring Page Report.rdl 2 of 7 # - TD in development U - TD unavailable

60 Metric Reporting Level 541: % of patients receiving treatment for cancer within 62 days upgrade their priority (MONTHL) % of patients treated for cancer who were not B'burn D'wen originally referred via an urgent GP/GDP CCG referral for suspected cancer, but have been seen by a clinician who suspects cancer, who has upgraded their 1878: % of patients receiving treatment for cancer within 62 days upgrade their priority (QUARTERL) % of patients treated for cancer who were not B'burn D'wen originally referred via an urgent GP/GDP CCG referral for suspected cancer, but have been seen by a clinician who suspects cancer Information Last Updated: 09/04/2014 Last Updated: 06/03/ Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar RAG R A R R G G R A R G R A Actual 62.50% % 75.00% 75.00% % % 70.00% % % % 75.00% % Target 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% 86.00% T'Hold 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% 80.00% RAG R G R R Actual % % 75.00% 75.00% Target 86.00% 86.00% 86.00% 86.00% 86.00% T'Hold 80.00% 80.00% 80.00% 80.00% 80.00% Trend Ambulance 546: Category A calls responded to within 19 minutes Category A calls responded to within 19 minutes Metric Ref: 546 B'burn D'wen CCG Last Updated: 10/04/2014 RAG G G G G G G G G G G G G Actual % % % % % % % % 96.64% % 98.59% % Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% T'Hold 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% Last Updated: 10/04/2014 RAG G G G G G A G A G G G G NWAS Actual 96.17% % % 95.54% % % % % % 95.83% 96.41% % Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% T'Hold 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 1887: Category A Calls Response Time (Red1) Number of Category A (Red 1) calls resulting in an emergency response arriving at the B'burn D'wen scene of the incident within 8 minutes CCG Metric Ref: 1887 NWAS Last Updated: 10/04/2014 Last Updated: 10/04/2014 RAG G G G G G G A G G G G G Actual % 93.75% 87.50% 82.00% % 81.25% % % % % 82.00% % Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% T'Hold 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% RAG G G G G G A A A A G G G Actual % % % % % % % % % % 75.27% % Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% T'Hold 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 1889: Category A (Red 2) 8 Minute Response Time Number of Category A (Red 2) calls resulting in an emergency response arriving at the B'burn D'wen scene of the incident within 8 minutes CCG Metric Ref: 1889 NWAS Last Updated: 10/04/2014 Last Updated: 10/04/2014 RAG G G G G G G G G G G G G Actual 85.19% % % % % % % % % % 84.10% % Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% T'Hold 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% RAG G G G G G G G A G G G G Actual % % % % % 75.53% % 74.82% % % 76.03% % Target 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% 75.00% T'Hold 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% 70.00% Library/Performance Monitoring Page Report.rdl 3 of 7 # - TD in development U - TD unavailable

61 Metric Reporting Level Information Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Trend Enhancing Quality of Life for People with Long Term Conditions Mental Health 138: Proportion of patients on (CPA) discharged from inpatient care who are followed up within 7 days The proportion of those patients on Care Programme Approach discharged from inpatient care who are followed up within 7 days B'burn D'wen CCG Last Updated: 06/03/2014 RAG Actual Target T'Hold A G G G % % % % 95.00% 95.00% 95.00% 95.00% 95.00% 90.00% 90.00% 90.00% 90.00% 90.00% Unplanned Hospitalisation 1374: Unplanned hospitalisation for chronic ambulatory care sensitive conditions per 100,000 population The proportion of persons aged over 18 with chronic conditions admitted to hospital as an emergency admission. Rate per 100,000 population 1375: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Rate of emergency admission episodes in people under 19 yrs for asthma, diabetes or epilepsy per 100,000 B'burn D'wen CCG B'burn D'wen CCG Last Updated: 00:00:00 Last Updated: 00:00:00 RAG Actual Target T'Hold RAG Actual Target Metric Ref: 1375 Helping People to Recover from Episodes of Ill Health or Following Injury T'Hold Emergency Re-admissions 1425: Emergency Re-admissions within 30 days of discharge % of Admissions which are Emergency Re- Admissions Metric Ref: 1425 B'burn D'wen CCG Last Updated: 06/03/2014 RAG G G A G G A G G A G G Actual % % % % % % % % % % 13.72% Target 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% 13.92% T'Hold 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% 14.92% Ensuring that People Have a Positive Experience of Care EMSA 1067: Mixed sex accommodation breaches - All Providers No. of MSA breaches for the reporting month in question for all providers B'burn D'wen CCG Metric Ref: : Mixed Sex Accommodation - MSA Breach Rate MSA Breach Rate (MSA Breaches per 1,000 FCE's) Metric Ref: 1812 B'burn D'wen CCG Last Updated: 11/04/2014 Last Updated: 11/04/2014 RAG G G G G G G G G G G G G Actual Target T'Hold RAG G G G G G G G G G G G G Actual Target T'Hold Library/Performance Monitoring Page Report.rdl 4 of 7 # - TD in development U - TD unavailable

62 Metric Reporting Level Information Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Trend Referral to Treatment (RTT) & Diagnostics 61: Referral to Treatment (Adjusted Admitted) Percentage of patients seen within 18 weeks Referral to Treatment (RTT) for adjusted admitted pathways (Commissioner) B'burn D'wen CCG Last Updated: 01/04/2014 RAG G G G G G G G G G G G G Actual 90.85% 92.90% % % % % % % % % % % Target 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% Metric Ref: 61 T'Hold 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 62: Referral to Treatment (Non-Admitted) Percentage of patients seen within 18 weeks Referral to Treatment (RTT) for non-admitted pathways (Commissioner) B'burn D'wen CCG Metric Ref: 62 Last Updated: 24/03/2014 RAG G G G G G G G G G G G G Actual % % 98.74% % % % % % % % % % Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% T'Hold 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 1291: Referral to Treatment (Incomplete) Percentage of patients waiting at period end (RTT) for incomplete pathways (Commissioner) Metric Ref: 1291 B'burn D'wen CCG Last Updated: 01/04/2014 RAG G G G G G G G G G G G G Actual % % % % % % % % % % % % Target 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% 92.00% T'Hold 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 87.00% 1839: Referral to Treatment - No of Incomplete Pathways Waiting >52 weeks The number of patients waiting at period end for incomplete pathways >52 weeks Metric Ref: 1839 B'burn D'wen CCG Last Updated: 11/04/2014 RAG G G G G G G G G G G G G Actual Target T'Hold : % of patients waiting 6 weeks or more for a diagnosic test The % of patients waiting 6 weeks or more for a diagnosic test Metric Ref: 1828 B'burn D'wen CCG Last Updated: 18/03/2014 RAG G G G G G G G G A A G G Actual 0.367% 0.308% 0.047% 0.438% 0.369% 0.844% 0.809% 0.644% 1.327% 1.124% 0.626% 0.626% Target 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% 1.00% T'Hold 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% 6.00% Treating and Caring for People in a Safe Environment and Protect them from Avoidable Harm HCAI 497: Number of MRSA Bacteraemias Incidence of MRSA bacteraemia (Commissioner) Metric Ref: 497 B'burn D'wen CCG Last Updated: 09/04/2014 RAG G G G G G G R R R R R R TD Target T'Hold : Number of C.Difficile infections Incidence of Clostridium Difficile (Commissioner) Metric Ref: 24 B'burn D'wen CCG Last Updated: 09/04/2014 RAG G G G G G G G G G G G G TD Target T'Hold Library/Performance Monitoring Page Report.rdl 5 of 7 # - TD in development U - TD unavailable

63 Metric Reporting Level Information Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Trend Accident & Emergency 431: 4-Hour A&E Waiting Time Target (Monthly Provider Aggregate) % of patients who spent less than four hours in A&E (Total Acute position) Metric Ref: : 4-Hour A&E Waiting Time Target (SUS / Monthly / CCG) A&E Waiting Time - total time in A&E department (Acute) - (Proxy) Metric Ref: : A&E Attendances: Type 1 Line 1: Number of attendances Type 1 A&E depts Metric Ref: 1926 E Lancs Hospitals B'burn D'wen CCG E Lancs Hospitals Last Updated: 08/04/2014 Last Updated: 08/04/2014 Last Updated: 11/04/2014 RAG A G G A A A A A A A G A A Actual % % % % % % % % % 92.27% % % % Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% T'Hold 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% RAG A G G A R A A A R A A A Actual % % % 93.49% % % % % % % % % Target 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% 95.00% T'Hold 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% 90.00% RAG Actual 8,165 10,040 7,949 8,350 9,749 7,439 9,493 7,561 7,691 9,440 7,918 8, ,989 Target T'Hold 1927: A&E Attendances: All Types Line 2: Number of attendances at all A&E depts Metric Ref: 1927 E Lancs Hospitals Last Updated: 11/04/2014 RAG Actual 13,637 17,121 13,810 14,583 16,700 13,005 17,080 13,580 13,298 16,456 13,998 14, ,223 Target T'Hold 1928: 12 Hour Trolley waits in A&E Total number of patients who have waited over 12 hours in A&E from decision to admit to admission Metric Ref: 1928 E Lancs Hospitals Last Updated: 11/04/2014 RAG G G G G G G G G G G G G G Actual Target T'Hold Activity Activity 72: Number of G&A non-elective FFCEs in the period - Total Number of non-elective G&A FFCEs, excluding well babies Metric Ref: 72 77: Number of G&A elective ordinary admission FFCEs in the period Number of elective G&A ordinary admission FFCEs Metric Ref: 77 71: Number of G&A elective FFCEs in the period - Day Cases Number of elective G&A day case FFCEs Metric Ref: 71 B'burn D'wen CCG B'burn D'wen CCG B'burn D'wen CCG Last Updated: 11/04/2014 Last Updated: 11/04/2014 Last Updated: 11/04/2014 RAG R R R G G G G G G G G G TD 1,788 3,549 5,221 6,954 8,618 10,123 11,709 13,339 15,122 16,928 18,586 18,586 Target 1,703 3,450 5,202 7,036 8,721 10,484 12,335 14,076 15,987 17,782 19,626 21,509 19,626 T'Hold 1,670 3,382 5,100 6,898 8,550 10,278 12,093 13,800 15,674 17,433 19,241 21,087 19,241 RAG TD ,016 1,363 1,655 1,986 2,327 2,695 3,000 3,354 3,665 3,665 Target T'Hold RAG TD 1,391 2,897 4,324 5,830 7,145 8,622 10,155 11,619 12,991 14,551 16,019 16,019 Target T'Hold Library/Performance Monitoring Page Report.rdl 6 of 7 # - TD in development U - TD unavailable

64 Metric 1529: Number of G&A elective FFCEs in the period Total number of FFCEs in the period Metric Ref: 1529 Reporting Level B'burn D'wen CCG Information Last Updated: 11/04/ Q1 Q2 Q3 Q4 TD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar RAG R G G G G G G G G G G G TD 1,711 3,573 5,340 7,193 8,800 10,608 12,482 14,314 15,991 17,905 19,684 19,684 Target 1,685 3,575 5,683 7,691 9,527 11,570 13,525 15,533 17,221 19,151 21,121 23,285 21,121 Trend T'Hold 1,652 3,505 5,572 7,540 9,340 11,343 13,260 15,228 16,883 18,775 20,707 22,828 20,707 73: All first outpatient attendances (consultant-led) in general and acute specialties Total number of first outpatient attendances B'burn D'wen (consultant led) in general & acute specialties CCG Metric Ref: 73 Last Updated: 11/04/2014 RAG R R G G G G G G G G G G TD 3,824 7,680 11,257 15,145 18,427 22,044 25,945 29,550 32,883 36,601 39,996 39,996 Target 3,457 7,574 11,841 15,706 19,768 24,094 28,109 32,587 36,147 40,412 44,546 49,043 44,546 T'Hold 3,389 7,425 11,609 15,398 19,380 23,622 27,558 31,948 35,438 39,620 43,673 48,081 43,673 Library/Performance Monitoring Page Report.rdl 7 of 7 # - TD in development U - TD unavailable

65 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 12 REPORT TITLE: RESPONSIBLE OFFICER: NHS Blackburn with Darwen CCG Governing Body Assurance Framework Mr Roger Parr, Chief Finance Officer SUMMAR: The purpose of this report is to present NHS Blackburn with Darwen (BwD) Clinical Commissioning Group s (CCG) Governing Body with an update on the risks held on the Governing Body Assurance Framework (GBAF) for the period January - March 2014 (Q3). GOVERNING BOD ACTION: The Governing Body is requested to note the content of the report. EQUALIT IMPACT ASSESSMENT (EIA): Has an EIA been completed in respect of this report/issue requiring decision? n/a COMMUNICATION: Communication and/or engagement undertaken or required? n/a RISKS: Have any risks been assessed? es RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified with the report) n/a Page 1 of 7

66 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feels valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate N N N N N NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Page 2 of 7

67 1. Introduction Governing Body Assurance Framework Update Quarter The purpose of this report is to provide the Clinical Commissioning Group s (CCG) Governing Body with an update on the risks currently held on the Governing Body Assurance Framework (GBAF) for the period January - March The report also provides an update on the process for reviewing the GBAF at year end, and progress with the 2014/15 assurance framework document. 2. Background 2.1 The GBAF (Appendix 1) forms part of the CCG s overall governance framework and systems of internal control which support the achievement of the organisation s strategic aims and objectives. The GBAF has been developed in alignment with the CCG s Corporate Objectives for 2013/14, and is designed to ensure the requirements of the Annual Governance Statement are met and that principal risks are managed. 2.2 In accordance with the CCG s Risk Management Strategy and Policy, the GBAF has been presented for review at the following meetings: Update 1: 7 August 2013 Update 2: 6 November 2013 Update 3: February 2014 Update 4: 7 May 2014 The Risk Management Strategy and Policy is currently being reviewed and will be presented to the Quality, Performance and Effectiveness Committee at its meeting on 28 May 2014 for approval. 3. Corporate Objectives 2013/14 ear End Review 3.1 At year-end there are 10 principal risks held on the GBAF; these were aligned to the following Corporate Objectives: We will encourage healthier lifestyles across Blackburn with Darwen to help residents live longer and have a better quality of life We will maintain a grip on performance and quality We will ensure the services we commission are of high quality in terms of safety, experience and effectiveness We will use resources wisely, improving sustainability and meet the productivity challenge To understand the differentials in Primary Care and achieve parity We will deliver NHS Reform and ensure people have a positive experience of care Page 3 of 7

68 3.2 The governing body is asked to note the following reduction in risk score and recommendation for closure at the end of Quarter 4: CO4.FIN2: Demand, activity levels and cost pressures all financial targets were achieved. CO4.FIN3: Failure to achieve QIPP savings all QIPP savings were achieved. CO2.FIN4: Failure to ensure financial stability allocation exercise completed. CO4.FIN2 and CO4.FIN3 will transfer to the Q1 2014/15 risk register, with a re-assessed risk rating at the beginning of the new financial year. 3.3 The following risks are recommended for transfer to the Q1 2014/15 GBAF with a suggested opening risk rating (see Appendix 1 for risk assessment grading matrix): Risk ID Title Opening Risk Rating CO1.PH1 Failure to deliver the strategic aims of the CCG (4x3)=12 CO2.FIN1 Failure to actively recognise, respond to and (3x3)=9 manage the wider economic downturn. CO2.COM1 Failure to achieve equality requirements (4x3)=12 CO2.COM2 Failure to ensure commissioned services effectively (4x3)=12 discharge their safeguarding duties CO2.COM3 Failure to reduce HCAIs (4x3)=12 CO3.COM4 Failure to identify and rectify quality issues within (4x3)=12 provider organisations CO4.FIN2 Demand, activity levels and cost pressures (4x3)=12 CO4.FIN3 Failure to achieve QIPP savings in 2014/15 (4x3)=12 CO6.COM6 Failure to deliver plans if interface between CCG (4x3)=12 and CSU is not achieved as expected External Strategic Risk Monitoring Unwarranted variation in primary care (previously CO5.COM5) 4. Corporate Objectives 2014/ The CCG is currently reviewing its mission and vision statement following the workshop held at the staff away day on 19 th March The development of the CCG s 5 year strategy and 2 year operational plan is also underway and will inform the development of the corporate objectives for the forthcoming year and the principal risks to the achievement of those objectives. 5. Recommendations 5.1 The Governing Body is requested to note the content of the report. Claire Moir Governance, Performance and Risk Manager 25 th April 2014 Page 4 of 7

69 Impact Assessment Risk Grading / Severity score Descriptor Insignificant Minor Moderate Major Catastrophic Objectives/ Insignificant cost increase / <5% over budget / 5-10% over budget / 10-25% over budget / Projects schedule slippage. Barely schedule slippage. Minor schedule slippage. schedule slippage. Does noticeable reduction in scope or reduction in scope or Reduction in scope or not meet secondary quality quality quality objectives Injury Minor injury not requiring first aid Minor injury or illness. First RIDDOR / Agency Major injuries or long term aid treatment needed reportable incapacity / disability (loss Client/Patient Unsatisfactory client/patient Unsatisfactory client/patient Experience experience not directly related to experience readily patient care resolvable Complaint Locally resolved complaint Justified complaint peripheral to clinical care Service/ Business Interruption Staffing and Competence Loss / interruption up to 1 hour Loss / interruption up to 8 hours Short term low staffing level temporarily (<1 day) reduces service quality On-going low staffing level reduces service quality Financial Loss <0.1% of budget Loss 0.1 to 0.24% of budget Potential cost Or up to 10K Or between 10,000-25,000 Inspection / Minor recommendations. Minor Recommendations made. Audit non-compliance with standards Non-compliance with standards Mismanagement client/patient care of Below excess claim. Justified complaint involving lack of appropriate care Loss / interruption up to 1 day Late delivery of key objective / service due to lack of staff. Minor error due to poor training. Ongoing unsafe staffing level Loss 0.25 to 0.49% of budget Or between 0.25m - 0.5m Reduced rating. Challenging recommendations. Noncompliance with core standards of limb) Serious mismanagement of client/patient care Claim above excess level. Multiple justified complaints Loss / interruption up to 1 week Uncertain delivery of key objective / service due to lack of staff. Serious error due to poor training Loss 0.5 to 0.99% of budget Or between 0.5m - 1m Or over 1m Enforcement action. Low rating. Critical report. Major non-compliance with core standards >25% over budget / schedule slippage. Does not meet primary objectives Death or major permanent incapacity Totally unsatisfactory client/patient outcome or experience Multiple claims or single major claim Permanent loss of service or facility Non-delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to insufficient training Loss >1% of budget Prosecution. Zero rating. Severely critical report Page 5 of 7

70 Descriptor Rare Unlikely Possible Likely Almost Certain Frequency Not expected to occur for Expected to occur at Expected to occur at Expected to occur at Expected to occur at years least annually least monthly least weekly least daily Probability <1% 1-5% 6-20% 21-50% >50% Will only occur in Unlikely to occur Reasonable chance of Likely to occur More likely to occur exceptional circumstances occurring than not Likelihood Consequence Low 2 Low 3 Low 4 Moderate 5 Moderate 2 2 Low 4 Moderate 6 Moderate 8 Significant 10 Significant 3 3 Low 6 Moderate 9 Significant 12 Significant 15 High 4 4 Moderate 8 Significant 12 Significant 16 High 20 High 5 5 Moderate 10 Significant 15 High 20 High 25 High FOLLOW-UP ACTION Every manager is responsible for management of risks in their area of activity but may designate a risk owner to take responsibility for further action. Once a risk has been identified and assessed, a decision needs to made as to whether it can be: o o o o accepted without further mitigation; rejected or avoided (by ceasing to undertake the activity or using a substitute method, equipment or substance); treated by improving internal control; or transferred (typically via insurance/risk pooling or contract arrangements). In all instances where the risk cannot be tolerated, an Action Plan showing Immediate, Short Term and Long Term actions should be drawn up, with a nominated responsible person and a deadline for completion, and be reported as shown below. Risk mitigation actions should be commensurate with the degree of risk. At its simplest, this means not spending more on risk improvement than the event would cost if it occurred. The following broad guidelines may help: Page 6 of 7

71 Green risks (low) require no action, though that does not necessarily mean that you should ignore quick and cheap actions to reduce the risk still further; ellow risks (moderate) require a contingency plan, i.e. a prepared response if the risk materialises; Amber risks (significant) require a contingency plan which has been tested (at least by a desk top exercise) and an action plan to reduce the risk to as low a level as reasonably practicable within a realistic timeframe; Red risks (high) require a contingency plan which has been tested (at least by a desk top exercise) and an action plan to reduce the risk to as low a level as reasonably practicable within 12 months. Alternatively, the Quality, Performance and Effectiveness Committee may intervene to require more urgent attention or specific action. Risks which require action that is outside the authority of the manager (e.g. exceed the budget or require action by another department or organisation) should be escalated to the relevant Executive Team Member/Officer so that a SMART action plan can be devised. Page 7 of 7

72 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 13 REPORT TITLE: RESPONSIBLE OFFICER: Blackburn with Darwen Outcomes Analysis Update Mrs Debbie Nixon, Chief Operating Officer Mr Dominic Harrison, Director of Public Health SUMMAR: This report summarises Blackburn with Darwen health related outcomes profiles published in the public domain so far in up to April The report is provided for information and discussion. GOVERNING BOD ACTION: The Governing Body is asked to: i. Note this report ii. Discuss further what action may be required by the CCG Governing Body (or others) to ensure that information contained in these profiles is made more accessible to BwD residents. iii. Discuss further how the CCG Governing Body should respond to the issues identified in these profiles particularly where issues are identified with health and social outcomes that are not already priorities or targets. EQUALIT ANALSIS: Has an Equality Analysis been completed in respect of this report/issue requiring decision? No COMMUNICATION: Communication and/or engagement undertaken or required? No RISKS: Have any risks been assessed? No RELATED FUNDING IMPLICATIONS/COSTS: None Page 1 of 1

73 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate es es es es es es es es es es es NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. es es es es es es es Page 2 of 2

74 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 BLACKBURN WITH DARWEN OUTCOMES ANALSIS UPDATE 1. Introduction A range of governmental and non-governmental bodies are increasingly publishing data on the internet relating to a wide range of health related outcomes. The timing and subject of these publications often tend to be ad hoc with some being picked up rapidly by national or local media and some receiving no publicity at all. This paper provides a summary and brief analysis of all such profiles that are currently in the public domain up to April (Appendix 1). 2. Discussion It is not possible to summarise the 23 profiles detailed in Appendix 1. These cover a wide range of health related outcome indicators for Blackburn with Darwen residents that are drawn from data available to the health and social care system mostly from routine sources. Many of the indicators detailed in these profiles are not contained in the three Outcome Frameworks (NHS, Public Health and Social Care) against which the local health and social care system are required to report. It is important to note therefore that: 3. Conclusion Not all of the indicators identified are either targets or priorities for Blackburn with Darwen CCG. They are not all indicators of CCG performance. Many of the outcomes indicators identified have a complex and multi-sectoral causes. They will require action by a wide range of stakeholders across the borough not just the CCG -in order to make a difference. Many of the profiles will league table Blackburn with Darwen s outcomes against statistical neighbours or the England or north west average. 3.1 Many of the indicators will show Blackburn with Darwen having poor health outcomes compared to the English average. A dilemma in interpreting this data is that the Borough has over 52% of its residents living in the 20% least wealthy lower super output areas in England (a lower super output area is a unit of about 1,500 people i.e. a few streets). This is the principal driver of comparatively poor health outcomes. We should therefore expect (statistically speaking) to be often amongst those Local Authority areas with poor health outcomes- but we should be dissatisfied with this. The data is often simply telling us more about deprivation related health status than the outcome of BwD health and social care service interventions. This makes the need to improve health and social care outcomes in the Borough- and reduce inequalities at an even faster pace than the England average- even more of a priority for BwD CCG than it might be for an average English CCG. Page 3 of 3

75 4. Recommendations 4.1 The Governing Body is asked to: i. Note this report ii. Discuss further what action may be required by the CCG Governing Body (or others) to ensure that information contained in these profiles is made more accessible to BwD residents. iii. Discuss further how the CCG Governing Body should respond to the issues identified in these profiles particularly where issues are identified with health and social outcomes that are not already priorities or targets. Mr Dominic Harrison, Director of Public Health Mrs Debbie Nixon, Chief Operating Officer Mrs Anne Cunningham, Public Health Analyst 11 th April 2014 Page 4 of 4

76 Appendix 1: Health Related Profiles * April 2014 General Profile Latest Level Description Versions Example content Local Health Profiles Small area Profiles Sept Lowertier LA Down to MSOA Broad overview of health issues and determinants. Miscellaneous health indicators. Static (4 page pdf) 14 page report (not pdf) Interactive Interactive ew.aspx?rid= x?qn=hp_interactive (Select level of geography, click on desired area, wait for green menu to appear, and choose Detailed Reports from Reports tab.) Early death rates from cancer have fallen Rate of STIs is better than England average Male life expectancy strongly related to deprivation MSOA at top right of Blackburn with Darwen (Roe Lee etc) has: Life Expectancy slightly higher than BwD average but significantly worse than England Child poverty similar to England Higher than average GCSE achievement End of life care Profile Latest Level Description Versions Example content End of Life Profiles 2012 Uppertier LA Mortality, place of death, cause of death, care home and social care provision. Static (4 page pdf) _profiles/la_2012_pdfs Interactive Above average percentage of deaths from liver disease Higher than average expenditure on residential and nursing care per head * All Public Health England unless otherwise stated Static version: only included in where there is a separately designed static document not just a facility to export the Interactive version. Ward data on this website is not reliable, as it is approximated from MSOAs. 1

77 Children/oung People Profile Latest Level Description Versions Example content Child Health Profiles Early ears Profiles Infant Mortality Profiles Breastfeeding Profiles Healthy Schools Profiles National Child Measurement Programme Local Authority Profile March 2014 March 2014 Approx 1yr old Upper tier LA Interactive Uppertier LA PCT Interactive Uppertier LA Upper tier LA Interactive Uppertier LA Broad overview of health issues and determinants for children and young people. Designed to help commissioners and providers of health visiting services. NB spine chart does not follow usual layout Key indicators re health inequalities in infant mortality Strangely lacking in data only five indicators (none of them dealing with breastfeeding itself). Key local data about child health & wellbeing Summary of prevalence of under /over weight children Static (4 page pdf) Interactive Interactive Interactive view.aspx?qn=profiles_static ews/report/fullpage?viewid=439&re portid=489&geoid=4&georeportid= ews/earlyyearsprofile ews/report?reportid=108&viewid=6 0&geoReportId=3499&geoId=1&geo SubsetId= ews/report?reportid=351&viewid=3 55&geoReportId=3504&geoId=4&ge osubsetid= ews/report?reportid=55&viewid=30 7&geoReportId=3755&geoId=4&geo SubsetId= national child measurementprogramme 25.3% of children aged under 16 years living in poverty Highest rate of hospital admissions for asthma aged <19 Above average proportion of lowbirthweight babies Below average breastfeeding prevalence at 6 8 weeks Higher than average tooth decay at age 5 Infant mortality, children living in poverty and low birthweight all significantly higher than average. High rate of children killed or seriously injured in road traffic accidents Significantly better than average for overweight (non obese) children in ear 6. However, it does not really make sense to classify an intermediate group in this way. Significantly higher than average proportion of underweight children in Reception. Highest proportion in England of underweight children in ear 6. 2

78 Cancer Profile Latest Level Description Versions Example content GP Cancer Profiles CCG Cancer Profiles PCT Cancer Profiles Gynaecological Cancer Profiles Urological Cancer Profiles 2013 Practice 2013/14 Q2 2013/14 Q2? (fairly recent) Oct 2013 CCG PCT PCT PCT & lowertier LA Stats on cancer cases, deaths, screening, waiting times, etc. Available from Public section without logging in. Currently, some stats are available by CCG and others by PCT need to refer to both profiles Incidence, mortality, screening etc Prostate / bladder / kidney / testicular Interactive Interactive Interactive Interactive Interactive _and_topic_specific_work/cancer_ty pe_specific_work/gynaecological_ca ncer/gynaecological_cancer_hub/pr ofiles _and_topic_specific_work/cancer_ty pe_specific_work/urological_cancer/ urological_cancer_hub/profiles Whether practice has high or low level of breast & cervical screening Whether practice has high or low rate of two week wait referrals Close to average % two week wait referrals with cancer diagnosis Low 1 year survival rate for lung cancer Mortality, incidence and survival rates from various gynaecological cancers are not significantly different from England average Prostate cancer mortality significantly below average. Bladder cancer incidence (M) significantly above average. Health Behaviours Profile Latest Level Description Versions Example content Local Alcohol Profiles Local Tobacco Control Profiles Aug 2012 (update due April 2014) Feb 2014 PCT & lowertier LA PCT & lowertier LA Alcohol attributable admissions, crime, etc, drinking behaviours (largely synthetic estimates) Smoking prevalence, smokingattributable mortality / admissions, etc. Static (5 page pdf) Interactive Static (6 page pdf) Interactive (choose LA or PCT then Download ) file/tobacco control/data (Use Download option. Not available for lower tier LAs.) file/tobacco control/data High rates of alcohol attributable hospital admissions. Above average rate of incapacity benefit claimants where main medical reason is alcoholism. Significantly higher than average for most indicators, e.g. o Smoking prevalence o Smoking attributable mortality o Smoking attributable hospital admissions 3

79 Injuries and Violence Profile Latest Level Description Versions Example content Profile Injuries profile Violence indicator profiles Bit old latest data is 2010/11 Oct 2012 Lowertier LA Interactive Lowertier LA Summary of injury data. PHE have yet to get the go ahead to update it ( rce/view.aspx?rid=130709). Only eight indicators. Interactive /atlas.html aspx?reg=b Higher than average deaths and admissions due to injury. Higher than average injuries on the road, but lower than average deaths. Significantly above average on all falls indicators. Learning disabilities Profile Latest Level Description Versions Example content Profile Learning Disability Profiles Mostly data Uppertier LA Summary of 26 indicators, with spine chart, tartan rugs, maps and trend charts. Static (28 page pdf) Interactive s.org.uk/profiles/ Good (i.e. low) percentage of people with learning disabilities living in nonsettled accommodation. Lowest expenditure in England on residential social care per 1000 people with learning disabilities. 4

80 Long term conditions Profile Latest Level Description Versions Example content Profile Cardiovascular disease profiles Diabetes profiles Diabetes footcare activity profiles Early 2013 (approx) Dec 2013 Jan 2013 Uppertier LA CCG CCG Wide range of indicators on outcomes, services, precipitating factors, etc. Various measures of diabetes prevalence, care processes, complications and spending. Summary of hospital admissions data for diabetic footcare. Static (20 page pdf) Interactive Static (6 page pdf) Static (5 page pdf) VD/NationalCVDProfiles.aspx VD/atlas/atlas.html ommunityhealthprofiles/default.asp x rofilesfoot/default.aspx High rate of CHD emergency admissions, with clear deprivation gradient. High proportion of patients with longterm conditions who smoke. Approx 3375 adults with undiagnosed diabetes. Risk of amputation is elevated in people with diabetes, but to a much lesser extent than England average. Inpatient episodes and length of stay for diabetic footcare both well below average. Rate of minor amputations is one of the lowest in England. Mental health Profile Latest Level Description Versions Example content Profile Community mental health profiles 2013 Uppertier LA 31 indicators, displayed as spine charts, tartan rugs, maps, trend charts etc. Static (38 page pdf) Interactive High level of contacts with mental health services per 1000 pop. High admission rate for self harm High suicide rate (but not significant due to small numbers) Sexual health Profile Latest Level Description Versions Example content Profile Sexual and reproductive health profiles March 2014 Uppertier LA 20 indicators on STIs, conception, contraception etc, shown as maps and charts. Interactive exualhealth High proportion of abortions performed before 10 weeks High rate of ectopic pregnancy admissions (though unclear how this relates to sexual health) 5

81 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 14 REPORT TITLE: General Practitioner Out of Hours (OOHs) Service RESPONSIBLE OFFICER: Mrs Debbie Nixon, Chief Operating Officer SUMMAR: The purpose of this paper is to inform the Governing Body of the current position regarding the Out of Hours Service contract, and to review options in order to make an informed decision on the future of the GP Out of Hours (OOHs) contract provided by East Lancashire Medical Services (ELMS). GOVERNING BOD ACTION: The Governing Body is asked to consider the content of the report and support option 3. EQUALIT ANALSIS: A stage 1 pre-assessment Equality Analysis checklist is in progress COMMUNICATION: This will be undertaken as part of the action plan RISKS: This will be presented to the Governing Body RELATED FUNDING IMPLICATIONS/COSTS: Not at this time Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 1 of 8

82 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feels valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 2 of 8

83 1. Purpose CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 GENERAL PRACTITIONER OUT OF HOURS (OOHs) SERVICE The purpose of this paper is to inform the Governing Body (GB) of the current position regarding the Out of Hours service contract, and to assist the GB review options in order to make an informed decision on the future of the GP Out of Hours (OOHs) contract currently provided by East Lancashire Medical Services (ELMS). 2. Background In 2010/11, the Legacy East Lancashire (EL) and Blackburn with Darwen (BwD) PCTs made a decision to tender the GP Out of Hours (OOH) Services across Pennine Lancashire and notice was duly served to the provider, East Lancashire Medical Services (ELMS). This reflected recommendations by internal auditors in 2009, in line with best practice procurement policy, to ensure transparency and best value for the taxpayer. Following concerns expressed by various parties, the decision to tender was deferred to enable a Primary Care led urgent care service to be provided on a pilot basis. The pilot was to be provided in partnership with East Lancashire Hospitals NHS Trust (ELHT) and East Lancashire Medical Services (ELMS). The GP OOH contract with ELMS was extended by both PCTs to allow implementation and evaluation of the pilot and the contract was due to expire on 31st December In April 2013 the BwD and EL CCGs reviewed the position and took a decision to extend the contract until September This was in the context of the pressures within the urgent care system and the opportunity to further implement the primary care / urgent care redesign including GP Acute Visiting Scheme and the co-location of the GP OOHs service with the Urgent Care Centre (UCC). The decision taken in April 2013 means that the CCG s will now need to commence a formal procurement exercise within a matter of weeks in order to achieve a mobilisation date for an OOH s contract in September Current Context In April 2014, BwD CCG s GB was asked to consider the proposed tendering of the GP OOHs contract. This was in the context of a number of key changes that have occurred since the original decision to procure GP OOHs services was taken. The GB requested officers to seek out expert procurement advice. The key issues to consider are set out below: Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 3 of 8

84 3.1 The current plans for Integration and Primary Care The Better Care Fund (BCF) and the Prime Minister s Call to Action have placed 24/7 integrated primary care at the heart of the agenda. In addition General Medical Services (GMS) Contract Guidance Audit 2014/15 require GP practices that have opted out of providing OOHs services to monitor the quality of the local OOHs offered to their registered patients. In BwD this means all 28 GP Practices. The GP Practices are therefore very interested in the outcomes for patients using the OOHs service and the views of the Membership are central to informing any decision about this and associated services. At the recent meeting of the Senate on 29 th April, the overwhelming view was that the health care system has changed and that individual elements of the service, such as OOHs should not be tendered in isolation. The approach of bringing all the services together was supported. 3.2 The current plans for the Unscheduled Care System The Unscheduled Care system across Pennine Lancashire has been under significant pressure during 2013/14 with the Accident and Emergency 4 hour standard not being achieved. The transformation of the Unscheduled Care system is a key priority for the CCG in order to provide sustainable high quality services which meet the needs of the local population. This is reflected in the Single Integrated plans, which set out the strategic aims for the next 3-5 years for both BwD and EL CCGs. ELMS have been key partners in the development of these Unscheduled Care Services over recent years, including the implementation of a GP clinical support service to underpin the roll out of the national 111 programme. The health economy is at a critical stage in assessing, and building on, the improvements that have been introduced across the Unscheduled Care system. The recent pilot of a Primary Care pathway in the Urgent Care Centres in Burnley and Blackburn is in line with the recommendations from the Bruce Keogh Emergency Care Review Phase One Report (November 2013). The Primary Care Pathway Pilot has been extended until March Appendix 2 illustrates the range of services provided by ELMS both in and out of hours. 3.3 Procurement policy and advice Current revised procurement guidance Procurement, Patient Choice and Competition Regulations requires CCGs to ensure transparency and best value, whilst exercising judgement about the quality and responsiveness of local services. Monitor offer guidance on the regulations and put forward 9 questions to help decide if a service should be tendered. These questions put the emphasis on the decision putting patient needs at the centre, and procurement activity needs to be proportionate. Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 4 of 8

85 Appendix 1 contains the Monitor questions and the CCG responses would indicate that exploring other options prior to proceeding to full tender are preferable. 3.4 Developments in East Lancashire CCG 4. Options EL CCG is planning to engage on the development of a 24/7 integrated Primary Care model that includes a range of services. BwD CCG understands that EL CCG will be making a final decision in September. Analysis of the position described above has led to the development of a number of options: 1) Put the Out of Hours Service out to tender. 2) Delay decision until September and undertake engagement in line with EL CCG. 3) Discount separate GP OOHs procurement and develop an integrated 24/7 specification based upon the needs of patients, that includes the OOHs service as part of a number of services (see appendix 2), for a meaningful pilot period in BwD (minimum of 3 years). 4) Develop integrated specification and proceed to full tender (see appendix 2). 5. Recommendation An option appraisal for the above identifying the risks and benefits associated with each option are attached in appendix 3. It is clear from this analysis that the preferred option is option 3. This is because it supports the CCG s plans for integration and has been tested against the 9 Monitor questions. The Governing Body is asked to consider the content of the report and support option 3. Debbie Nixon Chief Operating Officer Roger Parr Chief Finance Officer 30 th April 2014 Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 5 of 8

86 Appendix 1 Question does the CCG need to put the GP OOHs contract out to tender? 1. What are the needs of the ELHT emergency attendances are a national outlier. health care service users we The development of an integrated 24/7 specification are responsible for? presents a significant opportunity to provide care out 2. How good are our current services? Can we improve them? of hospital improving patient choice. Current service delivers on all the National Quality Standards Requirements for OOHs Services consistently and has excellent patient satisfaction. 3. How can we make sure that the services are provided in a more joined up way with other services? 4. Could services be improved by giving patients a choice of provider to go to and / or enabling providers to compete to deliver services? 5. How can we identify the most capable provider or providers of the service? 6. Are our actions transparent? Do people know what decisions we are taking and the reasons why we are taking them? 7. How can we make sure that providers have a fair opportunity to express their interest in providing services? 8. Are there any conflicts between the interests of those commissioning services and those providing them? 9. Are our actions proportionate? Do they reflect the value complexity and clinical risk associated with the services in question and are they consistent with our commissioning priorities? The CCG wishes to develop an integrated specification Developing 24/7 services in the community provides a better choice for patients who need to access urgent care. The current provider consistently delivers contract Key Performance Indicators (KPIs) and quality standards. CCG Membership has been consulted and discussion held in public Governing Body meetings. Previous decision have been supported by a Voluntary Ex-Ante Transparency (VEAT) notice and no challenge was received The CCG recognises and manages the Conflicts of Interest for those commissioning the service, supported by the CCG Conflict of Interest Policy The value of the OOH contract is approximately 0.6% of the CCG turnover, and this service is a part of the commissioning priorities that deliver a 24/7 integrated Unscheduled Care Model - a clear CCG priority to reduce demand and improve quality of care for patients nearer to home Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 6 of 8

87 Appendix 2 Unscheduled and Urgent Care Services NWASPATHFINDER URGENT CARE CENTRE (APPOINTMENTS) MENTAL HEALTH EMERGENC DEPT PENNINE LANCASHIRE ROUTINE SERVICES 111 & Directory of Services HOME SUPPORT INTEGRATED HEALTH AND SOCIAL CARE TEAMS AVS RAPID ASSESSMENT TEAM GP OOHs Current cover across the 24 hour period. Mon to Fri 00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 00:00 AVS UCC GP OOH CORE PRI CARE PATHFINDERS Sat and Sun 00:00 01:00 02:00 03:00 04:00 05:00 06:00 07:00 08:00 09:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00 19:00 20:00 21:00 22:00 23:00 00:00 AVS UCC GP OOH CORE PRI CARE PATHFINDERS overning Body GP OOH Paper Draft V2 April 29 th 2014 Page 7 of 8

88 Appendix 3 Option Benefits Risks 1) Put the Out of Hours Service out to tender Tests the market Lost opportunity to develop a more integrated solution Non delivery of integrated service / Better Care Fund proposals 2) Delay decision until September and undertake engagement in line with EL CCG 3) Discount separate GP OOHs procurement and develop an integrated 24/7 specification, that includes the OOHs service as part of a number of services (see appendix 2), for a meaningful pilot period in BwD (minimum of 3 years). 4) Develop integrated specification and proceed to full tender (see appendix 2) Consistent approach across Pennine Lancs Allows a formal engagement process Considers the wholes of the system and puts the patient at the centre of the decision Consistent with Call to Action objectives Allows the commissioner to develop the 24/7 service and respond to changes that can then inform a tender in the future Allows the provider to plan for delivery of an integrated service Considers the wholes of the system and puts the patient at the centre of the decision Consistent with Call to Action objectives Tests the market Continual delay of decision that can destabilise the provider Non delivery of integrated service / Better Care Fund proposals Plans on hold that could impact on Winter provision Potential challenge from other providers Unable to develop the service in a flexible way that a pilot would allow Commissioning resource focusing on procurement rather than developing an integrated service Governing Body GP OOH Paper Draft V2 April 29 th 2014 Page 8 of 8

89 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 15 REPORT TITLE: RESPONSIBLE OFFICER: Revision to the Clinical Commissioning Group Constitution Mr Iain Fletcher, Head of Corporate Business SUMMAR: The purpose of this report is to update the Governing Body on the revision and amendments made to the CCG Constitution, in line with the constitutional requirement for an annual review. GOVERNING BOD ACTION: The Governing Body is requested to:- 1. Note the contents of the report; 2. Note that the Membership and Clinical Senate consented; no one objected to the proposed changes; 3. Approve the highlighted changes to the Constitution in appendix 1. EQUALIT IMPACT ASSESSMENT (EIA): Has an EIA been completed in respect of this report/issue requiring decision? COMMUNICATION: Communication and/or engagement undertaken or required? The pre-pear tool kit is completed and will be sent to the E&D Team. es RISKS: Have any risks been assessed? es RELATED FUNDING IMPLICATIONS/COSTS: Training and Development costs es Page 1 of 3

90 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Page 2 of 3

91 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 REVISED CCG CONSITUTION Introduction 1.1 The purpose of this report is to update the Governing Body on the revision and amendments made to the CCG Constitution, in line with the constitutional requirement for an annual review. The amendments and highlighted changes were shared with the membership prior to the Clinical Senate meeting. 2. The CCG Constitution 2.1 The revised CCG constitution for is attached as appendix 1, for ease of identification the changes to the Constitution are highlighted. The statutory requirements have not been changed. The main changes reflect the new organisational structures and name changes such as: The Commissioning Board to NHS England and references to the CCG Board to Governing Body etc. Other fundamental changes are to the mission statement as requested by the Governing Body at a previous meeting and the number of elected Executive GPs to the Governing Body. The appendices within the constitution have all been cross referenced for consistency and accuracy; these include Standing Orders, Scheme of Reservation and Delegation, Delegation of Financial Limits and the Terms of Reference for the Sub Committees of the Governing Body. There were no changes to the Scheme of Reservation and Delegation regarding those matters maintained by the Membership. This review was undertaken by the Head of Corporate Business, Governance, Performance and Risk Manager and the Lay Member for Governance. 3. Membership and Clinical Senate 3.1 The revised Constitution and identified changes were circulated to the Membership for comment and were considered at the Clinical Senate on 29 April The Membership and Clinical Senate consented; no one objected to the proposed changes. 4. Recommendation The Governing Body is requested to: 1. Note the contents of the report; 2. Note that the Membership and Clinical Senate consented; no one objected to the proposed changes; 3. Approve the highlighted changes to the Constitution in appendix 1. Mr Iain Fletcher Head of Corporate Business 30 th April 2014 Page 3 of 3

92 Appendix 1 NHS BLACKBURN WITH DARWEN CLINICAL COMMISSIONING GROUP CONSTITUTION Version: 30 NHS England Effective Date: to be inserted once amendments approved by NHS England

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94 CONTENTS Part Description Page Foreword 3 1 Introduction and Commencement Name Statutory framework Status of this constitution Amendment and variation of this constitution 4 2 Area Covered 5 3 Membership Membership of the clinical commissioning group Eligibility Variations to the CCGs membership Cessation of Membership 7 4 Mission, Values and Aims Mission Values Aims Principles of good governance Accountability 9 5 Functions and General Duties Functions General duties General financial duties Other relevant regulations, directions and documents 15 6 Decision Making: The Governing Structure Authority to act Scheme of reservation and delegation General Committees of the group Joint arrangements The governing body 17 7 Roles and Responsibilities Practice representatives Other GPs or primary care health professionals All members of the group s governing body The chair of the governing body The vice chair of the governing body Role of the Clinical Chief Officer Role of the Chief Operating Officer Role of the chief finance officer 22 1

95 Part Description Page 8 Standards of Business Conduct and Managing Conflicts of Interest Standards of business conduct Conflicts of interest Declaring and registering interests Transparency in Procuring Services 25 9 The Group as Employer Transparency, Ways of Working and Standing Orders General Standing orders 27 Appendix Description Page A Definitions of Key Descriptions used in this Constitution 28 B List of Member Practices 30 C Standing Orders 32 D Scheme of Reservation and Delegation 55 E Prime Financial Policies 67 F The Nolan Principles 81 G The Seven Key Principles of the NHS Constitution 83 H Tendering and Contracting 84 I Procurement Procedures 93 J Delegated Financial Limits 96 K Fraud and Corruption Policy 99 L Committee Terms of Reference 116 M Standards for members of NHS Boards & Clinical Commissioning Governing Bodies in England 138 2

96 FOREWORD The constitution was drawn up on 27 th July 2011, and revised on 15 April 2014 between the members listed in section 4 of this constitution document and applies to the organisation called NHS Blackburn with Darwen (BwD) Clinical Commissioning Group (CCG). The purpose of the organisation will be to act as the body that will discharge commissioning responsibility on behalf of its members. Membership of the CCG consists of every General Practitioner currently on BwD s performers list, as per the election roll. This allows for members who are not directly affiliated with general practices to engage within the BwD CCG. However, it is recognised that the majority of members will be affiliated with general practices and from hereon in, those practices shall be referred to as member practices. As the CCG organisation forms with its constituent members, the culture which will give a voice to patients, carers and local communities will emerge. The CCG Governing Body will sit within a local structure that has been developed around a clinical leadership model where GPs provide authority, support, challenge and accountability to the process of commissioning healthcare services for the local population. In Blackburn with Darwen the CCG Governing Body will operate, informed by the Senate and Membership and will participate fully in the Health and Well Being Board. The CCG will work constructively in a spirit of partnership with providers of healthcare services, the Local Authority, Public Health, The Joint Commissioning Executive and NHS England. Supporting this structure will be the NHS Staffordshire and Lancashire Commissioning Support Unit with its distinct functions: service re-design, service planning, contracting and other critical support services. The mission of NHS Blackburn with Darwen Clinical Commissioning Group is; to deliver effective, efficient, high quality, safe, integrated care. This will improve the health and wellbeing of the population of Blackburn with Darwen and help people live better for longer, reducing health inequalities and improving outcomes in the borough 3

97 INTRODUCTION AND COMMENCEMENT 1.1. Name The name of this clinical commissioning group is NHS Blackburn with Darwen Clinical Commissioning Group Statutory Framework This Clinical Commissioning Group (CCG) is established under the Health and Social Care Act 2012 ( the 2012 Act ). 1 CCGs 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 the 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 NHS England is responsible for assessing applications from prospective groups to be established as clinical commissioning groups 4 and undertakes an annual assessment of each established CCG. 5 NHS England has the 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 CCGs are clinically led membership organisations which are made up from local general medical practices and others on the performers list. The members of the CCG 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 constitution is made between the members as listed in section 3 of this document and has effect from to be inserted. The constitution will be published on the CCG s website See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act See section 275 of the 2006 Act, as amended 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 amended 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 by section 26 of the 2012 Act See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 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 any regulations issued 4

98 1.4. Amendment and Variation of this Constitution This constitution which will be formally reviewed annually at the Annual General Meeting can only be varied in two circumstances 8 a) where the group applies to the NHS England and that application is granted; b) where in the circumstances set out in legislation NHS England varies the group s constitution other than on application by the group. Within Blackburn with Darwen, proposals for amendment must be sent to the CCG Chair who will then place the proposal before the full Governing Body for consideration. If recommended by the Governing Body the amendment will be put to the Senate / full membership for decision by vote. A practice member may invoke an extraordinary CCG meeting to propose an amendment to the constitution if it is supported in writing by 5 member practices. 2. AREA COVERED NHS Blackburn with Darwen Clinical Commissioning Group will commission services for all patients resident in Blackburn with Darwen and all those patients registered within its constituent practices. 3. MEMBERSHIP Membership of the Clinical Commissioning Group The membership of the CCG consists of every General Practitioner on NHS England s Local Area Team s performers list as per the election roll. This allows for members who are not directly affiliated with general practices to engage within the BwD CCG. However, it is recognised that the majority of members will be affiliated with general practices and from hereon in, those practices shall be referred to as member practices within this document. The following practices comprise the members of NHS Blackburn with Darwen Clinical Commissioning Group. Practice Name Dr E Ahmed & Partners Dr S Ahmed Dr D Andrews & Partners Dr A Alam & Partner Dr I Bhojani Dr A Black Dr Z Bux Dr A Calow & Partner Dr I Chorlton Address Darwen Health Centre Darwen Health Centre Darwen Health Centre Umar Medical Centre Bangor St Health Centre Bentham Road Health Centre Brookhouse Medical Centre Redlam Surgery Waterside Health Centre 8 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations issued 5

99 Practice Name Dr S Clarkson Drs M K & S Datta Dr M U Din/ Dr A K Gupta Dr D Gebbie & Partners Dr S Gunn & Partners Dr A K Gupta Dr A Hirst &Partner Dr P Jagadesham Dr C Marlborough & Partners Dr Mathur, Dr Siva Maikandanathan Dr I Moodie & Partners Dr Bristow & Partners Dr A Murdoch & Partners Drs N & S Nagpal Dr Phillips & Partner Dr R Pollock & Partners Dr R C Rautray & Partner Dr C Rushton Dr I Timson & Partner Address The Family Practice Audley Health Centre Spring Fenisco Healthlink Limefield Surgery Witton Medical Centre Pringle St Surgery Darwen Health Centre Hollins Grove Surgery The Montague Practice Ewood Medical Centre Oakenhurst Medical Practice Little Harwood Health Centre The Cornerstone Practice, Shadsworth Rd William Hopwood Street Surgery Brownhill Surgery St Georges Surgery Primrose Bank Medical Centre Roman Road Medical Centre Roe Lee Surgery Appendix B of this constitution contains the list of practices, together with the signatures of practice representatives confirming their agreement to this constitution Eligibility Providers of primary medical services to a registered list of patients under the General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract or practitioners on the performers list, will be eligible to apply for membership of this group Application for membership a) Applications from the practices to enter BwD CCG should initially be made to the CCG Chair. b) New practices may join if they are willing to abide by the constitution and rules of the BwD CCG Variations to the CCGs membership Any member may voluntarily leave BwD CCG by writing formally to the CCG Chair to announce their decision Withdrawal will be subject to a minimum notice period, linked to formal contracting requirements (minimum 6 months, maximum 12 months). 6

100 The member practice will also be required to notify NHS England If a practice voluntarily leaves BwD CCG and then wishes to re-join, the practice will go through the application process in section 3.2 of this constitution. 3.4 Cessation of Membership A member ceases to be a member if they cease to be eligible for membership through non-compliance with paragraph The CCG shall notify NHS England in the event that it becomes aware that any member has ceased to meet the requirements of paragraph and shall propose any such amendments to this constitution under the terms of paragraph Membership of the CCG is not transferable and any proposed changes to the membership (including those arising from a merger of members) shall be subject to the approval of NHS England. 3.5 The Clinical Senate The Senate represents all practices each entitled to have one representative member in attendance Decisions will be made on a consensus basis, where this is not possible issues will need to be voted upon at Senate meetings Each practice is entitled to one vote per practice up to a list size of 5000 registered patients. Practices greater than 5000 registered patients will be awarded two votes. Quoracy of the Senate will require at least 66% attendance at each meeting and decisions will be passed with a majority vote of 66% 4. MISSION, VALUES AND AIMS 4.1. Mission 4.2. Values The mission of NHS Blackburn with Darwen Clinical Commissioning Group is: to deliver effective, efficient, high quality, safe, integrated care. This will improve the health and wellbeing of the population of Blackburn with Darwen and help people live better for longer, reducing health inequalities and improving outcomes in the borough The group will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties. 7

101 Good corporate governance arrangements are critical to achieving the group s objectives. Our values which lie at the heart of our work have helped us identify our central goals and mean we are determined that; We will improve the health and wellbeing outcomes for patients and the local population. We will promote co-operation and integration before competition and fragmentation. We will ensure GP Leadership is the central force to effect change and improvement. We will develop transparency and trust to ensure positive relationships. We will be a "can-do, innovative organisation, looking for solutions rather than problems. We will plan and redesign services be guided by needs rather than wants using the principles of commissioning We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone; to go hand-in-hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce that feels valued, motivated and inspired with high morale. This will be achieved through: involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven. We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular community orientated primary care. We will support colleagues to say no where appropriate Aims The group s aim is to; Act as a body that will discharge commissioning responsibility on behalf of its members Principles of Good Governance In accordance with section 14L(2)(b) of the 2006 Act, 9 the group will at all times observe such generally accepted principles of good governance in the way it conducts its business. These include: 9 Inserted by section 25 of the 2012 Act 8

102 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; The Good Governance Standard for Public Services; 10 the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the Nolan Principles 11 the seven key principles of the NHS Constitution; 12 the Equality Act Standards for Members of NHS Boards and CCG governing bodies in England (Appendix M) Accountability The group will demonstrate its accountability to its members, local people, stakeholders and NHS England in a number of ways, including by: publishing its constitution; appointing independent lay members and non GP clinicians to its governing body; holding meetings of its governing body in public (except where the group considers that it would not be in the public interest in relation to all or part of a meeting); publishing annually a commissioning plan and taking the relevant joint health and wellbeing strategy fully into account when preparing or revising these commissioning plans; complying with local authority health overview and scrutiny requirements, ensuring consultation and engagement with the health and wellbeing board in revising or substantially changing commissioning intentions linked to the health and wellbeing strategy; publishing and presenting our annual report to the public; producing annual accounts in respect of each financial year which must be externally audited; 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 & Accountability (CIPFA), 2004 See Appendix F See Appendix G See 9

103 having a published and clear complaints process; complying with the Freedom of Information Act 2000; providing information to NHS England as required The governing body of the group will, throughout each year, have an on-going role in reviewing the group s governance arrangements to ensure that they continue to reflect the principles of good governance. 5. FUNCTIONS AND GENERAL DUTIES 5.1. Functions The functions that the group is responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act 14. An outline of these appears in the Department of Health s Functions of clinical commissioning groups: a working document. They relate to: commissioning certain health services (where NHS England is not under a duty to do so) that meet the reasonable needs of: all people registered with member GP practices, and people who are usually resident within the area and are not registered with a member of any clinical commissioning group; commissioning emergency care for anyone present in the group s area; 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 group s employees; determining the remuneration and travelling or other allowances of members of its governing body In discharging its functions the group will: act 15, 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 16 and with the objectives and requirements placed on NHS England through the mandate 17 published by the Secretary of State before the start of each financial year by: developing annually, robust commissioning plans and intentions that support the delivery of efficient and effective high quality integrated health and social care See sections 14B(6), 14D(2) and 14I(4) 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 10

104 developing robust commissioning plans that comply with national requirements as published by NHS England Meet the public sector equality duty 18 by: a) putting the patient at the heart of what we do; through effective engagement and involvement of local people in decision making, buying health care to meet local needs, involving local people in recruiting to CCG posts, showing improved health outcomes for those in protected groups. b) ensuring that all the policies and practices implemented by the CCG or on behalf of the CCG have been informed by decisions based on equality analysis and assessment of impact that has identified if there are any effects on people; specifically with protected characteristics; within our community who may use our services or on the people we employ in line with the Equality Act c) the adoption of the NHS Equality Delivery System by which the CCG aims to demonstrate to the people we serve how we are meeting the three aims of the Equality Duty. d) publishing equality information gathered as part of the Equality Delivery System (EDS) self-assessment annually and working with local people and equality stakeholders to grade the CCG s performance against the four goals of EDS Work in partnership with our local authority to develop joint strategic needs assessments 19 and joint health and wellbeing strategies 20 by: a) contributing data, intelligence and capacity to the production of the JSNA / ISNA b) informing the agreed priorities of the health and wellbeing strategy as part of the health and wellbeing board. c) developing commissioning plans so that they contribute to the priorities outlined in the health and wellbeing strategy General Duties - in discharging its functions the group 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 21 by: a) commissioning a comprehensive patient and public engagement programme which is tailored to specific audiences and will utilise a range of participatory methods b) arranging direct lay membership on the CCG Governing Body See section 149 of the Equality Act 2010, as amended 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 amended by section 192 of the 2012 Act See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act 11

105 c) engagement with Healthwatch d) publishing information about health services on our website and through other media e) encouraging and acting on feedback f) monitoring and reporting compliance with the engagement principles set out in the Local Strategic Partnership (i.e. the committee/mechanism to oversee this) Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution 22 by: a) informing the patients and public about key priorities and objectives in the CCG Strategy explaining the rationale for identifying these priorities b) commissioning services that promote shared decision making, in accordance with the ethos no decision about me, without me c) using community development approaches / models, education and culturally appropriate health information to raise awareness of the constitution Act effectively, efficiently and economically 23 by: a) reviewing commissioning and organisational processes and seeking to reduce waste and duplication whilst increasing value for the public b) meeting the Quality, Innovation, Prevention, Productivity (QIPP) challenge by identifying how efficiencies can be driven and services re-designed c) measuring effectiveness d) reviewing patient and public experience and evaluating different options e) monitoring compliance to ensure the best possible outcomes, quality and value for money Act with a view to securing continuous improvement to the quality of services 23 by: a) Annual audits b) Financial monitoring c) Performance reviews d) The development of relationships e) Taking forward and implementing good practice and lessons learned Assist and support NHS England in relation to that Board s duty to improve the quality of primary medical services 23 by: a) The establishment of a Care Strategy that supports and secures continuous improvement in quality of primary medical care See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as amended by 2012 Act) See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 12

106 b) Developing demand management strategies to improve referral and patient pathways with a focus on improving patient flows Have regard to the need to reduce inequalities 24 by: a) Basing commissioning and investment decisions on rigorous assessment of need. b) Prioritising investment in services and interventions that are likely to reduce inequalities in health between socio economic, gender, age or ethnic groups. c) Assessing whether there is evidence of differential access, use and outcomes of commissioned services by, socio economic, gender, age, or ethnic groups. d) Ensuring that disadvantaged groups are involved in the design and planning of services they use. e) Using intelligence and evidence from the local population to identify those at highest risk, to intervene early and maximise the health benefits. f) Integrating support in primary medical care to address the determinants of health to promote community and individual self-reliance (e.g. self-care) Promote the involvement of patients, their carers and representatives in decisions about their healthcare 25 by: a) Co-designing and co-delivery of health programmes (working in partnership with patients and the local community to secure the best care for them). b) Inclusion of patient and public opinions, views, experiences and suggestions in the Integrated Needs Assessment Act with a view to enabling patients to make choices 25 by: a) Co-designing and co-delivery of health programmes. b) Commissioning of services that promote shared decision making in accordance with the ethos no decision about me, without me Obtain appropriate advice 26 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by: a) Incorporating specialist public health advice into decision making processes, in order that public health skills and expertise inform commissioning decisions. b) Utilising specialist public health skills to target services at greatest population need and thereby moving towards a reduction of health inequalities. c) Utilising the expertise of the Clinical members of the Governing Body including the Nurse and Secondary Care Doctor Promote innovation 26 by: See section 14T 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 13

107 a) Supporting research, development and innovation by working with key partners including the newly emerging Academic Health Science Networks; Specialist Public Health, the local Research and Intelligence Unit and the Comprehensive Local Research Network Promote research and the use of research 26 by: a) Incorporating research advice from specialist public health and local research and intelligence unit into the decision making processes, in order that evidence base and research policy inform key commissioning decisions. b) Liaising and collaborating on research, service evaluation and training to maintain high standards of service delivery. c) Ensuring that there is compliance with the Research Governance Framework; outsourcing to the Comprehensive Local Research Network for National Institute for Health Research (NIHR) portfolio studies and the Joint Inspection Unit (JIU) for non-portfolio studies, to ensure that there is NHS statutory approval of research in local sites Have regard to the need to promote education and training 27 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 27 by: a) Developing and annually reviewing the organisational development plan and linking this to individual employee s key performance indicators, annual appraisals and supervision 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 group considers that this would improve the quality of services or reduce inequalities 27 by: a) Collaborating through the Integrated Commissioning Network (ICN) whose role is to ensure that the right commissioning capacity and capability are in place locally to meet the challenge of reform. b) Collaborating with other CCGs through the CCG Network to enable the most appropriate delivery of NHS services that fall within the commissioning remit of the CCG but serve residents over a wider geographical area. c) Enabling care to be given in the right place, by the right person, at the right time to reduce pressure on acute services General Financial Duties the group will perform its functions so as to: Ensure its expenditure does not exceed the aggregate of its allotments for the financial year 28 by: 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 14

108 a) Monitoring income and expenditure on a monthly basis. b) Maintaining a strong working relationship with support functions to ensure accurate and timely reporting systems are in place 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 29 by: a) Establishing affordable contracts. b) Closing any financial gaps via QIPP. c) Monitoring of expenditure against the resources allocated by the NHSCB Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the group does not exceed an amount specified by NHS England 30 by: a) Establishing strong working relationships with NHS England. b) Establishing business groups within the CCG charged with delivering any such directions. c) Having financial systems in place to monitor delivery Publish an explanation of how the group spent any payment in respect of quality made to it by NHS England 31 by: a) Establishing quality schedules as part of the contract process b) Ensuring that quality indicators can be measured c) Monitoring and reporting on any such payments as part of the governance arrangements within the CCG 5.4. Other Relevant Regulations, Directions and Documents The group will; a) comply with all relevant regulations; b) comply with directions issued by the Secretary of State for Health or NHS England; and c) take account, as appropriate, of documents issued by NHS England The group 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. 6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to act See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act 15

109 The CCG is accountable for exercising the statutory functions of the group. It may grant authority to act on its behalf to: a) any of its members; b) its governing body; c) employees; d) a committee or sub-committee of the group The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the group as expressed through: a) the group s scheme of reservation and delegation; and b) for committees their terms of reference Scheme of Reservation and Delegation The group s scheme of reservation and delegation (Appendix D) sets out: a) those decisions that are reserved for the membership as a whole; b) those decisions that are the responsibilities of its governing body (and its committees), the group s committees and sub-committees, individual members and employees. c) those decisions that are delegated to the Commissioning Support Unit The CCG remains accountable for all of its functions, including those that it has delegated General In discharging their delegated responsibilities, the governing body and its sub committees and individuals must: a) comply with the group s principles of good governance, 33 b) operate in accordance with the group s scheme of reservation and delegation, 34 c) comply with the group s standing orders, 35 d) comply with the group s arrangements for discharging its statutory duties, 36 e) where appropriate, ensure that member practices have had the opportunity to contribute to the group s decision making process When discharging their delegated functions, sub-committees must also operate in accordance with their approved terms of reference See Appendix D See section 4.4 on Principles of Good Governance above See appendix D See appendix C See chapter 5 above 16

110 6.4. Committees of the group The following sub committees have been established by the group: a) Quality, Performance and Effectiveness Committee b) Commissioning Business Group c) Audit Committee d) Remuneration & Terms of Service 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 group or the committee they are accountable to Joint Arrangements The group has a joint arrangement with the following local authority: a) Integrated Commissioning Network (ICN) with Blackburn with Darwen Borough Council 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. The governing body has responsibility for: a) ensuring that the group has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the groups principles of good governance 37 (its main function); b) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the group and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act; c) approving any functions of the group that are specified in regulations; 38 d) commissioning safe and effective community and secondary care services e) improving the quality of primary care; f) working in partnership with other CCGs and agencies to secure the overall health and wellbeing of the population; g) ensuring that the register of interests is reviewed regularly, and updated as necessary; h) ensuring that all conflicts of interest or potential conflicts of interest are declared 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 17

111 Composition of the Governing Body - the governing body shall comprise: a) The Clinical Chief Officer (GP) b) Clinical Director for Quality and Effectiveness (GP) c) 5 elected members of the BwD Clinical Commissioning Group s Governing Body including the Clinical Chief Officer. One of the five elected members will act as Vice Chair d) Chief Operating Officer e) Chief Finance Officer f) The Chair (lay member) g) 1 lay member governance h) 1 lay member registered nurse i) 1 lay member secondary care doctor Co-opted members will include the Director of Public Health Blackburn with Darwen Local Authority Committees of the Governing Body - the governing body has appointed the following sub-committees: a) Audit Committee it is vital that the audit committee, which is accountable to the group s governing body, provides the governing body with an independent and objective view of the group s financial systems, financial information and their compliance with laws, regulations and directions governing the group; in so far as they relate to finance. The governing body has approved and keeps under review the terms of reference for the audit committee, which includes information on the membership of the audit committee 39. b) Remuneration & Terms of Service Committee it is important that the remuneration committee, which is accountable to the group s governing body makes recommendations to the governing body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the group and on determinations about allowances under any pension scheme that the group may establish as an alternative to the NHS pension scheme. The governing body has approved and keeps under review the terms of reference for the Remuneration & Terms of Service Committee, which includes information on the membership of the Remuneration & Terms of Service Committee 40. c) Quality Performance and Effectiveness Committee The Quality, Performance and Effectiveness Committee is accountable to the CCG Governing Body. Its role is to approve and keep under review the See appendix L for the terms of reference of the Audit Committee See appendix L for the terms of reference of the Remuneration & Terms of Service Committee 18

112 committee s terms of reference 41, and is responsible for the following functions delegated to it: (i) All matters relating to the development and implementation of a comprehensive vision and strategy for continuous quality improvement, covering all aspects of patient safety and experience, service effectiveness, performance management and ensuring compliance with regulatory standards. (ii) Assurance Framework (iii) Risk Register d) Commissioning Business Group The Commissioning Business Group is accountable to the CCG Governing Body. Its role is to develop, deliver and report to the CCG Governing Body on the commissioning plans and intentions of the CCG, ensuring appropriate clinical and public involvement in all aspects of the planning and implementation of commissioning decisions. 7. ROLES AND RESPONSIBILITIES 7.1 The CCG will expect all of its members to act in a manner so as to ensure that systems and processes are in place to fulfil their specific duties of co-operation and partnership including demonstrating that it meets best practice in relation to safeguarding. Practice Roles Practice representatives represent their practice s views and act on behalf of the practice in matters relating to the group. The role of each practice is to: a) nominate a lead representative and deputy to sit on the Senate and release them to perform their roles and meet responsibilities. b) make themselves aware of the work of the CCG and support its vision & values once agreed by the CCG. c) adhere to the scheme of delegation and support the commissioning decisions made. d) be responsible for the elements of a balanced budget that can be affected directly by the actions of the CCG Other Primary Care and Health Professionals In addition to the practice representatives identified in section 7.1 above, the group has identified a number of other GPs / primary care health professionals from member practices to either support the work of the group and / or represent the group rather than represent their own individual practices. These GPs, primary 41 See appendix L for the terms of reference of the Quality, Performance and Effectiveness Committee 19

113 care and other health professionals will undertake the following roles on behalf of the group: a) Secondary Care Doctor will (as set out in the regulations): (i) 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. (ii) be a doctor who is, or has been a secondary care specialist, who has a high level of understanding of how care is delivered in a secondary care setting. (iii) be competent, confident and willing to give an independent, strategic and clinical view on all aspects of CCG business. (iv) be highly regarded as a clinical leader, preferably with a track record of collaborating. (v) be able to understand the balance of a clinical and management agenda. (vi) provide an understanding of how secondary care providers work within the health system, to bring appropriate insight to discussions regarding service re-design, clinical pathways and system reform. b) Registered Nurse (as set out in regulations) will: (i) bring a broader view, from their perspective as a registered nurse, on health and care issues to underpin the work of the CCG especially the contribution of nursing to patient care. (ii) be a registered nurse who has developed a high level of professional expertise and knowledge. (iii) be competent, confident and willing to give an independent, strategic and clinical view on all aspects of CCG business. (iv) be a highly regarded clinical leader, probably across more than one clinical discipline. (v) be able to understand the balance of a clinical and management agenda. (vi) bring detailed insight from a nursing perspective into discussions regarding service re-design, clinical pathways and system reform All Members of the Group s Governing Body The members of the governing body are key appointments for the CCG. The governing body will as part of a team, ensure that the CCG exercises its functions effectively, efficiently and economically with good governance and in accordance with the terms of this CCG as agreed with its members 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; 20

114 b) building and developing the group s governing body and its individual members; c) ensuring that the group 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 Clinical Chief Officer in discharging the responsibilities of the organisation; f) contributing to building a shared vision of the aims, values and culture of the organisation; g) leading and influencing to achieve clinical and organisational change to enable the group to deliver its commissioning responsibilities; h) overseeing governance and particularly ensuring that the governing body and the wider group 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 organisation is able to account to its local patients, stakeholders and NHS England; k) ensuring that the group builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from the local authority The Vice Chair of the Governing Body The vice 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. This role is undertaken by a clinician Role of the Clinical Chief Officer The Clinical Chief Officer of the group is an elected GP member of the governing body. The Clinical Chief Officer is also the Accountable Officer for this CCG This role of Clinical Chief Officer has been summarised in a national document 42 ; a) being responsible for ensuring that the clinical commissioning group fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of health services delivered and also 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 external audit bodies and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems. 42 See the latest version of NHS England s Clinical commissioning group governing body members: Role outlines, attributes and skills 21

115 c) working closely with the chair of the governing body, the Clinical Chief Officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the governing body) of the organisation s on-going capability and capacity to meet its duties and responsibilities. This will include arrangements for the on-going development of its members and staff. d) take the lead in interactions with stakeholders, including NHS England. 7.7 Role of the Chief Operating Officer The Chief Operating Officer is a member of the governing body and is responsible for the development of strategic leadership to ensure safe and efficient business functioning, business continuity and compliance with corporate governance. The post holder will provide high level strategic leadership and management to the CCG with an emphasis on; a) developing the CCG to maintain authorisation b) undertaking delegated responsibilities and duties from the CCO c) securing contracts with the Commissioning Support Service (CSU) and other providers and undertake ongoing contract reviews d) ensure the CCG develops a framework for risk assurance and business continuity e) ensure systems are in place to support and engage the wider CCG membership f) ensure the CCG maintains a grip on managing its strategic relationships with key providers, contractors, stakeholders and the CSU 7.8. 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 clinical commissioning group and for supervising financial control and accounting systems This role of chief finance officer has been summarised in a national document 43 as: 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; 43 See the latest version of the NHS England s Clinical commissioning group governing body members: Role outlines, attributes and skills 22

116 b) making appropriate arrangements to support, monitor and inform the governing body on the group s finances; c) overseeing robust audit and governance arrangements leading to propriety in the use of the group s resources; d) being able to advise the governing body on the effective, efficient and economic use of the group s allocation to remain within that allocation and meet required financial targets and fulfil 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; f) within limitations as a non-clinician covering the responsibilities in their absence and deputising as required for the Clinical Chief Officer and/or Chief Operating Officer 23

117 8. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST 8.1. Standards of Business Conduct Employees, members, Governing Body, committee and sub-committee members of the group 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 group 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. All members should understand and be committed to the practice of good governance and to the legal and regulatory frameworks in which they operate. Guidance has been published by the Professional Standards Authority They must comply with the group s policy on business conduct, including the requirements set out in the policy for managing conflicts of interest. This policy will be available on the group s website at Individuals contracted to work on behalf of the group or otherwise providing services or facilities to the group 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 Conflicts of Interest As required by section 14 O of the 2006 Act, as inserted by section 25 of the 2012 Act, the clinical commissioning group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the group will be taken and will be seen to be taken without any possibility of the influence of external or private interest A conflict of interest can be defined as: a set of conditions in which professional judgement concerning a primary interest (such as patients welfare or the validity of research) tends to be unduly influenced by a secondary interest (such as financial gain) or a situation in which one s ability to exercise judgement in one role is impaired by one s obligation in another. See Conflict of Interests Policy for full details Declaring and Registering Interests The group will maintain one or more registers of the interests of: a) the members of the group; b) the members of its governing body; c) the members of the Committees and working groups; The registers will be published on the 24

118 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 group, 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 Where 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 CCG Governing Body will ensure that the register of interest is reviewed regularly, and updated as necessary. 8.4 Transparency in Procuring Services The group 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 group will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers The group will publish a Procurement Strategy approved by its governing body which will ensure that: a) all relevant clinicians (not just members of the group) 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 Copies of this Procurement Strategy will be available on the group s website at 9. THE GROUP AS EMPLOER 9.1. The group recognises that its most valuable asset is its staff. It will seek to enhance their skills and experience and is committed to their development in all ways relevant to the work of the group The group 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 The group will ensure that it employs suitably qualified and experienced staff who will discharge their responsibilities in accordance with the high standards expected 25

119 of staff employed by the group. All staff will be made aware of this constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work The group 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 group will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters The group will ensure that its rules for recruitment and management of staff provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff The group will ensure that employees' behaviour reflects the values, aims and principles set out above The group will ensure that it complies with all aspects of employment law The group 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 The group will adopt a Code of Conduct for staff and will maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced The group 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 group, any member of its Governing Body, any member of any of its Committees or Sub-Committees or the Committees or Sub-Committees of its Governing Body, or any employee of the group or of 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 chapter, will be available on the CCG s website The group will develop and annually review the organisational development plan and link this to individual employee s key performance indicators, annual appraisals and supervision. 10. TRANSPARENC, WAS OF WORKING AND STANDING ORDERS General 26

120 The group will publish annually a commissioning plan and an annual report, presenting the group s annual report to a public meeting Key communications issued by the group, including the notices of procurements, public consultations, governing body meeting dates, times, venues, and certain papers will be published on the group s website at The group may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public Standing Orders This constitution is also informed by a number of documents which provide further details on how the group will operate. They are the group s: a) Standing orders (Appendix C) which sets out the arrangements for meetings and the appointment processes to elect the group s representatives and appoint to the group s committees, including the governing body; b) Scheme of reservation and delegation (Appendix D) which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the group s governing body, the governing body s committees and sub-committees, the group s committees and sub-committees, individual members and employees; those decisions that are delegated to the Commissioning Support Unit c) Prime financial policies (Appendix E) which set out the arrangements for managing the group s financial affairs. 27

121 APPENDIX A DEFINITIONS OF KE DESCRIPTIONS USED IN THIS CONSTITUTION 2006 Act National Health Service Act Act Health and Social Care Act 2012 (this Act amends the 2006 Act) Clinical Chief Officer Area Chair of the Governing Body Chief Operating Officer Chief Finance Officer Clinical Commissioning Group Committee Financial year Group Governing body an individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by NHS England, with responsibility for ensuring the group: 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. the geographical area that the group has responsibility for, as defined in Chapter 2 of this constitution the individual appointed by the group to act as chair of the governing body responsible for the development of strategic leadership to ensure safe and efficient business functioning, business continuity and compliance with corporate governance. the qualified accountant employed by the group with responsibility for financial strategy, financial management and financial governance a body corporate established by NHS England in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act) a committee or sub-committee created and appointed by: the membership of the group a committee / sub-committee created by a committee created / appointed by the membership of the group a committee / sub-committee created / appointed by the governing body 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 NHS Blackburn with Darwen Clinical Commissioning Group, whose constitution this is 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. 28

122 Governing body member any member appointed to the governing body of the group Lay member Member Practice representatives Registers of interests a lay member of the governing body, appointed by the group. A lay member is an individual who is not a member of the group or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations a provider of primary medical services to a registered patient list, who is a members of this group (see tables in Chapter 3 and Appendix B) an individual appointed by a practice (who is a member of the group) to act on its behalf in the dealings between it and the group, 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) registers a 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 group; the members of its governing body; the members of its committees or sub-committees and committees or subcommittees of its governing body; and its employees. 29

123 APPENDIX B - LIST OF MEMBER PRACTICES Practice Name Address Practice Representatives Signature Dr E Ahmed & Partners Dr S Ahmed Dr D Andrews & Partners Darwen Health Centre Darwen Health Centre Darwen Health Centre Dr A Alam & Partner Dr I Bhojani Umar Medical Centre Bangor St Health Centre Dr A Black Bentham Road Health Centre Dr Z Bux Brookhouse Medical Centre Dr A Calow & Partner Redlam Surgery Dr I Chorlton Dr S Clarkson Waterside Health Centre The Family Practice Drs M K & S Datta Dr M U Din/ Dr A K Gupta Dr D Gebbie & Partners Dr S Gunn & Partners Dr A K Gupta Dr A Hirst &Partner Audley Health Centre Spring Fenisco Healthlink Limefield Surgery Witton Medical Centre Pringle St Surgery Darwen Health Centre Dr P Jagadesham Dr C Marlborough & Partners Dr Mathur, Dr Siva Maikandanathan Hollins Grove Surgery The Montague Practice Ewood Medical Centre 30

124 Practice Name Address Practice Representatives Signature Dr I Moodie & Partners Oakenhurst Medical Practice Dr Bristow & Partners Dr A Murdoch & Partners Little Harwood Health Centre The Cornerstone Practice, Shadsworth Rd Drs N & S Nagpal William Hopwood Street Surgery Dr Phillips & Partner Dr R Pollock & Partners Dr R C Rautray & Partner Brownhill Surgery St Georges Surgery Primrose Bank Medical Centre Dr C Rushton Dr I Timson & Partner Roman Road Medical Centre Roe Lee Surgery 31

125 APPENDIX C STANDING ORDERS 1. STATUTOR FRAMEWORK AND STATUS 1.1. Introduction These standing orders have been drawn up to regulate the proceedings of the NHS Blackburn with Darwen Clinical Commissioning Group so that group can fulfil its obligations, as set out largely in the National Health Service 2006 Act, as amended by the Health and Social Care 2012 Act and related regulations. They are effective from the date the group is established The standing orders, together with the group s scheme of reservation and delegation 44 and the group s prime financial policies 45, provide a procedural framework within which the group discharges its business. They set out: a) the arrangements for conducting the business of the group; b) the appointment of member practice representatives; c) the procedure to be followed at meetings of the group, the governing body and any committees or sub-committees of the group 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 46 of any relevant guidance The standing orders, scheme of reservation and delegation and prime financial policies have effect as if incorporated into the group s constitution. Group members, employees, members of the governing body, members of the governing body s committees and sub-committees, members of the group s committees and sub-committees and persons working on behalf of the group 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 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 group with powers to delegate the group s functions and those of the governing body to certain bodies 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. 32

126 (such as committees) and certain persons. The group has decided that certain decisions may only be exercised by the group in formal session. These decisions and also those delegated are contained in the group s scheme of reservation and delegation (see Appendix D). 2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KE ROLES AND APPOINTMENT PROCESS 2.1. Composition of membership Chapter 3 of the group s constitution provides details of the membership of the group (also see Appendix B) Chapter 6 of the group s constitution provides details of the governing structure used in the group s decision-making processes, whilst Chapter 7 of the constitution outlines certain key roles and responsibilities within the group and its governing body, including the role of practice representatives (section 7.1 of the constitution) Key Roles Paragraph of the group s constitution sets out the composition of the group s governing body whilst Chapter 7 of the group s constitution identifies certain key roles and responsibilities within the group and its governing body. These standing orders set out how the group appoints individuals to these key roles The Clinical Chief Officer, as listed in paragraph of the group s constitution, is subject to the following appointment process: a) Nominations by GP membership; b) Eligibility GP within the Blackburn with Darwen performers list c) Appointment process nominations followed by panel interview and assessment centre d) Term of office permanent; e) Eligibility for reappointment N/A f) Grounds for removal from office termination of contract of employment g) Notice period 3 months The Chief Operating Officer as listed in paragraph of the group s constitution is subject to the following appointment process: a) Nominations by application b) Eligibility must have very senior board/governing Body level experience within the NHS or another large complex organisation c) Appointment process panel interview and assessment centre d) Term of office - permanent e) Eligibility for reappointment N/A f) Grounds for removal from office - termination of contract of employment 33

127 g) Notice period 26 weeks The Chief Finance Officer as listed in paragraph of the group s constitution, is subject to the following appointment process: a) Nominations by application b) Eligibility must be a qualified accountant c) Appointment process panel interview and assessment centre d) Term of office - permanent e) Eligibility for reappointment N/A f) Grounds for removal from office - termination of contract of employment g) Notice period 26 weeks The Clinical Director for Quality and Effectiveness, as listed in paragraph of the group s constitution, is subject to the following appointment process: a) Nominations by GP membership; b) Eligibility GP within the Blackburn with Darwen performers list c) Appointment process panel interview and assessment centre d) Term of office permanent; e) Eligibility for reappointment N/A f) Grounds for removal from office termination of contract of employment g) Notice period 3 months The Chair, as listed in paragraph of the group s constitution, is subject to the following appointment process: a) Nominations application b) Eligibility must be a lay member and a resident within Blackburn with Darwen and have the knowledge skills and ability to lead the governing body ensuring it remains able to discharge its duties and responsibilities c) Appointment process panel interview and assessment centre d) Term of office 3 years e) Eligibility for reappointment by application and interview f) Grounds for removal from office vote of no confidence by the Governing Body g) Notice period 1 month The Registered Nurse as listed in of the group s constitution, is subject to the following appointment process: a) Nominations application and appointment b) Eligibility cannot be an employee of the current Care Trust Plus or employee of a provider of significant contracts to the and will be a registered nurse with the knowledge skills and ability to give an independent strategic clinical view on all aspects of CCG business c) Appointment process application and panel interview d) Term of office 3 years e) Eligibility for reappointment by application and interview 34

128 f) Grounds for removal from office - termination of contract of employment g) Notice period 1 month The Secondary Care Doctor as listed in of the group s constitution, is subject to the following appointment process: a) Nominations application and appointment b) Eligibility cannot be an employee of the current Care Trust Plus or employee of a provider of significant contracts to the CCG and must be a consultant with the knowledge skills and ability to give an independent strategic clinical view on all aspects of CCG business c) Appointment process application and panel interview d) Term of office 3 years e) Eligibility for reappointment by application and interview f) Grounds for removal from office - termination of contract of employment g) Notice period 1 month The GP Governing Body members as listed in of the group s constitution, is subject to the following appointment process: a) Nominations by application b) Eligibility GP within the Blackburn with Darwen CCG Performers list c) Appointment process election by membership d) Term of office 3 years e) Eligibility for reappointment nomination and election f) Grounds for removal from office recommendation to the Senate by the CCO or through a motion raised by CCG members relating to poor conduct and agreed by 75% majority of CCG members. Senate recommendation to NHS England as appropriate. g) Notice period 1 month The Lay Member as listed in of the group s constitution, is subject to the following appointment process: a) Nominations application and appointment b) Eligibility The lay member will be a resident of Blackburn with Darwen with the knowledge skills and ability to oversee key elements of governance including audit remuneration and managing conflicts of interest they must have qualifications expertise or experience which equips them to express informed views about financial management and audit matters c) Appointment process application and panel interview d) Term of office 3 years e) Eligibility for reappointment every 3 years f) Grounds for removal from office termination of contract of employment g) Notice period 1 month The roles and responsibilities of these key roles are set out in Chapter 7 of the group s constitution. 35

129 3 MEETINGS OF THE CLINICAL COMMISSIONING GROUP (FULL MEMBERSHIP) 3.1 Calling meetings Ordinary meetings of the group shall be held at regular intervals at such times and places as the Group may determine The CCO of the Clinical Commissioning Group may call a meeting of the Group at any time One-third or more members of the Group may requisition a meeting in writing. If the CCO refuses, or fails, to call a meeting within seven days of a requisition being presented, the members signing the requisition may forthwith call a meeting. 3.2 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 CCO at least 15 working days (i.e. excluding weekends and bank holidays) before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least 7 days before the date the meeting will take place No business shall be transacted at the meeting other than that specified on the agenda, or emergency motions allowed under Standing Order A member desiring a matter to be included on an agenda shall make his/her request in writing to the CCO at least 15 clear days before the meeting. The request should state whether the item of business is proposed to be transacted in the presence of the public and should include appropriate supporting information. Requests made less than 15 days before a meeting may be included on the agenda at the discretion of the CCO. 4 MEETINGS OF THE CLINICAL COMMISSIONING GROUP GOVERNING BOD Agendas and certain papers for the group s governing body including details about meeting dates, times and venues - will be published on the group s website at The governing body will meet in public 6 times per year The agenda will give the opportunity for questions from members of the public. 4.2 Petitions Where a petition has been received by the group, the chair of the governing body shall include the petition as an item for the agenda of the next meeting of the governing body. 36

130 4.3 Notice of Motion Subject to the provision of Standing Orders 4.5 Motions: Procedure at and during a meeting and 4.6 Motions to Rescind a Resolution, a member of the Governing Body wishing to move a motion shall send a written notice to the Clinical Chief Officer who will ensure that it is brought to the immediate attention of the Chair The notice shall be delivered at least 15 clear days before the meeting. The Clinical Chief Officer shall include in the agenda for the meeting all notices so received that are in order and permissible under governing regulations. This Standing Order shall not prevent any motion being withdrawn or moved without notice on any business mentioned on the agenda for the meeting. 4.4 Emergency Motions Subject to the agreement of the Chair, and subject also to the provision of Standing Order 4.5 Motions: Procedure at and during a meeting, a member of the Governing Body may give written notice of an emergency motion after the issue of the notice of meeting and agenda, up to one hour before the time fixed for the meeting. The notice shall state the grounds of urgency. If in order, it shall be declared to the CCG Governing Body at the commencement of the business of the meeting as an additional item included in the agenda. The Chair s decision to include the item shall be final. 4.5 Motions: Procedure at and during a meeting i) Who may propose A motion may be proposed by the Chair of the meeting or any member present. It must also be seconded by another member. ii) Contents of motions The Chair may exclude from the debate at their discretion any such motion of which notice was not given on the notice summoning the meeting other than a motion relating to: 1) the reception of a report; 2) consideration of any item of business before the CCG Governing Body; 3) the accuracy of minutes; 4) that the Governing Body proceed to next business; 5) that the Governing Body adjourn; 6) that the question be now put on the web iii) Amendments to motions A motion for amendment shall not be discussed unless it has been proposed and seconded. 37

131 Amendments to motions shall be moved relevant to the motion, and shall not have the effect of negating the motion before the Governing Body. If there are a number of amendments, they shall be considered one at a time. When a motion has been amended, the amended motion shall become the substantive motion before the meeting, upon which any further amendment may be moved. iv) Rights of reply to motions a) Amendments The mover of an amendment may reply to the debate on their amendment immediately prior to the mover of the original motion, who shall have the right of reply at the close of debate on the amendment, but may not otherwise speak on it. b) Substantive/original motion The member who proposed the substantive motion shall have a right of reply at the close of any debate on the motion. v) Withdrawing a motion A motion, or an amendment to a motion, may be withdrawn. vi) Motions once under debate When a motion is under debate, no motion may be moved other than: a) an amendment to the motion; b) the adjournment of the discussion, or the meeting; c) that the meeting proceed to the next business; d) that the question should be now put; e) the appointment of an ad hoc committee to deal with a specific item of business; f) that a member/director be not further heard; g) a motion under Section l (2) or Section l (8) of the Public Bodies (Admissions to Meetings) Act l960 resolving to exclude the public, including the press (see Standing Order 4.16). In those cases where the motion is either that the meeting proceeds to the next business or that the question be now put in the interests of objectivity these should only be put forward by a member of the Governing Body who has not taken part in the debate and who is eligible to vote. If a motion to proceed to the next business or that the question be now put, is carried, the Chair should give the mover of the substantive 38

132 motion under debate a right of reply, if not already exercised. The matter should then be put to the vote. 4.6 Motion to Rescind a Resolution Notice of motion to rescind any resolution (or the general substance of any resolution) which has been passed within the preceding six calendar months shall bear the signature of the member who gives it and also the signature of three other members, and before considering any such motion of which notice shall have been given, the CCG may refer the matter to any appropriate Committee or the Clinical Chief Officer for recommendation When any such motion has been dealt with by the CCG it shall not be competent for any director/member other than the Chair to propose a motion to the same effect within six months. This Standing Order shall not apply to motions moved in pursuance of a report or recommendations of a CCG or the Clinical Chief Officer. 4.7 Chair of a meeting At any meeting of the group or its governing body or of a committee or subcommittee, the chair of the group, governing body, committee or sub-committee, if any and if present, shall preside. If the chair is absent from the meeting, the vice chair, if any and if present, shall preside If the chair is absent temporarily on the grounds of a declared conflict of interest the vice chair, if present, shall preside. If both the chair and vice chair are absent, or are disqualified from participating, or there is neither a chair or deputy a member of the group, governing body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside. 4.8 Chair's ruling The decision of the chair of the governing body 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. 4.9 Quorum No business shall be transacted at a meeting unless at least one-third of the whole number of the Chair and members (including at least one member who is a GP Governing Body member, a paid employee of the group (Officer) and one member who is not) (lay member) is present An Officer in attendance for an Officer Member but without formal acting up status may not count towards the quorum If the Chair or member has been disqualified from participating in the discussion on any matter and/or from voting on any resolution by reason of a declaration of a 39

133 conflict of interest (see SO No.8.1) that person shall no longer count towards the quorum. If a quorum is then not available for the discussion and/or the passing of a resolution on any matter, that matter may not be discussed further or voted upon at that meeting. Such a position shall be recorded in the minutes of the meeting. The meeting must then proceed to the next business For all other of the group 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 The voting members of the Governing Body will include Chair, Clinical Chief Officer, GP Governing Body members, Vice Chair in the absence of the Chair, Chief Operating Officer, Chief Finance Officer, Secondary Care Doctor and Registered Nurse Decision making Chapter 6 of the group s constitution, together with the scheme of reservation and delegation, sets out the governing structure for the exercise of the group s statutory functions. Generally it is expected that at the group s / governing body s meetings decisions will be reached by consensus. Should this not be possible then a vote of members will be required, the process for which is set out below: Eligibility A manager who has been formally appointed to act up for an Officer Member during a period of incapacity, or temporarily to fill an Officer Member vacancy, shall be entitled to exercise the voting rights of the Officer Member. A manager attending the CCG meeting to represent an Officer Member during a period of incapacity or temporary absence without formal acting up status may not exercise the voting rights of the Officer Member. An Officer s status when attending a meeting shall be recorded in the minutes Majority necessary to confirm a decision - Save as provided in Standing Orders 4.12 Suspension of Standing Orders and 4.13 Variation and Amendment of Standing Orders, 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 Casting vote - In the case of an equal vote, the person presiding i.e.: the Chair of the meeting shall have a second, and casting vote Dissenting views - If at least one-third of the members present so request, the voting on any question may be recorded so as to show how each member present voted or did not vote (except when conducted by paper ballot). If a member so requests, their vote shall be recorded by name. In no circumstances may an absent member vote by proxy. Absence is defined as being absent at the time of the vote. 40

134 Should a vote be taken the outcome of the vote, and any dissenting views, must be recorded in the minutes of the meeting For all other of the group s committees and sub-committees, including the governing body s committees and sub-committee, the details of the process for holding a vote are set out in the appropriate terms of reference Emergency powers and urgent decisions The powers which the Group has reserved to itself within these Standing Orders may in emergency or for an urgent decision be exercised by the Clinical Chief Officer, the Chair or Lay Member. The exercise of such powers by the Clinical Chief Officer and the Chair or Lay Member shall be reported to the next formal meeting of the CCG in public session for formal ratification 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 that at least two-thirds of the whole number of the Group are present and that at least two thirds of those members present signify their agreement to such a suspension A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting A separate record of matters discussed during the suspension shall be kept No formal business may be transacted whilst material Standing Orders are suspended These records shall be made available to the governing body s audit committee for review of the reasonableness of the decision to suspend standing orders Variation and amendment of Standing Orders These Standing Orders shall not be varied except in the following circumstances: (i) Upon a notice of motion under Standing Order 4.3; (ii) Upon a recommendation of the Chair or Clinical Chief Officer included on the agenda for the meeting; (iii) That two-thirds of the CCG GP Governing Body members are present at the meeting where the variation or amendment is being discussed, and that at least half of the CCG s Non-Officer Members vote in favour of the amendment; (iv) Providing that any variation or amendment does not contravene a statutory provision or direction made by the Secretary of State Record of Attendance 41

135 The names of all individual members of the meeting present at the meeting shall be recorded in the minutes of the group s meetings. The names of all members of the governing body present shall be recorded in the minutes of the governing body meetings. The names of all members of the governing body s committees / subcommittees present shall be recorded in the minutes of the respective governing body committee / sub-committee meetings Minutes 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 person presiding at it. 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 members wishes. Where providing a record of a public meeting the minutes shall be made available to the public as required by Code of Practice on Openness in the NHS Admission of public and the press (i) Admission and exclusion on grounds of confidentiality of business to be transacted The public and representatives of the press may attend all public bimonthly meetings of the Group, but shall be required to withdraw from the meeting as follows: 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 (Admission to Meetings) Act l960 (ii) General disturbances The Chair (or Vice-Chair if one has been appointed) 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 such as to ensure that the Group s business shall be conducted without interruption and disruption and, 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 Group s resolving as follows: 42

136 `That in the interests of public order the meeting adjourn for (the period to be specified) to enable the Group to complete its business without the presence of the public. Section 1(8) Public Bodies (Admissions to Meetings) Act l960. (iii) Business proposed to be transacted when the press and public have been excluded from a meeting Matters to be dealt with by the Group following the exclusion of representatives of the press, and other members of the public, as provided in (i) and (ii) above, shall be confidential to the members of the Governing Body. Members and Officers or any employee of the Group in attendance 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 Group. This prohibition shall apply equally to the content of any discussion during the Group meeting which may take place on such reports or papers. (iv) Use of Mechanical or Electrical Equipment for Recording or Transmission of Meetings Nothing in these Standing Orders shall be construed as permitting the introduction by the public, or press representatives, of recording, transmitting, video or similar apparatus into meetings of the Group or Committee thereof. Such permission shall be granted only upon resolution of the Group Observers at CCG meetings The CCG 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 CCG s meetings and may change, alter or vary these terms and conditions as it deems fit. 5. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES 5.1 Appointment of committees and sub-committees The Governing Body may appoint committees and sub-committees, subject to any regulations made by the Secretary of State 47, and make provision for the appointment of committees and sub-committees of its governing body. Where such committees and sub-committees of the group, or committees and sub-committees of its governing body, are appointed they are included in Chapter 6 of the group s constitution Other than where there are statutory requirements, such as in relation to the governing body s audit committee or remuneration committee, the group shall determine the membership and terms of reference of committees and sub- 47 See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act 43

137 committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the group 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 subcommittee s terms of reference. 5.2 Terms of Reference Terms of reference shall have effect as if incorporated into the constitution and shall be added to this document as an appendix. 5.3 Delegation of Powers by Committees to Sub-committees Where committees are authorised to establish sub-committees they may not delegate executive powers to the sub-committee unless expressly authorised by the group. 5.4 Approval of Appointments to Committees and Sub-Committees The group shall approve the appointments to each of the committees and subcommittees which it has formally constituted including those of the governing body. The group shall agree such travelling or other allowances e.g. reimbursement for loss of earnings and/or expenses where appropriate within national guidance. 5.5 Committees established by the CCG Governing Body The committees, sub committees and joint committees established by the Governing Body are: Audit Committee In line with the requirements of the NHS Audit Committee Handbook, NHS Codes of Conduct and Accountability, and more recently the Higgs report, an Audit Committee will be established and constituted to provide the CCG with an independent and objective review on its financial systems, financial information and compliance with laws, guidance, and regulations governing the NHS. The Terms of Reference will be approved by the CCG and reviewed on a periodic basis. It is prescribed that the Chair of the Audit Committee will be a Lay Member and will have significant, recent and relevant financial experience and qualification. The Chair of the Audit Committee is appointed in line with current approved practice Remuneration and Terms of Service Committee 44

138 In line with the requirements of the NHS Codes of Conduct and Accountability, and more recently the Higgs report, a Terms of Service and Remuneration & Terms of Service Committee will be established and constituted. The Higgs report recommends the Committee be comprised exclusively of Governing Body members who are independent of management. The purpose of the Committee will be to advise the CCG Governing Body about appropriate remuneration and terms of service for the Clinical Chief Officer and other Officers including: a) all aspects of salary (including any performance-related elements/bonuses); b) provisions for other benefits, including pensions and cars; c) arrangements for termination of employment and other contractual terms Other Committees The Governing Body may also establish such other committees as required to discharge the CCG s responsibilities. These include: a) Quality, Performance and Effectiveness Committee b) Commissioning Business Group c) Audit Committee d) Remuneration & Terms of Service Committee The group has a joint arrangement with the following local authority: a) Executive Joint Commissioning Group with Blackburn with Darwen Borough Council Terms of reference for all CCG Committees can be found in Appendix L of this document. 6 DUT TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES 6.1 If for any reason these standing orders are not complied with, full details of the noncompliance 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 group and staff have a duty to disclose any non-compliance with these standing orders to the Clinical Chief Officer as soon as possible. 7 USE OF SEAL AND AUTHORISATION OF DOCUMENTS 7.1 Clinical Commissioning Group s seal The group may have a seal for executing documents where necessary. 45

139 7.1.1 The common seal of the Group shall be kept by the Clinical Chief Officer or a nominated manager by him/her in a secure place Where it is necessary that a document shall be sealed, the seal shall be affixed in the presence of two senior managers duly authorised by the Clinical Chief Officer, and not also from the originating department, and shall be attested by them Register of Seal The Clinical Chief Officer shall keep a register in which he/she, or another manager of the Group authorised by him/her, shall enter a record of the sealing of every document Use of Seal General guide a) All lease agreements where the annual lease charge exceeds 10,000 per annum and the period of the lease exceeds beyond five years b) Any other lease agreement where the total payable under the lease exceeds 100,000 c) Any contract or agreement with organisations other than NHS or other government bodies including local authorities where the annual costs exceed or are expected to exceed 100, Execution of a document by signature The following individuals are authorised to execute a document on behalf of the group by their signature. a) The Clinical Chief Officer b) The Chief Operating Officer c) The Chair of the Governing Body d) The Chief Finance Officer e) Head of Corporate Business 8 OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLIC STATEMENTS / PROCEDURES AND REGULATIONS 8.1 Policy statements: general principles The group will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by NHS Blackburn with Darwen 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 group s standing orders Specific Policy statements 46

140 Notwithstanding the application of SO No. 8.1 above, these Standing Orders and Prime Financial Policies must be read in conjunction with the following Policy statements: i. The Standards of Business Conduct and Conflicts of Interest Policy for NHS Blackburn with Darwen CCG staff; ii. Code of Conduct for NHS Managers 2002; iii. ABPI Code of Professional Conduct relating to hospitality/gifts from pharmaceutical/external industry; iv. The staff Disciplinary and Appeals Procedures adopted by the CCG both of which shall have effect as if incorporated in these Standing Orders Prime Financial Policies Prime Financial Policies adopted by the CCG in accordance with the Financial Regulations shall have effect as if incorporated in these Standing Orders Specific guidance Notwithstanding the application of SO No. 8.1 above, these Standing Orders and Prime Financial Policies must be read in conjunction with the following guidance and any other issued by the Secretary of State for Health: i. Caldicott Guardian 1997; ii. Human Rights Act 1998; iii. Freedom of Information Act DUTIES AND OBLIGATIONS OF GOVERNING BOD MEMBERS/DIRECTORS AND SENIOR OFFICERS UNDER THESE STANDING ORDERS 9.1. Declaration of Interests Requirements for Declaring Interests and applicability to CCG Members (i) The NHS Code of Accountability requires CCG members to declare interests which are relevant and material to the NHS Board/governing body of which they are a member. All existing CCG members should declare such interests. Any CCG members appointed subsequently should do so on appointment Interests which are relevant and material (i) Interests which should be regarded as relevant and material are: a) Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies); b) Ownership or part-ownership of private companies, businesses or consultancies likely or possibly seeking to do business with the NHS; 47

141 c) Majority or controlling share holdings in organisations likely or possibly seeking to do business with the NHS; d) A position of authority in a charity or voluntary organisations in the field of health and social care; e) Any connection with a voluntary or other organisations contracting for NHS services. f) Research funding/grants that may be received by an individual or their department; g) Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with the CCG must be declared); (ii) Any Member of the Group who comes to know that the CCG has entered into or proposes to enter into a contract in which he or any person connected with him (as defined in Standing Order below and elsewhere) has any pecuniary interest, direct or indirect, the CCG member shall declare his/her interest by giving notice in writing of such fact to the CCG as soon as practicable Advice on Interests If the CCG members have any doubt about the relevance of an interest, this should be discussed with the Chair of the CCG, with the Clinical Chief Officer or Chief Operating Officer or the Chief Financial Officer Financial Reporting Standard No 8 (issued by the Accounting Standards Board) specifies that influence rather than the immediacy of the relationship is more important in assessing the relevance of an interest. The interests of partners in professional partnerships including general practitioners should also be considered Recording of Interests in CCG minutes At the time CCG members interests are declared, they should be recorded in the Group minutes Any changes in interests should be declared at the next CCG meeting following the change occurring and recorded in the minutes of that meeting Publication of declared interests in Annual Report CCG Governing Body members, Directorships of companies likely or possibly seeking to do business with the NHS should be published in the CCG s annual report. The information should be kept up to date for inclusion in succeeding annual reports Conflicts of interest which arise during the course of a meeting During the course of a CCG meeting, if a conflict of interest is established, the CCG Member concerned should declare the interest to the meeting in accordance 48

142 with the CCG Conflict of Interest Policy. Where the conflict is material to the discussion of the governing body that member shall withdraw from discussions pertaining to that agenda item and leave the meeting whilst the relevant item is being discussed and take no part in the relevant discussion or decision Register of Interests The Clinical Chief Officer will ensure that a Register of Interests is established to record formally declarations of interests of CCG members. In particular the Register will include details of all Directorships and other relevant and material interests (as defined in SO 9.1.2) which have been declared by both executive and non-executive CCG Members. These details will be kept up to date by means of an annual review of the Register in which any changes to interests declared during the preceding twelve months will be incorporated. The Register will be available to the public and the Clinical Chief Officer will take reasonable steps to bring the existence of the Register to the attention of local residents and to publicise arrangements for viewing it Exclusion of Chair and Members in proceedings on account of pecuniary interest Interpretation of Pecuniary interest For the sake of clarity in interpreting this Standing Order: (i) (ii) (iii) spouse shall include any person who lives with another person in the same household (and any pecuniary interest of one spouse shall, if known to the other spouse, be deemed to be an interest of that other spouse); contract shall include any proposed contract or other course of dealing; subject to the exceptions set out in this Standing Order, a person shall be treated as having an indirect pecuniary interest in a contract if:- a) he/she, or a nominee of his/her, is a member of a company or other body (not being a public body), with which the contract is made, or to be made or which has a direct pecuniary interest in the same, or b) he/she is a partner, associate or employee of any person with whom the contract is made or to be made or who has a direct pecuniary interest in the same. iv) a person shall not be regarded as having a pecuniary interest in any contract if:- 49

143 a) neither he/she or any person connected with him/her has any beneficial interest in the securities of a company of which he/she or such person appears as a member, or b) any interest that he/she or any person connected with him/her may have in the contract is so remote or insignificant that it cannot reasonably be regarded as likely to influence him/her in relation to considering or voting on that contract, or c) those securities of any company in which he/her (or any person connected with him/her) has a beneficial interest do not exceed 10,000 in nominal value or one per cent of the total issued share capital of the company or of the relevant class of such capital, whichever is the less. Provided however, that where paragraph (i) above applies the person shall nevertheless be obliged to disclose/declare their interest in accordance with Standing Order (i) Exclusion in proceedings of the CCG Governing Body or Committees (i) (ii) (iii) (iv) Subject to the following provisions of this Standing Order, if the Chair or a member of the CCG, has any pecuniary interest, direct or indirect, in any contract, proposed contract or other matter and is present at a meeting of the CCG at which the contract or other matter is the subject of consideration, they shall at the meeting and as soon as practicable after its commencement disclose the fact and shall withdraw and not take part in the consideration or discussion of the contract or other matter or vote on any question with respect to it. The CCG may exclude the Chair or a member of the Governing Body from a meeting of the Governing Body while any contract, proposed contract or other matter in which he/she has a pecuniary interest is under consideration. Any remuneration, compensation or allowance payable to the Chair or a member by virtue of paragraph 11 of Schedule 5A to the National Health Service Act 1977 (pay and allowances) shall not be treated as a pecuniary interest for the purpose of this Standing Order. This Standing Order applies to a committee or sub-committee and to a joint committee or sub-committee as it applies to the CCG and applies to a member of any such committee or sub-committee (whether or not he is also a member of the CCG) as it applies to a Member of the CCG Waiver of Standing Orders 50

144 (1) The Conflict of Interest Policy sets out circumstances under which the governing body has the power to waive restrictions on any clinical professional Governing Body member participating in board business, where to authorise such a conflict would be in the interests of the CCG (2) Application of waiver A waiver will apply in relation to the disability to participate in the proceedings of the CCG on account of a pecuniary interest. It will apply to: (i) A member of the Blackburn with Darwen Clinical Commissioning Group ( the CCG ) who is a healthcare professional, within the meaning of regulation 5(5) of the Regulations, and who is providing or performing, or assisting in the provision or performance, of (a) (b) services under the National Health Service Act 1977; or services in connection with a pilot scheme under the National Health Service (Primary Care) Act 1997; (ii) Where the pecuniary interest of the member in the matter which is the subject of consideration at a meeting at which he is present:- (a) (b) arises by reason only of the member s role as such a professional providing or performing, or assisting in the provision or performance of, those services to those persons; has been declared by the relevant chair as an interest which cannot reasonably be regarded as an interest more substantial than that of the majority of other persons who: (i) (ii) are members of the same profession as the member in question; are providing or performing, or assisting in the provision or performance of, such of those services as he provides or performs, or assists in the provision or performance of, for the benefit of persons for whom the CCG is responsible. (3) Conditions which apply to the waiver and the removal of having a pecuniary interest The removal is subject to the following conditions: 51

145 (a) (b) the member must disclose his interest as soon as practicable after the commencement of the meeting and this must be recorded in the minutes; the relevant chair must consult the Clinical Chief Officer before making a declaration in relation to the member in question pursuant to paragraph (2) (b) above, except where that member is the Clinical Chief Officer; In the case of a meeting of the CCG: (i) (ii) the member may take part in the consideration or discussion of the matter which must be subjected to a vote and the outcome recorded; but may not vote on any question with respect to it Standards of Business Conduct CCG Policy and National Guidance All CCG staff and members of the Group must comply with the CCG s Standards of Business Conduct and Conflicts of Interest Policy and the national guidance contained in HSG (93) 5 on Standards of Business Conduct for NHS staff, the Code of Conduct for NHS Managers 2002 and the ABPI Code of Professional Conduct relating to hospitality/gifts from pharmaceutical/external industry Interest of Officers in Contracts (i) ii) iii) Any officer or employee of the CCG who comes to know that the CCG has entered into or proposes to enter into a contract in which he/she or any person connected with him/her (as defined in SO 9.1.8) has any pecuniary interest, direct or indirect, the Officer shall declare their interest by giving notice in writing of such fact to the Chair, Clinical Chief Officer, Chief Operating Officer or the Chief Finance Officer as soon as practicable. An Officer should also declare to the Clinical Chief Officer any other employment or business or other relationship of his/her, or of a cohabiting spouse, that conflicts, or might reasonably be predicted could conflict with the interests of the CCG. The CCG will require interests, employment or relationships so declared to be entered in a register of interests of staff Canvassing of and Recommendations by Members in Relation to Appointments 52

146 (i) ii) Canvassing of members of the CCG or of any Committee of the CCG directly or indirectly for any appointment under the CCG shall disqualify the candidate for such appointment. The contents of this paragraph of the Standing Order shall be included in application forms or otherwise brought to the attention of candidates. Members of the CCG shall not solicit for any person any appointment under the CCG or recommend any person for such appointment; but this paragraph of this Standing Order shall not preclude a member from giving written testimonial of a candidate s ability, experience or character for submission to the CCG. iii) Informal discussions outside appointments panels or committees, whether solicited or unsolicited, should be declared to the panel or committee Relatives of Members or Officers (i) (ii) (iii) (iv) Candidates for any staff appointment under the CCG shall, when making an application, disclose in writing to the CCG whether they are related to any member or the holder of any office under the CCG. Failure to disclose such a relationship shall disqualify a candidate and, if appointed, render him/herself liable to instant dismissal. The Chair and every member and officer of the CCG shall disclose to the CCG Governing Body any relationship between himself and a candidate of whose candidature that member or officer is aware. It shall be the duty of the Clinical Chief Officer to report to the CCG any such disclosure made. On appointment, members (and prior to acceptance of an appointment in the case of Executive Directors) should disclose to the CCG whether they are related to any other member or holder of any office under the CCG. Where the relationship to a member of the CCG is disclosed, the Standing Order headed Exclusion of Chair and members in proceedings on account of pecuniary interest (SO 9.1.8) shall apply. 10. MISCELLANEOUS (see overlap with PFP Sections 13 and 14) Joint Finance Arrangements The Governing Body may confirm contracts to purchase from a voluntary organisation or a local authority using its powers under Section 256 of the 2006 Act. The Governing Body may confirm contracts to transfer money from the NHS 53

147 to the voluntary sector or the health related functions of local authorities where such a transfer is to fund services to improve the health of the local population more effectively than equivalent expenditure on NHS services, using its powers under Section 256 of the 2006 Act. See overlap with Prime Financial Policy Sections 13 and

148 APPENDIX D SCHEME OF RESERVATION & DELEGATION 1. SCHEDULE OF MATTERS RESERVED TO THE CLINICAL COMMISSIONING GROUP AND SCHEME OF DELEGATION 1.1. The arrangements made by the Group as set out in this scheme of reservation and delegation of decisions shall have effect as if incorporated in the Group s constitution On a day to day basis the Chief Finance Officer shall be accountable to the Group s Clinical Chief Officer. However, nothing in the scheme of reservation and delegation should impair the discharge of the direct accountability to the council of members or governing body of the chief finance officer 1.3. The Clinical Commissioning Group remains accountable for all of its functions, including those that it has delegated Unless stated in the group s constitution or in its scheme of reservation and delegation, the group s Clinical Chief Officer has responsibility for the operational management of the Group. Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility 1. POLIC AREA: REGULATION AND CONTROL 1.1 Determine the arrangements by which the members of the Group approve those decisions that are reserved for the membership Clinical Chief Officer 1.2 Consideration and approval of applications to NHS England on matters concerning changes to the Governing Body Clinical Chief Officer 55

149 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility Group s constitution, including proposed changes to the appendices to its constitution. 1.3 Exercise or delegation of those functions of the Clinical Commissioning Group which have not been retained as reserved by the Group or delegated to the governing body or to a committee or sub-committee of the Group or to one of its members or employees Clinical Chief Officer 1.4 Approval of the Group s overarching scheme of reservation and delegation, which sets out those decisions that are in statue the responsibility of the Group and that are reserved to the membership and those delegated to the Group s governing body committees, sub-committees, or advisory panels of the Group or its members or employees Governing Body Clinical Chief Officer 1.5 Prepare the scheme of reservation and delegation, which sets out those decisions that are in statue the responsibility of the governing body are reserved to the governing body and those delegated to the governing body s committees and sub-committees, members of the governing body, an individual who is member of the Group but not the governing body or a specified person the Commissioning Support Unit Clinical Chief Officer Clinical Chief Officer 1.6 Promulgate the governance arrangements of the Group to members, employees of the Group and to Clinical Chief Officer Clinical Chief Officer 56

150 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility people working on behalf of the Group 1.7 Final authority on interpretation of the Group s constitution and supporting appendices (i.e. standing orders, prime financial policies and scheme of reservation and delegation) Chair Chief Finance Officer Clinical Chief Officer 1.8 Disclosure of non-compliance with the Group s constitution (incorporating its standing orders, prime financial policies and scheme of reservation and delegation) All Staff Clinical Chief Officer 1.9 Suspension of standing orders Chief Finance Officer 1.10 Review of suspension of standing orders Audit Committee 1.11 Approval of the Group s operational scheme of delegation that underpins the Group s overarching scheme of reservation and delegation as set out in the constitution Clinical Chief Officer Clinical Chief Officer 1.12 Approve the Group s prime financial policies Chief Finance Officer 1.13 Approve detailed financial procedures Audit Committee Chief Finance Officer 1.14 Approve arrangements for managing exceptional funding requests Chief Finance Officer Chief Finance Officer Chief Finance Officer Clinical Chief Officer Chief Operating 57

151 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility Officer 1.15 Set out who can execute a document by signature / use of the seal Clinical Chief Officer Clinical Chief Officer 2 PRACTICE MEMBER REPRESENTATIVES AND MEMBERS OF THE GOVERNING BOD 2.1 Approve the arrangements for identifying practice members to represent practices in matters concerning the work of the Group; and appointing clinical leaders to represent the Group s membership on the Group s governing body. 2.2 Approve the appointment of governing body members, the process for recruiting and removing non-elected members to the governing body (subject to any regulatory requirements) and succession planning 2.3 Approve arrangements for recruiting the Group s Clinical Chief Officer. Clinical Chief Officer Clinical Chief Officer Chair Chair Clinical Chief Officer Clinical Chief Officer Chair 3 STRATEG AND PLANNING 3.1 Approve the vision, values and overall strategic direction of the Group 3.2 Approve the Group s operating structure 58 Quality, Performance and Effectiveness Committee Clinical Chief Officer Chief Operating Officer Clinical Chief Officer

152 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility Chief Operating Officer 3.3 Approve the Group s commissioning plan Commissioning Business Group Clinical Chief Officer Chief Operating Officer 3.4 Approve the Group s arrangements for engaging the public and key stakeholders in the Group s planning and commissioning arrangements. Chair Clinical Chief Officer Clinical Chief Officer 3.5 Approve the Group s corporate budgets that meet the financial duties of the Group. 3.6 Approve variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure or the Group s ability to achieve its agreed strategic aims 4 ANNUAL REPORTS AND ACCOUNTS 4.1 Approval of the Group s annual report and annual accounts 4.2 Approval of the arrangements for discharging the Group s statutory financial duties 5 HUMAN RESOURCES & ORGANISATIONAL DEVELOPMENT Chief Finance Officer Chief Finance Officer Audit Committee Clinical Chief Officer Chief Finance Officer Chief Finance Officer Clinical Chief Officer Chief Finance Officer Chief Finance Officer 59

153 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility 5.1 Determine the remuneration and conditions of service of the Executive Officers and GP Governing Body members Remuneratio n and Terms of service committee Clinical Chief Officer 5.2 Review the performance of the Executive and other senior team members and determining annual salary awards, if appropriate. Remuneratio n and Terms of service committee Clinical Chief Officer 5.3 Consider the severance payments of the Executive and including other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance Managing Public Money (available on the HM Treasury.gov.uk website). Remuneratio n and Terms of service committee Clinical Chief Officer 5.4 Approve terms and conditions of employment for all lay members of the Governing Body and all other allowances Clinical Chief Officer Chief Finance Officer 5.5 Approve disciplinary arrangements where the Group has joint appointments with another Group and the individuals are employees of that Group. Quality, Performance and Effectiveness Committee Policy Group Clinical Chief Officer 5.6 Approval of the arrangements for discharging the Group s statutory duties as an employer Clinical Chief Officer 5.7 Approve human resources policies for employees and for other persons working on behalf of the Group Quality, Performance and Effectiveness Clinical Chief Officer 60

154 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility Committee Policy Group 5.8 Approve the Group s succession planning for elected members and other governing body nominations and members Clinical Chief Officer 5.9 Approve the Group s organisational development plans Clinical Chief Officer 6 QUALIT AND SAFET 6.1 Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes Quality, Performance and Effectiveness Committee Clinical Chief Officer Chief Operating Officer 6.2 Approve the Group s arrangements for handling complaints 6.3 Approve the Group s arrangements for safeguarding children and vulnerable adults 6.4 Approve the Group s arrangements for engaging patients and their carers in decisions concerning their healthcare 6.5 Approve arrangements for supporting NHS England in 61 Quality Performance and Effectiveness Committee Quality Performance and Effectiveness Committee Quality Performance and Effectiveness Committee Quality Performance Clinical Chief Officer Clinical Chief Officer Clinical Chief Officer Clinical Chief Officer

155 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services and Effectiveness Committee 7 OPERATIONAL AND RISK MANAGEMENT 7.1 Approve the Group s counter fraud and security management arrangements. Audit Committee Chief Finance Officer 7.2 Approval of the Group s risk management arrangements Quality Performance and Effectiveness Committee Chief Finance Officer 7.3 Approve arrangements for risk sharing and or risk pooling with other organisations (for example arrangements for pooled funds with other clinical commissioning Groups or pooled budget arrangements under section 75 of the NHS Act 2006). Quality Performance and Effectiveness Committee Clinical Chief Officer Chief Finance Officer 7.4 Approve a comprehensive system of internal control, including budgetary controls that underpin the effective, efficient and economic operation of the Group. Chief Finance Officer Clinical Chief Officer 7.5 Approve the thresholds above which quotations or formal tenders must be obtained Chief Finance Officer 7.6 Approve the arrangements for seeking professional advice regarding the supply of goods and services Chief Finance Officer 7.7 Approve proposals for action on litigation against or on behalf of the clinical commissioning Group Chief Finance Officer Clinical Chief Officer 62

156 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility 7.8 Approve the Group s arrangements for business continuity and emergency planning Chief Finance Officer 7.9 Approve the Group s banking arrangements Chief Finance Officer 8 INFORMATION GOVERNANCE 8.1 Approve the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data. 8.2 Approve information sharing protocols with other organisations Information Governance Steering Group Information Governance Steering Group 9 PARTNERSHIP, JOINT OR COLLABORATIVE WORKING (see also paragraph 7.3 above and paragraph 11.3 below of this Scheme of Reservation and Delegation) 9.1 Approve the arrangements governing joint or collaborative arrangements between the Group and another statutory body(ies), where those arrangements incorporate decision making responsibilities Senior Information Risk Owner Caldicott Guardian Clinical Chief Officer Chief Operating Officer Clinical Chief Officer Clinical Chief Officer Senior Information Risk Owner 63

157 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility 9.2 Approve the delegated decision making responsibilities of individual members or employees of the Group who represent the Group in joint or collaborative arrangements with another statutory body(ies) Clinical Chief Officer 9.3 Receive the minutes of meetings of, or reports from, joint or collaborative arrangements between the Group and another statutory body(ies) Clinical Chief Officer 9.4 Authorise an individual to act on behalf of the Group in discharging the Group s duty in respect of statutory and local joint working arrangements, within the financial limits determined under sections 10 and 12 of this scheme of reservation and delegation. For example: Safeguarding (children s and adult) Health & Wellbeing Board Clinical Chief Officer 10 TENDERING 10.1 Approve the Group s tendering arrangements for any commissioning or corporate support in excess of 500, (over the life time of the contract) Chief Finance Officer 11 COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES 11.1 Approve the arrangements for discharging the Group s statutory duties associated with its commissioning functions. Commissioning Business Group Commissioning Business Group Clinical Chief Officer 64

158 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility 11.2 Approve arrangements (including where appropriate, an individual s authority to act) for co-ordinating the commissioning of services with other clinical commissioning Groups. Commissioning Business Group Clinical Chief Officer 11.3 Approve arrangements (including where appropriate, an individual s authority to act) for co-ordinating the commissioning of services with the local authority(s) Commissioning Business Group Clinical Chief Officer 11.4 Approval of contracts for clinical services with a value in excess of 500, per annum Commissioning Business Group Clinical Chief Officer 11.5 Approve contracts for clinical services with a value less than 500, per annum Commissioni ng Business Group Clinical Chief Officer 12 COMMISSIONING AND CONTRACTING FOR NON-CLINICAL SERVICES 12.1 Approve arrangements for co-ordinating the commissioning of non-clinical services with other Groups Commissioning Business Group Clinical Chief Officer 12.2 Approve arrangements for co-ordinating the commissioning of non-clinical services with local authority(ies) Clinical Chief Officer 12.3 Approval of contracts for non-clinical services with a value in excess of 100, (over the life time of the contract) Clinical Chief Officer 12.4 Approve contracts for non-clinical services with a value less than 100, (over the life time of the Clinical Chief Officer Chief Finance Officer Chief Finance Officer 65

159 Ref No Reserved or Delegated Matter Matter Reserved to the Membership Matter Reserved to the Governing Body Delegated To Committee or Sub- Committee Individual Member or Officer Responsible for Recommending a course of action Operational Responsibility contract) 13 COMMUNICATIONS 13.1 Approve arrangements for handling Freedom of Information requests. Information Governance Steering Group Clinical Chief Officer 66

160 APPENDIX E PRIME FINANCIAL POLICIES 1. INTRODUCTION 1.1. General These prime financial policies and supporting detailed financial policies shall have effect as if incorporated into the group s constitution The prime financial policies are part of the group s control environment for managing the organisation s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration, lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Clinical Chief Officer and Chief Finance Officer to effectively perform their responsibilities. They should be used in conjunction with the scheme of reservation and delegation found at Appendix D In support of these prime financial policies, the group has prepared more detailed policies, approved by the chief finance officer known as detailed financial policies. The group refers to these prime and detailed financial policies together as the clinical commissioning group s financial policies These prime financial policies identify the financial responsibilities which apply to everyone working for the group and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The chief finance officer is responsible for approving all detailed financial policies A list of the group s detailed financial plans will be published and maintained on the group s website at Should any difficulties arise regarding the interpretation or application of any of the prime financial policies then the advice of the Chief Finance Officer must be sought before acting. The user of these prime financial policies should also be familiar with and comply with the provisions of the group s constitution, standing orders and scheme of reservation and delegation Failure to comply with prime financial policies and standing orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal Throughout these prime financial policies reference is made to the limits of financial authorities against the role of officers, Committees and Governing Body. Annex J Delegated Financial Limits provides a summary of the limits of financial authorities and responsibilities approved by the Governing Body which will be reviewed and updated periodically. Containing these details within an Annex limits the need to review and revise the body of the prime financial policies in this regard. 67

161 1.2. Overriding Prime Financial Policies If for any reason these prime financial policies 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 s audit committee for referring action or ratification. All of the group s members and employees have a duty to disclose any non-compliance with these prime financial policies to the chief finance officer as soon as possible Responsibilities and delegation The roles and responsibilities of the group s members, employees, members of the governing body, members of the governing body s committees and subcommittees, members of the group s committee and sub-committee (if any) and persons working on behalf of the group are set out in chapters 6 and 7 of this constitution The financial decisions delegated by members of the group are set out in the group s scheme of reservation and delegation (see Appendix D) Clinical Chief Officer The Clinical Chief Officer will, as far as possible, delegate their detailed responsibilities, but they remain accountable for financial control. Within the Prime Financial policies, it is acknowledged that the Clinical Chief Officer is ultimately accountable to the Group, and as Clinical Chief Officer, to the Secretary of State, for ensuring that the Group meets its obligation to perform its functions within the available financial resources. The Clinical Chief Officer has overall executive responsibility for the CCG s activities; is responsible to the Chair and the Group for ensuring that its financial obligations and targets are met and has overall responsibility for the CCG s system of internal control. It is a duty of the Clinical Chief Officer to ensure that Members of the Group employees and all new appointees are notified of, and put in a position to understand their responsibilities within these Instructions The Chief Finance Officer The Chief Finance Officer is responsible for: (a) (b) implementing the CCG s financial policies and for co-coordinating any corrective action necessary to further these policies; maintaining an effective system of internal financial control including ensuring that detailed financial procedures and systems incorporating the principles of separation of duties and internal checks are prepared, documented and maintained to supplement these instructions; 68

162 (c) ensuring that sufficient records are maintained to show and explain the CCG s transactions, in order to disclose, with reasonable accuracy, the financial position of the CCGs at any time; and, without prejudice to any other functions of the CCG, and employees of the CCG, the duties of the Chief Finance Officer include: (d) (e) (f) the provision of financial advice to other members of the CCG and employees; the design, implementation and supervision of systems of internal financial control; and the preparation and maintenance of such accounts, certificates, estimates, records and reports as the CCG may require for the purpose of carrying out its statutory duties CCG Members and Employees All members of the CCG and employees, severally and collectively, are responsible for: (a) (b) (c) (d) The security of the property of the CCG; Avoiding loss; Exercising economy and efficiency in the use of resources; and Conforming with the requirements of Standing Orders, Prime Financial Policies, Financial Procedures and the Scheme of Delegation Contractors and their employees Any contractor or employee of a contractor who is empowered by the group to commit the group to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Clinical Chief Officer to ensure that such persons are made aware of this Amendment of Prime Financial Policies To ensure that these prime financial policies remain up-to-date and relevant, the chief finance officer will review them at least annually. Following consultation with the Clinical Chief Officer and scrutiny by the governing body s audit committee, the chief finance officer will recommend amendments, as fitting, to the Audit Committee for approval. As these prime financial policies are an integral part of the group s constitution, any amendment will not come into force until the group applies to NHS England and that application is granted. 2. INTERNAL CONTROL 2.1. The governing body is required to establish an audit committee with terms of reference agreed by the governing body (see paragraph 6.6.3(a) of the group s constitution for further information). 69

163 2.2. The Clinical Chief Officer has overall responsibility for the group s systems of internal control The Chief Finance Officer will ensure that: 3. AUDIT a) financial policies are considered for review and update annually; b) a system is in place for proper checking and reporting of all breaches of financial policies; and c) a proper procedure is in place for regular checking of the adequacy and effectiveness of the control environment In line with the terms of reference for the governing body s audit committee, the person appointed by the group to be responsible for internal audit and the appointed external auditor will have direct and unrestricted access to audit committee members and the chair of the governing body, Clinical Chief Officer and Chief Finance Officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity The person appointed by the group to be responsible for internal audit and the external auditor will have access to the audit committee and the Clinical Chief Officer to review audit issues as appropriate. All audit committee members, the chair of the governing body and the Clinical Chief Officer will have direct and unrestricted access to the head of internal audit and external auditors The Chief Finance Officer will ensure that: a) the group has a professional and technically competent internal audit function; and b) the governing body s audit committee approves any changes to the provision or delivery of assurance services to the group External Audit External Auditor provision will be determined nationally but paid for by the CCG. The Audit Committee must ensure a cost-effective service. 3.5 Fraud and Corruption In line with their responsibilities the Clinical Chief Officer and the Chief Finance Officer shall monitor and ensure compliance with the CCGs Anti-Fraud and Corruption Policy (Appendix K). The CCG shall nominate a suitable person to carry out the duties of the Local Anti-Fraud Specialist (LAFS) as specified on the NHS Counter Fraud and Corruption Manual and guidance. 70

164 The LAFS shall report to the CCG Chief Finance Officer and shall work with staff in the NHS Counter Fraud Service (NHS CFS) and the Operational Fraud Team (OFT) in accordance with the NHS Counter Fraud and Corruption Manual. The LAFS will provide a written report, at least annually, on counter fraud work within the CCG. 4. FRAUD AND CORRUPTION 4.1. The governing body s audit committee will satisfy itself that the group has adequate arrangements in place for countering fraud (see 3.5) and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme The governing body s audit committee will ensure that the group has arrangements in place to work effectively with NHS Protect. The Clinical Commissioning Group s Anti-fraud and Corruption policy is shown in Appendix K. 5. EXPENDITURE CONTROL 5.1. The group is required by statutory provisions 48 to ensure that its expenditure does not exceed the aggregate of allotments from NHS England and any other sums it has received and is legally allowed to spend The Clinical Chief Officer has overall executive responsibility for ensuring that the group complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money The Chief Finance Officer will: a) provide reports in the form required by NHS England; b) ensure money drawn from NHS England is required for approved expenditure only is drawn down only at the time of need and follows best practice; c) be responsible for ensuring that an adequate system of monitoring financial performance is in place to enable the group to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of NHS England. 6. ALLOTMENTS The group s Chief Finance Officer will: See section 223H of the 2006 Act, inserted by section 27 of the 2012 Act See section 223(G) of the 2006 Act, inserted by section 27 of the 2012 Act.

165 a) periodically review the basis and assumptions used by NHS England for distributing allotments and ensure that these are reasonable and realistic and secure the group s entitlement to funds; b) prior to the start of each financial year submit to the CCG for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and c) regularly update the NHS Blackburn with Darwen CCG on significant changes to the initial allocation and the uses of such funds. 7. COMMISSIONING STRATEG, BUDGETS, BUDGETAR CONTROL AND MONITORING POLIC the group will produce and publish an annual commissioning plan 50 that explains how it proposes to discharge its financial duties. The group will support this with comprehensive medium term financial plans and annual budgets 7.1. The Clinical Chief Officer will compile and submit to the CCG a commissioning strategy which takes into account financial targets and forecast limits of available resources Prior to the start of the financial year the chief finance officer will, on behalf of the Clinical Chief Officer, prepare and submit budgets for approval by the CCG Governing Body The Chief Financial Officer shall monitor financial performance against budget and plan, periodically review them, and report to the CCG. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial plans or budgets The Clinical Chief Officer is responsible for ensuring that information relating to the group s accounts or to its income or expenditure, or its use of resources is provided to NHS England as requested The Chief Finance Officer shall monitor financial performance against budget and plan, periodically review them and report to the CCG All budget holders must provide information as required by the Chief Finance Officer to enable budgets to be compiled The Chief Finance Officer has responsibility to ensure that adequate training is delivered in an on-going basis to budget holders to help them manage successfully The Clinical Chief Officer will approve consultation arrangements for the group s commissioning plan See section 14Z11 of the 2006 Act, inserted by section 26 of the 2012 Act. See section 14Z13 of the 2006 Act, inserted by section 26 of the 2012 Act

166 8. ANNUAL ACCOUNTS AND REPORTS POLIC the group will produce and submit to NHS England accounts and reports in accordance with all statutory obligations 52, relevant accounting standards and accounting best practice in the form and content and at the time required by NHS England 8.1. The Chief Finance Officer will ensure the group: a) prepares and submits financial returns in accordance with accounting policies and guidance given by the Department of Health and the Treasury, the CCG s accounting policies and international financial reporting standards b) prepares a timetable for producing the annual report and accounts and agrees it with external auditors and the governing body. c) prepares and submits the annual financial reports according to the Department of Health in accordance with current guidelines. d) complies with statutory requirements and relevant directions for the publication of annual report; e) considers the external auditor s management letter and fully address all issues within agreed timescales; and f) publishes the external auditor s management letter on the group s website at The CCG s annual accounts must be audited by external auditors. The CCG s audited annual accounts must be presented to a public meeting and made available to the public. 9. INFORMATION TECHNOLOG 9.1. The Chief Finance Officer is responsible for the accuracy and security of the group s computerised financial data and shall a) devise and implement any necessary procedures to ensure adequate (reasonable) protection of the group's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998; b) ensure that adequate (reasonable) controls exist over data entry, processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system; See paragraph 17 of Schedule 1A of the 2006 Act, as inserted by Schedule 2 of the 2012 Act.

167 c) ensure that adequate controls exist such that the computer operation is separated from development, maintenance and amendment; d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the chief finance officer may consider necessary are being carried out In addition the chief finance officer shall ensure that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation. 10. ACCOUNTING SSTEMS The Chief Finance Officer will ensure: a) the group has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of NHS England; b) that contracts for computer services for financial applications with another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes Where another health organisation or any other agency provides a computer service for financial applications, the chief finance officer shall periodically seek assurances that adequate controls are in operation. 11. BANK ACCOUNTS POLIC the group will keep enough liquidity to meet its current commitments The Chief Finance Officer will: a) review the banking arrangements of the group at regular intervals to ensure they are in accordance with Secretary of State directions 53, best practice and represent best value for money; b) manage the group's banking arrangements and advise the group on the provision of banking services and operation of accounts; c) prepare detailed instructions on the operation of bank accounts The Chief Finance Officer shall approve the banking arrangements See section 223H(3) of the NHS Act 2006, inserted by section 27 of the 2012 Act

168 11.3. GBS Accounts The Chief Finance Officer is responsible for: a) the Government Banking Services (GBS) accounts; b) ensuring payments from GBS accounts do not exceed the amount credited to the account except where arrangements have been made; c) reporting to the Governing Body all arrangements made with the CCG s bankers for accounts to be overdrawn; d) monitoring compliance with DH guidance on the level of cleared funds Banking Procedures The Chief Finance Officer will prepare detailed instructions on the operation of the GBS accounts which must include: a) the conditions under which the GBS account is to be operated; b) those authorised to sign cheques or other orders drawn on the CCG s accounts. 12. INCOME, FEES AND CHARGES AND SECURIT OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS POLIC the group will operate a sound system for prompt recording, invoicing and collection of all monies due seek to maximise its potential to raise additional income only to the extent that it does not interfere with the performance of the group or its functions 54 ensure its power to make grants and loans is used to discharge its functions effectively The Chief Financial Officer is responsible for: a) designing, maintaining and ensuring compliance with systems for the proper recording, invoicing, and collection and coding of all monies due; b) establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments; c) approving and regularly reviewing the level of all fees and charges other than those determined by NHS England or by statute. Independent professional advice on matters of valuation shall be taken as necessary; See section 14Z5 of the 2006 Act, inserted by section 26 of the 2012 Act. See section 14Z6 of the 2006 Act, inserted by section 26 of the 2012 Act.

169 76 d) for developing effective arrangements for making grants or loans. 13. TENDERING AND CONTRACTING PROCEDURE POLIC the group: will ensure proper competition that is legally compliant within all purchasing to ensure we incur only budgeted, approved and necessary spending will seek value for money for all goods and services shall ensure that competitive tenders are invited for o the supply of goods, materials and manufactured articles; o the rendering of services including all forms of management consultancy services (other than specialised services sought from or provided by the Department of Health); and for the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals The procedure for making all contracts by or on behalf of the CCG shall comply with the standing orders and prime financial policies (except where Standing Order no Suspension of Standing Orders is applied) Details of the procedure for the Tendering and Contracting is detailed in Appendix I The group shall ensure that the firms / individuals invited to tender (and where appropriate, quote) are among those on approved lists or where necessary a framework agreement. Where in the opinion of the chief finance officer it is desirable to seek tenders from firms not on the approved lists, the reason shall be recorded in writing to the Clinical Chief Officer The governing body may only negotiate contracts on behalf of the group, and the group may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with: i. the group s standing orders; ii. the Public Contracts Regulation 2006, any successor legislation and any other applicable law; and iii. take into account as appropriate any applicable NHS England or the Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with (ii) above In all contracts entered into, the group shall endeavour to obtain best value for money. The Clinical Chief Officer shall nominate an individual who shall oversee and manage each contract on behalf of the group. 14. COMMISSIONING POLIC working in partnership with relevant national and local stakeholders, the group will commission certain health services to meet the reasonable requirements of the persons for whom it has responsibility

170 14.1. The group will coordinate its work with NHS England, other clinical commissioning groups, local providers of services, local authority(ies), including through Health & Wellbeing Boards, patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans The Clinical Chief Officer will establish arrangements to ensure that regular reports are provided to the governing body detailing actual and forecast expenditure and activity for each contract The Chief Finance Officer will maintain a system of financial monitoring to ensure the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality. 15. RISK MANAGEMENT AND INSURANCE The Chief Operating Officer shall ensure that the CCG has a programme of risk management, in accordance with current Department of Health assurance framework requirements, which must be approved and monitored by the Governing Body The programme of risk management shall include: a) a process for identifying and quantifying risks and potential liabilities; b) engendering among all levels of staff a positive attitude towards the control of risk; c) management processes to ensure all significant risks and potential liabilities are addressed including effective systems of internal control, cost effective insurance cover, and decisions on the acceptable level of retained risk; d) contingency plans to offset the impact of adverse events; e) audit arrangements including; internal audit, clinical audit, health and safety review; f) a clear indication of which risks shall be insured; g) arrangements to review the risk management programme The existence, integration and evaluation of the above elements will assist in providing a basis to make a statement on the effectiveness of internal control within the Annual Report and Accounts as required by current Department of Health guidance. 16. PAROLL The Chief Finance Officer will ensure that the payroll service selected: 77 a) is supported by appropriate (i.e. contracted) terms and conditions; b) has adequate internal controls and audit review processes;

171 c) has suitable arrangements for the collection of payroll deductions and payment of these to appropriate bodies In addition the chief finance office shall set out comprehensive procedures for the effective processing of payroll. 17. NON-PA EXPENDITURE The CCG will approve the level of non-pay expenditure on an annual basis and the Clinical Chief Officer will determine the level of delegation to budget managers The Clinical Chief Officer shall set out procedures on the seeking of professional advice regarding the supply of goods and services The Chief Finance Officer will: a) advise the CCG on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the scheme of delegated financial limits as shown in Appendix J. b) be responsible for the prompt payment of all properly authorised accounts and claims; c) be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable. 18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURIT OF ASSETS POLIC the group will put arrangements in place to manage capital investment, maintain an asset register recording fixed assets and put in place polices to secure the safe storage of the group s fixed assets The Clinical Chief Officer will a) ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon plans; b) be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost; c) shall ensure that the capital investment is not undertaken without confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges; d) be responsible for the maintenance of registers of assets, taking account of the advice of the chief finance officer concerning the form of any register and 78

172 79 the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year The Chief Finance Officer will prepare detailed procedures for the disposals of assets. 19. DISPOSALS AND CONDEMNATIONS, LOSSES AND SPECIAL PAMENTS Disposals and Condemnations Procedures The Chief Finance Officer must prepare detailed procedures for the disposal of assets including condemnations, and ensure that these are notified to managers When it is decided to dispose of a CCG asset, the Head of Department or authorised deputy will determine and advise the Chief Finance Officer of the estimated market value of the item, taking account of professional advice where appropriate All unserviceable articles shall be: (a) condemned or otherwise disposed of by an employee authorised for that purpose by the Chief Finance Officer; (b) recorded by the Condemning Officer in a form approved by the Chief Finance Officer which will indicate whether the articles are to be converted, destroyed or otherwise disposed of. All entries shall be confirmed by the countersignature of a second employee authorised for the purpose by the Chief Finance Officer The Condemning Officer shall satisfy himself as to whether or not there is evidence of negligence in use and shall report any such evidence to the Chief Finance Officer who will take the appropriate action Losses and Special Payments Procedures The Chief Finance Officer must prepare procedural instructions on the recording of and accounting for condemnations, losses, and special payments Any employee or officer discovering or suspecting a loss of any kind must either immediately inform their Head of Department, who must immediately inform the Clinical Chief Officer and the Chief Finance Officer or inform an officer charged with responsibility for responding to concerns involving loss. This officer will then appropriately inform the Chief Finance Officer and/or Clinical Chief Officer. Where a criminal offence is suspected, the Chief Finance Officer must immediately inform the police if theft or arson is involved. In cases of fraud and corruption or of anomalies which may indicate fraud or corruption, the Chief Finance Officer must inform the

173 relevant LAFS and Operational Fraud Team (OFT) in accordance with the CCG s Anti-Fraud and Corruption Policy (Appendix K) Suspected fraud The Chief Finance Officer must notify the NHS CFS and the External Auditor of all frauds For losses apparently caused by theft, arson, neglect of duty or gross carelessness, except if trivial, the Chief Finance Officer must immediately notify: (a) the Clinical Commissioning Group, and (b) the External Auditor Within limits delegated to it by the Department of Health, the CCG shall approve the writing-off of losses The Chief Finance Officer shall be authorised to take any necessary steps to safeguard the CCG s interests in bankruptcies and company liquidations For any loss, the Chief Finance Officer should consider whether any insurance claim can be made The Chief Finance Officer shall maintain a Losses and Special Payments Register in which write-off action is recorded No special payments exceeding delegated limits shall be made without the prior approval of the Department of Health All losses and special payments must be reported to the Audit Committee at every meeting. 20. RETENTION OF RECORDS POLIC the group will put arrangements in place to retain all records in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance The Clinical Chief Officer shall: (a) (b) (c) be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance; ensure that arrangements are in place for effective responses to Freedom of Information requests; publish and maintain a Freedom of Information Publication Scheme. 80

174 APPENDIX F - NOLAN PRINCIPLES 1. The Nolan Principles set out the ways in which holders of public office should behave in discharging their duties. The seven principles are: a) Selflessness Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends. b) Integrity Holders of public office should not place themselves under any financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties. c) Objectivity In carrying out public business, including making public appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit. d) Accountability Holders of public office are accountable for their decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office. e) Openness Holders of public office should be as open as possible about all the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands. 81

175 f) Honesty Holders of public office have a duty to declare any private interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest. g) Leadership Holders of public office should promote and support these principles by leadership and example. Source: The First Report of the Committee on Standards in Public Life (1995) Available at

176 APPENDIX G NHS CONSTITUTION The NHS Constitution sets out seven key principles that guide the NHS in all it does: 1. The NHS provides a comprehensive service, available to all - irrespective of gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to diagnose, treat, and improve both physical and mental health. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population 2. Access to NHS services is based on clinical need, not an individual s ability to pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament. 3. The NHS aspires to the highest standards of excellence and professionalism - in the provision of high-quality care that is safe, effective and focused on patient experience; in the people it employs, and in the support, education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and the promotion, conduct and use of research to improve current and future health and care of the population. Respect, dignity, compassion and care should be at the core of how patients and staff are treated not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported. 4. The NHS aspires to put patients at the heart of everything it does it should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve services. 5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population - the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with other local authority services and a wide range of other private and voluntary sector organisations to deliver improvements in health and well-being 6. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources - public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves 7. The NHS is accountable to the public, communities and patients that it serves - the NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always clear and up-to-date statement of NHS accountability for this purpose 83

177 APPENDIX H TENDERING AND CONTRACTING 1.1 Duty to comply with Standing Orders and Prime Financial Policies The procedure for making all contracts by or on behalf of the CCG shall comply with these Standing Orders and Prime Financial Policies (except where Standing Order No Suspension of Standing Orders is applied). 1.2 EU Directives Governing Public Procurement (a) (b) Directives by the Council of the European Union promulgated by the Department of Health (DH) prescribing procedures for awarding all forms of contracts shall have effect as if incorporated in these Standing Orders and Prime Financial Policies. Clinical Commissioning Group s should consider obtaining support from the NHS Purchasing and Supply Agency for procurement to ensure compliance when engaging in tendering procedures. 1.3 Reverse e Auctions The CCG should have policies and procedures in place for the control of all tendering activity carried out through Reverse eauctions. For further guidance on Reverse eauctions refer to Formal Competitive Tendering General Applicability The CCG shall ensure that competitive tenders are invited for: the supply of goods, materials and manufactured articles; the rendering of services including all forms of management consultancy services (other than specialised services sought from or provided by the DH); Health Care Services Where the CCG elects to invite tenders for the supply of healthcare services these Standing Orders and Prime Financial Policies shall apply as far as they are applicable to the tendering procedure and need to be read in conjunction with Prime Financial Policy No Exceptions and instances where formal tendering need not be applied Formal tendering procedures need not be applied where: (a) (b) the estimated expenditure or income does not, or is not reasonably expected to, exceed 50,000. where the supply is proposed under special arrangements negotiated by the DH in which event the said special arrangements must be complied with; (c) regarding disposals as set out in Prime Financial Policy No. 19; Formal tendering procedures may be waived in the following circumstances: (d) in very exceptional circumstances where the Clinical Chief Officer decides that formal tendering procedures would not be practicable or the estimated expenditure or income 84

178 would not warrant formal tendering procedures, and the circumstances are detailed in an appropriate CCG record; (e) where the requirement is covered by an existing contract; (f) where PASA agreements are in place and have been approved by the Governing Body; (g) where a consortium arrangement is in place and a lead organisation has been appointed to carry out tendering activity on behalf of the consortium members; (h) (i) (j) (k) (l) where the timescale genuinely precludes competitive tendering but failure to plan the work properly would not be regarded as a justification for a single tender; where specialist expertise is required and is available from only one source; when the task is essential to complete the project, and arises as a consequence of a recently completed assignment and engaging different consultants for the new task would be inappropriate; there is a clear benefit to be gained from maintaining continuity with an earlier project. However in such cases the benefits of such continuity must outweigh any potential financial advantage to be gained by competitive tendering; for the provision of legal advice and services providing that any legal firm or partnership commissioned by the CCG is regulated by the Law Society for England and Wales for the conduct of their business (or by the Bar Council for England and Wales in relation to the obtaining of Counsel s opinion) and are generally recognised as having sufficient expertise in the area of work for which they are commissioned. The Chief Finance Officer will ensure that any fees paid are reasonable and within commonly accepted rates for the costing of such work. (m) where allowed and provided for in the Capital Investment Manual. The waiving of competitive tendering procedures should not be used to avoid competition or for administrative convenience or to award further work to a consultant originally appointed through a competitive procedure. Where it is decided that competitive tendering is not applicable and should be waived, the fact of the waiver and the reasons should be documented and recorded in an appropriate CCG record and reported to the Audit Committee at each meeting Fair and Adequate Competition Where the exceptions set out in paragraph Nos. 1.3 and apply, the CCG shall ensure that invitations to tender are sent to a sufficient number of firms/individuals to provide fair and adequate competition as appropriate, and in no case less than two firms/individuals, having regard to their capacity to supply the goods or materials or to undertake the services or works required List of Approved Firms The CCG shall ensure that the firms/individuals invited to tender (and where appropriate, quote) are among those on approved lists. Where in the opinion of the Chief Finance Officer it is desirable to seek tenders from firms not on the approved lists, the reason shall be recorded in writing to the Clinical Chief Officer (see paragraph 1.8 (a) Competitive Tendering) Items which subsequently breach thresholds after original approval 85

179 Items estimated to be below the limits set in this Prime Financial Policies for which formal tendering procedures are not used which subsequently prove to have a value above such limits shall be reported to the Clinical Chief Officer, and be recorded in an appropriate CCG record E-tendering and E-Auctions E-tendering provides web based technology that allows buyers and suppliers to securely manage their interactions during the tender process on-line. For e-tendering, the CCG will work with the North West Collaborative Procurement Hub (NWCPH) which uses Bravo Solutions e-tendering programme. Appendix I details the procedural guidance on e- tendering. The standing orders and standing financial instructions around the tender process must be applied to any e-tendering process. 1.5 Contracting/Tendering Procedure Invitation to tender (i) (ii) All invitations to tender shall state the date and time as being the latest time for the receipt of tenders. All invitations to tender shall state that no tender will be accepted unless: submitted in a plain sealed package or envelope bearing a pre-printed label supplied by the CCG (or the word tender followed by the subject to which it related) and the latest date and time for the receipt of such tender addressed to the Clinical Chief Officer or nominated Manager; that tender envelopes/ packages shall not bear any names or marks indicating the sender. The use of courier/postal services must not identify the sender on the envelope or on any receipt so required by the deliverer. (iii) Every tender for goods, materials, services or disposals shall embody such of the NHS Standard Contract Conditions as are applicable. (iv) Every tender must have given, or give a written undertaking, not to engage in collusive tendering or other restrictive practice Receipt and safe custody of tenders The Clinical Chief Officer or his/her nominated representative will be responsible for the receipt, endorsement and safe custody of tenders received until the time appointed for their opening. The date and time of receipt of each tender shall be endorsed on the tender envelope/package Opening tenders and Register of tenders (i) As soon as practicable after the date and time stated as being the latest time for the receipt of tenders, they shall be opened by two senior officers/managers designated by the Clinical Chief Officer and not from the originating department. (ii) A member of the CCG Governing Body will be required to be one of the two approved persons present for the opening of tenders estimated above 250,000. The rules relating to the opening of tenders will need to be read in conjunction with any delegated authority set out in the CCG s Scheme of Delegation. 86

180 (iv) (v) (v) The originating Department will be taken to mean the Department sponsoring or commissioning the tender. The involvement of Finance Directorate staff in the preparation of a tender proposal will not preclude the Chief Finance Officer or any approved Senior Manager from the Finance Directorate from serving as one of the two senior managers to open tenders. All Executive Directors/members will be authorised to open tenders regardless of whether they are from the originating department provided that the other authorised person opening the tenders with them is not from the originating department. The CCG s Company Secretary will count as a Director for the purposes of opening tenders. (vi) (vii) Every tender received shall be marked with the date of opening and initialed by those present at the opening. A register shall be maintained by the Clinical Chief Officer, or a person authorised by him, to show for each set of competitive tender invitations despatched: - the name of all firms individuals invited; - the names of firms individuals from which tenders have been received; - the date the tenders were receives and opened; - the persons present at the opening; - the price shown on each tender; - a note where price alterations have been made on the tender and suitably initialed. Each entry to this register shall be signed by those present. A note shall be made in the register if any one tender price has had so many alterations that it cannot be readily read or understood. (viii) Incomplete tenders, i.e. those from which information necessary for the adjudication of the tender is missing, and amended tenders i.e., those amended by the tenderer upon his/her own initiative either orally or in writing after the due time for receipt, but prior to the opening of other tenders, should be dealt with in the same way as late tenders. (paragraph No below) Admissibility (i) (ii) If for any reason the designated officers are of the opinion that the tenders received are not strictly competitive (for example, because their numbers are insufficient or any are amended, incomplete or qualified) no contract shall be awarded without the approval of the Clinical Chief Officer. Where only one tender is sought and/or received, the Clinical Chief Officer and Chief Finance Officer shall, as far practicable, ensure that the price to be paid is fair and reasonable and will ensure value for money for the CCG Late tenders (i) Tenders received after the due time and date, but prior to the opening of the other tenders, may be considered only if the Clinical Chief Officer or his/her nominated officer decides that there are exceptional circumstances i.e. despatched in good time but delayed through no fault of the tenderer. 87 (ii) Only in the most exceptional circumstances will a tender be considered which is received after the opening of the other tenders and only then if the tenders that have been duly opened have

181 not left the custody of the Clinical Chief Officer or his/her nominated officer or if the process of evaluation and adjudication has not started. (iii) (iv) While decisions as to the admissibility of late, incomplete or amended tenders are under consideration, the tender documents shall be kept strictly confidential, recorded, and held in safe custody by the Clinical Chief Officer or his/her nominated officer. Accepted late tenders will be reported to the Governing Body Acceptance of formal tenders (See overlap with paragraph No. 1.7) (i) (ii) Any discussions with a tenderer which are deemed necessary to clarify technical aspects of his/her tender before the award of a contract will not disqualify the tender. The lowest tender, if payment is to be made by the CCG, or the highest, if payment is to be received by the CCG, shall be accepted unless there are good and sufficient reasons to the contrary. Such reasons shall be set out in either the contract file, or other appropriate record. It is accepted that for professional services such as management consultancy, the lowest price does not always represent the best value for money. Other factors affecting the success of a project include: (a) experience and qualifications of team members; (b) understanding of client s needs; (c) feasibility and credibility of proposed approach; (d) ability to complete the project on time. Where other factors are taken into account in selecting a tenderer, these must be clearly recorded and documented in the contract file, and the reason(s) for not accepting the lowest tender clearly stated. (iii) (iv) No tender shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with these Instructions except with the authorisation of the Clinical Chief Officer. The use of these procedures must demonstrate that the award of the contract was: (a) not in excess of the going market rate / price current at the time the contract was awarded; (b) that best value for money was achieved. (vi) All Tenders should be treated as confidential and should be retained for inspection Tender reports to the CCG Governing Body Reports to the CCG Governing Body will be made on an exceptional circumstance basis only List of approved firms (see paragraph 1.4.5) (a) Responsibility for maintaining list 88 A manager nominated by the Clinical Chief Officer shall on behalf of the CCG maintain lists of approved firms from who tenders and quotations may be invited. These shall be kept under frequent review. The lists shall include all firms who have applied for permission to tender and as to whose technical and financial competence the CCG is satisfied. All suppliers must be made aware of the CCG s terms and conditions of contract.

182 (b) Financial Standing and Technical Competence of Contractors The Chief Finance Officer may make or institute any enquiries he/she deems appropriate concerning the financial standing and financial suitability of approved contractors. The Director with lead responsibility for clinical governance will similarly make such enquiries as is felt appropriate to be satisfied as to their technical / medical competence Exceptions to using approved contractors If in the opinion of the Clinical Chief Officer and the Chief Finance Officer or the Director with lead responsibility for clinical governance it is impractical to use a potential contractor from the list of approved firms/individuals (for example where specialist services or skills are required and there are insufficient suitable potential contractors on the list), or where a list for whatever reason has not been prepared, the Clinical Chief Officer should ensure that appropriate checks are carried out as to the technical and financial capability of those firms that are invited to tender or quote. An appropriate record in the contract file should be made of the reasons for inviting a tender or quote other than from an approved list. 1.6 Quotations: Competitive and non-competitive General Position on quotations Quotations are required where formal tendering procedures are not adopted and where the intended expenditure or income exceeds, or is reasonably expected to exceed 10,000 but not exceed 50, Competitive Quotations (i) (ii) (iii) (iv) Quotations should be obtained from at least 3 firms/individuals based on specifications or terms of reference prepared by, or on behalf of, the CCG. Quotations should be in writing unless the Clinical Chief Officer or his nominated officer determines that it is impractical to do so in which case quotations may be obtained by telephone. Confirmation of telephone quotations should be obtained as soon as possible and the reasons why the telephone quotation was obtained should be set out in a permanent record. All quotations should be treated as confidential and should be retained for inspection. The Clinical Chief Officer or his nominated officer should evaluate the quotation and select the quote which gives the best value for money. If this is not the lowest quotation if payment is to be made by the CCG, or the highest if payment is to be received by the CCG, then the choice made and the reasons why should be recorded in a permanent record Non-Competitive Quotations Non-competitive quotations in writing may be obtained in the following circumstances: (i) (ii) (iii) the supply of proprietary or other goods of a special character and the rendering of services of a special character, for which it is not, in the opinion of the Responsible Officer, possible or desirable to obtain competitive quotations; the supply of goods or manufactured articles of any kind which are required quickly and are not obtainable under existing contracts; miscellaneous services, supplies and disposals; 89

183 (iv) where the goods or services are for building and engineering maintenance the responsible works manager must certify that the first two conditions of this Appendix (i.e.: (i) and (ii) of this Appendix) apply Quotations to be within Financial Limits No quotation shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with Prime Financial Policies except with the authorisation of either the Clinical Chief Officer or Chief Finance Officer. 1.7 Authorisation of Tenders and Competitive Quotations Providing all the conditions and circumstances set out in these Prime Financial Policies have been fully complied with, formal authorisation and awarding of a contract may be decided by the following staff to the value of the contract as follows: Chief Finance Officer up to 250,000 Clinical Chief Officer up to 250,000 Chair up to 250,000 CCG Governing Body over 250,000 These levels of authorisation may be varied or changed and need to be read in conjunction with the CCG Governing Body s Scheme of Delegation. Formal authorisation must be put in writing. In the case of authorisation by the CCG Governing Body this shall be recorded in their minutes. 1.8 Instances where formal competitive tendering or competitive quotation is not required Where competitive tendering or a competitive quotation is not required, the CCG should adopt one of the following alternatives: (a) the CCG shall use the NHS Purchasing & Supplies Agency for procurement of all goods and services unless the Clinical Chief Officer or nominated officers deem it inappropriate. The decision to use alternative sources must be documented. (b) if the CCG does not use the NHS Purchasing & Supplies Agency where tenders or quotations are not required, because expenditure is below 10,000 the CCG shall procure goods and services in accordance with procurement procedures approved by the Chief Finance Officer. 1.9 Compliance requirements for all contracts The Governing Body may only enter into contracts on behalf of the CCG within the statutory powers delegated to it by the Secretary of State and shall comply with: (a) (b) The CCG s Standing Orders and Prime Financial Policies; EU Directives and other statutory provisions; (c) Such of the NHS Standard Contract Conditions as are applicable; 90 (d) (e) (f) Essential Standards of Quality and Safety ; Contracts with Foundation Trusts must be in a form compliant with appropriate NHS guidance; Where appropriate contracts shall be in or embody the same terms and conditions of contract as was the basis on which tenders or quotations were invited;

184 (g) In all contracts made by the CCG, the Governing Body shall endeavour to obtain best value for money by use of all systems in place. The Clinical Chief Officer shall nominate an officer who shall oversee and manage each contract on behalf of the CCG Personnel and Agency or Temporary Staff Contracts The Clinical Chief Officer shall nominate officers with delegated authority to enter into contracts of employment, regarding staff, agency staff or temporary staff service contracts Healthcare Services Agreements Service agreements with NHS providers for the supply of healthcare services shall be drawn up in accordance with the NHS and Community Care Act 1990 and administered by the CCG. Service agreements are not contracts in law and are not enforceable by the courts. However, a contract with a Foundation Trust, being a PBC, is a legal document and is enforceable in law. The Clinical Chief Officer shall nominate officers to commission service agreements with providers of healthcare in line with a commissioning plan approved by the Governing Body Disposals Competitive Tendering or Quotation procedures shall not apply to the disposal of: (a) (b) (c) any matter in respect of which a fair price can be obtained only by negotiation or sale by auction as determined (or pre-determined in a reserve) by the Clinical Chief Officer or his nominated officer; obsolete or condemned articles and stores, which may be disposed of in accordance with the supplies policy of the CCG; items to be disposed of with an estimated sale value of less than [n], this figure to be reviewed on a periodic basis; 1.13 In-house Services The Clinical Chief Officer shall be responsible for ensuring that best value for money can be demonstrated for all services provided on an in-house basis. The CCG may also determine from time to time that in-house services should be market tested by competitive tendering In all cases where the Group determines that in-house services should be subject to competitive tendering the following groups shall be set up: (a) Specification group, comprising the Clinical Chief Officer or nominated officer/s and specialist. (b) In-house tender group, comprising a nominee of the Clinical Chief Officer and technical support. (c) Evaluation team, comprising normally a specialist officer, a supplies officer and a Chief Finance Officer representative. For services having a likely annual expenditure exceeding 250,000, a non-officer member should be a member of the evaluation team All groups should work independently of each other and individual officers may be a member of more than one group but no member of the in-house tender group may participate in the evaluation of tenders The evaluation team shall make recommendations to the Governing Body The Clinical Chief Officer shall nominate an officer to oversee and manage the contract on behalf of the CCG. 91

185 92

186 APPENDIX I PROCUREMENT PROCEDURES E-TENDERING & E-AUCTIONS FOR CONTRACTS FOR SUPPLIES & SERVICES E-Tendering Introduction 1. CCG Prime Financial Policy specify that e-tendering may be undertaken instead of the traditional paper based tendering processes. 2. E-tendering replaces the traditional paper-based tendering process with an electronic equivalent which enables the Trust to issue tender invitations and receive tender submissions electronically. This can engender cost and efficiency savings for both potential contractors and for the Trust. Approvals and Authorisations 3. E-tendering shall only be undertaken using an e-tendering system approved for use by the Chief Finance Officer. In approving such a system, the Chief Finance Officer shall have regard to security issues such as access control, data encryption, verification of supplier identity, and measures to minimise risks arising from viruses. The Chief Finance Officer shall take advice as necessary from I.T. Services. 4. Where consideration is being given to an e-tender process, advice shall also be sought as necessary from the Head of Procurement. Controls - General 5. In undertaking an e-tendering process, it must be ensured that the same level of control is applied as would normally be applied to a paper-based process, in accordance with the CCG Prime Financial Policies and the CCGs Procurement Procedures issued by the Head of Procurement. 6. Access to an e-tendering system must be password controlled and users shall ensure that they comply with the guidelines on passwords issued by I.T. Services. 7. It must be ensured that access permissions within an e-tendering system, e.g. in terms of owner, edit, view etc. are set up to minimise the risk of security breaches. 8. It must also be ensured that commercial sensitivities are respected and that appropriate restrictions are placed upon those areas of the system, and information, that potential suppliers may view or access. Controls E-Tenders 93

187 9. Tenders must be received via a secure electronic tender box which cannot be accessed or viewed prior to the closing date and time for the receipt of tenders. 10. It must not be possible to amend or alter in any way tenders once submitted. 11. There shall be a full audit trail showing the details, including dates and times, of the key events during the tendering process, e.g. issue of invitations to tender, reminders issued to suppliers, receipt of tenders, and opening of tenders. This shall also identify the staff members involved. 12. E-tenders shall be evaluated on the same basis as paper tenders and where tenders are evaluated electronically the same principles of control shall be adhered to. 13. Electronic tender data shall be retained for six years and shall be readily available for audit inspection. E-Auctions 1. Introduction a. CCGs Prime Financial Policies specify that e-auctions may be undertaken instead of the traditional paper based tendering processes. b. An e-auction is a process whereby electronic bids are submitted in a real - time environment by potential contractors who bid lower as the auction unfolds. It is anticipated that an e-auction would normally be undertaken after a pre-qualifying process. 2. Approvals and Authorisations 94 a. E-auctions shall only be undertaken using an e-auction system approved for use by the Chief Finance Officer. In approving such a system, the Chief Finance Officer shall have regard to security issues such as access control, data encryption, verification of supplier identity, and measures to minimise risks arising from viruses. The Chief Finance Officer shall take advice as necessary from I.T. Services. b. E-auctions must only be undertaken with the approval of the Chief Finance Officer. Where consideration is being given to an e-auction process, advice shall also be sought as necessary from the Head of Procurement. 3. Controls - General a) In undertaking an e-auction process, it must be ensured that the same level of control is applied as would normally be applied to a paper-based process, in accordance with the CCGs Prime Financial Policies and the CCGs Procurement Procedures issued by the Head of Procurement.

188 b) Access to an e-auction system must be password controlled and users shall ensure that they comply with the guidelines on passwords issued by I.T. Services. c) It must be ensured that access permissions within an e-auction system are set up to minimise the risk of security breaches. d) It must also be ensured that commercial sensitivities are respected and that appropriate restrictions are placed upon those areas of a system, and information, that potential bidders may view or access. 4. Controls - E- Auctions a. It must not be possible to amend or alter bids in any way once submitted, although they may (obviously) be superseded by later bids made by the same bidder. b. The rules of the auction shall be clearly established beforehand - for example, bidders shall be aware of the duration of the auction, shall know what to do if they have a problem during the auction, and shall be notified when it ends. c. There shall be a full audit trail showing the details, with dates and times, of key events in the auction process. This shall also identify the staff members involved. d. E-auctions shall normally incorporate a scoring process based on the bids submitted. When bids are evaluated the same principles of control shall be adhered to as for tenders. e. Electronic auction data shall be retained for six years and shall be readily available for audit inspection. 95

189 APPENDIX J DELEGATED FINANCIAL LIMITS Delegated Financial Limits Note these delegated limits form part of the Corporate Governance Manual and should be read together with the Standing Orders, Scheme of Delegation and Prime Financial Policies. All thresholds are exclusive of VAT irrespective of recovery arrangements Financial Limits Notes 1 Gifts & Hospitality Received policy follows guidance contained in DH circular HSG(93) 5 Standards of Business Conduct for NHS Staff & the code of conduct for NHS managers All NHS Staff Up to 25 2 Litigation Claims Governing Body Over 1,000,000 Clinical Chief Officer Up to 1,000,000 Chief Finance Officer Up to 250,000 3 Losses and Special Payments - To be reported to CCG Audit Committee Governing Body Over 100,000 Clinical Chief Officer Up to 100,000 Chief Finance Officer Up to 100,000 4 Petty Cash If a gift is offered exceeding this employees/governing Body members must seek approval of Clinical Chief Officer/Chief Finance Officer Chief Finance Officer Over 100 See Petty Cash Procedures available from Finance Budget Holder Up to 100 Department 5 Removal Expenses: Clinical Chief Officer Over 8,500 With Remuneration Committee approval With Remuneration Committee Chief Finance Officer Up to 8,500 approval 6 Approval of Contracts Health Care Contracts (Including Primary Care and Public Health) Governing Body Over 100,000,000 Chair Up to 100,000,000 Clinical Chief Officer Up to 100,000,000 Chief Finance Officer Up to 100,000,000 7 Approving Healthcare Ad Hoc payments (incl. Continuing Healthcare, Bespoke Care, Non Contract Activity etc.) Clinical Chief Officer Unlimited 96

190 Chief Finance Officer Senior Operating Officers Commissioning Support Unit Unlimited As per their Authorised signing levels Up to 100,000 8 Approval and Authorisation of Requisitions and Invoice Payments for non-healthcare contracts Chair Clinical Chief Officer Chief Finance Officer Senior Operating Officers Unlimited Unlimited Unlimited As per their Authorised signing levels 9 The requirement to obtain Quotations and Tenders (over lifetime of contract) Also in Prime Financial Policies - Tax linked transactions to be treated cumulatively (in compliance with EU Procurement thresholds: over 50,000 to EU Limit As at Jan 2012: Supplies & Services 113,057, Part B 173,934 and Works 173,934 please check current rates at Obtain a minimum of 3 written competitive tenders 10,000 up to 49,999 Obtain a minimum of 3 written quotes 1,000 to 9,999 obtain two verbal quotations 100 to 999 obtain one verbal quotation 10 Virement (excluding new allocations and earmarked resources) Governing Body Over 5,000,000 Clinical Chief Officer Up to 5,000,000 Chief Finance Officer Up to 5,000, Disposals and Condemnations - All assets at Market Value. Governing Body Clinical Chief Officer Chief Finance Officer 97 Over 100,000 per item Up to 100,000 per item Up to 100,000 per item Use of capital receipts must be authorised by NHS North

191 12 Approving Monthly Contract payments/ Service level agreement Payments Healthcare ( Linked to Section 6 above) Approval from two of the following: Chair Clinical Chief Officer Unlimited Chief Finance Officer 98

192 APPENDIX K LOCAL ANTI-FRAUD AND CORRUPTION POLIC DOCUMENT CONTROL TITLE Local Anti-Fraud and Corruption Policy DATE OF ISSUE February 2013 REVIEW DATE AND B WHOM PREPARED B January 2013 by Local Anti-Fraud Specialist and Chief Finance Officer LAFS for Blackburn with Darwen CCG APPROVED B Local Assurance Group AUTHORISED B Chief Finance Officer APPROVAL DATE January

193 CONTENTS SUMMAR Page 4 INTRODUCTION Page 4 General Generic areas of action Aims and scope DEFINITIONS Page 5 Fraud Bribery and Corruption Employees CODES OF CONDUCT Page 7 ROLES AND RESPONSIBILITIES Page 7 Role of Blackburn with Darwen CCG Employees Managers Local Anti-Fraud Specialist (LAFS) Area Anti-Fraud Lead (AAFL) Chief Finance Officer Internal and External Audit Human Resources Information Management and Technology THE RESPONSE PLAN Page 13 Reporting fraud or corruption Disciplinary action Police involvement Managing the investigation Gathering evidence Reporting the results of the investigation THE RECOVER OF LOSSES TO FRAUD AND CORRUPTION Page 15 Case example Reporting the results of the investigation Action to be taken Timescales Recording APPENDICES Page 18 Desktop guide Referral Form FURTHER READING 100

194 SUMMAR Blackburn with Darwen Clinical Commissioning Group (the CCG) is committed to reducing the level of fraud and corruption within the NHS to an absolute minimum and keeping it at that level, freeing up public resources for better patient care. This policy has been produced by the Local Anti-Fraud Specialist (LAFS),t: ; and is intended as a guide for all members and employees on anti-fraud and corruption work within the NHS. All genuine suspicions of fraud and corruption can be reported: to the LAFS through the NHS Fraud and Corruption Reporting Line (FCRL) on (freephone) (Lines open 8.00 am to 6.00 pm) online at INTRODUCTION General One of the basic principles of public sector organisations is the proper use of public funds. The majority of people who work in the NHS are honest and professional and they find that fraud committed by a minority is wholly unacceptable as it ultimately leads to a reduction in the resources available for patient care. It is important that public sector staff are fully aware of the risks of fraud and the means of enforcing the rules against fraud/other illegal acts involving dishonesty. (Hereafter, all such offences are referred to as fraud except where specified). NHS Protect is a business unit of the NHS Business Services Authority. It has responsibility for all policy and operational matters relating to the prevention, detection and investigation of fraud and corruption and the management of security in the NHS. All instances where fraud is suspected are properly investigated until their conclusion by staff trained by NHS Protect. Any investigations will be handled in accordance with the NHS Counter Fraud and Corruption Manual. The CCG does not tolerate fraud and corruption within the NHS. The aim is to eliminate all NHS fraud and corruption as far as possible. Generic areas of action The CCG is committed to taking all necessary steps to counter fraud and corruption in accordance with this policy, the NHS Counter Fraud and Corruption Manual, the policy statement Applying Appropriate Sanctions Consistently published by NHS Protect and any other relevant guidance or advice issued by NHS Protect. To meet its objectives, the CCG has adopted the three key principles designed to minimise the incidence of crime and to deal effectively with those who commit crimes against the NHS. This approach, that is both proactive and reactive, was developed by NHS Protect and applies across the sector at national and local, strategic and operational levels. The three key principles are: Inform and Involve - those who work for or use the NHS about crime and how to tackle it. NHS staff and the public should be informed and involved with a view to increasing understanding of the impact of crime against the NHS. This can take place through communications and promotion such as public awareness campaigns and media management. Working relationships will be strengthened and maintained through active engagement. Where necessary, we will work to change the culture and perceptions of crime so that it is not tolerated at any level. NHS Protect will provide the tools to the Local Anti-Fraud Specialist (LAFS) so that they are equipped to 101

195 deliver this strategy at a local level. NHS Protect will also provide the LAFS with the information and intelligence they need in order to be able to detect and investigate crime. Prevent and Deter crime in the NHS, in order to reduce the opportunity for crime to occur or to re-occur and to discourage those individuals who may be tempted to commit crime. Successes will be publicised so that the risk and consequences of detection are clear to potential offenders. Those individuals who are not deterred should be prevented from committing crime by ensuring robust systems exist, which will be put in place in line with policy, standards and guidance developed by NHS Protect. Hold to account those who have committed crime against the NHS. Crimes must be detected and investigated, suspects prosecuted where appropriate; and redress sought wherever possible. Where necessary and appropriate, this work should be conducted in partnership with the police and other crime prevention agencies. In relation to economic crime, investigation and prosecution should take place locally wherever possible. NHS Protect will deal with cases which are complex or of national significance through the National Investigation Service. Where recovery of monies lost to crime is viable, this should be pursued. In relation to crimes against NHS staff, criminal damage or theft against NHS property, investigation and prosecution should be undertaken in liaison with the police and CPS or, where necessary, NHS Protect. NHS funded organisations will need to meet the relevant standards when tackling crime, and will be responsible for ensuring that they do so, supported by NHS Protect s quality assurance process. Aims and scope This policy relates to all forms of fraud and corruption and is intended to provide direction and help to employees who may identify suspected fraud. It provides a framework for responding to suspicions of fraud, advice and information on various aspects of fraud and implications of an investigation. It is not intended to provide a comprehensive approach to preventing and detecting fraud and corruption. The overall aims of this policy are to: improve the knowledge and understanding of everyone in the CCG, irrespective of their position, about the risk of fraud and corruption within the organisation and its unacceptability assist in promoting a climate of openness and a culture and environment where staff feel able to raise concerns sensibly and responsibly set out the CCG s responsibilities in terms of the deterrence, prevention, detection and investigation of fraud and corruption ensure the appropriate sanctions are considered following an investigation, which may include any or all of the following: o criminal prosecution o civil prosecution o internal/external disciplinary action. This policy applies to all employees and members of the CCG, regardless of position held, as well as consultants, vendors, contractors, and/or any other parties who have a business relationship with the CCG. It will be brought to the attention of all employees and members and form part of the induction process for new staff. 102

196 DEFINITIONS Fraud Historically, fraud was dealt with under Theft Act legislation. However, the Fraud Act 2006 represents an entirely new way of investigating fraud. It is no longer necessary to prove that a person has been deceived. The focus is now on the dishonest behaviour of the suspect and their intent to make a gain or cause a loss. The new offence of fraud can be committed in three ways: 1) Fraud by false representation (s.2) lying about something using any means, e.g. by words or actions 2) Fraud by failing to disclose (s.3) not saying something when you have a legal duty to do so 3) Fraud by abuse of a position of trust (s.4) abusing a position where there is an expectation to safeguard the financial interests of another person or organisation. It should be noted that all offences under the Fraud Act 2006 occur where the act or omission is committed dishonestly and with intent to cause gain or loss. The gain or loss does not have to succeed, so long as the intent is there. Activities constituting fraud include: Forgery or alteration of any document or record Destruction or removal of records Falsification of expenses claims Use of CCG assets to cause loss or gain Inaccurate recording of hours worked Working for another employer without express permission whilst on paid/unpaid sickness absence from the CCG (This list is not exhaustive and constitutes examples only) Bribery and Corruption The Bribery Act 2010 came into effect on 1 st July 2011 and it makes it a criminal offence to: give, promise or offer a bribe, and to request, agree to receive or accept a bribe a corporate offence of failure to prevent bribery by persons working on behalf of a commercial organisation, either in the UK or overseas. The CCG may avoid conviction if it can show that it had procedures and protocols in place to prevent bribery. The corporate offence is not a stand-alone offence, but always follows from a bribery and/or corruption offence committed by an individual associated with the company or organisation in question. On summary conviction, the penalties for these offences include a fine of up to 5,000 and (in the case of individuals) imprisonment for up to 12 months. On conviction on indictment, these penalties increase to an unlimited fine and (in the case of individuals) imprisonment for up to 10 years.any employee or member of the CCG suspected of any activity outlined above will be investigated under the CCG s Anti-Fraud Policy and the Disciplinary Policy and, where appropriate, prosecuted in accordance with the Bribery Act

197 Employees For the purposes of this policy, employees includes all CCG staff and members, including coopted and honorary members. CODES OF CONDUCT The codes of conduct for NHS boards and NHS managers set out the key public service values. They state that high standards of corporate and personal conduct, based on the recognition that patients come first, have been a requirement throughout the NHS since its inception. These values are summarised as: Accountability Probity Openness Everything done by those who work in the authority must be able to stand the tests of parliamentary scrutiny, public judgements on propriety and professional codes of conduct. Absolute honesty and integrity should be exercised in dealing with NHS patients, assets, staff, suppliers and customers. The health body s activities should be sufficiently public and transparent to promote confidence between the authority and its staff and the public. All employees and members should be aware of and act in accordance with these values. ROLES AND RESPONSIBILITIES Through our day-to-day work, we are in the best position to recognise any specific risks within our own areas of responsibility. We all have a duty to ensure that those risks, however large or small, are identified, reported and eliminated. Where you believe the opportunity for fraud or corruption exists, through deliberate action, poor procedures or oversight, you should report it to the LAFS or the NHS Fraud and Corruption Reporting Line or the online reporting facilitity. This section states the roles and responsibilities of employees and other relevant parties in reporting fraud or other irregularities. Role of Blackburn with Darwen CCG The CCG has a duty to ensure that it provides a secure environment in which to work and one where people are confident to raise concerns without worrying that it will reflect badly on them. This extends to ensuring that employees and members feel protected when carrying out their official duties and are not placed in a vulnerable position. If employees or members have concerns about any procedures or processes that they are asked to be involved in, the CCG has a duty to ensure that those concerns are listened to and addressed. The CCG s Clinical Chief Officer is liable to be called to account for specific failures in the CCG s system of internal controls. However, responsibility for the operation and maintenance of controls falls directly to line managers and requires the involvement of all of CCG employees and members. The CCG therefore has a duty to ensure employees and members who are involved in, or who are managing, internal control systems receive adequate training and support in order to carry out their responsibilities. Therefore, the Clinical Chief Officer and Chief Finance Officer will monitor and ensure compliance with this policy. 104

198 Employees and Members The CCG s Prime Financial Policies and procedures place an obligation on all employees and members to act in accordance with best practice. They are expected to act in accordance with the standards laid down by their professional institutes, where applicable, and have a personal responsibility to ensure that they are familiar with them. They also have a duty to protect the assets of the CCG, including information, goodwill and property. In addition, all employees and members have a responsibility to comply with all applicable laws and regulations relating to ethical business behaviour, procurement, personal expenses, conflicts of interest, confidentiality and the acceptance of gifts and hospitality. This means, in addition to maintaining the normal standards of personal honesty and integrity, all employees should always: avoid acting in any way that might cause others to allege or suspect them of dishonesty behave in a way that would not give cause for others to doubt that CCG employees and members deal fairly and impartially with official matters be alert to the possibility that others might be attempting to deceive. All employees and members have a duty to ensure that public funds are safeguarded, whether or not they are involved with cash or payment systems, receipts or dealing with contractors or suppliers. If an employee or member suspects that there has been fraud or corruption, or has seen any suspicious acts or events, they must report the matter to the nominated LAFS (see LAFS heading below). Register of Interests The Trust maintains a Register of Interests for employees and members. All must declare any business or commercial interests including commercial sponsorship or part-time work that could lead to a conflict of interests arising with their role in the Trust. Failure to disclose an interest will lead to disciplinary action. This subject is dealt with in more deta CCG s separate Conflict of Interest policy. Managers Managers must be vigilant and ensure that procedures to guard against fraud and corruption are followed. They should be alert to the possibility that unusual events or transactions could be symptoms of fraud and corruption. If they have any doubts, they must seek advice from the nominated LAFS. Managers must instill and encourage an anti-fraud and corruption culture within their team and ensure that information on procedures is made available to all employees. The LAFS will proactively assist the encouragement of an anti-fraud culture by undertaking work that will raise fraud awareness. 105

199 All instances of actual or suspected fraud or corruption which come to the attention of a manager must be reported immediately. It is appreciated that some employees will initially raise concerns with their manager. However, in such cases, managers must not attempt to investigate the allegation themselves; they have the clear responsibility to refer the concerns to the LAFS as soon as possible. Line managers at all levels have a responsibility to ensure that an adequate system of internal control exists within their areas of responsibility and that controls operate effectively. The responsibility for the prevention and detection of fraud and corruption therefore primarily rests with managers but requires the co-operation of all employees. As part of that responsibility, line managers need to: inform staff of the CCG s Code of Business Conduct and Anti-Fraud and Corruption policy as part of their induction process, paying particular attention to the need for accurate completion of personal records and forms ensure that all employees for whom they are accountable are made aware of the requirements of the policy assess the types of risk involved in the operations for which they are responsible ensure that adequate control measures are put in place to minimise the risks. This must include clear roles and responsibilities, supervisory checks, staff rotation (particularly in key posts), separation of duties wherever possible so that control of a key function is not invested in one individual, and regular reviews, reconciliations and test checks to ensure that control measures continue to operate effectively ensure that any use of computers by employees is linked to the performance of their duties within the CCG be aware of the CCG s Anti-Fraud and Corruption policy and the rules and guidance covering the control of specific items of expenditure and receipts identify financially sensitive posts LAFS ensure that controls are being complied with contribute to their director s assessment of the risks and controls within their business area, which feeds into the CCG s and the Department of Health Accounting Officer s overall statements of accountability and internal control. The Directions to NHS Bodies on Counter Fraud Measures 2004 or Clause 43 and Schedule 13 of the Standard NHS Contract for Acute Services require the CCG to appoint and nominate an LAFS. The LAFS s role is to ensure that all cases of actual or suspected fraud and corruption are notified to the Chief Finance Officer and reported accordingly. The LAFS will regularly report to the Chief Finance Officer on the progress of the investigation and when/if referral to the police is required. The LAFS will: ensure that the Chief Finance Officer is informed about all referrals/cases be responsible for the day-to-day implementation of the three key principles of antifraud and corruption activity and, in particular, the investigation of all suspicions of fraud investigate all cases of fraud in consultation with the Chief Finance Officer, report any case to the police or NHS Protect as agreed and in accordance with the NHS Counter Fraud and Corruption Manual report any case and the outcome of the investigation through NHS Protect s national case management system (FIRST) 106

200 ensure that other relevant parties are informed where necessary, e.g. Human Resources (HR) will be informed if an employee is the subject of a referral ensure that the CCG s incident and losses reporting systems are followed ensure that any system weaknesses identified as part of an investigation are followed up with management and reported to internal audit adhere to the Counter Fraud Professional Accreditation Board (CFPAB) s Principles of Professional Conduct as set out in the NHS Counter Fraud and Corruption Manual not have responsibility for or be in any way engaged in the management of security for any NHS body ensure that the Chief Finance Officer is informed of regional team investigations, including progress updates. Area Anti-Fraud Lead (AAFL) Each Area Anti-Fraud Lead works as part of the NHS Protect operations directorate, whose key objective is to combat fraud and corruption in the National Health Service. Chief Finance Officer The Chief Finance Officer, in conjunction with the Clinical Chief Officer, monitors and ensures compliance with Secretary of State Directions regarding fraud and corruption. The Chief Finance Officer will, depending on the outcome of investigations (whether on an interim/ongoing or concluding basis) and/or the potential significance of suspicions that have been raised, inform appropriate senior management accordingly. The LAFS shall be responsible, in discussion with the Chief Finance Officer, for informing third parties such as external audit or the police at the earliest opportunity, as circumstances dictate. The Chief Finance Officer will inform and consult the Clinical Chief Officer in cases where the loss may be above the agreed limit or where the incident may lead to adverse publicity. If an investigation is deemed to be appropriate, the Chief Finance Officer will delegate to the CCG s LAFS, who has responsibility for leading the investigation, whilst retaining overall responsibility him/herself. The Chief Finance Officer or the LAFS will consult and take advice from the Head of HR if a member of staff is to be interviewed or disciplined. The Chief Finance Officer or LAFS will not conduct a disciplinary investigation, but the employee may be the subject of a separate investigation by HR. Internal and External Audit Any incident or suspicion that comes to internal or external audit s attention will be passed immediately to the nominated LAFS. The outcome of the investigation may necessitate further work by internal or external audit to review systems. Human Resources HR will liaise closely with managers and the LAFS from the outset if an employee is suspected of being involved in fraud and/or corruption, in accordance with agreed liaison protocols. HR staff are responsible for ensuring the appropriate use of the CCG s disciplinary procedure. The HR department will advise those involved in the investigation on matters of employment law and other procedural matters, such as disciplinary and complaints procedures, as requested. Close liaison between the LAFS and HR will be essential to ensure that any parallel sanctions 107

201 (i.e. criminal, civil and disciplinary sanctions) are applied effectively and in a coordinated manner. HR will take steps at the recruitment stage to establish, as far as possible, the previous record of potential employees, as well as the veracity of required qualifications and memberships of professional bodies, in terms of their propriety and integrity. In this regard, temporary and fixed-term contract employees are treated in the same manner as permanent employees. Any reference or testimonial provided for persons dismissed in connection with fraud and corruption will disclose the fact that individuals have been dismissed. The Director of Human Resources MUST be consulted BEFORE any reference or testimonial is sent. This commitment reflects the CCG s view on the severity of incidence of fraud and corruption and the unceasing determination to combat fraud and corrupt practices from its activities. Public Relations The CCG s Head of Communications will need to present the CCG s views on any proven or suspected cases of fraud and corruption. Prior to any response to the media, the Head of Communications should liaise with Chief Finance Officer, the Chief Clinical Officer, the LAFS and NHS Protect. Any response to the media should stress the following key issues: The CCG has a policy for the prevention, detection and prosecution of fraud and corruption The CCG is committed to safeguarding public funds Where fraud and corruption has been detected, the CCG s approach to dealing with fraud and corruption has been vindicated, that it was the CCG s internal policies and procedures that helped detect the problem and that it has been resolved. Disclosure An employee or member who has exhausted all the locally established procedures, including reference to the Chair of the CCG, and who has taken account of advice which may have been given, might wish to consult his/her Member of Parliament in confidence. He/she might also, as a last resort, contemplate the possibility of disclosing his/her concern to the media. Such action if entered into unjustifiably, could result in disciplinary action and might unreasonably undermine public confidence in the service. In view of these considerations, any employee contemplating making a disclosure to the media is advised to seek further specialist guidance from professional or other representative bodies and to discuss matters further with his/her colleagues and, where appropriate, line and professional managers. There is also the possibility that any ill-considered public statement could frustrate legal action being taken against those who may be guilty of any offence. Information Management and Technology The Head of Information Security (or equivalent) will contact the LAFS immediately in all cases where there is suspicion that IT is being used for fraudulent purposes. HR will also be informed if there is a suspicion that an employee is involved. 108

202 THE RESPONSE PLAN Reporting fraud or corruption This section outlines the action to be taken if fraud or corruption is discovered or suspected. If an employee has any of the concerns mentioned in this document, they must inform the nominated LAFS or the CCG s Chief Finance Officer immediately, unless the Chief Finance Officer or LAFS is implicated. If that is the case, they should report it to the Chair or Clinical Chief Officer, who will decide on the action to be taken. Form 1 provides a reminder of the key contacts and a checklist of the actions to follow if fraud and corruption, or other illegal acts, are discovered or suspected. Managers are encouraged to copy this to staff and to place it on staff notice boards in their department. An employee can contact any member of the CCG to discuss their concerns if they feel unable, for any reason, to report the matter to the LAFS or Chief Finance Officer. Employees can also call the NHS Fraud and Corruption Reporting Line on (freephone) or via the online reporting facility at This provides an easily accessible route for the reporting of genuine suspicions of fraud within or affecting the NHS. It allows the CCG s employees and members who are unsure of internal reporting procedures to report their concerns in the strictest confidence. All calls are dealt with by experienced trained staff and any caller who wishes to remain anonymous may do so. Anonymous letters, telephone calls, etc are occasionally received from individuals who wish to raise matters of concern, but not through official channels. While the suspicions may be erroneous or unsubstantiated, they may also reflect a genuine cause for concern and will always be taken seriously. The LAFS will make sufficient enquiries to establish whether or not there is any foundation to the suspicion that has been raised. If the allegations are found to be malicious, they will also be considered for further investigation to establish their source. Employees and members should always be encouraged to report reasonably held suspicions directly to the LAFS. ou can do this by filling in the NHS Fraud and Corruption Referral Form (Form 2) or by contacting the LAFS by telephone or using the contact details supplied on Form 1. Disciplinary Action The disciplinary procedures of the CCG must be followed if an employee is suspected of being involved in a fraudulent or otherwise illegal act. It should be noted, however, that the duty to follow disciplinary procedures will not override the need for legal action to be taken (e.g. consideration of criminal action). In the event of doubt, legal statute will prevail. Police Involvement In accordance with the NHS Counter Fraud and Corruption Manual, the Chief Finance Officer, in conjunction with the LAFS, will decide whether or not a case should be referred to the police. Any referral to the police will not prohibit action being taken under the local disciplinary procedures of the CCG. 109

203 Managing the investigation The LAFS, in consultation with the Chief Finance Officer, will investigate an allegation in accordance with procedures documented in the NHS Counter Fraud and Corruption Manual issued by NHS Protect. The LAFS must be aware that employees and members under an investigation that could lead to disciplinary action have the right to be represented at all stages. In certain circumstances, evidence may best be protected by the LAFS recommending to the CCG that the employee or member is suspended from duty. The CCG will make a decision based on HR advice on the disciplinary options, which include suspension. The CCG will follow its disciplinary procedure if there is evidence that an employee or member has committed an act of fraud or corruption. Gathering Evidence The LAFS will take control of any physical evidence, and record this in accordance with the procedures outlined in the NHS Counter Fraud and Corruption Manual. If evidence consists of several items, such as many documents, LAFSs should record each one with a separate reference number corresponding to the written record. Note that in criminal actions, evidence on or obtained from electronic media needs a document confirming its accuracy. Interviews under caution or to gather evidence will only be carried out by the LAFS, if appropriate, or the investigating police officer in accordance with the Police and Criminal Evidence Act 1984 (PACE). The LAFS will take written statements where necessary. All employees have a right to be represented at internal disciplinary interviews by a trade union representative or accompanied by a friend, colleague or any other person of their choice, not acting in a legal capacity in connection with the case. The application of the Anti-Fraud and Corruption policy will at all times be in tandem with all other appropriate CCG policies, e.g. Prime Financial Policies. Recovery of losses incurred to fraud and corruption The seeking of financial redress or recovery of losses should always be considered in cases of fraud or corruption that are investigated by either the LAFS or NHS Protect where a loss is identified. As a general rule, recovery of the loss caused by the perpetrator should always be sought. The decisions must be taken in the light of the particular circumstances of each case. Redress allows resources that are lost to fraud and corruption to be returned to the NHS for use as intended, for provision of high-quality patient care and services. Reporting the results of the investigation The investigation process requires the LAFS to review the systems in operation to determine whether there are any inherent weaknesses. Any such weaknesses identified should be corrected immediately. If fraud or corruption is found to have occurred, the LAFS should prepare a report for the Chief Finance Officer and the next CCG Audit Committee meeting, setting out the following details: the circumstances the investigation process the estimated loss the steps taken to prevent a recurrence 110

204 the steps taken to recover the loss. This report should also be available to the CCG Governing Body. Action to be taken Sections 10 and 11 of the NHS Counter Fraud and Corruption Manual provide in-depth details of how sanctions can be applied where fraud and corruption is proven and how redress can be sought. To summarise, local action can be taken to recover money by using the administrative procedures of the CCG or the civil law. In cases of serious fraud and corruption, it is recommended that parallel sanctions are applied. For example: disciplinary action relating to the status of the employee/member in the NHS; use of civil law to recover lost funds; and use of criminal law to apply an appropriate criminal penalty upon the individual(s), and/or a possible referral of information and evidence to external bodies for example, professional bodies if appropriate. NHS Protect can also apply to the courts to make a restraining order or confiscation order under the Proceeds of Crime Act 2002 (POCA). This means that a person s money is taken away from them if it is believed that the person benefited from the crime. It could also include restraining assets during the course of the investigation. Actions which may be taken when considering seeking redress include: no further action criminal investigation civil recovery disciplinary action confiscation order under POCA recovery sought from ongoing salary payments. In some cases (taking into consideration all the facts of a case), it may be that the CCG, under guidance from the LAFS and with the approval of the Chief Finance Officer, decides that no further recovery action is taken. Criminal investigations are primarily used for dealing with any criminal activity. The main purpose is to determine if activity was undertaken with criminal intent. Following such an investigation, it may be necessary to bring this activity to the attention of the criminal courts (Magistrates court and Crown court). Depending on the extent of the loss and the proceedings in the case, it may be suitable for the recovery of losses to be considered under POCA. The civil recovery route is also available to the CCG if this is cost-effective and desirable for deterrence purposes. This could involve a number of options such as applying through the Small Claims Court and/or recovery through debt collection agencies. Each case needs to be discussed with the Chief Finance Officer to determine the most appropriate action. The appropriate senior manager, in conjunction with the HR department, will be responsible for initiating any necessary disciplinary action. Arrangements may be made to recover losses via payroll if the subject is still employed by the CCG. In all cases, current legislation must be complied with. Timescales Action to recover losses should be commenced as soon as practicable after the loss has been identified. Given the various options open to the CCG, it may be necessary for various departments to liaise about the most appropriate option. 111

205 Recording In order to provide assurance that policies were adhered to, the Chief Finance Officer will maintain a record highlighting when recovery action was required and issued and when the action taken. This will be reviewed and updated on a regular basis. 112

206 In Summary 1. FOLLOW THE ABOVE GUIDELINES 2. Do NOT attempt to carry out any investigation yourself, as there may be legal requirements, breaches of which could affect the outcome of the case if it went to Court. 3. ALL requests for Police assistance MUST be authorised beforehand by the Area Anti- Fraud Lead ( ) or, in exceptional circumstances, the Local AntiFraud Specialist ( ). 4. The member of staff reporting their suspicion may elect not to have their identity known; this election is subject to any legal requirements to disclose identity. 113

207 FORM 1 NHS fraud and corruption: dos and don ts A desktop guide for Blackburn with Darwen CCG FRAUD is the dishonest intent to obtain a financial gain from, or cause a financial loss to, a person or party through false representation, failing to disclose information or abuse of position. CORRUPTION is the deliberate use of bribery or payment of benefit in kind to influence an individual to use their position in an unreasonable way to help gain advantage for another. DO note your concerns Record details such as your concerns, names, dates, times, details of conversations and possible witnesses. Time, date and sign your notes. retain evidence Retain any evidence that may be destroyed, or make a note and advise your LCFS. report your suspicion Confidentiality will be respected delays may lead to further financial loss. Complete a fraud report and submit in a sealed envelope marked Restricted Management and Confidential for the personal attention of the LCFS. If you suspect that fraud against the NHS has taken place, you must report it immediately, by: directly contacting the Local Anti Fraud Specialist, or telephoning the freephone NHS Fraud and Corruption Reporting Line, or online at contacting the Chief Finance Officer. DO NOT confront the suspect or convey concerns to anyone other than those authorised, as listed below Never attempt to question a suspect yourself; this could alert a fraudster or accuse an innocent person. try to investigate, or contact the police directly Never attempt to gather evidence yourself unless it is about to be destroyed; gathering evidence must take into account legal procedures in order for it to be useful. our LCFS can conduct an investigation in accordance with legislation. be afraid of raising your concerns The Public Interest Disclosure Act 1998 protects employees who have reasonable concerns. ou will not suffer discrimination or victimisation by following the correct procedures. Do nothing! Do you have concerns about a fraud taking place in the NHS? Call the NHS Fraud and Corruption Reporting Line: All calls will be treated in confidence and investigated by professionally trained staff our nominated Local Anti Fraud Specialist can be contacted by telephoning If you would like further information about NHS Protect, please visit Protecting your NHS 114

208 FORM 2 NHS fraud and corruption referral form All referrals will be treated in confidence and investigated by professionally trained staff Note: Referrals should only be made when you can substantiate your suspicions with one or more reliable pieces of information. Anonymous applications are accepted but may delay any investigation. 1. Date 2. Anonymous application <Delete as appropriate> es (If es go to section 6) or No (If No complete sections 3 5) 3. our name 4. our organisation/profession 5. our contact details 6. Suspicion 7. Please provide details including the name, address and date of birth (if known) of the person to whom the allegation relates. 8. Possible useful contacts 9. Please attach any available additional information. Submit the completed form (in a sealed envelope marked Restricted Management and Confidential to the LAFS for Blackburn with Darwen CCG. Under no circumstances should this report, which contains personal details, be transmitted electronically. 115

209 Appendix L Committee Terms of Reference 1.0 Purpose of the Committee AUDIT COMMITTEE TERMS OF REFERENCE The Audit Committee (the Committee) is established in accordance with Blackburn with Darwen s (BwD s) Clinical Commissioning Group s Constitution. These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the Constitution. The duties of the Committee will be driven by the priorities identified by the Clinical Commissioning Group, and the associated risks. 2.0 Roles and Responsibilities 2.1 Integrated Governance, Risk Management and Internal Control The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the Clinical Commissioning Group s activities that support the achievement of the Clinical Commissioning Group s objectives. Its work will dovetail with that of the Quality, Performance and Effectiveness Committee which the Clinical Commissioning Group established to seek assurance that robust clinical quality is in place and drive improvements to services. In particular, the Audit Committee will review the adequacy and effectiveness of: All risk and control related disclosure statements (in particular the governance statement), together with any appropriate independent assurances, prior to endorsement by the Clinical Commissioning Group. The underlying assurance processes that indicate the degree of achievement of Clinical Commissioning Group objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements. The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification. The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Protect 116

210 Service. In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from Officers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. This will be evidenced through the Committee s use of an effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it. 2.2 Internal audit The Committee shall ensure that there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Audit Committee, Clinical Chief Officer and Clinical Commissioning Group. This will be achieved by: Consideration of the provision of the internal audit service, the cost of the audit and any questions of resignation and dismissal. Review and approval of the internal audit strategy, operational plan and more detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework. Considering the major findings of internal audit work (and management s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources. Ensuring that the internal audit function is adequately resourced and has appropriate standing within the Clinical Commissioning Group. An annual review of the effectiveness of internal audit. 2.3 External audit The Committee shall review the work and findings of the external auditors and consider the implications and management s responses to their work. This will be achieved by: Consideration of the performance of the external auditors, as far as the rules governing the appointment permit. Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy. Discussion with the external auditors of their evaluation of audit risks relating to both the financial statements and value for money conclusion, and associated impact on the audit fee. Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Clinical Commissioning Group and any work undertaken outside the annual 117

211 audit plan, together with the appropriateness of management responses. 2.4 Other assurance functions The Audit Committee shall review the assurance framework and the corporate risk register as well as findings of other significant assurance functions, both internal and external and consider the implications for the governance of the Clinical Commissioning Group. These will include, but will not be limited to, any reviews by Department of Health arm s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies). 2.5 Counter fraud The Committee shall satisfy itself that the Clinical Commissioning Group has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme. 2.6 Management The Committee shall request and review reports and positive assurances from Directors and Managers on the overall arrangements for governance, risk management and internal control. The Committee may also request specific reports from individual functions within the Clinical Commissioning Group as they may be appropriate to the overall arrangements. 2.7 Financial reporting The Audit Committee shall monitor the integrity of the financial statements of the Clinical Commissioning Group and any formal announcements relating to the Clinical Commissioning Group s financial performance. The Committee shall ensure that the systems for financial reporting to the Clinical Commissioning Group, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the Clinical Commissioning Group. The Audit Committee shall review the annual report and financial statements before submission to the governing body and the Clinical Commissioning Group, focusing particularly on: The wording in the governance statement and other disclosures relevant to the Terms of Reference of the Committee; Changes in, and compliance with, accounting policies, practices and estimation techniques; Unadjusted mis-statements in the financial statements; Significant judgements in preparing of the financial statements; Significant adjustments resulting from the audit; Letter of representation; and Qualitative aspects of financial reporting. 2.8 Review instances where Standing Orders / Standing Financial Instructions have been 118

212 waived 2.9 Review, at least annually, the Clinical Commissioning Group Governing Body s schedules of losses special payments and register of gifts and hospitality and declaration of Clinical Commissioning Group members interests. 3.0 Deliverables 3.1 Reports of assurance to the Clinical Commissioning Group Governing Body that the functions as identified in the Audit Committee Work plan have been performed. 3.2 Minutes recording the decisions reached and the reasons for such decisions shall be maintained and be submitted to the Clinical Commissioning Group Governing Body. 4.0 Constraints/Risks 4.1 Audit reporting and publishing of annual accounts are set within pre-determined dates. 5.0 Membership 5.1 The Committee shall be appointed by the Clinical Commissioning Group as set out in the Clinical Commissioning Group s Constitution and may include individuals who are not on the governing body. The Lay Member on the Governing Body with a lead role in governance will chair the Audit Committee. As a minimum membership shall be made up of:- Lay Member for Governance (Chair) Two other Lay Members GP Members must comply with the requirements of the CCG s Conflict of Interest Policy. In the event that all clinical members are excluded from decisions due to conflicts of interest clinical input will be sought from elsewhere. The Chief Finance Officer and other Executives from the Clinical Commissioning Group may be in attendance at the specific invitation of the Chair. 6.0 Governance and Reporting 6.1 The Audit Committee will report to the Clinical Commissioning Group Governing Body. 6. The Committee shall report after each meeting on all matters within its duties and responsibilities. The report should be completed in line with the agreed template and the full minutes will be submitted to the next meeting of the governing body. 6.3 Quorum Quorum shall be 2 members. 6.4 Frequency The Audit Committee shall meet at least four times per annum and at least once a year will meet with Internal Audit and External Audit with no other officers present. The Chief Finance Officer will arrange secretarial support for the committee. 7.0 Relationships/Interdependencies with other Bodies 7.1 The Audit Committee is informed by corporate business transacted by the Clinical Commissioning Group Governing Body and its Sub-Committees. 8.0 Location of information such as plans, or contact information 8.1 Information relating to the business of the Audit Committee is saved electronically on the Corporate Drive. 119

213 9.0 Related Policies 9.1 Being Open Policy Whistle Blowing Policy Fraud and Corruption Policy Conflict of Interest Policy Standing Financial Instructions Standing Orders 10.0 Schedule of Meetings times per annum as a minimum. 120

214 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD TERMS OF REFERENCE 1.0 Purpose of the Committee The purpose of the NHS Blackburn with Darwen Clinical Commissioning Group (CCG) Governing Body is, on behalf of their population, to: a. commission safe and effective community and secondary health care services b. continually work towards the quality improvement of health care c. work in partnership with other Clinical Commissioning Groups and agencies to secure the overall health and well-being of the population d. conduct the business in accordance with the constitution of the CCG and the NHS constitution and other NHS statutory guidance. In discharging its obligations the CCG Governing Body will be responsible and accountable for delivering financial balance, managing risks and for achieving national and local quality, productivity and service delivery targets. The CCG Governing Body will delegate responsibility for a range of functions to its committees and working groups, e.g. the Quality, Performance and Effectiveness Committee, the Audit Committee, the Remuneration and Terms of Service Committee, the Commissioning Business Group and the Executive Joint Commissioning Group. These functions are set out in the approved Terms of Reference of each committee/group and the CCG s Standing Orders and Schemes of Delegation. 2.0 Roles and Responsibilities 2.1 The CCG Governing Body will operate within the legal framework. 2.2 The CCG Governing Body will comply with its standing orders and standing financial instructions and the terms of reference will be reviewed at least annually. 2.3 The CCG Governing Body is subject to governance, ethical and legal guidelines. This includes requirements around ethical behaviour, conflicts of interest declarations and maintaining a register of interests. 2.4 The CCG Governing Body will establish committees and working groups as required to effectively transact the business of the Clinical Commissioning Group, approving all Terms of Reference and clearly setting out all delegated functions. 2.5 The CCG Governing Body will agree to delegate powers of budgetary responsibility to its committees and groups. A formal Scheme of Delegation will be agreed between the CCG Governing Body and its committees and groups. 2.6 NHS England will hold the CCG Governing Body to account for delivery of its delegated responsibilities / accountability. NHS England has the power to intervene in the work of the CCG should it be considered necessary. 2.7 The elected General Practitioner (GP) representatives on the Governing Body of the CCG Governing Body will, as part of a team, ensure that the CCG exercises its functions efficiently, effectively and economically with good governance and in accordance with the terms of the CCG as agreed with its members. The development of the governance arrangements is in accordance with the legal 121

215 requirements in the Health and Social Care Act 2012 for the establishment of CCGs. 2.8 The CCG Governing Body will receive regular reports from its committees and groups from which to gain assurance on the delivery of the annual and strategic Operational and Financial Plans. 2.9 The CCG Governing Body will be responsible for ensuring that services for the population of Blackburn with Darwen are informed and commissioned in a way which delivers improved health and social care, improved outcomes, improved patient experience, good productivity and minimises health inequalities and that its work is in accordance with the requirements of the NHS Constitution The CCG Governing Body will develop the commissioning intentions and oversee the conduct of contracting negotiations for the major CCG led contracts The CCG Governing Body will continually review quality and performance, outcomes and efficiency and effectiveness of spend in all commissioned services that fall within the scope of the CCG The CCG Governing Body will be responsible for the assurance that services are safe, of a consistently high quality, value for money and sustainable The CCG Governing Body will ensure continuous and meaningful engagement with the public and patients in the planning, delivery and prioritisation of services The CCG Governing Body will work collaboratively with a range of partners to commission services which will improve health and minimise health inequalities The CCG Governing Body will ensure that planning, prioritisation and decision making are transparent, equitable and auditable The CCG Governing Body will ensure that the CCG achieves a balanced budget, whilst delivering the agreed Single Integrated Plan The CCG Governing Body will lead the development of the strategic planning process for the CCG The CCG Governing Body will be responsible for and take ownership of Quality, Innovation, productivity and Prevention (QIPP) and performance management The CCG Governing Body will be responsible for determining remuneration levels for Lay Members including Nurse advisor, Secondary Care Doctor The CCG Governing Body will receive recommendations of remuneration levels for the Executive Officer, General Practitioner (GP) Members of the Governing Body and remuneration for other GP members from the Remuneration and Terms of Service Committee for approval. 3.0 Deliverables 3.1 To commission a comprehensive range of appropriate, cost effective and high quality health services for the population of Blackburn with Darwen. 3.2 Create and lead the development of the new system locally to ensure that the CCG remains fit for purpose. 3.3 Lead and drive the change of behaviour and culture in the NHS that is required for optimal productivity and sustainability by creating meaningful relationships across the whole system. 3.4 Ensure inclusion of all GP practices and that practices /clinical engagement is harnessed and targeted to deliver priorities. 3.5 Ensure that the CCG Governing Body has a mandate from its constituent practices/gps. 3.6 Be responsible for the organisational development of the CCG. 3.7 Ensure effective and appropriate practice education development and communication in relation to CCG led commissioning. 3.8 Develop meaningful engagement/links with Local Authority/Public Health Service/ NHS England / Health and Well-Being Board / Healthwatch and other organisations as appropriate to ensure system development in line with the implementation of the Health and Social Care Act

216 3.9 Communication and sharing of learning locally, regionally and nationally Minutes recording the decisions reached and the reasons for such decisions shall be maintained The Publication of the Governing Body s annual report. 4.0 Constraints/Risks 4.1 The CCG Governing Body will work within the constitution and legal framework of the NHS 5.0 Membership 5.1 The membership of the CCG Governing Body is: Chair (v) GP Clinical Chief Officer (CCO) (v) All elected GP Governing Body members (includes the Vice Chair) (v) Lay Member Governance (v) Chief Operating Officer (COO) (v) Chief Finance Officer (CFO) (v) Lay Member Secondary Care Doctor (v) Lay Member Registered Nurse (v) Co-opted Member Director of Public Health (Blackburn with Darwen Local Authority) In Attendance Administration Support Head of Corporate Business Voting members of the Governing Body are those indicated by (v). In the absence of the Chair the Vice Chair will conduct proceedings. In the absence of the Clinical Chief Officer one of the Executive Officers will act as their deputy. Members must comply with the requirements of the CCG s conflict of interest policy. 5.2 The CCG Governing Body will also invite other individuals to attend meetings as required from time to time. These individuals will not have voting rights. 5.3 The CCG Governing Body reserves the right to co-opt additional members where appropriate. 6.0 Governance and Reporting 6.1 Reporting arrangements - into The CCG Governing Body will report to NHS England. 6.2 The CCG Governing Body will make the minutes of meetings accountable to member 123

217 practices, after each Governing Body Meeting and will keep them informed by messages from the Clinical Chief Officer as key strategic decisions are taken. 6.3 Reporting arrangements from The CCGs sub-committees and groups listed below will report into the CCG Governing Body:- - Quality, Performance and Effectiveness Committee - Commissioning Business Group - Remuneration and Terms of Service Committee - Audit Committee - Executive Joint Commissioning Group - Information Governance Steering Group 6.4 Quorum A meeting of the Clinical Commissioning Group Governing Body shall be quorate when there are a minimum of five members, to include three GPs, one Executive Officer and one Lay Member present, unless the exceptional circumstances apply as described below:- 1. Where a decision is to be made where significant conflicts of interest exist with GP members the quorum will be achieved by five of the remaining six Governing Body members, COO, CFO, Lay Member Registered Nurse, Lay Member Secondary Care Doctor, Lay Member and Chair (and any non-conflicted GP members) re paragraph Where a decision is to be made on Remuneration etc. as paragraph for the Lay Member, Chair, Lay Member Secondary Care Doctor and Lay Member Registered Nurse the quorum will be achieved by a minimum of five members, COO or CFO and four GP members. The conflicts of interest policy will be applied to both these scenarios. 6.5 Attendance Each member is expected to attend a minimum of 75% of scheduled meetings per annum. 6.6 Review The Terms of Reference will be reviewed annually by the CCG Governing Body at the first meeting in the financial year. 7.0 Relationships/Interdependencies with other Bodies 7.1 The Governing Body will cooperate and collaborate with other organisations in order to achieve its objectives. 8.0 Location of shared information such as plans, or contact information 8.1 These will be stored electronically on the Clinical Commissioning Group drive. 9.0 Related Policies 9.1 Standing Financial Instructions 124

218 Standing Orders Scheme of Delegation Governance Framework Risk Management Policy Conflict of Interest Policy Constitution 10.0 Schedule of Meetings 10.1 The Governing Body will meet a minimum of 6 times per year in public with additional meetings being scheduled as required to ensure Governing Body development and discussion. 125

219 1.0 Purpose of the Committee COMMISSIONING BUSINESS GROUP (CBG) TERMS OF REFERENCE On behalf of the CCG Governing Body the CBG is responsible for considering proposals for investment and disinvestment, ensuring decisions and recommendations are based on appropriate evidence including impact on local health inequalities. The CBG will develop the commissioning plans and intentions of the CCG, ensuring appropriate clinical and public involvement in all aspects of the planning and implementation of commissioning decisions for recommendation to the CCG Governing Body. The Group make recommendations to the Governing Body for the preferred procurement options, associated contract awards following the procurement process and any de-commissioning decisions. 2.0 Roles and Responsibilities 2.1 To ensure that business cases for the commissioning of new or materially different services are sound, have had appropriate clinical input and corporate governance arrangements are in place Establishing a systematic approach to the assessment of investment, market testing, procurement, contract awards and renewals, and decommissioning proposals in coordination with the Staffordshire and Lancashire Commissioning Support Unit (CSU) To approve commissioning plans and intentions in line with the delegated authority given by the CCG Governing Body and/or make recommendations to the Governing Body as required in line with the Scheme of Delegation. To receive reports on, critically appraise and make recommendations about, all commissioning activity within the overall remit of the CCG. This will include: joint commissioning strategies and proposals to ensure they are consistent with and meet the requirements of the CCG strategic priorities and plans including the wider Borough Health and Wellbeing Strategy within the overall funding available. To take decisions or make recommendations on investment and disinvestment in services based on rigorous assessment of clinical and cost effectiveness, affordability and health benefit. To ensure the required equality analysis has been undertaken in relation to all proposed service changes. Review the delivery of all business cases and associated documentation and make recommendations to the Governing Body on the preferred procurement option for new services and of the preferred provider following the tender process. To have delegated authority, on behalf of the Governing Body, to determine the most suitable procurement options and award/renew contracts for lower level contracts as defined within the CCGs scheme of delegation up to the value of 500K. 126

220 To ensure that Quality, Innovation, Productivity and Prevention (QIPP) plans are developed and have had appropriate clinical input. Provide assurance to the CCG Governing Body that policy and guidance in relation to strategic commissioning, procurement, and contracting including consideration of applications for grants/finance for pilot schemes is implemented, in coordination with the CSU. Review commissioning proposals to confirm that they establish collaborative and seamless pathways of care, as appropriate, whilst considering and recommending areas where greater competition in the provision of services may be beneficial to the population. To consider and scrutinise the clinical implications of proposals by stakeholders/ other outside organisations and advise accordingly. This includes consideration of applications for grants / finance for pilot schemes from organisations in the 3 rd sector. To ensure appropriate patient and public involvement in commissioning and receive feedback from appropriate groups and sub groups on commissioning matters. To establish working groups, when appropriate, to deliver key commissioning intentions with clinical representation from relevant clinicians and social care colleagues. To act upon those issues identified by the performance monitoring of key contracts as advised by the Quality, Performance and Effectiveness Committee. To receive updates to policy and guidance in relation to contracting and procurement of services and ensure that CCG documentation reflects any changes and remains consistent with national policy. To feedback all decisions made by the Commissioning Business Group to the relevant individuals giving the rationale for the decision and monitoring the implementation of all decisions made ensuring that appropriate and timely action is taken. To oversee the production and publication of the Strategic Plan for the CCG and annual updates on progress, with draft plans presented to the Governing Body for approval. 3.0 Deliverables 3.1 To deliver the agreed commissioning intentions, in association with colleagues across Pennine Lancashire Establish a local framework for the approval of contracts for service providers under both the Any Qualified Provider (AQP) and any CCG accredited provider and make recommendations to the Governing Body on which providers to authorise if above the limit of the Group. Minutes recording the decisions reached and the reasons for such decisions shall be maintained. 3.4 Publication of the Committee s Annual Report to the Governing Body. 4.0 Constraints/Risks The Group will act within the remit of the CCGs Scheme of Delegation (SoD) Membership 127

221 5.1 GP Clinical Chief Officer (Chair) All GP Governing Body Members (5) Chief Operating Officer Chief Finance Officer Lay Member Lay Member Secondary Care Doctor In Attendance Head of Integrated Commissioning Head of Primary Care, Quality and Development Head of Unscheduled Care Head of Scheduled Care Consultant in Public Health Administration Head of Contracting (CSU) The group may co-opt others to give specialist advice as required. Members must comply with the requirements of the CCG s Conflict of Interest Policy. In the event that all clinical members are excluded from decisions due to conflicts of interest clinical input will be sought from elsewhere 6.0 Governance and Reporting Reporting arrangements into The Commissioning Business Group is directly accountable to the Clinical 6.1 Commissioning Group Governing Body, providing assurance through its minutes and regular written reports and updates Reporting arrangements from Any working groups established by the CBG Quorum A quorum shall comprise of a minimum of 3 GP Governing Body members and the CFO or COO and 1 Lay Member. Policy The conflicts of interest policy must be applied to all decision making, at any time where a material conflict of interest is declared the item will be referred to the CCG Governing body for a decision. Review These Terms of Reference will be reviewed annually at the first meeting in the financial year. 7.0 Relationships/Interdependencies with other Bodies The Commissioning Business Group is a formal sub-committee of the CCG 7.1 Governing Body. The work of the committee will also feed into the Integrated Commissioning Network. 8.0 Location of information such as plans, or contact information Information relating to the business of the Commissioning Business Group is stored 8.1 electronically. 9.0 Related Policies 9.1 Equality Impact Assessment Policy 128

222 Policy for managing conflicts of interests Schedule of Meetings 10.1 CBG will meet monthly. 129

223 1.0 Purpose of the Committee EXECUTIVE JOINT COMMISSIONING GROUP TERMS OF REFERENCE The Executive Joint Commissioning Group (Exec JCG) is the advisory body responsible for the ongoing assurance of the development and implementation of joint Health and Social Care commissioning across Blackburn with Darwen. This group provides strategic oversight and direction for integrated and joint commissioning to improve health and wellbeing across children s services, adult social care services, public health services and wider community services. This Exec JCG will, oversee delivery of integrated commissioning workplan, highlight any risks to delivery and provide advice, recommendations and assurance to CCG Governing Body and Council Executive Board. The Exec JCG will have delegated decision making authority at a level clearly outlined and agreed by Council Executive Board and CCG Governing Body. 2.0 Roles and Responsibilities 2.1 To understand and interpret the national and local agenda for integrated commissioning To agree a shared vision and provide strategic direction for integrated commissioning and service delivery To advise on integrated commissioning priorities derived from joint strategic needs analyses and support the development and delivery of integrated commissioning plans via a prioritised and agreed work programme. To advise on design of integrated commissioning arrangements capitalising on innovation, transformation, QIPP for Health and Social Care Outcome frameworks. To review and develop joint Commissioning intentions, overarching strategies and plans for the service areas in its remit, including funding requirements. To agree budget allocations to support joint developments across CCG and Local Authority. To manage and mitigate any risks associated with delivery of joint commissioning process and associated workplan and escalate issues as required to the relevant boards 3.0 Deliverables Minutes recording the decisions reached and the reasons for such decisions shall be maintained. The Group will determine its own work programme based on the viability and prioritised / quantified benefit of initiatives. It will then account and report to a range of formal governance bodies (notably the Clinical Commissioning Group Governing Body and the Council s Executive Board) with appropriate recommendations around these joint initiatives, agreed integrated commissioning priorities and work plan 4.0 Constraints/Risks 4.1 The Group will act within the remit of any Section 75 or other formal agreement and 130

224 4.2 the CCG s Scheme of Delegation and relevant Council Standing Orders. Risks arising from the process will be identified and managed between the CCG and Local Authority. 5.0 Membership Chair of Blackburn with Darwen CCG Chief Clinical Officer of Blackburn with Darwen CCG Council portfolio holder for Adult Social Care and Health NHS England Member (TBC) Chief Executive Blackburn with Darwen Borough Council Officers in attendance Chief Operating Officer- Blackburn with Darwen CCG Director of Public Health Blackburn with Darwen Borough Council Executive Director People Blackburn with Darwen Borough Council Other CCG/CSU staff as appropriate Exec JCG members are required to declare a conflict or expression of interest if they have any personal, professional or private connection with matters being raised or discussed within the Exec JCG arena. In the event that all clinical members are excluded from decisions due to conflicts of interest clinical input will be sought from elsewhere. 6.0 Governance and Reporting (see appendix 1) Reporting arrangements into 6.1 The Exec JCG will report into the CCG Governing Body and Council Executive Board. The JCG will report quarterly into the Health and Wellbeing Board. 6.2 Reporting arrangements from The Joint Commissioning and Recommendation Group (JCRG) will report directly into the Executive Joint Commissioning Group Quorum 1 CCG Executive Officer member, 1 Local Councillor member is required for quoracy, with specific requirement of attendance from Chair or Clinical Chief Officer of the CCG. The Chair of the Exec JCG will alternate between CCG and LA. Attendance: Deputies are acceptable by prior approval from the Chair. Review These TORs are to be reviewed annually at the first meeting in the financial year 6.5 alongside any changes to formal joint working arrangements between the CCG and LA. 7.0 Relationships/Interdependencies with other Bodies The Executive Joint Commissioning Group have clear links to internal committees 7.1 within CCG and Local Authority, including Senior Policy Team and CCG Executive Group 8.0 Location of information such as plans, or contact information 131

225 8.1 Information on the business of the Executive JCG is stored electronically on the Clinical Commissioning Group drive and on the LA Integrated Commissioning Unit shared drive. 9.0 Related Policies Scheme of delegation - Memorandum of Understanding - Equality Impact Assessment Policy - Policy for managing conflicts of interest 10.0 Schedule of Meetings The Committee will meet monthly 10.1 Appendix 1 132

226 QUALIT, PERFORMANCE AND EFFECTIVENESS COMMITTEE TERMS OF REFERENCE 1.0 Purpose of the Committee The Quality, Performance and Effectiveness Committee (QPEC) provide assurance to the CCG Governing Body on all matters relating to the development and implementation of a vision and strategy for continuous quality improvement. This will cover all aspects of performance management, service effectiveness, patient safety and experience. The Committee is responsible for ensuring compliance with regulatory standards. The Committee will seek to achieve this through close partnership working with other agencies and key stakeholders, whose role will be crucial in developing and enabling a culture of continuous quality improvement. 2.0 Roles and Responsibilities Assist the governing body to set and implement a Commissioning for Quality Strategy. Support the implementation and delivery of the CCG Plans ensuring quality is systematically addressed Promote a culture of continuous quality improvement across the health economy, supporting partnership working and organisational development to ensure the agreed vision and strategy is delivered through the development and delivery of quality and Commissioning for Quality and Innovation (CQUIN) schedules. Monitor quality and CQUIN performance in line with agreed timescales and oversee the delivery of improvement plans where quality measures are not achieving expected levels. Receive regular reports from the Safeguarding Lead in order to provide assurance to the CCG Governing Body that the health economy has robust systems and processes in place to fulfil its statutory duties for adult and children s safeguarding in Blackburn with Darwen, and that the CCG fulfils all its obligations in this regard Ensure the CCG has robust processes in place regarding risk management, quality measures for patient safety, clinical effectiveness, patient experience and complaints. This will involve oversight of the CCG s Risk Registers, Assurance Framework, risk policies and procedures and implementation of the CCG s risk management strategy. Provide assurance to the CCG Governing Body that a comprehensive and systematic review of the quality of commissioned services takes place; that risks to service quality are 2.7 proactively managed through the use of soft and hard intelligence including information gathered from service walkabouts and mitigated; and suitable investigations are commissioned to achieve desired improvements. 2.8 Escalate risks identified via the CCG Risk Register to the CCG Governing Body. Ensure 133

227 the processes for the mitigation of these risks is fully embedded, and improvement programmes contain details of the implications and actions for all departments/areas of CCG activity Provide regular reports to the CCG Governing Body around the quality of commissioned services which give assurance that appropriate interventions are being taken where quality is below expected levels. Establish processes to ensure that the CCG develops and maintains all necessary organisational policies. The committee will ratify all policies on behalf of the Governing Body and ensure these comply with statutory guidance, where appropriate, and are consulted upon, distributed and updated appropriately. The committee will scrutinise the quality and performance of the CCG on behalf of the Governing Body reporting areas for attention to the Governing Body. Publish an annual report at the end of the financial year setting out progress against the Quality Strategy and committee work plan, celebrating any key successes, and highlighting areas for attention and review in the following 12 months. 3.0 Deliverables 3.1 Minutes recording the decisions reached and the reasons for such decisions shall be maintained An annual cycle of business that supports the committees role and responsibilities and the delivery of objectives/milestones outlined in the Quality Strategy Regular evaluation of Quality and Effectiveness to test compliance with the CCG Quality Strategy. Publication of the Committee s Annual Report to the Governing Body. 4.0 Constraints/Risks 4.1 The Committee will act within the remit of the CCGs delegated authority as identified within the Scheme of Delegation (SoD) Services that fall outside of the remit of the CCG etc. Primary Care Commissioning but which may have an impact on the delivery of the CCG Strategy/Vision Risks may be identified which require financial resources to mitigate the risk and which necessitate recommendations to the Commissioning Business Group (CBG) and CCG Governing Body. 5.0 Membership 5.1 The Committee s membership shall consist of: 1 Lay Member Secondary Care Doctor (Chair) 1 GP Member 1 CCG Executive Member 1 Lay Member - Registered Nurse 1 Lay Advisor 1 Head of Quality 5.2 Co-opted members in attendance Non voting 1 Public Health representative 134

228 1 CSU support staff for Quality & Performance as required 1 Social Care representative as required 1 Governance Performance & Risk Manager 5.3 Members must comply with the requirements of the CCG s Conflict of Interest Policy. In the event that all clinical members are excluded from decisions due to conflicts of interest the decision will have to be referred to the Governing Body. 6.0 Governance and Reporting Reporting arrangements into Quality, Performance and Effectiveness Committee The Committee will receive and consider reports and intelligence, including Minutes of meetings, concerning clinical quality/contractual reviews; user experience of services, 6.1 safety incorporating system-wide Safeguarding and Infection Control, and application of best practice including research, development, audit and guidelines Reporting arrangements from Quality, Performance and Effectiveness Committee The Committee will report to each CCG Governing Body meeting, providing assurances in respect of all areas within its remit, key matters concerning performance and risk, including mitigating actions and decisions required by CCG Governing Body. The minutes will also be presented to the Audit Committee. Quorum A quorum shall comprise of 3 members including 1 GP member and 1 Executive member or GP deputy. 6.4 Review The Terms of Reference are to be reviewed when appropriate, but as a minimum, every 12 months at the first meeting in the financial year. Establishment of Sub Groups 6.5 The committee shall establish sub groups as and when necessary to support the delivery of the work required. 7.0 Relationships/Interdependencies with other Bodies 7.1 The Committee is a sub-committee of the CCG Governing Body. 8.0 Location of information such as plans, or contact information 8.1 Information will be stored electronically by the CCG. 9.0 Related Policies Being Open Following a Patient Safety Incident Complaints Policy/Procedure Equality Analysis Assessment Incident Reporting and Investigation 9.1 Performance Management of Serious Untoward Incidents Risk Management Policy Safeguarding Children and Vulnerable Adults Commissioning Policy Conflict of Interest Policy 10.0 Schedule of Meetings The Committee will meet monthly

229 1.0 Purpose of the Committee REMUNERATION AND TERMS OF SERVICE COMMITTEE TERMS OF REFERENCE The Committee has the responsibility to determine the remuneration levels for the Executive Officers and General Practitioner (GP) Executive Members of the Governing Body. The Committee will also determine levels of remuneration for other GP members. The Committee will inform its decisions of remuneration levels to the Governing Body. 2.0 Roles and Responsibilities 2.1 Determine the remuneration and conditions of service of the Executive Officers and GP Executive members Reviewing the performance of the Executive and other senior team members and determining annual salary awards, if appropriate. Considering the severance payments of the Executive and including other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance Managing Public Money (available on the HM Treasury.gov.uk website). 3.0 Deliverables 3.1 Minutes recording the decisions reached and the reasons for such decisions shall be maintained. 3.2 Details of the emoluments paid to Governing Body members and employees shall be made available for publication in the Annual Report. 3.3 Remuneration packages must be such as to enable people of appropriately high ability to be recruited retained and motivated within levels of affordability 4.0 Constraints/Risks The Committee shall take account of guidance from other relevant bodies including those 4.1 involved in negotiating national pay agreements. As appropriate the committee will seek independent advice about pay structures and the state of the market. 5.0 Membership Membership 5.1 The Committee shall comprise the CCG Governing Body Chair and Lay Member of Governance, together with the Lay Member Secondary Care Doctor and Lay Member Registered Nurse. In Attendance The Clinical Chief Officer, Chief Finance Officer and Human Resources Representative will normally attend each meeting 136

230 Members must comply with requirements of the CCG s Conflict of Interest Policy. 6.0 Governance and Reporting Reporting arrangements into The Committee reports into the Clinical Commissioning Group Governing Body Quorum Decisions by the Remuneration and Terms of Service Committee require at least two members to be present. Attendance: Meetings shall be scheduled around members availability and all members are expected to endeavour to attend every meeting where possible. Review The terms of reference will be reviewed annually at the first meeting in the financial year. 7.0 Relationships/Interdependencies with other Bodies The Committee will report directly to the Clinical Commissioning Group Governing Body 7.1 but has no interdependencies with other CCG Committees. 8.0 Location of information such as plans, or contact information Information relating to the business of the Remuneration Committee is saved electronically on the Clinical Commissioning Group drive. This will be a restricted area and protected with 8.1 limited access by Clinical Chief Officer, Chief Finance Officer and committee administrator. 9.0 Related Policies 9.1 Recruitment Policy Equal Opportunity Policy Code of Conduct Policy Conflict of Interest Policy 10.0 Schedule of Meetings Meetings shall be held when necessary and not less than once a year

231 Appendix M Standards for members of NHS boards and Clinical Commissioning Group governing bodies in England Professional Standards Authority Buckingham Palace Road, London SW1W 9SP Telephone: info@professionalstandards.org.uk Web: Professional Standards Authority, November 2012 The Professional Standards Authority for Health and Social Care is the new name for the Council for Healthcare Regulatory Excellence. 138

232 All members of NHS boards and CCG governing bodies should understand and be committed to the practice of good governance and to the legal and regulatory frameworks in which they operate. As individuals they must understand both the extent and limitations of their personal responsibilities. 139

233 Personal behaviour 1. As a Member1 I commit to: 1 The term Member is used throughout this document to refer to members of NHS boards and CCG governing bodies in England. 2 The term board is used throughout this document to refer collectively to NHS boards and CCG governing bodies in England. The values of the NHS Constitution Promoting equality Promoting human rights in the treatment of patients and service users, their families and carers, the community, colleagues and staff, and in the design and delivery of services for which I am responsible. 2. I will apply the following values in my work and relationships with others: Responsibility: I will be fully accountable for my work and the decisions that I make, for the work and decisions of the board2, including delegated responsibilities, and for the staff and services for which I am responsible Honesty: I will act with honesty in all my actions, transactions, communications, behaviours and decision-making, and will resolve any conflicts arising from personal, professional or financial interests that could influence or be thought to influence my decisions as a board member Openness: I will be open about the reasoning, reasons and processes underpinning my actions, transactions, communications, behaviours and decision-making and about any conflicts of interest Respect: I will treat patients and service users, their families and carers, the community, colleagues and staff with dignity and respect at all times Professionalism: I will take responsibility for ensuring that I have the relevant knowledge and skills to perform as a board member and that I reflect on and identify any gaps in my knowledge and skills, and will participate constructively in appraisal of myself and others. I will adhere to any professional or other codes by which I am bound Leadership: I will lead by example in upholding and promoting these Standards, and use them to create a culture in which their values can be adopted by all Integrity: I will act consistently and fairly by applying these values in all my actions, transactions, communications, behaviours and decision-making, and always raise concerns if I see harmful behaviour or misconduct by others. 140

234 Technical competence 3. As a Member, for myself, my organisation, and the NHS, I will seek: Excellence in clinical care, patient safety, patient experience, and the accessibility of services To make sound decisions individually and collectively Long term financial stability and the best value for the benefit of patients, service users and the community. 4. I will do this by: Always putting the safety of patients and service users, the quality of care and patient experience first, and enabling colleagues to do the same Demonstrating the skills, competencies, and judgement necessary to fulfil my role, and engaging in training, learning and continuing professional development Having a clear understanding of the business and financial aspects of my organisation s work and of the business, financial and legal contexts in which it operates Making the best use of my expertise and that of my colleagues while working within the limits of my competence and knowledge Understanding my role and powers, the legal, regulatory, and accountability frameworks and guidance within which I operate, and the boundaries between the executive and the nonexecutive Working collaboratively and constructively with others, contributing to discussions, challenging decisions, and raising concerns effectively Publicly upholding all decisions taken by the board under due process for as long as I am a member of the board Thinking strategically and developmentally Seeking and using evidence as the basis for decisions and actions Understanding the health needs of the population I serve Reflecting on personal, board, and organisational performance, and on how my behaviour affects those around me; and supporting colleagues to do the same Looking for the impact of decisions on the services we and others provide, on the people who use them, and on staff Listening to patients and service users, their families and carers, the community, colleagues, and staff, and making sure people are involved in decisions that affect them Communicating clearly, consistently and honestly with patients and service users, their families and carers, the community, colleagues, and staff, and ensuring that messages have been understood Respecting patients rights to consent, privacy and confidentiality, and access to information, as enshrined in data protection and freedom of information law and guidance. 141

235 Business practices 5. As a Member, for myself and my organisation, I will seek: To ensure my organisation is fit to serve its patients and service users, and the community To be fair, transparent, measured, and thorough in decision-making and in the management of public money To be ready to be held publicly to account for my organisation s decisions and for its use of public money. 6. I will do this by: Declaring any personal, professional or financial interests and ensuring that they do not interfere with my actions, transactions, communications, behaviours or decision-making, and removing myself from decision-making when they might be perceived to do so Taking responsibility for ensuring that any harmful behaviour, misconduct, or systems weaknesses are addressed and learnt from, and taking action to raise any such concerns that I identify Ensuring that effective complaints and whistleblowing procedures are in place and in use Condemning any practices that could inhibit or prohibit the reporting of concerns by members of the public, staff, or board members about standards of care or conduct Ensuring that patients and service users and their families have clear and accessible information about the choices available to them so that they can make their own decisions Being open about the evidence, reasoning and reasons behind decisions about budget, resource, and contract allocation Seeking assurance that my organisation s financial, operational, and risk management frameworks are sound, effective and properly used, and that the values in these Standards are put into action in the design and delivery of services Ensuring that my organisation s contractual and commercial relationships are honest, legal, regularly monitored, and compliant with best practice in the management of public money Working in partnership and co-operating with local and national bodies to support the delivery of safe, high quality care Ensuring that my organisation s dealings are made public, unless there is a justifiable and properly documented reason for not doing so. 142

236 REPORT TITLE: CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 RESPONSIBLE OFFICER: AGENDA ITEM: 16 Communication and Engagement: 12 months review: April 2013 March 2014 Mr Iain Fletcher, Head of Corporate Business SUMMAR: This report covers the communications and engagement activity between April 2013 and March 2014, including an assessment of areas for further work moving forward. It also includes the proposed strategic objectives for communications and engagement moving forward into 2014/15 for approval. GOVERNING BOD ACTION: The Governing Body is asked to 1. Note the contents of the report. 2. Suggest any additional content or amendments to the report. 3. Support the proposed objectives for the communication and engagement plan for 2014/ Receive a further quarterly report at its meeting in July EQUALIT ANALSIS: Has an EIA been completed in respect of this report/issue requiring decision? es COMMUNICATION: Communication and/or engagement undertaken or required? es RISKS: Have any risks been assessed? No RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified with the report) Not at this stage Page 1 of 1

237 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate N NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. N Page 2 of 2

238 1. Introduction NHS Blackburn with Darwen Clinical Commissioning Group (CCG) Governing Body Meeting 7 th May 2014 Communication and Engagement: Annual Assessment and Forward Plan April 2013 to March 2014 This report provides a summary of communication and engagement activity over the last 12 months, for the period April 2013 March Communication and engagement refers to activities which seek to build the relationships and reputation of the CCG and to use the intelligence from such activities to inform clinical commissioning. The purpose of this report is to evidence progress and highlight the difference this has made and to recommend a strategic and tactical approach moving forward through 2014/15. The report provides information concerning key aspects of communications and engagement support to the CCG, including: - Public Relations (PR) and marketing including campaigns; - Media relations; - Soft intelligence gathering and analysis; - Engagement activities, including events and their outputs and outcomes; - Website and social media support ; - Market research and insight; and - Design, branding and print support. 2. Overall assessment Over the first year of operation, the profile of communications and, in particular, engagement, has risen within the CCG and is now more closely integrated with the commissioning process. This positive trajectory has included a number of highlights, including: - Effective communications and engagement around the CCG s role as Lead Commissioner for Mental Health services in Lancashire, e.g. around the dementia consultation. - A substantial improvement in the amount of media coverage, which has increased over the year, and has included regional and national coverage, e.g. for the EMIS web work. - A series of listening events aimed at engaging the public in giving information on the quality of health services and the types of services needed in Blackburn with Darwen. - The development of a core network of Patient Participation Groups, whose representatives are both committed to improving health care services and willing to support the CCG in seeking the views of patients, carers and the public. - The development of engagement activities targeting hard to reach groups, including travellers, people from black and ethnic minorities, older people and Page 3 of 3

239 children with complex needs and their families. Since April, the CCG has had a positive and growing public profile and has effectively discharged its statutory duties in the context of communication and engagement functions. The proposed plan for 2014/15 will further seek to continue to position the CCG as an effective leader in the current health and social care environment. It will cover a potentially challenging time frame in the run up to the 2015 General Election and will seek to ensure that the CCG continues to discharge its statutory functions in terms of communications and engagement in an effective and open manner. 3 Context Communications and engagement activity is provided by the CCG working in partnership with the Staffordshire and Lancashire Commissioning Support Unit (CSU) and Blackburn with Darwen Borough Council. 4 Communications and Media The CCG has a growing media presence in local news and radio. 4.1 There were a total of 76 stories in print media in the first year, the majority of these were favourable (see Figure 1, below) Media coverage 12% 9% Positive Negative Neutral 79% Page 4 of 4

240 Media interest has been focused on a number of themes, including The CCG and its members Innovations (e.g. virtual ward, police liaison in A&E) Winter messages (e.g. Think! campaign, flu jabs) Commissioning decisions, including the Better care Fund and integrated working. A number of radio interviews were supported throughout the period, including an hour long discussion on the Sally Naden lunchtime show on BBC Radio Lancashire, for the CCG and partners, including East Lancashire Hospitals NHS Trust (ELHT), to discuss urgent care in the area. Coverage was generated in relation to winter care messages and the Think! campaign and a multi-channel marketing campaign also attracted attention for the key messages. Over the latter six months of the year, the balance of media engagement has shifted towards more proactive media responses (see Figure 2, below). There is a need to continue to create proactive media activity in the coming year to maintain and develop awareness of the CCG and inform the public, patients, carers and other stakeholders in addition to other engagement channels. CCGs and the new health arrangements are likely to come under enhanced scrutiny in the run up to the 2015 General Election and this will provide the CCG with opportunities as well as challenges, while remaining apolitical. As in the case of the winter campaigns, it is recommended that there should be some investment in paid-for advertising space to reinforce key CCG messages while having control over the content of those messages, e.g. via the Council s Shuttle publication and digital messaging on the local media websites. Proactive v reactive media activity 34% Proactive 66% Reactive Page 5 of 5

241 4.2 Media and stakeholder briefings and support A Pennine Lancashire Communications Group has been established to ensure that communications are joined up as far as possible between commissioners and providers. This group meets bi-monthly and also if a specific issue needs to be discussed. There has been considerable support across the Pennine Lancashire CCGs related to the post-keogh interest in ELHT, including for media relations and for soft intelligence gathering about service provision. The CCG has taken a page in each of the three editions of the Blackburn with Darwen publication The Shuttle which is distributed to every local household. These have been used as an opportunity to explain CCG plans, including its prospectus during 2013, get winter care messages across and demonstrate how the CCG has responded to people s views using ou said, We did. 4.3 Lead CCG for Dementia - additional communication and engagement support In addition to specific communication and engagement support for the CCG, the CSU has also supported the CCG as the lead commissioner for dementia. This has involved media management, stakeholder briefings (including briefing and attending Overview and Scrutiny Committees), retrospective analysis of the engagement work leading up to the dementia proposals, review of the statutory duties and an assurance audit, and finally, supporting individual CCGs across Lancashire with specific media and stakeholder queries. 4.4 Weekly Reporting and Horizon Scanning The CCG has received a weekly reputation and relationship tracker which provides the CCG with data and analysis of communication and engagement metrics. This also provides the CCG with a high level analysis of hot issues, and an update of work that the communication and engagement team have undertaken for the CCG in the last week, with plans for the subsequent week. In addition to this, the communication and engagement team provide the executive team with horizon scanning documents which brings together important policy, guidance, news and information. 5.0 Overview The first year has seen the CCG steadily establish its reputation and media presence a corresponding increase in proactivity. One of the challenges for communications and media is the planned transformation of health and social care services in the area (and across Lancashire) and the need to continue to agree and deliver integrated messages with other partners and stakeholders in order to ensure that the public, patients, carers and stakeholders are fully on board. There are currently robust mechanisms in place in Blackburn with Darwen to achieve this. There is a clear link to the further development of soft intelligence and engagement activity. The perceived issues around the ELHT continue to generate media coverage. The outcome of the latest Care Quality Commission /Trust Development Agency inspection will significantly affect this and will need to be actively managed. Page 6 of 6

242 6 6.1 Design The CCG, with the support of the CSU and Blackburn with Darwen Borough Council, has produced a number of design and marketing materials over the year. These include: The CCG Prospectus The CCG practice newsletters An infographic which summaries key facts about the CCG for use in engagement and communications Three supplements in the Shuttle (BwD Council newsletter to every household 66,000. Creation of materials for The Big Health Day Creation of the Think! Campaign leaflets and posters specifically for minor illnesses (which launched in November) Patients in Participation branding (for CCG Patient Participation Group involvement scheme) Advertisements for the Think! winter messages, including the #TeamWinter branding and pharmacy opening times at holiday periods. Design for a new website, operational from 1 April Minor illness campaign leaflets (one general leaflet and 10 X each of the top 10 minor illnesses) demonstrating how to self-care and when to seek medical help. Initial work on branding and an approach for integrated care in Blackburn with Darwen and across Pennine Lancashire (yet to be agreed). Work on the forthcoming first Annual Report. 6.2 Overview Working relationships across partners, particularly in relation to integrated care, have been strengthened and have become increasingly productive in terms of communications and design. The plan for 2014/15 will build on this to agree a joint approach where relevant and ensure that work is as effective as possible. There is a need to continue to build coordination and be clear on roles in terms of delivery of outputs and outcomes. 7. Web and Social Media The CCG s website is now hosted in-house by the CSU, making it more flexible in terms of content changes, which can now be made more quickly and cost-effectively. The new website can be found at the same web address: The website includes a blog by the Chair, Joe Slater, a carousel of prominent news features, and contacts for all GP practices. It also includes an updated news section. Twitter, along with other social media, is integrated with the site. Web Stats (1 st Apr st March 14) Page Views 38,384 Unique Page Views 29,111 Page 7 of 7

243 The most popular pages viewed are: 1. Contact details 2. About us 3. Members of the Governing Body 4. Local services. The CCG s presence has increased on social media during the year, with steadily increasing numbers of followers on Twitter and initial publicity undertaken for the new Facebook page. Social Media Stats (1 st Apr st March 14) Twitter 1313 Followers 504 Tweets 241 Retweets 36 Mentions 33 Favourites Facebook Joined on 21 st November Page Likes 20 Post Likes 5 Comments 7.1 Overview The CCG now has a fully integrated set of social media platforms. An Intranet is also under development, as part of the newly hosted website and a basic framework for this has been created and is awaiting work on initial content. The CCG plans to seek to become more proactive in using social media for conversations in addition to its existing success as an information-sharing method. 8 Campaigns and marketing The Think! campaign has been further developed and awareness of the messages increased throughout the year. The aim of this campaign is to encourage residents, patients and public to think about the local NHS services they use, and to encourage them to think about accessing the most appropriate care, from self-care and pharmacies through to the emergency department only when appropriate. The campaign was developed using focus groups and insight from the experiences of patients, and was created in partnership with both Pennine Lancashire CCGs and the acute trust. The messages were refreshed using the #teamwinter concept and has also included self-care and minor illnesses. The campaign has also been used to focus messages for the Easter and May Bank Page 8 of 8

244 Holidays and will continue to form the basis for activity around unscheduled care. 8.1 Overview The basic concept of the Think! campaign is still being well received by the public. However, a greater degree of forward planning is being adopted to ensure that messages are more consistently shared across the year, with an emphasis on times of increased demand, particularly winter. Proposals are already being prepared for the winter of 2014/15 in order to refresh the brand and expand its reach. Plans for 2014/15 include a major campaign to boost awareness of Patients in Participation, which will aim to recruit more members to Patient Participation Groups based in GP practices and create more events and opportunities for patients, carers and the public to give their views of health care services and integrated health and social care services, in partnership with Blackburn with Darwen Borough Council Complaints, Concerns, Compliments and Comments Between 01/04/13 and 31/03/14 there have been 33 complaints from Blackburn with Darwen residents, of which, eight are on-going and open at the present time. One of these open formal complaints has breached the statutory time frame for the management of formal complaints; However, the complaints team have on-going discussion with the family. The majority of the complaints received related to NHS continuing healthcare issues (13, 39%). The main reason for complaint in this area was around the delays and lack of communication the complainants experienced during the continuing healthcare process Over the year 72 concerns/enquiries were received. Out of these concerns/enquiries there are currently four still open and on-going. Again, the majority of the concerns/enquiries relate to the area of Individual Patient Activity (IPA) with 16 (22%) relating to the NHS Continuing Healthcare process and 13 (18%) relating to funding issues. Engagement, Insight and Market Research There have been an increasing number of engagement events during the year, a combination of those involving CCG and CSU staff, and a number linked to voluntary organisations, such as Age UK, or the local authority. These have given the CCG opportunities to ensure that the views of patients, carers and the public are integrated into commissioning decisions, monitor the quality of commissioned services and health and social care. They have led to increased opportunities for insight into the health needs and issues of the local population. A list of engagement activities is included at Appendix (1). The focus of engagement has been around a number of areas, - Urgent Care - Integrated health and social care, including the Better Care Fund; - Learning Disabilities Page 9 of 9

245 - Appropriate use of services; - Quality of health care services; and - Services for children with complex needs and their families. In addition, insight research was undertaken to support the CCG s role as the lead commissioner for dementia Overview Engagement activity has been stepped up during the latter half of the year, with a number of activities targeted directly at hard to reach groups, including the travelling communities, people from black and minority ethnic backgrounds and children and their families. A soft intelligence gathering system has been instigated, with the support of the CSU, aimed at analysing information from patients, carers and the public and identifying trends or areas of good practice or which need improvement. The Patient Participation Group Network, Patients in Participation has been set up and a number of meetings held to obtain patient and carer feedback. It is planned to further develop and expand this during the coming year, based on the new locality-based integrated health and social care areas. Engagement during 2014/15 will be planned in line with: - The 5-year strategic plan priorities; - Commissioning intentions (building on existing work); and - Feedback from stakeholders, in particular the public, on the quality and shape of services. 11 Communications and Engagement Plan for 2014/15 The proposed communications and engagement strategy for 2014/15 is attached at Appendix (2). Its strategic objectives are: To maintain and develop the reputation of the CCG by ensuring that Blackburn with Darwen CCG has a relevant, professional and high profile with its stakeholders. To provide a range of communications and engagement support to ensure that the CCG fulfils its statutory obligations. To ensure that the CCG is proactive in communicating and engaging with stakeholders, with a particular emphasis on the public, patients and carers, to ensure that they are appropriately involved in the planning, commissioning, delivery and monitoring of services. To support the CCG in its role as the lead commissioner for mental health services. Page 10 of 10

246 The plan includes an emphasis on: 12 Conclusion - The CCG s 5-year plan - Urgent and unscheduled care - Self-care - The development of integrated locality teams and the implementation of the Better Care Fund; - A focus on hard to reach groups. - The development of care closer to home, including for scheduled (planned) care; and - The development of patient and carer engagement, linked to GP Practice Patient Participation Groups, through Patients in Participation. With the establishment of the CCG Communication and Engagement Strategy, the forward plan, a joint working initiative with the Council, it is anticipated that the CCG, with the support of the communication and engagement team, will (a) shift towards a more proactive communication and engagement footing over the coming months and (b) aid the communication and engagement team to deepen its support to developing the CCGs commissioning plans and intentions. As the data relating to communication, engagement and soft intelligence activity increases, it is anticipated that graphical representations and more detailed analysis of patterns and trends will be introduced. 13 Recommendations The Governing Body is asked to: 1. Note the contents of the report 2. Suggest any additional content or amendments to the report 3. Support the action and activity to date, and the plans moving forward 4. Receive a further report at its meeting in July David Rogers Senior Executive Communication and Engagement (Staffordshire and Lancashire CSU) Colette Booth Head of Locality: Communications and Engagement, Blackburn with Darwen CCG (Staffordshire and Lancashire CSU) 28 th April 2014 Page 11 of 11

247 Appendix 1, Table 1 Engagement and Insight Focus of Engagement Urgent Care radio event Sally Naden Show, Radio Lancashire Date Participants Audience./ numbers engaged with CSU Comms and Engagement Team (Jeanette Pearson) supported Charles Thompson Emergency Dept, ELHT, Dr David White and Dr Zaki Patel and a nurse from UCC Streaming Pilot, RBH who were interviewed on Radio Lancashire regarding the ELHT Streaming Pilot Rural Event Iain Fletcher, CCG, and CSU Snr Engagement Officer, Sharon Walkden Integrated Care Pilot Drop in session CSU Snr Engagement Officer Jeanette Pearson, Naomi Wood, Lancashire Mind 250,000 audience (Rajar figures October 2013) 18 people approximately 15 residents living in Shadsworth Audience segments Benefit Outcome Broad cross section Members of the farming community who are part of a national sensory programme or a care farm organisation Long term medical conditions, unemployed, lack of knowledge of NHS services Audience will have learned about appropriate use of urgent care as the programme was an opportunity to explain this. The show is a highly respected and listened to show in peak time which means that this coverage will have helped manage the reputation of urgent care and the CCGs in Pennine Lancashire. Audience learnt of the role of the CCG in terms of commissioning responsibilities Findings show that residents of this area use the urgent care centre (UCC) inappropriately. To gain insight of residents of Shadsworth s experiences of using Audience understanding of appropriate use of urgent care will have translated into awareness of the issues, and may have created behavioural change to help reduce inappropriate use of urgent care Audience obtained a better understanding of the process of NHS budgets and what the CCG commission Residents gave feedback of the difficulties they have on a day to day basis. They were informed of NHS services available to them and when to use them. Encouraged to use the right place for NHS treatment when required. Informed of pilot and if any of the residents are referred to pilot they agreed to volunteer to attend a focus group. Page 12 of 12

248 Big Health Day Learning and Disability Event Patient Participation Group engagement meeting CSU Snr Engagement Officer, Jeanette Pearson and Engagement Support Worker Katie Doyle Chair Joe Slater, Iain Fletcher, Head of Corporate Business, Colette Booth, Head of Locality Communications and Engagement, The event was very well attended - 45 people came 8 PPG representatives attended. Meeting was well received. Self-advocates, carers and family members PPG representatives from Blackburn area practices NHS services. To raise awareness of self-care and the new Integrated Care Pilot and when to use NHS services To obtain views on services provided directly from service users and carers so the NHS can plan and deliver them more effectively No decision about me without me To explain CCG role and obtain views on key issues affecting health and health commissioning locally. Big Health Day 2013 report.docx Audience obtained understanding of NHS and Social Care. Feedback obtained for CCG/Social Care regarding the experiences of people with learning disabilities Issues raised included the need for clear messages to the public about how to access care, using a number of channels, concerns about TB, high local rates of diabetes and Saturday access to GP appointments. Think Campaign launch onwards CSU Snr Engagement Officer, Jeanette Pearson Continually reaching patients and members of the public through promotional materials throughout Pennine Lancashire Approximately 800 face to face Broad cross section Raised awareness and gave out information to members of the public and patients re access to NHS services. Further drop-in sessions in all main health centres across Pennine Lancashire took place during October. Promotional Patients, members of the public informed regarding where to obtain the right treatment in the right place. Educating people to think before they seek help and advice regarding NHS services. Page 13 of 13

249 Patient Participation Group engagement meeting - Darwen Chair Joe Slater, Iain Fletcher, Head of Corporate Business, Paul Hinnigan, CCg Lay Members, Colette Booth, Head of Locality Communications and Engagement 8 people attended from various practices in Blackburn and Darwen Included PPG representatives, carers and people with multiple conditions. packs delivered to all GP practices across Pennine Lancs. Raised awareness of CCG and collected views Issues raise including the need for better signposting to services, difficulties in accessing services including GP appointments, difficulties of coordinating care for children and young people with complex needs, difficulty in arranging direct access to paediatric wards via 111 where previously agreed, and questions about influencing health lifestyles. Health and Wellbeing Board Health Event CSU Snr Engagement Officer, Jeanette Pearson Approx. 100 Invited residents were aged between years and represented different ethnicities, gender and geographical areas in the borough Raised awareness re CCG / Think Campaign. Also Pharmacist in attendance who asked people what medicines they kept in their medicine cabinet at home. Members of the public informed regarding where to obtain the right treatment in the right place. Educating people to think before they seek help and advice regarding NHS services. Pharmacist advised what medicines to have in home medicine cabinet and advice given regarding self-care Health Talk.pdf BwD Engagement Plan Page 14 of 14

250 Weekly Tracker Ongoing All To give heads up to the CCG of comms and engagement activity undertaken and also future activity Tracker_BwD_issued _ docx Families Health and Wellbeing Forum Sharon Walkden Care closer to home and better care fund talk to stakeholder groups who work with families Listening Event, Blackburn Library Listening Event, Darwen Health Centre Katie Doyle Rashda Iqbal Jeanette Pearson Rashda Iqbal 17 members of the public gave feedback 24 members of the public gave feedback To obtain feedback from patients and members of the public regarding local NHS services. Three general questions asked: What is good, what is bad and suggestions for improvement To obtain feedback from patients and members of the public regarding local NHS services. Three general questions asked: What is good, what is bad and suggestions for improvement The CCG s statutory duty to engage with their patients, residents and carers The CCG s statutory duty to engage with their patients, residents and carers Feedback to be reported to the CCG via the soft intelligence report Feedback to be reported to the CCG via the soft intelligence report Page 15 of 15

251 Listening Event Barbara Castle Way Health Centre, Blackburn Katie Doyle Rashda Iqbal 13 members of the public gave feedback To obtain feedback from patients and members of the public regarding local NHS services. Three general questions asked: What is good, what is bad and suggestions for improvement The CCG s statutory duty to engage with their patients, residents and carers Feedback to be reported to the CCG via the soft intelligence report Age UK Event 'Fit for Future' Better Care Fund' Jeanette Pearson Rashda Iqbal Broad cross section of people over people engaged with To obtain feedback from members of the public regarding the new Better Care Fund The CCG s statutory duty to engage with their patients, residents and carers Feedback to be reported to the CCG via the soft intelligence report Stakeholder list Ongoing Rashda Iqbal Page 16 of 16

252 Better Care Fund /Integrated Care engagement tbc Patients in Participation (PIP) Three meetings per year per locality plus one annual BwD-wide meeting Exact formats to be agreed. Three meetings attended. Jeanette Pearson/ Colette Booth Page 17 of 17

253 Item Introduction Pennine Lancashire Health Economy/ Blackburn with Darwen Clinical Commissioning Group (CCG) Strategic Priorities Communications and Engagement This document has been produced in order to inform the direction and priorities of communications and engagement activity across the Pennine Lancashire health economy and, specifically on behalf of Blackburn with Darwen Clinical Commissioning Group (CCG), from 2014 onwards, with a particular focus on The following have been used as a basis for establishing the key business objectives which, in turn, have informed the communications and engagement proposed priorities and activity. Strategic plans for each CCG Cases for change documents Feedback from commissioners Identified areas of strategic work which have identified communications and/or engagement to be critical to success, e.g. cancer. Proposed service changes related to reprocurement, e.g. dementia/calderstones The detailed communications and engagement strategy and action plans for Blackburn with Darwen CCG for 2013/14 and a review of activity carried out during the year. This strategy and action plan aims to build on the initial objectives identified for the CCG and progress them into 2014/15, laying the foundations for work onwards from that date. 2. Strategic Communications and Engagement Objectives To maintain and develop the reputation of the CCG by ensuring that Blackburn with Darwen CCG has a relevant, professional and high profile with its stakeholders. To provide a range of communications and engagement support to ensure that the CCG fulfils its statutory obligations. To ensure that the CCG is proactive in communicating and engaging with stakeholders, with a particular emphasis on the public, patients and carers, to ensure that they are appropriately involved in the planning, commissioning, delivery and monitoring of services. To support the CCG in its role as the lead commissioner for mental health services. 3. Pennine Lancashire Priorities The following have been initially identified as across the health economy 1 Pennine Lancashire: Urgent care demand management, including: Page 1 of 4

254 a. Providing the public with information about the most appropriate places to access care, including direction to 111 (particularly once reprocured in spring/summer 2014). ear-round awareness is required, with seasonal flexibility, e.g. winter push. b. Self-care, including continued emphasis on minor illness and self-care. 2 Pennine Lancashire: Integrated care development, localised as appropriate..*nb While this is relevant across the health economy, each CCG has its own approach, different local authorities and stakeholder groups and models, in addition to health economy and/or pan-lancashire-wide approaches. 3 Pennine Lancashire Cancer. Mainly as support to public health activity around awareness and prevention and support for the MacMillan Cancer Improvement Partnership. 4 Blackburn with Darwen-led pan-lancashire service reconfiguration: - Development of dementia services, including community-based services, and review of mental health services. 5 Blackburn with Darwen-specific - Integrated care, including the Better Care Fund, ongoing engagement in partnership with Blackburn with Darwen Borough Council, and communications about newly-created localities and changes. - - Further development and implementation of engagement model focused on Patients in Participation. - Development of comprehensive soft intelligence collection system, linked to Patients in Participation. - Engagement with people from hard to reach groups. - Proactive reputation building for CCG and its Executive team. - Engagement aimed at informing the Cases for Change for the key pathways of: Frail elderly and long term conditions, including dementia (focus on development of community-based services). this model being specific to Blackburn with Darwen Scheduled care (with a model being developed at present for Blackburn with Darwen which is separate from the East Lancashire model) Page 2 of 4

255 4. Methodologies Children with complex needs and their families (a communications plan is already in development in association with BwDBC) The methodologies proposed are: Communications campaigns, including: A refreshed Think! campaign raising awareness of appropriate access to care, particularly unscheduled or urgent care (across Pennine Lancashire). This campaign to run across the year, but with a particular emphasis on times of high demand, such as Bank Holiday periods and winter. Promotion of self-care, in association with public health Development of Patients in Partnership branding for use to promote PPGs and a publicity campaign to support its launch and ongoing development, including a PiP newsletter Communications and engagement plan to raise awareness of the 5-year plan and invite the views of the public, patients, carers and other stakeholders on its contents and approach and how best to deliver it. Continued development of the soft intelligence gathering process, linked closely to quality monitoring, including listening events in localities and with hard to reach groups and links to Older People s Forum events (late spring onwards). Work to ensure that soft intelligence is assessed across the Pennine Lancashire health economy, particularly where providers are shared between both CCGs. Specific engagement around commissioning intentions, involving patients, carers and relevant organisations, e.g. voluntary sector. Media relations, increasing proactivity and managing enquiries, including any crises or controversial proposals which might arise. Targeting relevant trade press, e.g. HSJ as well as local and regional media. Links, where appropriate, with NHS England communications and engagement, including Lancashire-wide engagement on the future shape of health and hospital services. Engagement and surveys as appropriate, with hard-to-reach groups and planned service changes a priority. Further development of website, following the successful transfer to hosting in-house, and the development of an Intranet. Page 3 of 4

256 Further development of the use of social media for appropriate target audiences, e.g. Facebook page and Twitter, with greater use of podcasts and video. Continued development of support for legal requirements such as engagement on commissioning intentions, including scheduled care and mental health. Support for engagement with GP practices, including in relation to Intranet development and the production of the practice newsletter. Support for Lancashire-wide projects on mental health and dementia, Calderstones commissioning and service transformation. A detailed schedule of activities will be prepared as an action plan to deliver the above objectives by the end of May 2014, in conjunction with the CSU and Blackburn with Darwen Borough Council. David Rogers, Senior Executive, Communications and Engagement Colette Booth, Head of Locality, Communications and Engagement, 23 April 2014 Page 4 of 4

257 CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 Agenda Item: 17 REPORT TITLE: RESPONSIBLE OFFICER: Governing Body Sub-Committees and Groups Summary Mr Iain Fletcher, Head of Corporate Business SUMMAR: This document summarises each Committee Meeting for the Governing Body, identifying key decisions, recommendations and items of particular interest. Full copies of the minutes are available from the Corporate Support Officer, if required. GOVERNING BOD ACTION: The Governing Body is asked to note the content of the report. EQUALIT ANALSIS: Has an Equality Analysis been completed in respect of this report/issue requiring decision? No COMMUNICATION: Communication and/or engagement undertaken or required? No RISKS: Have any risks been assessed? No RELATED FUNDING IMPLICATIONS/COSTS: (A note of any funding implications identified within the report) None Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 1 of 1

258 VISION AND VALUES SUPPORTED B THIS REPORT: Improving the health and wellbeing outcomes for patients and the local population shall be our central goal. We will promote co-operation and integration before competition and fragmentation. GP Leadership will be a central principle to effect change and improvement. Transparency and trust will be developed to ensure positive relationships We will be a Can-do, innovative organisation, looking for solutions rather than problems. Planning and service redesign to be guided by needs rather than wants using the Principles of commissioning. We will maintain financial balance and stability within the whole health economy. We will promote empowerment (i.e. engagement, involvement and choice) for everyone to go hand in hand with responsibility and accountability. We will endeavour to support the local economy in our commissioning plans where appropriate. We will strive for high quality and efficiency. We will develop a workforce who feel valued, motivated, inspired with high morale. This will be by involvement, engagement, empowerment and accountability. We will also continually develop our workforce at all levels. We will be outcome driven not process driven We will develop and expand primary care (inclusive of all care outside an acute care environment) and in particular Community Orientated Primary Care. We will support colleagues to say no where appropriate NHS CONSTITUTION PRINCIPLES SUPPORTED B THIS REPORT: The NHS provides a comprehensive service, available to all. Access to NHS services is based on clinical need, not an individual s ability to pay. The NHS aspires to the highest standards of excellence and professionalism. The NHS aspires to put patients at the heart of everything it does. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is committed to providing best value for taxpayers money and the most effective, fair and sustainable use of finite resources. The NHS is accountable to the public, communities and patients that it serves. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 2 of 2

259 1) Introduction CLINICAL COMMISSIONING GROUP (CCG) GOVERNING BOD MEETING 7 TH MA 2014 GOVERNING BOD SUB-COMMITTEES AND GROUPS SUMMAR This document summarises each Committee Meeting for the Governing Body (GB), identifying key decisions, recommendations and items of particular interest. Full copies of the minutes are available from the Corporate Support Officer, if required. 2) Commissioning Business Group (CBG) Chair Dr Chris Clayton, Clinical Chief Officer Minutes of the Meeting held on 22 nd January 2014 The members present declared their conflicts of interest to the appropriate agenda items. a) Commissioning Intentions Business Cases - Dr Zaki Patel and Dr Pervez Muzaffar, CCG Executive Committee, declared a direct conflict of interest in relation to this item. Members discussed the draft Business Cases relating to the unscheduled and integrated care workstreams, noting that further work is required to align Commissioning Intentions, Business Cases and planning assumptions associated with Everyone Counts: Planning for Patients. b) Draft Pennine Lancashire Co-Location Model Activity and options Modelling - The risks and benefits relating to the 2 options for the extension of the current pilot were considered. In conclusion members supported Option 2 (Primary Care pathway to be delivered within both Blackburn and Burnley Urgent Care Centres from 2pm-11pm 5 days a week and 11am-11pm on weekends) based on the evidence provided and value for money and welcomed a detailed review to be undertaken in June The funding approved equates to 238,885 nonrecurrent. Mr Roger Parr, Chief Finance Officer, assured members that this has been built into the financial plans for the next 2 years. c) Pennine Lancashire Hospital Early Action Team (Police Liaison Role) - The Business Case to outline the proposal to initiate a 12 month pilot, a co-ordinated and integrated police support role within the Accident & Emergency (A&E) Department was discussed. Members supported the proposal providing the further evidence requested is scrutinised by the Chief Finance Officer. d) Redesign of the Children s Observation Assessment Unit (COAU) - Members supported the steps being taken to progress this service redesign. e) Paediatric Community Respiratory Nursing Service - Members were presented with details of the proposal, as part of the wider aims and objectives of the Pennine Lancashire Paediatric Pathways Group, to develop a paediatric respiratory community nursing service across Pennine Lancashire. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 3 of 3

260 Risks and benefits were discussed and it was suggested that a review of investments should be undertaken to establish what has worked previously and any learning that can be shared with this proposal. f) Development of Locality Based Integrated Care Teams - Following discussion members approved the overall integration plan and the 4 locality structure and timeframe for phasing; commencement in February Members also approved the non-recurrent funding totalling 237,000. g) Integrated Care Primary Care Locality Teams Mrs Julie Kenyon, Senior Operating Officer, provided an overview of the progress to date on the agreed development of the Practice Locality Groupings and the progress towards the formation of integrated primary care teams. Following discussion members supported the next steps towards progression of integrated health teams and welcomed further progress reports and action plan for delivery in March. h) Dementia Local Enhanced Services Dr Pervez Muzaffar, Dr Tom Phillips, Dr Zaki Patel, Dr Chris Clayton and Dr Malcolm Ridgway declared a generic interest in this item as General Practitioners (GPs). Miss Sophie ates, Service Redesign Officer, provided an overview of the circulated report which proposes the development of a Local Improvement Scheme (LIS) and highlighted key points including the costings within the financial appraisal (which are based on all practices sign up). Members discussed the benefits and the risks and agreed the proposal and associated finances: Dementia LIS 97,080 Older Adult Hospital Liaison Service 180,000 Single Point of Access 150,000 Police Liaison Service 32,000 Total 459,080 i) Winter Investments Monitoring Framework Update Members received an update of the winter investment and monitoring in place for all 7 day working, additional services and initiatives in place for Winter 2013/14. j) Enhanced Services Review Mr Parr reported that the CCG is working with the Commissioning Support Unit (CSU) as well as seeking advice from Hempsons with regards to contracting for the Enhanced Service Reviews. k) Lancashire Collaborative Arrangements Group Minutes (Nov) East Lancashire Medicines Management Board Minutes (Dec) Pennine Lancashire Clinical Transformation Board Minutes (Dec) The minutes of the above meetings were noted. 2.1 Minutes of the Meeting held on 12 th February 2014 a) Paediatric Community Respiratory Nursing Service A review of the figures is underway and the outcome of this will be fedback to the CBG. b) Commissioning Intentions Drs Pervez Muzaffar, Tom Phillips, Malcolm Ridgway, Chris Clayton, Zaki Patel, CCG Executive Committee members, declared a generic interest in this item as GPs. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 4 of 4

261 Mental Health and Dementia Mrs Debbie Nixon, Chief Operating Officer, provided an update on the progress to date with both the Mental Health Case for Change and the Dementia Case for Change and outlined the key priorities. Scheduled Care Note: Dr Chris Clayton, Clinical Chief Officer, declared a conflict of interest in the Dermatology discussion due to his partner at Darwen Health Centre who is the General Practitioner with Special Interest providing this service; it was noted that the service is a separate business to Darwen Health Centre. These three areas will be the focus for 2014/15: Ophthalmology, Dermatology, Integrated MSK, Pain Management and Rheumatology service. The rationale in the decision making process relating to the preferred options for each of the business cases was explained along with the risks and benefits. Members did not reach an agreement to progress with any of the preferred options until due diligence and further evidence in relation to the Equality Impact Assessments had been scrutinised members of the group. c) Primary Care Quality & Local Improvement Scheme (LIS) - Dr Malcolm Ridgway, Clinical Director for Quality and Effectiveness, presented the circulated report and highlighted that the scheme will be delivered in three phases: Planning Stage Improvement Plans Outcome Achievement The financial investment of this LIS will be a maximum of 2 per head of practice population. This has been included within the financial plans and equates to approximately 320,000 for Blackburn with Darwen, non-recurrently for 12 months. The Area Team are not contributing to this funding. Following discussion members noted the content of the report and approved the funding for the implementation of the Primary Care Access and Quality LIS which equates to 2 per head of population. d) Integrated Strategic Needs Assessment (ISNA) Local Strategic Review of Cancer Mrs Anne Cunningham, Public Health Intelligence Specialist, introduced the Local Strategic Review of Cancer which forms part of Blackburn with Darwen s Integrated Strategic Needs Assessment. Dr Malcolm Ridgway agreed to contact Dr Neil Smith, Clinical Lead for Cancer, with a request for him to review the information presented and to feedback some recommendations to the Cancer Locality Group, linking with the Cancer LIS with regards to the new data. e) Annual/Winter Resilience Evaluation Members noted the circulated report and welcomed a full evaluation of Winter in April f) Acute Visiting Scheme (AVS) Update Mrs Debbie Nixon, Chief Operating Officer, reported that the full evaluation of this pilot is being presented to the March Governing Body meeting along with a proposal to extend the current pilot for a further 12 months. All members to feedback comments before 28th February Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 5 of 5

262 g) Research & Development (R&D) Quarterly Update Ruth oung, Public Health Research and Development (R&D) Manager joined the meeting to provide an update regarding R&D, and service development projects that the Blackburn with Darwen Public Health Team is currently involved in. h) Lancashire Collaborative Arrangements Group Minutes (Dec) East Lancashire Medicines Management Board Minutes (Dec) Pennine Lancashire Clinical Transformation Board Minutes (Jan) The minutes of the above meetings were noted. 2.2 Minutes of the Meeting held on 12 th March 2014 Drs Pervez Muzaffar, Malcolm Ridgway, Penny Morris and Zaki Patel, Clinical Commissioning Group (CCG) Executive Committee members, declared a generic interest in the Unscheduled Care Highlight report item as GPs. a) Scheduled Care Update - Dr Malcolm Ridgway, Clinical Director for Quality and Effectiveness, presented the Scheduled Care Update Report, which provided an update in relation to the Case for Change Business Cases and a summary of the cost of the Advice and Navigation Scheme. In conclusion: The Advice and Navigation Scheme should be reviewed The CCG should build on advice and guidance functionality It should be ensured that Choose and Book is robust The view of the Clinical Panel on the way forward should be sought A further proposal should be worked up and brought back There will be a period of three months until a way forward can be agreed No specialties should be ceased in the meantime Mrs Sam Jones, Scheduled Care Manager, to meet with Dr Chris Clayton, Clinical Chief Officer, regarding timescales, due diligence and plans and bring these back to a future meeting. Members noted the content of the report and agreed that the next three months should continue under the same arrangements during which time the CCG will consult with the Clinical Panel regarding a review of the specialties within the Advice and Navigation Scheme. b) Improving Access to Psychological Therapies Business Case Members were provided an update on the Service Redesign proposal for Improving Access to Psychological Therapies (IAPT). The proposal indicated the direction of travel and work in progress and was useful for background information but the recommendations in it were no longer valid. A re-worked proposal will be presented to a future meeting. c) Unscheduled Care Highlight Report (Including Winter Update) - Mrs Jillian Wild, Head of Unscheduled Care, presented the Unscheduled Care Highlight Report, which provided the CBG with a high level overview of current and planned work of the Pennine Lancashire (PL) Unscheduled Care Group. Mrs Wild highlighted key elements of the report. Following the discussion on extending Primary Care access over the Easter period, Mrs Wild and Dr Zaki Patel agreed to discuss arrangements for the Easter holiday with Dr Chris Clayton. It was noted that there were recommendations and learning points in the report to be considered further from the following four schemes: Blackburn with Darwen (BwD) Social Care, Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 6 of 6

263 Enhanced Continuing Healthcare Assessment and Discharge Process, Maundy Relief, Springfield Beds (BwD only). Members delegated consideration of the recommendations and learning points from the above four schemes to the Executive Team (ET), as the next meeting of the CBG would fall after the deadline for decisions on the schemes should be made. This was agreed. The ET s decisions would be fed back to the CBG at the next meeting. d) Integrated Health and Social Care Teams Members were presented with a report, which outlined the proposed structure and timetable for the expansion and roll out of integrated health and social care teams across BwD via the four locality profile. Members noted that there would be a project to oversee the formation of an Integrated Care Team. Following an enquiry regarding the Equality Analysis, Mr Peter Sellars, Interim Manager, agreed to ensure that this would be completed and any potential issues reported back to the CBG. Members noted the content of and approved the report; approved the proposed action and associated timetable and noted the project commencement date. e) Lancashire Collaborative Arrangements Group Minutes (Jan) East Lancashire Medicines Management Board Minutes (Jan) Pennine Lancashire Clinical Transformation Board Minutes (Feb) The CBG reviewed the contents of the above minutes for information. 3) Quality, Performance and Effectiveness Committee (QPEC) Chair Dr Nigel Horsfield, Lay Member Secondary Care Doctor (Retired) Minutes of the Meeting held on 30 th January 2014 a) Risk: Blackburn with Darwen CCG Risk Report Qtr 3: Mrs Claire Moir, Governance Performance and Risk Manager, briefed committee members with the risks currently held on the CCG s Corporate Risk Register and asked the committee to note the contents of the report and approve the inclusion of one new risk - ID 2014/01 Failure of East Lancashire Hospitals NHS Trust not meeting the standard for stroke patients. Conclusion: Approved. b) Quality & Performance Report Month 8 (November) The committee received an update on the overall position for November 2013 against the NHS Constitution rights and pledges indicators which has been rated as amber due to the improved performance against the 62 day cancer wait time standard which was achieved in November. c) East Lancashire Hospitals NHS Trust Quality and Commissioning for Quality and Innovation (CQUIN) Exception Reports: Accident and Emergency (A&E) 4 Hour Waiting Time Target East Lancashire Hospitals NHS Trust (ELHT) failed to meet the 4 hour maximum waiting time target this month by 2.2% i.e. achieving 92.8% against a target of 95%. ear to date performance currently stands at 93.7%. Blackburn Emergency Department and Blackburn Urgent Care Centre identified as main source of delays. Cancer waits Un-satisfactory performance persists in this area including delays in all subsequent treatment times. The percentage of patients receiving subsequent drug treatment for cancer within 31 days was 2.35% below the 98% target i.e. only achieving 95.65%. Only 90% of patients received subsequent radiotherapy treatment for cancers within 31 days compared to the 94% target i.e. falling short of that target by 4%. Only 93.3% of patients received subsequent chemotherapy treatment within 31 days which is 5.7% short of the 98% target % of cancer patients received treatment for cancer Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 7 of 7

264 within 62 days upgrade their priority which falls short of the 86% target by 2.67% however this is an improvement on the previous month s performance of 70%. Admission to Stroke Unit within 4 hour - Following an improvement in October ELHT achieved 64.62% against a target of 90% - whilst this falls significantly short of the target it was an improvement on previous performance. Data received to date indicates a drop in performance in November to 41.18% however, not all patient discharges have been fully coded to enable identification of all stroke patients, therefore, this performance figure could be higher than reported to date. Friends & Family Test - There has been a small percent increase in the response rate for November with a notable increase in patient satisfaction. However, response rates still fall short of the 15% standard i.e. 8% A&E and 13% Family Care Division. d) Cancer Wait Times: Dr Malcolm Ridgway, Clinical Director for Quality and Effectiveness, presented to the committee the cancer target measures reached by ELHT over the last twelve months and asked the committee to note that: 31 Day standard for Radiotherapy Currently failing to reach target and reported a potential problem. 62 Day Cancer First Definitive Treatment - Currently Failing 62 Day wait for first treatment following a consultants decision to upgrade a patients priority Currently failing e) Lancashire Care NHS Foundation Trust (LCFT): Mental Health Exception report: Dr Ridgway briefed the committee on the exceptions for LCFT for Qtr 3: Improving Access to Psychological Therapies (IAPT) - There is lack of assurance still around the quality and timely reporting of data from LCFT pertaining to IAPT. Lancashire Care NHS Foundation Trust - Quality Measures - Performance against the 95% target regarding the number of patients with adult mental illness on care plan approach (CPA) who were followed up within 7 days of discharge from psychiatric inpatient care was variable across Lancashire, though not significantly away from target. Memory Assessment - The latest data received for referral to treatment for initial assessment within 3 months within this service relates to September when LCFT s performance was 64.7% against a target of 100%. LCFT has reported that it has an action plan to meet a target of 90% by quarter 4. Early Intervention Psychosis Services - There continues to be a time lag in the receipt of data from LCFT relating to early intervention psychosis and dementia. This is due to change over in data collection process i.e. from a local system to a national system with an expected implementation date of January Data reporting - Difficulties continue to be experienced in receiving timely, accurate and meaningful performance information from LCFT to enable CCG s to effectively monitor performance against contractual obligations. This issue will be addressed within contract negotiations for 2014/15 to ensure improved business intelligence. Lancashire Care NHS Foundation Trust BwD Mindcare IAPT Waiting Times Dr Ridgway reported a massive improvement with regards to the IAPT waiting times. Figures to date reported for counselling the average wait time is now down to one week and for Cognitive Behavioural Therapy it is now down to nine weeks. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 8 of 8

265 f) Qtr 3 Serious Incident Report 1 st Oct 31 st December Dr Ridgway provided committee members of the new/on-going/closed/legacy incidents on the Strategic Executive Information Systems for serious untoward incidents (StEIS) in Qtr 3 that involved BwD CCG s registered patients to which there was a total of 13 incidents. g) Local Authority Public Health Outcomes Briefing: Dr Gifford Kerr, Consultant in Public Health, outlined the broad range of opportunities to address the health inequalities for the population of BwD, and asked the committee to note the contents of the report which briefs on the accountabilities of Public Health on delivery of the three year plan. Dr Kerr asked the committee to note that table 1 lists all the Public Health Outcomes Framework Indicators that are shared with the CCG Outcomes Indicator Set. h) Safety: GP Safeguarding 8 Point Framework Dr Ridgway asked the committee to note the contents of the framework to which 90% of GP practices need to have completed their safe guarding training. Dr Ridgway reported that the framework is shortly to be updated to which the practices that are currently red will then change to green. 3.1 Minutes of the meeting held on 6 th March 2014 Quality Schedule and CQUIN: a) Performance Report & Appendix 1: Mrs Claire Moir, Governance Performance and Risk Manager and Mrs Anne Barnish, Interim Quality and Performance Manager, jointly presented the Month 9 Quality and Performance Report produced by the CSU. Members were requested to note: NHS Constitution The overall position for BwD CCG has deteriorated from November 2013, moving from Amber to Red. A&E - 4 hour Performance at East Lancashire Hospitals NHS Trust remains red at 90.82% in December against the 95% operational standard. ear to date performance currently stands at 93.39% demonstrating a deterioration in performance since last month. Blackburn Emergency Department (ED) and Blackburn Urgent Care Centre (UCC) continue to be the main source of delays. Significant improvement is required in order to achieve 95% target. 6 week diagnostic In December performance has gone above the <1% target for the first time this year, although cumulative position is within target. 31 Day Cancer Performance against the overarching 31 day cancer indicator (i.e. all treatment types) has moved from Green to Red with performance in December at 91.5% against target of 94%. 31 Day Drug moved from Red in November to Green in December (100%) 31 Day Radiotherapy Moved from Red in November to Green in December (100%) 31 Day Surgery Remained at Green in December (100%) Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 9 of 9

266 62 Day Cancer Performance against the 62 day cancer indicators for patients receiving first definitive treatment following referral has varied in December: Within 2 months of urgent referral for suspected cancer from GP or dentist 80.65%. Within 2 months of referral from NHS Screening Service 100%. Within 2 months of originally referral, where such was NOT an urgent GP referral for suspected cancer, but Consultant subsequently upgraded their priority 72.73%. Safety: Francis/Keogh/Berwick Update: DRAFT BWD CCG s Response Francis report: Mrs Anne Barnish highlighted to the committee the key recommendations that require implementation within the services that the CCG commission and asked committee members to note the contents of the paper and be assured that robust processes are in place to monitor compliance with the recommendations. Keogh Review & Appendix 1 Mrs Anne Barnish updated the committee on the progress by East Lancashire Hospitals Trusts on the actions from the Keogh report and to note the current position in relation to the submission of evidence against the framework. Committee members noted the contents but commented that since Christmas there has been a deterioration, and it is clear that there appears to be a lack of evidence being presented by East Lancashire Hospitals Trust. Safety Infection Prevention and Control/Health Care Acquired Infections Mrs Anne Barnish updated committee members of the new case of MRSA Bacteraemia to which Blackburn with Darwen CCG had been assigned to carry out the Post Infection Review. Whilst there were no identifiable causative factors from this review, following discussion with the microbiologist at East Lancashire Hospitals NHS Trust it was evident that there was a variety of contributory factors. Final Decision: Community Acquired Infection. From the review, learning outcomes have been identified. A discussion took place regarding future healthcare acquired infections strategy. 4) Audit Committee Chair Mr Paul Hinnigan, Lay Member Governance Minutes of the Meeting held on 26 th February 2014 Matters Arising a) Minute Audit Committee Members Training and Development The Chair remarked that he had not yet been able to discuss Audit Committee members training and development with all members. He stated that the Healthcare Financial Management Association (HFMA) has produced a series of NHS Finance training modules which comprise of a number of introductory guides. It was noted that these guides cover a range of financial topics and are aimed specifically at Non-Executive Directors, Lay Members and Non-Finance Professionals. RESOLVED: Following discussion, it was agreed that each full member of the Audit Committee should undertake the HFMA modules covering an introduction to NHS Finance; NHS Governance, and Internal and External Audit. b) Minute External Audit/Progress Report Personal Health Budgets Mr Roger Parr, Chief Finance Officer, reported that the Staffordshire and Lancashire Commissioning Support Unit (S&LCSU) are responsible for managing Personal Health Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 10 of 10

267 Budgets. The S&LCSU is producing a paper which will be presented to the Commissioning Business Group and he will inform the Audit Committee if there are any issues. c) Minute Out of Pocket Expenses Update The Chair stated that it had been agreed at the last meeting that this standing item should be removed from the meeting agenda. It had also been agreed that a future stocktake should be undertaken. Mr Parr reported that a report had been produced and Out of Pocket Expenses had returned to normal levels, indicating that the action taken had had an impact. d) Minute Any Other Business Governing Body (GB) Members Indemnity Cover Mr Parr reported that information had been obtained from the NHS Litigation Authority which had resolved the query by confirming that individual members do have indemnity cover for commissioning decisions. e) Risk Management Report Mrs Claire Moir, Governance, Performance and Risk Manager, presented the Risk Management Report, which provided members with an update on the management of risks held on the Corporate Risk Register (CRR) for the period October December 2013, quarter 3. NHS Audit North West had reviewed the CCG s systems of internal control including the design and operation of the CCG s Governing Body Assurance Framework (GBAF). There were four actions for the CCG to implement within agreed timescales but significant assurance was provided. RESOLVED: That the Audit Committee noted the content of the report. f) External Audit Mr Chris Whittingham, Manager, Assurance, Grant Thornton UK LLP and Mrs Karen Murray, Director, Assurance, Grant Thornton UK LLP, presented items from External Audit the Progress Report, which provided an update against key elements of the 2013/14 plan, highlighting any issues, and the Audit Plan which had been shared with Mr Parr prior to today s meeting. Progress Report Mr Whittingham highlighted key elements of the report and assured members that any areas of concern will be brought to the CCG s attention as necessary. The report contained a series of challenge questions which could be posed to all CCGs and were not specific concerns for Blackburn with Darwen (BwD). The challenge questions were discussed and considered in detail by the members of the Committee. Audit Plan Mrs Murray presented the Audit Plan which sets out the work that Grant Thornton will undertake on behalf of the CCG and identifies and assesses risk, i.e. the CCG s business risk and also risks from the wider environment. The report identified two significant risks to all CCGs, not just BwD. Grant Thornton s work will cover how risk is assessed and will focus on healthcare contracting. Mrs Murray added that this is a development year with regard to reviewing CCG s from a Value for Money perspective and stated that the picture will be clearer by the end of the year. Initial work has commenced and will be finalised over the next few weeks. There are currently no areas of concern. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 11 of 11

268 Guidance on Value for Money approach at CCGs 2013/14 Mr Whittingham presented the Auditor s conclusion of CCG arrangements to secure Value for Money for information, which had been shared with Mr Parr prior to the meeting. Key Issues for Clinical Commissioning Groups National Update Mrs Murray presented the above update in order to bring the content to the attention of the CCG, as the document highlighted common issues of concern across CCGs. RESOLVED: That the Audit Committee noted the content of the reports. g) Internal Audit Progress Report Mrs Lisa Warner, Senior Audit Manager, NHS Audit North West, highlighted key elements of the report which informed the Audit committee of the progress made against planned work for 2013/14, which is almost complete. It was noted that since the last meeting of the Audit Committee, Internal Audit has produced seven final reports. One of the reports contained one high priority recommendation in respect of the need to produce a Primary Care Strategy (PCS) to be presented to the GB. It was noted that the CCG is in the process of producing a PCS. Introduction to Mersey Internal Audit Agency Mrs Karan Wheatcroft, Assistant Director, Mersey Internal Audit Agency, gave a presentation to the Committee on the Mersey Internal Audit Agency (MIAA). MIAA would be taking over the CCG s current Internal Audit provider, Audit North West, and providing internal audit services to the CCG. Following an enquiry from the Chair, Mrs Wheatcroft confirmed that the service will be provided through the framework agreement, providing continuity of service and within the same cost envelope. RESOLVED: That the Audit Committee noted the content of the reports. h) Anti-Fraud Progress Report Mr Chris Morris, Senior Counter Fraud Manager, NHS Audit North West, presented a progress report on work undertaken by the Local Counter Fraud Service (LCFS) against the Annual Plan and highlighted key elements of the report. Inform and Involve Bribery Act Legislation A compliance check list has been completed with the CCG. An exercise has been undertaken across the patch to gauge levels of awareness specifically related to bribery and corruption. This has raised issues related to due diligence and if CCGs have undertaken due diligence on suppliers. Mr Morris added that the Audit Committee will be kept updated on developments. Prevent and Deter Risk Assessments The LCFS is currently undertaking a Risk Assessment exercise at the CCG to assess how the CCG protects itself against fraud. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 12 of 12

269 Fraud Notices/Requests Alerts and notices have been issued by NHS Protect none affected BwD. Hold to Account Investigations Mr Morris confirmed that there has been little by way of referrals of fraud allegations against CCGs, although some better quality information is being received. RESOLVED: That the Audit Committee noted the content of the report. i) Losses and Special Payments: Mr Parr presented the Losses and Special Payments report. There were no losses or special payments made during the period 1 st October 2013 to 31 st December RESOLVED: That the Audit Committee noted the content of the report. j) Waivers and Standing Orders Mr Parr presented the Waivers and Standing Orders report. There were two single tender waivers for the period 1 st October 2013 to 31 st December These were the first two waivers reported for the year. RESOLVED: That the Audit Committee noted the content of the report. k) Gifts and Hospitality/Register of Interests Mr Parr presented the Registers Update. There were no additions to the Gifts and Hospitality Register since the last meeting of the Committee. RESOLVED: That the Audit Committee noted the content of the update. l) Audit Committee Work Plan 2014/15 The Chair presented the work plan for 2014/15 for consideration and comment. RESOLVED: That, following the agreed amendments, the Audit Committee Work Plan for 2014/15 was agreed. m) Quality, Performance and Effectiveness Committee Dr Nigel Horsfield, Lay Member - Secondary Care Doctor, presented the minutes of the Quality, Performance and Effectiveness Committee (QPEC) for information.. Minutes of the meeting held on 30 th October 2013 The Audit Committee noted the minutes. Minutes of the Meeting held on 20 th November 2013 The Audit Committee noted the minutes. Minutes of the Meeting held on 18 th December 2013 The Audit Committee noted the minutes. RESOLVED: That the Audit Committee noted the content of the minutes of the QPEC. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 13 of 13

270 5) Information Governance Steering Group Chair Mr Roger Parr, Chief Finance Officer Minutes of the Meeting held on 14 th February 2014 a) Asset Registers and Information Mapping Mrs Lara Cousens, Information Governance (IG) Officer, explained the Information Asset register and Data Flow mapping report and confirmed that no significant risks have been identified. The asset register and data flow will be a continuing programme of monitoring, reviewing and updating assets. The group were concerned why medicines management still require the use of a fax machine. Mrs Cousens is to investigate this and find out from other CCGs if they use faxes for medicines management work. It would be safer to scan and documents than fax them. Other than this, the group were happy with the report. b) IG training BwD CCG is now 100% compliant with regards to staff IG training for 2013/14. c) IG incidents Mrs Cousens presented a confidentiality audit report that had been undertaken on the CCG shared drive. The group questioned one name that has access to the drive. Mrs Cousens to check this. Other than this, the group were happy with the report. Two incidents had been highlighted to the CCG 15 minutes prior to this meeting. Very few details were available at this time, however the CSU are investigating both incidents and will keep the CCG updated. d) Freedom of Information / Subject Access Requests The group requested that information be provided on how many Freedom of Information requests over the whole financial year have been completed within the 20 day deadline and how many breaches occurred. e) Caldicott log The Caldicott plan was presented to the group for agreement. Subject to the agreement of Mr Paul Hinnigan, Lay Member Governance, the plan was approved. f) Privacy Impact Assessments and Information Sharing Agreements Mrs Cousens and Mrs Linda Pickup, Information Governance Manager, will meet to prepare a full list of privacy impact assessments and information sharing agreements to take to the next meeting. g) CCG IG toolkit Mrs Cousens advised that the toolkit is currently at 64% and we are aiming for 66% which equates to a level 2. Two elements outstanding are the arrangements to circulate the CCGs business continuity plan to relevant staff and the minutes of this meeting. Next year the CCG will be able to aim for level 3 for some requirements. The group are happy with the work completed so far. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 14 of 14

271 6) Lancashire Clinical Commissioning Group Chairs Network Chair Dr Chris Clayton, Blackburn with Darwen CCG Minutes of the Meetings held on 31 st The ratified minutes of the above meetings are attached as Appendices A, B and C. 7) Blackburn with Darwen Health and Well-Being Board Chair Councillor Kate Hollern, Blackburn with Darwen Borough Council Minutes of the Meetings held on 12 th March 2014 The draft minutes of the above meeting are attached as Appendix D. 8) Recommendation The Governing Body is requested to note the content of the report. Iain Fletcher Head of Corporate Business 25 th April 2014 Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 15 of 15

272 Appendix A Meeting held on Thursday 19 December 2013, 9.00 am Meeting room 1, Conference Suite, Floor 1, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8D Present: Dr Chris Clayton (chair) Blackburn with Darwen Dr Gora Bangi Chorley & South Ribble Dr Ann Bowman Greater Preston Dr Tony Naughton Fylde & Wyre Dr Amanda Doyle Blackpool Dr John Caine West Lancashire In attendance: Mr Allan Jude Blackpool (items 6 & 7) Prof Helen Tierney-Moore (item 8) Mr Carl Ashworth (item 10) Mrs Linda Riley (item 10) In attendance: Mrs Debbie Nixon Blackburn with Darwen Mrs Jan Ledward Greater Preston/Chorley & South Ribble Mr Tim Mansfield East Lancashire Mr David Bonson Blackpool Mr Mike Maguire West Lancashire Mr Andrew Bennett Lancashire North Mr Peter Tinson Fylde & Wyre Mrs Jill Truby Network 1. Apologies for absence Apologies for absence were received from Mr Mike Barker, Dr Mike Ions and Dr Alex Gaw. 2. Declarations of interests There were no declarations of interests in relation to agenda items. 3. Minutes of meeting held on 28 November 2013 The minutes of the meetings held on 28 November were agreed as an accurate record. 4. Matters arising and action sheet 4.1 AQuA a précis had been received from AQuA. 4.2 It was confirmed that the Network development session would take place on Thursday 6 February. 4.3 The chair confirmed that a meeting had taken place to progress on call and information would be circulated detailing proposals at the January meeting. 4.4 The action sheet was updated. 5. Safeguarding Review Mr Bonson updated members on the current position following a review of safeguarding. A task and finish group had been formed to take forward. 6. MERIT Mr Allan Jude presented a briefing paper on Mobile Medical Emergency Response Incident Team (MERIT). He explained that this was a legacy issue from Primary Care Trusts. There was a requirement for the establishment of MERIT teams. A draft model had been produced by NWAS recommending a North West approach. The Network was asked to support NWAS s proposed MERIT model and arrangements. Following discussion the network asked for further clarification around costs Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 16 of 16

273 which seemed excessive. Mr Jude agreed to take forward. All accountable officers will be asked to sign up their agreement via . Resolved: The Network supported NWAS s proposed MERIT model and arrangements subject to clarification around cost. 7. Non-urgent patient transport Mr Jude presented a briefing paper on Non-urgent Patient Transport (PTS) Bespoke Services for noting. Again he explained that this was a legacy issue from Primary Care Trusts. Mr Jude detailed the background. There were a number of bespoke services which the PCTs had agreed to pick up locally, however this had not taken place. A mandate had been given by chief finance officers of the CCGs to carry on with the current arrangements. NWAS had undertaken a review and discovered that there was no service to tender for. Mr Jude suggested that individual CCGs review services required. Resolved: Members noted the content of the report. 8. NW LETB update Prof Heather Tierney-Moore verbally updated the Network in relation to LETB and tabled copies of a report that provided an update on Health Education North West s structure and processes for delivery of workforce transformation critical to the success of service transformation at a range of levels across the health and social care system. Prof Tierney-Moore reported that the LETB had established a new substantive Transformation Post. In partnership with area teams, CCGs and Local Authorities, Health Education North West is working to establish the initial workforce baseline across the three key service areas of: In hospital care, Primary care (including GP practice, dentistry, pharmacy & optometry) and Integrated care (including community and social services). General discussion followed. Members raised concerns around retention of work force following training and the need to establish a strategy making Lancashire more attractive to students once qualified. Prof Tierney-Moore reported that links had been established with Lancaster Medical School to encourage local students. Also the two deanery s were working together to make this economy more attractive. Members agreed that CCGs should develop relationships with Lancaster. Dr Clayton raised concern around scale, timescales and the complexities of organisations. Mr Bennett offered to give a 15 minute presentation at the next meeting to share a workforce model from Lancashire North. ACTION AB It was agreed that thinking outside of box was needed to encourage more applicants. It was considered that the key was being clear about what was wanted and to be more articulate on issues for LETB to act on. Dr Clayton thanked Prof Heather Tierney-Moore for an informative discussion. 9. Chairs reflections Dr Clayton asked members to consider appointing a management lead as a second vice chair of the network to help to take work streams forward. Mr Tinson also suggested the linking of the sub groups, in particular the lead managers group, and how the agendas work together. It was considered that the lead managers undertake the background work before it gets to the Network and was a useful forum for sharing experiences and good practice. There was also a need to link the Chief Finance Officers group back to the Network. Dr Clayton also suggested a possible forum for clinicians to enable them to bring in and share ideas and discuss models. Members were asked to bring forward their nominations for vice chair and thoughts on the network groups to the January Network. 10. Collaborative Programme Review Mr Tinson, in collaboration with Mrs Linda Riley and Mr Carl Ashworth (LCSU), gave a presentation on the proposed 2014/15 Collaborative Programme Review following on from CAG workshops and visits to individual CCG executive teams. This included an update around this year s collaborative programme plus potential plans for next year. Some areas had grown and some areas had been added to. Many of the areas added are operational in nature. There has been much discussion about Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 17 of 17

274 the right balance of strategic and operation work, much of the former pending the development of the Lancashire Strategy. Mr Tinson confirmed that all elements of the work programme had a CCG senior responsible officer and were supported by the collaborative team. Mrs Riley commented that this was a strategic perspective but also reviewing key big tickets items complete with gateway and milestones to demonstrate making a difference. Lancashire had common and local priorities which fit with green and blue boxes. What were CCGs priorities and were they making a difference to patient s outcome? Mrs Riley reported that conversations at roadshows had included challenging QUIPP and how do CCGs prioritise new areas of work to make sure they deliver maximum value for money. What s the mandate for delivering QUIPP savings? Mr Maguire questioned the need for a CAG as he considered that big ticket issues should be considered by the full Network. Mr Tinson responded that there were other operational issues that there would continue to be value to progress collaboratively. The Network asked Mr Tinson, Mrs Riley and Mr Ashworth to:- 1. Undertake a diagnostic to identify the big ticket or strategic items where a collaborative approach would add greatest value. This would inform and drive the development of the Lancashire Strategy. 2. Recommend future programme management arrangements, including considering the roles of other groups such as the CCGs Lead Managers. 3. Report on progress to the January 2014 meeting. 11. Any other business 11.1 The chair asked for representatives to attend the NW Specialised Commissioning Group meeting in January. Mr Raphael, Mr Parr and Mrs Ledward were nominated Correspondence had been received from John Herring who was creating a senate steering group around Lancashire and asked CCGs to nominate a chief clinical officer to chair group. The Terms of Reference to be circulated. ACTION 11.3 Andrea Baldwin had written with an offer of seats on the Lancashire and South Cumbria s OND Board (Critical Care and Major Trauma). It was agreed to write back explaining that CCGs have significantly fewer management resources than PCTs had and ask what exactly would be involved for the Network members Mrs Nixon updated members on Specialised Commissioning around CAMHS following a helpful teleconference organised by the Lancashire Area Team It was agreed that a representative from Specialised Commissioning would be invited along to the quarterly Network meetings with the Lancashire Area Team and these meetings would be extended to 2 hours Dr Doyle reported that she was sitting on an informal group set up by Richard Barker consisting of CCGs GP leads from the North West, Cumbria and North East and for members to feed any issues via her Items for the next agenda to include Primary Care changes for discussion with Lancashire Area Team and Drs Doyle and Bangi agreed to provide a summary for other members by Monday Dr Doyle updated the Network in relation to 111 and Christmas arrangements. 12. Next meeting Next meeting: 30 January 2014, meeting room 1, Conference Suite, Floor 1, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8D. The Chair closed the meeting by wishing everyone a very Happy Christmas and a prosperous New ear. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 18 of 18

275 Appendix B Meeting held on Thursday 30 January 2014 Meeting room 231, Floor 2, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8D Present: Dr Chris Clayton (chair) Blackburn with Darwen Dr Gora Bangi Chorley & South Ribble Dr Tony Naughton Fylde & Wyre Dr Mike Ions East Lancashire Dr John Caine West Lancashire Dr Alex Gaw Lancashire North In attendance: Mr Kevin Parkinson North Lancashire Mr Roger Parr Blackburn Local Area Team 9:00 11:00 Mr Jim Hayburn Mr Martin Clayton Mrs Carole Panteli Mr Richard Jones (from 9:30 am) In attendance: Mrs Debbie Nixon Blackburn with Darwen Mrs Jan Ledward Greater Preston/Chorley & South Ribble Mr Peter Tinson Fylde & Wyre Mr Tim Mansfield East Lancashire Mr Mike Maguire West Lancashire Mr Andrew Bennett Lancashire North Mr Andy Roach Blackpool Dr Andy Maddox Lancashire North (Item 3) Mrs Jill Truby Network CSU 11:00 12:00 Mr Carl Ashworth Mrs Paula Furnival Part A of the meeting joined by NHS England Lancashire Area Team members 17. Apologies for absence Apologies for absence were received from Dr Amanda Doyle, Dr Ann Bowman, Mr David Bonson, Mr Mike Barker, Mr Paul Kingan, Mr Mark oulton, Mr Gary Raphael, Mr Iain Stoddart, Mr Iain Crossley and Mrs Jane Higgs. 2. Declarations of interests There were no declarations of interests in relation to agenda items. 3. Workforce model Lancashire North Dr Andy Maddox provided a summary presentation of the work which has taken place in Lancashire North CCG on mapping the primary care workforce. This work creates a number of strategic challenges which were the main focus of the presentation. A lengthy discussion ensued and encompassed primary care changes. Issues considered included: Consensus around the importance of this work Importance of working with LETB and utilising resources available Clarity around role of LETB and need for consistent approach GP workforce and primary care linked together Strategy in primary care may be different to what members want to see as providers Encompass not just GP requirements but general practice Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 19 of 19

276 Mr Martin Clayton tabled a paper proposing the establishment of a local medical network. This had been proposed as several CCGs across Lancashire had expressed the need to establish an equivalent professional network for the medical profession. Local Professional Networks (LPNs) existed for dentistry, pharmacy and eye health but nothing for general practice; it was considered there was a need to have something similar. (Dr Andy Maddox left meeting at 10:00 am) Discussion ensued on the make-up of the forum, whether it is Lancashire wide or on a health economy scale/ccg level. It was agreed there was a need for a commissioner forum with localism feeding in, and for a strategy group for Lancashire with some sort of provider forum underneath. Funding was considered to be a separate issue. Mr Richard Jones reminded the group of their 5 year set of ambitions/aspirations and to consider what this all means with clarity around roles and activity. In principle it was agreed that there was a requirement for a general practice provider. Some amendments to the paper and the membership were suggested. Members were asked to let Dr Clayton and Mr Clayton have any further comments. This would then be piloted in Lancashire on behalf of the National Team. Resolved: Members were asked to forward comments on the paper to Dr Clayton and Mr Clayton. Each CCG was asked to provide Mr Andrew Bennett with a contact person to link into the work of Dr Andy Maddox. 4. Any other business 4.1 Mrs Nixon updated members following a planning event with Spec Comm. A task and finish group had been formed and representatives from CCGs were sought to attend a one off meeting. Messrs Roger Parr, Gary Raphael, Dr Mike Ions and Mrs Jan Ledward offered to attend on behalf of Lancashire CCGs. 5. Next meeting of Network and Lancashire Area Team/Specialist Commissioning, 27 February 2014, Meeting room 1, Conference Suite, Floor 1, Preston Business Centre, Preston Part B of the meeting joined by CSU members 6. Declarations of interest pertinent to agenda There were no declarations of interests in relation to agenda items. 7. Collaborative Programme The Network considered the outcomes of the collaborative programme review at its December meeting and tasked the CSU with three actions: 1. Undertake a diagnostic to identify the big ticket or strategic items where a collaborative approach would add greatest value. This would inform and drive the development of the Lancashire Strategy. 2. Recommend future programme management arrangements, including considering the roles of other groups such as the CCGs Lead Managers. 3. Report on progress to the January 2014 meeting. Mr Peter Tinson and CSU colleagues presented the proposals which included principles of collaboration for consideration by CCGs to adopt when working on the collaborative areas. A proposed structure to support delivery was also presented for consideration. Discussion followed on the merits of creating this new structure. In relation to the proposed principles, members considered that 5 CCGs was the right number to support collaborative issues. The presentation highlighted the need for the Network to finalise its governance arrangements and this issue would be further discussed at the development session of the network. Collaborative arrangements were discussed and it was considered that only exception reporting would be presented at the new group. Therefore the role of the Senior Responsible Officer would take on different responsibilities. Members deliberated over whether overarching Network governance Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 20 of 20

277 arrangements would be appropriate or if there needed to be specific governance arrangements for the proposed collaborative programme board. In conclusion Dr Chris Clayton confirmed that these areas, along with collaborative arrangements in general, would be considered further at the Network development session. 8. Interventions of Limited Clinical Priority Mr Peter Tinson presented an updated paper in relation to policy work for Interventions of Limited Clinical Priority. Mr Tinson reported that activity and spend on these policies had not changed significantly since their introduction. Some 80% of the activity and spend is associated with three policies in tranche 1 and one policy in tranche 2. Following procedural analysis on four procedures undertaken with Fylde and Wyre CCG and CSU it was suggested that each health community should discuss and agree its local approach to implementation. It was agreed that an immediate review of all policies was a priority for CCGs in conjunction with Public Health. Mrs Jan Ledward and Dr Mike Ions volunteered to lead this review. Mr Tinson agreed to lead on developing options for policy implementation for local CCG discussion and agreement and to provide an update for next Network meeting. 9. Transfer of Local Pharmacy Enhanced Services Mrs Jan Ledward raised the issue of transfer of local pharmacy enhanced services. CCGs had been advised of NHS England s commissioning intentions with regard to local pharmacy enhanced services for the financial year 2014/15. It was established that there were differences of approach within the CCGs and it was considered that it was an individual CCG choice. Mrs Jan Ledward and Mr Roger Parr agreed to pick up and progress to enable a collective approach. 10. Minutes of meeting held on 19 December 2013 The minutes of the meeting held on 19 December 2013 were agreed as an accurate record. 11. Matters arising and action sheet The action sheet was updated. 12. On call arrangements Mrs Jan Ledward updated members on progress in relation to on call arrangements. Advice had been sought from HR which highlighted contractual issues. In answer to a question raised Mrs Ledward confirmed that CCGs were mandated to have an on call rota. After discussion it was agreed that individual CCGs would maintain existing arrangements, or have discussions with neighbouring CCGs for a sub locality rota based on health economy. 17. Non-Emergency Transport Following the recommendation to the CCG network chair in August 2013 relating to specialist dementia services in Lancashire, the Lancashire Area Ambulance Commissioning Group were tasked with producing a document that could support CCGs in responding to the question of CCG responsibility for the provision of non-emergency transport for patients, family, and carers. Mr Andy Roach, Blackpool, presented an updated policy for non-emergency transport for recommending its adoption by the 8 CCG Governing bodies. The policy specified that whilst it is clear that CCGs have a responsibility to ensure that Patient Transport Services are provided for eligible patients in order for them to be able to access healthcare, it is also clear that CCGs are under no obligation to reimburse travel costs, or provide transport, for visitors i.e. relatives, friends, carers. The Network agreed to make recommendations to their governing bodies to adopt the proposed transport policy. Mrs Nixon reported that an update on progress with the Lancashire Dementia Consultation had been considered and signed off by the Joint Lancashire Health and Scrutiny Committee. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 21 of 21

278 Separately, the Network agreed to mandate Blackburn with Darwen CCG as the Lead Commissioner for LCFT, to ensure that the proposed solutions to support reasonable access for carers and families are agreed as part of the LCFT contracting round 2014/15 and contained in the service specification for the Harbour. The Network also recognised that local commissioners may need to develop local solutions to support reasonable access for relatives and carers in line with the needs of their local populations. Resolved: the Network 1. Supported the updated non-emergency transport policy and recommends it s adoption by the 8 CCG Governing Bodies in early The CCG Network mandates BwD CCG as the Lead Commissioner for LCFT, to ensure that the proposed solutions to support reasonable access for carers and families are agreed part of the LCFT contracting round 2014/15 and contained in the service specification for the Harbour. 3. The CCG Network recognises that local commissioners may need to develop local solutions (e.g. volunteering schemes) to support reasonable access for relatives and carers in line with the needs of their local populations and the Equality Impact Analysis. 17. Chairs reflections Development Session 6 February 2014 Dr Chris Clayton outlined the content for the development session on 6 February. 15. Minutes of meetings The minutes and action matrix of the meeting of the Collaborative Arrangements Group meeting held on 10 December 2013 were noted. 16. Any other business 16.1 Greater Manchester, Lancashire and South Cumbria Clinical Senate Council interview panel seeking volunteer for 7 February. Unfortunately no one was available on this day from the Network Advert for Clinical Leadership Posts of North West Coast Local Clinical Research Network 2 posts Applicants welcome from clinicians Divisional Clinical Lead / Specialty Research Group Lead. Request to be forwarded to members for consideration Wrightington Hospital and MRSA screens. Mr Mike Maguire offered to discuss with lead commissioner Dr Chris Clayton confirmed that Dr Neil Smith had volunteered to chair Cancer Steering Group Two representatives were invited to join Lancashire and South Cumbria s ODN Board, one representing Critical Care commissioners and one for Major Trauma. Details to be circulated and considered at the lead managers forum A letter re Liver Disease in Lancashire and Cumbria : A Call to Action was tabled. Mr Andy Roach offered to action on behalf of Blackpool CCG Dr Gorga Bangi reported on his involvement in a National Membership engagement group working on CCG succession planning and that a survey would be sent out for completion by each CCG. Dr Bangi asked for support from each CCG. 17. Next meeting Next meeting: 27 February 2014, meeting room 1, Conference Suite, Floor 1, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8D. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 22 of 22

279 Appendix C Meeting held on Thursday 27 February 2014 Meeting room 1, Conference Suite, Floor 1, Preston Business Centre, Watling Street Road, Fulwood, Preston PR2 8D Present: Dr Chris Clayton (Chair) - Blackburn with Darwen Dr Gora Bangi - Chorley & South Ribble Dr Tony Naughton Fylde & Wyre Dr Mike Ions East Lancashire Dr John Caine West Lancashire Dr Ann Bowman Greater Preston Local Area Team 9:00 11:00 Mr Richard Jones Mr Jim Hayburn Mrs Roz Jones WWCAT Mr Matt Powles Spec Comm In attendance: Mrs Debbie Nixon - Blackburn with Darwen Mrs Jan Ledward - Greater Preston/Chorley & South Ribble Mr Peter Tinson Fylde & Wyre Mr Tim Mansfield East Lancashire Mr Mike Maguire West Lancashire Mr Andrew Bennett Lancashire North Mr David Bonson - Blackpool Mrs Jill Truby Network Part A of the meeting joined by NHS England Lancashire Area Team members 1. Apologies for absence Apologies for absence were received from Dr Amanda Doyle, Dr Alex Gaw, Mr Mike Barker, Mrs Jane Higgs and Mr Martin Clayton. 2. Declarations of interests There were no declarations of interests in relation to agenda items. 3. BCF Performance Payment Mr Richard Jones reported that the first cut of the Better Care Plan had been submitted. He confirmed that much of the work completed in terms of metrics and performance had ticked the boxes but Lancashire as a whole has a lot more to do. As such five CCG narratives had been submitted but the County had not created an overall narrative. There was further work to do in unitary locations. Mr Jones outlined the Best Care performance payment. He explained that if a local area achieves 70% or more of the levels of ambition set out in each of the indicators in its plan, it will be allowed to use the held-back portion of the performance pool to fund its agreed contingency plan, as necessary. If an area fails to deliver 70%, it may be required to produce a recovery plan. In 2015/16 the Fund will be allocated to local areas, where it will be put into pooled budgets under Section 75 joint governance arrangements between CCGs and councils. Funding will be routed through NHS England to protect the overall level of health spending and ensure a process that works coherently with wider NHS funding arrangements. Each statutory Health and Wellbeing Board will sign off the plan for its constituent councils and CCGs. NHS England will support CCGs to ensure that plans are properly aligned. Governing Body Sub Committees and Groups Summary 7 th May 2014 Page 23 of 23