Salford Integrated Care System Governance Framework: Adult Health and Care Services FINAL

Salford Integrated Care System Governance Framework: Adult Health and Care Services FINAL 1 Background and Scope Salford is a forward thinking health and social care economy and as such has established new governance arrangements for the adult (meaning all adults including older people) health and social care Integrated Care System, reflecting the shared ambition in our Locality Plan to improve the health outcomes of residents of the City, while also moving towards financial and service for sustainability of health and care services. Salford has a strong history of partnership working. Over the last three years, under the banner of Salford Together, the four statutory organisations (Salford CCG, Salford City Council, Salford Royal NHS Foundation Trust and Greater Manchester West Mental Health NHS Foundation Trust), in conjunction with General Practice and other partners, have been working together to integrate care for older people. Latterly this has been supported by national Vanguard status, which has enabled Salford to benefit from external investment. This document sets out revised governance arrangements for the Integrated Care System in Salford. Its purpose is to support commissioners and providers to contribute to, and make collective decisions with regards to, the development of integrated health and social care. The ethos of partnership working will underpin the programme of work, recognising that, on occasion, difficult decisions may be required by partners in order to deliver the greater goal of benefits for Salford population. 2 Integrated Care System Salford s Locality Plan Our Vision for a Healthier Salford describes our strategy for improving health outcomes for the people of Salford and move towards a more sustainable system. Developed by the Health and Wellbeing Board, it explains why radical reform is required and how it will be delivered, supported by the creation of an Integrated Care System, including an Integrated Care Organisation (ICO) fully aligned with a neighbourhood strategy and driven by co-commissioning using Salford standards. Building on the success of existing partnership working, it has been agreed to: Extend the focus of the existing Integrated Care Programme for Older People to the full adult population; Integrate commissioning arrangements for local adult health and care services, extending the existing pooled budget arrangements to the entire adult population; Establish an Integrated Care Organisation (ICO), through a Salford Royal-led prime provider model, bringing together responsibility for adult community health, mental health, adult social care and local hospital services; and Move towards a neighbourhood-based federated structure for General Practice, coterminus with electoral ward boundaries, and covering populations of 30,000 to 50,000. This will provide the vehicle through which GPs can work together, and with the ICO, to support the delivery of neighbourhood services. 1 P a g e

Salford s Integrated Care System encompasses both commissioning and provision of adult health and care services, with a greater emphasis on prevention, reducing activity and shifting away from acute to community settings. The aim is to improve the care, health and wellbeing outcomes for the adult population of Salford and make a significant contribution to closing the projected gap in estimated future funding and costs. 3 Core Principles and Responsibilities The Integrated Care System will operate with the principle of collective decision-making, recognising that certain decisions will ultimately be taken by commissioners or providers The following core principles will underpin the way commissioners and providers operate: New care models will be developed by health and social care commissioners in partnership with providers, citizens and communities; Decisions will be based on achieving better outcomes and experience for adults who require Health and Care Services; Service transformation will deliver an effective and efficient use of resources whilst assuring safe and effective standards of service; Services will be evidence-based and of the best quality, encompassing safety, effectiveness and experience; Salford residents will be given more choice and control of services, supporting selfcare and independence; Clinical and democratic accountability will be implicit within all decisions; Respect for professional areas of knowledge and expertise; Collective management of risks and benefits; and Each organisation remains sovereign: whilst responsibilities can be delegated, accountability cannot. The partners have agreed to establish the governance arrangements for the Integrated Care System set out in Appendix A (the Governance Wiring Diagram). The governance arrangements include the establishment of the following groups: Integrated Adult Health and Care Commissioning Joint Committee a joint commissioning committee between Salford City Council and Salford CCG. Advisory Board for Integrated Care a board comprising representatives of Salford CCG, Salford City Council, Salford Royal NHS Foundation Trust, Greater Manchester West Mental Health NHS Foundation Trust and General Practice. Although the Integrated Adult Health and Care Commissioning Joint Committee and the Advisory Board for Integrated Care have discrete and defined responsibilities, they will need to work closely together and, to this end, have some common membership. They will work alongside the Health and Wellbeing Board, recognising the role of the latter in setting the Locality Plan and promoting integrated care and partnerships. They will also be subject to review by the Health and Adult Scrutiny Committee and audit, where appropriate. 2 P a g e

4 Integrated Adult Health and Care Commissioning Joint Committee The Integrated Adult Health and Care Commissioning Joint Committee is a joint committee of Salford CCG and Salford City Council. It will be responsible for the Service and Financial Plan for Adults and Older People s Service, otherwise known as the Commissioning Plan. It will have responsibility for all matters relating to the Adult Health and Social Care Pooled Budget as set in the Section 75 formal partnership agreement. It will have delegated decision making authority of up to 1m in relation to all commissioning decisions relating to the Service and Financial Plan, with regards to baseline pool budget funding, the Better Care Fund (BCF) and any other future funding streams. In line with the Service and Financial Plan, it will have responsibility for the management of system level performance as well as the overall performance of providers commissioned from the pooled budget, the most significant of which will be the ICO. The terms of reference for the Integrated Adult Health and Care Commissioning Joint Committee are set out in Appendix B to this framework. 5 Advisory Board for Integrated Care The Advisory Board for Integrated Care is a forum where the four statutory partners, in conjunction with General Practice, will jointly recommend the overall strategic direction for the integration of adult health and care services in Salford (ICS and ICO) and oversee the implementation of the new integrated care system arrangements. The Advisory Board will ensure the effective engagement with stakeholders and will advise on service strategy, service design and the development of an annual work programme. It will take decisions relating to Salford s Vanguard (Salford Together) programme, where consensus can be reached, including the use of transformation resources allocated to the programme, and other decisions agreed by each of the four statutory organisations and General Practice. Where consensus cannot be reached on such matters, decisions will be referred back to individual organisations. The terms of reference for the Advisory Board for Integrated Care are set out in Appendix C to this framework. 3 P a g e

6 Approval and Commencement This framework, including the Terms of Reference of both the Integrated Adult Health and Care Commissioning Joint Committee and the Advisory Board for Integrated Care, has been approved by the partners. The framework will be implemented as follows. The system changes will commence in April 2016 with establishment of the Pooled Budget and there will be a period of transition, as other changes are implemented, concluding with the ICO being formed in July 2016. 1 April 2016 Establishment of the Adult Health and Social Care Pooled Budget, as set in the section 75 partnership agreement Level 2 decisions for Older People retained by the Alliance Board Level 2 decisions for Adults retained by the CCG Governing Body and SCC City Mayor 31 May 2016 Alliance Board for Integrated Care dis-established 1 June 2016 Adult Health and Care Commissioning Joint Committee formally established (Level 2 decisions transferred to the Joint Committee for Adults and Older People) Advisory Board for Integrated Care established 1 July 2016 ICO formed (subject to separate approvals process and regulatory consent) 7 Partner Decisions, Escalation and Resolution of Disagreement The Terms of Reference for the Committee and the Advisory Board set out how decisions for those groups will be taken. The Commissioner Section 75 agreement sets out resolution of disagreement between commissioners in relation to joint commissioning and the pooled budget. The service contracts between partners set out processes for escalation and dispute resolution in relation to the terms of the contract. For issues that arise between partners relating to the Integrated Care System, outside of these arrangements, partners will seek to agree a collective view for recommendation to individual organisation s approving bodies. Where a collective view cannot be reached, the issue will be escalated to the Chief Executive / Chief Officer of each organisation to resolve and if resolution is still not reached to the Mayor/Chair of each organisation. The partners recognise the need for all of them to have certainty about the governance arrangements set out in this framework, for the effective operation of the Integrated Care System. Any variation to, or termination of, this framework will require the approval of all of the partners. 4 P a g e

Appendix A - Governance Wiring Diagram Proposed Integrated Care System Governance Infrastructure SRFT Board of Directors GMW Board of Directors Salford Health and Wellbeing Board Oversee Locality Plan Oversee Integrated Care System Advisory Board for Integrated Care ICS and ICO Adult Health and Care Engagement of ICO and ICS stakeholders Advisory in relation to: o Service strategy o Service design o Annual Programme Plan Decision making (up to 1m) by consensus in relation to: o Vanguard o Other elements on a case by case basis that are agreed by each of the four partner organisations Salford Council City Mayor & Cabinet Sets high level strategy & outcomes Approves contribution to pooled fund Approves Section 75/Contract Retains statutory responsibility Receives assurance reports Governing Body Sets high level strategy & outcomes Approves contribution to pooled fund Approves Section 75/Contract Retains statutory responsibility Receives assurance reports Integrated Adult Health and Care Commissioning Joint Committee Adult Health and Care Pool including ICO Commissioner Group (City Council & CCG) Membership to include GPs and SCC Members Service & Financial Plan (Commissioning Plan Integrated Care System & ICO) Decision Making Body (Up to 1m) in relation to: o Service strategy o Service design o Annual Programme Plan o Market Management Management of System & Performance Health and Adults Scrutiny Committee _ Accountability -- - - - Advice Scrutiny

Appendix B - Terms of Reference for the Integrated Adult Health and Care Commissioning Joint committee SALFORD CITY COUNCIL AND NHS SALFORD CLINICAL COMMISSIONING GROUP TERMS OF REFERENCE FOR THE INTEGRATED ADULT HEALTH AND CARE COMMISSIONING JOINT COMMITTEE FINAL DRAFT V0.15 P a g e 1 14

VERSION CONTROL Version Date Editor Purpose/Change Number 0.1 05.01.16 Louise Rigg First draft issued to Karen Proctor/J Mc Govern for comment. 0.2 09.01.16 Louise Rigg Second draft issued to Manchester Shared Legal Service for comment. 0.3 18.01.16 Louise Rigg Third draft issued to Integrated Care Commissioning Governance Working Group (ICCGWG) for comment. 0.4 19.01.16 Louise Rigg Incorporation of comments from ICGWG meeting and KP via email. Issued to J Mc Govern for Salford CC internal discussion. 0.5 20.01.16 Louise Rigg Incorporation of revised Annex 1 detail from J Mc Govern. 0.6 27.01.16 Louise Rigg Incorporation of amendments requested by J Mc Govern, K Proctor and H Dobrowolska. 0.7 04.02.16 Louise Rigg Incorporation of feedback from CCG Executive Team and Programme Management Group (PMG). 0.8 05.02.16 Louise Rigg Incorporation of greater quality emphasis and minor amendment to voting narrative. Also inclusion of narrative with regards to Advisory Board accountability. 0.9 11.02.16 Louise Rigg Minor amendments to wiring diagram (Advisory Board) and wording of core principles. Addition of specific Salford CC requirements following review by legal team. 0.10 23.02.16 Louise Rigg Incorporation of amendments to Annex 1 following final review at ICCGWG meeting (22/2/16). 0.11 07.03.16 Louise Rigg Incorporation of agreed amendments from SRFT and Hempsons. 0.12 14.03.16 Louise Rigg Incorporation of amendments following advice from Hempsons report. 0.13 22.03.16 Hannah Amendment to Annex 1, delegated limits for Dobrowolska Advisory Board following ICCGWG meeting (21/3/16) 0.14 22.03.16 Hannah Dobrowolska Amendment to Annex 1, delegated limits for Advisory Board following communication with Jennifer McGovern, Karen Proctor and Jack Sharp 0.15 22.03.16 Louise Rigg Inclusion of Appendix A Wiring Diagram 1.0 P a g e 2 14

RECORD OF STAKEHOLDER ENGAGEMENT Stakeholder Group Integrated Care Commissioning Governance Working Group Executive Management Team Programme Management Group Integrated Care Commissioning Governance Working Group Integrated Care Commissioning Governance Working Group Paper / Version No Date 0.3 18.01.16 0.6 03.02.16 0.6 03.02.16 Outcome/Feedback Agreement to structure respective organisations to share particular concerns with organisational colleagues. Agreement to content minor amendments re voting and patient engagement required. Content noted clarification of wording sought and minor amendments requested. 0.9 22.02.16 Amendment to Annex 1. 0.12 21.03.16 Amendment to Annex 1. P a g e 3 14

Integrated Adult Health and Care Commissioning Joint Committee Terms of Reference FINAL DRAFT V0.15 1 Background and Scope Salford recognises that it is a forward thinking economy and as such has established new governance arrangements for the Integrated Care System, reflecting the shared ambition in our Locality Plan to improve the health outcomes of residents of the City, while also moving towards financial and service for sustainability of health and care services. This document sets out new commissioning arrangements where GPs and Councillors can contribute to, and make decisions with regards to health and social care matters. These Terms of Reference should be read alongside those of the Advisory Board for Integrated Care (see Appendix A for the Governance Wiring Diagram). The ethos of partnership working will underpin the programme of work, recognising that on occasion, difficult decisions may be required to benefit the Salford population. The Integrated Adult Health and Care Commissioning Joint Committee ( the Committee ) is a joint committee established under Regulation 10(2) of the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000. For the avoidance of doubt, Salford City Council (Salford CC) and are delegating their functions to the Integrated Adult Health and Care Commissioning Joint Committee and not to their individual representatives on the Committee. The Committee will be responsible for the Service and Financial Plan for Adults and Older People s Service, otherwise known as the Commissioning Plan. It will have responsibility for all matters relating to the Adult Health and Social Care Pooled Budget as set out in the Section 75 formal partnership agreement between commissioners (Salford CC and NHS Salford CCG). It will have delegated decision making authority of up to 1m in relation to all commissioning decisions as they relate to the Service and Financial Plan, with regards to baseline pool budget funding, the Better Care Fund (BCF) and any other future funding streams. In addition, other officers and groups will have the authority to commit Pool resources as identified in Annex 1. Through its decision making processes it will adhere to Salford CC s duties of transparency in relation to Key Decisions (See Annex 1) as they relate to the Council s constitution. It will also adhere to all aspects of the s Constitution. In line with the Service and Financial Plan it will have responsibility for the management of system level performance as well as the overall performance of providers commissioned from the pooled budget, the most significant of which will be the Integrated Care Organisation. As required, the Committee may establish non-decision making groups and seek assurances about progress via the receipt of regular reports. These Terms of Reference have been prepared to outline the responsibilities of the Committee. They have been approved by s Governing Body in consultation with the CCG s Executive Team and Programme Management Group (PMG) and by Salford CC s City Mayor in consultation with Cabinet. They will remain valid until such time as there is a need to implement revised governance arrangements. Partnership working P a g e 4 14

is vital to the success of the programme, however it is acknowledged that at all times, sovereign powers remain in place. 2. Core Principles and Responsibilities Core Principles of The work of the Integrated Adult Health and Care Commissioning Joint Committee will be driven by the following core principles: Decisions will be based on achieving better outcomes and experience for Adults and Older People who require Health and Care Services; Service transformation will deliver an effective and efficient use of resources (within the statutory requirement to meet the CCG s and Council s financial duties) whilst assuring safe and effective standards of service; New care models will be developed by health and social care commissioners in partnership with providers, citizens and communities; Services will be evidence-based and of the best quality, encompassing safety, effectiveness and experience; Salford residents will be given more choice and control of services, supporting selfcare and independence; Clinical and democratic accountability will be implicit within all decisions; Respect for professional areas of knowledge and expertise; Collective management of risks and benefits; and Each organisation remains sovereign: whilst responsibilities can be delegated, accountability cannot. The Integrated Adult Health and Care Commissioning Joint Committee have responsibility to deliver clearly defined objectives which are detailed below: Contribute to the development of Salford CC s and s Strategic and Operational Plans and Salford s Locality Plan; Acknowledge the interdependencies of this programme of work ensuring that all options considered are congruent with, but not limited to: Greater Manchester Devolution Joint Commissioning of Primary Care; Partnership governance (to include NHS England); and Healthier Together/ North West Sector Acute Reconfiguration Programme. Respond and contribute to the Joint Strategic Needs Assessment (JSNA), working in partnership with other statutory and non-statutory organisations to improve health and wellbeing and reduce inequalities; P a g e 5 14

Lead the development and delivery of the Adults and Older People s Service and Financial Plan for approval by Salford CC Cabinet, CCG Governing Body and the Health and Wellbeing Board; Contribute to revisions of the Section 75 pooled budget agreement for approval by the Salford CC Cabinet and CCG Governing Body, including risk and gain sharing mechanisms; Inform the work of Adult and Health Scrutiny Committee as well as providing appropriate reporting in response to the call in resulting from key decisions; Develop a robust evaluation framework to ensure progress can be measured against the Service and Financial Plan s aims and improvement targets; Facilitate coherence and working towards shared goals and objectives with cocommissioners and other partners; Advocate engagement of public, service users and patients utilising the Integrated Engagement Board as appropriate; Ensure the quality improvement of all commissioned services; To receive reports on assurances and by exception on: The commissioned service performance against and compliance with Care Quality Commission (CQC) standards; The achievement of agreed Commissioning for Quality and Innovation (CQUIN) schemes; Compliance with best practice; and Themes and trends in relation to Patient Safety incidents, Serious Incidents (including Never Events) along with actions for improvement. To instigate performance intervention in line with the Quality Strategy and contract clauses e.g. performance notices, contract penalties etc. Information received will include: Compliance or any failure to comply with standards and targets; Service user/patient or carer experience feedback (including themes and trends from complaints and surveys); Measures of staff satisfaction; and Matters concerning healthcare-associated infections (HCAI) including HCAI reduction plans. To approve the Quality Account Commentary for all relevant providers; Make investment/disinvestment decisions and review evaluations; Consider provider performance, including quality assurance; Set improvement targets and timescales, using the identified improvement measures; Establish arrangements to enable the development of new models of care; P a g e 6 14

Review existing initiatives to align complimentary workstreams and consolidate projects; As appropriate, consult with and delegate responsibilities / tasks to the Advisory Board for Integrated Care; Ensure democratic accountability through the role of Elected Members on the Committee; Ensure clinical and professional accountability and leadership; Propose changes to existing payment mechanisms and contractual arrangements with relevant providers where necessary; Promote learning that could be shared with other programmes and / or applied to different client groups; Ensure that all aspects of best practice, both nationally and internationally are duly considered and where appropriate applied; Ensure that appropriate risk management and escalation processes are correctly adhered to; Ensure that all aspects of financial governance are followed; and Seek advice from the Advisory Board for Integrated Care about the impact that proposed Level 1 Level 4 decisions will have on other partners. These core principles and responsibilities should be read in conjunction with the delegated levels of decision making authority provided in Annex 1 of this document. 3. Membership, Attendance and Quorum Membership The Integrated Adult Health and Care Commissioning Joint Committee will comprise the following core members: Voting Members - Name Chief Accountable Officer Clinical Lead for Quality and Safety Clinical Lead for Strategic Planning and Partnerships Chief Finance Officer Neighbourhood Clinical Lead Eccles and Irlam Neighbourhood Clinical Lead Ordsall and Claremont Neighbourhood Clinical Lead - Swinton Neighbourhood Clinical Lead Walkden and Little Hulton Neighbourhood Clinical Lead - Broughton Councillor 1 To be nominated by the City Mayor Councillor 2 To be nominated by the City Mayor Councillor 3 To be nominated by the City Mayor Councillor 4 To be nominated by the City Mayor Organisation Salford City Council Salford City Council Salford City Council Salford City Council P a g e 7 14

Councillor 5 To be nominated by the City Mayor Councillor 6 To be nominated by the City Mayor Non-Voting Members - Name Director of Commissioning Director of Quality and Innovation Strategic Director of Adults and Children s Services Director of Finance and Corporate Business Assistant Director Integrated Commissioning Director of Public Health Salford City Council Salford City Council Organisation Salford City Council Salford City Council Salford City Council On behalf of Salford City Council and NHS Salford CCG Individuals will be co-opted onto the Committee as necessary on an ad-hoc basis to inform discussions and in addition, may cover areas including administration and communications. Such individuals will be non-voting members. The Committee may also invite people other than those people referred to above to address it, deliver a report to it and/or answer questions. The Integrated Adult Health and Care Commissioning Joint Committee will be jointly chaired by the Executive Lead Member Adult and Older People s Services on behalf of Salford CC and a Governing Body GP on behalf of with chairing responsibility rotated between meetings. Agendas will be jointly agreed in terms of content and forward planning. Officer support will be provided through a shared approach between and Salford CC. The main contact at will be the Senior Committee Support Officer. The main contact at Salford CC will be nominated by the Salford CC Monitoring Officer. Defined duties will specifically include the circulation of agendas and papers one week in advance of each scheduled meeting. In addition, officer support will assist the chair(s) in the management of all associated business. Attendance It will be important that nominated members or their deputies commit to attend the Integrated Adult Health and Care Commissioning Joint Committee. Where this is not possible, however, deputies are encouraged to attend. Deputies must be able to contribute and make decisions on behalf of the organisation they are representing. Quorum, Decision Making and Voting The Committee will be quorate providing one-third of the voting membership is in attendance, with at least three members in attendance from each of and Salford CC present. With regard to CCG members this may include any combination of GPs and CCG officers. The Integrated Adult Health and Care Commissioning Joint Committee will aim to achieve a consensus for all decisions. Given the nature of the programme, securing the support of both partners will be critical to the success of most of the decisions made. In those circumstances where consensus cannot be reached and a decision must be taken, the issue may be put to a vote. If a decision is put to a vote, then CCG Clinical Leads coupled with the CCG s Chief Accountable Officer and Chief Finance Officer will be entitled P a g e 8 14

to vote on behalf of. Councillor Members will be entitled to vote on behalf of Salford CC. Before a vote can be considered, however, the majority of voting members from both partner organisations must have agreed that it is appropriate to determine the issue in this manner. Before choosing to put the issue to a vote, the Committee may instead ask for further work to be undertaken on the issue to explore, clarify, mitigate or minimise any concerns. The Committee may ask for specific individuals who may or may not be part of this Committee to discuss the issue further to try to find a suitable resolution on the issue. The issue would then be brought back to a future Committee meeting. Where a decision cannot be made through consensus and it is not acceptable to undertake further work or discussion on the issue outside of the Committee meeting or put the issue to a vote, the issue will be referred back to the sovereign bodies of each partner organisation. Should it be agreed that a matter should be taken to a vote, both and Salford CC will have an equal number of votes, regardless of the number of members in attendance. The number of votes will be determined by the party with the lower number of voting members in attendance. Votes will be given in the order of the voting members listed in the table above, to the number required to meet the least number of attendees from either organisation. The order of the CCG Neighbourhood Clinical Leads is based on size of their neighbourhood practice population (as at November 2015). As an illustration, should the CCG have all voting members present and Salford CC have four, then both parties are entitled to four votes. All four of the Salford CC Councillors will vote and the four votes ascribed to the CCG would be determined as follows: Chief Accountable Officer; Clinical Lead for Quality and Safety; Clinical Lead for Strategic Planning and Partnerships; and Chief Finance Officer. A vote will be carried by a simple majority. Should a vote be tied, the process will be to take the issue outside of the meeting to obtain further detail/information relevant to the decision in hand. The issue will then be brought back to the next meeting of the committee with a clear recommendation for approval or alternatively the matter will be taken back to each sovereign body. Responsibilities and Behaviour Members of the Integrated Adult Health and Care Commissioning Joint Committee have a collective responsibility for its operation. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. Members of the Integrated Adult Health and Care Commissioning Joint Committee will behave in a manner consistent with the Core Principles outlined in Section 2 of these Terms of Reference and will adhere to the behaviours highlighted in the Nolan Principles, recognising that the success of the work programme will depend upon relationships and an environment of integrity, trust, collaboration and innovation. Specific reference will be paid to both organisations core values: P a g e 9 14

Salford CCG: Salford City Council: Collaborative; Innovative: and Act with integrity. Pride; Passion; People; and Personal Responsibility. Decision Making Authority The Integrated Adult Health and Care Commissioning Joint Committee has delegated decision making authority of up to 1m in relation to the Service and Financial Plan. Decisions Reserved to the Sovereign Bodies of Partner Organisations Whilst the need to retain some reserved matters is recognised, it will be critical that the Integrated Adult Health and Care Commissioning Joint Committee has a clear mandate and sufficient delegated authority to take forward the Programme without requiring separate approvals at each stage in the process. Whilst the Committee will act as a responsible body for integrated care for adults and older people (in line with relevant statutory responsibilities), it will work alongside the Advisory Board for Integrated Care and the Health and Wellbeing Board, recognising the latter s role in setting city wide strategy and promoting integrated care and partnerships. The work of the Committee will be subject to review by the Health and Adult Scrutiny Committee and audit on both sides, where appropriate. 4. Patient, Public and Service User Involvement The Integrated Adult Health and Care Commissioning Joint Committee will ensure that commissioning activities include appropriate service user/patient and public involvement in line with Salford CC s and s respective duties. The outputs of relevant sub groups will be considered and evidenced on an annual basis e.g. by way of an annual report. Officer support to this work will be provided by staff working as part of an integrated Communications and Engagement Team, under the management of and comprising CCG staff, dedicated staff supporting the Integrated Care Programme and seconded User Development Workers from Salford CC. 5. Conflicts of Interest/ Codes of Conduct Members will be aware of what may constitute a Conflict of Interest, will ensure that Conflicts of Interest are formally disclosed and will ensure they are subsequently managed in adherence with the organisations respective Conflict of Interest Policies. In addition, appropriate Codes of Conduct will be followed at all times alongside adherence to the Nolan Principles and compliance with any statutory bar on participation and/or voting in particular circumstances. P a g e 10 14

The committee will formally record its deliberations within relevant minutes/action notes. This function will be undertaken by the designated officer support, alongside the management of paperwork and version control. Depending upon the topic under discussion and the nature of the conflict of interest, the member may be: Allowed to remain in the meeting and contribute to the discussion; Allowed to remain in the meeting and contribute to the discussion but leave the meeting at the point of decision; or Asked to leave the meeting for the duration of the item under consideration. Where items are deemed to be privileged or particularly sensitive in nature, these should be identified and agreed by the Chair. Such items should not be disclosed until such time as it has been agreed that this information can be released. 6. Frequency of Meetings Meetings will ordinarily be scheduled on a bi-monthly basis. There is also the option to rotate meetings on a formal and informal basis as required and to supplement meetings with developmental sessions. The Chair(s) of the Integrated Adult Health and Care Commissioning Joint Committee may call extraordinary meetings at their discretion. A minimum of five working days will be required. 7. Reporting The Integrated Adult Health and Care Commissioning Joint Committee will be accountable to the City Mayor in consultation with his Cabinet within Salford CC and to the Governing Body within. As such both will receive regular written reports. 8. Policy and Best Practice The Integrated Adult Health and Care Commissioning Joint Committee will apply best practice in its deliberations and in making any recommendations. It will conduct its business in accordance with national guidance and relevant codes of conduct and good governance practice. 9. Review of Terms of Reference These Terms of Reference will be formally reviewed by Salford CC and and may be amended by mutual agreement between both parties at any time to reflect changes in circumstances which may arise. Annex 1 will be reviewed after 6 months (i.e. October 2016). Terms of Reference Agreed (Date): 1 st April 2016 Review Date: March 2017 P a g e 11 14

Annex 1 DELEGATED LEVELS OF DECISION MAKING AUTHORITY Level 1 Responsibility s Governing Body/Salford CC City Mayor Scope Determination of the size of the pooled budget (including any planned in-year variations in expenditure that would require the total pooled resources to be increased); Approve the Service and Financial Plan for Adult Health and Care including the associated investment and disinvestment plans; All investment or disinvestment plans within the pooled budget that exceed 1m for individual service lines; Decisions that would materially, adversely impact on NHS Salford CCG or Salford CC; Decisions that cannot be agreed through consensus or a majority vote within the Integrated Adult Health and Care Commissioning Joint Committee; Financial risk and benefit sharing framework; and Annual refresh of the total pooled budget for integrated care. Level 2 Integrated Adult Health and Care Commissioning Joint Committee Integrated Care service models, service specifications and associated funding envelope with each service / initiative; Set improvement targets and trajectories; Approve business cases where investment or disinvestment plans are up to and including 1m for individual service lines*; In-year non-recurrent investment or variations, providing these are within the overall value of the agreed pooled budget; and Changes to payment mechanisms and contractual arrangements (see below regarding key decisions). Level 3 Level 4 CCG Chief Finance Officer/ Salford CC Strategic Director of Children s Services Assistant Salford CC Director Integrated Commissioning & CCG Director of Commissioning Recommendations to the Integrated Adult and Health Commissioning Joint Committee (in light of advice from the Service Development and Finance Group) regarding changes to service models and costs; Use and variation of agreed Programme Management budget; Agree service level variations and changes, within the context of the agreed model and overall financial ceiling of the pooled budget, up to and including 100k; and Where it is not possible to reach a consensus, the approach to be adopted will be one of escalation upwards. Service level investment variations within the context of the agreed model and overall financial ceiling of the pooled budget, up to and including 20k- 25k (dependent on the delegated limit for individuals); Where it is not possible to reach a consensus, the approach to be adopted will be one of escalation upwards. Level 5 Advisory Board for Provide advice and recommendations; P a g e 12 14

Integrated Care Agree use of Vanguard funding where consensus can be reached up to and including 1m (where this is not possible matter will be taken back to individual organisations for decision making); and Significant service variations or developments within the scope of the agreed model and funding envelope (as provided for within contractual arrangements) where input is required from partners. Key Decisions *All decision making will be made in line with Salford CC s Constitution. The Constitution will be amended to reflect the proposed amendments. It will be subject to a democratic call in process in accordance with the relevant legislation. P a g e 13 14

Appendix C Terms of Reference for the Advisory Board for Integrated Care NHS SALFORD CLINICAL COMMISSIONING GROUP SALFORD CITY COUNCIL SALFORD ROYAL NHS FOUNDATION TRUST GREATER MANCHESTER WEST MENTAL HEALTH NHS FOUNDATION TRUST AND GENERAL PRACTICE TERMS OF REFERENCE FOR THE ADVISORY BOARD FOR INTEGRATED CARE DRAFT V0.6 P a g e 1 10

VERSION CONTROL Version Date Editor Purpose/Change Number 0.1 14.02.16 Jack Sharp 0.2 24.02.16 Hempsons 0.3 10.03.16 Jack Sharp Changes agreed at ICO session with J McGovern & Liz Calder 0.4 17.03.16 Jack Sharp Changes reflecting discussion with Hannah Dobrowolska 0.5 22.03.16 Hannah Dobrowolska Amendments following ICCGWG meeting (21/3/16) 0.6 22.03.16 Hannah Amendments following communication with Dobrowolska Jennifer McGovern, Karen Proctor and Jack Sharp RECORD OF STAKEHOLDER ENGAGEMENT Stakeholder Group Paper / Version No Date Outcome/Feedback P a g e 2 10

Advisory Board for Integrated Care Terms of Reference DRAFT V0.6 1 Background and Scope Salford is a forward thinking economy and as such has established new governance arrangements for the Integrated Care System ( ICS ), reflecting the shared ambition in our Locality Plan to improve the health outcomes of residents of he City, while also moving towards financial and service for sustainability of health and care services. This document sets out revised arrangements for commissioners and providers to work together to recommend the overall strategic direction for the integration of health and care services for the adult population in Salford, including but not limited to those within the scope of the Integrated Care Organisation ( ICO ). These Terms of Reference form part of new Governance Framework for Salford s Integrated Care System. They replace those of the existing Alliance Board for Integrated Care and should be read alongside the Terms of Reference of the Integrated Adult Health and Care Commissioning Joint Committee. The ethos of partnership working will underpin the programme of work, recognising that on occasion, difficult decisions may be required to benefit the Salford population. The Advisory Board for Integrated Care ( the Advisory Board ) is a board comprising officers from Salford Royal NHS Foundation Trust (SRFT), Greater Manchester West Mental Health NHS Foundation Trust (GMW), (Salford CCG), Salford City Council (SCC) and representatives of General Practice (agreed representatives of GP practices as primary care providers). The Advisory Board does not have decision-making powers in its own right but its members have been delegated decision-making authority by their respective organisations. The Advisory Board is a forum where the four statutory partners (Salford CCG, SCC, SRFT and GMW), in conjunction with General Practice, will jointly recommend the overall strategic direction for the integration of adult health and care services in Salford (ICS and ICO). The Advisory Board will operate with the principle of collective decision-making, whilst recognising that commissioning decisions will ultimately be taken by Salford CCG and SCC, through the Integrated Adult Health and Care Commissioning Joint Committee, and that, as the prime provider, SRFT has direct responsibility for the scope of services within the ICO. The Advisory Board will ensure the effective engagement of stakeholders and will advise on service strategy, service design and the development of an annual work programme. It will maintain an overview of the implementation of the system redesign at a partnership level, enabling partners to consider any issues that arise for resolution. It will take decisions relating to Salford s Vanguard (Salford Together) programme where consensus can be reached, including the use of transformation resources allocated to the programme, and other decisions agreed by each of the four statutory organisations and General Practice. Where consensus cannot be reached on such matters, decisions will be referred back to individual organisations. It will also provide advice to the Integrated Adult Health and Care Commissioning Joint Committee. It will enable partners to consider and develop together emerging strategy for the adult population with a focus on neighbourhood working. P a g e 3 10

Through its decision making processes, the Advisory Board will adhere to SCC s duties of transparency in relation to Key Decisions (See Annex 1) as they relate to the Council s constitution. It will also adhere to constitutions of Salford CCG, SRFT and GMW. As required, the Advisory Board will establish task-and-finish groups and will seek assurances on progress via the receipt of regular reports. These Terms of Reference have been prepared to outline the responsibilities of the Advisory Board. They have been approved by Salford CCG s Governing Body in consultation with the CCG s Executive Team and Programme Management Group (PMG), SCC s City Mayor in consultation with Cabinet, SRFT s Board of Directors, and GMW s Board of Directors. They will remain valid until such time as there is a need to implement revised governance arrangements. Partnership working is vital to the success of the programme; however it is acknowledged that, at all times, sovereign powers remain in place. 2. Core Principles and Responsibilities The work of the Advisory Board for Integrated Care will be driven by the following core principles: Decisions will be based on achieving better outcomes and experience for Adults and Older People who require Health and Care Services; Service transformation will deliver an effective and efficient use of resources (within the statutory requirement to meet the CCG s, Council s, SRFT s and GMW s financial duties) whilst assuring safe and effective standards of service; New care models will be developed by health and social care commissioners in partnership with providers, citizens and communities; Services will be evidence-based and of the best quality, encompassing safety, effectiveness and experience; Salford residents will be given more choice and control of services, supporting selfcare and independence; Clinical and democratic accountability will be implicit within all decisions; Respect for professional areas of knowledge and expertise; Collective management of risks and benefits; and Each organisation remains sovereign: whilst responsibilities can be delegated, accountability for those responsibilities cannot. The Advisory Board for Integrated Care has responsibility to deliver clearly defined objectives which are detailed below: Acknowledge the interdependencies of this programme of work ensuring that all options considered are congruent with, but not limited to: Greater Manchester Devolution Joint Commissioning of Primary Care; Partnership governance (to include NHS England); and P a g e 4 10

Healthier Together/ North West Sector Acute Reconfiguration Programme. Respond and contribute to the Joint Strategic Needs Assessment (JSNA), working in partnership with other statutory and non-statutory organisations to improve health and wellbeing and reduce inequalities; Facilitate coherence and working towards shared goals and objectives with cocommissioners, health and care providers and other partners; Advocate engagement of public, service users and patients utilising the Integrated Engagement Board as appropriate; Ensure that all aspects of best practice, both nationally and internationally are duly considered and where appropriate applied; Advise the Integrated Adult Health and Care Commissioning Joint Committee on the development and delivery of the Adults and Older People s Service and Financial Plan for approval by the SCC Cabinet, CCG Governing Body and Health and Wellbeing Board; Provide recommendations with regard to the formulation ofstrategies and tactical approaches for achieving the objectives of the ICS and ICO; Oversee the implementation and management of transformation plans and delivery of the agreed model of integrated care; Develop and approve proposals for the use of Vanguard (Salford Together) and other transformation funding where consensus can be reached (where this is not possible these matters will be referred back to individual organisation for decision making); Establish arrangements to enable the development of new models of care; Review existing initiatives to align complimentary workstreams and consolidate projects; Develop a robust evaluation framework to ensure progress can be measured against the ICS and ICO aims and improvement targets; Support quality improvement for all ICS services including ICO services; Advise the Integrated Adult Health and Care Commissioning Joint Committee on the setting of improvement targets and timescales, using the identified improvement measures; Monitor delivery of the agreed improvement targets and trajectories, providing assurance to the Integrated Adult Health and Care Commissioning Joint Committee; Inform the work of Adult and Health Scrutiny Committee and respond as required, as well as providing appropriate reporting in response to the call in resulting from key decisions; Respond to requests for advice from the Integrated Adult Health and Care Commissioning Joint Committee on investment/disinvestment decisions and evaluations; P a g e 5 10

Ensure that all aspects of financial governance are followed; Advise on proposed changes to existing payment mechanisms and contractual arrangements where necessary; Ensure that appropriate risk management and escalation processes are correctly adhered to; Approve significant service variations or developments within the scope of the agreed model and funding envelope (as provided for within contractual arrangements) where input is required from partners; and Advise the Integrated Adult Health and Care Commissioning Joint Committee about the impact that proposed Level 1 - Level 4 decisions will have on the other partners. The Advisory Board will discharge its responsibilities with the support of task-and-and-finish groups as deemed necessary. 3. Membership, Attendance and Quorum 3. embership, Attendance and Quorum Membership The Advisory Board will comprise the following core members: Organisation Director of Commissioning Director of Quality and Innovation Strategic Partnerships and Planning Clinical Lead Chief Finance Officer Strategic Director of Adults and Children s Services Assistant Director Integrated Commissioning Elected Member Adult Social Care portfolio Elected Member Health portfolio Executive Director Clinical Chair, Salford Care Managing Director, Salford Care Director of Social Care, Salford Care Director of Nursing, Salford Care Executive Director of Nursing Head of Salford Division Clinical Director for Salford Division GP Design Group Member from General Practice GP Design Group Member from General Practice GP Design Group Member from General Practice GP Design Group Member from General Practice Salford City Council Salford City Council Salford City Council Salford City Council Salford Royal Salford Royal Salford Royal Salford Royal Salford Royal Greater Manchester West Greater Manchester West Greater Manchester West General Practice General Practice General Practice General Practice P a g e 6 10

Members of the Salford Together / ICO Programme Management Office to be in attendance Each member of the Advisory Board has delegated decision-making authority from the organisation that he / she represents to take the decisions described in these terms of reference. Individuals will be co-opted onto the Advisory Board as necessary on an ad-hoc basis to inform discussions and in addition, may cover areas including administration and communications. The Committee may also invite people other those people referred to above to address it, deliver a report to it and/or answer questions. The Advisory Board will be chaired by the Clinical Chair of Salford Care, on behalf of SRFT. The Advisory Board will have to two Vice Chairs; GP Design Group Member from General Practice and an Elected Member from SCC. Agendas will be jointly agreed in terms of content and forward planning. Officer support will be provided through the Salford Together / ICO Programme Management Office. Attendance It will be important that nominated members commit to attend the Advisory Board. Where this is not possible, however, deputies are encouraged to attend. Deputies must be able to contribute and make decisions on behalf of the individual / organisation they are representing. Quorum, Decision Making and Voting The Advisory Board will be quorate providing one-third of the membership is in attendance, with at least one member in attendance from each of the four statutory bodies and General Practice. The Advisory Board is required to achieve a consensus for all decisions. Given the nature of the programme, securing the support of all partners will be critical to the success of most of the decisions made. In those circumstances where consensus cannot be reached and a decision must be taken, the issue will be referred back to the sovereign bodies of each organisation for a decision. Before choosing to put the issue to a vote, the Advisory Board may ask for further work to be undertaken on the issue to explore, clarify, mitigate or minimise any concerns. The Advisory Board may ask for specific individuals who may or may not be part of the committee to discuss the issue further to try to find a suitable resolution. The issue would then be brought back to a future meeting. Responsibilities and Behaviour Members of the Advisory Board have a collective responsibility for its operation. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view. Members will behave in a manner consistent with the Core Principles outlined in Section 2 of these Terms of Reference and will adhere to the behaviours highlighted in the Nolan Principles, recognising that the success of the work programme will depend upon relationships and an environment of integrity, trust, collaboration and innovation. P a g e 7 10