Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group Governing Body Meeting In-Common

Transcription

1 Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group Governing Body Meeting In-Common Date: Tuesday 3rd October 2017 Time: Location: Clevedon Hall, Elton Road, Clevedon, BS21 7RH Agenda item: 11.1 Furthering Transition: Aligning governance across Bristol, North Somerset and South Gloucestershire (BNSSG) CCGs update on progress Report Author Jeanette George Report Sponsor Julia Ross 1. Purpose This paper provides an update on progress on the implementation of aligned governance arrangements for the BNSSG CCGs as part of the next stage of the transition to a single commissioning voice. It also presents terms of reference for approval for the BNSSG CCG Quality Committee and the BNSSG Commissioning Executive. 2. Recommendations The Bristol, North Somerset and South Gloucestershire Governing Bodies are asked to: Note the progress on aligned governance arrangements Approve the terms of reference for the following committees o BNSSG Commissioning Executive o BNSSG Joint Quality and Performance Committee Approve the change of title of the BNSSG Joint Quality and Performance Committee to the BNSSG Joint Quality Committee and amend the overall framework accordingly. 3. Background At the meeting on 5 th September 2017, the Bristol CCG, North Somerset CCG and South Gloucestershire CCG Governing Bodies received proposals to align the governance arrangements for the three CCGs as a next step in the transition to a single commissioning voice. The Governing Bodies:

2 BNSSG CCG Governing Body Meeting-in-common Considered and approved the overall approach to proposed alignment of governance arrangements for the CCGs. Approved the way of working document for in-common meetings of the Governing Body. Approved in principle the change in scope of the Audit Committee to encompass Governance and Risk. Approved in principle the way of working document in-common for meetings of the: o Remuneration Committees o Audit, Governance and Risk Committees Approved in principle the terms of reference for the joint committees: o Joint Quality and Performance Committee o Joint Strategic Finance Committee o Joint Commissioning Executive Relevant Committees were asked to consider the draft terms of reference and propose any amendments with final terms of reference coming to Governing Bodies for approval. Governing Body members agreed to submit comments on the terms of reference and membership of joint committees after the meeting to be taken into consideration in finalising these. Governing body members asked that further consideration be given to Workforce Governance, approval of HR policies etc. and the best place for these to be considered. It was also agreed that Audit Committees should be asked to consider whether auditors should be asked to review the aligned governance arrangements once the terms of reference for committees have been finalised. Specific CCG Governing Bodies also approved or agreed the following: Bristol CCG Governing Body: Approved the delegation of responsibilities from the Bristol CCG Finance, Performance and Planning Committee to the BNSSG Joint Strategic Finance Committee. Agreed that the Clinical Leadership Group becomes a sub-committee of the BNSSG Joint Commissioning Executive. North Somerset CCG Governing Body: Agreed that the Clinical Commissioning Leadership Group becomes a subcommittee of the BNSSG Joint Commissioning Executive Approved the delegation of the role of the Decision Scrutiny Panel to the In- Common Audit, Governance and Risk Committee. South Gloucestershire CCG Governing Body: Approved the delegation of responsibilities from the South Gloucestershire CCG Finance Committee to the BNSSG Joint Strategic Finance Committee. Agreed that the Clinical Operational Executive Group Committee becomes a sub-committee of the BNSSG Joint Commissioning Executive. Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups 2

3 BNSSG CCG Governing Body Meeting-in-common 4. Update on progress Comments were received from a number of members of the Governing Bodies. And have been considered by relevant Executive leads. Feedback has been provided directly to members or is being fed into relevant committees by Executive leads to inform discussions where appropriate. The BNSSG Commissioning Executive met on 13 th September 2017 to consider and agree draft terms of reference for the Committee. Appendix 1 shows the final draft for consideration and approval by the BNSSG Governing Bodies. Changes include: Alignment of membership to incorporate the emerging BNSSG Clinical Leadership model Responsibility for overseeing the work of the Clinical Policy Review Group added to responsibilities Factual, typographical and grammatical errors corrected The BNSSG Quality and Governance Committee met on 19 th September 2017 to consider and agree the terms of reference for the Quality and Performance Committee. Appendix 2 shows the final draft for consideration and approval by the BNSSG Governing Bodies. Changes include: Lay members from each CCG to continue to be members of the group. It is proposed that the Lay members will Chair in rotation until the independent nurse is in post Addition of the clinical lead/s for into the membership, aligned to the emerging BNSSG Clinical Leadership model Factual, typographical and grammatical errors corrected Following discussion at a meeting of the Executive Team it is also proposed to change the title of this committee to the Quality Committee as the Committee will only consider performance on Quality and not Contractual or Financial performance which will be considered by the BNSSG Strategic Finance Committee. If agreed the overall aligned governance structure will be amended accordingly. The North Somerset and South Gloucestershire Audit Committees have met in September and the Bristol Audit Committee will meet before the next meeting of the Governing Body. The Bristol CCG Finance Review Group has also met. The interim BNSSG Chief Finance Officer will provide an update on progress once discussions on the outcome of these discussions at the meeting of the Governing Bodies on 3 rd October Financial/resource implications Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups 3

4 BNSSG CCG Governing Body Meeting-in-common Implementation of the proposed aligned governance structure will reduce operating costs of the Governing Bodies (for example in hiring venues and servicing meetings), and over time may reduce pay costs. 6. Legal implications The aligned governance arrangements are based on the models of good governance established for NHS organisations, including guidance on incommon and joint committee. Legal advice on the proposed governance structure has been taken to ensure that the proposed changes meet statutory requirements. Legal advisers have concluded that the documents are internally consistent and that in-common and joint arrangements appear appropriate. Of particular note with regard to the law in relation to this paper is that the NHS Act 2006 as amended by the Health and Social Care act 2012 requires that each CCG has its own governing body and that the governing body of a CCG must have an audit committee and a remuneration committee. The law does not permit CCGs to have joint arrangements where a single governing body, audit committee or remuneration committee acts for more than one CCG. FAQs published by NHS England in 2012 confirmed that joint audit or remuneration committees are not permitted. 7. Risks/mitigations A key risk that has been identified through engagement on these aligned governance arrangements are that the local voice of each CCG areas may be lost. This has been mitigated by: Maintaining local clinical leadership groups which will be further developed as part of work on clinical leadership arrangements across BNSSG and area/locality structures. Ensuring strong clinical representation on the BNSSG Commissioning Executive. Maintaining the existing patient and public engagement forums for each area and proposing the development of a BNSSG Patient and Public Engagement Forum Adopting a principle of subsidiarity where decision making is delegated to the lowest appropriate level, whilst ensuring unified leadership and a shared BNSSG vision, strategy and prioritisation process informs our work. A risk that the public may not attend Governing Body meetings that are not in their local area has also been identified. This will be mitigated by: Rotating the meetings around the CCG areas and planning ahead so that where there are topics that are likely to generate specific local interest we locate meetings in common in that area. Ensuring in-common meetings of Governing Bodies are located in places with good parking and public transport links. Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups 4

5 BNSSG CCG Governing Body Meeting-in-common There is a risk that decision making may become more difficult as a result of meeting in common as consensus may not be reached by in-common meetings. This is mitigated by: A commitment from Executives, Clinical Leaders and Lay members to achieving consensus in decision making wherever possible Ensuring that we listen and respond to individual concerns of members of the Governing Bodies and Committees, seeking to understand each other s viewpoint and ensuring these are taken into consideration wherever possible. Encouraging honest debate and openness, with engagement at an early point in development of proposals. 8. Implications on equalities and health inequalities The contents of this paper do not directly address equalities or health inequalities. The intention is to establish a governance structure that reflects our core role to reduce health inequalities. 9. Consultation and Communication including Public Involvement The development of this governance structure has not involved local people, patients or carers. It is proposed that a BNSSG Patient and Public Engagement Forum is established to advise the Governing Bodies. Lay members with a lead responsibility for Patient and Public Engagement (PPE) and CCG PPE leads. The terms of reference for the Forum are being developed by Lay members with a lead for Patient and Public Engagement. 10. Appendices Appendix 1 Terms of Reference BNSSG Commissioning Executive Appendix 2 Terms of reference BNSSG Joint Quality Committee Glossary of terms and abbreviations NHS England (NHSE) Sustainability and Transformation Plan (STP) NHS England leads the National Health Service (NHS) in England. They set the priorities and direction of the NHS and encourage and inform the national debate to improve health and care. Sustainability and Transformation Plans (STPs), are place-based, multi-year plans built around the needs of local populations. STPs will help drive a genuine and sustainable transformation in health and care outcomes between 2016 and Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups 5

6 DRAFT 3 (FINAL DRAFT). Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups Commissioning Executive Terms of Reference Version Control Version Date Consultation Draft version 1 11/08/17 Produced by Claire Thompson Draft version /8/2017 Comments from Jeanette George incorporated. To BNSSG Executive Team Draft version 2 21/8/2017 Amended to reflect Executive Team and Commissioning Executive comments. To legal adviser for review. Draft version /09/2017 To BNSSG Governing Bodies Draft /9/17 Reviewed by BNSSG Commissioning Executive. Amendments made. Draft 3 (FINAL DRAFT) 21/9/17 To Governing Bodies for approval Meeting / Version Number Page 1 of 5

7 DRAFT 3 (FINAL DRAFT). Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups Commissioning Executive Terms of Reference 1. Introduction The Commissioning Executive (the Committee) of the Bristol, North Somerset and South Gloucestershire (BNSSG) Clinical Commissioning Groups (CCGs) (the Committee) is established in accordance with the BNSSG Clinical Commissioning Groups (the Groups) Constitutions, Standing Orders and Schemes of Reservation and Delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee shall have effect as if incorporated into the Group's Constitution and Standing Orders. This joint Committee is a committee of each of the three individual CCGs and has no executive powers other than those specifically delegated in these Terms of Reference. The joint Committee is authorised by the Governing Bodies to act within its terms of reference. All members and employees of the Groups are directed to cooperate with any request made by the joint Committee. 2. Responsibilities of the Committee The joint Committee shall carry out the following duties on the behalf of their respective Governing Bodies as delegated by their constitutions and these terms of reference: Development of the CCGs Commissioning Strategy and recommendation to the Governing Body's Development of the CCGs Operational Plan and recommendation to the Governing Body's Development of the CCGs IM&T Strategy and recommendation to the Governing Body's Recommends to Governing Bodies the implementation plan to deliver the IM&T Strategy in line with the local digital roadmap agreed through the STP Considers the CCGs annual procurement strategy and plans for the procurement of new services and disinvestment from existing services, making recommendations to Governing Bodies where this exceeds delegated limits Recommends savings and investment plans arising in year, recommending these to Governing Bodies where these exceed delegated limits. This includes the CCG's Turnaround Plans. Recommends to Governing Bodies commissioning intentions. Meeting / Version Number Page 2 of 5

8 DRAFT 3 (FINAL DRAFT). Approval of commissioning policies, recommending these to the Governing Bodies where these might be contentious. Overseas the Clinical Policy Review Group and recommends to Governing Bodies individual funding policies and procedures Reviews provider performance taking action where required and monitoring improvement Consider new contracting models to deliver the CCGs ambition and that of the STP, in line with the Five Year Forward View. 3. Membership The Committee shall be appointed by the Groups as set out in the Groups Constitution and may include individuals who are not on the Governing Bodies. The membership of the Commissioning Executive shall consist of: Clinical Chairs for Bristol, North Somerset and South Gloucestershire CCGs who will chair the meeting in rotation BNSSG Clinical Pathway leads BNSSG Corporate Clinical leads Chief Executive Officer Chief Finance Officer Director of Nursing & Quality Director of Commissioning Director of Transformation Medical Director - Clinical Effectiveness Area Director (North Somerset) Area Director (Bristol) Area Director (South Gloucestershire) A representative Director of Social Care to be identified by the Local Authorities A representative Director of Public Health to be identified by the Local Authorities Members of the Committee can, send a nominated deputy to the meeting. These individuals must be able to operate with full authority over any issue arising at the meeting. Other persons may be invited to attend, as appropriate, to enable the Committee to discharge its functions effectively. The Committee may also invite guests to attend to present information and/or provide the expertise necessary for the Committee to fulfil its responsibilities. 4. Administration A named administrator will be responsible for the provision of administrative support to the Committee and they will ensure that minutes of the meeting are accurately produced and agreed with members. The Chief Executive will be responsible for supporting the Clinical Chairs in the management of the Committee and in drafting the agenda and forward plan. Meeting / Version Number Page 3 of 5

9 DRAFT 3 (FINAL DRAFT). 5. Quorum The meeting will be quorate with the attendance of the following persons: One of the Clinical Chairs Three clinical leads Three Executive Directors (or their deputies) to include either the Chief Executive Officer or the Chief Financial Officer 6. Frequency and notice of meetings The Committee shall meet fortnightly. The meeting papers shall be circulated at least 2 working days in advance of the meeting 7. Reporting arrangements The minutes of meetings of the Committee shall be submitted to the BNSSG Governing Bodies. The Committee will provide the BNSSG Governing Bodies with an Annual Report on its work. The Bristol CCG Clinical Leadership Group, North Somerset CCG Clinical Commissioning Leadership Group and the South Gloucestershire CCG Clinical Operational Executive Group will report to the Committee via the Clinical Chairs. The Committee will take account of the views and deliberations of these groups in making decisions. The Clinical Policy Review Group will report to the Committee. The Committee will receive reports relevant to its responsibilities from any other group or working group as appropriate. 8. Approval and Review These terms of reference will be reviewed on an annual basis or sooner if required with recommendations made to BNSSG Governing Bodies for approval. Annually, the Committee shall review its work to ensure it is operating at maximum effectiveness. It will use this exercise to inform the review of its Terms of Reference. 9. Review History Reviewed and Approved by BNSSG CCGs Governing Bodies Approved by <meeting> Meeting / Version Number Page 4 of 5

10 DRAFT 3 (FINAL DRAFT). Meeting / Version Number Page 5 of 5

11 Draft 3 (FINAL DRAFT) Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group s Joint Quality and Performance Committee Terms of Reference Version Control Version Date Consultation Draft version 1 11 August 2017 Anne Morris, Director of Nursing and Quality, BNSSG CCGs Draft version August 2017 Comments from Jeanette George Draft version 2 21/8/2017 5/9/2017 Amended to reflect Executive Team comments. To legal adviser for review. To in-common GBs Draft version /9/2017 To QAG in-common 19/9/2017 Draft 3 FINAL DRAFT 19/09/17 Amendments made as agreed at QAG in-common meeting. To Governing Bodies for approval. TOR Joint Performance and Quality Committee /Version 2 Page 1 of 5

12 Draft 3 (FINAL DRAFT) Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups Joint Quality and Performance Committee Terms of Reference 1. Introduction The Joint Quality and Performance Committee is established in accordance with NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Groups (BNSSG CCGs) constitution, standing orders and scheme of delegation. BNSSG CCGs are responsible for ensuring that there is a cohesive and comprehensive structure in place for the oversight and monitoring of: The quality of commissioned services including patient safety, patient experience and clinical effectiveness; The effectiveness of commissioned services; and Performance against service delivery indicators. The Joint Committee is a committee of each of the three individual CCGs and has no executive powers other than those specifically delegated in these Terms of Reference. The Joint Committee is authorised by the Governing Bodies to act within its terms of reference. All members and employees of the Groups are directed to cooperate with any request made by the Joint Committee. 2. Responsibilities of the Joint Committee The Joint Committee shall carry out the following duties on the behalf of their respective Governing Bodies as delegated by their constitutions and these terms of reference: Provide assurance to Governing Bodies that Quality is integral to all CCG activities and that the CCGs meet all relevant statutory and regulatory obligations including the duty of quality set out in the Health and social care Act Oversee, on behalf of the Governing Body, the systems and processes for Clinical Governance and Research Governance. Provide assurance that commissioning plans fully reflect all elements of quality (patient experience, effectiveness and patient safety), TOR Joint Performance and Quality Committee /Version 2 Page 2 of 5

13 Draft 3 (FINAL DRAFT) Provide robust and comprehensive assurance that commissioned services are being delivered in a high quality and safe manner by seeking assurance on the performance of NHS organisations in terms of the Care Quality Commission, NHSI and any other relevant regulatory Body. Providing the Governing Body with assurance that the CCG Early Warning Systems for potential provider failure on quality of service provision are effective. Provide assurance that effective processes are in place for safeguarding children and young people, safeguarding vulnerable adults, domestic violence, forced marriage and the PREVENT agenda. Ensure that the CCGs fulfil their role as members of Local Safeguarding Boards. Provide assurance that NHS Constitutional Standards are being met and where they are not that there are plans in place to address any underperformance. Consider the CCG Improvement and Assessment Framework Clinical Indicators and assure plans to improve performance against clinical priority areas. Provide assurance on equalities and diversity strategies, and equality delivery systems. Promote research and development within commissioned services and seek assurance of robust governance Assuring clinical workforce governance and developing and recommending the clinical workforce strategy 3. Membership The Joint Committee shall be appointed by the Groups as set out in the Groups Constitution and may include individuals who are not on the Governing Body. The membership of the Joint Committee shall consist of: A Lay member from each CCG (Chair/Vice Chair in rotation) BNSSG Independent Registered Nurse once in post will become Chair Clinical Chairs for Bristol, North Somerset and South Gloucestershire The Clinical leader/s for Quality BNSSG Director of Nursing and Quality BNSSG Medical Director BNSSG Director of Commissioning BNSSG Chief Financial Officer The managers representing the following areas will be in attendance at the Joint Committee: Quality Lead Safeguarding lead Medicines Management TOR Joint Performance and Quality Committee /Version 2 Page 3 of 5

14 Draft 3 (FINAL DRAFT) Research Lead Constitutional and Clinical Indicator Performance lead Lay volunteer/s Members of the Joint Committee can, send a nominated representative to the meeting. These individuals must be able to operate with full authority over any issue arising at the meeting. Other persons may be invited to attend, as appropriate, to enable the Joint Committee to discharge its functions effectively. The Joint Committee may also invite guests to attend to present information and/or provide the expertise necessary for the Joint Committee to fulfil its responsibilities. A Vice Chair will be nominated by the Joint Committee to act in the absence of the Chair. 4. Administration A named administrator will be responsible for the provision of administrative support to the Joint Committee and they will ensure that minutes of the meeting are accurately produced and agreed with members. The Director of Nursing and Quality will be responsible for supporting the Chair in the management of the Joint Committee and in drafting agendas; forward planners and specifying content of reports. 5. Quorum The meeting will be quorate with the attendance of the following persons: One of the Clinical Chairs The BNSSG Director of Nursing and Quality or BNSSG Medical Director The BNSSG Chief Finance Officer or the BNSSG Director of Commissioning 6. Frequency and notice of meetings The Joint Committee will meet monthly or at a frequency the Joint Quality and Performance Committee determines is appropriate to fulfil its duties. At least 2 weeks notice will be given of a meeting (with a six monthly plan). A forward plan will be developed which sets out the schedule for reporting to the Joint Committee. 7. Reporting arrangements The minutes of meetings of the Joint Committee shall be submitted to the BNSSG Governing Bodies The Joint Committee will provide the BNSSG Governing Bodies with an Annual Report on its work. The Joint Committee will work closely with Committee s responsible for Primary Care when dealing with Primary Care matters. TOR Joint Performance and Quality Committee /Version 2 Page 4 of 5

15 Draft 3 (FINAL DRAFT) The Joint Committee will receive reports relevant to its responsibilities from any group or working group as appropriate. 8. Approval and Review These Terms of Reference will be reviewed on an annual basis or sooner if required with recommendations made to BNSSG Governing Bodies for approval. Annually, the Joint Committee shall review its work to ensure it is operating at maximum effectiveness. It will use this exercise to inform the review of its Terms of Reference. 9. Review History Approved by <meeting> Month Year (Version X) Reviewed and Approved by BNSSG CCGs Governing Bodies Approved by <meeting> Reviewed and Approved by <meeting committee reports to> TOR Joint Performance and Quality Committee /Version 2 Page 5 of 5