To consider the proposals to establish a Northern CCG Joint Committee covering Cumbria and the North East.

NHS North Cumbria CCG Governing Body Agenda Item 7 June 2017 6 Joint Committee of Clinical Commissioning Groups Purpose of the Report To consider the proposals to establish a Northern CCG Joint Committee covering Cumbria and the North East. Outcome Required: Approve X Ratify For Discussion For Information Assurance Framework Reference: 1, Better Health There is a need to ensure that Cumbria s children & young people (including children looked after are kept safe and transition into health adulthood 2, Better Care Commission services that ensure the delivery of high quality and safe care patients 3, Sustainability Commission services that ensure the delivery of high quality and safe care for patients in a manner that is sustainable for the whole health economy 4, Leadership - The CCG needs to develop and implement robust governance and management arrangements to operate in a safe and sound manner. Recommendation(s): The Governing Body is asked to approve, in principle, the establishment of a Northern CCG Joint Committee and confirms that its Chair and Accountable Officer will attend its meetings with delegated decision-making authority. Executive Summary: Key Issues: The attached report outlines the strategic context and the legal background for establishing a Northern CCG Joint Committee. It defines the proposal and sets out a draft Terms of Reference for the Committee. The attached report also provides clear benefits to ensuring that the CCG has the best of both

worlds by establishment of a Joint Committee whilst retaining the statutory decision-making authority as local commissioners. Key Risks: For reasons of geography and provider catchment area, there may be decisions about service change that have no bearing on North Cumbria CCG. Similarly, on account of legal directions, there may be decisions around discretionary spend that North Cumbria CCG is unable to commit to. Our mitigation is to have negotiated an opt-out clause. Implications/Actions for Public and Patient Engagement: The Committee would meet 4 times a year and the expectation is that the forward programme of work would allow sufficient time for public and patient engagement. Financial Impact on the CCG: See above under key risks Strategic Objective(s) supported by this paper: Support quality improvement within existing services including General Practice Commission a range of health services appropriate to Cumbria s Needs Develop our system leadership role and our effectiveness as a partner Improve our organisation and support our staff to excel Impact assessment: (Including Health, Equality, Diversity and Human Rights) Please select (X) X X N/A Conflicts of Interest Describe any possible Conflicts of interest associated with this paper, and how they will be managed No conflicts of interest have been identified Lead Director Stephen Childs, Chief Executive Presented By Stephen Childs, Chief Executive Contact Details Stephen.childs1@nhs.net Date Report Written 1 June 2017 2

Official Enclosure 04 Northern Clinical Commissioning Group Forum (NCCGF) For NCCGF of (Date): 1 June 2017 Does paper need to be circulated before the agenda goes out (ie earlier than 6 days prior to NCCGF) (please circle): No Title of report: Revised draft of Joint Committee Terms of Reference Purpose of report (brief description): To consider the revised draft of the Joint Committee Terms of Reference. Recommendations: Is the paper for (please tick): Decision-making Information Sharing Discussion x x x Actions required by NCCGF: Report Author: Dan Jackson Job Title: Head of Strategic CCG Development Date: 26 May 2017

Joint Committee of Clinical Commissioning Groups Proposals to establish a Northern CCG Joint Committee covering Cumbria and the North East Strategic Context A strategic commissioning framework for the North East and Cumbria 1. As STP plans are being developed new commissioning arrangements are taking shape across the country often based on greater formal collaboration between CCGs, increasing numbers of CCG mergers, joint committees and joint appointments, and new models of care that blur the boundaries between commissioner and provider, shifting the ways in which services are planned and funded. 2. NHS England is encouraging CCGs to integrate and work across larger geographical footprints and build capacity in the commissioning system, and give primacy to tasks-in-common over formal organisational boundaries so as not to artificially limit their influence and relevance as local system leaders. 1 3. In considering our response to this changing policy landscape, commissioners in Cumbria and the North East recognise that we start from a good collaborative base. We have had a strong Northern CCG Forum and MOU in place since 2012, with several important shared work programmes, including the Urgent and Emergency care network, the joint Learning Disabilities Transformation Programme, the regional QIPP and medicines optimisation groups, as well as joint commissioning arrangements for ambulance services. 4. In addition to this, our CCG members in the Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby STP area (DDTHRW) have established a Joint Committee to make collective decisions on their STP priorities. That committee has the authority to reach unanimous decisions amongst the CCGs on an agreed mandate to deliver the hospital reconfiguration plan in line with NHS Planning Guidance through to public consultation (where decisions that would normally require formal CCG Governing Body agreement will take the form of recommendations to the Joint Committee ). 5. The DDTHRW approach has provided a useful governance model for the Northern CCG Forum to consider and this report sets out below how CCGs could adopt this approach across the whole of the CNE region. 1 NHS Operational Planning and Contracting Guidance, 2017-19 (NHS England, September 2016) 2

Ensuring the best of both worlds 6. Where health and care challenges need to be addressed at scale then CCGs recognise the need to strengthen regional and sub-regional commissioning structures to rationalise and jointly commission some services. This will build on our long-established Northern CCG Forum arrangements. But given the increasing focus on prevention and out of hospital care, then the local structures we have in place (and coterminosity with local authorities) as well as our relationships with GPs, Social Care providers, the voluntary sector and local communities will only grow in importance. So whilst committed to strengthening how we make collective decisions, Northern CCGs are keen to preserve the best of local clinical leadership and accountability, and avoid the distraction of major restructures and the destabilisation of vital local relationships. 7. In considering the scale of the challenge as set out in STP plans the Northern CCG Forum has, therefore, agreed the following (pending support from CCG Governing Bodies): A commitment to jointly resourcing a Cumbria and the North East (CNE)-wide STP delivery approach, supporting thirteen shared workstreams (led by individual SROs) overseen by a strengthened Northern CCG Forum with decision-making authority delegated from individual CCGs Retaining CCGs statutory place-based clinical leadership and accountability to local populations, and maintaining their focus on local relationships and local delivery. Legislative Background 8. The NHS Act 2006 (as amended) ( the NHS Act ) was amended in 2014 to allow Clinical Commissioning Groups (CCGs) to form joint committees. This means that two or more CCGs exercising commissioning functions jointly may form a joint committee. The Legislative Reform Order ( LRO ), which amended section 14Z3 (CCGs working together) of the NHS Act, was passed by Parliament and the reforms took effect from 1 October 2014. 9. These reforms mean that CCGs will no longer find it necessary to operate work-around arrangements such as committees in common, and can instead establish Joint Committees as a statutory mechanism for undertaking collective strategic decision making. 10. In addition, the NHS Act provides, at section 13Z, that some of NHS England s functions may be exercised jointly with a CCG and that functions exercised jointly in accordance with that section may be exercised by a joint committee of NHS England (and Section 13Z of the NHS Act further provides that arrangements made under that section may be on such terms and conditions as may be agreed between NHS England and the CCG). 11. However, individual CCGs will remain as statutory bodies and will retain accountability for meeting their statutory duties. The aim of the LRO is to encourage the development of strong collaborative decision making between partners. 3

Proposal 12. It is proposed that a Joint Committee of Clinical Commissioning Groups (hereafter referred to as the Joint Committee) is established covering all twelve CCG areas in Cumbria and the North East. 13. This proposal is not about reorganising CCGs, or taking away the statutory decision-making authority of local commissioners. Nor will this entail setting up a new organisation, or incurring any additional administrative costs. 14. This Joint Committee must at law be a joint committee of the CCGs and not their governing bodies (who are not themselves able to establish joint committees). The Joint Committee will be referenced in, and any decision making function will be subject to, the terms of the constitutions of the CCGs. The CCG Constitutions will include reference to the Joint Committee along with provision for regular reporting and oversight to the governing bodies by its members to assure themselves that the CCG is delivering its functions effectively and efficiently and in compliance with generally accepted principles of good governance. Role of the Northern CCG Joint Committee 15. The Northern CCG Forum has never had formal decision-making powers. Its purpose has always been as a forum for CCG chairs and chief officers to discuss matters of common concern, identify solutions and plan jointly where appropriate, but without joint decisionmaking authority delegated from individual CCG Governing Bodies. 16. However the Northern CCG Forum is increasingly looked to as the voice of CCGs in Cumbria and the North East, and is frequently presented with issues that require either a decision or at least a definitive shared response. 17. It is therefore proposed that the Northern CCG Forum establishing a formal decision-making body called the Northern CCG Joint Committee (hereafter referred to as the Joint Committee ), with voting membership comprised of the Clinical Chair and Chief Officer from each member CCG. TERMS OF REFERENCE Northern CCG Joint Committee: membership and functions 18. The Northern CCG Joint Committee (hereafter referred to as the Joint Committee ) will be a joint committee of the twelve undermentioned clinical commissioning groups : NHS Darlington CCG NHS Durham Dales, Easington & Sedgefield CCG 4

NHS Hambleton, Richmondshire & Whitby CCG NHS Hartlepool & Stockton CCG NHS Newcastle Gateshead CCG NHS North Cumbria CCG NHS North Durham CCG NHS Northumberland CCG NHS North Tyneside CCG NHS South Tees CCG NHS South Tyneside CCG NHS Sunderland CCG 19. Voting membership of the joint committee will comprise the Clinical Chair and Chief Officer from each member CCG, or a nominated deputy. 20. The Chair and Vice Chair of this Joint Committee will be elected by the members of the Joint Committee, and must come from the twelve member CCGs. Both roles cannot be undertaken by members of the same CCG. 21. Given that the committee s proposed membership is the same (CCG Chairs and Chief Officers), the committee will convene straight after the monthly meetings of the Northern CCG Forum. Also attending the meeting (in a non-voting capacity) will be the Managing Director of NECS, a named Director from NHS England, and the Head of Strategic CCG Development. 22. This Joint Committee will make decisions on subjects recommended to it by the Northern CCG Forum. These will be confined to issues that pertain to all CCG areas in Cumbria and the North East, including Any service reconfiguration that explicitly affects either the whole population of Cumbria and the North East, or any significant change to health services at a sub-regional level that would have implications for the rest of the health and care system in CNE. The commissioning of specialist acute and ambulance services Shared clinical policies and pathway redesign (including QIPP/VBC/IFRs) Policies on ICT, data management and Digital Care 23. The Joint Committee will not make decisions on the following areas (which will remain the exclusive preserve of individual CCG Governing Bodies) including but not limited to: Financial planning Strategic planning for the locality eg 5 year plans, annual plans, primary care strategy The commissioning, contracting and performance management of - Local hospital services - Community Services - Primary care services - Mental Health and Learning Disability services - Community pharmacy services Health and Social Care integration 5

Continuing Health Care, Funded Nursing Care, and other individual level commissioning arrangements eg S117 and other associated responsibilities 24. The Joint Committee will be guided by the following principles: Securing continuous improvement to the quality of commissioned services to improve outcomes for patients with regard to clinical effectiveness, safety and patient experience Promoting innovation and seeking out and adopting best practice, by supporting research and adopting and diffusing transformative, innovative ideas, products, services and clinical practice within its commissioned services, which add value in relation to quality and productivity. Developing strong working relationships with clear aims and a shared vision putting the needs of the people we serve over and above organisational interests Avoiding unnecessary costs through better co-ordinated and proactive services which keep people well enough to need less acute and long term care. 25. The Joint Committee will also ensure compliance with the four key tests for service change as established by the Department for Health: Strong public and patient engagement. Consistency with current and prospective need for patient choice. Clear, clinical evidence base. Support for proposals from commissioners 26. In accordance with statutory powers under s.14z3 of the NHS Act 2006, the proposed Northern CCG Joint Committee will be able to make decisions on procuring services and awarding contracts, chiefly to the providers of specialised acute and ambulance services. In discharging this function the committee will Determine the options appraisal process for commissioning services, including agreeing the evaluation criteria and weighting of the criteria Where appropriate, determine the method and scope of the consultation process, and make any necessary decisions arising from a Pre-Consultation Business Case (and the decision to go run a formal consultation process). That includes any determination on the viability of models of care pre-consultation and during formal consultation processes, as set out in s.13q, s.14z2 and s.242 of the NHS Act 2006 (as amended). Approve the formal report on the outcome of the consultation that incorporates all of the representations received in order to reach a decision, taking into account all of the information collated and representations received in relation to the consultation process. Make decisions to satisfy any legal requirements associated with consulting the public and making decisions arising from it, ensuring that individual CCGs retained duties can be met. Decision-making and links to individual CCG Governing Bodies 27. The NHS Act 2006 (as amended) enables CCGs to exercise certain functions jointly and to take collective binding decisions as to the exercise of these functions. To be clear, this legislative 6

permission only applies to Joint Committees of CCGs and does not apply to enable decisionmaking to be exercised by any alternatively constituted or wider group (for example, an STP Board or Programme Board). 28. Under this legal framework, the power to take commissioning decisions in respect of health services sits with CCGs (and to a more limited extent NHS England), with decisions being taken by the Governing Body or otherwise, as determined in the relevant governance documents. On this basis, all commissioning decisions must be taken by the CCGs acting independently or as a formally constituted joint CCG committee. Therefore, when functions are delegated to the Joint Committee, it will transact all the work necessary to discharge those functions. The Joint Committee will be the decision maker in relation to that work and those functions. 29. The relevant parties to whom any Joint Committee decision applies must be agreed first by the Joint Committee itself before any recommendations are brought back to it for decisionmaking (this will allow for the exclusion of certain CCGs where the geographical scope of a proposal does not apply to them or because of their current status, e.g. where legal directions prohibits them from taking the decision). 30. The collective decisions of the Joint Committee shall be binding on all member CCGs, and decisions will be published by individual CCG members on their websites. All decisions of the Joint Committee must be unanimous. 31. The Joint Committee will have a forward plan to ensure CCG members are clear which decisions they need to prepare for. It will be the responsibility of each member CCG to ensure that their Governing Body and/or other CCG decision making body is appropriately consulted and briefed ahead of Joint Committee meetings, and is provided with regular updates on the business of the Joint Committee so that they are clear on the implications of the decisions made. Implementation of the decisions will be the remit of each member CCG. (The Joint Committee will make regular written reports to the Governing Bodies of its member CCGs, and will review its aims, objectives, strategy and progress and produce an annual report for the member Governing Bodies.) 32. Should this joint commissioning arrangement prove to be unsatisfactory, the Governing Body of any of the member CCGs can decide to withdraw from the arrangement. This withdrawal to be on such terms as is agreed between the other CCG members of the Joint Committee and the withdrawing CCG member. Meetings of the Northern CCG Joint Committee: 33. Members of the Joint Committee have a collective responsibility for the operation of the Joint Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavor to reach a collective view. 34. The committee will usually meet on a quarterly basis, but additional meetings can be called as required. 7

35. The Joint Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions. 36. The Joint Committee has the power to establish sub groups and working groups and any such groups will be accountable to the Joint Committee. 37. Para 8 of Schedule 1A of the NHS Act 2006 requires meetings of a Governing Body to be in public unless it is not in the public interest to hold them in public. It will be for the members of the formally constituted Joint CCG Committee to decide whether their meetings (or parts of them) are held in public to help them meet their statutory duties of transparency and public involvement. 38. The Joint Committee shall adopt the standing orders of North Durham CCG (which is one of its constituent CCGs) insofar as they relate to the: Notice of meetings Recording and minuting of meetings Agendas Circulation of papers Conflicts of interest (together with complying with the statutory guidance issued by NHS England) At least one full voting member from each CCG must be present for the meeting to be quorate. All decisions of the Joint Committee must be unanimous. 39. Members of the Joint Committee shall respect confidentiality requirements as set out in the Standing Orders unless separate confidentiality requirements are set out for the Joint Committee in which event these shall be observed. 40. The secretariat to the Joint Committee will: Circulate agenda and associated documents at least ten working days prior to the meeting Work in collaboration with CCG and NECS communication and engagement personnel to publicise the meeting/agenda and documents on all CCG websites Circulate the minutes and action notes of the Joint Committee within three working days of the meeting to all members Present the minutes and action notes to the governing bodies of the CCGs. 41. These terms of reference will be formally reviewed annually by the CCGs and may be amended by mutual agreement between the CCGs at any time to reflect changes in circumstances as they may arise. Recommendations 42. The Governing Bodies of CCGs in Cumbria and the North East *approve the setting up of a Northern CCG Joint Committee and confirm that their Clinical Chairs and Chief Officers will attend its meetings with delegated decision-making authority. 8

Dan Jackson Head of Strategic CCG Development 25 May 2017 *this may be just for governing bodies to note the setting up of a committee, and it is actually the Council of Member practices of a CCG who have to approve this. Advice being sought on this. 26 May 2017 9