NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body Public Meeting In-Common

Tuesday 7th February 2017 at 2pm In North Shore Academy, Stockton-on-Tees

Time Item No.

Item Attached or

Verbal

Presented By Page No

14:00 1.1 Welcome, Introductions and Apologies for absence: Dr Saleem Hassan

Verbal All

14:02 1.2 Declaration of Interests Verbal All 14:05 Pre–critique of the Governing Body Meeting 14:08

1.3.1 1.3.2

Minutes of Previous Meetings: NHS Hartlepool and Stockton-on-Tees CCG held on 29th November 2016 NHS Darlington CCG held on 6th December 2016

Attached Attached

Chair Chair

14:15 1.4 Matters Arising and Action Log Attached Chair

14:25 1.5 Chair’s Report Verbal Chair

14:35 1.6 Chief Officer’s Report Attached Ali Wilson

14:45 14:50 14:55

1.7 Locality Reports: Darlington Hartlepool Stockton-on-Tees

Verbal Verbal Verbal

Dr Jenny Steel Dr Nick Timlin Dr Saleem Hassan

15:00

15:10

1.8.1 1.8.2 1.8.3

DCCG Patient and Public Involvement Report HaST CCG Patient and Public Involvement Report Patient Story

Verbal Verbal Verbal

Michelle Thompson Hilary Thompson Hilary Thompson

15:20 Break Performance/Operational

15:25

2.1.1 2.1.2 2.1.3 2.1.4

Darlington CCG Financial Report Performance Report Quality Report Governance and Assurance report

Attached Graeme Niven Lisa Tempest Diane Murphy Graeme Niven

15:55 2.2.1 2.2.2 2.2.3 2.2.4

HaST CCG Financial Report Performance report Quality Report Governance and Assurance Report

Attached Graeme Niven Lisa Tempest Jean Golightly Graeme Niven

Strategy and Planning 16:25 3.1 HaST CCG Communication and

Engagement Strategy Attached Judith

McGuinness

16:35 3.2 Local Safeguarding Children’s Boards Annual Reports: Hartlepool Stockton-on-Tees

Attached Jean Golightly

Governance/Assurance 16:45 4.1.1 DCCG Constitution Review Attached Andrew Carter

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4.1.2 HaST CCG Constitution Review Attached Andrew Carter Items to note without discussion

5.1 5.1.1 5.1.2 5.1.3 5.1.4 5.1.5

DCCG Confirmed Committee Minutes: Governance and Risk Committee, 13th September 2016 Hartlepool Borough Council Health and Wellbeing Board meeting held on 17th October 2016 Hartlepool Borough Council Health and Wellbeing Board meeting held on 5th December 2016 Stockton-On-Tees Borough Council Health and Wellbeing Board meeting held on 26th October 2016 Stockton-On-Tees Borough Council Health and Wellbeing Board meeting held on 30th November 2016

Attached Attached Attached Attached Attached

Hilary Thompson Ali Wilson Ali Wilson Ali Wilson Ali Wilson

16:50 Questions from the Public – Members of the public may raise issues of general interest which relate to the Agenda

16:58 Post –critique of the Governing Body Meeting Date and Time of Next Meeting: Tuesday 28th March 2017, 2pm, in the Community Safety

Centre, Park Place, Darlington DL1 5LR “Representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity in which would be prejudicial to the public interest (Section 1(2) of the Public Bodies Admissions to

Meetings Act 1960)” Contact for the meeting: Sarah Cook-Smith, Corporate Secretary Tel: 01642 745956 or email NECSU.hastcorpgov@nhs.net

A recording will be made of this meeting to assist with the preparation of the minutes. This recording will be made on an encrypted device owned by the CCG and will be held securely for a maximum of three weeks before being deleted

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Draft Minutes of the NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body Meeting (Public)

Held on Tuesday 29 November 2016 at 2pm

In Hartlepool College of Further Education, Stockton Street, Hartlepool TS24 7NT

Present Dr Boleslaw Posmyk Chair of the Governing Body Ms Ali Wilson Chief Officer Mr Graeme Niven Chief Finance Officer Ms Jean Golightly Executive Nurse Dr Nick Timlin Governing Body GP member (Hartlepool) Dr Saleem Hassan Governing Body GP Member (Stockton) Dr David Hodges Governing Body GP Member Dr Salvi Patel Governing Body GP Member Dr Charles Stanley Governing Body Secondary Care Doctor Mrs Hilary Thompson Governing Body Lay Member (Patient and Public Involvement), Mr John Flook Governing Body Lay Member (Audit and Governance), Mrs Karen Hawkins

Associate Director Commissioning and Delivery

In Attendance Mr Andrew Carter Corporate Governance and Risk Officer Mrs Sarah Cook-Smith Corporate Secretary (Minute taker) Members of Public in Attendance Mr Gary Davidson Connect Health Representative (MSK) Mrs Rita Taylor Senior Independent Director, North Tees and Hartlepool

Foundation Trust The Chair welcomed everyone to the meeting. GB/117/16 Apologies for Absence 117.1 Apologies for absence were received from Mr Andie Mackay, Governing Body Lay

Member, Primary Care.

GB/118/16 Declarations of Interests 118.1 There were no additional interests declared at this point. GB/119/16 Pre-critique of the Governing Body

119.1 The Chair explained that the aim of the meeting is to seek assurance in the

Governing Body (GB) that the CCG are working strategically, and asked that the meeting be conducted with courtesy and respect for other people’s point of view and keep to allotted time for agenda items. Any questions were requested to be raised through the Chair.

GB/120/16 Minutes of Previous Meeting held on 18 October 2016 The minutes of the previous meeting held on the 18 October 2016 were accepted as

a true and accurate record.

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The Governing Body ACCEPTED the minutes to be a true and accurate with minor amendments.

GB/121/16 Matters Arising and Action Log 121.1 It was agreed that the actions marked completed would be closed. Open items on

the Action Log were discussed in turn 121.1.1 GB/16/15 – Quality Report, Safeguarding - Mrs Thompson raised concern that the

issue of Safeguarding Training at STHFT remains unresolved after being raised with the trust numerous times; Mrs Thompson added that this is also an issue at TEWV Mental Health Trust. Ms Golightly informed the Governing Body that this issue has been raised at every forum possible and for STHFT it is being escalated through the South Tees Contract Management Board process, and for TEWV this is being raised through the CQRG meeting. Ms Golightly added that it is an improving trajectory and the Trusts have to be allowed time for this to improve. Ms Wilson asked for a trajectory for when the Trusts will become compliant. 02/02/2016 Ms Golightly advised that further action has been taken and the issue has been raised at performance meetings and is being discussed with Directors. Ms Golightly added that the contractual escalation process is in place and the issue is being taken forward by the Director of Nursing. It was confirmed that no trajectory has been received to date.29/03/2016 Ongoing. 24/05/2016 Ms Golightly advised this issue remains to be an area of concern and asked for the action to remain open. 19/07/2016 Mrs Ferguson provided updated STHFT training figures which were circulate to GB members. Mrs Ferguson has requested a trajectory but this has not been provided by the Trust as yet, advising they will however, endeavour to receive this is as soon as possible. 26/07/2016 Ms Golightly advised that the CCG is still not assured but confirmed that the TEWV trajectory was continuing to improve. STHFT have been asked to provide data by service area and individual profession groups, Ms Golightly requested this action to be kept open until resolved.18/10/2016 Ms Golightly advised that the information is expected at the end of the week and Ms Golightly will advise further after then, requested action to remain open. 29/11/2016 Ms Golightly advised that the position is improving and remains to be monitored. GB agreed action to be closed.

121.1.2 GB/25/16 – Governance and Assurance Report - The GB noted that In December

2015 a report was presented to the Audit Committee, “What keeps CCG Governing Bodies awake at night? Mr Carter informed the GB that the report raised 6 key questions. The questions were presented to the Governance and Risk Committee who discussed each question in turn and considered how the CCG will take forward any actions identified as part of the Governing Body Assurance Framework review. The committee concluded that there was a robust process in place, and that the draft 2016/17 framework will be presented to the Governance and Risk Committee on 13th September 2016, followed by Audit Committee for comment on 20th September and finally Governing Body approval on 27th September 2016. 11/10/2016 - GB Assurance Framework development has been delayed due to ongoing discussions regarding shared management structure with Darlington CCG. 18/10/2016 Ongoing. 29/11/2016 Still being developed as part of the joint working with Darlington CCG. The Framework will be brought back in April next year. Agreed action to be closed.

121.1.3 The Following action was closed:

• GB/27/16 GB/122/16 Chair’s Report

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122.1 Dr Posmyk provided the GB with an update on progress and events since the last meeting.

122.2 The Chair advised that 3:1 meetings have started with Mrs Jones, Darlington CCG

Chair and Ms Wilson, and the Chair continues to attend Local Medical Committee (LMC) meetings where GP manpower and GP Clinical staff remains to be high on the agenda.

122.3 In relation to the 5 year forward view the Chair advised that work is progressing on

how to develop this in relation to Primary Care with the CCGs developing financial position.

122.4 The Chair continues to attend the GP locality leads cluster visit meetings where the

Chair provides updates in regards to the Sustainability and Transformational Plan (STP). The Chair added that there is currently a lot of work ongoing in relation to STP and he is supporting other chairs with this. The GB was thanked for attending the STP development session on Friday 25TH November.

The Governing Body NOTED the Chair’s Report

GB/123/16 Chief Officer’s Report 123.1 Ms Wilson provided the GB with an update on progress made since the last meeting

and highlighted the following issues: 123.2 HR Update Q2 Ms Wilson explained that at the end of Q2, the CCG had a headcount of 35

members of staff with a FTE of 24.25. There were 3 leavers and 6 new starters in Q2, giving the CCG a 20.74% turnover rate (12month period). One member of staff was on maternity leave during Q2. Absence peaked in July 2016, largely due to long term sickness, and has started to reduce in the latter two months of the quarter.

123.3 Community Health Ambassadors (CHA) Ms Wilson advised that the CHA Peer Support Meeting took place on 20th October

and the CHA’s are focusing their efforts on discussions relating to the national implementation of discharge to assess. An evaluation of the Community Health Ambassadors initiative has now been undertaken and will be used to input into the CCG’s Communications and engagement strategy.

123.4 Better Health Programme (BHP) Public Engagement Events – Phase 4

The GB was informed that During October, the BHP undertook Phase 4 of the public engagement events to engage with the public and stakeholders. Within our CCG area, there were two events on 24th October 2016 at Hartlepool College of Further Education and one on 28th October at South Thornaby Community and Resource Centre. The focus of the engagement events was out of hospital care and looking at services that are being delivered in this setting. The engagement event also looked at the possible scenarios for acute hospital reconfiguration.

123.5 Integrated Urgent Care Service Ms Wilson informed the GB that the CCG has procured a GP led service provision

for Integrated Urgent Care which will provide services 24 hours a day, seven days a week, 365 days a year including bank holidays and public holidays to deliver a timely, highly responsive, joined up care that encompasses what was traditionally referred to as minor injury, urgent primary care walk-in provision and GP out of hours provision.

123.6 Local Digital Roadmap

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The GB was advised that as part of the CCG’s Local Digital Roadmap we are currently working on the development of an Integrated Digital Care Record and the CCG have taken a 3 phase approach to this. The CCG’s have recently implemented the simple telehealth system ‘Florence’ in the respiratory Hospital at Home service. The mobile phone text based tool should support patients in being able to manage their respiratory condition and build confidence in being able to self-manage.

123.7 Fens, Hartfields and Wynyard Road Practices The GB were informed that in August 2016 as part of an 8 week consultation

exercise the CCG consulted on future commissioning options for Primary Care Services currently provided at Fens Medical Practice, Wynyard Road Primary Care Centre and Hartfields Medical Practice. Following full consideration of the options and the outcome of the consultation at the CCGs Primary Care Co-commissioning Committee on 25 October 2016, it was agreed to procure one APMS contract which will be delivered from Wynyard Road Primary Care Centre and Hartfields Medical Practice with effect from 1 April 2017. The GB were informed that the borough council have deferred the CCG to the Secretary of state, the CCG have sought legal advice which advised that the procurement can go ahead as long as any possible provider is made aware of the current referral.

123.8 Sustainability and Transformation Plan (STP)

Ms Wilson informed the GB that the STP identifies four areas for improvement and the plan describes how we want to make progress in achieving this over the next five years. Ms Wilson highlighted that the STP was available on the CCG website along with an easy read version which was distributed to staff and stakeholders. Dr Hodges added that the BBC website covered the STP on the day the STP was released. Ms Wilson reiterated that this is a draft plan and engagement will continue.

123.9 Integrated Personal Commissioning (IPC)

Ms Wilson briefed the GB in relation to Stockton-On-Tees IPC site being approached by NESTA (Health Innovations Lab), a voluntary organisation who help people and organisations bring their ideas to life. NESTA have been commissioned through NHS England to work with two IPC sites over the next six months. NESTA will be completing a ‘100 day challenge’, where they will work very intensively with the Stockton site on frontline workforce development. There will be a three-month preparatory work phase, which will bring together frontline staff to look at how to work as integrated frontline teams and implement IPC at scale. The leadership team for the NESTA 100 day challenge is working for live launch in January 2017. Ms Wilson asked the GB to note the challenge of Accelerating the work that is being done.

123.10 Working with Darlington CCG Ms Wilson reported that the CCG is making good progress with the implementation

of the shared management structure with NHS Darlington CCG is progressing with new appointments made to Director posts: Graeme Niven having been appointed as the joint CFO, Lisa Tempest as the Director of Performance planning and assurance, Karen Hawkins as Director of commissioning and transformation, and Andrew Carter, Head of Risk and Governance. It is expected that the structure will be fully in place by the beginning of January.

The Governing Body NOTED the Chief Officer’s Report

GB/124/16 Locality Report 124.1 Hartlepool

Dr Timlin provided a brief update on issues, progress and events in Hartlepool since the last meeting:

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• Practices remain under pressure to recruit GPs. There are some good locum Drs that can be used but this can be costly.

• Some practices haven’t signed up yet to the 111 vanguard proposals to access GP appointments

• Dr Timlins first cluster meeting took place with 4 out of 6 practices attending. Mr Niven and Dr Posmyk were also in attendance. Feedback was that it was a good forum for discussion and a good interactive meeting.

• Dr Timlin advised that all practices were reported as overspent apart from Seaton Surgery. Commissioning Support Officers (CSO)s are working with the practices to analyse their data and look at areas for improvement and areas which are doing well.

• All practices have signed up to the Anticoagulant LES. • Dr Timlin will be attending a meeting on 30th November with HASH to look at

GP extended hours. 124.2 Stockton-on-Tees

Dr Hassan provided a brief update on issues, progress and events in Stockton since the last meeting:

• Dr Hassan highlighted that Stockton has the same GP recruitment issues and recruitment is a fluctuating position. Dr Hassan added that it is difficult to recruit to salaried or partner posts

• Cluster visits are planned monthly, feedback has been that practices find it useful to compare and contrast practice data. In relation to financial budgets only 1 practice was within budget. Dr Hassan advised that practices queried how practice budgets are calculated.

• Integrated urgent care service will be running from April and staffing will need to be worked through.

124.2.1 Mr Niven added that cluster visits were well received and CSOs are work is going

well. In relation to the budget setting for practices Mr Niven advised this is a national budget formula and historic data is used. The Governing Body NOTED the Stockton-on-Tees Locality Report

GB/125/16 Patient Story 125.1 Mrs Thompson read out patient Bs story. Patient B went to Hartlepool One Life with

severe stomach pains on Mon 30th September 2016 who advised Patient B to go to North Tees Hospital where she was admitted to Ward 30. She said nursing staff were good but she had to keep gesturing to explain she was Deaf.

125.2 On Wednesday 5th October Patient B underwent a procedure to remove several gall

stones. Patient B reported that staff at the theatre didn’t know anything about an interpreter being booked, but one eventually arrived. Patient B was unhappy to find that one of the nurses had written in her notes that she had ‘memory loss’ due to her confusion about what was happening, which was actually down to her not understanding what was being said due to deafness.

125.3 Another issue for Patient B was that they didn’t know anything about the medication

they were prescribed at discharge; the doctor wrote down on a piece of paper that they were painkillers called codeine and paracetamol. Patient B attended the HD Centre on 10th October and a Mrs Harrison explained that codeine is a strong pain killer.

125.4 Patient B was also told at discharge that she was going on a waiting list to have her

gall bladder removed some time in November and asked the hospital to contact her by text to let her know when her appointment would be. Patient B wanted to know if

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an interpreter would be booked for the operation so Mrs Harrison called Ward 30 on Patient Bs behalf and a nurse advised that Patient B was on the Hot Gall Bladder Clinic list, which meant Patient B would be contacted just one day before the operation. The Nurse confirmed that Patient B would definitely be contacted by text, as it was written on the paperwork. However the nurse agreed there may be a problem getting an interpreter a short notice although ELS always try to provide one in such situations.

125.5 Mrs Thompson highlighted the main issues from this case study were the lack of

Deaf awareness among hospital staff and appropriate information about this. Another issue hi-lighted here is around the discharge process – especially around medication and the Deaf patient understanding what it is and when and how to take it. Mrs Thompson queried how the issues would be addressed.

125.6 Mr Carter advised that Mrs Leonard, NTHFT Quality Nurse was picking up the issues raised in the story. Mr Carter added that the patient story will be passed on to the CCG Quality Team and Commissioning Team to ensure any issues are addressed.

ACTION: GB/28/16 (Mr Carter)

125.7 Mrs Hawkins gave assurance in relation to information sharing and the introduction of the accessible information standard, a requirement of both health and social care standards which includes GPs, hospitals and social care. Mrs Hawkins advised that in January-March 2016 the CCG instructed all Commissioners to ensure that they are compliant with this standard by March next year and this will be audited by NHSE in 2017.

GB/126/16 Patient and Public Involvement Report

Mrs Thompson provided a verbal update on business conducted in her capacity as Patient and Public Involvement Lay Member of the CCG since the last GB meeting.

126.1 Community Health Ambassadors Mrs Thompson attended the Peer Support Group on 20th October with the next peer Support group is in January and the groups continue to meet at coffee mornings in both towns monthly.

126.2 Hartlepool Healthwatch (HHW)

Mrs Thompson advised that the Dementia Report has been sent to TEWV, the GP Federation, the LA and the CCG and there is interest from other Healthwatches. The main issue arising from the report are in relation to communication, clear language, and regular contact with GPs in the early stages of Dementia. Mr Thomas, Health watch Manager is working with one of other CHAs for the deaf community Mrs Harrison, in particular looking at the experience with hospitals. HHW is looking at engaging with young people, including Looked After Children and supporting training for young people in engaging with others at a residential event in York.

126.3 Stockton Healthwatch

The GB were notified that SHW have produced three reports, Analysis of GP Service Feedback, NHS 111 Service Feedback, and the Delays to Patient Discharge Follow-up Visit Report which have been received by the CCG. Mrs Thompson reported that SHW Youth engagement work is going really well and it has been an interesting engagement project engaging with around 250 young individuals. A report will be produced which summarises the data gathered.

126.4 Lay Member PPI Network Forum

Mrs Thompson attended the meeting on 21st November where each LM told the group about a particular CCG initiative in their area. The GB were informed that the

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Lay Member PPI group will be going to a group of six and the group intends to carry on with three meetings per year to share good practice and any concerns.

126.5 NHS Commissioners Lay Members Network

Mrs Thompson briefed the GB that the meeting on 22nd November in London was well attended with around 50 CCGs represented. Sir Malcolm Grant, Chair of NHSE was a key speaker. Mrs Thompson went through the topics covered advising that the meeting was very useful with good networking and relevant issues discussed.

126.6 Evening Gazette Community Champions Awards

The GB was told that the awards are due to take place on Thursday 8th December with Mrs Thompson and Dr Posmyk presenting Champion Carer award.

126.7 Primary Care Commissioning Committee (PCCC)

Mrs Thompson briefed the GB that the PCCC continues to be presented with difficult decisions regarding Primary Care across HaST areas and the local input from our non-voting attendees is greatly appreciated. The Committee sent a letter on 20th October requesting another representative from H&WB be nominated to attend the Committee to represent Hartlepool Local Authority as there has been no representation for some time.

126.8 In the Media

Mrs Thompson raised the subject of Airedale NHS Foundation Trust introducing an around-the-clock service that connects care home residents to nurses over a video link has slashing unnecessary ambulance journeys, hospital admissions and GP appointments, and asked if this was something that would be looked into.

126.8.1 Ms Golightly added that Airedale NHS Foundation Trust attended the Chief Nursing

officers meeting to provide a brief in relation to the work which was 5 years in implementation and is a developing process. The Trust are outreaching with care homes and there could be opportunities.

126.8.2 Dr Hassan reported that a similar scheme is being tried in Redcar where GPs are

consulting with Care homes before attending homes. Mr Niven added that the CCG are working with Care homes to implement SystmOne, and are providing tablets to carry out an early scoring system.

GB/127/16 Finance Report 127.1 Mr Niven presented the finance report advising that the CCG commissioning spend

(including Reserves) is forecasting a planned year end surplus of £5,060k, with running costs reporting an underspend of £220k. The closing monthly cash balance of £318k is within cash efficiency targets set. Mr Niven advised that there is significant concern with the delivery of the Quality Innovation Productivity Prevention (QIPP), forecast to be under-delivered with a final position of £4,730k at year-end. Better Payment Practice Code (BPPC) with 95% of invoices to be paid in 30 days has exceeded the 95% target for the financial year so far.

127.2 With regards to Continuing Health Care (CHC), Mr Niven highlighted that there is

risk and pressures in this area with a forecast of £2m overspend. Mr Niven informed the GB that the CCG had commissioned an external company to assess the top 20 high cost packages of care. The company has reported back with some recommendations such as looking at the size of the packages of care, and the policies around the decision making which are being looked into by the team.

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127.3 Mr Niven reported that as the CCG are looking into financial recovery a Finance Committee has been put in place to monitor recovery going forward where areas to explore have been identified strengthening the CCG Governance Structure.

127.4 The GB were informed that prescribing figures are forecasting a £437K underspend

and Mr Niven took the GB through the detail of the primary care services spend.

127.5 In relation to QIPP, Mr Niven explained that as at 31October 2016 £2.615m has been delivered (forecast £4.730m) against the plan of £11.858m. Current performance now includes data flows from the implementation of the MSK pathway in addition to the previously reported respiratory, spinal procedures, and lucentis pathways. Walk in centre activity is below plan therefore the benefit of this QIPP is now included in the year to date & forecast outturn position. The impact of the new data received has increased the forecast outturn from active schemes to £4.7m. Pathway changes as noted above have continued to be behind plan. Current performance is now being analysed at provider level and will be used in individual contract meetings to identify that planned pathways are being adhered to and thereby to assess whether the new pathways have had the desired effect.. Medicines Management schemes are forecasting to achieve their contracted target and contribute to the unallocated QIPP. Forecast outturn has been based upon current performance for pathway changes and the detailed forecast received from the Medicines Optimisation team. Mr Niven advised that the first GP variation and excess bed days data has been received from NTH and this is currently being analysed. These schemes are now classified as medium risk. Audiology at South Tees is still in negotiation, and S117 agreements are not expected to deliver until later in the year – these schemes have been re-classified as high risk. The risk profile of all schemes has been reviewed as part of the implementation of a financial recovery plan for the CCG and the revised risk assessment in shown in in the following tables. The CCG is on course to deliver the green rated risk of £4.4m and make a contribution to the amber risk schemes of circa £1.0 m.

127.6 Mr Flook queried NTHFT data issues. Mr Niven confirmed that the data issues

started in October 2015 so the management of finances. Mr Flook asked in relation to CHC, is there an opportunity to do some comparison with DCCG, Mr Niven confirmed that there was opportunity and took the GB through the benchmarking already carried out. Mr Flook questioned the stopping of over counter drugs from the grey list, Mr Niven clarified that the CCG will not be stopping the dispensing of all of the items on the list but reviewing the prescribing of them so further judgement will be applied at a prescribing stage. Dr Timlin added that the grey list scheme has worked well when it was implemented in an area close by.

127.7 Dr Hodges asked if costs were getting cheaper in relation to hospital at home. Mr

Niven advised the admission profile has not changed as the CCG are still seeing 0 length stays. Ms Wilson added that we may start to see lower levels but it feels like the right thing to do and there may appear to be slow progress with schemes as they take time to embed.

15:25pm ~ Mr Flook left the meeting

The Governing Body NOTED the Finance Report GB/128/16 Performance Report 128.1 Mr Niven took the GB through the Performance Report raising some of the

performance issues. The GB was informed that the CCG Performance against the NHS Constitutional Indicators in 2016/17 is very good with the only areas of non-compliance against the Cancer 2 week wait, Cancer 62 day urgent GP referral, 62

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day screening indicator and NEAS Ambulance response times. Mr Niven highlighted that this picture is mirrored by NTHFT who are compliant against all indicators with the exception of A&E waits & Cancer 62 days. STHFT are also non-compliant against Cancer 2 week waits, 2ww breast symptomatic, 62 day Screening and 62 day urgent GP referral as well as the RTT and diagnostic indicators. Mr Niven added that NEAS are now failing both the 8 minute & 19 minute response time targets at CCG and Provider level.

128.2 Mr Niven explained that the cancer 2ww is improving, but performance against the

62 day indicator is still an issue but there are a number of actions in place. With regards to Ambulance response times Mr Niven advised that there is focus around this and a Manager from NECS has been asked to provide a deep dive report at the next Quality, Performance and Finance Committee for assurance.

128.3 Dr Hodges asked in relation to the new out of hours service and NEAS going to be

part of the delivery, Dr Hodges queried if there was concern with NEAS responses as NEAS are already part of another contract. Mrs Hawkins advised that the contract is with NTHFT and the Trust is responsible for the management and delivery of the contract. Mrs Hawkins briefed the GB in regards to how the new service will work with the service triaging calls as part of a collaborative approach.

15:30pm ~ Mr Flook rejoined the meeting 128.3.1 Ms Wilson advised the NEAS performance is looked at continuously and in order to

look at how to deliver good performance in the ambulance service we do need to look at how the rest of the system impacts on this service. Ms Wilson added that all CCGs have agreed to work with the Trust and there are different escalation mechanisms and progress though the vanguard. Dr Hodges reiterated that the there was concern that an already stretched resource was being spread too thinly.

The Governing Body NOTED the Performance Report

GB/129/16 Governance and Assurance Report 129.1 Mr Carter delivered the report advising that the report provides detail on significant

governance and assurance issues since the last GB meeting and provides assurance to the GB of the CCG on delivery of key governance processes. Mr Niven apologised that the front sheet asks for the GB to approve the Information Governance Strategy as this was from the last meeting.

129.2 Risk Register

Mr Carter explained that there are currently two risks high risks on the CCG Risk Register, Risk 1032 - Failure to commission the appropriate number of high quality nursing care beds in all residential settings where the CCG is the responsible commissioner. Risk 1448 - Deprivation of Liberty Processes are not put in place in relation to Continuing Healthcare Cases. Mr Carter advised that both risks currently have a residual risk rating of 16 and this risk is being actively managed and updates being presented to the GB.

129.3 The GB were informed that the CCG Risk Register was reviewed in the week before

the GB and advised that there is a proposal of two additional risks to be added to the Risk register, a risk in relation to the delivery of the Sustainability and Transformational plan, and a risk in relation to an open post of a Designated Medical Officer for Special Education needs and Disability.

129.4 Emergency Planning Resilience and Response (EPRR) process

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Mr Carter reported that on an annual basis, NHS England require each individual CCG to undertake a self-assessment against the NHS England Core Standards for EPRR. The Corporate Governance and Risk Officer has undertaken the self-assessment and following the assessment, the organisation has been self-assessed as demonstrating the Substantial compliance level. Mr Carter confirmed that the relevant documentation was submitted to our local health resilience partnership (LHRP) and reviewed by them on 15th November 2016. The LHRP agreed with the CCG’s self-assessment, as part of the assurance process, the Governing Body are requested to note the self-assessment.

129.5 NHS Constitution

NHS England has published updated statutory guidance for CCGs considering constitutional change, merger or dissolution. This document supersedes guidance published in October 2015. It outlines the process a CCG can take to apply to NHS England to make changes to its constitution, and to dissolve or merge two or more CCGs. This guidance has been revised to provide CCGs with a set of clear criteria when considering mergers. Mr Carter advised that the CCG will be undertaking its annual review of the CCG’s constitution in line with this new guidance and changes will be submitted to the Council of Members for approval at their meeting on 31st January 2017.

The Governing Body NOTED the Governance and Assurance Report

GB/130/16 Quality Report 130.1 Ms Golightly presented the Quality and Safeguarding Report which reflected the

position as at the end of October 2016. The report included information in relation to the key issues within the CCG’s commissioned services and provides assurance that actions are being undertaken where appropriate. Ms Golightly presented the report by exception.

130.2 North Tees and Hartlepool NHS Foundation Trust (NTHFT)

The GB were informed that the Trust has exceeded the Clostridium Difficile annual trajectory and has 1 trust attributable case of MRSA reported. The independent, external Maternity Services review has been completed and the report is still awaited and mortality metrics continue to improve.

130.3 South Tees Hospitals NHS Foundation Trust (STHFT)

A CQC follow up inspection at the Trust has rated STHFT as GOOD in all 5 domains of care, and GOOD overall in published results. The Trust has 5 published Trust attributable MRSA cases.

130.4 Tees Esk and Wear Valley NHS Foundation Trust (TEWV)

Serious incident national reporting framework timescales remains a challenge for the Trust with non-compliance continuing, this has been raised with the Director of Quality. An unannounced CQC inspection of Adult and Older Persons Mental Health Services has been carried out and there is no feedback or report available as yet.

130.5 North East Ambulance Service (NEAS)

The Trust was rated GOOD in all 5 domains of care, and GOOD overall in published results of CQC follow up inspection.

130.6 CCG

An Ofsted and Care Quality Commission joint inspection of Special Educational Needs and Disabilities (SEND) for Children and Young People in Hartlepool was carried out and a draft narrative inspection report has been received for accuracy checks but has not been published. Ms Golightly reported the reintroduction of

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NHSE CNE weekly tracker for Learning Disabilities in-patients, post Winterbourne View, community based.

130.7 Dr Timlin asked if there were any additional visits to NTHFT in relation to the

ongoing C.Diff issues. Ms Golightly advised that Commissioner Assurance Visits continue as does work with the 90 day rapid improvement scheme along with other measures and ongoing work.

130.8 Mrs Thompson asked how reliable the data was that is provided in the tables within

the report when the narrative advises that the data from October 2015 may be skewed. Ms Golightly advised that we can only work with the data provided at the time but information is updated, and rebased and improvement work is ongoing. The Chair added that the CCG do triangulate data and information.

130.9 Dr Hassan reported that in relation to C.Diff, the microbiology department will be

sending letters out to GPs to inform them of any reported C.Diff and the need to review prescribing is being reiterated.

130.10 Dr Stanley asked in relation to TEWV and the serious incidents issues, Dr Stanley

asked if the CCG can be assured that the Trust will follow the Mazars report. Ms Golightly advised that the Trust recognise the need for assurance and confirmed that Mazars are working with the Trust along the way and the CCG are also working with the Trust on the issues.

The Governing Body NOTED the Quality Report

15:53pm ~ The GB had a comfort break, Mr Gary Davidson and Mrs Rita Taylor left the meeting GB/131/16 Equality and Diversity (E&D) Strategy 131.1 Mr Carter informed the GB that the Equality and Diversity Strategy is a refreshed

strategy due to the necessity to include the Workforce Race Equality Standard (WRES), and the Accessible Information Standard which became mandatory for the NHS in 2016.

131.2 Mr Carter explained that there is a requirement to carry out and annual report and

action plan to ensure that the CCG is compliant with the E&D Strategy. With regards to the WRES, Mr Carter reported that due to the CCG being a small organisation and data being easily identifiable to an individual, the decision has been made to amalgamate the data with of 12 CCGs to ensure this is not the case. Mr Carter advised that the Accessible Information Standard requires ‘Commissioners of NHS and publicly-funded adult social care must have regard to this standard, in so much as they must ensure that they enable and support compliance through their relationships with provider bodies’. Mr Carter informed the GB how the CCG will ensure they are compliant.

131.3 The Chair asked in relation to WRES, are the GB representative of the ‘Board’ or is

it member practices. Mr Carter advised this means the GB, and in terms of represented it means the areas in which we work in and cover.

The Governing Body APPROVED the Equality and Diversity Strategy

GB/132/16 Declaration of Interest and Standards of Business Conduct Policy 132.1 Mr Carter explained that a comprehensive review of the CCG’s Standards of

Business Conduct and Declarations of Interest Policy has been undertaken. This was to ensure that the CCG complies with the Statutory Guidance on Managing

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Conflicts of Interest that was published by NHS England in June 2016. Mr Carter asked the GB to note that newer guidance is expected imminently.

Mr Carter took the GB through the key amendments to the policy: • The recommendation for CCGs to have a minimum of three lay members on the

Governing Body, in order to support with conflicts of interest management; • The introduction of a conflicts of interest guardian in CCGs. We expect that the

CCG audit chairs will assume this role, which will be an important point of contact for any conflicts of interest queries or issues;

• The requirement for CCGs to include a robust process for managing any breaches within their conflict of interest policy and anonymised details of the breach to be published on the CCG’s website for the purpose of learning and development

• Strengthened provisions around decision-making when a member of the governing body, or committee or sub-committee is conflicted;

• Strengthened provisions around the management of gifts and hospitality, including the need for prompt declarations and a publicly accessible register of gifts and hospitality;

• A requirement for CCGs to include an annual audit of conflicts of interest management within their internal audit plans and to include the findings of this audit within their annual end-of-year governance statement.

• A requirement for all CCGs employees, governing body and committee members and practice staff with involvement in CCG business, to complete mandatory online conflict of interest training, which will be provided by NHS England. The online training will be supplemented by a series of face to face training sessions for CCG leads in key decisions-making roles.

132.2 Chair advised that the CCG do apply a high degree of CoI management already.

The Governing Body APPROVED the Declaration of Interest and Standards of Business Conduct Policy

GB/133/16 Joint Committee of Clinical Commissioning Groups Sustainability and

Transformation plans (STP) Terms of Reference 133.1 Ms Wilson took the GB through the minor changes to the terms of reference which

reflect that the Better Health Programme sits within the STP and that North Durham are now not part of the STP although it is important that they attend meetings: • A changed form of words to reflect North Durham change of footprint but

attending the meeting (non-voting) • Slight strengthening of section 1.5 to explain the relationship between the STP

and BHP which is within the STP • Reordering of the paragraphs in section 3 • A note that reminds members that it is their responsibility to ensure GBs are

appropriately briefed • Changes to membership reflected in the body of ToR also reflected in the

annex. 133.2 Ms Wilson advised that the ToR were discussed at a meeting attended by some GB

members. The Chair advised that there was a discussion in relation to specific members being named in the Tor but the ToR do not reflect this decision therefore allowing leeway. Ms Wilson confirmed that the discussion was around there being 1 person per site or organisation having a decision, the end decision was that a decision would be unanimous.

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133.3 Dr Hodges queried with the end point of the STP possibly being reconfiguration of Primary Care and possibly the loss of acute services delivered from a specific locality, asked would the decision be delegated to the joint committee. Ms Wilson stressed that there would be no loss of premises just the possibility of change of services from some premises and that yes the decision would be delegated to the Joint Committee as the decision needs to be made in collaboration with others.

133.4 Dr Hodges asked what would happen if member practices disagreed with a

decision, Ms Wilson advised member practices have delegated authority to the GB for such decisions during consultation for change to deliver the standards for the people across the areas, there will be a right to challenge proposals. The Chair clarified that everyone involves understands the importance to discuss and document discussions to ensure that if the decisions are challenged it is apparent where and how the decisions were made.

The Governing Body APPROVED the Joint Committee of Clinical

Commissioning Groups Sustainability and Transformation plans (STP) Terms of Reference

GB/134/16 Confirmed Minutes 134.1 Confirmed minutes of the Quality, Performance, and Finance Committee

The confirmed minutes of the QPF Committee held on 30 August 2016 were noted.

134.2 Confirmed minutes of the Hartlepool Borough Council Health and Wellbeing Board The confirmed minutes of the Hartlepool Borough Council Health and Wellbeing Board meeting held on 19 September 2016 were noted.

134.5 Confirmed minutes of the Stockton-on-Tees Borough Council Health and Wellbeing Board The confirmed minutes of the Stockton Borough Council Health and Wellbeing Board meeting held on 28 September 2016 were noted.

GB/135/16 Questions and Comments from Members of the Public 135.1 There were no members of the public left at the meeting. GB/136/16 Post Critique 136.1 The Chair acknowledged that the meeting had ran a few minutes over but felt that

there was a good level of discussion. The Chair thanked everyone for coming to the meeting and for directing questions through the Chair.

GB/137/16 Date and Time of Next Meeting 137.1 The next meeting is scheduled to take place at 2pm on Tuesday 31st January 2017,

2pm, in The Activity Studio, North Shore Academy, Talbot Street, Stockton-on-Tees TS20 2AY

GB/138/16 Exclusion of Press and Public 138.1 The Chair moved the following resolution in order to move The GB into a private

session to consider private items of business; 138.2 that representatives of the press and other members of the public be excluded for

the remainder of the meeting having regard to the confidential nature of the

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business to be transacted, publicity on which would be prejudicial to the public interest (Section 1(2), Public Bodies (Admission to Meetings) Act 1960)

The meeting closed at 16:37pm Signed: ……………………………………………….. Date: ……………………………… Dr Boleslaw Posmyk

Chair of the Governing Body

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DARLINGTON CLINICAL COMMISSIONING GROUP GOVERNING BODY

Tuesday 6th December 2016

12noon – 2pm

The Hackworth Room, Community Safety Centre, Park Place, Darlington DL1 5LR

UNCONFIRMED MINUTES

Present: Andrea Jones (AJ) Chair Ali Wilson (AW) Chief Officer Lisa Tempest (LT) Chief Finance Officer Michelle Thompson (MT) Lay Member – Patient and Public Involvement John Flook (JF) Lay Member – Governance Angela Galloway (AG) Secondary Care Clinician Alison MacNaughton-Jones GP Representative Richard Harker(RH) Clinical Quality Lead Diane Murphy (DM) Interim Chief Nurse In attendance: Miriam Davidson (MD) Director of Public Health, DBC Karen Hawkins (KH) Director of Commissioning and Transformation Andrew Carter (AC) Corporate Governance and Risk Manager Mary Bewley (MB) Head of Comms and Engagement, NECS (Item 59)

Glenda Lynn (GL) PA/Minute Taker

Action

GB/16/50 Apologies for Absence/Welcome Apologies were received from Andie McKay, Jackie Kay and Suzanne Joyner

GB/16/51 Declarations of Interest/Register of Interests Diane Murphy, Interim Chief Nurse is seconded to Darlington CCG from County Durham and Darlington NHS Foundation Trust. DM declared an interest in any items relating to CDDFT during the Governing Body meeting. John Flook declared an interest as a Lay Member at NHS Hartlepool and Stockton-on-Tees CCG

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Michelle Thompson declared an interest as the Chief Executive of Healthwatch Darlington to item 59, Engagement Plan Update. The Register of Interests can be seen on Darlington CCG website.

GB/16/52 Minutes of the NHS Darlington Clinical Commissioning Group (CCG) Governing Body held on 6th September 2016 The minutes of the meeting held on 6th September 2016 were accepted as a true record.

GB/16/53 Matters Arising and Action Log There were no matters arising from the minutes of the meeting held on 6th September 2016. The action log was discussed and updated accordingly.

GB/16/54 Chair and Chief Officer Report The Governing Body considered a report that provided an update from the Chief Officer and the Chair. AW highlighted some of the areas within the report and provided updates since the production of the written report. HR Update Current Darlington CCG sickness levels remain very low, with no sickness absence reported for five of the last six months. Joint Working with Hartlepool and Stockton-on-Tees CCG The implementation of the shared management structure across the two CCGs is progressing. New appointments made to Director posts are Graeme Niven to Director of Finance, Lisa Tempest as Director of Performance, Planning and Assurance and Karen Hawkins as Director of Commissioning and Transformation. AJ welcomed Karen to the meeting today and also Andrew Carter, Corporate Governance and Risk Manager. Sustainability and Transformation Plan (STP) During 2016, NHS staff, including GPs and hospital consultants have been talking to local people about NHS services at over 50 events. The public are clearly passionate about NHS services and have brought to these events this passion and also their frustrations and concerns. A documentation about the plan is now available on the CCG website. Estates and Technology Transformation Fund (ETTF) Since reporting to the Governing Body of the schemes submitted to the ETTF, NHS England have subsequently notified CCGs of changes to the methodology and approval process which are being worked through. A number of Darlington schemes have

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been agreed to the next step of the approvals process and we will continue to ensure the necessary documentation is prepared for the due diligence process. Primary Care Transformation and New Models of Care Progress continues to design and develop the community hubs model in Darlington with involvement of all of the practices in the town. Cancer Services Review The review of cancer services in Darlington is progressing well. This work is now being used to inform the review’s focus for 2017 and the development of a long term commissioning plan for cancer services in Darlington and aligned to the National Cancer Strategy. Consideration to be given to bringing more information to a future Governing Body meeting. Urgent Care and Out of Hours Services In order to develop a specification and establish the best service in the short and long term, the CCG established an Urgent Care Project Group in July 2016 and there has been ongoing work looking at what the model will be. On 14th December the Urgent Care Centre, currently located in Doctor Piper House (DPH) will be relocated to the Darlington Memorial Hospital (DMH) site. At the present time there are no plans to move any services from DMH to DPH. Medical Intraoperability Gateway (MIG) All eleven GP practices in Darlington have signed up for the MIG and for 111 direct access to appointment with the training delivered to support the implementation. New Measure to Support Whistleblowing in Primary Care New whistleblowing guidance has been drawn up following a five week consultation with staff working in primary care. In April this year, NHS England became a ‘prescribed person’ which means primary care service staff working at GP surgeries, opticians, pharmacies and dental practices can raise concerns about inappropriate activity directly to NHS England. The Governing Body:

i) received the report ii) noted the updates and considered the issues

highlighted

GB/16/55 Patient and Public Involvement Governing Body received a verbal update report from the Lay Member – Patient and Public Involvement.

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Community Council Community Council has recently appointed three new members taking the total to nine or ten. The members have recently been considering the Darlington Infographics having been asked to give feedback on whether this is considered to be user friendly. Community Council members see the move towards Saturday and Sunday and evening access to GPs as a positive move, asking that every effort is made to ensure that the communication of this new service is appropriate to ensure the working population in particular are reached. AW informed Governing Body that a communication will be made widely available of this service but also for access to services over the Christmas period. The message will be to ring 111 to be given a local GP appointment. The Community Council agreed it was good to hear that GP practices will be working together with the new hub arrangements. Feedback has been passed to Communications about the movement of Urgent Care at Doctor Piper House to Darlington Memorial Hospital. Community Council felt that many in Darlington still refer to the Urgent Care Centre as the Walk In Centre which may result in confusion and there needs to be more clarification Urgent Care and A&E. Attendance at a recent Better Health Programme event held at Morton Park Business Centre had been poor. Community Council had pointed out that this could have been due to buses being available to the venue but not available at the time of the end of the event. More care needs to be taken to ensure that venues are fit for purpose. Word on the Street Maternity Services at Darlington Memorial Hospital. Feedback had been received from a lady who at the recent delivery of her child had experienced a number of different changes in personnel due to the length of time she spent in hospital. The lady reported that one her arrival, staff were very caring, informative and encouraging, giving sufficient detail about what was happening. However, when the shift changed and new staff came on duty, the experience had been completely different, staff were rude, dismissive and very unhelpful. The Governing Body received the verbal report.

GB/16/56 Finance Report – Month 7 Governing Body was informed of the CCG’s financial position for the seven months to 31st October 2016.

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Darlington CCG has reported a year-to-date surplus of £1,034k which is in line with the forecast for the year which required the CCG to deliver a surplus of £1.771m to comply with NHS England business rules. This situation has continued to deteriorate in month 8. Governing Body was informed that current performance indicates that the CCGs QIPP plan will fail to deliver the planned £4.9m savings, with a shortfall of £2.38m expected due to slippage in a number of schemes involving pathway changes due to a delay in obtaining engagement with acute hospital clinicians. Additional schemes identified for demand management and prescribing are currently being developed to mitigate part of this however the CCG will need to utilise all remaining reserves to enable the forecast surplus to be delivered. This excludes the £1.6m ‘1% headroom’ which NHS England have notified cannot be committed by CCGs at this time and should not be used as mitigation for financial risk. Acute Services Spend on acute hospital services is forecast to be £1,353k higher than planned. The contract with the lead provider County Durham and Darlington NHS Foundation Trust (CDDFT) is forecast to exceed plan by £1,495k. Mental Health Services Mental Health spend is forecast to be in line with plan with some variance on individual contracts due to changes in care packages. Community Health Services A forecast over-spend on NHS Contracts mainly relating to CDDFT is based on five months of data indicating Urgent Care over performance of £133k and Podiatry £22k and Orthotics £40k over performance for the year. Continuing Health Care The forecast underspend is largely due to CHC joint packages with Darlington Borough Council. Package data is expected for Quarter 1 and 2 which will allow additional validation to take place. Prescribing Costs Prescribing costs are in excess of plan by £680k. The expected impact of Category M price reduction and stretch QIPP schemes have been factored into the reported position of achieving budget for the full year. Primary Care Co-Commissioning

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There are a number of small variances against the plan, however the primary care costs are expected to be in line with the plan for the year. Running Costs The CCG is forecasting that costs will be managed within the running cost allowance. Financial Recovery The CCG faces a risk of not being able to delivery against its financial plan. A Financial Recovery plan has been developed and shared with NHS England. This plan is monitored on a monthly basis by the CCGs Finance Committee and exceptions will be reported to Governing Body. The Governing Body expressed concern for the deteriorating financial position, however were assured that all possible actions were taking place to manage this position. It was noted that NHS England has also assured the recovery plan and whilst they continue to be aware of the risks, are content that the appropriate actions are being taken by the CCG. The Governing Body considered the financial position and received the report.

GB/16/57 Clinical Quality Report – December 2016 The Governing Body was advised that the purpose of this report was to provide an update of current issues relating to the quality of services and their impact on patient experience. The key issues identified highlighted within the report were: County Durham and Darlington NHS Foundation Trust

• Never Events – Following on from declaring a seventh never event since 1 April 2016, the CCG Chief Nurses held a conference call with the CDDFT Director of Nursing to discuss the actions the Trust is undertaking. This is the highest number of never events for a Trust across the North East and Cumbria. All never events have been of a surgical nature, though not all have been during surgery. During the conference call, assurance was given that all steps are being taken to implement the changes necessary.

• Maternity Services is now out of escalation and is currently being reviewed by the QRG. The Trust has raised some issues, though have not provided any detail, a meeting is to be held with the Trust to get an understanding of the issues.

• Multiple Births – Delivery of multiple births continues outside of CDDFT, though these ladies are cared for at

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their local hospital. DMH continues to receive support from South Tees Hospital three days per week.

South Tees Hospitals NHS Foundation Trust

• Health Care Associated Infections - The Trust has published data showing that STHFT has reported two cases of C Diff in October. The Trust remains better than trajectory with a total of 24 reported cases so far in 2016/17. The Trust has an infection prevention control action plan in place, progress on this is reported to STHFT Trust Board. South Tees CCG has undertaken two Commissioner Assurance visits and gained assurance.

North East Ambulance Service NHS Foundation Trust and 111 Service

• Care Quality Commission Inspection Report - The CQC inspection report was published on 1st November 2016 giving NEASFT an overall rating of ‘good’ across all five domains. This followed an announced visit in April and an unannounced visit in May 2016.

• Emergency Care Performance – Latest validated figures for emergency care performance across all three indicators continued to be below national targets. Performance showed a decrease in the R1 response rate at 63.2%, though improvements were made in both R2 (65.8%) and R19 (91.3%) rates.

• Handover Delays – Time lost to handover delays exceeding 15 minutes in September stood at 458 hours, which equates to 38 double crewed shifts.

Funding Request from NEAS AW advised that correspondence had recently been received by Chairs, Chief Officers and Chief Executives across the region from NEAS expressing their concerns on their performance and the impact on patients. NEAS has carried out some benchmarking work and are now requesting a significant increase in the level of funding they receive. This will be taken into account during contract negotiations which are due to complete by 23rd December. Agreement has been reached in principle to streamline contracting processes and that a single responsible Director and contracting team will be hosted by one CCG across the North East. Assurance has been provided to all CCGs that they will continue to be able to influence decisions at a local level to secure improved local performance. Priory, Middleton St George

• Care Quality Commission Inspection Report – A CQC report published on 30 March 2016 gave Priory an overall rating of ‘requires improvement’. Following re-inspection

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on 7 and 13 September a revised report published on 19 October giving a rating of ‘good’.

The Governing Body received the report and agreed that necessary actions were being taken forward to improve quality and experience for patients.

GB/16/58 Performance Report – November 2016 The Governing Body was informed of the CCG’s performance in respect of NHS Constitutional Standards using the most up to date performance information for each indicator. On a year to date basis Darlington CCG is currently achieving the following constitutional standards:

• Referral to Treatment within 18 weeks • No mixed sex accommodation breaches • % of people followed up within 7 days of discharge from

inpatient psychiatric care. • No patients to wait for over 52 weeks for treatment • Patients waiting for diagnostic tests should not wait more

than 6 weeks from referral • Ambulance category A response times (8 minutes) • Improving Access to Psychological Therapies (IAPT) –

proportion of people entering therapies and moving to recovery

• Incidence of C-Diff The Governing Body was informed that a number of standards are currently not being achieved:

• Percentage of patient seen within 2 weeks of an urgent referral for breast symptoms. Darlington CCG has failed to achieve the standard during 2016/17 reporting 88% achievement against a target of 93%. Breaches were cited as relating to patient choice and capacity issues due to the closure of services at Sunderland, however this service was reinstated in September and performance is expected to improve in Q3.

• At least 85% of patients should be treated within 62 days of an urgent GP referral for suspected cancer. Darlington CCG are failing to achieve the 62 day target reporting 75.2% year to date, as at 30th September against the 93% target.

• The CCG has failed to achieve the required standard for radiotherapy and drug indicators for the treatment of cancer, also year to date performance remains above target.

• Less than 95% of patients should spend more than four

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hours in an A&E or minor injury unit. CDDFT have achieved this target since June after failing to do so for six consecutive months prior to this.

• Handover between ambulance and A&E should not exceed 30 minutes. CDDFT are a regional outlier. However performance has improved significantly.

• Ambulance category A response times. NEAS performance remains below target in 2016/17 reporting a declining position for both the 8 min indicator and 19 min indicator in October. Actions targeting demand, capacity and efficiency have been identified however improvement is not expected to be seen until later in 2016/17.

• Incidents of MRSA. The CCG had one confirmed case of MRSA in June. All breaches are discussed at monthly Clinical Quality Review Group meetings.

Governing Body was assured that the CCG continues to monitor the performance standards and receives weekly data from the Trust on actions taken to rectify underperformance. The Governing Body received the report.

GB/16/59 Engagement Plan Update Governing Body was informed that this was to be a verbal update with a written report being brought to a future meeting. MB explained that discussions with Healthwatch Darlington are ongoing to ensure that delivery on some of the pieces of work is achievable. The first meeting of the partners has taken place and they will work with Comms on the templates. Meetings have taken place with the three workstream leads to establish where they would like the focus to be. The focus groups are planned. Consideration is being given to the tools to be used by the focus groups, and the outcome of these will feed back into an event to be held in April, 2017. KH pointed out the need to ensure links with the planning round 2017/19. KH and MB to meet to talk about how the engagement plan will link with these plans. The CCG needs meaningful information rather than just a tick box exercise and every effort will be made to ensure the finer detail is recorded. DM pointed out the need to work closely with partners as a lot of work has already been done.

MB KH/MB

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The Governing Body received the verbal update and noted a written report would be brought to a future meeting.

GB/16/60 Darlington 2020 Vision Update The Governing Body was provided with an update on progress against plans in place to deliver the Darlington 2020 vision. There are a number of strands associated with this vision: New Models of Care Progress continues on the development of the ‘community hub’ approach across Darlington, with key involvement of all eleven GP practices. The three hubs are:

• Hub 1 – Neasham Road, Parkgate and Clifton Court • Hub 2 – Moorlands, Orchard Court, Carmel, Rockliffe

Court and Blacketts • Hub 3 – Whinfield, Denmark Street and Felix House

Discussions have begun regarding the contracting mechanism appropriate for this transformational change. Several of the practices have different issues and the planning will need to ensure the balance is right for all. MT asked what patient and public engagement had taken place when considering the development of the hubs. JS explained that at the present time the work is with the practices to ensure they are fully engaged with the rationale for the hub working and she gave assurance that patients and carers and practice patient group will have an opportunity to become involved. JF asked about the different issues the practices are facing, in particular the workforce concerns. JS explained that not all practices have workforce concerns but some are struggling. A third of the GP and Nursing workforce in Darlington is due to retire in the next few years. The CCG believes that the New Models of Care work is key to being able to provide resilience going forward, along with ‘skilling up’ other health workers. The infrastructure needs to be in place to attract health workers, particularly GPs to Darlington to live and work. DM said she felt that there are a number of opportunities being developed to attract newly qualified nurses to the town. The new hub way of working will offer exposure to a range of difference areas of work. Urgent Care and Out of Hours Service The need for integration between emergency care and urgent care services was recognised along with potential gaps in service provision. An Urgent Care Project Group was established in July 2016 to plan to address short and longer term inefficiencies. As a result of this work a proposed model of

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GP led service provision 24 hours a day, 7 days a week, 365 days a year to deliver timely, highly responsive, joined up emergency care services, incorporating the GP Out of Hours and Home Visiting services. An interim service specification has been developed and shared, and the interim arrangements will be in place to support service delivery over the winter period. North East Urgent and Emergency Care (UEC) Vanguard Development All 11 GP practices in Darlington have signed up for the Medical Interoperability Gateway and for 111 direct access to appointments. For the patient this means they are able to directly book an appointment with their GP for the following morning. The 111 Clinical Hub The 111 Clinical Hub pilot containing GPs and other health care professionals came to an end at the end of October 2016 having demonstrated a 76% diversion of activity away from Emergency Departments. The scheme will now be carried forward with the support of the CCGs across the North East and Cumbria. Estates and Technology Transformation Fund (ETTF) Two digital schemes proposed for Darlington have been given significant priority and are identified for early funding:

• Improving Darlington’s Digital Capability • Enhancing Darlington’s Digital Capability

GP Access Fund The CCG is working with Primaryhealthcare Darlington on the following initiatives:

• Saturday and Sunday pre-bookable GP clinics • Evening pre-bookable appointments with nurse or GP

from 6.30pm – 9pm Monday to Thursday and on a Friday 6.30pm – 8.30pm

Work on this will be finalised for implementation of the scheme in early January 2017. The Governing Body noted the contents of the report.

GB/16/61 Planning Round 2017/19 The Governing Body was informed that the purpose of this report and presentation was to provide a summary of the requirements of the Planning Round for 2017 – 19 and the key issues to be addressed by the CCG, noting that the required

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submission date means that the plan will be draft and will not be able to return to the Governing Body for final decision until after submission. KH explained that a further report will be brought to a Governing Body meeting early in 2017. Planning this year is very different to previous years because of the Five Year Forward View and the 2020 Vision. We have clear guidance that the Five Year Forward View is to continue. The Sustainability and Transformation Plan (STP) becomes the route map for how the local NHS and our partners make the Five Year Forward View a reality. We have nine must do areas:

• STP • Finance • Primary Care • Urgent and Emergency Care • Referrals and elective care • Cancer • Mental Health • Learning Disabilities • Improving quality in organisations

The STP plan is underpinned by the local plan and will be fully aligned contractually to the local plan. The first draft of the STP plan was submitted on 24th November with the final plan to be submitted by 23rd December. The CCG planning ambitions are mapped for four years. NHS England will be provided with a two year plan, but alongside this will sit a four year action plan. Governing Body will be given assurance on plans. With regard to the Better Care Fund, national guidance is awaited and the CCG will continue to work with the local authority to build on what has already been achieved. Further engagement work with Communications will begin in January 2017. KH gave assurance that the CCG will oversee this engagement work. KH explained, relating to finance, it is difficult to see where there will be flexibility but the CCG will continue to look at what can be done for year 2. Next year the CCG is accountable to control its own targets. The CCG must continue to plan to achieve the necessary surplus. A 3% QIPP target is a local requirement for next year, this is consistent with this year. Contracts need to be signed by 23rd December 2016. The CCG

KH

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continues to negotiate with our providers to achieve this. NHS England has asked to be informed if it was considered that arbitration would be needed in order to agree the CDDFT contract. The Chief Finance Officers from each of the CCGs along with the Chief Officers, are holding weekly meetings with the Director of Finance for CDDFT which enables early escalation of any issues. NHS England is receiving weekly contract trackers, which will enable them to decide if any support is needed. The Governing Body noted the briefing provided and agreed a further report comes to Governing Body early in 2017 once the final plans have been submitted.

GB/16/62 STP Public Document This item had been covered in the Chair and Chief Officers Report.

GB/16/63 Risk Management – December 2016 The Governing Body was advised that the purpose of this paper was to provide an overview of the Darlington CCG risk register as of December 2016 and provide assurance to the Governing Body. Management of risk is a continual activity, which must be performed throughout the organisation. Without on-going and effective risk management processes it is not possible to give confidence that the organisation will meet its objectives. There has been no overall change in the number of risks since the last report. One risks has been closed and one new risk identified: The following risk has been escalated to red since the last report: Risk 1529: Ambulance Performance. NEAS performance throughout Aug-15 to Oct-16 was reported below the operational standard for both 8 minute response times and 19 minute response times. Risk increased to red by the Quality, Performance and Innovation Committee in September 2016. Risk 1530: Failure to meet cancer 62 day waiting target. Darlington CCG have failed to achieve the 62 day target since September 2015. Risk increased to red by the Quality, Performance and Innovation Committee in September 2016. The following risks remain red:

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Risk 1101 –Premises Costs - CCG experiences higher than planned premises costs due to current arrangements for funding void space following the relocation of services - under current NHS England guidance the CCG is responsible for paying NHS Property Services for void space. Risk increased to red (residual rating 16) by Finance Committee in December 2014. Risk 1501- Ability to Deliver the 2016/7 Financial Plan – The CCGs QIPP plan is forecast to under deliver by £1.8m which leaves no residual reserves to mitigate additional financial pressures arising during the year. Risk increased to red (residual rating 16) by the Finance Committee in June 2016. The following risk has been reduced from red since the last report: Risk 845- A&E Handovers – The CCGs main provider continues to be a regional outlier in respect of A&E handover delays causing delay in clinical assessment and treatment of patients. The Trust has significantly reduced handover delays during 2016 and the Quality, Performance and Innovation Committee agreed to reduce the level of risk in September due to this sustained improvement in performance. The responsible committees and Governance, Audit and Risk committee continue to monitor the above risks and associated action plans closely. The Governing Body noted the content of the report and the progress made in terms of managing the risks rated as extreme.

GB/16/64 Confirmed Committee Minutes The Governing Body received minutes from its Committees • Formal Executive Committee – August, September, October

2016

• Extraordinary Formal Executive Committee – August 2016

• Quality and Performance Innovation Committee – August, September, October 2016

• Finance Committee – July, September, October 2016

• Governance, Audit and Risk Committee – July 2016

• Primary Care Commissioning Committee – June, August

2016

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• Community Council – July, September 2016

• South IFR Panel – September, October, November 2016

GB/16/65 Any Other Business No other business was discussed.

Date and time of next meeting The next Governing Body meeting will be held In Common with Hartlepool and Stockton-on-Tees CCG on Tuesday 7th February 2017 commencing at 2pm at North Shore Academy, Stockton-on-Tees.

Signed………………. Chair.…………………. Date……………………

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Action number

Date of meeting Subject Action Responsible officer

Due date Comments Date reviewed Status

GB/28/16 29/11/2016 Patient Story Mr Carter advised that Mrs Leonard, NTHFT Quality Nurse was picking up the issues raised in the story. Mr Carter added that the patient story will be passed on to the CCG Quality Team and Commissioning Team to ensure any issues are addressed.

Andrew Carter 07/02/2017 Open

1 15/09/2015 Safeguarding and Looked After Children Annual Report 2014-2015

Governing Body expressed concern at the poor achievement of initial health assessments timescales, recognising that this is a multi-agency issue which needs to be addressed by all concerned. AJ agreed that a letter be sent to the Safeguarding Board on behalf of the Governing Body to formally record the concerns raised.

Dr Andrea Jones A letter of concern had been sent to the Safeguarding Board. No reply has yet been received though it is recognised that the Board has not met again since the letter was sent.A response was still awaited and Miriam Davidson would follow this up. Initial health assessments had improved but would be a challenge to maintain the improvement and was part of the improvement plan for the board01.03.16 - Ms Davidson confirmed letter had been sent to the Head of Children’s Services and the LSCB Chair, Richard Burrows. There was some improvement but this has since declined. (See appendix)01.03.16 - Mrs Murphy explained that the area of concern has been identified. Mrs Murph is a member of the Improvement Board which is performance monitoring this. Mrs Murph to provide an update on this at the next Governing Body meeting in June.14.06.16 Mrs Murphy advised that the Improvement Board has found it difficult to obtain data in a timely way. More focus needs to be given to timelines.06.09.16 - SJ explained this is an ongoing issue for both organisations. An action plan is being taken to the Improvement Board. Further information will be made available to Governing Body in the future, but indications are that there are signs of improvement.06.12.16 - Mrs Murphy recognised this is an ongoing concern. A lot of work around the reorganisation of the Safeguarding team and the review of processes across Health and Social Care. A report is to be taken to the Improvement Board. Mrs Murph will bring to Governing Body is required. Board which is performance monitoring this. Mrs Murph to provide an update on this at the next Governing Body meeting in June.14.06.16 Mrs Murphy advised that the Improvement Board has found it difficult to obtain data in a timely way. More focus needs to be given to timelines.06.09.16 - Mrs Murphyr explained this is an ongoing issue for both organisations. An action plan is being taken to the Improvement Board. Further information will be made available to Governing Body in the future, but indications are that there are signs of improvement.06.12.16 - Mrs Murphy recognised this is an ongoing concern. A lot of work around the reorganisation of the Safeguarding team and the review of processes across Health and Social Care. A report is to be taken to the Improvement Board. DM will bring to Governing Body is required.

Open

DCCG2 Engagement Plan Update

A written report to be brought to a future Governing Body meeting

Mary Bewley Open

DCCG3 Engagement Plan Update

KH and MB to meet to discuss how the engagement plan will link with the planning round 2017/19

Karen Hawkins/ Mary Bewley

Open

DCCG4 Planning Round 2017/19

A further report to be brought to Governing Body in early 2017

Open

Darlington CCG and Hartlepool and Stockton on Tees CCG Governing Body In-Common Action Log

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 1.6

7th February 2017

Title Chief Officers Report

Purpose Approval ☐ Discussion ☐ Information ☒

Responsible CCG Member / Lead

Ali Wilson, Chief Officer

Author of Report Ali Wilson, Chief Officer

Recommendation(s) Governing Body to receive the report

Executive Summary

The report provides an update on operational priorities, challenges and key national policy developments since the last Governing Body meeting.

Clinical Engagement

Not Applicable

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Not Applicable

Has an Equality Analysis been completed?

Not Applicable

Attachments Chief Officers Report

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Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☒

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☒

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☒

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☒

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☒ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☒

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☒ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☒ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None

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NHS Darlington Clinical Commissioning Group and NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group

Chief Officers Report – February 2017

1.0 Joint Working Arrangements

Darlington Clinical Commissioning Group (CCG) and Hartlepool and Stockton-on-Tees Clinical Commissioning Group have informally been working together since May 2015. From the 1 May 2016 we took the first step to bring together a shared management arrangement by the appointment of a single Accountable Officer (known as the Chief Officer), and this has been followed by a review and redesign of the full management team.

The CCG Governing Bodies believe that this collaboration will not only support the delivery of our statutory responsibilities but in addition help to deliver the transformational challenges and aspirations for our respective communities. The collaboration is intended to create two successful and sustainable organisations through shared learning and development.

Whilst each CCG will remain a statutory organisation in its own right, we believe that greater collaboration, including a shared management arrangement, will be beneficial for the following reasons:

• Greater opportunities for addressing health inequality and health improvement given the similar population health challenges

• Changes to the planning processes that mean working across a bigger health footprint including collaboration and co-ordination with social care colleagues

• Facilitating the shared responsibility and delivery of the Sustainability and Transformation Plan including the Better Health Programme, working as a key system leader within a complex health and care system

• Potential for greater overall clinical engagement and input • Support for both clinical and managerial succession planning • Opportunity to benefit from management efficiencies at a time when

running costs are limited • Greater potential for influence locally, regionally and nationally • Opportunity to re-focus, re-energise and align the team to support both the

local and wider complex and significant transformation agenda by working at scale

• Reputational benefits for both CCGs as joint working brings shared benefits for delivery, improved performance and capacity to achieve stretching ambitions

• Strengthens our ability to manage future as well as current health care challenges

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Our new management structure has now come into place and there remains a number of positions still to fill.. As we continue to be in a transitional phase, some staff are as yet unable to take up the full responsibilities of their new roles until all staff are recruited

You will note that the structure strengthens functions at a Director level, sharing their specific skills and expertise across both organisations. It was also very important to our Governing Bodies that we strengthened our locality focus given the importance of engagement with our member practices and local authorities and their critical reach into local communities. We have therefore appointed locality commissioning leads to complement Locality GP leaders and Nursing and Quality Directors.

We have recently been working on refreshing our organisational values which are focused on how we work effectively together to deliver the best possible care for patients in collaboration with our key stakeholders. We will bring these back to the Governing Bodies for approval once fully developed.

2.0 Sustainability and Transformation Plan (STP)

As reported previously, the Better Health Programme arrangements are now transitioning into the STP programme; the STP will be the main planning vehicle for the next 5 years for delivering the NHS 5 year Forward View, working across 44 geographic areas (footprints). The STPs are not an entity in themselves and are about organisations collaborating on a shared strategy for their populations across health and social care. The STP acts as an ‘umbrella’ plan including specific plans for key challenges across Darlington, Durham and Tees such as:

• Improving cancer diagnosis • Mental health • Transforming urgent and emergency care services • Providing more care outside hospital • Prevention

The STP does not replace existing local plans to improve services but should build on existing engagement through Health and Wellbeing Boards and other existing local arrangements. In February the BHP Team will be seeking patient views on maternity and children’s services across Durham, Darlington, Tees.. In addition, smaller

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targeted focus groups will be held along with 1-1 conversations with a minimum of 1,000 people.

This will form Phase 5 of the public engagement events to engage with the public and stakeholders. Within the Darlington CCG area, there is one event being held tomorrow (February 8th). Within the HaST area two events have been held one yesterday on 6th February at Hartlepool College of Further Education and one on 2nd February at South Thornaby Community and Resource Centre.

3.0 CCG 360 stakeholder survey 2016-17

The CCG 360 stakeholder survey 2017 is currently being conducted by Ipsos MORI on behalf of NHS England and will last from 16 January to 24 February 2017, due to CCGs requesting the survey be conducted earlier. The survey provides valuable feedback for CCGs to learn from examples of successful engagement. It also focuses on key areas for improvement in stakeholder relationships and enables an understanding of how views may have changed over time. The CCGs have encouraged those stakeholders they have invited to participate to complete the survey.

4.0 Integrated Urgent Care Service 4.1 Darlington

One of the main priorities in the urgent and emergency care strategy for Darlington Clinical Commissioning Group is the integration between emergency and urgent care services, particularly within the A&E department within Darlington Memorial Hospital. the planned move of the daytime activity in the Urgent Care Centre from Dr Piper House to Darlington Memorial Hospital took place on December 14th 2016. Early indications are that the move has impacted in a positive way to improve performance and the streaming of patients on arrival, to be seen by the most appropriate clinician. Alison MacNaugton-Jones remains the clinical lead for this area of work and we have been fortunate to secure additional clinical support and advice from Dr Caroline Gibson. Caroline is a GP at Clifton Court Surgery and also works in the Urgent Care Centre in Darlington so has valuable clinical experience to help inform our further plans to improve urgent care services for patients including proposals for the development of community hubs.

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4.2 Hartlepool and Stockton-on-Tees The CCG is currently procuring a GP led service provision for Integrated Urgent Care which will provide services 24 hours a day, seven days a week, 365 days a year including bank holidays and public holidays to deliver a timely, highly responsive, joined up care that encompasses what was traditionally referred to as minor injury, urgent primary care walk-in provision and GP out of hours provision. The Governing Body at their meeting on 15th November 2016 agreed a preferred bidder for the service. The service will provide assessment, diagnosis and treatment for service users who present with an urgent care issue and enhanced out of hours elements of care such as Home Visiting and Prison visiting as part of the integrated model. The Integrated Urgent Care Service will be accessible and central to the population they are serving, prioritising and navigating patients to the right care at the right time. Supporting self–care, changing culture and behaviour the service will be safe and sustainable, enabling system resilience and improved patient experience. Located at the NorthTees Hospital site and the Hartlepool hospital site the service will be in place by April 2017.

5.0 Planning 2017/19

The revised NHS Operational Planning and Contracting guidance 2017-19 was published on the 22nd September, three months earlier than the previous planning timetable. The guidance clearly described the requirements of CCGs, in terms of the key actions, improvement and commitments for the next two years and required the CCG to submit a draft Operational Plans to NHS England by 23 December outlining how we will respond to these requirements. Formal feedback is awaited from NHS England and once this has been received and the draft plan further reviewed by the Executive, the full Plan will be presented to the March Governing Body. There is an expectation that further detail will eb required setting out the quarterly milestones for delivery. A significant amount of work had been undertaken with our providers to ensure contracts were developed to meet the requirements of the revised NHS Operational Planning and Contracting guidance 2017-19. Agreement and signature of the contracts were secured before the deadline of 23rd December.

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6.0 Assisted Reproduction Unit

Following North Tees and Hartlepool NHS Foundation Trust advising that they could no longer deliver a safe and clinically effective assisted reproduction service (IVF, IUI) at University Hospital of Hartlepool, NHS Hartlepool and Stockton-on-Tees CCG, along with NHS Durham Dales, Easington and Sedgefield CCG, NHS Darlington CCG and NHS South Tees CCG undertook a formal public consultation between 31st May and 15th July 2016.

The findings of the consultation were received by the HaST CCG Governing Body on 22nd July 2016. Governing Body convened on 26th July 2016 and agreed to progress the recommended option which was option 1; to procure a comprehensive assisted reproductive service including HFEA (Human Fertilisation and Embryology Authority) licensed and unlicensed provision at Hartlepool delivered by an alternative provider.

The risk of this option (highlighted in the consultation document) was that the CCG may be unable to secure and commission an alternative provider to deliver a full service from the University Hospital of Hartlepool site.

Unfortunately, due to a limited response from the provider market and the bids received not meeting the required quality standards, we have not been successful in securing a provider that can offer both licensed and unlicensed fertility services at Hartlepool.

The priority of the CCGs is to ensure that patients can continue to have as much of their care delivered locally at the Hartlepool site and on this basis we are working closely with existing NHS commissioned providers in the region to deliver unlicensed services at the Hartlepool site. We are disappointed that we have not been able to secure a provider but as commissioners our priority is to ensure any service we commission is safe, clinically effective and of the highest quality. Although patients told us during the consultation that they would be prepared to travel for fertility treatment we do know that this will be difficult for some and we will work with providers to minimise the impact of these changes as much as possible.

North Tees and Hartlepool Foundation Trust will be contacting all patients who have embryos in storage at their site to ask them to choose which HfEA licenced provider in the region they would like their embryos to transfer to for continued storage and any subsequent treatments.

Hartlepool Borough Council have requested attendance from the CCG at a meeting of the Audit and Governance Committee on 8th February 2017 to discuss the issues surrounding the Assisted Reproduction Service and the Chief Officer and Director of Commissioning and Transformation will be in attendance to present the requested information.

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7.0 Medical Interoperability Gateway (MIG)

All 11 GP practices in Darlington have signed up for the MIG and for 111 direct access to appointments with the training delivered to support implementation. This puts Darlington in a good position for the roll out of the Great North Care Record where an expanded version of the patient record will be accessible across all parts of the health system including hospital, community and primary care services. In HaST, all bar one practice has signed up for the MIG, and discussions remaining ongoing with this practice regarding their concerns. Discussions have also been undertaken with social care to establish what access they may require to the information accessed via the MiG. Rollout of a communication programme has now commenced in order to make patients and the public aware of the MiG, including the distribution of 2 posters and 250 leaflets to each GP practice.

8.0 Integrated Personal Commissioning (IPC)

Over 60 professionals from the NHS, local authority and voluntary sector gathered at the Destiny Centre, Norton on 23rd and 24th January to take part in the launch of the NESTA 100 day challenge. The Stockton-On-Tees IPC site has been approached by NESTA (Health Innovations Lab), a voluntary organisation which helps people and organisations bring their ideas to life. NESTA have been commissioned through NHS England to work with two IPC sites over the next six months. They are undertaking a 100 day challenge, where they will work very intensively with the Stockton site on frontline workforce development. Attendees came from across the Tees Valley and were specifically selected to attend by NESTA, for their expertise and experience in particular areas. Before the two-day launch event, NESTA divided the attendees into three teams, Stockton Town Centre community, Norton and Billingham community and the University Hospital of North Tees. Over the two days, the teams collaborated, shared and identified priorities and goals relating to their own specialisms. They will now continue to collaborate throughout the challenge. A series of review events will take place, where the teams will re-assemble to check progress on their end goals. The challenge concludes in the middle of May.

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9.0 National Developments 9.1 Allied Health Professions join forces to help shape future healthcare

‘Allied Health Professions into Action‘ has bought together the views of the third largest workforce in the health and care system, including chiropodists, dieticians, orthoptists, paramedics, physiotherapists, art therapists and speech and language therapists. It sets out how the 12 Allied Health Professional groups across England can be at the forefront of innovative changes to patient care and shape future health policy by having a full involvement in transformation plans being developed across the country. The new guidance aims to provide a blueprint for Clinical Commissioning Groups, provider organisations, health leaders and local authorities to fully utilise and involve Allied Health Professionals (AHPs) in transformation programmes and the delivery of NHS England’s Five Year Forward View. It offers 53 examples of AHPs working to drive and support change by working innovatively, and a framework to help utilise AHPs in the development and delivery of transformation planning. ‘Allied Health Professions into Action‘ has taken a collaborative approach in its development by inviting AHPs and the wider health, social and care workforce, including patients and the general public, to contribute via an online platform using crowdsourcing as a method to air their views and then vote on them. More than 16,000+ individual contributions from 2,000 people were put forward in this way.

9.2 New National Clinical Director for Learning Disabilities for NHS England

Dr Jean O’Hara has been appointed as the new National Clinical Director for Learning Disabilities for NHS England. Jean qualified in medicine in 1983 and in psychiatry in 1988. She took up her first consultant role in learning disabilities in 1992 and is currently clinical director and a consultant psychiatrist at the Maudsley NHS Foundation Trust, South London, and King's Health Partners Academic Health Sciences Centre.

9.3 Refreshing Transforming Participation in Health and Care - guidance for CCGs

NHS England is in the process of refreshing Transforming Participation in Health and Care, its statutory guidance for CCGs on involving patients and carers in decisions relating to their care. The new guidance will cover how CCGs can meet their legal duty to involve the public in commissioning and their duty to promote the involvement of each patient in their own care.

NHS England are planning to produce two sets of guidance to outline CCGs’ legal duties – the duty to make arrangements for public involvement in commissioning and the duty to promote the involvement of each patient in their own care. The guidance will show how CCGs can best meet their legal

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duties in practice and also highlight the importance of patients and the public in transforming services – how we can work together to reduce health inequalities, improve quality and outcomes, and make services more sustainable.

Ali Wilson Chief Officer 31st January 2017

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.1.1

7th February 2017

Title Darlington CCG Finance Report - Month December 2016

Purpose Approval ☐ Discussion ☒ Information ☒

Responsible CCG Member / Lead

Mr Graeme Niven , Chief Finance Officer

Author of Report Mrs Anthea Thompson , Senior Finance Manager, NECs

Recommendation(s) 1.1 . The Governing Body is requested to;

• Consider the reported financial performance • Note the financial forecast for 2016/17 as at 31

December 2016. • Note the reported financial risks and mitigating actions

being taken to ensure delivery of the CCGs statutory financial duties.

• Note the current performance and remedial actions against the CCG key performance indicators

Executive Summary

In summary the CCG is on track to deliver its key performance indicators. Risks have materialised in year in particular in Acute and prescribing which have been offset by the use of some planned mitigations. If further risks (worst case) do materialise in year then there is the chance that the control surplus may not be delivered. The delivery of QIPP is therefore very important to maintaining financial balance.

Clinical Engagement

Please outline clinical engagement undertaken and if none, reasons why

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Risk of not delivering our financial indicators.

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Has an Equality Analysis been completed?

none

Attachments Finance Report

Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☒

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☐

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☐ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☐ 44 of 570

7. Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None

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Darlington CCG Finance Report for the nine months

ended 31st December 2016

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£1,330k (Favourable)

£1,771k (Favourable)

£0k £0k

£127,825k £162,377k

£0k £0k

98.68%

99.85%

97.67%

98.90%

YTD Forecast

Executive Summary Commissioning spend The CCG is reporting a YTD surplus of £1,330k and forecast surplus of £1,771k. This is in line with the plan submitted to NHS England. Running Costs The CCG is reporting a breakeven YTD forecast outturn position. Cash The forecast cash drawdown is in line with the cash limit for the year.

Quality Innovation Productivity Prevention (QIPP) Forecast QIPP efficiencies of £2,685k against a plan of £4,948k.

Capital There is £10k of capital included in the plan submitted to NHS England for IT equipment, as yet there has been no business case submitted. Better Payment Practice Code (BPPC) 95% of invoices to be paid in 30 days The CCG is exceeding the 95% target for NHS and Non NHS invoices.

Invoices Value

Non NHS

NHS 1

£2,086k £2,685k

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Overview

This report provides an update on the financial performance of NHS Darlington CCG for the nine months to 31st December 2016 as well as the expected outturn position for the 2016/17 financial year. This includes performance against those primary care budgets for which delegated responsibility was awarded to the CCG from 1 April 2016.

The CCG’s financial position is under continual review and the current position shows the organisation to be on track to achieve its key financial targets, although there are significant potential financial risks to be managed, particularly in relation to increasing secondary care acute activity and QIPP.

It should be noted that although this report covers nine months of the year, there is still only seven months actual data available for the majority of commissioned services expenditure on which to base the forecast outturn position, with continued issues around the level of un-coded data on certain acute contracts causing difficulties in forecasting accurately. The key areas are Acute overspend of £669k, Mental Health overspend of £388k and CHC underspend of £1,106k which is currently awaiting reconciliation with the council. The report highlights the risk of £600k Acute non-delivery of QIPP, £200k prescribing non-delivery of QIPP and a risk of breaching the CCGs running costs total linked to the restructure costs.

The current position shows a total year to date underspend of £1,330k on a funding allocation of £164,161k. The CCG received an allocation of £12k relating to Prime Minister's Challenge Fund and £211k Quality Premium Award 2015-16 during December 2016.

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Summary of Financial Position 31st December 2016

3

Darlington CCG Revenue Expenditure 2016-17 YTD Budget YTD Actual

YTD Variance (Under)/

Overspend 2016-17 Budget Forecast Outturn

Forecast Variance (Under)/

Overspend

Worst Case Variance (Under)/

Overspend£000's £000's £000's £000's £000's £000's £000's

Programme Services

Acute Services 56,205 56,770 565 75,124 75,792 669 2,790Mental Health Services 12,484 12,519 35 16,646 17,034 388 883Community Health Services 11,373 11,745 372 15,164 15,566 402 501Continuing Care Services 9,471 8,593 (878) 12,508 11,402 (1,106) (648)Prescribing and Primary Care Services 14,029 14,667 638 18,706 19,212 506 1,110Other 3,323 3,531 209 4,430 4,771 341 354Co-Commissioning 10,331 10,301 (30) 13,775 13,748 (27) 0

Total Programme Services 117,216 118,126 910 156,353 157,526 1,173 4,990

RUNNING COSTS 1,697 1,697 (0) 2,290 2,290 0 247

RESERVES 2,240 0 (2,240) 5,518 2,574 (2,944) (2,588)

CCG Net Expenditure 121,153 119,823 (1,330) 164,161 162,390 (1,771) 2,649

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Reserves £1,173k of reserves have been consumed by overspends in the programme position.

Budget Actuals Variance Budget Forecast Variance£000 £000 £000 £000 £000 £000

Control surplus 1,328 -1,328 1,771 -1,771Allocations - GP Development Programme / other 0 17 17 0

Total protected reserves 1,328 0 -1,328 1,788 17 -1,771

0.5% Contingency 645 -645 817 -817

1% Non recurrent headroom (bal) 0 1,592 1,592 0

Planned reserves held as risk cover 267 -267 356 -356

Local Investments 0 965 965 0

Total reserves held as risk cover 912 0 -912 3,730 2,557 -1,173

Reserves total 2,240 0 -2,240 5,518 2,574 -2,944

Reserves YTD Annual

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Financial Risks & Mitigation - current

OVERSPEND (+) UNDERSPEND (-) FORECAST (£000) WORST CASE (£000)

Acute Services 669 2,790

Mental Health Services 388 883

Community Health Services 402 501

Continuing Care Services -1,106 -648

Prescribing and Primary Care Services 506 1,110

Other 341 354

Co-Commissioning -27 0

Running Costs 0 247

TOTAL 1,173 5,237

MITIGATION - USED

General reserve 0.5% - contingency -817 -817

Non recurrent drawdown

Risk Reserves -356 -356

Local Reserve -708

Shortfall – would risk control surplus failure

-3,356

TOTAL -1,173 -5,237

MITIGATIONS - REMAINING

General reserve 0.5% 0 0

Local Reserve -708 0

1% non recurrent - must remain set aside NHS E

-1,592 -1,592

TOTAL -2,300 -1,592

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Acute Services

4

Acute services is currently showing a year to date and forecast outturn overspend of £565k and £669k respectively. The month 9 position has been based on 6 months fixed and 1 month flex data which is subject to change. There is still a high level of un-coded data within the NHS contract positions and work is ongoing with the providers to resolve these issues and therefore, a risk to the reported position. County Durham and Darlington FT is showing a forecast outturn over-spend of £1,706k, this has been reduced to £606k and assumes achievement of £1,100k QIPP savings by the end of the financial year. Main areas of pressure are A&E, Critical Care, Outpatients and Direct Access. The favourable movement from month 8 relates to a reduction in elective, non-elective activity, outpatients, excess bed days and drugs and devices. There remains a high level of un-coded activity within this providers data (c.35%). South Tees Hospitals NHS FT is showing a forecast overspend of £163k and includes pressures within non-elective, outpatients, excess bed days and critical care. Newcastle NHS FT is showing a forecast underspend of £152k mainly due to ITU/critical care underspend offset by a high level of non elective activity. Non NHS Acute mainly comprises BMI Woodlands Hospital with an annual budget of £4,921k. The budget shows a significant increase in funding to this provider and reflects the increasing activity experienced in 2015/16. Daycases are lower than plan offset by a higher level of activity for electives leaving a forecast underspend of £143k. BPAS invoices to date have been 100% higher than plan and is currently forecasting a pressure of 19k. Urgent Emergency Care Vanguard relates to payments to GP Practices for 111 Bookings.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

County Durham and Darlington FT 42,546 43,023 477 56,861 57,467 606 2,161South Tees Hospitals NHS FT 4,296 4,454 158 5,736 5,899 163 253Newcastle Hospitals NHS FT 1,442 1,326 (116) 1,922 1,770 (152) 0North Tees and Hartlepool NHS FT 673 682 9 899 910 11 55NHS Acute NCA 946 970 24 1,262 1,294 32 152Non NHS Acute 3,888 3,789 (100) 5,226 5,096 (130) 22NEAS 2,156 2,199 44 2,874 2,933 59 66NHS Networks 9 9 0 12 12 0 0Winter Resilience 249 249 0 332 332 0 0Urgent Emergency Care Vanguard 0 70 70 0 80 80 80

Total Acute Services 56,205 56,770 565 75,124 75,792 669 2,790

YTD Annual

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Mental Health Services

5

Tees, Esk and Wear Valley NHS Foundation Trust (TEWV) - the forecast overspend of £382k relates to the Acute Liaison and Care Home Liaison services which were originally funded as part of the BCF. Northumberland, Tyne and Wear NHS Foundation Trust (NTW) – the forecast overspend of £100k is based on the activity report for month 7 which continues to show a pressure in Aldervale and in the low volume, high cost Affective Disorder – Inpatient service. Higher activity in this service is also being seen in other CCGs and is being investigated. Pressures are offset by savings relating to Gainsborough Adult Acute Assessment ward. There has been no change in the overall position since month 6 and early sight of finance and activity data indicates a similar position in month 8. Independent / Voluntary Sector – the forecast underspend has increased by £10k which is due to an updated forecast on S12 Mental Health Act Assessment claims which are variable in nature.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

TEWV 10,026 10,050 24 13,368 13,750 382 382NTW 228 309 81 304 404 100 150Other NHS 29 21 (7) 38 31 (7) 0Independent / Voluntary Sector 2,190 2,131 (59) 2,920 2,839 (81) (74)Mental Health Services - Winter Resilience 4 0 (4) 5 0 (5) (5)Local Authority Agreements 8 8 0 10 10 0 430Total Mental Health 12,484 12,519 35 16,646 17,034 388 883

YTD Annual

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Community Health Services

6

The forecast over-spend on NHS Contracts of £349k mainly relates to County Durham and Darlington NHS FT and is based on 6 months fixed and 1 month flex data for Urgent Care over performance of £94k, £195k Continence and Orthotics, £23k for Podiatry and £26k for AQP Audiology, these are currently being challenged with the trust. There is a forecast of £10k for community diabetes at Newcastle Hospitals NHS FT. The main Hospice contract with St Theresa’s has been agreed as a block and is reflected in the reported budget above. The £2k overspend relates to Teesside Hospice where adhoc charges have been received for the period to date. Other Community contracts have been agreed for all community providers and are reflected in the reported budgets above. For the month 9 forecast, the majority of contracts have been based on an average of year to date actuals received to month 8 and where activity has not been received to date they have been assumed to perform in line with plan. The forecast overspend relates to increased activity for Specsavers audiology of £47k.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

NHS Contracts 9,310 9,594 283 12,414 12,762 349 381Hospice 565 566 1 753 755 2 2Other Community 1,498 1,585 87 1,997 2,049 51 117

Total Community Health Services 11,373 11,745 372 15,164 15,566 402 500

YTD Annual

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Continuing Care Services

7

The £1,106k forecast underspend is largely due to CHC Joint packages with Darlington Borough Council. The Q1 reconciliation has still not taken place, however, package data has now been received from DBC and is to be reviewed in January which will allow additional validation to take place. The annual budget was set as per guidance within the Demand Plan. The adverse movement within the month of £233k is largely due to three high cost package notified in December and backdated from 1st April 2016. The cost impact of these packages is £122k. Future growth has been included within the forecast at a value of £64k. The change in packages in month 9 for each Benchmarking category are shown below:- • CHC Fast Track - New 11, Increase 3, Change of Provider 3, End 10 • Joint Packages - New 2, Increase 2, End 2 • Section 117 – New 2, Increase 3, Change of Provider 6, End 1 • Continuing Health Care – New 11, Increase 5, Decrease 1, Change of Provider 8, End 2 • Funded Nursing Care – New 6, Increase 1, Change of Provider 20 End 4 • PHB – End 1

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

National risk pool contribution - CHC restitution cases 359 359 0 359 359 0 0CHC - Management costs 153 153 0 205 205 0 0CHC Fast Track 375 373 (2) 500 497 (3) 0Continuing Care - Joint Packages 2,068 1,120 (948) 2,758 1,493 (1,264) (978)Continuing Care - Section 117 1,238 1,236 (2) 1,650 1,647 (3) 37Continuing Health Care 4,160 4,134 (26) 5,547 5,576 29 91Personal Health Budget 0 75 75 0 99 99 105Funded Nursing Care 544 662 118 726 883 157 187Children 573 481 (92) 764 642 (122) (90)Total Continuing Care Services 9,471 8,593 (878) 12,508 11,402 (1,106) (648)

YTD Annual

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Prescribing and Primary Care Services

8

Prescribing – forecast information has been received from the Prescription Pricing Division (PPD) and is used to inform the forecast overspend shown above. Historically there has been significant volatility in prescribing forecasts, hence the forecast should be treated with a degree of caution. Cat M savings of £133k and assumed QIPP achievement of £200k are also reflected in the forecast above. Enhanced Services (minor ailments scheme) has been forecast to underspend based on 7 months actual data received. Commissioning Schemes forecast overspend of £81k relates to care home beds. Other Primary Care mainly relates to the Oxygen contract and GPIT. To date 7 months actual data has been received for oxygen and the forecast outturn overspend assumed based on this data is £101k. The forecast overspend also includes £10k relating to the messaging service used by GP practices and £20k relating to Care Home computer scheme.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

Prescribing 13,404 13,896 493 17,872 18,186 314 885Enhanced Services 76 57 (18) 101 80 (21) 0Commissioning Schemes 102 162 61 136 217 81 81Other Primary Care 448 551 103 597 728 131 144Total Other 14,029 14,667 638 18,706 19,212 506 1,110

YTD Annual

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Primary Care Co-Commissioning

9

For December, both YTD and forecast outturn are showing a small underspend. Below is an overview of expenditure included within primary care delegated budgets:-

GMS budget includes 0.5% growth. No increases have been paid to date and is based on Quarter 1 Global Sum payments. The slight change in forecast is due to the Q2 list size.

PMS is a local contract and payments are made in line with the Statement of Financial Entitlement. The slight change in forecast is due to the Q2 list size.

QOF overspend YTD and forecast based on 15/16 achievement.

Enhanced Services : Extended hours is forecast to underspend based on Quarter 1. This is offset by overspend on Minor Surgery which is based on Quarter 1 actual data plus 3 quarters 2015-16.

Premises costs relate to rent, rates and water and are based on Quarter 1 payments.

Other GP services underspend relates to seniority based on Quarter 1 spend.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

General Practice - GMS 6,992 6,911 (81) 9,310 9,216 (94) 0General Practice - PMS 288 299 11 383 400 17 0QOF 1,158 1,230 72 1,544 1,630 86 0Enhanced services 671 669 (1) 909 909 0 0Premises cost reimbursements 818 814 (4) 1,091 1,087 (4) 0Dispensing/Prescribing Drs 136 136 0 182 182 (0) 0Other GP Services 267 240 (27) 356 324 (32) 0Total Co - Commissioning 10,331 10,301 (30) 13,775 13,749 (27) 0

YTD Annual

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Other

10

Patient Transport Services is showing a £46k forecast overspend. This relates to the unfunded ERS contract partially offset by the EMS contract transferred to NEAS in November. Programme Projects relates to the Regional Backpain project and Salaried GPs . The variance both year to date and forecast outturn is mainly down to Cruse Bereavement Support £12k, GP Payments and adhoc expenditure including Carmel GP Practice. Reablement relates to the Better Care Fund which is an agreed joint funded pooled arrangement with Darlington Borough Council. The overspend relates to a shortfall in planned baseline budget. NHS Property Services has been assumed as plan at month 9. Work is ongoing with NHSPS to identify and validate 2016/17 charges for void space.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

Patient Transport Services 452 464 11 603 648 46 56Programme Projects 120 168 48 160 220 60 62NHS 111 235 235 0 314 314 0 0Exceptions & Prior Approvals 42 32 (10) 56 56 0 0Safeguarding 45 43 (2) 60 58 (1) 0Practice Nurse Link 24 27 3 33 37 4 4Reablement 2,185 2,359 174 2,914 3,146 232 232Other - NHS Property Services 219 203 (16) 292 292 0 0Total Other 3,322 3,531 209 4,430 4,771 341 354

YTD Annual

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Running Costs

11

Pay is currently overspending due to redundancy costs paid as a consequence of a restructure within the CCG. Non Pay (CSU) is the cost of commissioning support services from NECS and is forecast to underspend by £43k. Non Pay (Other ) includes, accommodation, audit fees and other corporate costs, this is being managed along with reserves to ensure the running costs position comes in as planned. The CCG is currently showing a breakeven year to date and forecast position against a total running cost allocation of £2,290k, however, from 1st January, a Joint Management Structure with HAST CCG has been implemented. There is a potential risk of further restructure costs following this.

Budget Actuals Variance Budget Forecast Variance Worst£000 £000 £000 £000 £000 £000 £000

Pay 351 519 167 469 621 153 247Non Pay (CSU) 939 838 (101) 1,252 1,209 (43) 0Non Pay (Other) 407 341 (66) 570 460 (110) 0Total Running Costs 1,697 1,697 (0) 2,290 2,290 0 247

YTD Annual

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Statement of Financial Position

11

Below is the Statement of Financial Position as at 31st December 2016.

Dec-16 Nov-16 Movement£000's £000's £000's

Non Current Assets Property, plant and equipment 0 0 0Intangible Assets 0 0 0Other Financial Assets 0 0 0

Total Non Current Assets 0 0 0

Current Assets Trade and other Receivables 38 38 0Prepayments & Accrued Income 10,214 5,954 4,260Cash and cash equivalents 213 243 -30

Total Current Assets 10,465 6,235 4,230

Total Assets 10,465 6,235 4,230

Current Liabilities Trade and other payables -3,141 -2,365 -776 Accruals -7,873 -6,231 -1,642 Other liabilities 0 0 0Provisions 0 0 0Borrowings 0 0 0

Total Current Liabilities -11,014 -8,596 -2,418

Non-Current Assets plus/less Net Current Assets/Liabilities -549 -2,361 1,812

Non-Current liabilities Other liabilities 0 0 0Provisions 0 0 0Borrowings 0 0 0

Total Non-Current Liabilities 0 0 0

TOTAL ASSETS EMPLOYED -549 -2,361 1,812

Financed by Taxpayers Equity

Capital & Reserves General Fund -549 -2,361 1,812Revaluation Reserve 0 0 0Other reserves 0 0 0

TOTAL TAXPAYERS EQUITY -549 -2,361 1,812

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QIPP

12

The table below summarises the forecast savings by key programme area as at 31st December 2016, compared to the QIPP plan for the year:

Project Rag Status Indicators

PlanRisk Adjusted Forecast Variance Upside Forecast Downside Forecast

Financial Recovery Plan Forecast

Green 1,229£ 1,546£ 317£ 1,554£ 1,396£ 1,675£ N/A -£ -£ -£ -£ -£ 66£ Amber 600£ -£ 600-£ -£ -£ 62£ Green 150£ -£ 150-£ -£ -£ -£ Red 400£ 357£ 43-£ 392£ 321£ 300£ Green 250£ 407£ 157£ 471£ 190£ 407£

Frail Elderly and Discharge Amber 1,176£ 376£ 800-£ 413£ 339£ 636£ N/A 1,143£ -£ 1,143-£ -£ -£ -£ N/A 4,948£ 2,685£ 2,263-£ 2,830£ 2,246£ 3,145£

Pipeline Projects

Scheme Total

Productivity and Efficiency

T&O & MSK

Ophthalmology

Respiratory

Primary Care Demand Management

Medicines Optimisation

Project Name Project RAG

2016/17 QIPP ProgrammeProject RAG Dashboard

Darlington CCG

Project on track

Missed milestone unlikely to have material impact/savings within 75% of target/concern

raised

Missed milestone with a material impact/an issue/savings less than 75% of target

Data not available and or not applicable

Forecast £000s

All Schemes

Apr May June July Aug Sep Oct Nov Dec Jan Feb MarMonthly savings £158 £177 £170 £296 £72 £308 £304 £332 £269 £108 £300 £192Financial Recovery Plan £250 £250 £250 £250 £250 £252 £255 £258 £258 £291 £291 £291

£-

£50

£100

£150

£200

£250

£300

£350

£000

s

Monthly savings Profile

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Better Payment Practice Code (BPPC) – cumulative to 31st December 2016

Note: Credit notes, CHC and Non Contracted Activity invoices have been adjusted from the above figures. A delay in the approval of Property Services 15/16 invoices resulted in the CCG missing the Non NHS Trade by value target.

13

The BPPC (Better Payment Practice Code) requires NHS organisations to pay all invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

Better Payment Practice Code - 30 Days NUMBER £000's

Non-NHSTotal Non-NHS Trade Invoices Paid in the Year 5,766 31,581Total Non-NHS Trade Invoices Paid Within 30 Day Target 5,690 30,844Percentage of Non-NHS Trade Invoices Paid Within 30 Day Target 98.68% 97.67%

NHS Total NHS Trade Invoices Paid in the Year 1274 83,611Total NHS Trade Invoices Paid Within 30 Day Target 1260 83,485Percentage of NHS Trade Invoices Paid Within 30 Day Target 98.90% 99.85%

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.1.2

7 February 2017

Title Performance Report Darlington CCG January 2017

Purpose Approval ☐ Discussion ☒ Information ☒

Responsible CCG Member / Lead

Lisa Tempest

Author of Report Lisa Tempest

Recommendation(s) The Governing Body is asked to:

Receive and consider the report

Executive Summary

This report is to inform the Governing Body of the CCG’s performance in respect of NHS Constitutional Standards and the Quality Premium using the most up to date performance information for each indicator. NHS Constitutional Standards On a year to date basis Darlington CCG is currently achieving the following constitutional standards:

• Referral to Treatment within 18 weeks • No mixed sex accommodation breaches • % of people followed up within 7 days of discharge from

inpatient psychiatric care • No patients to wait for over 52 weeks for treatment • Patients waiting for diagnostic tests should not wait more

than 6 weeks from referral • Ambulance category A response times (8 minutes) • Improving Access to Psychological Therapies (IAPT) –

proportion of people entering therapies and moving to recovery:

• Incidence of C-Diff The below standards are currently not being achieved:

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Percentage of patients seen within 2 weeks of an urgent GP referral for suspected cancer: Following 3 months of non-compliance, Darlington CCG achieved the 2ww urgent GP referral target in Nov-16 reporting 95.0% performance. Out of 278 referrals, 264 patients were seen within 14 days upon receipt of referral. 11 out of the 14 breaches were due to patient choice. Unfortunately due to poor performance in previous months the YTD position is still under target Percentage of patients seen within 2 weeks of an urgent referral for breast symptoms: Darlington CCG has failed to achieve the standard during 2016/17, reporting 89.7% achievement against a target of 93%. Breaches were cited as relating to patient choice and capacity issues due to the closure of services at Sunderland. This service was reinstated in September and performance has improved since October however achievement of the standard for the year is still at risk. A regional review of breast services has commenced with recommendations will to be reported to the Northern GGC Forum in February 2017for consideration and implementation.

• At least 85% of patients should be treated within 62 days of an urgent GP referral for suspected cancer: Darlington CCG has failed to achieve the 62 day urgent GP standard for the 8th consecutive month in November 2016, reporting a declining position of 69.4% against a target of 85.0% in month, which in turn has caused a decreasing YTD position of 74.0%. In November 2016, 11 treatments out of 36 were not carried out within 62 days of the receipt of referral. Breaches occurred in the following treatment modalities: drug treatments, surgical treatments, radiotherapy treatments and palliative treatments. Delay reasons were cited as complex diagnostic pathways, capacity issues and medical reason. The draft Service Development and Improvement Plan for 2017/8 focuses on key areas where improvement is required, supported by the CDDFT Cancer Operations Group.

• Less than 95% pf patients should spend more than 4 hours in an A&E or minor injury unit: County Durham and Darlington NHS Foundation Trust were non- compliant in November reporting 91.82%. Unvalidated data provided by CDDFT indicates further non-compliance in December 89.53%. This is below the Monitor trajectory and also the national 95% standard. Under achievement reported in 5 out of 9 months has negatively impacted on current YTD position standing at 94.1% to Nov-16. CDDFT have continued to experience pressures within A&E, with increased attendances reported across both 64 of 570

sites. In Apr-Dec 2016, A&E attendances grew by 2.1% compared to the same period in 2015 (0.8% at DMH and 3.3% at UHND). In December, attendances fell by 1.7% with across both sites and performance was 89.53% (86.52% at DMH and 70.26% at UHND) which equates to 76 breaches per day. CDDFT have identified a number of initiatives which are being implemented as part of the Trusts Transforming Emergency Care Plan to assist delivery and sustainability of the 4 hour standard. CDDFT continue to prioritise work on improving & sustaining compliance of the 4 hour standard and the CD&D A&E Delivery Board are supportive of this

• Handover between ambulance and A&E should not

exceed 30 minutes: The pressures experienced throughout A&E have resulted in an increase in handover delays being reported especially on the UHND site which broke the zero tolerance policy by putting ambulance diverts in place. In December. Both sites experienced growth in ambulance arrivals compared to December 2015 (3.7% at DMH and 3.4% at UHND). In December, 20 patients at UHND and 1 at DMH waited >120 minutes, root cause analyses were undertaken for each of these delays. NEAS experienced delays totalling 421 hours at UHND and 92 hours at DMH during the period w/ending 4th Dec to w/ending 1st January. Of the 458 over 30 minute handovers in December, 92 were attributed to Darlington Memorial Hospital and 366 attributable to UHND The Transforming Emergency Care (TEC) Plan implemented within CDDFT is expected to have a positive impact on performance against the 4 hour A&E operational standard and Ambulance handover & Ambulance diverts.

• Ambulance category A response times (19 minutes): NEAS performance remains below target in 2016/17, although performance for Darlington improved for both the 8min indicator (72.6%) and 19 min indictor (83.3%) in November 2016. Actions targeting demand, capacity and efficiency have been identified however improvement is not expected to be seen until later in 2016/7.

• Incidence of MRSA:

The CCG had two confirmed cases of MRSA, one in June and the second in October 2016. All breaches are discussed at monthly Clinical Quality Review Group meetings. The post infection review process has been followed for all identified cases with relevant lessons learnt identified and actions implemented as appropriate

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An overview of Darlington CCG performance in respect of NHS Constitution Standards is included in Appendix 1. Quality Premium An overview of the CCGs performance in respect of local and national Quality Premium indicators is included in the performance report. Data for a number of indicators will not be available until 2017 however YTD performance in relation to A&E, Cancer and Ambulance standards during 2016/7 indicates that the premium will be reduced by 75%. The CCG has written to practices not achieving the 80% e-referrals target which is a national indicator to request that all efforts are made to increased e-referrals where appropriate. This report was presented to the Quality, Finance and Performance Committee on 31st January 2017.

Clinical Engagement

There is clinical representation at the Quality, Finance and Performance Committee

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Has an Equality Analysis been completed?

Attachments Appendix 1 – Performance Report January 2017

Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☒

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Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☒

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☐ Other Committees/Meetings where this report has been presented Please

specify Does this need to be reported to another Committee/Meeting? Please

specify

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Performance Report

January 2017

Authors: Andrew Rowlands & Victoria Phelps

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Darlington CCG - NHS Constitution Performance Summary Latest Reporting Data

PeriodOperational

Standard National Average Exception Report

Referral to treatment access times

% patients waiting for initial treatment on incomplete pathways within 18 weeks 92.0% 89.2% 93.4% 93.4% 92.0% 92.5%Number patients waiting more than 52 weeks for treatment 0 0 0 0 0Diagnostic waits

% patients waiting less than 6 weeks for the 15 diagnostics tests (including audiology) Nov-16 1.00% 1.08% 0.55% 0.04% 0.55% 1.67% NTHFT ER01

A&E waits

% patients spending 4 hrs. or less in A&E or minor injury unit YTD Nov-16 95.0% 88.4% 94.1% 95.9% 94.8%

Handover between ambulance and A&E over 30 minutes 0 1764 175 66 6087

Handover between ambulance and A&E over 60 minutes 0 551 29 8 1284

Trolley waits in A&E not longer than 12 hours YTD Nov-16 0 3 0 0Ambulance response times

RED 1 response in 8 mins 78.4%RED 2 response in 8 mins 72.2%RED 1&2 response in 8 mins 72.6%Cat A Response within 19 mins 95.0% 91.0% 85.0% 90.4%

Number of crew clear delays over 30 mins 0 8330Number of crew clear delays over 60 mins 0 465Mixed Sex accommodation

Mixed Sex accommodation - number of unjustified breaches YTD Nov-16 0 0 2 0 0HCAI

Incidence of MRSA 0 2 3 6 1Incidence of C Diff CCG 17 15 14 32 30Cancelled Operations

All patients who have operations cancelled to be offered another binding date within 28 days YTD Nov-16 0 0 0 0Mental Health

% people followed up within 7 days of discharge from psychiatric in patient care YTD Nov-16 95.0% 96.0%Cancer

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 95.2% 91.9% 93.1% 92.4% 94.0%

% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0% 96.1% 89.7% 91.6% 91.4% 96.8%

% of patients treated within 31 days of a cancer diagnosis 96.0% 97.2% 98.2% 99.6% 96.8% 99.7%% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0% 99.5% 98.1% 100.0% 99.6% 100.0%% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0% 94.5% 98.7% 98.9% 96.0% 98.4%% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy 94.0% 97.7% 95.6% 97.8%% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 82.1% 74.0% 85.0% 79.9% 85.5%

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service 90.0% 92.5% 100.0% 74.6% 87.8% 97.7%

% of patients treated for cancer within 62 days of consultant decision to upgrade status N/A 89.7% 100.0% 100.0% 90.9% 100.0%

Darlington CCG NTHFTSTHFTCDDFT NEAS

NEAS ER01

YTD Dec-16

YTD Nov-16 STHFT ER01

CDDFT ER01/02/03 STHFT ER02 NTHFT

ER02/03

YTD Dec-1675.0% 64.3%

YTD Dec-16

63.6%

D'ton CCG ER02 STHFT ER05

To 11th Jan-17 HCAI01

D'ton CCG ER01 CDDFT ER04 STHFT

ER03

STHFT ER04

YTD Nov-16

YTD Nov-16

YTD Nov-16

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NHS Constitutional Indicators by month – Darlington CCG 2016/17

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Q3 YTD Q3 YTD

pts treated < 18 wks 4,557 4,483 4,539 4,525 4,420 4,565 4,622 4,778 4,804 5,225 5,074 4,846 14,170 54,858 9,920 38,333total pts 4,848 4,779 4,760 4,762 4,706 4,845 4,959 5,121 5,154 5,564 5,444 5,249 15,060 57,957 10,693 41,042% Compliance 94.0% 93.8% 95.4% 95.0% 93.9% 94.2% 93.2% 93.3% 93.2% 93.9% 93.2% 92.3% #DIV/0! 94.1% 94.7% 92.8% 93.4%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 0

pts waiting > 6 wks 3 4 5 18 14 7 14 7 8 8 9 9total pts 1,508 1,880 1,511 1,670 1,594 1,709 1,794 1,521 1,501 1,627 1,587 1,627% Compliance 0.20% 0.21% 0.33% 1.08% 0.88% 0.41% 0.78% 0.46% 0.53% 0.49% 0.57% 0.55% #DIV/0!

Response < 8 min 38 36 37 42 50 29 34 37 31 42 29 39 39 95 372 107 330Total Responses 58 50 53 62 58 37 46 47 38 52 43 46 54 142 515 143 421% Compliance 65.5% 72.0% 69.8% 67.7% 86.2% 78.4% 73.9% 78.7% 81.6% 80.8% 67.4% 84.8% 72.2% 66.9% 72.2% 74.8% 78.4%Response < 8 min 404 481 430 479 420 452 426 380 424 410 385 415 357 1,181 4,946 1,157 3,669Total Responses 610 678 604 629 545 575 556 534 595 559 560 572 588 1,762 6,685 1,720 5,084% Compliance 66.2% 70.9% 71.2% 76.2% 77.1% 78.6% 76.6% 71.2% 71.3% 73.3% 68.8% 72.6% 60.7% 67.0% 74.0% 67.3% 72.2%Response < 8 min 442 517 467 521 470 481 460 417 455 452 414 454 396 1,276 5,318 1,264 3,999Total Responses 668 728 657 691 603 612 602 581 633 611 603 618 642 1,904 7,200 1,863 5,505% Compliance 66.2% 71.0% 71.1% 75.4% 77.9% 78.6% 76.4% 71.8% 71.9% 74.0% 68.7% 73.5% 61.7% 67.0% 73.9% 67.8% 72.6%Response < 19 min 527 586 516 508 506 520 537 508 541 527 514 513 453 1,581 6,218 1,480 4,619Total Responses 652 723 638 641 582 585 600 581 628 611 602 616 627 1,885 7,099 1,845 5,432% Compliance 80.8% 81.1% 80.9% 79.3% 86.9% 88.9% 89.5% 87.4% 86.1% 86.3% 85.4% 83.3% 72.2% 83.9% 87.6% 80.2% 85.0%

Mixed Sex accommodation - number of unjustified breaches 0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Incidence of MRSA up to 11th January 2017 0 Total Number 1 0 1 0 0 0 1 0 0 0 1 0 0 1 3 1 2Actual 0 1 2 1 0 3 1 3 2 1 1 2 2 6 23 5 15Target 1 2 1 1 2 2 1 2 1 1 2 1 1 4 17 4 17Variance 1 1 -1 0 2 -1 0 -1 -1 0 1 -1 -1 -2 -6 -1 2

% of people followed up within 7 days of discharge from psychiatric in-patient care

95.0% % Compliance 100.0% 100.0% 100.0% 100.0% 88.2% 100.0% 100.0% 100.0% 90.0% 92.9% 100.0% 92.3% 99.5% 96.0%

pts seen < 2 wks 253.0 220.0 221.0 252.0 235.0 226.0 304.0 244.0 254.0 257.0 211.0 264.0 758.0 2,907.0 475.0 1,995.0total pts 273.0 233.0 235.0 276.0 273.0 255.0 319.0 260.0 278.0 281.0 227.0 278.0 810.0 3,105.0 505.0 2,171.0% Compliance 92.7% 94.4% 94.0% 91.3% 86.1% 88.6% 95.3% 93.8% 91.4% 91.5% 93.0% 95.0% #DIV/0! 93.6% 93.6% 94.1% 91.9%pts seen < 2 wks 34.0 43.0 36.0 45.0 42.0 46.0 30.0 35.0 28.0 39.0 24.0 36.0 106.0 487.0 60.0 280.0total pts 37.0 45.0 38.0 49.0 46.0 56.0 34.0 38.0 34.0 42.0 24.0 38.0 112.0 515.0 62.0 312.0% Compliance 91.9% 95.6% 94.7% 91.8% 91.3% 82.1% 88.2% 92.1% 82.4% 92.9% 100.0% 94.7% #DIV/0! 94.6% 94.6% 96.8% 89.7%pts treated < 31 days 55.0 54.0 36.0 42.0 27.0 39.0 44.0 46.0 53.0 65.0 44.0 64.0 143.0 525.0 108.0 382.0total pts 55.0 54.0 37.0 42.0 28.0 39.0 46.0 46.0 54.0 66.0 44.0 66.0 146.0 532.0 110.0 389.0% Compliance 100.0% 100.0% 97.3% 100.0% 96.4% 100.0% 95.7% 100.0% 98.1% 98.5% 100.0% 97.0% #DIV/0! 97.9% 98.7% 98.2% 98.2%pts treated < 31 days 12.0 6.0 11.0 10.0 6.0 8.0 13.0 12.0 17.0 20.0 10.0 17.0 35.0 123.0 27.0 103.0total pts 12.0 6.0 11.0 10.0 6.0 8.0 13.0 12.0 17.0 21.0 11.0 17.0 35.0 123.0 28.0 105.0% Compliance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 95.2% 90.9% 100.0% #DIV/0! 100.0% 100.0% 96.4% 98.1%pts treated < 31 days 12.0 14.0 10.0 8.0 6.0 3.0 8.0 10.0 8.0 8.0 12.0 19.0 34.0 110.0 31.0 74.0total pts 13.0 14.0 10.0 8.0 6.0 4.0 8.0 10.0 8.0 8.0 12.0 19.0 37.0 113.0 31.0 75.0% Compliance 92.3% 100.0% 100.0% 100.0% 100.0% 75.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! 91.9% 97.3% 100.0% 98.7%pts treated < 31 days 17.0 13.0 7.0 16.0 7.0 7.0 8.0 7.0 19.0 9.0 14.0 16.0 38.0 148.0 30.0 87.0total pts 17.0 14.0 7.0 16.0 8.0 7.0 8.0 7.0 19.0 11.0 14.0 17.0 38.0 149.0 31.0 91.0% Compliance 100.0% 92.9% 100.0% 100.0% 87.5% 100.0% 100.0% 100.0% 100.0% 81.8% 100.0% 94.1% #DIV/0! 100.0% 99.3% 96.8% 95.6%pts treated < 62 days 19.0 15.0 12.0 15.0 8.0 17.0 19.0 17.0 18.0 25.0 16.0 25.0 56.0 196.0 41.0 145.0total pts 23.0 25.0 17.0 24.0 13.0 23.0 25.0 21.0 25.0 32.0 21.0 36.0 73.0 258.0 57.0 196.0% Compliance 82.6% 60.0% 70.6% 62.5% 61.5% 73.9% 76.0% 81.0% 72.0% 78.1% 76.2% 69.4% #DIV/0! 76.7% 76.0% 71.9% 74.0%pts treated < 62 days 3.0 2.0 0.0 1.0 0.0 1.0 6.0 5.0 9.0 5.0 6.0 12.0 4.0 13.0 18.0 44.0total pts 3.0 2.0 0.0 1.0 0.0 1.0 6.0 5.0 9.0 5.0 6.0 13.0 5.0 14.0 19.0 45.0% Compliance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.3% #DIV/0! 80.0% 92.9% 94.7% 100.0%pts treated < 62 days 0.0 1.0 0.0 1.0 0.0 0.0 0.0 1.0 1.0 0.0 4.0 0.0 2.0total pts 0.0 1.0 0.0 1.0 0.0 0.0 0.0 1.0 1.0 0.0 4.0 0.0 2.0% Compliance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! #DIV/0! 100.0% 100.0% 100.0% 100.0%

% patients waiting for initial treatment on incomplete pathways within 18 weeks

92.0%

RTT

2015/16 2015/16Exception ReportIndicator Threshold

2016/17

Mental Health

% of patients treated for cancer within 62 days of consultant decision to upgrade status

N/A

MSA

HCAI

HCAI01Incidence of CDIFF up to 11th January 2017 17

% of patients receiving subsequent treatment for cancer within 31 days - surgery

94.0%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

DCCG ER01

Diagnostics

Cat A 19 min

Cat A Red 1 8 min 75.0%

95.0%

Cat A Red 2 8 min 75.0%

% Patients waiting more than 6 weeks from referral for a diagnostic test

<1.00%

Ambulance Response Times

Cat A Red 1&2 8 min 75.0%

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

90.0%

% of patients receiving subsequent treatment for cancer within 31 days - drugs

98.0%

94.0%

% of patients treated within 31 days of a cancer diagnosis

% of patients treated within 62 days of an urgent GP referral for suspected cancer

85.0% DCCG ER02

96.0%

Cancer

% of patients seen within 2 weeks of an urgent referral for breast symptoms

93.0%

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

93.0%

NEAS ER01

70 of 570

NHS Constitutional Indicators by month – CDDFT

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Q3 YTD Q3 YTD

pts treated < 18 wks 19,992 19,523 19,403 19,948 19,518 20,546 20,966 21,663 20,921 21,258 20,540 19,919 61,897 230,045 40,459 165,331total pts 21,360 20,911 20,607 21,230 20,865 21,839 22,304 23,070 22,423 22,883 22,134 21,521 65,854 244,239 43,655 177,039% Compliance 93.6% 93.4% 94.2% 94.0% 93.5% 94.1% 94.0% 93.9% 93.3% 92.9% 92.8% 92.6% #DIV/0! 94.0% 94.2% 92.7% 93.4%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 Total Number 4 1 0 0 0 0 0 0 0 0 0 0 7 11 0 0

pts waiting > 6 wks 0 205 130 15 17 9 29 14 12 8 6 3total pts 7,217 7,773 8,108 7,570 7,688 7,607 8,040 7,540 7,142 7,280 7,435 6,967% Compliance 0.00% 2.64% 1.60% 0.20% 0.22% 0.12% 0.36% 0.19% 0.17% 0.11% 0.08% 0.04% #DIV/0!

pts seen < 4 hrs 22,188 21,366 20,684 23,366 21,249 24,243 22,646 24,167 21,837 22,193 22,463 20,931 68,102 271,573 43,395 179,729total pts 24,350 24,517 23,878 26,369 23,192 26,015 23,718 25,396 22,818 23,270 23,816 22,801 72,582 291,508 46,617 191,026% Compliance 91.1% 87.1% 86.6% 88.6% 91.6% 93.2% 95.5% 95.2% 95.7% 95.4% 94.3% 91.8% #DIV/0! 93.8% 93.2% 93.1% 94.1%

Total Type 1 attendances Total Number 10,775 17,254 10,611 11,347 10,546 11,675 10,957 11,688 10,674 10,859 11,166 10,727 32,727 136,721 21,893 88,292Total Type 2 attendances Total Number 0 0Total Type 3 attendances Total Number 13,575 7,263 13,226 15,022 12,646 14,340 12,761 13,708 12,144 12,411 12,650 12,074 39,855 154,746 24,724 102,734Handover between ambulance and A&E over 30 minutes

0 Total Number 503 602 640 512 241 247 108 145 92 72 133 268 458 930 3,622 859 1,764Handover between ambulance and A&E over 60 minutes or more

0 Total Number 190 283 267 206 98 94 25 32 21 17 20 78 166 288 1,250 264 551

Trolley waits in A&E longer than 12 hours 0 Total Number 2 0 0 0 0 1 0 0 0 0 0 2 2 2 2 3

Mixed Sex accommodation - number of unjustified breaches

0 Total Number 0 0 0 0 0 0 0 2 0 0 0 0 0 0 2 CDDFT ER03

Incidence of MRSA up to 11th January 2017 0 Total Number 1 0 1 0 0 0 0 1 0 0 1 1 0 1 3 2 3Actual 4 3 0 1 2 2 0 1 0 3 1 2 3 7 21 6 14Trajectory 1 1 1 1 2 2 2 2 2 2 2 1 1 4 19 4 19Variance -3 -2 1 0 0 0 2 1 2 -1 1 -1 -2 -3 -2 -2 5

All patients who have operations cancelled to be offered another binding date within 28 days

0 % Compliance 1 0 0 0 0 0 0 0 0 0 0 0 1 2 0

pts seen < 2 wks 1,429.0 1,275.0 1,385.0 1,540.0 1,467.0 1,550.0 1,590.0 1,399.0 1,526.0 1,559.0 1,404.0 1,498.0 4,352.0 17,020.0 2,902.0 11,993.0total pts 1,517.0 1,355.0 1,450.0 1,626.0 1,577.0 1,686.0 1,676.0 1,501.0 1,682.0 1,693.0 1,496.0 1,572.0 4,616.0 18,047.0 3,068.0 12,883.0% Compliance 94.2% 94.1% 95.5% 94.7% 93.0% 91.9% 94.9% 93.2% 90.7% 92.1% 93.9% 95.3% #DIV/0! 94.3% 94.3% 94.6% 93.1%pts seen < 2 wks 204.0 174.0 155.0 210.0 168.0 189.0 187.0 147.0 115.0 174.0 161.0 182.0 609.0 2,315.0 343.0 1,323.0total pts 223.0 191.0 167.0 224.0 186.0 212.0 200.0 158.0 148.0 187.0 165.0 189.0 654.0 2,508.0 354.0 1,445.0% Compliance 91.5% 91.1% 92.8% 93.8% 90.3% 89.2% 93.5% 93.0% 77.7% 93.0% 97.6% 96.3% #DIV/0! 93.1% 92.3% 96.9% 91.6%pts treated < 31 days 172.0 156.0 142.0 173.0 141.0 168.0 172.0 178.0 149.0 166.0 166.0 166.0 502.0 2,039.0 332.0 1,306.0total pts 172.0 159.0 142.0 174.0 142.0 168.0 174.0 178.0 150.0 166.0 166.0 167.0 503.0 2,046.0 333.0 1,311.0% Compliance 100.0% 98.1% 100.0% 99.4% 99.3% 100.0% 98.9% 100.0% 99.3% 100.0% 100.0% 99.4% #DIV/0! 99.8% 99.7% 99.7% 99.6%pts treated < 31 days 31.0 30.0 12.0 21.0 14.0 32.0 30.0 21.0 26.0 17.0 20.0 27.0 114.0 343.0 47.0 187.0total pts 31.0 30.0 12.0 21.0 14.0 32.0 30.0 21.0 26.0 17.0 20.0 27.0 114.0 343.0 47.0 187.0% Compliance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! 100.0% 100.0% 100.0% 100.0%pts treated < 31 days 30.0 35.0 25.0 43.0 27.0 23.0 36.0 40.0 34.0 43.0 27.0 37.0 100.0 385.0 64.0 267.0total pts 30.0 35.0 26.0 43.0 28.0 24.0 37.0 40.0 34.0 43.0 27.0 37.0 100.0 388.0 64.0 270.0% Compliance 100.0% 100.0% 96.2% 100.0% 96.4% 95.8% 97.3% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! 100.0% 99.2% 100.0% 98.9%pts treated < 31 days 1.0 0.0 1.0total pts 1.0 0.0 1.0% Compliance #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100.00% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100.00%pts treated < 62 days 80.5 83.0 69.0 89.5 74.5 90.0 100.0 97.0 89.0 95.5 85.0 94.5 260.5 1,030.5 179.5 725.5total pts 91.5 97.0 80.5 104.5 87.0 106.5 116.0 113.0 101.0 110.5 102.5 117.0 300.5 1,191.0 219.5 853.5% Compliance 88.0% 85.6% 85.7% 85.6% 85.6% 84.5% 86.2% 85.8% 88.1% 86.4% 82.9% 80.8% #DIV/0! 86.7% 86.5% 81.8% 85.0%pts treated < 62 days 4.5 5.0 3.0 4.5 2.5 5.0 1.0 6.0 2.5 3.5 2.0 4.0 12.0 46.5 6.0 26.5total pts 4.5 5.0 3.0 5.0 2.5 6.0 2.5 7.0 6.0 4.5 2.0 5.0 14.5 50.5 7.0 35.5% Compliance 100.0% 100.0% 100.0% 90.00% 100.0% 83.3% 40.0% 85.7% 41.7% 77.8% 100.0% 80.0% #DIV/0! 82.8% 92.1% 85.7% 74.6%pts treated < 62 days 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.0 1.0 0.0 0.5total pts 0.0 0.0 0.5 0.0 0.0 0.0 0.0 0.5 0.0 1.5 0.0 0.5% Compliance 100.0% 100.0% 0.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100.0% 66.7% 100.0% 100.0%

% patients waiting for initial treatment on incomplete pathways within 18 weeks

HCAI

Cancelled Ops

MSA

% Patients waiting more than 6 weeks from referral for a diagnostic test

<1.00%

95.0%% patients spending 4 hrs. or less in A&E or minor injury unit

CDDFT ER01

19

2015/16

92.0%

Cancer

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

% of patients seen within 2 weeks of an urgent referral for breast symptoms

93.0%

% of patients receiving subsequent treatment for cancer within 31 days - surgery

93.0%

% of patients treated within 62 days of an urgent GP referral for suspected cancer

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

% of patients treated for cancer within 62 days of consultant decision to upgrade status

90.0%

N/A

85.0%

94.0%% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

96.0%

98.0%

94.0%

% of patients receiving subsequent treatment for cancer within 31 days - drugs

% of patients treated within 31 days of a cancer diagnosis

RTT

Diagnostics

Emergency Department

Indicator Threshold2015/16

Exception Report

Incidence of CDIFF up to 11th January 2017

CDDFT ER04

2016/17

CDDFT ER02

HCAI 01

71 of 570

NHS Constitutional Indicators by month – TEWV/MH

STANDARD DEC 15 JAN 16 FEB 16 MAR 16 APR 16 MAY 16 JUN 16 JUL 16 AUG 16 SEP 16 OCT 16 NOV 16 2015/16 YTD 2016/17

ER REF

PROPORTION OF PEOPLE THAT ENTER TREATMENT AGAINST THE LEVEL OF NEED IN THE GENERAL POPULATION 15.0% 10.7% 11.9% 13.9% 14.0% 21.1% 17.3% 18.8% 18.9% 19.2% 19.3% 21.8% 17.5% 13.6% 19.5%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 43.3% 39.7% 48.0% 43.9% 58.4% 51.0% 57.6% 52.1% 47.5% 43.9% 40.5% 46.0% 41.5% 47.4%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - %AGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 95.5% 98.8% 98.8% 98.8% 78.5% 71.1% 87.9% 86.3% 82.1% 82.1% 85.3% 100.0% 98.2% 78.0%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - %AGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 99.0% 100.0% 100.0% 100.0% 96.6% 95.6% 97.6% 98.6% 97.0% 93.3% 96.9% 100.0% 99.8% 96.6%

2 %AGE OF CPA DISCHARGES FOLLOWED UP WITHIN 7 DAYS 95.0% 100.0% 100.0% 100.0% 100.0% 89.5% 100.0% 100.0% 100.0% 90.0% 92.9% 100.0% 92.3% 99.5% 96.0%

39 %AGE OF CPA FOLLOW UPS UNDERTAKEN ON A FACE TO FACE BASIS 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

42%AGE OF SERVICE USERS ON CPA WHO HAVE HAD A REVIEW IN THE LAST 12 MONTHS 98.0% 98.3% 97.2% 98.6% 96.6% 95.7% 94.3% 97.6% 93.8% 97.3% 99.3% 99.3% 98.8% 98.3% 98.8%

40%AGE OF PATIENTS ON CPA WITH A CRISIS PLAN IN PLACE (ADULT MENTAL HEALTH SERVICES) 90.0% NA NA NA NA 97.3% 97.4% 97.4% 97.5% 97.2% 97.2% 96.4% 98.8% NA 97.4%

41%AGE OF PATIENTS ON CPA WITH A CRISIS PLAN IN PLACE (OLDER PERSONS MENTAL HEALTH SERVICES) 90.0% NA NA NA NA 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NA 100.0%

25 %AGE OF CRISIS REFERRALS SEEN WITHIN 4 HOURS 95.0% 96.7% 97.4% 100.0% 95.6% 100.0% 95.0% 95.0% 100.0% 100.0% 95.0% 97.0% 97.1% 97.7% 98.2%

24%AGE OF ADMISSIONS TO INPATIENT SERVICES WHICH ARE GATE KEPT BY THE CRISIS SERVICE 95.0% 81.8% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 87.5% 100.0% 96.0% 98.8%

26%AGE OF SECTION 136 ADMISSIONS WHERE THE TIME FROM REFERRAL TO ASSESSMENT IS UNDER 48 HOURS 98.0% NA NA NA NA 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NA 100.0%

22+23THE NUMBER OF NEW "AT RISK MENTAL STATE" AND "FIRST EPISODE IN PSYCHOSIS" CASES INFO NA NA NA NA 3.0 3.0 0.0 2.0 4.0 4.0 3.0 1.0 NA 20.0

7%AGE OF FIRST EPISODES IN PSYCHOSIS WHO COMMENCE A PACKAGE OF CARE WITHIN 2 WEEKS OF REFERRAL 50.0% NA NA NA NA 75.0% 100.0% 100.0% 0.0% 75.0% 100.0% 50.0% 100.0% NA 77.8%

21%AGE OF FIRST EPISODES IN PSYCHOSIS WHO DO NOT COMMENCE A PACKAGE OF CARE WITHIN 4 WEEKS OF REFERRAL 5.0% NA NA NA NA 0.0% 0.0% 0.0% 100.0% 25.0% 0.0% 50.0% 0.0% NA 16.7% MHER02

QUALITY INDICATOR

MHER01

IMPROVNG ACCESS TO PSYCHOLOGICAL THERAPIES

CARE PROGRAMME APPROACH

CRISIS SERVICES

EARLY INTERVENTION IN PSYSCHOSIS

72 of 570

NHS Constitutional Indicators by month – TEWV/MH

STANDARD DEC 15 JAN 16 FEB 16 MAR 16 APR 16 MAY 16 JUN 16 JUL 16 AUG 16 SEP 16 OCT 16 NOV 16 2015/16 YTD 2016/17

ER REF

%AGE OF ASSESMENTS IN A&E WHICH ARE UNDERTAKEN WITHIN 1 HOUR OF REFERRAL NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

%AGE OF ASSESMENTS UNDERTAKEN ON WARDS WITHIN 24 HOURS OF REFERRAL NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

35%AGE OF ADULTS WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 97.8% 97.9% 98.5% 98.6% 100.0% 96.3% 96.7% 97.6% 99.1% 98.2% 94.5% 97.4% 96.6% 97.6%

37%AGE OF CAMHS WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 95.0% 97.1% 97.5% 71.8% 45.7% 36.4% 52.9% 96.1% 97.6% 85.7% 100.0% 100.0% 91.8% 77.1% MHER03

36%AGE OF OPMHS WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 99.9% 100.0%

38 %AGE OF LD WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 92.3% 100.0% 100.0% 100.0% 100.0% 100.0% 98.4%

%AGE OF PATIENTS SEEN FACE TO FACE WITHIN 4 HRS BY SUITABLY TRAINED PRACTITIONER (URGENT RESPONSE - CRISIS) TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

%AGE OF PATIENTS WITH A PAIRED CROM IN THE REPORTING PERIOD TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

%AGE OF PATIENTS WITH AN IMPROVEMENT IN THEIR PAIRED CROM MEASURE IN THE REPORTING PERIOD TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

70%AGE OF CAMHS PATIENTS AGED 17.5 PLUS WITH A TRANSITION PLAN (SNAPSHOT) TBA NA NA NA NA 43.8% 33.3% 54.2% 53.6% 50.0% 47.6% 82.6% 84.6% NA 84.6%

THE PROPORTION OF EATING DISORDER PATIENTS SEEN WITHIN TWO WEEKS OF REFERAL (ADJUST TO STANDARD DEFINITION) TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

QUALITY INDICATOR

MENTAL HEALTH LIAISON SERVICES

SERVICE WAITING TIMES

CHILD AND ADOLESCENT MENTAL HEALTH

73 of 570

Performance Issue CDDFT were non compliant in November reporting 91.82%. Unvalidated data provided by CDDFT indicates further non-compliance in December 89.53%. This fell below the Monitor trajectory and also the national 95% standard. Under achievement reported in 5 out of 9 months has negatively impacted on current YTD position standing at 94.1% to Nov-16. CDDFT have continued to experience pressures within their A&E, with increased attendances reported across both sites. In Apr-Dec 2016, A&E attendances grew by 2.1% compared to the same period in 2015 (0.8% at DMH and 3.3% at UHND). In December, attendances fell by 1.7% with small falls at both sites. In December, performance was 89.53% (86.52% at DMH and 70.26% at UHND). In December there were 76 breaches per day.

Exception Report CDDFT ER01

Actions Taken CDDFT have a number of actions underway to assist compliance of the A&E Standard, these include: • A number of initiatives shown overleaf (CDDFT ER02 have been implemented as part of the Trusts Transforming Emergency Care Plan to assist

delivery and sustainability of the 4 hour standard. CDDFT continue to prioritise work on improving & sustaining compliance of the 4 hour standard and the CD&D LADB are supportive of this.

• CDDFT winter resilience schemes have been agreed by the CD&D LADB. The schemes are intended to assist delivery of the A&E 4 hour standard and are aligned to the 8 High Impact Interventions and the 5 Must Do’s. Regular progress updates will be fed into the LADB.

• ECIP team have been commissioned to carry out a whole system diagnostic in CDDFT A&E as part of the A&E Improvement Plan. The findings and recommendations of the ECIP review were presented to the CD&D LADB on Friday 16th December, members were asked to provide comment/feedback and/or amends no later than 30th December. The final report and agreement of the concordat will be made at the 20th January LADB meeting.

• Discharge to assess implemented in County Durham and Darlington from 5thDecember 2016 on three medical wards across County Durham and Darlington NHS Foundation Trust (CDDFT). The ambition being to fully implement this pathway from 1st April 2017. A key element to the discharge to assess pathway is patients being identified as suitable at the point of admission to CDDFT to a multi-agency discharge team (MADT) who will work together to plan the safe and timely discharge of patients so that when they will no longer benefit from any medical or therapeutic interventions they can be discharged home/ usual place of residence.

• Patients with non-life threatening illnesses and minor GP ailments will have access to more capacity within primary care throughout the winter period.

Timescale for performance improvement CDDFT reported achievement throughout June – September. An extensive programme of support from ECIP has commenced within the Trust and across the whole health care system to assist recovery of the national standard.

Other Intelligence: Although published weekly A&E data had previously been available, national guidance has resulted in A&E performance data now only being reported monthly. Local arrangements have been made with CDDFT to provide daily unvalidated information.

Indicator Threshold Trend Line

Dec-15 – Nov-16 CDDFT Nov-16

CDDFT YTD Nov-16

% patients spending 4 hrs. or less in A&E or minor injury unit

95.0% 91.8% 94.1%

74 of 570

Exception Report CDDFT ER01

CDDFT TEC Plan (A&E Initiatives)

8

Indicator Threshold Trend Line

Dec-15 – Nov-16 CDDFT Nov-16

CDDFT YTD Nov-16

% patients spending 4 hrs. or less in A&E or minor injury unit

95.0% 91.8% 94.1%

Front of House

Medicine/ED A&EC ED Access to Acute MedicineImprove fast track referral process to acute medicine, following DTA in ED, reducing the need for RMO to 'accept' every patient.

ED 4 hour wait

Front of House

All clinical areas

All care groups Flow Through A&E

Develop flow chart for achieving time-specific standards in ED (as per ED SAFER Bundle). CGs to develop SOPs to support, and clinical escalation plans when standards are not met.

ED 4 hour wait

Front of House

ED/UC/Acute Assessment

Units

A&EC / Surgery /

Family HealthStreaming at the Front Door

Introduce streaming for walk-in patients in ED. Develop an integrated approach particularly with UC / AEC, introduce a clinical navigator role to manage the stream and increase direct referrals to AEC / other acute specialty assessment units direct from triage.

ED 4 hour wait

Cont Care Patient FlowCorporate Nursing

Electronic Flow Management (SAFER)

Develop Nervecentre as primary source of patient flow information; train & support staff in real time data entry and develop functionality to manage referrals, patients waiting, etc. using a 'pull' system to reduce internal transfer delays.

ED 4 hr wait / Discharge before midday/ Reduce discharge delays

CSS/Enabler

ED /UC / Acute

Assessment Units

A&EC P2: Emergency Care Centre (UHND)Develop and deliver new build EC centre to facilitate delivery of improved emergency care for residents of County Durham (as per TEC clinical model).

Improve ambulance handovers/ 4 hour access/ Reduced

LoS

CSS/Enabler

ED /UC / Acute

Assessment Units

A&EC P3: Integrated ED/UC (DMH)Business case approved to progress integration of ED/UC at DMH to facilitate the delivery of improved urgent/emergency care for residents of Darlington.

Improve ambulance handovers/ 4 hour access/ Reduced

LoS

CSS/Enabler

Medicine A&EC P5: Reprovide AEC/AMU (DMH)Reprovide AEC/AMU to third floor of DMH (from first floor) as part of STEM reconfiguration of services.

4 hour access/ Reduced LoS

CSS/Enabler

Business Continuity/

Performance

System Collaborative

Winter Plan

Review learning from previous winter plan. Co-ordinate contributions from all care groups to ensure the Trust maintains TEC performance trajectory during periods of surge.

Improve ambulance handovers/ 4 hour access/ Reduced

LoS

CSS/Enabler

Business Continuity/

Performance

System Collaborative

Full Capacity ProtocolDevelop a full capacity protocol and clear guidance for use - internally and in collaboration with regional UEC Network

4 hour access

CSS/Enabler

All All Spotlight on SAFERDeliver SAFER Spotlight (Nov/Dec) to further enhance performance following relaunch of SAFER and completion of SAFER audit.

4 hour access/ Discharge before midday/ Reduce discharge delays

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Performance Issue The pressures experienced throughout A&E have resulted in an increase in handover delays being reported especially on the UHND site. UHND has experienced significant pressures throughout December and as a consequence broke the zero tolerance policy by putting ambulance diverts in place. In December, both sites experienced growth in ambulance arrivals compared to December 2015 (3.7% at DMH and 3.4% at UHND). In December, 20 patients at UHND and 1 at DMH waited >120 mins. NEAS experienced delays totalling 421 hours at UHND and 92 hours at DMH during the period w/ending 4th Dec to w/ending 1st Jan. A total of 458 over 30 minutes handovers and 166 over 60 minutes were reported throughout December. Acuity of patients in ED and high ambulance attendances resulted in some patients waiting in excess of 120 minutes to be handed over. CDDFT have carried out RCAs on each over 120 minute case reported. Of the 458 over 30 minute handovers in December, 92 were attributed to Darlington Memorial Hospital and 366 attributable to UHND.

Exception Report CDDFT ER02

Actions Taken CDDFT have implemented a number of actions to minimise the number of handover delays being reported, these include: • The Transforming Emergency Care (TEC) Plan implemented within CDDFT is having a positive impact on performance against the 4 hour A&E

operational standard and Ambulance handover & Ambulance diverts. The TEC Plan is monitored monthly at the CD&D LADB. Information supporting the A&E actions put in place, which will in turn reduce ambulance handover breaches, can be found in CDDFT ER01.

• CDDFT have used some of their 2016/17 Winter resilience monies to employ 6x Band 7 WTE Ambulance Handover Nurses to be responsible for ambulance handovers of patients attending the Emergency Departments at DMH and UHND. Regular updates on the progress of the scheme will be given at the monthly CD&D LADB meetings.

• ECIP team have been commissioned to carry out a whole system diagnostic in CDDFT A&E as part of the A&E Improvement Plan. The findings and recommendations of the draft ECIP review were reported presented to the CD&D LADB on Friday 16th December the final report and agreed concordat will be presented to the CD&D LADB on Friday 20th January 2017. Timescale for performance improvement

The Trust understands that this indicator carries a zero tolerance and continues to work hard to reduce the numbers being reported. Commissioners will continue to monitor CDDFT performance.

Other Intelligence

Indicator Threshold Trend Line

Jan-16 –Dec-16 YTD

Dec-16

Handover between ambulance and A&E over 30 minutes 0 1,764

Handover between ambulance and A&E over 60 minutes or more 0 551

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Performance Issue North East Ambulance Service (NEAS) are commissioned to provide the operational standards at a service level. NEAS performance is still under target in 2016/17, and reports a declining position from the previous month for both the 8min indicator (53.8%) and 19 min indictor (82.8%) in Dec-16. This in turn has decreased the YTD position to 64.3% and 90.4% respectively. Darlington CCG reported under achievement of both indicators in Dec-16 and continue to be non-compliant at the year to date position. Performance deterioration is reflective of: • There has been an historic shortage of paramedic workforce within the NHS. NEAS have suffered greatly from this resource gap. • Over recent years, there has been a measurable increase in the number of Red 1 and Red 2 Incidents:

• NEAS are of the view that this change is a result of Healthcare Professionals changing behaviours in requesting more urgent responses for patients. Anecdotally, this is believed to correlate with a lack of confidence in ambulance response times.

• Ambulance Handover pressures – we continue to experience delays in ambulance handovers leading to lost capacity across the North East. Modelling suggests that if the North East was able to eradicate handover delays that it would result in a c4% improvement in ambulance response times.

Key issues: • Red activity levels have not reduced to those forecast prior to the financial year beginning. Following the identification of the drivers behind

the increased Red demand, action is required to manage this pressure through the remainder of the year. • Buy in is required from the local acute providers to reduce pressures at hospitals and inform NEAS in advance of any bypass arrangements

Indicator Threshold CCG

YTD Dec-16 CCG Trend Line Jan-16 – Dec-16

NEAS YTD Dec-16

NEAS Trend Line Jan-16 – Dec-16

8 minute response 75.0% 72.6% 64.3%

19 minute response 95.0% 85.0% 90.4%

Exception Report NEAS ER01

10

Incident type YTD Sept 2015/16

YTD Sept 2016/18

% Change

Red 1 5,339 5,978 12.0% Red 2 84,408 91,987 9.0% Green 78,082 71,155 -8.9% GP Urgent 19,051 16,617 -12.8% HD 339 336 -0.9%

Unknown 216 390 80.6% All Incidents 187,435 186,463 -0.5%

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Exception Report NEAS ER01 continued

11

Actions Taken A comprehensive action plan is in place which is monitored through the Contract Management Board along with the Clinical Quality Review Group. The action plan is broken down into three main areas/themes: Demand Actions: • Reduce the volume of Red incidents generated at the point of call

– Monitored by NEAS Operations Centre – Work to understand where Healthcare Professionals are requesting/escalating to a Red incident

• Capacity Actions: The points of focus for capacity are to: • Meet the Trust’s full establishment; anticipated that NEAS will be at full establishment in April 2017. • Utilise third party providers to cover shortfalls in the current staffing levels. • Extension of the Emergency Medical Response (EMR) pilot with the four local Fire and Rescue Services (FRS). • Increase the level of Rapid Response Vehicles (RRV) available per shift. • 2017/18 contract negotiations have led to an agreement regarding a package of additional investments:

– Additional 49 Paramedics to be appointed (FYE £3.9m) • First tranche of recruits in place October 2017 • Final tranche of recruits in place February 2018

– Investment into the Clinical Hub in 2017/18 (2018/19 subject to NHS 111 procurement) (£1.7m) – Increase resources to upskill Paramedics to treat a greater number of patients on scene (£1m)

Efficiency Actions: • Reduce/eradicate Handover delays – work continues with the FT Providers that experience delays • Reduce crew downtime to increase resource available on the roads. control staff about processes used (June 2016)

Timescale for performance improvement Monitor is fully aware of the Trust’s position and has been working with NEAS during the compilation of the Operational Plan for 2016/17, understanding that NEAS may continue to underperform in the early part of 2016/17 and performance improvement is expected to be incremental. Failure of the Provider Level Indicators will result in a 25% reduction to the 2016/17 Quality Premium for all North East CCGs.

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Exception Report NEAS ER01 continued

12

Additional performance metrics to note: In addition to the nationally reported performance metrics, a number of different measures are available to assess the quality and performance of NEAS: The above report demonstrates NEAS’ performance against the National Clinical Indicators. Historically, NEAS performs very well in comparison to other Ambulance Services. This information is scrutinised within the Clinical Quality Review Group, in which any variation is picked up by the CCG Executive Nurses.

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Quality Premium 2016/17

The Quality Premium for 2016/17 is now available, and the new template can be found on the following page. As was the case in 2015/16, the 'quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and the associated improvements in health outcomes and reducing inequalities. The quality premium paid to CCGs in 2017/18 will reflect the quality of the health services commissioned by them in 2016/17 and will be based on four national measures (three of which are new, one remaining from the previous year) and three new local measures. The total payment for a CCG based on performance against the four national measures and the three local measures will be reduced if providers do not meet the NHS Constitutional rights or pledges for patients. The total amount possible for CCGs to receive in achievement of the Quality Premium will be £5 per patient in the CCG, according to the same formula as the payment of the running cost allowance. For Darlington CCG this equates to £525,000. The following page includes the new 2016/17 quality premium and highlight the indicators against which the quality premium will be determined, together with the relevant financial value attributed to each indicator. This summary includes a ‘best and worst’ scenario as due to the timing of published data it is sometimes difficult to forecast achievement. There are some new changes to the 2016/17 quality premium to take into consideration: • The four new national measures now cover the following areas: Cancer staging at diagnosis (20%), E-referrals

(20%), achieving a positive experience through the GP Patient Survey (20%) and the fourth has carried on from 2015/16, Improving antibiotic prescribing (10%)

• The three new local measures chosen by Darlington CCG are: Delayed transfer of care from hospital (10%); Emergency admission rates for children with asthma (10%); and Mental Health indictor assessing the estimated percentage of people entering IAPT services who have anxiety/depression (10%)

• Most of the NHS constitutional measures remain the same, except the cancer 2ww standard has now been replaced with the Cancer 62 day urgent GP referral measure. Each NHS constitutional measure is now equally weighted at 25% each.

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National and Local Quality Premium Indicators 2016/17

14

Population 105,548 Potential Fund £527,740

Measure

% of QPValue for

CCGThreshold Published Data Measure Achieved/Forecast Best Worst

20.00% 105,000

Demonstrate a 4% improvement in the proportion of cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and

2 in the 2016 calendar year compared to the 2015 calendar year.Or

2. Achieve greater than 60% of all cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the 2016

calendar year

HSCIC

Need to find out annual 2015/16 figure.Previously published annually, quarterly

data will be available from May 2016. Data will be a rolling window of one

year's worth of data. The data will be lagged by 12 months.

Baseline will not be available nationally until Mar-17.

Comparison Data will not be published until Mar-18.

£105,000 £0

20.00% 105,000

Meet a level of 80% by March 2017 (March 2017 performance only) and demonstrate a year on year increase in the percentage of referrals

made by e-referrals (or achieve 100% e-referrals) Or

March 2017 performance to exceed March 2016 performance by 20%

Numerator: NHS e-referral system

(HSCIC)Denominator: Monthly activity return (MAR)

(NHS England)

Need March 2016’s performance to use as a baseline.

Done on a Monthly basis (two month lag due to lag in MAR data)

Target = 80% by March 2017. Performance up to Jul-16 = 78.2% No new updates as of 15.12.2016

£105,000 £0

20.00% 105,548

Achieve a level of 85% of respondents who said they had a good experience of making an appointment

OrA 3% increase from July 2016 publication on the percentage of

respondents who said they had a good experience of making an appointment

www.ipsos-mori.com

Currently published twice annually, this will become annual in 2016/17.

Publication will be in July representing data collection from January to March.

Baseline = 74% (Released Jul-16 on ipsos-mori website, however

my NHS website showing different figure of 88.1% with caveat: Annual, these results are for fieldwork in January to March

2015 and July to September 2015) Comparison data will not be

published until Jul-17.

£105,548 £0

10.00% 52,774

Part a) a minimum of 4% reduction on 2013/14 performance or equal to (or below) the England 2013/14 mean performance of 1.161 items per

STAR-PU. Part b) to be equal to or lower than 10%, or to reduce by 20% from the

CCG’s 2014/15 value

NHSE Website MonthlyTo Oct-16

Achieving co-amoxiclav elementand antibiotic element

£52,774 £0

Local Measure 1Access to IAPT services: People entering IAPT services as a % of those estimated to have anxiety/depression

10.00% 52,774D'ton CCG propose to achieve 15% against this indicator cumulatively for 2016/17. The baseline performance has been identified as 12.85% and therefore this equates to a 16.7% improvement.

RAIDR MonthlyBaseline: 12.8%. Target = 15%

YTD up to Nov-16 = 19.5%£52,774 £0

Local Measure 2Emergency admission rate for children with asthma per

100,000 population aged 0–18 years10.00% 52,500

D'ton CCG propose to set a target rate of 281.0 against this indicator cumulatively for 2016/17. The baseline performance has been identified as 294.7 and therefore this equates to a 4.7% improvement.

RAIDR MonthlyBaseline: 294.7. Target = 281

YTD up to Nov-16 = 124.09£52,500 £0

Local Measure 3Delayed transfers of care from hospital per 100,000

population aged 18+10.00% 52,774 D'ton CCG propose to report under 500 DTOC per quarter. RAIDR Quarterly

Target = under 500 DTOC per quarter.

Q1 = 520. Q2 = 543 YTD = 1465

£52,774 £0

100.00% 526,370 £526,370 £0

% of QPValue for

CCGException

ReportRTT Incomplete 25% 131,593 93.4% YTD Nov-16

A&E A&E 4 hour target 25% 131,593 94.1% YTD Nov-16 -£131,593 CDDFT ER01

Cancer Cancer 62 day Urgent GP Referral 25% 131,593 74.0% YTD Nov-16 -£131,593 D'ton CCG ER03NEAS Category A Red 1 ambulance calls 25% 131,593 64.3% YTD Dec-16 -£131,593 NEAS ER01

100% 526,370 -£394,778 £0£0 £0

£131,593 £0

Indicator

D'ton CCG

Data Source Achievement Exception Report

Value

Operational Standard Achievement/Current Performance Quality Premium Funding

Adjustment

National Indicators

National Indicators

Cancer

Improving Antibiotic Prescribing

Other Adjustments (adverse variance against planned financial position)Revised Total

E-Referrals

GP Patient Survey

92%

95%

93%

75%

Total Constitutional Adjustment

Local Indicators

D'ton CCG Local Indicator

Total

NHS Consitutional rights and pledges

Indicator

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Glossary NHS Constitutional Indicators TARGET

CCG LEVEL

TRUST LEVEL

ADDITIONAL INFORMATION

Patients on incomplete, routine pathways should wait no longer than 18 weeks from receipt of referral

92.00% Yes Yes

Number of patients waiting more than 52 weeks on an incomplete pathway

0 Yes Yes

Dia

gnos

tics

6 Week Diagnostic tests - patients should wait no longer than 6 weeks for a diagnostic test from date of decision to refer for the test

99.00% Yes Yes

The 6 week target applies to 15 key diagnostic tests: Audiology assessment, Barium Enema, Colonoscopy, CT, Cystoscopy, DEXA Scan, Echocardiography, Electrophysiology, Flexi-sigmoidoscopy, Gastroscopy, MRI, Non-obstetric Ultrasound, Peripheral Neurophysiology, Sleep Studies and Urodynamics.

MS

A

Mixed Sex accommodation (MSA) - number of unjustified breaches

0 Yes No

The focus of this indicator is on MSA breaches in respect of sleeping accomodation. Sleeping accomodation includes areas where patients are admitted and cared for on beds or trolleys, even when they do not stay overnight. It therefore includes all admission and assessment units plus day surgery and endoscopy units. It does not include areas where patients have not

Incidence of MRSA (meticillin-resistant staphylococcus aureus)

0 Yes Yes

Incidence of Clostridium Difficile 17 (CCG

level)Yes Yes

The decision to carry over the 2015/16 objectives has been prompted by the fact that there has been a slight increase in the median CDI rate from the year to November 2014 to the year to November 2015. The current methodology for calculating new CDI objectives relies on requiring organisations that are worse than the median in terms of their rate of CDI to improve by the same amount that the wider median CDI rate hasimproved from one year to the next. If there is no improvement in this wider rate, it cannot be used to calculate revised objectives. It has therefore been decided to carry over the 2015/16 CDI objectives into 2016/17.

Incomplete pathways are waiting times for patients waiting to start treatment at the end of the month. All referrals will be counted as incomplete pathways until a treatment starts, this will then determine whether a patient is on an admitted on non-admitted pathway. A clock starts when any care professional or service refers to a consultant led service or interface/referral management service which might lead to onward referral to a consultant led service. Self-referrals, where the service allows, should also result in a clock start. A clock stops for treatment when first definitive treatment (medical/surgical) starts or a clinical decision is made to refer the patient back to primary care for non-consultant led treatment or where a patient is added to a transplant list.A clock stops for non-treatment when a clinical decision is made not to treat or to start a period of active monitoring. Other non-treatment clock stops include where a patient declines treatment, or a patient DNA’s first or subsequent appointments in accordance to the DNA policy and is discharged back to primary care. 25% of the Quality Premium

DESCRIPTION

Hea

lthca

re A

ssoc

iate

d In

fect

ions

(H

CA

I)R

efer

ral t

o tre

atm

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RT

T)

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Glossary NHS Constitutional Indicators continued TARGET

CCG LEVEL

TRUST LEVEL

ADDITIONAL INFORMATION

A&E 4 hour waits - patients should be admitted, transferred or discharged within 4 hours of their arrival to the A&E department.

95.00% No Yes

A&E activity includes:• Type 1 – Consultant led 24 hour service with full resuscitation facilities• Type 2 – Consultant led single speciality service (i.e. dental)• Type 3 – walk in centre or minor injury unit (MIU)25% of the Quality Premium

12 hour Trolley waits in A&E - no patients should wait more than 12 hours in A&E from decision to admit

0 No YesThe waiting time for admission is measured from the time a decision is made to admit or treatment in the A&E department is completed to the time the patient is admitted.

Category A 8 minute response times - patients who required an ambulance urgently because their condition was considered immediately life threatening should not wait any longer than 8 minutes for ambulance arrival.

75.00% YesYes

(NEAS)

The target is monitored at Trust level (NEAS) but is also available at CCG level. The Category A 8 minute response times indicator is split into two parts, Red 1 and Red 2. • Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions. For Red 1 calls, the existing call connect clock start will remain (when the call is presented to the control room telephone switch), ensuring that patients who require immediate emergency ambulance care will continue to receive the most rapid response.• For Red 2 calls, which are serious but less immediately time critical and cover conditions such as stroke and fits, a new clock start will allow call handlers to get more information about patients so that they receive the most appropriate ambulance resource based on their specific clinical needs. Red 2 clock starts when a vehicle is assigned or 60 seconds after the call is presented. The clock stops when the first emergency responder arrives at the scene. 25% of the Quality Premium

Category A 19 minute response times - patients who required an ambulance to attend urgently but did not have a condition considered immediately life threatening should not wait any longer than 19 minutes for ambulance arrival.

95.00% YesYes

(NEAS)

The target is monitored at Trust level (NEAS) but is also available at CCG level.

The 19 minute clock stops when the first emergency responder able to transport the patient arrives at the scene.

Ambulance handovers - the number of handover delays over 30 minutes long and those over 60 minutes long.

0 Yes NoHandover start time is defined as the time of arrival of the ambulance at the accident and emergency department, with the end time defined as the time of handover of the patient to the care of accident and emergency staff

Cancelled operations - All patients who have operations cancelled to be offered another binding date within 28 days

0 No Yes

When a patient's operation is cancelled by the hospital at the last minute for non-clinical reasons, the hospital will have to offer another binding date within a maximum of the next 28 days or fund the patient's treatment at the time and hospital of the patient's choice.

DESCRIPTION

Urg

ent C

are

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Glossary NHS Constitutional Indicators continued TARGET

CCG LEVEL

TRUST LEVEL

ADDITIONAL INFORMATION

2 week wait standard - maximum 2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

93.0% Yes YesPatients urgently referred with suspected cancer by their GP (General Medical Practitioner or General Dental Practitioner) to be seen within 14 working days. Direct to test (DTT) also counts as a first appointment.

2 week wait breast symptomatic - maximum 2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

93.0% Yes YesPatients urgently referred with breast symptoms whereby cancer is not initially suspected, by their GP to be seen within 14 working days.

31 day first definitive treatment (FDT) standard - maximum of 31 days wait from diagnosis to first definitive treatment across all cancers

96.00% Yes Yes The 31 day clock starts from the date of decision to treat

31 day subsequent surgery treatment target - maximum of 31 days wait for subsequent treatment where the treatment is surgery

94.00% Yes Yes The 31 day clock starts from the date of decision to treat

31 day subsequent drugs treatment standard - maximum of 31 days wait for subsequent treatment where the treatment is an anti-cancer drug regimen

98.00% Yes YesAnti-cancer drug regimens includes: Cytotoxic chemotherapy, immunotherapy, hormone therapy and other specified drug treatments

31 day subsequent radiotherapy treatment - maximum of 31 days wait for subsequent treatment where the treatment is radiotherapy

94.00% Yes YesRadiotherapy treatments include: Teletherapy, proton therapy, brachytherapy and chemoradiotherapy.

62 day Urgent GP referral for suspected cancer - maximum of 62 days wait from urgent GP referral to date of first definitive treatment

85.00% Yes YesMaximum wait of 62 days (2 month) from receipt of urgent GP referral suspecting cancer to first definitive treatment of diagnosed cancer25% of the Quality Premium

62 day NHS Screening standard - maximum of 62 days wait from referral from a NHS screening service to first definitive treatment

90.00% Yes YesMaximum wait of 62 days (2 month) from receipt of a screening referral from a NHS screening service where cancer is suspected, to first definitive treatment of diagnosed cancer

62 day consultant upgrade standard - maximum of 62 days wait for first definitive treatment following a consultants decision to upgrade the priority of the patient from routine to urgent

N/A Yes YesMaximum wait of 62 days (2 month) from the date a consultant has decided to upgrade the priority of a referral from routine to urgent based on a suspicion of cancer, to first definitive treatment of diagnosed cancer

Can

cer W

aitin

g T

imes

(CW

T)

DESCRIPTION

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% of QP

Potential value for

CCG Technical guidance 2016/17

Baseline Measure (Technical Guidance)

Improvement required to achieve (Technical Guidance)

Improving antibiotic prescribing in primary care

10% £52,500

Two part QP:Part a) reduction in the number of antibiotics prescribed in primary care Part b) reduction in the proportion of broad spectrum antibiotics prescribed in primary care

Part a) <1.191Part b) 10 or below

Part a) a minimum of 4% reduction on 2013/14 performance or equal to (or below) the England 2013/14 mean performance of 1.161 items per STAR-PU. Part b) to be equal to or lower than 10%, or to reduce by 20% from the CCG’s 2014/15 value

Cancer 20% £105,000

Demonstrate a 4 percentage point improvement in the proportion of cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year compared to the 2015 calendar year.Or2. Achieve greater than 60% of all cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year

Need to find out annual 2015/16 figure.

Previously published annually, quarterly data will be available from May 2016. Data will be a rolling window of one year's worth of data. The data will be lagged by 12 months.

Baseline will not be available nationally until Mar-17. Comparison Data will not be published until Mar-18

4% improvement from 2015 to 2016 OR 60% of all cancers to be diagnosed at stage 1 or 2 from Jan-16 to Dec-16

E-Referrals 20% £105,000

Meet a level of 80% by March 2017 (March 2017 performance only) and demonstrate a year on year increase in the percentage of referrals made by e-referrals (or achieve 100% e-referrals) OrMarch 2017 performance to exceed March 2016 performance by 20 percentage points.

Need March 2016’s performance to use as a baseline. Done on a Monthly basis (two month lag due to lag in MAR data)

Meet 80% in March 2017 and demonstrate year on year increase in % or achieve 100% e-referralsor 20% improvement from March 2016 to March 2017

GP Patient Survey 20% £105,000

Achieve a level of 85% of respondents who said they had a good experience of making an appointment OrA 3 percentage point increase from July 2016 publication on the percentage of respondents who said they had a good experience of making an appointment

Baseline = 74% (Released Jul-16 on www.ipsos-mori.com) Comparison data will not be published until Jul-17

85% of respondents to answer ‘Very good’ or ‘Fairly good’ to Q18 of the survey. OR3% increase from July 2016 to July 2017 answering the same question.

Access to IAPT services: People

entering IAPT services as a % of those estimated to

have anxiety/depression

10% £52,500

D'ton CCG propose to achieve 15% against this indicator cumulatively for 2016/17. The baseline performance has been identified as 12.85% and therefore this equates to a 16.7% improvement.

Emergency admission rate for

children with asthma per

100,000 population aged 0–18 years

10% £52,500

D'ton CCG propose to set a target rate of 281.0 against this indicator cumulatively for 2016/17. The baseline performance has been identified as 294.7 and therefore this equates to a 4.7% improvement.

Delayed transfers of care from hospital per

100,000 population aged 18+

10% £52,500D'ton CCG propose to report under 500 DTOC per quarter.

NATI

ONAL

LOCA

L

Local Indicators are not detailed within technical guidance

Measure

Glossary Quality Premium

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NHS Darlington Clinical Commissioning Group and NHS Hartlepool and

Stockton-on-Tees Clinical Commissioning Group Governing Body

Agenda Item: 2.1.3

7 February 2017

Title Quarterly Clinical Quality Update (Governing Body)

Purpose Approval ☐ Discussion ☒ Information ☒

Responsible CCG Member / Lead

Diane Murphy, Chief Nurse, NHS Darlington Clinical Commissioning Group

Author of Report Daniel Webber, Senior Clinical Quality Officer, North of England Commissioning Support Diane Murphy, Chief Nurse, NHS Darlington Clinical Commissioning Group

Recommendation(s) The Governing Body is asked to;

• receive and consider the report, • agree that necessary actions are being taken forward with the respective organisations to improve quality and experience for patients.

Executive Summary

The purpose of this report is to provide Darlington Clinical Commissioning Group (CCG) Governing Body with an update of current issues (by exception) relating to the quality of services and their impact on patient experience. Patient Experience - CCG Formal complaints, concerns & compliments - In December 2016, there were two formal complaints received by the NECS Complaints Team on behalf of Darlington CCG. County Durham and Darlington NHS Foundation Trust (CDDFT) NHS England - North Region Quality Dashboard - The latest NHS England Quality Dashboard received in December indicates CDDFT are flagged as an outlier for Elective Emergency re-admissions, Never Events and CAS patient safety alerts. Healthcare Associated Infections (HCAI) - The latest published data shows CDDFT reported 1 case of C. difficile in November. 86 of 570

NHS Safety Thermometer The latest data published in December (November data) shows CDDFT as similar to the national average for Harm Free care. South Tees Hospitals NHS Foundation Trust (STHFT) NHS England - North Region Quality Dashboard- The NHS England Quality Dashboard received in December shows STHFT as outliers for Central Alerting System (CAS) patient safety alerts and cases of MRSA. Health Care Associated Infections (HCAI)- The latest published data shows STHFT reported five cases of C. difficile in November. The Trust remains better than trajectory with a total of 29 reported cases so far in 2016/17. NHS Safety Thermometer- The latest data published in December (November data) shows STHFT performing to a similar rate to the national average for Harm Free Care. Tees, Esk and Wear Valleys NHS Foundation Trust (TEWVFT) NHS England Mental Health Quality Dashboard- The NHS England Quality Dashboard received in December indicates that TEWVFT are an outlier for consistency of reporting to the National Reporting and Learning System. NHS Safety Thermometer- The latest data published in December (November data) shows that TEWVFT are performing better than the national average for harm free care across all indicators with the exception of falls with harm despite showing improvements in November. North East Ambulance Service NHS Foundation Trust (NEASFT) and 111 Service Emergency Care Performance- Latest validated figures for Emergency Care Performance across all three indicators continued to be below national targets.

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

The report addresses some of the risks identified within the CCG risk register.

Has an Equality Analysis been completed?

N/A

Attachments Clinical Quality Update

Darlington CCG strategic objectives supported by this report

Objective Domain Tick

1. Well-led Organisation To be well-led and governed ensuring continuous development of the CCG

☐

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2.

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

3.

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

4. Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☒

5.

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

Other Committees/Meetings where this report has been presented

The report has not been to any other committee although the information contained within it has been presented to a number of different meetings (CQRGS/QPI)

Does this need to be reported to another Committee/Meeting?

No

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HaST CCG strategic objectives supported by this report Objective Tick 1. To be well-led and governed ensuring continuous development of the

CCG, enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☐

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒

3. Delivery of financial balance including the 1% surplus and delivery of value for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with

partners, including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☐ 7. Delivery of the CCG’s delegated functions including joint commissioning

of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

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Clinical Quality Update

1. Background The purpose of this report is to provide Darlington Clinical Commissioning Group (CCG) Governing Body with an update of issues relating to the quality of services and their impact on patient experience. It also includes information relating to compliance against national and local standards. Where key issues, risks and areas of concern are identified these are challenged through the respective Clinical Quality Review Groups (CQRGs). A summary of the discussions which have taken place at the CQRGs is also included within the report to provide assurance of the actions being taken forward. 2. Discussion, implications and risks The primary areas of interest, concern or risk for Darlington CCG are as follows: 2.1 Patient Experience - CCG Formal complaints, concerns & compliments In December 2016, there were two formal complaints received by the NECS Complaints Team on behalf of Darlington CCG. One related to an unsuccessful outcome of a CHC claim and the other was from a legal representative of a patient who was unhappy that they did not meet the triggers to warrant further CHC assessment. 2.2 Acute & Community Services This section provides, where known, the quality intelligence for CDDFT and South Tees Hospitals NHS Foundation Trust (STHFT). 2.2.1 County Durham and Darlington NHS Foundation Trust (CDDFT) NHS England - North Region Quality Dashboard The latest NHS England Quality Dashboard received in December indicates CDDFT are flagged as an outlier for Elective Emergency re-admissions, Never Events and CAS patient safety alerts (alerts which are not showing as ‘action complete’ over the last 12 months). The Trust is achieving below the national average for A&E 4 hour waits and Cancer 62 day waits. Key actions: The above exceptions continue to be challenged and monitored at the CQRG and contract review group. A&E performance improvement is overseen by A&E delivery board. Healthcare Associated Infections (HCAI) The latest published data shows CDDFT reported 14 cases of C. Difficile as at December meaning the Trust are 2 cases under Trajectory in 2016/17. 2 cases of MRSA bacteraemia have been reported against an ambition of zero.

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NHS Safety Thermometer The latest data published in December (November data) shows CDDFT as similar to the national average for Harm Free care. The Trust is showing as higher than the national average for falls with harm for the last reporting period. This is monitored closely at CQRG and in addition each case is subject to a Root Cause report which is scrutinized by the designated nurse for adult safeguarding. The latest data shows the Trust remain significantly lower than the national average for Pressures Ulcers and VTE. Never Events The Trust Action plan for the 7 Never Events was presented to CQC in November. The Trust continues to implement these actions and expects completion in February. Cancer Breaches At the QRG in December the Trust shared an action plan for Acute Oncology Service (AOS) and Carcinoma of Unknown Primary (CUP) following a peer review. For AOS there were 6 areas of concern relating to:

• dedicated oncologists time to review patients, • dedicated time for AOS lead clinician, • fast track referral protocol for A&E, • admin support for oncology training • No flagging system to alert staff to patients who have had cancer related treatment

within last 6 weeks.

For CUP there were 4 risks and 2 areas of serious concern relating to:

• No formalised CUP service, • No designated CUP MDT in place, • No designated consultant in palliative medicine to provide assessments • No allocated time in consultant’s job plan for face to face assessments.

Key actions: The action plan to be monitored through the QRG. Maternity services Multiple births continue to be managed by South Tees hospitals with clinical leadership provided to CDDFT. Ladies are managed at CDDFT antenatally and are delivered at JCUH (or another provider of their choice). Leadership posts have been filled and training has been commenced for the CDDFT Foetal medicine lead, this will take circa 18 months to complete including a period of embedding practice. As a consequence it is not expected that changes to the current pathway will be made before 18 months. The level of quality surveillance has been de-escalated in agreement with NHSE and NHSI with routine monitoring at CQRG now in place. 2.2.2 South Tees Hospitals NHS Foundation Trust (STHFT)

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NHS England - North Region Quality Dashboard The NHS England Quality Dashboard received in December shows STHFT as outliers for Central Alerting System (CAS) patient safety alerts and cases of MRSA. The Trust was however flagged as below the national standard for cancer 62-day wait (urgent GP referrals) and Cancelled Ops-28 day target Key actions: The above exceptions continue to be challenged via the South Tees Performance Clinic and Contract Review Group. The Trust has an extensive action plan in place to improve the MRSA position with a particular focus on equipment cleaning regimes. STCCG Head of Quality and Safeguarding attends the Infection Prevention Action Group and works proactively to support the Trust in delivering the required improvement. Health Care Associated Infections (HCAI) The latest published data shows STHFT reported five cases of C. difficile in November. The Trust remains better than trajectory with a total of 29 reported cases so far in 2016/17. There were no reported cases of MRSA in November. NHS Safety Thermometer The latest data published in December (November data) shows STHFT performing to a similar rate to the national average for Harm Free Care. Falls and VTE were below the national average. Pressure Ulcers were slightly above the national average for November data. Cancer Breaches South Tees CCG is establishing a group to focus on Cancer improvement which will include the 104 day backstop review process to gain assurance. The Trust cancer action plan has been refreshed with more focus on delivering improvement targets for outcomes rather than processes. The cancer programme manager is now in post and dedicated service improvement capacity has been secured with initial focus on the lung and head and neck pathways. 2.3 Mental Health Services 2.3.1 Tees, Esk and Wear Valleys NHS Foundation Trust (TEWVFT) NHS England Mental Health Quality Dashboard The NHS England Quality Dashboard received in December indicates that TEWVFT are an outlier for consistency of reporting to the National Reporting and Learning System (NRLS) and are below standard for the proportion of discharges from hospital followed up within 7 days NHS Safety Thermometer The latest data published in December (November data) shows that TEWVFT are performing better than the national average for harm free care across all indicators with the exception of falls with harm despite showing improvements in November. New VTEs and UTIs in patients with a catheter were both reported as harm free in November. Children & Adolescent Mental Health Services (CAMHS) Access & Waiting Times

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The service has struggled to meet the waiting time target and previous initiatives achieved short term impact which resulted in staff managing high caseloads. Longer term initiatives included implementation of a single point of access, daily team huddles to provide access to support and guidance, improvements to case load management and activity planning. 2.3.2 North East Ambulance Service NHS Foundation Trust (NEASFT) and 111

Service Emergency Care Performance Latest validated figures for Emergency Care Performance across all three indicators continued to be below national targets. NEAS performance is still under target in 2016/17, and reports a declining position from the previous month for both the 8min indicator (53.8%) and 19 min indictor (82.8%) in Dec-16. This in turn has decreased the YTD position to 64.3% and 90.4% respectively. Darlington CCG reported under achievement of both indicators in Dec-16 and continues to be non-compliant at the year to date position at 72.2% and 85% respectively. NEAS continue experience delays in ambulance handovers leading to lost capacity across the North East. Modelling suggests that if the North East was able to eradicate handover delays that it would result in a c4% improvement in ambulance response times. Clinical Hub: The Trust announced a realignment of the current three Clinical Hubs to into two hubs across the NEASFT footprint, one for North and one South. Sickness Absence NEASFT reported to the Contract Meeting on 28 October 2016 that the Trust absence rate rose to 7.03% in September. Key actions: A working group has been established and 12 works streams identified to review and improve performance. Included in the work streams is a focus on the Nature of Call (NOC) with a view to improving Red 1 performance and the move to the new code change in April 2017. An update on progress against the emergency recovery action plan has been requested at the 999 contract/quality review group meeting on 25 November 2016. CQRG continue to focus on quality impact of performance and identifying areas to improve quality. A&E delivery boards are leading a whole system/cross organisation approach to improvement of performance. Care Homes There is currently one care home in Local authority escalation. A joint visit has been undertaken by the Local Authority and CCG Chief Nurse and designated adult safeguarding nurse which showed improvements and gave assurance of safety of residents. The home has since been subject to a CQC visit and that report is awaited.

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3. Recommendations The CCG Executive Team is asked to:

• Receive and consider the report, • Agree that necessary actions are being taken forward with the respective

organisations to improve quality and patient experience.

Authors: Dan Webber, Senior Clinical Quality Officer, North of England Commissioning Support Unit (NECS)

Diane Murphy, Interim Chief Nurse, NHS Darlington CCG Sponsor and Executive lead: Diane Murphy, Interim Chief Nurse, NHS Darlington CCG Date: 23 January 2016

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.1.4

7th February 2017

Title Darlington Governance and Assurance report

Purpose Approval ☐ Discussion ☐ Information ☒

Responsible CCG Member / Lead

Graeme Niven, Chief Finance Officer

Author of Report Graeme Niven, Chief Finance Officer

Recommendation(s) The Governing Body is requested to receive the Governance and

Assurance Report;

Executive Summary

The report provides detail on significant governance and assurance issues since the last Governing Body meeting and provides assurance to the Governing Body of the CCG on delivery of key governance processes.

Clinical Engagement

Not Applicable

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

This report directly relates to the assurance framework and risk register by its very nature.

Has an Equality Analysis been completed?

Not Applicable

Attachments Governance and Assurance report Darlington Risk Register

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Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☒ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☒

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☒ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☒ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None

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Darlington CCG Governance and Assurance Report 1 Purpose 1.1 The purpose of this document is to;

• Report on significant governance and assurance issues since the last

Governing Body meeting.

• Provide assurance to the Governing Body of the CCG on delivery of key governance processes

2 Risk Register

2.1 Four risks are currently classified as being high risk:

Risk 1101 - CCG experiences higher than planned premises costs due to current arrangements for funding void space. Increased level of void space due to the relocation of services - under current NHS England guidance the CCG is responsible for paying NHS Property Services for void space. Financial pressure for CCG Risk 1501 - CCG is unable to deliver financial plan for 2016/17 Risk 1529 - NEAS have consistently failed to deliver on ambulance response targets at both Trust and DCCG level NEAS performance throughout Aug-15 toMar-16 was reported below the operational standard for both 8 minute response times and 19 minute response times. Risk 1530 - Failure to meet cancer 62 day performance objective Darlington CCG failed to achieve the 62 day target since September 2015 These risks are being actively managed and updates being presented to the Governing Body.

2.2 A review of the full risk register is scheduled to be undertaken ahead of the

Audit and Risk Committee in March. A full copy of the Darlington CCG risk register is attached to this report.

3 Policy Framework 3.1 The CCG continues to review all of its policies to ensure that it complies with

relevant legislation and good practice by reviewing policies in accordance with the specified review date, or earlier where required.

3.2 One corporate policy was approved by the Governance, Audit and Risk

Committee at their meeting on December 5th, the serious incident management policy.

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3.3 Due to the change in governance arrangements, approval of all CCG policies will be made by the Governing Body. The executive team will recommend policies for approval by the Governing Body and this will be reported in this Governance and Assurance Report in the future. Significant policies will still be approved separately by the Governing Body where they relate to core responsibilities, such as Standards of Business conduct and Declarations of Interest Policy.

4 IG Toolkit 4.1 The Information Governance Toolkit is a performance tool produced by the

Department of Health (DH) that draws together the legal rules and guidance that the CCG is required to comply with in one place as a set of information governance requirements. The purpose of the assessment is to enable organisations to measure their compliance against the law and central guidance and to see whether information is handled correctly and protected from unauthorised access, loss, damage and destruction.

4.2 The CCG is currently ensuring it has the required evidence to demonstrate compliance with the requirements. At the Governance, Audit and Risk Committee on 5th December 2016, the IG Annual report, IG management Framework and IG Strategy were all approved. The Governing Body will be asked to formally agree the CCG’s level of compliance before submission by the Chief Finance Officer as Senior Information Risk Owner before the deadline date of 31st March 2017.

5 Recommendations 5.1 The Governing Body is requested to;

• receive the Governance and Assurance Report;

Graeme Niven Chief Finance Officer HAST CCG February 2017

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Description

NHS Darlington CCG Risk Register30/01/2017

Gaps in controlsDomain

142 Introduction of tariffs forMental Health Services

New tariffs for MentalHealth Services introducegreater financial risk tocommissioners. Cost ofmental health servicesbased on a tariff basis ishigher than existing blockcontract value and is notaffordable to the CCG

03/05/2012 LisaTempest

LisaTempest

3 4 12 22 4Work ongoing with providers andNECS to understand any impact andmitigate through an appropriatecontract.Ring fence arrangements for mentalhealth budgets in place for 2015/16 toreduce the financial risk of futurechanges to payment mechanismPBR process will be based on "cost"rather than a "price" based tariff whichmeans that the current budget will formthe total cost of services and amemorandum of understanding to thiseffect will form part of the contractagreement.Monitor have published a consultationdocument on local payment rules forMH, Darlington submitting combinesresponse with Durham and Tees CCGs

Oversight of impact of tariffson CCG budget by FinanceCommittee

Awaiting affordablecontact updateand details onmental health tariff

Action Plan CCG and TEWV developing ring fencingarrangements for Mental Health funding tomitigate risk of introduction of PbR tariffsand impact of Winterbourne.

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erformance

1101 CCG experiences higherthan planned premisescosts due to currentarrangements for fundingvoid space

Increased level of voidspace due to the relocationof services - under currentNHS England guidance theCCG is responsible forpaying NHS PropertyServices for void space.Financial pressure for CCG

22/09/2014 LisaTempest

LisaTempest

4 5 20 44 16Joint Estates Group comprising CCGs,CDDFT and NHS PS representativesfor Durham and Darlington to beconvened to discuss premises issuesand plans for property in Darlingtonand Durham to enable better planningto take place for disposal/identificationof new tennants for void space.NECS to review community contract toidentify the amount of funding currentlytransferred to CDDFT for premises asagreed under TCS. Contract valueshould be reduced when CDDFT leavepremises to enable CCG to fund voidspace - NHS PS seeking legal adviceon this position.2016/7 financial plan includes fundingfor voids/subsidies in line with latestNHS PS estimate - £449k.Exit plan for DPH in 2019 to bedevelopedIssues re NHS PS charging for spaceoccupied by third parties to CCGsescalated to NHSE in Sept 16 -21/11/16 - response awaited

Finance Committee tomonitor financial impact ofproposed changes

No writtenagreement fromCDDFT that theywill agree toreduction incontract values forpremisesNo strategic planfor estates inDarlington No incentive forNHS PS to identifynew tennants forvoid spaceAdditional voidcost for 2016/7due to HealthVisitor serviceleaving DPHawaited, estimateis £250k

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1501 Ability to deliver 2016/7financial plan

CCG is unable to deliverfinancial plan for 2016/7

14/03/2016 LisaTempest

LisaTempest

4 4 16 44 16Financial plan developed to meet allbusiness rules Full year effect of 2015/6 costsincorporated into plan with realisticexpactations of growth and costinflationTriangulation to be performed withprovider plans for acute activityQIPP plan developed based onbenchmarking, BCFplans andRightcare data pack Reporting and monitoring of QIPPdelivery to be enhancedFinancial Recovery Plan developedand submitted to NHSE E on 22/7

Finance Committee tomonitor financialperformanceFinancial Recovery group inplace with CDDFT, meetingon a monthly basis

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Description

NHS Darlington CCG Risk Register30/01/2017

Gaps in controlsDomain

Monthly financial monitoring meetingswith NHSEQIPP delivery and reporting issuesescalated to NECS leadership teamwho have agreed to review processesand NECS QIPP offer

1502 Impact of local authorityfunding cuts on healthservices and costs

Darlington local authorityhas announced proposalsto decommission serviceswhich are likely to impacthealth services and CCGcosts

14/03/2016 LisaTempest

LisaTempest

3 5 15 43 12DBC to share plans fordecommissioning and reducingservicesCCG to determine impact on healthservices and possible mitigation -report to be presented to Exec in April16Formal response to proposed cuts sentto DBC by CCG to highlight concernsand risksFinal impact assessment to beundertaken as DBC plans finalised, tobe considered at Exec in August

Exec to consider impact andmitigation

Impact on healthservices and costsnot yet clarifiedand quantified

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1529 NEAS have consistantlyfailed to deliver onambulance repsonsetargets at both Trust andDCCG level

NEAS performancethroughout Aug-15 toMar-16 was reported belowthe operational standardfor both 8 minute responsetimes and 19 minuteresponse times.

20/04/2016 LisaTempest

LisaTempest

4 5 20 54 20NEAS have provided commissionerswith a recovery plan setting out actionsalready undertaken or underway tocontribute to improving emergencycare performance, as well as tomitigate systems pressure/weather andprotect a level of performanceContract negotiations for 2017-9 tofocus on identifying further initiatives toimprove performance

LADB monitoring deliver ofrecovery plan

QRG and contract meetingsreview performance andactions in response

Improvement trajectory agreed forperformance in 2016/7

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erformance

1530 Failure to meet cancer 62day performance objective

Darlington CCG failed toachieve the 62 day targetsince September 2015

20/04/2016 LisaTempest

LisaTempest

4 5 20 53 15Patient level breach analysisundertaken for all failures to indentifyroot cause and actions required toadddressCancer Locality and Operations Groupmeetings in place to provide a forumfor Providers and Commissioners tomeet and progress/resolve issuesCancer Network preparing timelines forthe major tumour sites which will give aguide as to how quickly each stepneeds to be undertaken to achieve the62 day targetDarlington CCG Cancer Plan indevelopmentRegional Task and Finish group inplace to review breast services

Provider performancemonitored by ContractManagement Boards

Timed pathwayswill not address orhighlight capacityissues in beingable to deliveragainst thatpathway

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erformance

1090 Unexpected CostPressures realting toLearning Disabilites(non-winterbourne) andMental Health patientsdischarged fromSpecialised MH services to

03/09/2014 LisaTempest

DianeMurphy

3 3 9 33 9Data sharing issues to be raised withthe Area Team following RegionalNetwork Meeting (issue is specific toDDT)

Joint Commissioning support teampicking up additional functions tosupport maintenance of current

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Description

NHS Darlington CCG Risk Register30/01/2017

Gaps in controlsDomain

CCG funded Services

Barriers to informationsharing between CCG'sand Specialised Services tosupport futurecommissioning of MH andLD services resulting inhigh cost individualpackages of careLimited resoruces includingclinical support to maintainthe current inpatient list,attended CPA's/reviewsand facilitate discharge ofpatients with Mental Healthand Learning Disabilities.While LD/MH patients areinpatients within an IShospital they are theresponsibility of NHSEngland, however ondischarge they become theresponsibility of the CCG.The CCG's (and NECS)are not being made awareof the patients and theirindividual needs in a timleymanner meaning thathigher cost packages ofcare may be required atshort notice to ensure thatdischarges for the patientinto the community are notdelayed.

inpatients

List of 21 potential packages identified- currently being reviewed to determinepotential cost and timing. Meeting withDCC held in Jan 16 to discuss dowryarrangements

regular meeting with specialisedcommissioning team ( Chief Nurse) (bi monthly) and updates given on allpatients in the system.

7 Failure to adhere to theWinterbourne ViewConcordat. CCG is at riskof not meeting NHSEngland's target ofdischarge of 50% patientsby March 2016

Needs of patients, carersand quality of placementsare not considered fully inthe planning of clientsfuture care.Inappropriate care plansand placementsPotential increased costsPatients may not havebeen kept safe

04/03/2013 DianeMurphy

DianeMurphy

3 2 6 23 6Apply learning from initial stocktakeshare experience acrosscommissioners both LA/NHS

internal review undertaken by Lizgraham for the 4 darlington patientsinvolved. i of the patients does requirevery specilised care planning

Patient plans reviewed withdue advocacy and allpatients have been placedappropriately. The care planof the one patient whoneeds specialist careremains under closereviewed and monitoring

a weekly tracker at individual pateintlevel is prepared and subitted by NECS( Donna Owen as lead) to CCG ChiefNurse.LD tracker meetings held fortnightlywith NECS to review progress atinividual client and CCG level. Meeting being set up with LD leads andChief Nurse and AO to review detail(patient story) for each client to ensureunderstanding of issues/history Tracker submissions to NHSE

Tracker reports receivedweekly

Action Plan Lisa

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Description

NHS Darlington CCG Risk Register30/01/2017

Gaps in controlsDomain

Fortnightly tracker meetings in placewhere activity for each CCDG at Clientlevel is reviewed to ensurerequirements in place to meetdischarge dates and ensure CTRs inplace . Chaired jointly on a rota byChief nurses across Durham and tees.

weekly updates now given to NHSEand issues identified early forresolution

fortnightly tracker reprots recived.

845 CDDFT Performance inA&E Handovers

CDDFT continues toexperience constant highlevels of handover delaysresulting in poorperformance in relation tothe ambulance handovertarget. CDDFT account for52% of the 30-60minutewaits and 61% of th over60minute waits whenanalysed against the NEASYTD total figures. Patientswith delayed clinicalassessment and treatment, potentially impcts onoutcomes and experience,ambulances queuing andwhich affects NEAS abilityto respond to emergencycalls

10/02/2014 LisaTempest

LisaTempest

4 5 20 43 12The NECS Winter Alliance Team areworking with CDDFT to develop anaction plan for feedback to the AreaTeam, highlighting key initiatives toaddress handover delays

Additional winter monies have beenallocated to NEAS and CDDFT tosupport close management of patientflow from the Ambulance Handoverqueue into urgent/emergency care andadditional PTS discharge ambulancesupport for UHND to transport patientswho are being discharged from hospital

regualr review in place at both CQRGand contract monitoring whereperformacne is reviewed and actionsreviewed/agree

Oversight of performance by local A&Edelivery board

Action Plan CDDFT have confirmed their intention toimplement 'quick win' recommendationsfrom the recent ECIST review to improvepatient flow and reduce pressure 'Front ofHouse'

Action Plan CDDFT Front of House Task Force havebeen asked to ensure that therecommendations from a recent jointlycommissioned review of handover andturnaround issues (the Pease Report) aretaken into account in the A&E ImprovementPlan

Action Plan CDDFT agreed that all ambulancehandovers delayed for two hours or morewill be reported as a serious incident

Jackie Kay Action Plan CDDFT are refreshing thier ECIST work tobe completed by end of September 2015which includes focus on UC and A&E. Thiswill be reported through the SRG.

Jackie Kay Action Plan as a result of implementing the "perfectweek" no handover delays were recordedwith achievement of A&E 4 hr target .Perfect week in DMH takes place 9 Dec 15

Action Plan Funding given to CDDFT by DDES tosupport additional nursing to support timelyambulance handovers

Action Plan

LisaTempest

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1554 Limited Intermediate Care /Community Bed Capacityin Darlington

Existing care home hasbeen sold to new provider

12/05/2016 LisaTempest

LisaTempest

3 4 12 33 9Monitor performance of currentprovidersExtend contract with Ventress Hall for 1yearSource additional intermediate careprovision in short term

QPI to monitor existingservice provisionUnit of Planning to overseedevelopment of longer termstrategy

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Description

NHS Darlington CCG Risk Register30/01/2017

Gaps in controlsDomain

with no local track record ofservice provisionCCG unable to deliver2020 vision due to lack ofintermediate care provision

Explore alternative models throughHealthy New Towns initiativeIntermediate Care services acrossDarlington to be subject to externalreview to take place in Q3 as part ofreview of all BCF services

970 Absence of a structuredprogramme fordevelopment of theorganisation

OD plan not aligned to thestrategic direction andpriorities of theorganisation and willimpact negatively on theperformance of individualsand delivery of theorganisation strategic aimsand goals.Without a structured andresourced organisationdevelopment programmethe business of theorganisation will not bedelivered in the mosteffective way and the staffwill not perform to secureoptimal businessoutcomes. The capacityand capablility of theorganisation will fall shortof the ambition andpriorities of the CCG.

20/05/2014 Jackie Kay

Jackie Kay

3 3 9 23 6Executive lead identified for thedevelopment of the OD plan.OD plan is regularly refreshed toensure fit with organisation priorities.

Reporting to the Exec 6monthly and GB annually

External resource has been secured toundertake interviews with CCG staffand member practices to inform ODplan. Results of 360 survey will be usedin this exercise

Report will be provided toExec in late July to enableOD plan to be revised

Refresh of the OD plan following GBand MA agreement of the taks grouprecommendations. OD plan to alsorelfect findings from the Dawn Parkin121 interviews and the 360 degreesurvey

Refreshed OD plan to besigned off by the EXec andGB

OD plan priorities shared with GB indevelopment session 2nd February2016. Full version of OD plan with outcomesand actions to go to GB in April 2016

Refreeshed OD plan to go toformal exec as needsfinancial committment andthen to GB

GB development sessions and Exec tohelp shape and endorse refreshedplans

GB development sessionApril and infromal exec endMarch to review refreshedplans alongside the newemerging CCG assessmentframework

Jackie Kay Action Plan Refresh OD plan

Martin Howe Action Plan OD plan to be fully costed costed andresourced

Jackie Kay Action Plan Annual cycle of business to include OD planoversight at Exec and GB

Jackie Kay Action Plan GB development session in April 2016 todevelop OD plan and priorties. Plan needsto fit with new CCG assurance frameworkand potentila review of strategic aims.

Jackie Kay Action Plan Need to review timing of refresh owing torecent joint appointment of CO for DCCGand HAST CCG.

Jackie Kay Action Plan OD plan to refresh in line with the new jointmanagement arrangements which go liveDecember 2016/January 2017

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rganisation

1136 Decisions made by theCCG are not clinicallyinformed

Lack of clinical capacityand committment toengage from clinciansprimary care and memberrepresentatives. Decisonsmade without clincialinvolvement andengagement

12/11/2014 Jackie Kay

Jackie Kay

4 4 16 24 8Chair heading work with extendedCLG. Members and PHD to consolidatepriorities and secure maximum impactof clinical capacity

Recruiting Medical Director

Advertising for Salaried GP to releasecapacity

Develop co-working arrangements forPHD

Evidence of clinicallyinformed decision -discussion at CLG/allmembers meeting forexpression of interest recommissioning primary care

Clinical Lead rolesto be properlycodified withobjectives,measures andtimescales

Task group established from MembersAssembly to look at 4 key areas andmake recommendations back to fullMemebers assembly in September andthen for GB approval

Task group dates set andadditional resource identifiedto support the task group

Summary of actions and action plantaken through Governing Body andalso Members Asembly(/NovemberDecember 2015 andJanuary 2016). 4 workstreams established in february2016- workstreams headed up by

Apporach endorsed bymembers assembly

1 workstreamleads not as yetidentifed

Jackie Kay Action Plan Dawn Parkin consultant to do 121interviews with CCG staff, member reps,Lay members.Report and findings to inform andsupplement the 360 survey to informdecions of the task group and exec

Jackie Kay Action Plan Task group to remain in place to overseeimplementation of recommendationsagreed by GB and MA

Jackie Kay Action Plan to identify clinical workstream leads forMH/LD

Jenny Steel Action Plan Workstream leads to review clinical leadsprevious and those required for identifiedpriorities

Jackie Kay

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Gaps in controlsDomain

workstream clinical leads

Workstream development sessions tobe held in February to early March todefine key outcomes and targets andschemes of to deliver. Use logic modelapproach to produce a plan on a pageby end March 2016

Additional clinical leadership secured inthe form of workstream clinical leadsand also Exec GP for Transformationas a new role from March 2016. Chair of members assembly also nowpart of the GB membership

Evidence of clinicianspresent at workstreammeetings and exec and GBmeetings where decisionsare made

Review of clinicalleads for specifiedareas of priorityremainsoutstanding

1411 System Resilience plans donot mitigate the demandson the system

The plans do notadequately enable thesytstem to cope with peaksin demand over the wintermonths and surgegenerally

21/09/2015 Jackie Kay

Jackie Kay

4 4 16 34 12CCG has direct involvement with theCD&D SRG which has oversight of thewinter plans and assurance of winterplans. Exec lead identified for systemresilience.

SRG minutes Papers to CCG exec, GBand Darlington HWB BoardNHS England selfassessment for systemresilience

SRG has asignificant agendaand extendedresponsiblities

SRG reported through to the Darlingtonunit of planning as well as exec vialead.

Reporting of SRG throughUoP established. In hospitalworkstream also providestwo way flow between SRGand CCG.

Issues wrt NECSSRG leads notdirectly linked tothe Darlingtonlocal issues wrtDTOC, perfectweek andmanaging demandas well as localdevelopments forthe UC/OOHservices

Jackie Kay Action Plan SRG to review its membership and agendato ensure its reposnsibilities are adequatelycovered. ACO to influence where possible

Jackie Kay Action Plan Agree a mechanism for reporting back fromSRG to the CCG Exec

Kathleen Berry Action Plan Risk register established for the SRG

Jackie Kay Action Plan CCG part of the weekly winter calls withproviders, NECS and CCGS, LAs and NHSEngland. Weekly SRG calls in place and frequencystepped up when in surge

Jackie Kay Action Plan Analysis of impact of winter schemes toinform planning

Lorrae Rose Action Plan NECS resource to be identifed for inhospital workstream linked to the SRGpriorities and activities

Jackie Kay Action Plan Revised winter schemes commissioned tosupport winter and surge.

Jackie Kay

09/11/2016

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1745 Primary care unable tomaintain quality of servicesdelivered.

Significant workload shiftfrom secondary care toprimary care affecting theway in which primary careare able to manage needsof the registered population

09/11/2016 JennySteel

JennySteel

3 3 9 32 6Work on-going to develop a resilientand sustainable primary care.Access to resilience programmesupport from NHSE

Oversight via Executive.Discussions with practicemembers at MembersAssembly

Lack of clarity wrtC2C referralspolicy and itsimpact. Alignmentwith ambitions ofthe GPFV need tobe worked through

Jackie Kay Action Plan Check C2C policy and status

Jackie Kay Action Plan Understand the contract implications for theGPFV wrt workload shift and ensure this iscarried forward in the contract round for2017/18 with FT providers

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Gaps in controlsDomain

1636 SEND - CCGresponsibilities

CCG have responsibliltiesin repect of SENDrequirements and currentlydo not meet the standardsdescribed

11/08/2016 DianeMurphy

DianeMurphy

4 3 12 33 9NECs Children's joint commissioningmanager has completed a selfassessment of SEND responsibilitiesand identified areas of compliance andareas that require action,SEND steering group establishedoverseeing strategy development andpreparedness for inspection.

joint work is in progress withDarlingotn Borough Counciland a SEND steering groupestablished with NECs andChief Nurse representaion.Paper has been received atFormnal exec.

The SEND agendais a developingagenda in respectof achievingstandards

Ruth Kimmins Action Plan The SEND action plan requires regularupdating and reporting to formal exec.

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1568 Risk of judicial DoLs

Assessment of number ofpotentail cases acrosscounty Durham andDarlington is 90 cases ofwhich 10 have beenconsidered to be urgent.There are no specificnumbers as yet forDarlington.

24/05/2016 DianeMurphy

DianeMurphy

3 3 9 33 9The Adult safeguarding team areworking with the Continuing Healthcareteam and LA partners to identifypatients/client at risk and seekingindependent support to manage theprocess through the legal framework .Audult safegauring reports recived atQPI

Audult safegaurdingdesignated nurse is aprt of aregional/natinla networkwhere it has been advisedthat nationally there has benvery few cases taken up byway of legal challenege,

No Darlingtonspecific dataprovided to date atQPI no action planreceived

Sue Nuttall Action Plan CHC/Adult Safeguarding leads to developan action plan for review at QPI

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1610 Primary care workforcesustainability

There are recognisedchallenges in GPrecruitment and practicenurse recruitment in theface of national shortages.

26/07/2016 DianeMurphy

DianeMurphy

3 4 12 33 9Monitoring of risk events via SIRMS toidentify risk events

Regular review of sirmsevents

NHSE quality monitoring Primary care commissioningcommittee receive updates

reports not yetrecived by DCCG

Action Plan 20:20 vision acknowledges workforcechallenges and seeks to go some way tomaximising resources and also makeDarlington an attractive place to work forprospective GPs.

Pauline Lax Action Plan CCG are presentaed on regional work thatis teie din to the pilot programmes.

Pauline Lax Action Plan report developed and is now in draft to befinlaised and formally recived by QPI

Jenny Steel Action Plan Darlington CCG have support PHD bid to beapart of the CEPN ( community edicuatinprovider network) led by HENE - and thatwill support community edication andworkforce planning.

LisaTempest

27/09/2016

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1758 Looked after Childrenmight not recieve timelyInitial health assesmentson entering looked aftersystem.

CDDFT and DarlingtonBorough council are notmeeting the standrd ofIHAs being completedwithin 20 working workingdays.

29/11/2016 DianeMurphy

DianeMurphy

3 4 12 33 9Analysis of performance and issuesidentified received at QPI.Performance metrics and monitoringagreed with CDDFT reports to DSCB and Children'simprovement board.

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Gaps in controlsDomain

1551 Stroke performance

That Darlington residentswith a diagnosis of strokeare not consistently beingtransported to andadmitted to UHND strokeunit as per agree protocolsand mortality rate isincreased in this group ofpatients.

04/05/2016 DianeMurphy

DianeMurphy

5 4 20 13 3CQRG review quality performance onmonthly basis and receive reports fromCDDFt on Mortality and audit includingexternal/national audit reports onstroke performance.

SIRMs reporting and review of same byNECs and CCG identifying issues andthemes . themneatic reprots are nowbeing taken to CDDFT QRG. No issuesidentified re stroke admisison

SUI reports from CDDFT and NEASare regularly reported and each arereviewed by CCG Chief nursesensuring detailed RCA and lessonsidentified. This would pick up SUI inregards to stroke care.

NECS business intelligence reportprepared and reviewed

data includesNEAS data whichis unreliable

Analysis received from CDDFT at QRG.stroke perfroamce ( SINAP) is part ofregular QRG agenda.

Diane Murphy Action Plan A report on Stroke pathways in CountyDurham and Darlington has been producedwith additional info re data sources.This requires further discussion betweenDCCG and DDEs Chief nurses anddiscussion at CQRG and with CDDFT.

DianeMurphy

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1412 The CCGs has ineffectivemechanisms forengagement with the public

The CCGs commissioningdecisions are notunderpinned by patient andpublic engagement.

21/09/2015 Jackie Kay

Jackie Kay

3 3 9 23 6The CCG is refreshing its communitycouncil in 2015 to ensure it is morerepresentative of the population ofDarlington.

Portfolio lead identified for comms andengagement

Report to exec for theproject plan for the refreshof the community council

The CommunityCouncil is not theonly means ofengagementactivity

Refresh of the CCG communicationand engagement strategy underway

update on thecommunications plans viateam meetings

Refreshed CC in place from February2016

Development sessions toprime new CC members ofrole and responsiblities

agenda items tobe part of theannual cysle ofbusiness

Annual cycle of business for thecommittee to refect key areas of CCGbusiness and ensure timelyengagement with CC members

Reports on refreshedcommunity council to Execand update to GB.

Need to alignannual cycles ofbusiness across allcommittees

Andrew Stainer Action Plan To develop a comms and engagementstrategy plan aligned to the priorties andplans of the CCG

Jackie Kay Action Plan NECS agreed sub contract arrangementswith HWD for engagement activities alignedto commissioning plans and priorities

Jackie Kay Action Plan Refreshed comms and engagement plan tobe signed off by GB December 6th 2016

Jackie Kay Action Plan Comms representative to be part ofmembership of NMC/UoP arrangements

Jackie Kay

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1510 Urgent care and OOHservices in Darlington donot meet the needs of thepopulation.

CCG commissions anurgent care and OOHservice which does notalign to identified needsand the 2020 vision/NewModels of Care. Urgentcare services continue tobe a high financialpressure to the

17/03/2016 Jackie Kay

Jackie Kay

4 3 12 24 8CCG reviewing its commissioning plansto ensure UC and OOH services areappropriately commissioned. This isidentifed as a priority project in 2016/17

Managed via inside ofhospital workstream withclose working with not inhospital workstream

No timescalesidentifed at thisstage as at anealry stage ofplanning

Discussions on UC and OOH servicesbrought into the NMC workstream toensure consistent approach alignedwith 2020 vision and DarlingtonBlueprint

Pending scoping ofthe project of work-no timelines yetagreed for CCG inconjunction withCDDFT

Co location onto one site and updatedcontract spec are part of contractnegotiations for 2017/18

Project group in place withdedicated resource fromNECS

no clear deadlinefor colocation

Jackie Kay Action Plan day time activity to move from DPH to DMHsite from December 14th 2016

Jackie Kay Action Plan Scoping of the work for UC and OOH viaNMC worksstream

Jackie Kay Action Plan Application via ETTF to include the capitalcost to colocate UC

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organisation

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.2.1

7th February 2017

Title HAST CCG Finance Report - Month December 2016

Purpose Approval ☐ Discussion ☒ Information ☒

Responsible CCG Member / Lead

Mr Graeme Niven , Chief Finance Officer

Author of Report Mr Rob Sands, Finance Manager, NECs

Recommendation(s) 1.1 . The Governing Body is requested to;

• Consider the reported financial performance • Note the financial forecast for 2016/17 as at 31

December 2016. • Note the reported financial risks and mitigating actions

being taken to ensure delivery of the CCGs statutory financial duties.

• Note the current performance and remedial actions against the CCG key performance indicators

Executive Summary

In summary the CCG is on track to deliver its key performance indicators. Risks have materialised in year in particular in Acute and continuing health care which have been offset by the use of some planned mitigations. If further risks (worst case) do materialise in year then there is the chance that the control surplus may not be delivered. The delivery of QIPP is therefore very important to maintaining financial balance.

Clinical Engagement

Please outline clinical engagement undertaken and if none, reasons why

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Risk of not delivering our financial indicators.

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Has an Equality Analysis been completed?

none

Attachments Finance Report

Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☐

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☐ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☒ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☐ 109 of 570

7. Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None

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Hartlepool & Stockton-on-Tees CCG Finance Report for the nine months

ended 31st December 2016

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Executive Summary

Commissioning spend (including Reserves) The CCG is forecasting a year end surplus of £5,060k.

Running costs The CCG is reporting a forecast underspend of £613k.

Cash The closing monthly cash balance of £415k is within cash efficiency targets set.

Quality Innovation Productivity Prevention (QIPP) QIPP efficiencies to be under-delivered with a final position of £4,844k at year-end against a target of £11.9m.

Better Payment Practice Code (BPPC) – 95% of invoices to be paid in 30 days Invoices Value The CCG has exceeded the 95% target for the financial year so far.

Capital Expenditure The CCG has a budget of £10k for any IT running cost need, but nothing is anticipated. LD transformation budget of £432k is forecast to spend and the scheme is with NHSE legal team.

YTD Forecast

£3,795k

(Favourable) £5,060k

(Favourable)

£239k (Favourable)

£613k (Favourable)

£415k £230k

£3,295k £4,844k

99.76% 100%

Non NHS

NHS

97.58% 99.40%

Number £000’s

Budget Forecast

£10k £0k

£432k £432k

HQ IT

LD

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Overview This report provides an update on the financial performance of NHS Hartlepool and Stockton-on-Tees CCG for the nine months to 31st December 2016, as well as the expected outturn position for the 2016/17 financial year. The CCG’s financial position is under continual review and the current forecast position shows the organisation to be on track to achieve its key financial targets, but only due to the use of a significant amount of available CCG reserves including significant non recurrent reserves to offset over spends, as risks have materialised. This has created a scenario where all financial investments for this year must be held/reviewed as the CCG is in a high risk position. The position reflects increasing under delivery of QIPP, particularly on North Tees & Hartlepool FT Acute. It should be noted that at this stage of the year, there is an increasing level of data available for the majority of commissioned services expenditure, seven months on which to base the forecast outturn position (for North Tees & Hartlepool FT there have been significant issues regarding quality but this has improved). There are current forecast overspends reported on Acute (£10.2m) and continuing healthcare (£2.5m). The report highlights in the current ‘Risks & Mitigations – current’ section, that there is a risk (worst case) of further pressures materialising as the year develops - another £5m on top of the current overspends. If this comes about, it would mean that the CCG would not deliver its control surplus which includes the additional 1% non recurrent. This position reinforces that it is vital that the CCG deliver all possible planned QIPP, as well as scoping out the options explored for additional QIPP in year. The CCG has developed a financial recovery plan and will be monitored in a newly established finance sub committee. It is unlikely that the CCG will be allowed to access the protected 1% non recurrent resource, but NHS England insisted at planning, that this resource remain unused by CCG’s to support ‘system-wide risk’.

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Summary Financial Position 31st December 2016

YTD Annual

Budget Actual Variance Budget Forecast Variance Worst

£000s £000s £000s £000s £000s £000s £000s Acute Services 149,899 156,357 (6,458) 201,835 211,988 (10,153) (13,442) Mental Health Services 33,503 32,993 511 44,912 44,267 646 446 Community Health Services 23,236 23,493 (257) 31,002 31,329 (327) (397) Continuing Healthcare (CHC) Services 21,699 23,531 (1,832) 29,028 31,555 (2,527) (3,430) Other Services 15,717 15,628 89 21,189 21,119 70 34 Prescribing 38,661 38,671 (10) 51,656 51,272 385 0 Primary Care Services 32,948 31,883 1,065 45,659 43,845 1,814 1,683

Total Programme Services 315,664 322,556 (6,892) 425,282 435,374 (10,093) (15,106)

Running Costs 4,525 4,286 239 6,374 5,761 613 613

Reserves 10,448 0 10,448 19,298 4,758 14,540 15,040

CCG NET EXPENDITURE 330,636 326,842 3,795 450,954 445,894 5,060 547

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Reserves

£9,481k of reserves have been consumed by overspends in the programme position.

Reserves

YTD Annual

Budget Actual Variance Budget Forecast Variance £000's £000's £000's £000's £000's £000's Control surplus 3,795 0 3,795 5,060 0 5,060 Allocations - GP Training / SRG /Diagnostic Capacity / Maternity 0 0 0 392 392 0 Total protected reserves 3,373 0 3,373 5,452 392 5,060 0.5% Contingency 0 0 0 2,446 0 2,446 1% Non recurrent headroom (bal) 0 0 0 4,366 4,366 0

Planned reserves held as risk cover 3,647 0 3,647 4,028 0 4,028

Local Investments 3,006 0 3,006 3,006 0 3,006 Total reserves held as risk cover 6,653 0 6,653 13,846 4,366 9,481 0 Reserves total 10,448 0 10,448 19,300 4,759 14,541

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Financial Risks & Mitigation - current OVERSPEND (-) UNDERSPEND (+) FORECAST (£000) WORST CASE (£000)

Acute (including QIPP non delivery) (10,153) (13,442)

Mental Health 646 446

Community (327) (397)

Joint Commissioning (2,527) (3,430)

Prescribing (including QIPP non delivery) 385 0

Primary Care 1,814 1,683

Other 70 34

TOTAL (10,093) (15,106)

MITIGATION - USED

General reserve 0.5% (part) 2,446 2,446

Non recurrent drawdown

56 56

Risk Reserves 4,028 4,028

Local Reserve 2,950 2,950

Slippage on Running Costs 613 613

BCF Risk Management 0 500

Shortfall – would risk control surplus failure 0 4,513

TOTAL 10,093 15,106 MITIGATIONS - REMAINING General reserve 0.5% 0 0

Slippage on Running Costs 0 0

BCF Risk Management 500 0

Quality Premium – estimate of resource 0 0

1% non recurrent - must remain set aside NHS E 4,366 4,366

TOTAL 4,866 4,366 116 of 570

Acute Services

Summary – Acute forecast position is £10.2m overspend, mainly due to over activity and non delivery of QIPP in relation to Rightcare. North Tees and Hartlepool FT – The forecast overspend reflects under delivery of non contracted QIPP. There have been significant data quality issues with activity information from this provider., but this is improving. The forecast reflects some under delivery of contracted QIPP. The worst case represents £2.5m of non contracted QIPP and £5m contract overspend (including non delivery of QIPP schemes). South Tees FT – Based on Month 7 data, the forecast overspend reflects under delivery of QIPP and continuing increases in Non Electives and Electives. Worst case figure is based on the unadjusted FOT position where adjustments had been made for Electives, Non Electives, Outpatients and Critical Care. NEAS FT – While this is a block contract, the net position reflects the estimate of a small release of 2015/16 accruals. Private providers – Forecasting an overspend of £743k, mainly due to Nuffield (£302k) and BMI Woodlands (£304k) – based on Month 8 activity. Worst case includes under delivery of QIPP in relation to MSK service reductions on T & O activity. Walk in centres – activity has been profiled using 2015/16 outturn, the position is slightly underspent (£74k), based on nine months data. Worst case scenario is based on activity trends and peak months. Other acute services – this overspend reflects the net position across a number of providers and reflects some under delivery of QIPP. The largest overspends are with Newcastle upon Tyne Hospitals (£366k) and City Hospitals Sunderland (£715k).

YTD Annual

Acute Services

YTD Budget YTD Actual

YTD Variance Under/

(Overspend)

2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst

£000s £000s £000s £000s £000s £000s £000s North Tees & Hartlepool NHS Foundation Trust 103,604 106,743 (3,139) 139,551 144,890 (5,339) (7,539) South Tees Hospitals NHS Foundation Trust 26,373 28,864 (2,491) 35,180 38,157 (2,977) (3,533) North East Ambulance NHS Foundation Trust 5,952 5,939 13 7,935 7,947 (12) (17) Private Providers 4,228 4,221 7 5,929 6,672 (743) (797) Walk In Centres 2,367 2,299 68 3,187 3,114 74 42 Other Acute Services 7,376 8,292 (916) 10,053 11,208 (1,155) (1,598) 149,899 156,357 (6,458) 201,835 211,988 (10,153) (13,442)

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Mental Health Services

Tees, Esk & Wear Valley FT This contract is a block arrangement and therefore would normally show as breakeven, however some funding has been included for Liaison services which is not required in 16-17, though the enhancement to the liaison service did start at the beginning of 2016-17 and SRG funding was included for the full year but the service didn’t start until July 2016. The forecast underspend has increased by £70k due to some funding originally given to TEWV in 2015-16 for some schemes which have not materialised therefore the funds have been returned to the CCG. Mental Health & Learning Disability Risk Share Packages The forecast underspend of £157k is consistent with the previous month as there were no new packages admitted in December 2016. Information on new or changes to existing packages is updated on a monthly basis based on notifications received from the In Patient Nurse Co-ordinators. Worst case scenario is based upon additional high cost packages materialising through the year. Other Mental Health IAPT services - The forecast underspend, which is based on invoices received for April to November activity, has reduced by £67k compared with what was reported in the previous month. The budget does include growth and it is anticipated that activity will continue to increase as the year progresses. Mental Health Investment Reserves - A ring fenced agreement has been reached with Tees, Esk & Wear Valleys NHS Foundation Trust for 2016-17 which means that the FT will work with the CCG to ensure that the Mental Health and Learning Disability budgets is in balance at the end of the financial year, which will also maintain parity of esteem. The reserves budget is no longer forecasting an overspend to offset the underspends in the other mental health areas, as it is expected that the year end position will be underspent.

YTD Annual

Mental Health Services

YTD Budget YTD Actual

YTD Variance Under/

(Overspend) 2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst £000s £000s £000s £000s £000s £000s £000s

Tees, Esk & Wear Valley NHS Foundation Trust 25,321 25,121 200 33,805 33,549 256 256 Mental Health / Learning Disability/Risk Share Packages 4,980 4,826 154 6,640 6,483 157 (43) Other Mental Health 3,202 3,046 156 4,467 4,235 233 233 33,503 32,993 511 44,912 44,267 646 446

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Community Health Services

The main Community Health Services contract is with North Tees and Hartlepool FT and is a block contract. It is therefore reported as breakeven. There are now four AQP Adult Hearing contracts (Boots have de-commissioned the service). The two principal contracts are still: • North Tees and Hartlepool FT – forecast overspend £45k based on month 7 data. • Specsavers – budget was reduced by £308k in 16/17 due to a plateau of activity in the previous two years, currently showing a

forecast overspend of £122k.

Other Community Health Services contracts include South Tees Hospitals FT, which is £24k overspent. The main driver of the worst case is continued pressure in AQP audiology activity.

YTD Annual

Community Health Services YTD Budget YTD Actual

YTD Variance Under/

(Overspend) 2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst £000s £000s £000s £000s £000s £000s £000s

North Tees & Hartlepool NHS Foundation Trust 21,440 21,440 0 28,587 28,587 0 0 AQP Adult Hearing 659 860 (201) 879 1,127 (248) (280) Other Community 1,137 1,193 (56) 1,537 1,615 (78) (117) 23,236 23,493 (257) 31,002 31,329 (327) (397)

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Continuing Health Care Services

Continuing Healthcare (CHC) costs are based on the annual cost of individual packages of care included in the finance database at the end of the month which is the most up to date information at the time of publishing. A check against the NHS spine of recorded deaths has also been performed. Annually costs are increasing due to new packages , and increases in existing package costs following review . The main areas of increase during month 9 are: CHC - an additional amount was included for Quality Scheme 5% CHC fees (+£266k ) and an additional (+£75k) for Darlington Road clients expected rate increase. An increase in the LA recharge brought costs more inline with the database resulting in a decrease of CCG adjustments and an increase in FOT of (+£584k). There was also a reduction in the NOF accrual (-65k) and reduction in equipment estimate(-£30k) due to more up to date information received. There was also a benefit from a regional S117 Risk Share (-£96k) and a growth reduction of (-£71k). The database movements in month resulted in (-£63k) movement this included: Fast track and PHBs increased, whilst CHC, Children’s, FNC and S117 decreased. Fast Track increase is mainly due to 14 package increases and 1 transfer from FNC to CHC. PHB increases mainly due to 5 package increases. Decreases in CHC are mainly due to a higher number of deaths compared to new clients but in addition there were more package increases than decreases. The decrease in Children is due to 1 high cost package ending. FNC has decreased due to higher RIPs compared to new clients and S117 has decreased mainly due to 2 RIPs. Discussions around S117 packages are underway and there was an expectation of £500k QIPP attached to this which is not forecast to deliver.

YTD Annual

Continuing Health Care YTD Budget YTD Actual

YTD Variance Under/

(Overspend) 2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst £000s £000s £000s £000s £000s £000s £000s CHC - Fast Tracks 621 837 (216) 828 1,116 (288) (312) CHC 7,983 10,292 (2,309) 10,854 14,112 (3,258) (4,059) CHC - Joint Packages 5,076 4,526 550 6,768 6,035 733 730 CHC - Children 863 549 313 1,150 733 418 401 CHC - Equipment 114 92 22 152 123 30 30 CHC - Personal Health Budgets 1,086 1,118 (31) 1,448 1,490 (42) (66) CHC- S117 2,903 3,047 (144) 3,870 3,967 (96) (113) FNC 2,322 2,341 (18) 3,096 3,121 (25) (41) CHC Team NECS 394 392 1 523 523 0 0 CHC Risk Pool 337 337 0 337 337 0 0 21,699 23,531 (1,832) 29,028 31,555 (2,527) (3,430)

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Prescribing

Prescribing figures have been prepared using month 7 data from the BSA, and the forecasted position based on this data and other factors, as stated below, is £307k underspend. • Factored into the prescribing budget there is an element of ‘rightcare’ QIPP delivery, and the Medicines Optimisation workstream

practice work plan projects in year savings of £1.4m to offset this, to date this plan has delivered year end savings of £552k. There are many ongoing projects such as Improving systems for ordering of repeat prescriptions, Right Care and Care Home medication reviews as well as options

• New projects such as Community pharmacy managed repeat ordering services. • Worst case scenario is based on the worst impact of five different expenditure profiling options.

Also shown above: Central Drugs £89k - Underspend based on Month 7 data, calculated at BSA Profiles. Oxygen £11k - Overspend based on Month 8 data.

YTD Annual

Prescribing YTD Budget YTD Actual

YTD Variance Under/

(Overspend) 2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst £000s £000s £000s £000s £000s £000s £000s PC Prescribing 36,498 36,531 (33) 48,725 48,418 307 (49) Central Drugs 1,060 997 63 1,414 1,325 89 71 Scriptswitch Licence 86 76 10 115 115 0 0 Home Oxygen 704 719 (15) 939 951 (11) (22) Medicine Mgt Team NECS 313 348 (35) 464 464 0 0 38,661 38,671 (10) 51,656 51,272 385 0

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Primary Care Services

Included in ‘Primary Care Core - Other’ are Community Based Services and RIVIE scheme underspends , which relate to estimated benefits from 2015/16 scheme completion. The worst case scenario is based on activity pressures.

YTD Annual

Primary Care YTD Budget YTD Actual

YTD Variance Under/

(Overspend) 2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst £000s £000s £000s £000s £000s £000s £000s Delegated Commissioning GMS 17,985 18,144 (159) 23,979 24,077 (98) (104) PMS 262 262 0 350 350 0 0 Other List Based Services (APMS included) 934 912 23 1,246 1,301 (55) (70) Premises Cost Reimbursement 4,263 4,221 42 5,685 5,595 90 90 Enhanced Services 1,403 1,325 78 1,871 1,756 115 80 QOF 3,024 3,032 (8) 4,033 4,033 0 0 Other GP Services 581 582 (1) 775 775 0 0 Dispensing Prescribing Drs 238 250 (12) 318 333 (15) (51) Reserves (Delegated Primary Care) 0 0 0 617 0 617 617 Total Delegated Commissioning 28,692 28,728 (36) 38,874 38,220 653 562 Out of Hours 1,585 1,585 0 2,113 2,113 0 0 GP IT 565 565 0 753 766 (13) (13) Other 2,107 1,006 1,101 3,920 2,745 1,174 1,134

Total Primary Care Core 4,257 3,156 1,101 6,786 5,625 1,161 1,121 32,948 31,883 1,065 45,659 43,845 1,814 1,683

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Other

Spend in this category relates mainly to block contracts or has been fully committed. Better Care Fund (BCF) – the position is based on the agreed values with Hartlepool and Stockton Councils. NHS Property Services (NHS PS) / Community Health Partnerships (CHP) – budgets have been set on historic void and subsidy charges and are shown as break even. In 2016/17 NHS PS will be moving the basis of recharging tenants to market rents. The DoH have earmarked a central budget to fund the impact to tenants. When the impact to individual tenants has been calculated by NHS PS and validated as accurate, this budget will be transferred to CCG’s as resource allocations. The CCG’s are then to increase contract values with these affected providers in order to transfer this funding across to tenants. The intention is for nil affect to the CCG. As at month 9 no allocation has yet been confirmed or received. The position is showing a £13k underspend which relates to CHP confirmed charges.

YTD Annual

Other Services YTD Budget YTD Actual

YTD Variance Under/

(Overspend) 2016-17 Budget

Forecast Outturn

Forecast Variance Under/

(Overspend) Worst £000s £000s £000s £000s £000s £000s £000s NEAS PTS 1,428 1,428 0 1,904 1,904 0 0 NEAS 111 663 643 20 884 864 20 20 NHS Property Services / CHP 480 471 9 640 628 13 0 BCF 11,934 11,934 0 15,912 15,912 0 0 Other Services 1,212 1,152 60 1,849 1,812 37 14 15,717 15,628 89 21,189 21,119 70 34

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Running costs

The running cost allowance is the budget allocated to pay for non-clinical management and administrative support, including commissioning support services. Non pay costs include the cost of commissioning support services (CSU), clinical engagement, accommodation, audit fees and other corporate costs. A forecast outturn underspend of £613k has been reported at month 9 against Administration running costs .

Running Costs

YTD

Annual

Budget Actual Variance Budget Forecast Variance £000s £000s £000s £000s £000s £000s Pay 954 891 63 1273 1193 80 Non Pay (CSU) 2,761 3,073 (312) 3,681 3,681 0 Non Pay (Other) 810 322 488 1,420 887 533 Running Costs Total 4,525 4,286 239 6,374 5,761 613

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QIPP As at 31 December 2016 £3.295m has been delivered (forecast £4.844m) against the plan of £11.858m. Current performance (based on activity data to November) now includes data flows from the implementation of the MSK pathway in addition to the previously reported respiratory, spinal procedures, and lucentis pathways. Walk in centre activity is below plan therefore the benefit of this QIPP is now included in the year to date & forecast outturn position. Pathway changes as noted above have continue to be behind plan. Current performance is now being analysed at provider level and will be used in individual contract meetings to identify that planned pathways are being adhered to and thereby to assess whether the new pathways have had the desired effect. The new data flows are enabling QIPP monitoring to be undertaken at a more granular level. Medicines Management schemes are forecasting to achieve their contracted target and contribute to the unallocated QIPP. Forecast outturn has been based upon current performance for pathway changes and the detailed forecast received from the Medicines Optimisation team. Audiology at South Tees is still in negotiation and is classified as high risk of non delivery as are , the CHC S117 review where a teeswide group has been established, but here has been no impact seen to date and the delayed discharge partnership group which although in place, no impact yet has been seen to date. In summary the CCG is on course to deliver the green rated risk of £4.4m and make a contribution to the amber risk schemes of circa £1.0 m.

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QIPP – Analysis by scheme

QIPP Schemes 2016-17

As at 31 December 2016 - Activity to November 2016 MONTH 7

REF Workstream Unique

QIPP Ref

Scheme Name 16/17 Value

£

Contracted QIPP

£ Expected Unidentified Perform'ce

dependent? Delivered Not Delivered Low risk Medium risk High risk

1 IHC Q01 MSK (1,765,733) (1,765,733) 0 0 Yes (918,691) (847,042) (847,042)

2 IHC Q02 Value based Commissioning Spinal procedures (354,662) (354,662) 0 0 Yes (17,769) (336,893) (336,893)

3 IHC Q03 COPD (611,000) (611,000) 0 0 Yes 32,598 (643,598) (643,598)

5 Contract Q05 A&E linked to 111 clinical hub (261,909) (21,041) (132,720) (108,148) Yes (84,458) (177,451) (60,327) (117,124)

6 PC Q06 GP variation elective care (1,282,084) (377,510) (904,574) 0 Yes 0 (1,282,084) (641,042) (641,042)

7 OHC Q07 Excess bed days (1,000,000) (512,500) (487,500) 0 Yes (26,400) (973,600) (973,600)

8 Contract Q08 Audiology block (500,000) (500,000) 0 0 Yes 0 (500,000) (500,000)

9 Contract Q09 Lucentis (350,000) (199,494) 0 (150,506) part delivered (129,860) (220,140) (220,140)

4 - Q04 Long Stay Patients (342,000) (342,000) 0 0 Delivered (342,000) 0

10 - Q10 Walkin centre inflation (104,490) (104,490) 0 0 Delivered (104,490) 0

11 IHC Q11 righcare cancer electives (891,819) 0 0 (891,819) Yes 0 (891,819) (891,819)

12 IHC Q12 rightcare gi elective (600,000) 0 0 (600,000) Yes 0 (600,000) (600,000)

13 IHC Q13 rightcare gi non elec (600,000) 0 0 (600,000) Yes 0 (600,000) (600,000)

14 IHC Q14 rightcare GUI non elec (205,794) 0 0 (205,794) Yes 0 (205,794) (205,794)

Sub Total Acute (8,869,491) (4,788,430) (1,524,794) (2,556,267) 0 (1,591,070) (7,278,421) (1,244,262) (1,401,764) (4,632,395)

15 - Q15 Reduced Block contract with NTW (40,000) (40,000) 0 0 Delivered (40,000) 0

16 - Q16 Community Recovery Tender (30,000) (30,000) 0 0 Delivered (30,000) 0 0

(70,000) (70,000) 0 0 0 (70,000) 0 0 0 0

17 - Q17 Sexual Health block (19,951) (19,951) 0 0 Delivered (19,951) 0

(19,951) (19,951) 0 0 0 (19,951) 0 0 0 0

18 - Q18 NECS mgt reduction 5% (27,250) (27,250) 0 0 Delivered (27,250) 0

19 - Q19 Spectrum of Care (107,000) (107,000) 0 0 Delivered (107,000) 0

31 S117 Q31 CHC (s.117) (500,000) (500,000) 0 Yes 0 (500,000) (500,000)

(634,250) (134,250) (500,000) 0 0 (134,250) (500,000) 0 0 (500,000)

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QIPP – Analysis by scheme (cont)

20 MO Q20 1% Prescribing Target (506,640) (506,640) 0 0 Yes (506,640) 0 0

21 MO Q21 Waste Campaign repeat prescribing (500,000) (500,000) 0 0 Yes (565,218) 65,218 65,218

25 MO Q25 Right Care Prescribing cancer (464,000) 0 (216,530) (247,470) Yes 0 (464,000) (65,218) (398,782)

26 MO Q26 Right Care Prescribing respiratory (286,000) 0 (133,470) (152,530) Yes 0 (286,000) (286,000)

22 - Q22 Scriptswith Tender price reduction (10,109) (10,109) 0 0 Delivered (10,109) 0

23 - Q23 NECS mgt reduction 5% (20,750) (20,750) 0 0 Delivered (20,750) 0

24 - Q24 Oxygen tender price change (40,000) (40,000) 0 0 Delivered (40,000) 0

(1,827,499) (1,077,499) (350,000) (400,000) 0 (1,142,717) (684,782) 0 (684,782) 0

27 - Q27 OOH inflation (63,833) (63,833) 0 0 Delivered (63,833) 0

32 - Q32 GMS (33,000) (33,000) 0 0 Delivered (33,000) 0

33 - Q33 Premises Costs (186,000) (186,000) 0 0 Delivered (186,000) 0

(282,833) (282,833) 0 0 0 (282,833) 0 0 0 0

28 - Q28 NHS Property Services (12,788) (12,788) 0 Delivered (12,788) 0

29 - Q29 NECS mgt reduction 5% (17,154) (17,154) 0 Delivered (17,154) 0

(29,942) (29,942) 0 0 0 (29,942) 0 0 0 0

30 - Q30 Management reduction of contigency (24,000) (24,000) 0 Delivered (24,000) 0

(24,000) (24,000) 0 0 0 (24,000) 0 0 0 0

Total (11,757,966) (6,426,905) (2,374,794) (2,956,267) 0 (3,294,763) (8,463,203) (1,244,262) (2,086,546) (5,132,395)

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-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

£ 00

0's

QIPP Performance - April to November 2016

Plan

Plan - contracted

Actual YTD

Forecast

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Key Financial Risks The key risks which impact on the ability to deliver the financial position in 2016/17 are shown in the table below, together with relevant controls and assurances with actions taken to mitigate the risks. Although pressures continue to be experienced, they are being effectively managed within the overall financial resource. The risk in respect of increased secondary care activity remains as a corporate risk. A sub group of the Finance and Performance Committee has been established to focus on Activity and Demand.

Risk Areas of Spend affected Management response Increased activity over Winter period

Acute (non elective), Prescribing, Continuing Healthcare

Surge planning, SRG, BCF, EHCP.

Elective activity showing trajectory towards day case with outpatients falling

Acute (elective) Contracting.

Increasing demand for continuing health care due to ageing population

Continuing Healthcare, Acute (potential delayed discharges due to lack of CHC beds)

BCF, PHB. Financial planning on high growth.

Prescribing growth and Cat M price reduction impact

Prescribing Medicines Optimisation Workstream actions / QIPP. Risk cover.

Recurrent Resource Funding - level of future years growth

All Sensitivity analysis in financial planning for various scenarios of allocation growth level.

Payment By Results tariff rates -level of future years net deflator

All Sensitivity analysis in financial planning for various scenarios of tariff net deflator.

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Statement of Financial Position Below is the Statement of Financial Position as at 31st December 2016. Dec-16 Nov-16 Movement

£000's £000's £000's Non Current Assets Property, plant and equipment 0 0 0 Intangible Assets 0 0 0 Other Financial Assets 0 0 0 Total Non Current Assets 0 0 0 Current Assets Trade and other Receivables 295 223 72) Prepayments & Accrued Income 462 1,081 (619) Cash and cash equivalents 415 230 185 Total Current Assets 1,172 1,534 (362) Total Assets 1,172 1,534 (362) Current Liabilities Trade and other payables (5,022) (5,913) 891 Accruals (18,147) (22,439) 4,292 Other liabilities 0 0 0 Provisions (31) (31) 0 Borrowings 0 0 0 Total Current Liabilities (23,200) (28,383) 5,183

Non-Current Assets plus/less Net Current Assets/Liabilities (22,028) (26,849) 4,821

Non-Current liabilities Other liabilities 0 0 0 Provisions 0 0 0 Borrowings 0 0 0 Total Non-Current Liabilities 0 0 0 TOTAL ASSETS EMPLOYED (22,028) (26,849) 4,821 Financed by Taxpayers Equity Capital & Reserves General Fund (22,028) (26,849) 4,821 Revaluation Reserve 0 0 0 Other reserves 0 0 0

TOTAL TAXPAYERS EQUITY (22,028) (26,849) 4,821

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Better Payment Practice Code (BPPC) – cumulative to 31st December 2016 The BPPC (Better Payment Practice Code) requires NHS organisations to pay all invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later.

Note 6.1: Better Payment Practice Code

2016-17 2016-17 2015-16 2015-16

Number £'000 Number £'000

N6A N6B N6C N6D Non-NHS Payables: CCG Total Non-NHS trade invoices paid in the year 11,668 80,209 8,134 75,274 Total Non-NHS trade invoices paid within target 11,386 79,729 8,008 74,687 Percentage of CCG non-NHS trade invoices paid within target

97.58% 99.40% 98.45% 99.22%

NHS Payables: CCG Total NHS trade invoices paid in the year 1,637 206,610 2,100 274,416 Total NHS trade invoices paid within target 1,633 206,603 2,094 274,359 Percentage of CCG NHS trade invoices paid within target

99.76% 100.00% 99.71% 99.98%

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.2.2

7 February 2017

Title Performance Report Hartlepool and Stockton-on-Tees CCG January 2017

Purpose Approval ☐ Discussion ☒ Information ☒

Responsible CCG Member / Lead

Lisa Tempest

Author of Report Lisa Tempest

Recommendation(s) The Governing Body is asked to:

Receive and consider the report

Executive Summary

This report is to inform the Governing Body of the CCG’s performance in respect of NHS Constitutional Standards and the Quality Premium using the most up to date performance information for each indicator. NHS Constitutional Standards On a year to date basis Hartlepool and Stockton-on-Tees CCG is currently achieving the following constitutional standards:

• No mixed sex accommodation breaches • % of people followed up within 7 days of discharge from

inpatient psychiatric care • No patients to wait for over 52 weeks for treatment • Percentage of patients seen within 2 weeks of an urgent

referral for breast symptoms • Percentage of patients seen within 2 weeks of an urgent

GP referral for suspected cancer • Ambulance category A response times (8 minutes) • Improving Access to Psychological Therapies (IAPT) –

proportion of people entering therapies and moving to recovery:

• Incidence of C-Diff 132 of 570

The below standards are currently not being achieved:

Referral to Treatment within 18 weeks RTT – compliance against the 92% target remains in November 2016, reporting an increased position of 93.6%. Unfortunately 1 patient attributable to HaST CCG was not treated within 52 weeks in Sep-16, and so the CCG has failed this indicator for the year South Tees NHS Hospitals Trust is failing to achieve the 92% target on a YTD basis although performance has improved in recent months. Patients waiting for diagnostic tests should not wait more than 6 weeks from referral For the first time since January 2016, HaST CCG underperformed against the 6 week diagnostic test standard in Nov-16, reporting 1.47% against the <1.00% threshold. Out of a total of 4,434 patients waiting for a diagnostic test, 65 patients waited longer than 6 weeks from referral for their diagnostic test in November 2016. 56 of the breaches were attributable to North Tees Hospital Foundation Trust (NTHFT), in the speciality of echocardiography. The main problems occurred in the speciality of echocardiography at NTHFT are a result of staff sickness and vacancies within the physiology service. An action plan is in place to address issues.

• At least 85% of patients should be treated within 62 days of an urgent GP referral for suspected cancer: Darlington CCG has failed to achieve the 62 day urgent GP standard for the 8th consecutive month in November 2016, reporting a declining position of 69.4% against a target of 85.0% in month, which in turn has caused a decreasing YTD position of 74.0%. In November 2016, 11 treatments out of 36 were not carried out within 62 days of the receipt of referral. Breaches occurred in the following treatment modalities: drug treatments, surgical treatments, radiotherapy treatments and palliative treatments. Delay reasons were cited as complex diagnostic pathways, capacity issues and medical reason. The draft Service Development and Improvement Plan for 2017/8 focuses on key areas where improvement is required, supported by the CDDFT Cancer Operations Group.

• Less than 95% pf patients should spend more than 4 hours in an A&E or minor injury unit: A&E performance was above the national threshold for the 5th consecutive month in November, reporting 95.4%. However, the year-to-date performance remains below the required threshold level due to poor performance in Q1.

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• Handover between ambulance and A&E should not

exceed 30 minutes: Throughout 2016/17 NTHFT have recorded some of the lowest ambulance handover delays in comparison to local hospitals. The University of North Tees Hospital (UHNT) A&E department experienced 1,995 arrivals in December, 213 more than the previous month. As a result an increase in handover delays is noticeable in Dec-16, reporting nearly four times the amount of over 30 minute ambulance handovers (15) and 5 ambulance handovers to the A&E department took longer than 60 minutes. NTHFT did not encounter any ambulance handover delays taking longer than 2 hours. The Trust understands that this indicator carries a zero tolerance and continues to work hard to reduce the numbers being reported

• Ambulance category A response times (8 and 19 minutes): North East Ambulance Service (NEAS) are commissioned to provide the operational standards at a service level. NEAS performance is still under target in 2016/17, and reports a declining position from the previous month for both the 8min indicator (53.8%) and 19 min indictor (82.8%) in December 2016. This in turn has decreased the YTD position to 64.3% and 90.4% respectively. HaST CCG reported under achievement of both indicators in December 2016 and continue to be non-compliant at the year to date position. Actions targeting demand, capacity and efficiency have been identified however improvement is not expected to be seen until later in 2016/7

• Incidence of MRSA:

The CCG had two confirmed case of MRSA. All breaches are discussed at monthly Clinical Quality Review Group meetings. The post infection review process has been followed for all identified cases with relevant lessons learnt identified and actions implemented as appropriate

An overview of Hartlepool and Stockton-on_Tees CCG performance in respect of NHS Constitution Standards is included in Appendix 1. Quality Premium An overview of the CCGs performance in respect of local and national Quality Premium indicators is included in the performance report. Data for a number of indicators will not be available until 2017 however YTD performance in relation to A&E, Cancer and Ambulance standards during 2016/7 indicates

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that the premium will be reduced by 75%. The CCG has written to practices not achieving the 80% e-referrals target which is a national indicator to request that all efforts are made to increased e-referrals where appropriate. This report was presented to the Quality, Finance and Performance Committee on 31st January 2017.

Clinical Engagement

There is clinical representation at the Quality, Finance and Performance Committee

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Has an Equality Analysis been completed?

Attachments Appendix 1 – Performance Report January 2017

Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☒

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☒

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

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2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☐ Other Committees/Meetings where this report has been presented Please

specify Does this need to be reported to another Committee/Meeting? Please

specify

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Performance Report

January 2017

Author: Victoria Phelps

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2

Performance Summary Latest Reporting Data

Period (published)Operational

Standard National Average Exception Report

Referral to treatment access times

% patients waiting for initial treatment on incomplete pathways within 18 weeks 92.0% 89.2% 93.4% 92.5% 92.0%Number patients waiting more than 52 weeks for treatment 0 1 0 0Diagnostic waits

% patients waiting more than 6 weeks for the 15 diagnostics tests (including audiology)Nov-16

1.00%1.08% 1.47% 1.67% 0.55%

HaST CCG ER01 NTHFT ER01

A&E waits

% patients spending 4 hrs. or less in A&E or minor injury unit YTD Nov-16 95.0% 88.4% 94.8% 95.9%

Handover between ambulance and A&E over 30 minutes 0 66 175 6087

Handover between ambulance and A&E over 60 minutes 0 8 29 1284

Trolley waits in A&E not longer than 12 hours YTD Nov-16 0 0 0Ambulance response times

RED 1 response in 8 mins 68.0%RED 2 response in 8 mins 66.4%RED 1&2 response in 8 mins 66.5%Cat A Response within 19 mins 95.0% 91.0% 91.7% 90.4%

Number of crew clear delays over 30 mins 0 8,330 Number of crew clear delays over 60 mins 0 465 Mixed Sex accommodation

Mixed Sex accommodation - number of unjustified breaches YTD Nov-16 0 0 0 0HCAI

Incidence of MRSA 0 2 1 6Incidence of C Diff CCG 72 86 30 32Cancelled Operations

All patients who have operations cancelled to be offered another binding date within 28 days YTD Nov-16 0 0 0Mental Health

% people followed up within 7 days of discharge from psychiatric in patient care YTD Nov-16 95.0% 97.40%Cancer

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0% 95.2% 93.0% 94.0% 92.4%% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0% 96.1% 96.8% 96.8% 91.4%

% of patients treated within 31 days of a cancer diagnosis 96.0% 97.2% 98.4% 99.7% 96.8%% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0% 99.5% 99.5% 100.0% 99.6%% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0% 94.5% 96.0% 98.4% 96.0%% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy 94.0% 97.7% 98.3% 97.8%% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0% 82.1% 82.1% 85.5% 79.9%% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service 90.0% 92.5% 97.0% 97.7% 87.8%% of patients treated for cancer within 62 days of consultant decision to upgrade status N/A 89.7% 100.0% 100.0% 90.9%

NEAS ER01

YTD Dec-16

YTD Nov-16 STHFT ER01

NTHFT ER02/03 STHFT ER02

YTD Dec-1675.0% 64.3%

YTD Dec-16

63.6%

HaST CCG NTHFT STHFT NEAS

To 11th Jan-17 QER04

YTD Nov-16

HaST CCG ER02 STHFT ER03/04/05

YTD Nov-16

YTD Nov-16

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Performance HaST CCG

3

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Q3 YTD Q3 YTD

pts treated < 18 wks 14,128 15,061 16,237 13,622 14,715 15,110 13,658 14,725 15,377 15,107 15,264 14,957 42,960 174,958 30,221 118,913total pts 15,071 15,984 17,302 14,488 15,683 16,169 14,623 15,766 16,534 16,244 16,343 15,988 45,525 184,411 32,331 127,350% Compliance 93.7% 94.2% 93.8% 94.0% 93.8% 93.5% 93.4% 93.4% 93.0% 93.0% 93.4% 93.6% #DIV/0! #DIV/0! 94.4% 94.9% 93.5% 93.4%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 Total Number 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1

pts waiting > 6 wks 33 48 28 38 30 53 38 40 18 35 15 65total pts 4,012 4,266 5,125 5,278 5,097 5,360 5,470 4,810 4,613 4,908 4,457 4,434% Compliance 0.82% 1.13% 0.55% 0.72% 0.59% 0.99% 0.69% 0.83% 0.39% 0.71% 0.34% 1.47% #DIV/0! #DIV/0!

Response < 8 min 76 84 80 89 69 85 65 60 82 79 85 70 78 233 924 233 673Total Responses 122 126 133 133 100 125 103 100 109 116 118 104 115 360 1,323 337 990% Compliance 62.3% 66.7% 60.2% 66.9% 69.0% 68.0% 63.1% 60.0% 75.2% 68.1% 72.0% 67.3% 67.8% #DIV/0! 64.7% 69.8% 69.1% 68.0%Response < 8 min 1,057 1,155 1,010 1,166 1,100 1,114 963 1,041 1,095 1,098 1,073 1,080 1,056 3,273 13,129 3,209 9,620Total Responses 1,656 1,737 1,639 1,809 1,514 1,550 1,516 1,587 1,568 1,629 1,594 1,619 1,901 4,757 18,518 5,114 14,478% Compliance 63.8% 66.5% 61.6% 64.5% 72.7% 71.9% 63.5% 65.6% 69.8% 67.4% 67.3% 66.7% 55.5% #DIV/0! 68.8% 70.9% 62.7% 66.4%Response < 8 min 1,133 1,239 1,090 1,255 1,169 1,199 1,028 1,101 1,177 1,177 1,158 1,150 1,134 3,506 14,053 3,442 10,293Total Responses 1,778 1,863 1,772 1,942 1,614 1,675 1,619 1,687 1,677 1,745 1,712 1,723 2,016 5,117 19,841 5,451 15,468% Compliance 63.7% 66.5% 61.5% 64.6% 72.4% 71.6% 63.5% 65.3% 70.2% 67.4% 67.6% 66.7% 56.3% #DIV/0! 68.5% 70.8% 63.1% 66.5%Response < 19 min 1,561 1,675 1,632 1,769 1,531 1,572 1,499 1,529 1,558 1,594 1,578 1,552 1,706 4,716 18,614 4,836 14,119Total Responses 1,740 1,831 1,762 1,905 1,606 1,660 1,615 1,681 1,662 1,742 1,706 1,718 2,006 5,073 19,706 5,430 15,396% Compliance 89.7% 91.5% 92.6% 92.9% 95.3% 94.7% 92.8% 91.0% 93.7% 91.5% 92.5% 90.3% 85.0% #DIV/0! 93.0% 94.5% 89.1% 91.7%

Mixed Sex accommodation - number of unjustified breaches

0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Incidence of MRSA up to 11th January 2017 0 Total Number 0 0 0 2 1 0 1 0 0 0 0 0 0 0 0 3 0 2Actual 2 10 11 8 7 11 11 10 7 13 5 13 8 1 18 95 26 86Target 5 3 3 3 5 9 7 9 10 10 5 3 5 3 13 72 13 72Variance 3 -7 -8 -5 -2 -2 -4 -1 3 -3 0 -10 -3 2 -5 -23 -13 -14

% of people followed up within 7 days of discharge from psychiatric in-patient care

95.0% % Compliance 95.0% 100.0% 100.0% 92.5% 96.3% 92.3% 97.0% 100.0% 100.0% 100.0% 100.0% 96.4% 98.3% 97.4%

pts seen < 2 wks 755.0 624.0 696.0 779.0 780.0 790.0 788.0 784.0 826.0 829.0 801.0 821.0 2,252.0 8,724.0 1,622.0 6,419.0total pts 811.0 667.0 768.0 825.0 840.0 823.0 869.0 863.0 886.0 882.0 863.0 874.0 2,412.0 9,394.0 1,737.0 6,900.0% Compliance 93.1% 93.6% 90.6% 94.4% 92.9% 96.0% 90.7% 90.8% 93.2% 94.0% 92.8% 93.9% #DIV/0! #DIV/0! 93.4% 92.9% 93.4% 93.0%pts seen < 2 wks 136.0 83.0 118.0 113.0 123.0 126.0 88.0 124.0 103.0 106.0 97.0 110.0 370.0 1,414.0 207.0 877.0total pts 143.0 88.0 124.0 123.0 128.0 132.0 94.0 129.0 107.0 106.0 99.0 111.0 386.0 1,499.0 210.0 906.0% Compliance 95.1% 94.3% 95.2% 91.9% 96.1% 95.5% 93.6% 96.1% 96.3% 100.0% 98.0% 99.1% #DIV/0! #DIV/0! 95.9% 94.3% 98.6% 96.8%pts treated < 31 days 107.0 122.0 101.0 130.0 107.0 119.0 156.0 113.0 133.0 132.0 132.0 156.0 333.0 1,375.0 288.0 1,048.0total pts 110.0 126.0 103.0 130.0 108.0 120.0 157.0 115.0 137.0 135.0 133.0 160.0 347.0 1,410.0 293.0 1,065.0% Compliance 97.3% 96.8% 98.1% 100.0% 99.1% 99.2% 99.4% 98.3% 97.1% 97.8% 99.2% 97.5% #DIV/0! #DIV/0! 96.0% 97.5% 98.3% 98.4%pts treated < 31 days 35.0 43.0 45.0 50.0 67.0 47.0 43.0 45.0 60.0 53.0 56.0 55.0 144.0 565.0 111.0 426.0total pts 35.0 44.0 45.0 50.0 67.0 47.0 43.0 45.0 61.0 53.0 57.0 55.0 144.0 566.0 112.0 428.0% Compliance 100.0% 97.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.4% 100.0% 98.2% 100.0% #DIV/0! #DIV/0! 100.0% 99.8% 99.1% 99.5%pts treated < 31 days 16.0 17.0 22.0 24.0 18.0 18.0 21.0 17.0 22.0 26.0 20.0 26.0 57.0 235.0 46.0 168.0total pts 17.0 19.0 22.0 27.0 20.0 20.0 22.0 18.0 23.0 26.0 20.0 26.0 58.0 248.0 46.0 175.0% Compliance 94.1% 89.5% 100.0% 88.9% 90.0% 90.0% 95.5% 94.4% 95.7% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! 98.3% 94.8% 100.0% 96.0%pts treated < 31 days 35.0 39.0 18.0 39.0 23.0 25.0 60.0 28.0 42.0 30.0 38.0 48.0 113.0 458.0 86.0 294.0total pts 35.0 39.0 18.0 40.0 23.0 26.0 61.0 29.0 42.0 30.0 39.0 49.0 113.0 463.0 88.0 299.0% Compliance 100.0% 100.0% 100.0% 97.5% 100.0% 96.2% 98.4% 96.6% 100.0% 100.0% 97.4% 98.0% #DIV/0! #DIV/0! 100.0% 98.9% 97.7% 98.3%pts treated < 62 days 45.0 49.0 42.0 50.0 56.0 58.0 55.0 42.0 59.0 55.0 64.0 78.0 147.0 578.0 142.0 467.0total pts 52.0 65.0 52.0 60.0 64.0 70.0 72.0 56.0 72.0 68.0 77.0 90.0 191.0 731.0 167.0 569.0% Compliance 86.5% 75.4% 80.8% 83.3% 87.5% 82.9% 76.4% 75.0% 81.9% 80.9% 83.1% 86.7% #DIV/0! #DIV/0! 77.0% 79.1% 85.0% 82.1%pts treated < 62 days 2.0 11.0 8.0 17.0 12.0 12.0 16.0 13.0 11.0 10.0 12.0 12.0 11.0 97.0 24.0 98.0total pts 2.0 11.0 8.0 19.0 13.0 12.0 16.0 13.0 12.0 10.0 12.0 13.0 13.0 102.0 25.0 101.0% Compliance 100.0% 100.0% 100.0% 89.5% 92.3% 100.0% 100.0% 100.0% 91.7% 100.0% 100.0% 92.3% #DIV/0! #DIV/0! 84.6% 95.1% 96.0% 97.0%pts treated < 62 days 2.0 7.0 1.0 2.0 2.0 0.0 3.0 3.0 2.0 4.0 1.0 2.0 8.0 42.0 3.0 17.0total pts 3.0 7.0 1.0 3.0 2.0 0.0 3.0 3.0 2.0 4.0 1.0 2.0 10.0 49.0 3.0 17.0% Compliance 66.7% 100.0% 100.0% 66.7% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! 80.0% 85.7% 100.0% 100.0%

NEAS ER01

% of patients treated within 62 days of an urgent GP referral for suspected cancer

85.0% HaST ER02

Mental Health

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

90.0%

% of patients receiving subsequent treatment for cancer within 31 days - drugs

98.0%

Cancer

% of patients seen within 2 weeks of an urgent referral for breast symptoms

93.0%

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer

% of patients treated for cancer within 62 days of consultant decision to upgrade status

N/A

MSA

HCAI

QER04Incidence of CDIFF up to 11th January 2017 72

% of patients receiving subsequent treatment for cancer within 31 days - surgery

94.0%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

94.0%

% of patients treated within 31 days of a cancer diagnosis

96.0%

93.0%

Cat A Red 2 8 min 75.0%

Diagnostics

% Patients waiting more than 6 weeks from referral for a diagnostic test

<1.00% HaST ER01

Ambulance Response Times

Cat A Red 1&2 8 min 75.0%

Cat A 19 min

Cat A Red 1 8 min 75.0%

95.0%

% patients waiting for initial treatment on incomplete pathways within 18 weeks

92.0%

2015/16 2015/16Exception ReportIndicator Threshold

2016/17

139 of 570

Performance NTHFT

4

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Q3 YTD Q3 YTD

pts treated < 18 wks 10,164 11,254 12,174 8,632 9,852 9,690 8,797 10,383 10,135 9,307 9,669 9,815 31,895 132,547 19,484 77,648total pts 10,985 12,103 13,123 9,361 10,708 10,531 9,549 11,201 10,945 10,072 10,397 10,523 33,887 139,415 20,920 83,926% Compliance 92.5% 93.0% 92.8% 92.2% 92.0% 92.0% 92.1% 92.7% 92.6% 92.4% 93.0% 93.3% #DIV/0! #DIV/0! 94.1% 96.7% 93.1% 92.5%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

pts waiting > 6 wks 23 32 10 21 27 41 35 29 9 28 2 76total pts 4,467 4,840 5,546 5,927 5,726 5,876 5,884 5,285 4,954 5,140 4,690 4,557% Compliance 0.51% 0.66% 0.18% 0.35% 0.47% 0.70% 0.59% 0.55% 0.18% 0.54% 0.04% 1.67% #DIV/0! #DIV/0!

pts seen < 4 hrs 6,690 6,780 6,705 6,973 6,618 7,448 7,150 7,826 7,048 7,462 7,236 6,847 20,002 84,630 14,083 57,634total pts 6,935 7,238 7,259 7,730 7,069 7,974 7,692 8,212 7,292 7,850 7,509 7,177 21,250 89,503 14,686 60,775% Compliance 96.5% 93.67% 92.37% 90.21% 93.62% 93.4% 93.0% 95.3% 96.7% 95.1% 96.4% 95.4% #DIV/0! #DIV/0! 94.1% 94.6% 95.9% 94.8%

Total Type 1 attendances Total Number 5,670 5,874 5,861 6,280 5,650 6,264 6,005 6,330 5,657 6,016 5,894 5,748 17,189 71,512 11,642 47,564Total Type 2 attendances Total Number 0 0Total Type 3 attendances Total Number 1,265 1,364 1,398 1,450 1,419 1,710 1,687 1,882 1,635 1,834 1,615 1,429 4,061 17,991 3,044 13,211Handover between ambulance and A&E over 30 minutes

0 Total Number0 7 18 27 7 10 6 11 5 3 5 4 15 8 72 24 66

Handover between ambulance and A&E over 60 minutes or more

0 Total Number 0 0 5 6 2 1 0 0 0 0 0 0 5 0 12 5 8

Trolley waits in A&E longer than 12 hours 0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mixed Sex accommodation - number of unjustified breaches

0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Incidence of MRSA up to 11th January 2017 0 Total Number 0 0 0 0 0 0 0 0 0 1 0 0 0 0 2 2 0 1Actual 2 5 1 5 2 4 4 3 3 3 3 5 2 1 7 36 10 30Trajectory 1 1 1 1 2 1 1 1 1 1 1 1 1 1 3 13 3 13Variance -1 -4 0 -4 0 -3 -3 -2 -2 -2 -2 -4 -1 0 -4 -23 -7 -17

All patients who have operations cancelled to be offered another binding date within 28 days

0 % Compliance 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

pts seen < 2 wks 768.0 630.0 691.0 730.0 763.0 803.0 792.0 879.0 972.0 882.0 920.0 938.0 2,219.0 8,665.0 1,858.0 6,949.0total pts 830.0 677.0 759.0 769.0 812.0 822.0 872.0 946.0 1,037.0 948.0 971.0 983.0 2,386.0 9,350.0 1,954.0 7,391.0% Compliance 92.5% 93.1% 91.0% 94.9% 94.0% 97.7% 90.8% 92.9% 93.7% 93.0% 94.7% 95.4% #DIV/0! #DIV/0! 93.0% 92.7% 95.1% 94.0%pts seen < 2 wks 195.0 140.0 171.0 160.0 189.0 185.0 148.0 254.0 222.0 229.0 220.0 238.0 508.0 1,916.0 458.0 1,685.0total pts 207.0 147.0 181.0 173.0 198.0 196.0 154.0 268.0 226.0 234.0 222.0 242.0 531.0 2,031.0 464.0 1,740.0% Compliance 94.20% 95.24% 94.48% 92.49% 95.45% 94.4% 96.1% 94.8% 98.2% 97.9% 99.1% 98.3% #DIV/0! #DIV/0! 95.7% 94.3% 98.7% 96.8%pts treated < 31 days 103.0 100.0 95.0 123.0 90.0 120.0 118.0 114.0 123.0 125.0 121.0 152.0 306.0 1,305.0 273.0 963.0total pts 104.0 101.0 97.0 123.0 91.0 121.0 119.0 114.0 123.0 125.0 121.0 152.0 307.0 1,315.0 273.0 966.0% Compliance 99.0% 99.0% 97.9% 100.0% 98.9% 99.2% 99.2% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! 99.7% 99.2% 100.0% 99.7%pts treated < 31 days 61.0 73.0 64.0 61.0 73.0 60.0 69.0 59.0 68.0 66.0 61.0 67.0 193.0 778.0 128.0 523.0total pts 61.0 73.0 64.0 61.0 73.0 60.0 69.0 59.0 68.0 66.0 61.0 67.0 193.0 778.0 128.0 523.0% Compliance 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! 100.0% 100.0% 100.0% 100.0%pts treated < 31 days 20.0 15.0 19.0 19.0 19.0 10.0 15.0 14.0 13.0 17.0 17.0 15.0 54.0 205.0 32.0 120.0total pts 20.0 15.0 19.0 19.0 20.0 11.0 15.0 14.0 13.0 17.0 17.0 15.0 54.0 207.0 32.0 122.0% Compliance 100.0% 100.0% 100.0% 100.0% 95.0% 90.9% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! 100.0% 99.0% 100.0% 98.4%pts treated < 31 daystotal pts% Compliance #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!pts treated < 62 days 33.0 43.0 38.5 53.0 45.0 59.0 43.5 39.5 56.5 52.0 54.5 80.0 117.5 519.0 134.5 430.0total pts 37.5 55.5 46.5 61.0 52.0 67.0 58.0 50.5 65.0 63.0 60.5 87.0 139.0 618.5 147.5 503.0% Compliance 88.0% 77.5% 82.8% 86.9% 86.5% 88.1% 75.0% 78.2% 86.9% 82.5% 90.1% 92.0% #DIV/0! #DIV/0! 84.5% 83.9% 91.2% 85.5%pts treated < 62 days 34.0 28.0 22.5 34.0 21.5 28.5 34.5 28.5 23.0 30.5 35.0 37.0 89.5 384.0 72.0 238.5total pts 35.5 28.0 22.5 36.0 22.5 28.5 35.5 29.0 24.5 31.0 35.0 38.0 93.5 394.5 73.0 244.0% Compliance 95.8% 100.0% 100.0% 94.4% 95.6% 100.0% 97.2% 98.3% 93.9% 98.4% 100.0% 97.4% #DIV/0! #DIV/0! 95.7% 97.3% 98.6% 97.7%pts treated < 62 days 3.0 3.5 0.5 0.5 1.0 0.0 2.0 1.5 1.5 2.5 1.0 1.5 6.5 28.0 2.5 11.0total pts 4.0 3.5 0.5 1.0 1.0 0.0 2.0 1.5 1.5 2.5 1.0 1.5 10.0 34.0 2.5 11.0% Compliance 75.0% 100.0% 100.0% 50.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% #DIV/0! #DIV/0! 65.0% 82.4% 100.0% 100.0%

Cancelled Ops

% of patients treated for cancer within 62 days of consultant decision to upgrade status

N/A

MSA

HCAI

QER04Incidence of CDIFF up to 11th January 2017 13

% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0%

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

90.0%

% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

94.0%

% of patients treated within 31 days of a cancer diagnosis 96.0%

% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0%

Cancer

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0%

% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0%

Exception Report

RTT

% patients spending 4 hrs. or less in A&E or minor injury unit

95.0%

NTHFT ER02

% patients waiting for initial treatment on incomplete pathways within 18 weeks

92.0%

Diagnostics

% Patients waiting more than 6 weeks from referral for a diagnostic test

<1.00% NTHFT ER01

Emergency Department

2016/17

NTHFT ER03

Indicator Threshold2015/16 2015/16

140 of 570

Performance STHFT

5

Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Q3 YTD Q3 YTD

pts treated < 18 wks 25,725 25,385 26,107 26,722 27,611 28,585 27,633 27,230 27,821 30,855 30,586 29,563 78,193 315,796 60,149 229,884total pts 27,913 27,419 28,234 28,949 29,839 30,918 30,036 29,792 30,708 33,502 33,173 31,965 84,625 338,993 65,138 249,933% Compliance 92.2% 92.6% 92.5% 92.3% 92.5% 92.5% 92.0% 91.4% 90.6% 92.1% 92.2% 92.5% #DIV/0! 92.4% 93.2% 92.3% 92.0%

Number patients waiting more than 52 weeks for treatment (Incomplete pathways only)

0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 13 0 0

pts waiting > 6 wks 62 74 61 69 52 35 11 89 129 81 53 38total pts 5,253 4,625 6,243 5,707 5,373 6,961 6,622 6,544 5,880 7,661 6,820 6,928% Compliance 1.18% 1.60% 0.98% 1.21% 0.97% 0.50% 0.17% 1.36% 2.19% 1.06% 0.78% 0.55% #DIV/0!

pts seen < 4 hrs 15,016 15,215 14,324 16,591 15,045 16,945 15,612 17,037 15,605 15,379 15,359 14,328 46,286 189,057 29,687 125,310total pts 15,805 16,214 15,430 17,780 15,750 17,729 16,427 17,535 16,033 15,950 16,155 15,033 48,356 198,681 31,188 130,612% Compliance 95.0% 93.84% 92.83% 93.31% 95.52% 95.6% 95.0% 97.2% 97.3% 96.4% 95.1% 95.3% #DIV/0! 95.7% 95.2% 95.2% 95.9%

Total Type 1 attendances Total Number 9,804 10,255 9,949 11,141 10,077 11,500 10,875 11,692 10,727 10,703 10,797 10,066 30,682 127,574 20,863 86,437Total Type 2 attendances Total Number 0 0Total Type 3 attendances Total Number 6,001 5,959 5,481 6,639 5,673 6,229 5,552 5,843 5,306 5,247 5,358 4,967 17,674 71,107 10,325 44,175Handover between ambulance and A&E over 30 minutes

0 Total Number23 60 50 61 29 23 19 15 12 17 26 10 24 65 474 60 175

Handover between ambulance and A&E over 60 minutes or more

0 Total Number 5 19 7 17 12 1 2 4 1 0 7 1 1 10 97 9 29

Trolley waits in A&E longer than 12 hours 0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Mixed Sex accommodation - number of unjustified breaches

0 Total Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Incidence of MRSA up to 11th January 2017 0 Total Number 0 1 0 0 0 0 0 1 2 1 2 0 0 0 2 2 6Actual 7 7 4 1 4 3 1 3 6 5 2 5 3 17 61 10 32Trajectory 5 5 4 4 5 5 5 4 4 5 4 5 5 14 55 14 55Variance -2 -2 0 3 1 2 4 1 -2 0 2 0 2 -3 -6 4 23

All patients who have operations cancelled to be offered another binding date within 28 days

0 % Compliance 0 0 0 0 0 0 0 0 0 0 0 0 7 0

pts seen < 2 wks 1,262.0 1,060.0 1,224.0 1,348.0 1,317.0 1,322.0 1,319.0 1,190.0 1,254.0 1,338.0 1,204.0 1,219.0 3,840.0 15,265.0 2,423.0 10,163.0total pts 1,321.0 1,128.0 1,327.0 1,440.0 1,431.0 1,440.0 1,446.0 1,315.0 1,343.0 1,430.0 1,286.0 1,307.0 4,038.0 16,206.0 2,593.0 10,998.0% Compliance 95.5% 94.0% 92.2% 93.6% 92.0% 91.8% 91.2% 90.5% 93.4% 93.6% 93.6% 93.3% #DIV/0! 95.1% 94.2% 93.4% 92.4%pts seen < 2 wks 126.0 124.0 130.0 122.0 133.0 102.0 104.0 23.0 24.0 31.0 24.0 17.0 398.0 1,762.0 41.0 458.0total pts 131.0 132.0 136.0 135.0 142.0 112.0 118.0 28.0 27.0 32.0 25.0 17.0 427.0 1,882.0 42.0 501.0% Compliance 96.2% 93.9% 95.6% 90.4% 93.7% 91.1% 88.1% 82.1% 88.9% 96.9% 96.0% 100.0% #DIV/0! 93.2% 93.6% 97.6% 91.4%pts treated < 31 days 267.0 234.0 209.0 241.0 228.0 222.0 298.0 214.0 257.0 270.0 251.0 284.0 760.0 2,962.0 535.0 2,024.0total pts 275.0 240.0 212.0 242.0 232.0 224.0 313.0 218.0 266.0 280.0 259.0 298.0 792.0 3,045.0 557.0 2,090.0% Compliance 97.1% 97.5% 98.6% 99.6% 98.3% 99.1% 95.2% 98.2% 96.6% 96.4% 96.9% 95.3% #DIV/0! 96.0% 97.3% 96.1% 96.8%pts treated < 31 days 42.0 38.0 49.0 53.0 64.0 50.0 65.0 33.0 70.0 50.0 77.0 86.0 135.0 689.0 163.0 495.0total pts 42.0 42.0 49.0 53.0 64.0 50.0 65.0 33.0 71.0 50.0 77.0 87.0 135.0 693.0 164.0 497.0% Compliance 100.0% 90.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 98.6% 100.0% 100.0% 98.9% #DIV/0! 100.0% 99.4% 99.4% 99.6%pts treated < 31 days 41.0 47.0 35.0 49.0 35.0 39.0 38.0 43.0 46.0 31.0 32.0 45.0 123.0 478.0 77.0 309.0total pts 43.0 50.0 37.0 52.0 37.0 43.0 38.0 45.0 49.0 32.0 32.0 46.0 134.0 508.0 78.0 322.0% Compliance 95.3% 94.0% 94.6% 94.2% 94.6% 90.7% 100.0% 95.6% 93.9% 96.9% 100.0% 97.8% #DIV/0! 91.8% 94.1% 98.7% 96.0%pts treated < 31 days 135.0 140.0 80.0 186.0 69.0 107.0 171.0 95.0 150.0 112.0 138.0 169.0 421.0 1,804.0 307.0 1,011.0total pts 135.0 140.0 81.0 188.0 70.0 109.0 176.0 98.0 151.0 117.0 139.0 174.0 424.0 1,818.0 313.0 1,034.0% Compliance 100.0% 100.0% 98.8% 98.9% 98.6% 98.2% 97.2% 96.9% 99.3% 95.7% 99.3% 97.13% #DIV/0! 99.3% 99.2% 98.1% 97.8%pts treated < 62 days 124.0 93.5 94.0 94.0 102.5 114.5 132.0 101.5 108.5 118.0 111.5 108.0 342.5 1,297.0 219.5 896.5total pts 147.5 119.0 120.5 123.5 125.5 140.5 161.5 122.5 131.0 146.5 148.5 146.0 442.5 1,643.0 294.5 1,122.0% Compliance 84.1% 78.6% 78.0% 76.1% 81.7% 81.5% 81.7% 82.9% 82.8% 80.5% 75.1% 74.0% #DIV/0! 77.4% 78.9% 74.5% 79.9%pts treated < 62 days 3.5 2.5 0.5 1.5 3.0 3.5 2.5 2.0 2.5 3.5 2.0 2.5 7.0 25.0 4.5 21.5total pts 4.0 2.5 0.5 3.0 3.0 3.5 3.0 2.5 2.5 5.0 2.0 3.0 8.0 28.0 5.0 24.5% Compliance 87.5% 100.0% 100.0% 50.0% 100.0% 100.0% 83.3% 80.0% 100.0% 70.0% 100.0% 83.3% #DIV/0! 100.0% 89.3% 90.0% 87.8%pts treated < 62 days 6.0 7.0 3.5 4.0 8.0 2.0 3.0 3.5 9.0 7.0 5.0 7.5 17.0 59.5 12.5 45.0total pts 6.0 7.0 4.0 4.5 9.0 3.0 3.0 3.5 10.0 8.0 5.5 7.5 19.0 67.5 13.0 49.5% Compliance 100.0% 100.0% 87.5% 88.9% 88.9% 66.7% 100.0% 100.0% 90.0% 87.5% 90.9% 100.0% #DIV/0! 89.5% 88.1% 96.2% 90.9%

STHFT ER02

Cancelled Ops

94.0%

% of patients treated within 31 days of a cancer diagnosis 96.0%

% of patients treated for cancer within 62 days of consultant decision to upgrade status

N/A

MSA

HCAI

QER04Incidence of CDIFF up to 11th January 2017 55

% of patients treated within 62 days of an urgent GP referral for suspected cancer 85.0%

% of patients treated within 62 days of an urgent GP referral from an NHS Cancer Screening Service

90.0%

% of patients receiving subsequent treatment for cancer within 31 days - surgery 94.0%

% of patients receiving subsequent treatment for cancer within 31 days - radiotherapy

% of patients receiving subsequent treatment for cancer within 31 days - drugs 98.0%

Cancer

% of patients seen within 2 weeks of an urgent GP referral for suspected cancer 93.0%

% of patients seen within 2 weeks of an urgent referral for breast symptoms 93.0%

STHFT ER03

2016/17

% patients spending 4 hrs. or less in A&E or minor injury unit

95.0%

% patients waiting for initial treatment on incomplete pathways within 18 weeks

92.0% STHFT ER01

Diagnostics

% Patients waiting more than 6 weeks from referral for a diagnostic test

<1.00%

Emergency Department

STHFT ER04

Indicator Threshold2015/16 2015/16

Exception Report

RTT

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Performance NEAS

6

Performance NEAS 111

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Q3 YTD Q3 YTD

% Compliance 61.3% 62.3% 62.4% 70.0% 70.1% 66.5% 64.0% 65.5% 65.7% 62.1% 63.4% 53.8% 64.9% 68.6% 59.5% 64.3%% Compliance 89.4% 89.4% 89.0% 93.1% 92.8% 91.4% 90.9% 91.3% 91.3% 90.6% 90.5% 82.8% 90.5% 92.2% 87.8% 90.4%

No. of ambulance crews not ready to accept new calls within 30 minutes of handover to A&E (Clearance Time) YTD

0 Total Number497 509 465 369 416 375 553 547 545 520 557 4,448 1,296 4,318 5,525 8,330

No. of ambulance crews not ready to accept new calls within over 60 minutes of handover to A&E (Clearance Time)

0 Total Number34 37 34 18 34 16 34 18 22 27 23 273 75 250 323 465

Handover between ambulance and A&E over 30 minutes

0 Total Number 1,367 1,386 1,491 753 709 598 594 579 533 644 569 1,108 2,013 8,356 2,321 6,087Handover between ambulance and A&E over 60 minutes or more

0 Total Number 447 396 433 208 178 115 85 91 102 100 110 295 417 2,059 505 1,284

NEAS ER01

Ambulance Response TimesCat A Red 1&2 8 min 75.0%Cat A 19 min 95.0%

Exception ReportIndicator Threshold2015/16 2015/162016/17 2016/17

Quality Indicator Operational Standard

Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Exception Report

(NQR8) Total number of calls abandoned <5% 1.73% 1,24% 2.85% 0.95% 1.07% 1.24% 1.87% 2.00% 2.18% 2.03% 0.93% 2.39%

(NQR8) Total number of calls engaged <0.1% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

(NQR8) No of calls answered within 60 seconds at the end of the introductory message

>=95% 92.50% 94.12% 91.75% 97.74% 98.09% 96.27% 95.03% 96.24% 95.40% 94.79% 95.8% 92.5%

(LQR8) Percentage of answered calls triaged 60% 89.61% 89.99% 88.95% 88.10% 88.02% 87.95% 87.90% 87.03% 87.08% 87.60% 88.6% 88.0%

(NQR9) No of calls referred to Ambulance Service within 3 minutes which are life threatening

100% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.0% 100.0%

(LQR7) Time taken for call back <10 minutes 100% 39.84% 38.68% 36.43% 38.43% 40.05% 36.06% 33.36% 35.15% 36.70% 32.30% 34.6% 42.5%

(LQR5) Warm Transferred to NHS 111 service Clinician where required

98% 46.61% 46.41% 45.67% 47.48% 45.29% 41.43% 37.46% 37.12% 34.29% 33.54% 44.4% 42.2%

(LQR3) Percentage of answered calls transferred to 999 <10% 15.48% 15.61% 14.35% 14.96% 14.10% 15.02% 14.51% 14.26% 14.70% 15.18% 16.4% 15.5%

(LQR4) Percentage of patients advised to attend Accident and Emergency Department

<5% 6.41% 6.72% 6.52% 6.35% 6.30% 6.43% 6.22% 5.57% 5.73% 5.48% 5.74% 5.06%

(LQR9) Provision of all consultations (including appropriate clinical information) to the practice the patient is registered with by 8am the next working day

100% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.0% 100.0%

(LQR10) Percentage of frequent users (who call 111 more than 4 times a month) whose use is immediately highlighted to their registered GP

100% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.0% 100.0%

(LQR1) Frontline staff and Advisors training in recognition of safeguarding issues for adults and children to an appropriate level

100% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.0% 100.0%

(NQR3) Provision of interpretation service/ appropriate provision where required within 15 minutes of initial contact

100% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.0% 100.0%

NEAS ER02

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Performance TEWV / Mental Health

7

STANDARD DEC 15 JAN 16 FEB 16 MAR 16 APR 16 MAY 16 JUN 16 JUL 16 AUG 16 SEP 16 OCT 16 NOV 16 2015/16 YTD 2016/17

ER REF

PROPORTION OF PEOPLE THAT ENTER TREATMENT AGAINST THE LEVEL OF NEED IN THE GENERAL POPULATION 15.00% 1.4% 1.9% 1.7% 1.2% 20.9% 20.6% 22.3% 20.4% 18.3% 21.0% 20.9% 24.3% 19.4% 21.1%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 47.7% 53.2% 50.5% 52.4% 49.0% 51.0% 48.8% 49.0% 49.0% 48.0% 55.0% 50.0% 50.2% 50.0%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 75.0% 77.0% 77.0% 72.0% 82.0% 77.0% 95.0% 79.0% 80.0%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 98.0% 99.0% 97.0% 98.0% 94.0% 98.0% 100.0% 97.0% 99.0%

2 %AGE OF CPA DISCHARGES FOLLOWED UP WITHIN 7 DAYS 95.0% 95.0% 100.0% 100.0% 92.5% 96.3% 92.3% 97.0% 100.0% 100.0% 100.0% 100.0% 96.4% 98.3% 97.4%

39 %AGE OF CPA FOLLOW UPS UNDERTAKEN ON A FACE TO FACE BASIS 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

42%AGE OF SERVICE USERS ON CPA WHO HAVE HAD A REVIEW IN THE LAST 12 MONTHS 98.0% 99.6% 99.6% 100.0% 100.0% 99.7% 99.9% 99.4% 99.3% 98.8% 98.1% 98.8% 99.2% 99.7% 99.2%

40%AGE OF PATIENTS ON CPA WITH A CRISIS PLAN IN PLACE (ADULT MENTAL HEALTH SERVICES) 90.0% NA NA NA NA 98.9% 98.4% 97.6% 97.6% 97.7% 97.9% 96.8% 98.2% NA 97.2%

41%AGE OF PATIENTS ON CPA WITH A CRISIS PLAN IN PLACE (OLDER PERSONS MENTAL HEALTH SERVICES) 90.0% NA NA NA NA 97.6% 96.6% 95.9% 96.6% 95.7% 95.4% 96.6% 96.6% NA 96.4%

25 %AGE OF CRISIS REFERRALS SEEN WITHIN 4 HOURS 95.0% 95.7% 94.8% 98.8% 98.4% 97.3% 95.1% 100.0% 90.9% 97.1% 95.2% 98.8% 100.0% 99.0% 96.1%

24%AGE OF ADMISSIONS TO INPATIENT SERVICES WHICH ARE GATE KEPT BY THE CRISIS SERVICE 95.0% 100.0% 95.8% 100.0% 98.6% 100.0% 100.0% 96.0% 97.2% 100.0% 100.0% 100.0% 89.5% 98.5% 97.3%

26%AGE OF SECTION 136 ADMISSIONS WHERE THE TIME FROM REFERRAL TO ASSESSMENT IS UNDER 48 HOURS 98.0% NA NA NA NA 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% NA 100.0%

22+23THE NUMBER OF NEW "AT RISK MENTAL STATE" AND "FIRST EPISODE IN PSYCHOSIS" CASES INFO NA NA NA NA 8.0 8.0 9.0 13.0 7.0 7.0 8.0 3.0 NA 63.0

7%AGE OF FIRST EPISODES IN PSYCHOSIS WHO COMMENCE A PACKAGE OF CARE WITHIN TWO WEEKS OF REFERRAL 50.0% NA NA NA NA 50.0% 57.1% 81.8% 100.0% 85.7% 87.5% 100.0% 85.7% NA 79.5%

21%AGE OF FIRST EPISODES IN PSYCHOSIS WHO DO NOT COMMENCE A PACKAGE OF CARE WITHIN 4 WEEKS OF REFERRAL 5.0% NA NA NA NA 18.2% 14.3% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% NA 5.5% MHER01

QUALITY INDICATOR

IMPROVNG ACCESS TO PSYCHOLOGICAL THERAPIES

CARE PROGRAMME APPROACH

75.0% 73.0%

97.0% 89.0%

CRISIS SERVICES

EARLY INTERVENTION IN PSYSCHOSIS

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Performance TEWV / Mental Health

8

STANDARD DEC 15 JAN 16 FEB 16 MAR 16 APR 16 MAY 16 JUN 16 JUL 16 AUG 16 SEP 16 OCT 16 NOV 16 2015/16 YTD 2016/17

ER REF

%AGE OF ASSESMENTS IN A&E WHICH ARE UNDERTAKEN WITHIN 1 HOUR OF REFERRAL NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

%AGE OF ASSESMENTS UNDERTAKEN ON WARDS WITHIN 24 HOURS OF REFERRAL NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

35 %AGE OF ADULTS WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 100.0% 99.6% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 97.4% 100.0%

37 %AGE OF CAMHS WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 96.7% 92.3% 67.8% 87.8% 100.0% 99.5% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 85.3% 99.9%

36 %AGE OF OPMHS WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 100.0% 99.4% 99.1% 100.0% 100.0% 100.0% 100.0% 100.0% 99.6% 100.0% 100.0% 100.0% 99.5% 100.0%

38 %AGE OF LD WAITING LESS THAN 9 WEEKS FOR 1ST APPOINTMENT 90.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

%AGE OF PATIENTS SEEN FACE TO FACE WITHIN 4 HRS BY SUITABLY TRAINED PRACTITIONER (URGENT RESPONSE - CRISIS) TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

%AGE OF PATIENTS WITH A PAIRED CROM IN THE REPORTING PERIOD TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

%AGE OF PATIENTS WITH AN IMPROVEMENT IN THEIR PAIRED CROM MEASURE IN THE REPORTING PERIOD TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

70%AGE OF CAMHS PATIENTS AGED 17.5 PLUS WITH A TRANSITION PLAN (SNAPSHOT) TBA NA NA NA NA 82.0% 81.4% 74.1% 64.3% 76.2% 81.5% 82.8% 93.7% NA 82.8%

THE PROPORTION OF EATING DISORDER PATIENTS SEEN WITHIN TWO WEEKS OF REFERAL (ADJUST TO STANDARD DEFINITION) TBA NA NA NA NA DQIP DQIP DQIP DQIP DQIP DQIP DQIP DQIP NA DQIP

QUALITY INDICATOR

MENTAL HEALTH LIAISON SERVICES

SERVICE WAITING TIMES

CHILD AND ADOLESCENT MENTAL HEALTH

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Performance Issue A&E performance was above the national threshold for the 5th consecutive month in November, reporting 95.4%. However, the year-to-date performance remains below the required threshold level due to poor performance in Q1. So far in Q3 there has been a total of 14686 attendances, of which 14083 were seen within 4 hours. Currently the Q3 position is above target, reporting 95.9%, which is a 1.8% improvement on Q3’s position in 2015/16.

Actions Taken • Performance continues to be discussed at monthly contract meetings. • Emergency Department (ED) performance has also been regularly discussed at monthly SRG meetings. These have now been replaced

by the A&E Delivery Board; • Several schemes will continue and new schemes are in the process of being developed to support resilience during 2016/17 (this includes

some newly identified schemes via funding slippage) • Several initiatives have been put in place to look at how the discharge liaison team and the patient flow teams can work more closely

together including the establishment of a 7 day working service; the introduction of an internal delays database which is populated daily to monitor KPIs in respect of safe and timely discharge; and a trial period of co-location was carried out to improve communication between the teams.

• Local authorities have schemes in place to support early discharge and increasing step down, to improve patient flow, and these are currently being reviewed. Specifications have been approved and S256 agreements are with the Local Authorities.

• Technological developments being assessed and business case in development (i.e. vocera around ambulance handover/comms) • In consultation for senior nursing cover 24/7

Timescale for performance improvement December’s provisional position is non-compliant at 90.71%, which would mean Q3 overall is non-compliant at 94.21%.

Other Intelligence November saw eight declarations of NEEP 3, with the remainder of the month declared at NEEP 2. Thus, the average escalation level for the reporting period was NEEP 2.

Indicator Threshold Trend Line

Dec-15 – Nov-16 NTHFT Nov-16

NTHFT Q3

NTHFT YTD Nov-16

% patients spending 4 hrs. or less in A&E minor injury unit 95.0% 95.4% 95.9% 94.8%

3.2 Exception Report NTHFT ER02

9

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Performance Issue Throughout 2016/17 NTHFT have recorded some of the lowest ambulance handover delays in comparison to local hospitals. The University of North Tees Hospital (UHNT) A&E department experienced 1,995 arrivals in December, 213 more than the previous month. As a result an increase in handover delays is noticeable in Dec-16, reporting nearly four times the amount of over 30 minute ambulance handovers (15) and 5 ambulance handovers to the A&E department took longer than 60 minutes. NTHFT did not encounter any ambulance handover delays taking longer than 2 hours. The Trust understands that this indicator carries a zero tolerance and continues to work hard to reduce the numbers being reported.

3.2 Exception Report NTHFT ER03

Actions Taken It is anticipated that the A&E Action plan which is monitored routinely by Commissioners will continue to positively impact trying to minimise handover delays within the Trust in 2016/17. Work is ongoing with regards to the “discharge to assess” model. Information supporting the A&E actions put in place will in turn reduce the number of ambulance handover breaches.

Timescale for performance improvement Although never acceptable, instances of handover delays remain a challenge due to the increasing demand and pressures being faced within A&E. NTHFT submitted trajectories for 2016/17 whereby the A&E position was projected to be above target from Q2 onwards for the rest of the year; and so far this has been the case. Commissioners will continue to monitor NTHFT and apply the appropriate contractual penalties..

Other Intelligence

Indicator Threshold Trend Line

Jan-16 –Dec-16 YTD

Dec-16

Handover between ambulance and A&E over 30 minutes 0 66

Handover between ambulance and A&E over 60 minutes or more 0 8

10

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Performance Issue North East Ambulance Service (NEAS) are commissioned to provide the operational standards at a service level. NEAS performance is still under target in 2016/17, and reports a declining position from the previous month for both the 8min indicator (53.8%) and 19 min indictor (82.8%) in Dec-16. This in turn has decreased the YTD position to 64.3% and 90.4% respectively. HaST CCG reported under achievement of both indicators in Dec-16 and continue to be non-compliant at the year to date position. Performance deterioration is reflective of: • There has been an historic shortage of paramedic workforce within the NHS. NEAS have suffered greatly from this resource gap. • Over recent years, there has been a measurable increase in the number of Red 1 and Red 2 Incidents:

• NEAS are of the view that this change is a result of Healthcare Professionals changing behaviours in requesting more urgent responses for patients. Anecdotally, this is believed to correlate with a lack of confidence in ambulance response times.

• Ambulance Handover pressures – we continue to experience delays in ambulance handovers leading to lost capacity across the North East. Modelling suggests that if the North East was able to eradicate handover delays that it would result in a c4% improvement in ambulance response times.

Key issues: • Red activity levels have not reduced to those forecast prior to the financial year beginning. Following the identification of the drivers behind

the increased Red demand, action is required to manage this pressure through the remainder of the year. • Buy in is required from the local acute providers to reduce pressures at hospitals and inform NEAS in advance of any bypass arrangements

Indicator Threshold CCG

YTD Dec-16 CCG Trend Line Jan-16 – Dec-16

NEAS YTD Dec-16

NEAS Trend Line Jan-16 – Dec-16

8 minute response 75.0% 66.5% 64.3%

19 minute response 95.0% 91.7% 90.4%

Exception Report NEAS ER01

11

Incident type YTD Sept 2015/16

YTD Sept 2016/18

% Change

Red 1 5,339 5,978 12.0% Red 2 84,408 91,987 9.0% Green 78,082 71,155 -8.9% GP Urgent 19,051 16,617 -12.8% HD 339 336 -0.9%

Unknown 216 390 80.6% All Incidents 187,435 186,463 -0.5%

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Exception Report NEAS ER01 continued

12

Actions Taken A comprehensive action plan is in place which is monitored through the Contract Management Board along with the Clinical Quality Review Group. The action plan is broken down into three main areas/themes: Demand Actions: • Reduce the volume of Red incidents generated at the point of call

– Monitored by NEAS Operations Centre – Work to understand where Healthcare Professionals are requesting/escalating to a Red incident

• Capacity Actions: The points of focus for capacity are to: • Meet the Trust’s full establishment; anticipated that NEAS will be at full establishment in April 2017. • Utilise third party providers to cover shortfalls in the current staffing levels. • Extension of the Emergency Medical Response (EMR) pilot with the four local Fire and Rescue Services (FRS). • Increase the level of Rapid Response Vehicles (RRV) available per shift. • 2017/18 contract negotiations have led to an agreement regarding a package of additional investments:

– Additional 49 Paramedics to be appointed (FYE £3.9m) • First tranche of recruits in place October 2017 • Final tranche of recruits in place February 2018

– Investment into the Clinical Hub in 2017/18 (2018/19 subject to NHS 111 procurement) (£1.7m) – Increase resources to upskill Paramedics to treat a greater number of patients on scene (£1m)

Efficiency Actions: • Reduce/eradicate Handover delays – work continues with the FT Providers that experience delays • Reduce crew downtime to increase resource available on the roads. control staff about processes used (June 2016)

Timescale for performance improvement Monitor is fully aware of the Trust’s position and has been working with NEAS during the compilation of the Operational Plan for 2016/17, understanding that NEAS may continue to underperform in the early part of 2016/17 and performance improvement is expected to be incremental. Failure of the Provider Level Indicators will result in a 25% reduction to the 2016/17 Quality Premium for all North East CCGs.

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Exception Report NEAS ER01 continued

13

Additional performance metrics to note: In addition to the nationally reported performance metrics, a number of different measures are available to assess the quality and performance of NEAS: The above report demonstrates NEAS’ performance against the National Clinical Indicators. Historically, NEAS performs very well in comparison to other Ambulance Services. This information is scrutinised within the Clinical Quality Review Group, in which any variation is picked up by the CCG Executive Nurses.

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Performance Issue The year to date position is 5.5% which is above the threshold of less than 5%. The November position was 0% which is within the target threshold, and has been for the past 6 months. The year to date position has been adversely effected by poor performance in April and May.

Exception Report MH ER01

Actions Taken The target is currently being achieved. Data Quality concerns continue to be addressed within the Trust. This is a new indicator and the technical guidance is open to interpretation. TEWV FT are taking a very literal interpretation of the guidance and in any case of doubt, they have reported a breach. The primary barrier to achievement comes in timely identification of a Frist Episode in Psychosis and TEWV continue to embed pathways to tackle this issue.

Timescale for performance improvement The target is currently being achieved. Continued performance at current levels should see the YTD position improve to within target within the next month. There are low numbers of new cases of psychosis per month and therefore each breach has a significant impact on the performance outcome. As this is a new indicator and the service lines are also new the indicator will remain under close scrutiny whilst the system matures and working practices “bed in”.

Other Intelligence The national KPI is 50% of cases seen within 2 weeks. We have added this local indicator of no more than 5% of people will wait over 4 weeks to ensure that people remain a priority if they miss the 2 week target.

Indicator Threshold Trend Line YTD Nov-16

THE PERCENTAGE OF FIRST EPISODES IN PSYCHOSIS WHO DO NOT COMMENCE A PACKAGE OF CARE WITHIN FOUR WEEKS OF REFERRAL <5% 5.5%

14

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15

Provider Level Performance - IAPT

QUALITY INDICATOR STANDARD Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 YTD

OVERALL CCG MARKET SHARE BASED ON PROPORTION ENTERING TREATMENT N/A 37.7% 44.3% 39.8% 37.0% 39.2% 43.5% 37.3% 42.0% 39.5%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 45.9% 52.2% 48.5% 50.0% 49.0% 47.2% 51.1% 43.9% 48.4%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 43.1% 52.7% 44.4% 36.8% 50.5% 43.6% 46.0% 48.0% 45.6%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 94.5% 98.0% 93.4% 95.3% 91.8% 92.2% 90.8% 90.6% 93.3%

OVERALL CCG MARKET SHARE BASED ON PROPORTION ENTERING TREATMENT N/A 6.7% 8.7% 7.5% 6.8% 9.3% 6.1% 6.1% 6.7% 7.1%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 54.5% 44.8% 28.6% 30.8% 42.9% 50.0% 54.8% 50.0% 45.3%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 90.9% 79.3% 71.4% 92.3% 78.6% 100.0% 90.3% 94.4% 89.9%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 100.0% 96.6% 100.0% 100.0% 92.9% 100.0% 100.0% 100.0% 100.0%

OVERALL CCG MARKET SHARE BASED ON PROPORTION ENTERING TREATMENT N/A 33.9% 28.8% 33.1% 36.2% 32.5% 39.6% 34.4% 32.4% 33.2%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 51.2% 51.4% 51.7% 51.5% 48.3% 48.1% 65.8% 51.2% 50.8%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 96.5% 97.1% 99.4% 96.4% 96.1% 97.9% 100.0% 98.3% 99.0%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

OVERALL CCG MARKET SHARE BASED ON PROPORTION ENTERING TREATMENT N/A 5.7% 5.2% 5.1% 4.8% 6.6% 10.7% 6.1% 6.8% 6.2%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 40.6% 52.2% 42.4% 39.1% 54.2% 63.2% 33.3% 53.8% 46.8%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

OVERALL CCG MARKET SHARE BASED ON PROPORTION ENTERING TREATMENT N/A 16.0% 13.0% 14.4% 15.2% 12.4% 13.1% 16.1% 12.1% 13.8%

PROPORTION OF PEOPLE WHO COMPLETE TREATMENT WHO ARE MOVING TO RECOVERY 50.0% 53.4% 51.6% 49.4% 51.8% 49.5% 51.3% 53.6% 60.6% 52.8%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 6 WEEKS 75.0% 98.3% 98.4% 100.0% 100.0% 66.3% 98.3% 100.0% 98.2% 94.9%

OF THOSE INDIVIDUALS COMPLETING TREATMENT - THE PERCENTAGE OF WHICH HAD A REFERRAL TO TREATMENT WITHIN 18 WEEKS 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

STARFISH

INSIGHT

HARTLEPOOL AND EAST DURHAM MIND

MIDDLESBROUGH MIND

ALLIANCE

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Performance Issue September-November performance has breached the threshold. The Trust have attributed this to a change in recording as advised by NHS England whereby patients that require a DST meeting prior to discharge should be recorded (having not been previously). The Trust had previously been within the threshold for the earlier months of 2016/17. In November, 1187 delayed bed days occurred across Stockton and Hartlepool. NTHFT were responsible for 89% of HaST CCG’s delayed bed days in month. The key reasons cited for delays are as follows:

• Hartlepool - 52% waiting for nursing home, • Stockton - 35% waiting for residential home

Exception Report NTHFT ER04

Actions Taken • Escalated to and covered within exception report to Contract Review Meeting.

• The Trust have met with LAs and NHS England but are not in agreement with regard to whom the delay is attributable to. Whilst any

change to whom the delay is attributed to would impact upon this target, it would not impact upon total number.

• Reviewed within internal CCG/NECS group.

Timescale for performance improvement Dependent upon the attribution of the DST element, and also upon wider work around DToC.

Other Intelligence

16

Indicator Threshold Trend Line

Jun-16 – Nov-16 NTHFT Nov-16

NTHFT YTD Nov-16

Delayed transfers of care to be maintained at a minimum level 3.5% 6.64% 4.03%

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Performance Issue

NTHFT continue to report non-compliance in relation to the standards set out for core physio services however there have been improvements in subsequent months from Sep16 – Nov-16.

The average additional wait for those patients waiting beyond 2 weeks was 3 days. 7 patients are waiting beyond 2 weeks.

Exception Report NTHFT ER05

Actions Taken Trust challenged within Contract Review Meeting. Linked to the recent MSK expansion, a number of the core physiotherapy service staff moved into new roles in the MSK team creating vacancies in core service. Recruitment to replace these staff is on-going.

Timescale for performance improvement

Other Intelligence A recent meeting between CCG/NECS SPR and Trust MSK/Physio identified particular pressure around this target – it was noted that the waiting time targets for routine physio and MSK differ (2 weeks vs 4 weeks).

Indicator Threshold Trend Line

Dec-15 – Nov-16 NTHFT Nov-16

NTHFT YTD Nov-16

Percentage of patients referred directly for core physio are seen within 2 weeks 90.00% 67.00% 73.31%

17

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Performance Issue

NTHFT are compliant in November for 2nd successive month.

YTD however remains non-compliant at 70.71% given under-performance in each month thus far.

Exception Report NTHFT ER06

Actions Taken Monitored via contract review meeting - ongoing.

Timescale for performance improvement Measure is now compliant and would be expected to continue.

Other Intelligence

Indicator Threshold Trend Line

Dec-15 – Nov-16 NTHFT Nov-16

NTHFT YTD Nov-16

Percentage of MSK routine patients seen within 4 weeks 90.00% 95.63% 70.71%

18

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Corporate – CCG Quality Premium 2016/17 The new Quality Premium for 2016/17 is now available, and the new template can be found on the following page. As was the case in 2015/16, the 'quality premium’ is intended to reward CCGs for improvements in the quality of the services that they commission and the associated improvements in health outcomes and reducing inequalities. The quality premium paid to CCGs in 2017/18 will reflect the quality of the health services commissioned by them in 2016/17 and will be based on four national measures (three of which are new, one remaining from the previous year) and three new local measures. The total payment for a CCG based on performance against the four national measures and the three local measures will be reduced if providers do not meet the NHS Constitutional rights or pledges for patients. The total amount possible for CCGs to receive in achievement of the Quality Premium will be £5 per patient in the CCG, according to the same formula as the payment of the running cost allowance. For HaST CCG this amounted to £1,440,100 in 2015/16 and the 2016/17 figure will be confirmed in future reports. The following page includes the new 2016/17 quality premium and highlight the indicators against which the quality premium will be determined, together with the relevant financial value attributed to each indicator. This summary includes a ‘best and worst’ scenario as due to the timing of published data it is sometimes difficult to forecast achievement. There are some new changes to the 2016/17 quality premium to take into consideration:

• The four new national measures now cover the following areas: Cancer staging at diagnosis (20%), E-referrals (20%), achieving a positive experience through the GP Patient Survey (20%) and the fourth has carried on from 2015/16, Improving antibiotic prescribing (10%)

• The three new local measures chosen by HaST CCG are: Receiving cancer treatment within 2 months of an urgent GP referral (10%); prevalence of COPD on GP registers (10%); and Mental Health indictor determining people who are classed as "moving to recovery" of those who have completed IAPT treatment (10%)

• A new ‘actions’ column can be found next to the national and local measures, to be completed by relevant selected CCG members.

• Most of the NHS constitutional measures remain the same, except the cancer 2ww standard has now been replace with the Cancer 62 day urgent GP referral measure. Each NHS constitutional measure is now equally weighted at 25% each.

19

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Corporate – CCG Quality Premium Template 2015/16

20

Population 289,951 Potential Fund £1,449,757

Measure

% of QPValue for

CCGThreshold Published Data Measure Achieved/Forecast Actual

10.00% 144,976

average trend percentage reduction in the potential years of life lost (standardised for sex and age) from amenable mortality for the CCG

population to be achieved over the period between the 2012 and 2015 calendar years. This should be no less than 1.2%

HSCICBaseline data for 2014 will be available in summer 2015. Outcome data for 2015 will

be available in summer 2016

CCG Outcomes Indicator Set published 15 December 2016

states this indicator is not being updated at present due to

ongoing methodological review. Timeframe not available at

present.

Avoidable emergency admissions 15.00% 217,464a reduction, or a zero per cent change, in the annualised trended change in the Indirectly Standardised Rate of emergency admissions for these

conditions over the 4 years 2012/13 to 2015/16HES

Baseline data for 2014/15 will be available in summer 2015. Outcome data for

2015/16 will be available in summer 2016

2014/15 - 2,679To Mar-16 - 3,201

£0

Increase in the number of patients admitted for non-elective reasons, who are discharged at weekends or bank holidays.

15.00% 217,464

The proportion of patients discharged on a Saturday, Sunday or English Public Holiday should be

(a) at least 0.5% points higher in 2015/16 than in 2014/15; OR(b) Greater than 30% in 2015/16

HES Monthly14/15 - 18.97%

YTD Mar-16 =19.22%£0

Reduction in the number of patients attending an A&E department for a mental health-related needs who wait more than four hours to be treated and discharged, or admitted, together with a defined improvement in the

7.50% 108,732

The proportion of primary diagnosis codes at A&E with a valid 2 character A&E diagnosis or 3 digit ICD-10 code will be at least 90%; AND

The proportion of patients with a primary diagnosis of mentalhealth-related needs or poisoning that spend more than 4 hours in

HES Monthly86.2% to Mar-16

Target 95%£0

Reduction in the number of people with severe mental illness who are currently smokers

7.50% 108,732A reduction in the percentage of people with severe mental illness

who are current smokersGP data extracted by

GPES.Quarterly

Baseline used Apr-15 = 38.57%39.04% to Mar-16

£120,813

Increase in the proportion of adults in contact with secondary mental health services who are in paid employment.

7.50% 108,732

An increase in the percentage of people in contact with mentalServices (as measured in the MHMDS) who are in paid employment.; OR

a reduction in the gap between people in contact with mentalservices (as measured in the MHMDS) who are in paid

MH MDS MonthlyBaseline used =5.7% (Apr-15)

15.6% to Mar-16£0

Improvement in the health related quality of life for people with a long term mental health condition

7.50% 108,732A reduction in the difference between the health related quality oflife for people with any long term conditions compared to those

with a mental health long term condition

Data source: GP Patient Survey, CCG

OIS

Data availability:2014/15-September 20152015/16-September 2016

CCG Outcomes Indicator Set published 15 December 2016 states that there is no data

available at present. Timeframe not given.

£0

10.00% 144,976

Part a) reduction in the number of antibiotics prescribed in primary care by 1% or greater.

Individual practice reduction to be decided by the CCG.Part b) number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care to be reduced by 10% from each CCG’s 2013/14 value,

Part c) Secondary care providers validating their total antibiotic prescription data

NHSE Website Monthly

To Mar-16Achieving both elements and improving position showing a

downward trend

£161,084

Local Measure 1 Dementia C2.13 10.00% 144,976 Target of 72%

QOF prevalence and model based on age

of registered population

Quarterly 86.97%% to Mar-16 £161,084

Local Measure 2 Maternal smoking at delivery 1.14 10.00% 144,976 Reduction from 2014-15 published data (average over 4 quarters). PHE gov.uk website. Quarterly

2014/15 YTD: 18.13%2015/16 YTD: 18.13%

Q1 - 17.8% Q2 - 17.6% Q3 - 20.1% Q4 - 16.9%

£0

100.00% 1,449,757 £442,981

% of QPValue for

CCGException

ReportRTT Incomplete 30% 434,927 94.9% YTD Mar-16

A&E A&E 4 hour target 30% 434,927 94.6% YTD Mar-16

Cancer Cancer 2WW First seen OPA within 14 days of referral 20% 289,951 92.9% YTD Mar-16 -£88,596

NEAS Category A Red 1 ambulance calls 20% 289,951 68.6% YTD Mar-16 -£88,596

100% 1,449,757 -£177,192£0

£265,789

Achievement

Operational Standard Achievement/Current Performance

Indicator

NHS Hartlepool and Stockton-on-Tees CCGValue

0

Reducing potential years of life lost

Urgent and emergency care

Mental Health

Improving Antibiotic Prescribing

Data SourceException

Report

National Indicators

NHS Constitution Measures

Revised TotalOther Adjustments (adverse variance against planned financial position)

93%

75%

Total Constitutional Adjustment

92%

95%

NHS Hartlepool and Stockton-on-Tees CCG Local

Indicator

Total

Indicator

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Glossary

21

TARGETCCG

LEVELTRUST LEVEL

ADDITIONAL INFORMATION

Patients on incomplete, routine pathways should wait no longer than 18 weeks from receipt of referral

92.00% Yes Yes

Number of patients waiting more than 52 weeks on an incomplete pathway

0 Yes Yes

Dia

gnos

tics

6 Week Diagnostic tests - patients should wait no longer than 6 weeks for a diagnostic test from date of decision to refer for the test

99.00% Yes Yes

The 6 week target applies to 15 key diagnostic tests: Audiology assessment, Barium Enema, Colonoscopy, CT, Cystoscopy, DEXA Scan, Echocardiography, Electrophysiology, Flexi-sigmoidoscopy, Gastroscopy, MRI, Non-obstetric Ultrasound, Peripheral Neurophysiology, Sleep Studies and Urodynamics.

MS

A

Mixed Sex accommodation (MSA) - number of unjustified breaches

0 Yes No

The focus of this indicator is on MSA breaches in respect of sleeping accomodation. Sleeping accomodation includes areas where patients are admitted and cared for on beds or trolleys, even when they do not stay overnight. It therefore includes all admission and assessment units plus day surgery and endoscopy units. It does not include areas where patients have not

Incidence of MRSA (meticillin-resistant staphylococcus aureus)

0 Yes Yes

Incidence of Clostridium Difficile 72 (CCG

level)Yes Yes

The decision to carry over the 2015/16 objectives has been prompted by the fact that there has been a slight increase in the median CDI rate from the year to November 2014 to the year to November 2015. The current methodology for calculating new CDI objectives relies on requiring organisations that are worse than the median in terms of their rate of CDI to improve by the same amount that the wider median CDI rate hasimproved from one year to the next. If there is no improvement in this wider rate, it cannot be used to calculate revised objectives. It has therefore been decided to carry over the 2015/16 CDI objectives into 2016/17.

Incomplete pathways are waiting times for patients waiting to start treatment at the end of the month. All referrals will be counted as incomplete pathways until a treatment starts, this will then determine whether a patient is on an admitted on non-admitted pathway. A clock starts when any care professional or service refers to a consultant led service or interface/referral management service which might lead to onward referral to a consultant led service. Self-referrals, where the service allows, should also result in a clock start. A clock stops for treatment when first definitive treatment (medical/surgical) starts or a clinical decision is made to refer the patient back to primary care for non-consultant led treatment or where a patient is added to a transplant list.A clock stops for non-treatment when a clinical decision is made not to treat or to start a period of active monitoring. Other non-treatment clock stops include where a patient declines treatment, or a patient DNA’s first or subsequent appointments in accordance to the DNA policy and is discharged back to primary care. 25% of the Quality Premium

DESCRIPTION

Hea

lthca

re A

ssoc

iate

d In

fect

ions

(H

CA

I)R

efer

ral t

o tre

atm

ent (

RT

T)

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Glossary

22

TARGETCCG

LEVELTRUST LEVEL

ADDITIONAL INFORMATION

A&E 4 hour waits - patients should be admitted, transferred or discharged within 4 hours of their arrival to the A&E department.

95.00% No Yes

A&E activity includes:• Type 1 – Consultant led 24 hour service with full resuscitation facilities• Type 2 – Consultant led single speciality service (i.e. dental)• Type 3 – walk in centre or minor injury unit (MIU)25% of the Quality Premium

12 hour Trolley waits in A&E - no patients should wait more than 12 hours in A&E from decision to admit

0 No YesThe waiting time for admission is measured from the time a decision is made to admit or treatment in the A&E department is completed to the time the patient is admitted.

Category A 8 minute response times - patients who required an ambulance urgently because their condition was considered immediately life threatening should not wait any longer than 8 minutes for ambulance arrival.

75.00% YesYes

(NEAS)

The target is monitored at Trust level (NEAS) but is also available at CCG level. The Category A 8 minute response times indicator is split into two parts, Red 1 and Red 2. • Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions. For Red 1 calls, the existing call connect clock start will remain (when the call is presented to the control room telephone switch), ensuring that patients who require immediate emergency ambulance care will continue to receive the most rapid response.• For Red 2 calls, which are serious but less immediately time critical and cover conditions such as stroke and fits, a new clock start will allow call handlers to get more information about patients so that they receive the most appropriate ambulance resource based on their specific clinical needs. Red 2 clock starts when a vehicle is assigned or 60 seconds after the call is presented. The clock stops when the first emergency responder arrives at the scene. 25% of the Quality Premium

Category A 19 minute response times - patients who required an ambulance to attend urgently but did not have a condition considered immediately life threatening should not wait any longer than 19 minutes for ambulance arrival.

95.00% YesYes

(NEAS)

The target is monitored at Trust level (NEAS) but is also available at CCG level.

The 19 minute clock stops when the first emergency responder able to transport the patient arrives at the scene.

Ambulance handovers - the number of handover delays over 30 minutes long and those over 60 minutes long.

0 Yes NoHandover start time is defined as the time of arrival of the ambulance at the accident and emergency department, with the end time defined as the time of handover of the patient to the care of accident and emergency staff

Cancelled operations - All patients who have operations cancelled to be offered another binding date within 28 days

0 No Yes

When a patient's operation is cancelled by the hospital at the last minute for non-clinical reasons, the hospital will have to offer another binding date within a maximum of the next 28 days or fund the patient's treatment at the time and hospital of the patient's choice.

DESCRIPTION

Urg

ent C

are

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TARGETCCG

LEVELTRUST LEVEL

ADDITIONAL INFORMATION

2 week wait standard - maximum 2 week wait for first outpatient appointment for patients referred urgently with suspected cancer by a GP

93.0% Yes YesPatients urgently referred with suspected cancer by their GP (General Medical Practitioner or General Dental Practitioner) to be seen within 14 working days. Direct to test (DTT) also counts as a first appointment.

2 week wait breast symptomatic - maximum 2 week wait for first outpatient appointment for patients referred urgently with breast symptoms (where cancer was not initially suspected)

93.0% Yes YesPatients urgently referred with breast symptoms whereby cancer is not initially suspected, by their GP to be seen within 14 working days.

31 day first definitive treatment (FDT) standard - maximum of 31 days wait from diagnosis to first definitive treatment across all cancers

96.00% Yes Yes The 31 day clock starts from the date of decision to treat

31 day subsequent surgery treatment target - maximum of 31 days wait for subsequent treatment where the treatment is surgery

94.00% Yes Yes The 31 day clock starts from the date of decision to treat

31 day subsequent drugs treatment standard - maximum of 31 days wait for subsequent treatment where the treatment is an anti-cancer drug regimen

98.00% Yes YesAnti-cancer drug regimens includes: Cytotoxic chemotherapy, immunotherapy, hormone therapy and other specified drug treatments

31 day subsequent radiotherapy treatment - maximum of 31 days wait for subsequent treatment where the treatment is radiotherapy

94.00% Yes YesRadiotherapy treatments include: Teletherapy, proton therapy, brachytherapy and chemoradiotherapy.

62 day Urgent GP referral for suspected cancer - maximum of 62 days wait from urgent GP referral to date of first definitive treatment

85.00% Yes YesMaximum wait of 62 days (2 month) from receipt of urgent GP referral suspecting cancer to first definitive treatment of diagnosed cancer25% of the Quality Premium

62 day NHS Screening standard - maximum of 62 days wait from referral from a NHS screening service to first definitive treatment

90.00% Yes YesMaximum wait of 62 days (2 month) from receipt of a screening referral from a NHS screening service where cancer is suspected, to first definitive treatment of diagnosed cancer

62 day consultant upgrade standard - maximum of 62 days wait for first definitive treatment following a consultants decision to upgrade the priority of the patient from routine to urgent

N/A Yes YesMaximum wait of 62 days (2 month) from the date a consultant has decided to upgrade the priority of a referral from routine to urgent based on a suspicion of cancer, to first definitive treatment of diagnosed cancer

Can

cer W

aitin

g T

imes

(CW

T)

DESCRIPTION

Glossary

23

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24

Glossary % of QP

Potential value for

CCG Technical guidance 2016/17

Baseline Measure (Technical Guidance)

Improvement required to achieve (Technical Guidance)

Improving antibiotic prescribing in primary care

10% £144,010

Two part QP:Part a) reduction in the number of antibiotics prescribed in primary care Part b) reduction in the proportion of broad spectrum antibiotics prescribed in primary care

Part a) <1.353Part b) 10 or below

Part a) a minimum of 4% reduction on 2013/14 performance or equal to (or below) the England 2013/14 mean performance of 1.161 items per STAR-PU. Part b) to be equal to or lower than 10%, or to reduce by 20% from the CCG’s 2014/15 value

Cancer 20% £288,020

Demonstrate a 4 percentage point improvement in the proportion of cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year compared to the 2015 calendar year.Or2. Achieve greater than 60% of all cancers (specific cancer sites, morphologies and behaviour*) diagnosed at stages 1 and 2 in the 2016 calendar year

Need to find out annual 2015/16 figure.

Previously published annually, quarterly data will be available from May 2016. Data will be a rolling window of one year's worth of data. The data will be lagged by 12 months.

Baseline will not be available nationally until Mar-17. Comparison Data will not be published until Mar-18

4% improvement from 2015 to 2016 OR 60% of all cancers to be diagnosed at stage 1 or 2 from Jan-16 to Dec-16

E-Referrals 20% £288,020

Meet a level of 80% by March 2017 (March 2017 performance only) and demonstrate a year on year increase in the percentage of referrals made by e-referrals (or achieve 100% e-referrals) OrMarch 2017 performance to exceed March 2016 performance by 20 percentage points.

Need March 2016’s performance to use as a baseline. Done on a Monthly basis (two month lag due to lag in MAR data)

Meet 80% in March 2017 and demonstrate year on year increase in % or achieve 100% e-referralsor 20% improvement from March 2016 to March 2017

GP Patient Survey 20% £288,020

Achieve a level of 85% of respondents who said they had a good experience of making an appointment OrA 3 percentage point increase from July 2016 publication on the percentage of respondents who said they had a good experience of making an appointment

Baseline = 74% (Released Jul-16 on www.ipsos-mori.com) Comparison data will not be published until Jul-17

85% of respondents to answer ‘Very good’ or ‘Fairly good’ to Q18 of the survey. OR3% increase from July 2016 to July 2017 answering the same question.

Cancer - Receiving first definitive

treatment within two months of

urgent referral from GP

10% £144,010

HaST CCG are proposing to achieve a year end position of 85.9% against this indicator. This equates to a 6% increase in performance from the calculated baseline.

Respiratory - Reported

prevalence of COPD on GP

registers as % of estimated prevalence

10% £144,010

HaST CCG are poposing to report a year end position of 82.8% against this indicator, this is a 1% improvement from our current baseline and will continue to see us report above the national average and that of our peers.

Mental Health - % of people who are

"moving to recovery" of those

who have completed IAPT

treatment

10% £144,010

HaST CCG are proposing to report a year end position of 50.0% against this indicator, this is a 2.3% improvement against our current baseline and will bring us in line with the national target.

NATI

ONAL

LOCA

L

Local Indicators are not detailed within technical guidance

Measure

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.2.3

7th February 2017

Title Quality and Safeguarding Report Purpose

Approval ☐ Discussion ☒ Information ☐

Responsible CCG Member / Lead

Jean Golightly, Executive Nurse

Author of Report Jean Golightly, Executive Nurse Recommendation(s) The Committee are asked to note the overview of quality and

safeguarding issues raised in the report and the process for assurance and monitoring. This report reflects the position in October 2016

Executive Summary

Key Quality and Safeguarding concerns for the CCG: • North Tees and Hartlepool NHS Foundation Trust (NTHFT)

o Health Care Acquired Infections: Exceeded the Clostridium Difficile annual trajectory MRSA reported 1 trust attributable case

o The independent, external Maternity Services review has been completed and the report is still awaited

o Mortality metrics continue to improve • South Tees Hospitals NHS Foundation Trust (STHFT)

o Trust rated GOOD in all 5 domains of care, and GOOD overall in published results of CQC follow up inspection.

o 5 published Trust attributable MRSA cases • Tees Esk and Wear Valley NHS Foundation Trust (TEWV)

o Serious incident national reporting framework timescales remains a challenge for the Trust with non-compliance continuing

o Unannounced CQC inspection of Adult and Older Persons Mental Health Services

• North East Ambulance Service (NEAS) o Trust rated GOOD in all 5 domains of care, and GOOD

overall in published results of CQC follow up inspection. • CCG

o Ofsted and Care Quality Commission joint inspection of Special Educational Needs and Disabilities (SEND) for Children and Young People in Hartlepool DRAFT narrative inspection received for accuracy

checks. o Reintroduction of NHSE CNE weekly tracker for Learning

Disabilities in-patients

Does this report provide evidence of

Health and Social Care Act 2012, ‘Quality Duty’

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assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

To ensure the GB are provided with an overview of published data and where appropriate contemporaneous data relating to the quality of services they commission from their main NHS Providers. Ensures a standard of excellence in the provision of high quality care that is safe, effective and focused on patient experience. Working across organisational boundaries and in partnership with GP Practices and NHS organisations to provide and deliver improvements in managing and learning from incidents.

Has an Equality Analysis been completed?

N/A

Attachments N/A

Governing Body strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☐ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☐ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☐

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Quality and Safeguarding Governing Body Report November 2016

1. Purpose of report

The purpose of this report is to provide Hartlepool and Stockton-on-Tees Clinical Commissioning Group (HaST CCG) Governing Body with a Quality and Safeguarding exception report which headlines the key areas of concern within the CCG’s commissioned services and provides assurance that actions are being undertaken where appropriate. This paper reflects the position as at the end of October 2016.

2. Introduction This report provides information relating to the CCG’s position and that of its main healthcare providers with an NHS contract:

• North Tees and Hartlepool NHS Foundation Trust (NTHFT) • South Tees Hospitals NHS Foundation Trust (STHFT) • Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) • North East Ambulance Service NHS Foundation Trust (NEAS) • Where appropriate independent sector providers are also included.

Additional information is also included in relation to the CCG’s statutory duties and responsibilities in relation to Safeguarding Children and Adults.

3. Quality update

3.1. Key points to note

• North Tees and Hartlepool NHS Foundation Trust (NTHFT) o Health Care Acquired Infections:

Exceeded the Clostridium Difficile annual trajectory MRSA reported 1 trust attributable case

o The independent, external Maternity Services review has been completed and the report is still awaited

o Mortality metrics continue to improve • South Tees Hospitals NHS Foundation Trust (STHFT)

o Trust rated GOOD in all 5 domains of care, and GOOD overall in published results of CQC follow up inspection.

o 5 published Trust attributable MRSA cases • Tees Esk and Wear Valley NHS Foundation Trust (TEWV)

o Serious incident national reporting framework timescales remains a challenge for the Trust with non-compliance continuing

o Unannounced CQC inspection of Adult and Older Persons Mental Health Services • North East Ambulance Service (NEAS)

o Trust rated GOOD in all 5 domains of care, and GOOD overall in published results of CQC follow up inspection.

• CCG o Ofsted and Care Quality Commission joint inspection of Special Educational Needs

and Disabilities (SEND) for Children and Young People in Hartlepool DRAFT narrative inspection received for accuracy checks.

o Reintroduction of NHSE CNE weekly tracker for Learning Disabilities in-patients

4. North Tees and Hartlepool NHS Foundation Trust

4.1 Serious Incidents and Never Events As reported in the October 2016 Governing Body Quality and Safeguarding report, the Clinical Quality Team (CQT) continue to work with the Trust to address the backlog of open incidents. This work has been enhanced by the arrival of the new Head Clinical Governance the Trust.

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The table below shows the OPEN incidents for all the Trusts that HAST CCG commissions care from (not all incidents are for HAST patients).

Table 1.

4.2 Mortality

The Trust mortality metrics continue to show an improving picture, although the Summary Hospital Mortality Indicator (SHMI) remains an outlier. This position is expected to continue to improve with the focussed work underway led by the Associate Medical Director. This work includes a concentration on both the quality of data and also care delivered, and also integrates this into revalidation processes for medical staff.

The Trust was in receipt of Care Quality Commission (CQC) outlier alerts for Acute Kidney Injury and Urinary Tract Infection pathways. In early October the Trust received confirmation from the CQC that they are satisfied sufficient actions have been taken to reduce the risks to patients in relation to these two clinical conditions and as a result of this assurance provided by the Trust the CQC have now closed the outlier alerts for both of these conditions.

Table 2

4.3 Health Care Acquired Infection (HCAI) 4.3.1 Clostridium difficile: the Trust has breached the annual Clostridium Difficile Infection (CDI)

trajectory for 2016-17 and has also exceeded the Year to Date position for 2015-16.

02468

1012141618 North East Ambulance Service

NHS Foundation Trust

North Tees & Hartlepool NHSFoundation Trust

South Tees Hospitals NHSFoundation Trust

Tees, Esk and Wear Valleys NHSFoundation Trust

County Durham & Darlington NHSFoundation Trust

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• Current status = 22/13 (as at 31.10.16)

Table 3

The Trust held a CDI Summit on the 13th October, inviting all key stakeholders. The event included discussion around current and previous performance and the work carried out in relation to the NHS Improvement 90 Day Improvement Programme. The remaining part of the session discussed and weighted the principles identified by the CDI Task and Finish Group and agreed a prioritisation approach for implementation.

4.3.2 MRSA: the Trust has recently reported its first Trust attributable case. For comparison the published performance data for the rest of the region has been included in the table below.

Table 4

4.3.3 Ecoli

Health Secretary Jeremy Hunt has launched new plans to reduce E. coli infections in the NHS. There is large variation in hospital infection rates, and these can be cut with better hygiene and improved patient care in hospitals, surgeries and care homes, such as ensuring staff, patients and visitors regularly wash their hands. These new plans build on the progress made in infection control since 2010 with national reductions of MRSA cases by 57% and C. Further details are awaited around the specifics of the plans which include:

• more money for hospitals making the most progress in reducing infection rates with a new £45 million quality premium

• independent Care Quality Commission (CQC) inspections focusing on infection prevention based on E. coli rates in hospitals and in the community, and taking action against poor performers

• the NHS publishing staff hand hygiene indicators for the first time

MRSA Incidents Assigned to Trust Following PIR Process (unshaded columns contain unpublished data which will be recorded against trusts until the PIR process has taken place.)

Apr May Jun Jul Aug Sep Oct

City Hospitals Sunderland NHS Foundation Trust 1 1 0 0 1 1 1

County Durham And Darlington NHS Foundation Trust 0 0 0 1 0 0 2

Gateshead Health NHS Foundation Trust 0 0 0 0 0 0 0

North Cumbria University Hospitals NHS Trust 0 0 0 0 0 0 0

North Tees And Hartlepool NHS Foundation Trust 0 0 0 0 0 1 0

Northumbria Healthcare NHS Foundation Trust 0 2 0 1 0 0 1

South Tees Hospitals NHS Foundation Trust 0 0 0 1 2 1 2

South Tyneside NHS Foundation Trust 0 0 0 0 0 0 0

The Newcastle Upon Tyne Hospitals NHS Foundation Trust 0 0 2 0 0 0 3

University Hospitals Of Morecambe Bay NHS Foundation Trust

0 0 0 0 0 0 0

Other Trusts 13 26 20 13 28 28 54

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• displaying E. coli rates on wards, making them visible to patients and visitors in the same way that MRSA and C. difficile are currently

• improving training and information sharing so NHS staff can learn from the best in cutting infection rates

• appointing a new national infection lead, Dr Ruth May, who is also the Director of Nursing for NHS Improvement

The numbers of published cases is currently monitored and reviewed, however it is not categorized by Trust, CCG, or community or hospital acquired, as below. It is anticipated that 2017-18 may bring performance related trajectories however further clarity on this is awaited.

Table 5

4.4 Workforce: During September some Hartlepool GP practices began to experience difficulties with

access to District Nursing services. The Trust has advised that they are experiencing issues with sickness absence rates in this area and have mitigating measures in place. The CCG are in receipt of an improvement plan from the Trust and continue to monitor the situation closely.

4.5 Maternity Services: Receipt of the final report from the Trust commissioned independent external review of their Maternity Services, conducted by the Royal College of Obstetricians and Gynaecologists is still awaited.

5 South Tees Hospitals NHS Foundation Trust

5.1 Serious Incidents and Never Events: Please see Table 1 for details of the current OPEN serious incidents

5.2 Mortality: The latest mortality data continues to show steady improvement and the Trust is no

longer considered an outlier for these metrics.

5.3 Healthcare Associated Infections (HCAI) 5.3.1 Clostridium difficile: The Trust’s good performance in relation to Clostridium Difficile

Infections (CDI) continues with the number of cases remaining below trajectory for the year to date.

5.3.2 MRSA: this is now becoming a significant concern for the Trust with the current number of published Trust attributed cases as 5. It is anticipated that this will rise following the

E Coli (total = not split by Trust and CCG ) Apr May Jun Jul Aug Sep

City Hospitals Sunderland NHS Foundation Trust 26 24 28 25 29 27

County Durham And Darlington NHS Foundation Trust 27 25 26 45 41 38

Gateshead Health NHS Foundation Trust 18 13 17 14 11 17

North Cumbria University Hospitals NHS Trust 19 22 20 24 19 17

North Tees And Hartlepool NHS Foundation Trust 25 23 17 22 28 30

Northumbria Healthcare NHS Foundation Trust 26 33 43 40 40 29

South Tees Hospitals NHS Foundation Trust 34 38 45 39 43 36

South Tyneside NHS Foundation Trust 14 14 14 10 9 11

The Newcastle Upon Tyne Hospitals NHS Foundation Trust 35 44 48 28 26 36

University Hospitals Of Morecambe Bay NHS Foundation Trust

19 27 20 19 31 18

Other Trusts 2,811 3,099 3,132 3,377 3,476 3,207

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investigations of additional cases currently under investigation. The Trust Quality Assurance Committee are fully aware of this and have requested a review of the HCAI improvement plan to implement the additional necessary measures to address this increasing risk.

5.4 Cancer performance: The Trust continues to monitor delays to patients who are on a Cancer

pathway and are required to undertake ‘Clinical Harm Reviews’ for any patients who have experienced a delay of more than 104 days in commencing definitive treatment. These reviews are undertaken by the multidisciplinary team and the outcomes are to be reported to the commissioning CCG. If there is ‘harm’ to the patient due to the extended waiting times then the Trust is required to report these cases as serious incidents and undertake a ‘root cause’ analysis in line with the serious incident guidance. Although the Trust has reported a number of patients waiting longer than 104 days no serious incidents have been reported to date. The CCG is seeking further assurance from the Trust that the process of assessment is robust and meets the requirements of the national NHS England guidance.

5.5 Regulators: Care Quality Commission: On 28.10.16 the CQC published the results of the review

inspection undertaken earlier in the year. The Trust is now classified as GOOD in all domains of care, and GOOD overall. The Trust are to be congratulated on this news and for all the efforts by their staff and leadership teams in achieving this improvement.

6. Tees Esk and Wear Valley NHS Foundation Trust

6.1 Serious Incidents: Management of this process remains a concern as the Trust is non-compliant with the national reporting timescales. This has been the subject of much debate with the Trust who is very aware of the challenges that they face. These relate mainly to workforce issues and leadership within the patient safety team both of which are being addressed by the Trust.

As illustrated by Table 1 the Trust has a number of ongoing serious incidents which should be closed within shorter timeframes. This is due to internal trust process and the quality of the reports submitted to the commissioners. The Trust is working with their clinical teams to improve the quality of the reports and the clinical quality team is supporting the process on behalf of the CCG. These issues have been discussed with both the Director of Nursing and the Director of Quality for the Trust. The Clinical Quality Team will continue to monitor the positon and work with the Trust to improve the current position. The Trust’s Director of Quality recently visited a HAST CCG Governing Body development session to deliver a comprehensive and informative presentation on the work undertaken to date in response to the national publication of the Mazars Southern Health report. This included information on how the Trust has gained external independent assurance on their governance around serious incidents and mortality reviews.

6.2 Regulators - Care Quality Commission: The Trust notified commissioners in November of an

unannounced CQC inspection that started on 01.11.16. The focus of the inspection visit has been on Adult Mental Health services and also those for Older People. The early informal feedback has been positive, however no indication has been received for when the formal report will be available. The published results (11.05.16) of the previous inspection were GOOD overall and with the following ratings in each domain

• Safe Requires improvement • Effective Good • Caring Good • Responsive Good • Well-led Outstanding

7. North East Ambulance Services (NEAS)

7.1 Serious Incidents: Please see Table 1 for details of OPEN incidents. As the majority of these relate to issues associated with response time performance this is recognised by all involved and the CCGs are working with NEAS to support the system wide improvements required to improve the current position.

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NEAS also remains non-compliant with the national framework of timescales for reporting and management of serious incidents and this continues to be the subject of robust challenge at the joint Quality Review Group which is attended by all Lead Commissioner CCG Executive Nurses.

7.2 Quality Improvement: The Trust has signed up to the NHSE ‘Sign up to Safety Campaign’. The ambition of the scheme is to halve avoidable harm in the NHS over the next 3 years and save 6,000 lives as a result. The Trust’s development plan covers the following five areas: • To improve the reporting culture within the trust • Ensure learning from themes and trends are implemented to reduce potential for harm • Work collaboratively with acute trusts and partners to reduce incidence of pressure sores • Ensure better outcomes for those patients presenting with sepsis • Encourage staff to share ideas for innovation and service improvement and ensure they feel

supported in doing so.

7.3 Regulators: Care Quality Commission: On 01.11.16 the CQC published the results of the review inspection undertaken earlier in the year. The Trust is now classified as GOOD in all domains of care, and GOOD overall. The Trust are to be congratulated on this news and for all the efforts by their staff and leadership teams in achieving this improvement.

8. Safeguarding

The One North joint internal audit of HaST CCG and ST CCG safeguarding arrangements is still underway.

7.1 Adult Safeguarding

The team continue to work across Tees to monitor and promote adult safeguarding in all commissioned services

7.1.1.1 Care Home Quality: The CCG has received a number of requests for information both from the Hartlepool Local Authority Adult Services Committee and BBC Radio 4 in connection with residential and nursing home capacity within the borough.

The CCG is responsible for commissioning nursing residential care, and work with the local authorities (LA) who then manage the provider’s contract under local agreements between the CCG and LA. Like other LA areas across the region, Hartlepool has continued to experience pressures within the Residential and Nursing care home sector and despite providing significantly augmented additional NHS support there have been a number of closures across both residential and nursing home provision.

7.1.1.2 The CCG continue to progress work with partners and stakeholders on the Prevent agenda

7.1.1.3 As detailed in the Children’s Safeguarding part of this report the CCG is also engaged with LA partners in reviewing the effectiveness of Domestic Abuse arrangements across our locations.

7.2 Children’s Safeguarding 7.2.1 Serious Case Reviews: The Hartlepool serious case review continues and it is anticipated

that this will be published at the beginning of 2017.The Designated Nurse Safeguarding Children and Named GP Safeguarding Children continue to participate in the children’s review group sessions. The Head of Quality and Adult Safeguarding is integral to the adult review group sessions, and the Executive Nurse sits on the overarching governance group.

7.2.2 Inspections: 7.2.2.1 A special educational needs and disabilities (SEND) inspection was carried out in

Hartlepool at the beginning of October by CQC and Ofsted and the published result is expected at the end of November. Initial findings identified a requirement for improved joint commissioning arrangements between Hartlepool Local Authority and HAST CCG and a more robust strategic approach to meeting the needs of child with disabilities to ensure they are fully safeguarded. Local quality

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requirements for the forthcoming reporting year have been identified to capture relevant data in respect of children with SEND.

7.2.2.2 Domestic abuse and the impact on children is the current theme for a joint targeted area inspection (JTAI, Sept 16-March 17) undertaken by CQC, Ofsted, Her Majesty’s Inspection of Probation and Her Majesty’s inspectorate of constabulary. Multi-agency work is being undertaken across the Tees area to identify and address any gaps in service provision.

7.2.2.3 A NHS England Safeguarding assurance exercise was undertaken in April 2016 and an action plan developed for each CCG in relation to the findings and gaps identified. A report released on the 1st November presents the findings of the CCG safeguarding assurance process which was undertaken with all 66 CCGs across NHS England North Region during February 2016 – July 2016.

Analysis of the all CCG self-assessment returns has highlighted significant gaps in the following areas:

• Capacity within key safeguarding posts • Training strategy and compliance rates • Management of allegations against professionals • Complaints and Whistleblowing policies • Guidance regarding appropriate behaviours for staff working with children, young people and adults at risk.

The report made 11 recommendations in total for all CCGs. HAST CCG had 4 recommendations which they are progressing. These include:

•Including safeguarding responsibilities in all job descriptions –Action: safeguarding compact devised •Revision of whistle blowing policy – Action: awaiting direction from NECS as other changes required in relation to the policy •Pursuing the recruitment of a Designated Doctor for LAC –Action: pursuing this post to be combined with Designated Doctor for Safeguarding Children.

7.2.3. Work continues with the 4 Tees Local Safeguarding Children Boards’ (LSCB) Performance

Management Framework (PMF). The final iteration of the 2015-16 data was provided to the October Tees Directors of Children’s Services meeting, where the LSCB Chairs were also in attendance, together with the Chairs of Darlington LSCB and Teeswide Adults Safeguarding Board. The report was very well received and the more up to date edition covering 2016-17 Quarters 1 & 2 is awaited.

8 Learning Disabilities and Transforming Care

As an extension of the recent performance concerns raised in relation to NHSE CNE reducing in-patient bed trajectory, the CCG has undertaken an audit of all their patients, and provided detailed information in support of a “deep dive” of this area. Weekly “tracker” submission have also commenced with the information authorised by Chief Officer.

The Executive Nurse continues to work very closely with NECS Learning Disabilities and NHSE CNE dedicated colleagues.

9 Recommendation The Governing Body is asked to receive this report for information and discussion.

Author: Jean Golightly, Executive Nurse, HaST CCG Date: November 2016

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 2.2.4

7th February 2017

Title HaST Governance and Assurance report

Purpose Approval ☐ Discussion ☐ Information ☒

Responsible CCG Member / Lead

Graeme Niven, Chief Finance Officer

Author of Report Graeme Niven, Chief Finance Officer

Recommendation(s) The Governing Body is requested to receive the Governance and

Assurance Report;

Executive Summary

The report provides detail on significant governance and assurance issues since the last Governing Body meeting and provides assurance to the Governing Body of the CCG on delivery of key governance processes.

Clinical Engagement

Not Applicable

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

This report directly relates to the assurance framework and risk register by its very nature.

Has an Equality Analysis been completed?

Not Applicable

Attachments Governance and Assurance report HaST Risk Register

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Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☒ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☒

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☒ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☒ Other Committees/Meetings where this report has been presented None Does this need to be reported to another Committee/Meeting? None

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Darlington CCG Governance and Assurance Report 1 Purpose 1.1 The purpose of this document is to;

• Report on significant governance and assurance issues since the last

Governing Body meeting.

• Provide assurance to the Governing Body of the CCG on delivery of key governance processes

2 Risk Register

2.1 One risk is currently classified as being high risk:

Risk 1032 - Failure to commission the appropriate number of high quality nursing care beds in all residential settings where the CCG is the responsible commissioner.

This risk is being actively managed and updates being presented to the Governing Body.

2.2 Since the last Governing Body meeting, there has been a meeting of the Governance and Risk Committee. One risk that was previously classified as high, Risk 1448 - Deprivation of Liberty Processes are not put in place in relation to Continuing Healthcare Cases has been reclassified and is no longer ranked as a high risk. This is due to the approval of the Mental Capacity Act and Deprivation of Liberty Policy by the Governance and Risk Committee on 5th December.

2.3 A review was undertaken of the entire risk register with the executive team, which identified a number of changes to risks and to controls and assurances. These were presented to the Governance and Risk Committee on 5th December. Therefore an updated copy of the CCG’s risk register is provided as an appendix to this report for Governing Bod’s information.

2.4 However, the Governing Body will be aware that the CCG risk register is not a static document and risks remain under review.

3 Policy Framework 3.1 The CCG continues to review all of its policies to ensure that it complies with

relevant legislation and good practice by reviewing policies in accordance with the specified review date, or earlier where required.

3.2 Eight corporate policies were approved by the Governance, Audit and Risk

Committee at their meeting on December 5th:

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• Fire Safety Policy • Health & Safety Policy • Moving and Handling Policy • Security Policy • Violence and Aggression and Abuse Management Policy • Prevent Policy • Serious Incidents Policy • Mental Capacity Act and Deprivation of Liberty Policy

3.3 Due to the change in governance arrangements, approval of all CCG policies

will be made by the Governing Body. The executive team will recommend policies for approval by the Governing Body and this will be reported in this Governance and Assurance Report in the future. Significant policies will still be approved separately by the Governing Body where they relate to core responsibilities, such as Standards of Business conduct and Declarations of Interest Policy.

4 IG Toolkit 4.1 The Information Governance Toolkit is a performance tool produced by the

Department of Health (DH) that draws together the legal rules and guidance that the CCG is required to comply with in one place as a set of information governance requirements. The purpose of the assessment is to enable organisations to measure their compliance against the law and central guidance and to see whether information is handled correctly and protected from unauthorised access, loss, damage and destruction.

4.2 The CCG is currently ensuring it has the required evidence to demonstrate compliance with the requirements. At the Governance and Risk Committee on 5th December 2016, the IG Annual report, IG management Framework and IG Training Analysis were all approved. The Governing Body will be asked to formally agree the CCG’s level of compliance before submission by the Chief Finance Officer as Senior Information Risk Owner before the deadline date of 31st March 2017.

5 Recommendations 5.1 The Governing Body is requested to;

• receive the Governance and Assurance Report;

Graeme Niven Chief Finance Officer HAST CCG February 2017

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

NHS Hartlepool and Stockton-on-Tees CCG Risk Register30/01/2017

Gaps in controls

1448

Deprivation of Liberty Processes arenot put in place in relation toContinuing Healthcare CasesThose deprived of liberty could takelegal actionCases brought against the CCG

30/11/2015 Jean Golightly

BarbaraPotter

4 4 16 44 161. Legal advice sought on individual cases. 2. Draft Implementation Plan being developed3

Regular updates beingprovided to DT

Deprevation ofLiberty policy to beredrafted to reflectnew processesand procedures -in developmentTraining packagecurrently indevelopmentDoLs and CHCdirection of traveldocument

Barbara Potter Action Plan DoLs Policy to be developed.

Action Plan Training packages to be developed

31/05/2016

BarbaraPotter

10/10/2016

BarbaraPotter

Strategic (HAST)

253

Failure to deliver the LearningDisability Transformation Programme(transforming care) and RegionalFast Track.

01/04/2013 Jean Golightly

Donna Owens

4 5 20 34 121.CCG Action Plan developed, reviewed and updatedand received by Governing Body outlining progress 2.All reviews and individual support planning has beencompleted for individuals identified through the initialWinterbourne Concordat & quality assured viaindependent reviewers, updates in Quality reports toQPF and GB 3.Task & Finish Group established with regularreporting to QPF & GB via Quality report to overseeimplementation 4.Draft Locality specific joint action plans agreed withindividual LA's ,focusing on longer term sustainablesolutions including development of the market,procurement, etc to be reviewed , updated regularly,reported via Quality report to QPF & GB 5.CCG representation on Tees Commissioning Group,& have produced Joint strategic action plan integratinglocality actions common to all, updates via QualityReport to QPF, GB 6.Formal stocktakes completed by CCG and LA,submitted to LGA, NHS England reported to DT/ET.QPF, GB 7.Quality Assurance of all individual placements forpeople with learning disabilities and autism by CHCteam as part of review process 8.CQC Inspection reports reviewed by CCG(Intelligence shared) by CQC and LAs 9.CCG Learning disability & MH Workstream overseeprogress on the delivery of Winterbourne , updates toQPF, GB (HAST CCG) 10.Regular meetings in place between NECS Leadsand NHS England Specialist Teams ( Forensic) 11.LD Self-Assessment Framework (LDSAF) annual

Foot note: Winterbourne Joint ImprovementProgramme is led by the Local Government Association(LGA) and NHS England, and funded by theDepartment of Health. This Programme wasestablished in response to the Winterbourne Concordatand will ensure implementation.

1. Updates in Quality reportto QPF Committee, 2. Quality report to GB 3. Update provided as partof NHS England (DDATAssurance visits), 4. CHC individual careplacements updates toDT/ET, 5. Regular stock takecompleted and submitted toLGA, NHS England, DH 6.Stock take approved andor provided updates toHealth & Well being Board, 7. CCG representation onRegional networks whoprovide leadership anddirection (incorporated inCCG Plans), 8.Submission of informationto Health ScrutinyCommittees, 9. Learning DisabilityPartnership Board, (HBC,SBC MBC, only) 10. Teeswide SafeguardingVulnerable Adults Board 11. Local SafeguardingChildren's Boards(LSCBs)

1.Lack of robustQuality AssuranceFramework tomonitor Providerscompliance withclinical qualitymetrics/performance includingProgrammeAssurance/validation visits 2.Lack of robustand consistentcontractmonitoringarrangements forproviders ofservices learningdisability andautism ( in andout of area) 3.Limited CHCclinical expertiseand capacity (knowledge andexperience ofpeople withlearningdisabilities) toprovide robustchallenge andscrutiny ofproviders 4.Limitedavailability ofsuitable Providerswith the expertiseto provide safeplacements tomeet assessedindividual needs. 5.Limitedavailability of safehigh qualityappropriatecommunityplacements.

03/06/2015

AndrewCarter

30/11/2015

BarbaraPotter

07/03/2016

BarbaraPotter

Strategic (HAST)

1PageHAST RR01

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RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

NHS Hartlepool and Stockton-on-Tees CCG Risk Register30/01/2017

Gaps in controls

283

Restitution for CHC claims adverselyimpacts the CCG.The provison for restitituition claimsis not enough to offset actual claims.

01/04/2013 Graeme Niven

Graeme Niven

4 4 16 34 12SLA in place with NECS to provide a commissionedserviceOn-going monitoring and key KPIs for delivery of theserviceQPF Committee receives reports.National risk share proposal in place.Claims re-assessed every 6 months

Regular reports to QPFCommitteeNon-ISFE Reporting to theArea teamInternal Audit AssuranceExternal Audit Assurance

Quality report to NHS England regaqrding restituionclaims

Review to ensure thatprovision is still adequate

Action Plan

04/03/2016

AndrewCarter

Finance (HAST)

284

CHC expenditure exceeds budget.CHC service provision and financialallocation may not meet demandresulting in delayed reviews whichnot only has the potential to impactadversely on safety and patientexperiences but also may exceedaffordable financial limits due todelayed reviews. This also has thepotential to adversely affect theCCGs' reputation with the public andpartners.

01/04/2013 Graeme Niven

Graeme Niven

3 4 12 43 12SLA with NECS Monitoring through QPF High cost packages approved within CCG Contigency plans set weekly reports of packages of care changes Monthly report from CHC team

Regular reports to QPFCommitteeNon-ISFE Reporting to theArea teamInternal Audit AssuranceExternal Audit AssuranceGoverning Body report refinancial risks

quality of theinformation on thedatabase

Action Plan

Action Plan reviewing with NECS the operationalprocedures for the input into the database,exploring the purchase of a new atabase toreduce the number of inputs required

04/03/2016

AndrewCarter

Finance (HAST)

957

Failure to deliver the QIPP AgendaCCG is not able to achieve financialbalance whilst ensuring high qualityservices for patientsCCG does not deliver itsresponsibilities

14/05/2014 Graeme Niven

Graeme Niven

4 5 20 43 121. Embed a higher level of accountability for thedelivery of QIPP targets 2. Oversee performancethrough the QPF Committee 3. Monthly update of QIPPperformance to each CCG 4. GP variation process 5.Clinical and managerial work stream leads are in place6. Workstream and Project plans are defined. 7.Monthly workstream meetings.

Performance reviewmeetings. Performance'walls'. Peer review groups.Assurance reports.Escalation procedure inplace for issues arising fromthe projects. Regularmonitoring to Quality,Performance and FinanceCommittee. Internal Audit.Monthly QIPP managementmeetings

04/03/2016

AndrewCarter

Finance (HAST)

249

Failure of commissioned NHSservices to deliver quality outcomesfor patients in Hartlepool andStockton on Tees

01/04/2013 Jean Golightly

BarbaraPotter

4 4 16 43 121. NHS standard contract (inc compliance with Niceguidelines) , 2. Quality Indicators (local) developed and incorporatedinto NHS contract , 3. CQUIN Schemes 4. Clinical Quality Review Groups, review & challengeenabling scrutiny 5. Local Intelligence sharing ( multiagency) 6. Director of Nursing (DON) monthly meetings,scrutiny and challenge & information sharing 7. CQC monthly Exec Nurse meetings, intelligence andinformation sharing. 8. Commissioner Assurance Visit programme9. Serious Incident management process

Quality and Performancereports to Quality,Performance FinanceCommittee CMB Performance Reports Quality report to GoverningBody Provider assurance visits

Data set,Workforceinformation, NHSChoices (routineanalysis)

Kirsty Kitching Action Plan Review and update CQUIN in line withcommissioning intentions.

04/03/2016

AndrewCarter

07/03/2016

JeanGolightly

Quality (HAST)

1197

Failure to implement therequirements of the 5 year forwardview.

03/03/2015 Ali Wilson

KarenHawkins

5 4 20 34 12North of Tees Partnership Board Minutes of the Board anddecisions made

Hartlepool and Stockton-on-Tees Health andWell-Being Boards

Minutes of the individualboards and papers to theseboards

Engagement of member practices Council of membersClinical Reference Groups

CCG's clear and credible plan Delivery against the plan

Andrew Carter Action Plan CCG's communications and engagementstrategy to be reviewed and agreed by CCG

01/12/2015

AndrewCarter

31/05/2016

KarenHawkins

Strategic (HAST)

2PageHAST RR01

175 of 570

RefDate DirectorOwner

Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

NHS Hartlepool and Stockton-on-Tees CCG Risk Register30/01/2017

Gaps in controls

NHS England assurance of plans NHS England assurancemeeting output

Sustainability and Transformation Plan in place which issupported by robust governance arrangements

Minutes of the STPGovernance GroupSTP Project Plan

17/11/2016

AndrewCarter

1578

Failure to meet constitutionalstandards

31/05/2016 Graeme Niven

Graeme Niven

5 5 25 43 12Regular Monitoring of Performance by the QPFCommittee

QPF Committee reports andminutes

Regular contract monitoring meeting with providers Minutes of meetings

Report to Governing Body Governing body minutes

Action Plans in place to adress areas ofnon-compliance

Action PlansQPF Reports and minutes

Performance reporting disclosure via annual report Annual report

17/11/2016

GraemeNiven

Strategic (HAST)

1032

Failure to secure the appropriatenumber of high quality nursing carebeds in all residential settings wherethe CCG is the responsiblecommissioner.

07/07/2014 Jean Golightly

BarbaraPotter

4 4 16 34 121. Multiagency Project Group established , action planagreed , includes LTC opportunities, updates to DT 2. CCG CHC team receive weekly vacancy lists of carehomes from LA's, escalation of any concerns/issues toDT/ET 3 Meetings in place with providers to discuss ongoingissues and embargoes. 4. Care Quality assurance Tool being used to evaluatethe quality of provision. 5. Work programme to priorities the Care Home visitprogramme6. All commissioned services now being visited byQuality and Safeguarding Team

Updates Reports to DT/ETregarding nursing capacityissues via Project Group andUrgent Care workstream.Reports to the GoverningBodyCare Home Project GroupMinutes

1. Limitedevidence ofprogress inimproving capacitydue to lack ofmarket interest inproviding nursingcare in carehomes 2. Absence of aFair Cost ofNursing CareService Model toattracts newnursing careproviders

10/10/2016

BarbaraPotter

Strategic (HAST)

255

Risk to reputation of CCG due tonegative public perception ofservices commisssioned.

01/04/2013 Ali Wilson

Andrew Carter

4 5 20 43 12Collaborative working with providers

Contract and provider management processesincluding use of standard NHS contract .

Communications and Engagement Strategy in place tohandle complaints/MP enquiries and reactive mediacoverage.

Use of different forms of media in order to ensureCCG's message regarding services commissioned isreceived.

Project management approach to any changes to thecommissioning of key services

North of Tees PartnershipBoardContracts with providersApproval of CCGCommunications andEnagagement Strategy bythe Governing BodyCCG CommunicationsMinutes of projectmanagement groups

No gaps 31/05/2016

AndrewCarter

17/11/2016

AndrewCarter

Strategic (HAST)

282

The CCG does not deliver itsexpected financial position includingthe 1% surplus and its QIPPrequirements.

01/04/2013 Graeme Niven

Graeme Niven

4 3 12 34 12Financial Plan for 2016/17 in place Financial plan agreed byGoverning BodyInternal Audit ReportsExternal Audit ReportsBalanced Scorecard in placeISFE and non-ISFE Reports

No gaps

Bi-monthly monitoring of the financial position at theQuality, Performance and Finance(QPF) meeting

Bi-monthly monitoring of thefinancial position at QPFmeetingInternal Audit ReportsExternal Audit ReportsBalanced Scorecard in place

17/11/2016

GraemeNiven

Strategic (HAST)

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Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

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Gaps in controls

ISFE and non-ISFE Reports

NECS provision of financial services to the CCG SLA in place with NECS andmonthly CRM meetings heldto review KPIs in place.Internal Audit Reports

On-going monitoring of QIPP position and overallfinancial position on a monthly basis in line withnational requirements

Monthly QIPP ManagementGroupReporting to QPFCommitteeInternal Audit ReportsExternal Audit ReportsBalanced Scorecard in placeISFE and non-ISFE Reports

Negotiated risk share arrangements with mainproviders

Risk Share Arrangement inplace

Contingency Reserve in place Internal Audit ReportsExternal Audit ReportsBalanced Scorecard in placeISFE and non-ISFE Reports

Bi-monthly monitoring of the financial position at theGoverning Body meeting

Bi-monthly monitoring of thefinancial position at GBmeetingInternal Audit ReportsExternal Audit ReportsBalanced Scorecard in placeISFE and non-ISFE Reports

Financial Recovery plan in place Reports to QPF

Revised Financial Governance Arrangements in place Finance Sub-Committee

1149

The CCG working with its localauthority partners fails to implementand deliver the Better Care FundPlans

28/11/2014 KarenHawkins

PaulaSwindale

4 4 16 34 121. Through the work streams gain assurance that theschemes and projects outlined in the BCF plan willdeliver the required outcomes including regular reviewsto reconsider need, refine plans and flex spendingplans or potentially disinvest in schemes that fail todeliver the best outcomes. 2.Performance Management will be undertaken by theBCF Steering Group and partners are and will continueto be involved in the development of the BCF plans toensure connectivity with individual organisational plans.

3. The agreed governance arrangements ensure theimpact of decisions relating to BCF implementation areconsidered by all partners involved in the North of TeesPartnership Board including regular highlight reports. Ifthere are any issues these would be highlighted to theNorth of Tees Partnership Board to be escalated intothe appropriate organisation with an action plan. 4. Existing services that will contribute to delivery onthe BCF plan will review data collection andperformance metrics to enable measurement againstthe BCF outcomes. 5. BCF implementation plan will be phased to prioritisethose schemes likely to have the biggest impact onreducing emergency hospital admissions.

1. Regular reporting fromthe work stream on deliveryof BCF objectives andoutcomes.

2. Reports to the BCFSteering Group

3. Reports to the North TeesPartnership Board

4. Review of the metrics anddata collected to ensure itsupports BCF outcomes

5. BCF implementation Planreports 6. Reports to HWBB

17/11/2016

PaulaSwindale

Strategic (HAST)

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Initial rating Controls Assurances Current

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Actions Review dateReviewed by

Risk Type

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Gaps in controls

1450

Better Health Programme fails todeliver the intended commissioningoutcomesFailure to deliver appropriate acutehospital services for the CCG patientpopulation

01/12/2015 Ali Wilson

Andrew Carter

5 4 20 34 12Appropirate governance arrangements are put in placeincluding Better Healthcare Programme JointCommittee.

Minutes of the BetterHealthcare Programme JointCommittee.

Oversight provided by Accountable Officers acrossDurham and Tees Valley

Minutes of PrgrammeExecutive Board

Regular reporting to Delivery team and the Governingbody.

Minutes of DT and GB

Comms and Engagement Strategy for the programmein place

C&E Working Group minutes

Alignment of BHP with the STP STP Plan

17/11/2016

AndrewCarter

Strategic (HAST)

1756

CCG does not deliver theSustainability and TransformationPlan due to conflicting partnerpriorities and negative publicperception

25/11/2016 Ali Wilson

Ann Farrar

5 5 25 34 12Robust Governance and Decision Making Process inPlace

STP Joint Committee Termsof Reference and MinutesRegular reporting to theGoverning BodyBHP Programme Board ToRand Minutes

Public Engagement Exercise undertaken Results of Pre-engagementeventsPhase 5 ofpre-enegagement

Sign off of STP by NHS England

25/11/2016

AndrewCarter

Strategic (HAST)

1757

CCG does not currently have aDesignated Medical Officer (DMO)for Special Educational Needs andDisability (SEND) which is goodpractice in accordance with theSEND strategy

25/11/2016 Jean Golightly

Ruth Kimmins

3 5 15 43 12Business Case has been presented to DT DT MinutesStrategic (HAST)

1033

Without a designated doctor forLooked after Children the CCG failsto comply with statutory requirements

07/07/2014 Jean Golightly

Trina Holcroft

3 5 15 52 10Designated Nurse for Looked after Children in place

Weekly meetings of the CCG Quality team anddesignated doctor and safeguarding nurse ensurescommunication and transfer of information.

Weekly updates to DT to ensure awareness of localityleads.

QPF Committee reporting

Governing Body reporting

JD of designated nursePost is within CCG corporatestructure.QPF Committee and byexception GBDT reporting

Jean Golightly Action Plan Role to be advertised across HaST andSouth Tees CCG

31/05/2016

JeanGolightly

10/10/2016

TrinaHolcroft

Strategic (HAST)

1577

Financial and reputational risks inrelation to the primary carecommissioning agenda as the CCGis now fully delegated.

31/05/2016 KarenHawkins

Sue Greaves

4 5 20 33 9Delegation agreement in place with NHS England Regular reporting oncompliance to GB

Primary care commissioning committee in place Committee MinutesReporting to GB

17/11/2016

SueGreaves

Strategic (HAST)

251

Partners' commissioning prioritiesmay conflict with CCG plans and theCCG is not included incommissioning decisions of partners.

01/04/2013 KarenHawkins

KarenHawkins

4 3 12 33 9Formal Joint working through Health & WellbeingBoard - CCG a statutory member.

On-going engagement work with partners includingpartner representatives within CCG workstreammeetings

CCG member of LA HWB sub groups in bothHartlepool and Stockton

Minutes of Health WellbeingBoard Attendance of meetings Commissioning intentionsagreed Assurance meetings with AT MoU in place with PH Protocol in place withHealthwatchLocal authorities co-opted

Review ofpartnershiparrangements notundertaken

17/11/2016

KarenHawkins

Strategic (HAST)

5PageHAST RR01

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Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

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Gaps in controls

Engagement undertaken in relation to commissioningpriorities shared across CCG boundaries at CCGNorthern Forum

Collaborative commissioning arrangements in place toensure standardised approach

Stockton Voluntary Sector Compact and HartlepoolCompact in place with voluntary sectors and Councilpartners.

onto Governing Body

262

Failure to ahere to and deliver theCCG's legal and statutory dutiesincluding the CCG constitution

01/04/2013 Graeme Niven

Andrew Carter

4 3 12 33 91.Decision making committees' terms of reference arein place and are operating effectively

Internal Audit Review ofgovernance arrangementsscheduled

2. Governing Body and council of member practicesinvolvement in the continuing development of theconstitution

Review of governancearrangements in line withConstitution in September2013 and September 2014.

Report to Council ofMembers and the GoverningBody on Constitution andreview undertakenNHS England to review andapprove any suggestedchanges

3. Review of the constitution in line with good practiseguidelines

Constitution was reviewed inOctober 2013, September2014, December 2015 andhas been agreed byGoverning Body and Councilof Members

4. Legal Services Agreement in place Contract framework in useby CCG

17/11/2016

AndrewCarter

Strategic (HAST)

274

Weak GP engagement with theclinical commissioning group.

01/04/2013 Ali Wilson

Andrew Carter

4 3 12 33 91. Practice Visits Undertaken and rolling programme inplace for all practices

Outcome of practice visitsand action log to act uponany actions received.

2. Clinical Time outs to actively address and discussclincal engagaement.

Minutes of meetingsFeedback from meetings

3. Council of Members and Clinical Reference Groups.Both taking place bi-annually.

Minutes of meeting

4. Engagement with GPs through workstream leads Appointment of GPs to allworkstrealm lead roles.

5. Engagement with clincians through practicemanagers and practice nurses

Practice Nurse Leads forboth Hartlepool andStockton-on-Tees localaitiesin place and working withprimary care workstream

6. Locality Groups Minutes of meeting of bothHartelpool andStockton-on-Tees localaitygroups.

7. Action Plan in place to mitigate results of ccg 360survey - One of the actions being lack of membershipengagement

Progrees against action plan

17/11/2016

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Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

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Gaps in controls

8. Mapping exercise undertaken to establish how theCCG is engaging with member practices. Thosepractices engaging ;less with the CCG identified andcontacted direclty to ensure representation at CCGmeetings.

Attendance at meetings.

276

Failure to deliver the urgent carestrategy

01/04/2013 KarenHawkins

Tracie Jacobs

4 4 16 33 9Urgent Care strategic vision and strategy Strategy in place and agreedby GB

None at present

A&E Delivery Board in place Minutes of A&E DeliveryBoardA&E Delivery Board in place

Engagement plan developed Partners engaged throughHWBB

Urgent Care Project Group in place Minutes of the urgent careproject group

Updates to Governing Body regarding Urgent Careincluding the North East Vanguard. Governing Bodyresponsible for sign off of procurement.

GB Reports

Decision on Urgent Care Procurement made by theGoverning Body

Minutes of GB

17/11/2016

TracieJacobs

Strategic (HAST)

1198

Failure to procure commissioningsupport services to ensure delivery ofCCG statutory duties

03/03/2015 Graeme Niven

KarenHawkins

4 4 16 33 9Re-written service specifications to ensure clear aboutbuyer requirement

Service specifications

Engaged with NHS England to determine support forLead Provider Framework

Output of Lead providerframework

Recruited for internal capacity CCG organisationalstructure

Inform DT and Governing Body of process. DT and GB minutes andreports

Governing Body makes final decision regardingorganisational form in line with constitution

Signed contract in place byMarch 2017

31/05/2016

KarenHawkins

17/11/2016

KarenHawkins

Strategic (HAST)

257

Failure to translate clinicaldiscussions/decisions into publicunderstanding.

01/04/2013 Ali Wilson

Andrew Carter

5 4 20 42 81. Communications & Engagement Strategy in placeand engagement events take place

Engagement report followingengagement event

2. CCG meetings held in public Minutes from publicmeetings and questions

3. Working with OSC scrutiny of local health services Meeting minutes from OSCmeetingsEngagement with OSCduring consultation

4. Membership of both Hartlepool andStockton-on-Tees Health & Well Being boards includingclinical representation.

Meeting minutes of theHealth and Well-BeingBoards

Action Plan

17/11/2016

AndrewCarter

Strategic (HAST)

1196

Health and Social Care Act 2012required significant changes to howpersonal confidential data (PCD)could be used for commissioningpurposesCommissioners are not able toaccess and use PCD forcommissioning purposesAll CCGs and commissioners tomove to standardised ways ofcommissioning and data flows whichcan then be automated

03/03/2015 Graeme Niven

Graeme Niven

3 5 15 42 8HSCIC and NHS England have been asked to developand deliver a sustainable end-state within a two yearperiod, and avoid the need for further changes toexisting legislation and regulations.

Regular updates from theprogramme

� Implementation of the change programme totransition the people, process and information systemchanges necessary for commissioners (CCGs and NHSEngland) and their data processors (CSUs and other3rd parties) to utilise the de-identified data servicesfrom the HSCIC to undertake their statutory duties.

Regular updates from theprogramme

End state solution requires all CCGs andcommissioners to move to standardised ways ofcommissioning and data flows, which can then beautomated. .

Managed by NECS as amajor piece of theprogramme

17/11/2016

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Gaps in controls

269

Failure of clinical work streams todeliver required changes to deliverthe CCG's clear and credible planand commissioning intentions.

01/04/2013 KarenHawkins

KarenHawkins

5 3 15 23 6Workstream clinical and managerial leads in place.Executive sponsors of each workstreamCommissioning intentions agreed and prioritised byGoverning Body setting worsktream programme. Programme and project plans are defined. Monthly workstream meetings Monthly DT & reporting to QPF

Escalation procedure inplace for issues arising fromthe projects. Regular reports to DT andQPF.Governing Body Report

04/03/2016

AndrewCarter

Commissioning (HAST)

248

Partnerships with other accountablebodies are not put in place and/orthere is a failure to understand theboundaries of accountability.

01/04/2013 KarenHawkins

KarenHawkins

3 4 12 32 6MoU in place with local authorities regarding publichealth.

Regular communication and provision of information toNHS England Area Team.

Engagement with Healthwatch.

Member of Health and Well-Being Board

Member of Health and Well-being board sub groups

Attendance at Scrutiny Committee

Representative on Safer Partnership Boards

Representative on the Northern CCG Forum

Member of the Safeguarding Boards

Member of North of Tees Partnership Board

Memorandum ofUnderstanding approved bythe Governing Body.

Assurance meetings withNHS England LAT

Protocol in place withHealthwatch Hartlepool andStockton

Output from Health andWell-Being Board

Overview and ScrutinyCommittee.

Local authorities co-optedonto Governing Body.

Terms of Reference for eachcommittee outline roles andresponsibilities

CCG aware of duties inaccordance with the NHSEngland The Functions ofClinical CommissioningGroups which sets out dutiesand responsibilities of theCCG

Minutes of the North of TeesPartnership Board

04/03/2016

AndrewCarter

Commissioning (HAST)

281

Prescribing Costs Grow outwithAvailable Resource - Increasing useof medicines is a inevitableconsequence of the increasinglyageing population and the on-goingintroduction and development ofdrugs to prevent and treat ill health.In light of the current economicclimate there is a request thatallocated available resource may beinsufficient to meet legitimate needfor drugs.

01/04/2013 Graeme Niven

Graeme Niven

3 4 12 32 6Medicines Management team working with practices toanalyse and review drug expenditure and activity tosupport safe and clinically effective use of medicineswithin available cost envelope. Medicines Optimisation Strategy Mitigation Strategy in place but under constant review.

Budget allocationsmaintained.Prescribing outturn.PPA DataReports to Delivery Team onperformance

Mitigation Strategyunlikely to turnaround positionwithin timeframe.

Action Plan Mitigation strategy to be presented todelivery team in September 2013

04/03/2016

AndrewCarter

Finance (HAST)

252

North of England CommissioningSupport (NECS) does not undertake

01/04/2013 KarenHawkins

4 2 8 14 4Signed SLA in place with NECS.On-going monitoring of KPIs is undertaken.Monthly contract perfroamnce meeting (led by CCG)Weekly CRM Meetings

SLA reviewed and agreednew terms and conditionsNew KPI's developedWeekly CRM meetings held

04/03/2016

AndrewCarter

Commissioning (HAST)

8PageHAST RR01

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Initial rating Controls Assurances Current

C L ScoreC L Score

Actions Review dateReviewed by

Risk Type

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Gaps in controls

its responsibilities in line with theservice level agreement to enablethe CCG to commissionappropriately.

KarenHawkins

Action and issue logNECS senior representation at Delivery Team andGoverning Body

to ensure operational issuesare addressed in advance ofthe monthly SLA meetingsenior CCG representationin attendance at all SLAmeetings CFO/DoF/Head ofCommissioning

1752

Judicial Review process broughtagainst the CCG as a result of anIndividual Funding request decision

17/11/2016 KarenHawkins

KarenHawkins

4 5 20 00 0IFR Panel Process in place to ensure correct decisionare made

Minutes of IFR PanelMembers of IFR Panelappointed by the CCG

IFR Panel reports to Quality, Peformance and FinanceCommittee

Minutes and reports of IFRPanelMinutes and reports of QPF

Delegation for IFR decisions included within CCGconstitution

CCG Constitution

Strategic (HAST)

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 3.1

7th February 2017

Title HaST Communication and Engagement Strategy

Purpose Approval ☒ Discussion ☐ Information ☐

Responsible CCG Member / Lead

Karen Hawkins, Director of Commissioning and Transformation

Author of Report Judith McGuinness, Senior Communication Officer Recommendation(s) The Governing Body is requested to APPROVE the

Communications and Engagement Strategy. Executive Summary

The communication and engagement strategy is designed to support and enable the organisation to reach its objectives and vision. It sets out the CCG’s approach to communication and engagement, both within the CCG and externally with our many stakeholders. It outlines a strategy for the year 2017 – 2018. It sets out how we will:

• Communicate effectively with our members

• Build public confidence in, and manage the reputation of

the NHS in Hartlepool and Stockton- on-Tees.

• Develop close working relationships with our stakeholders to ensure there are meaningful opportunities to influence our decision-making.

Clinical Engagement Via Executive Team Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Communications and Engagement Strategy is a vital control against delivery of the CCG’s key risks.

Has an Equality Analysis been completed?

Included within strategy

Attachments HaST Communication and Engagement Strategy 183 of 570

Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☒ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☒

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☒ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☒ Other Committees/Meetings where this report has been presented DT Does this need to be reported to another Committee/Meeting? None

184 of 570

NHS Confidential / Protect / Unclassified (please classify)

COMMUNICATION AND ENGAGEMENT STRATEGY

FOR NHS HARTLEPOOL AND STOCKTON ON TEES

CLINICAL COMMISSIONING GROUP (CCG)

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NHS Confidential / Protect / Unclassified (please classify)

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Author: Judith McGuinness

Customer: NHS Hartlepool and Stockton-on-Tees CCG

Date: October 2016

Version: 1

Document number: 001

Change Record

Date Author Version Summary of Changes

October 2016 Judith McGuinness Draft Draft version

Reviewers

Name Position

Judith McGuinness Senior Communication Officer (NECS)

Andrew Carter Corporate Governance and Risk Officer (CCG)

Development Team

Distribution This document has been distributed to:

Name Title Date of issue Version

Ali Wilson Chief Officer tbc 1

Dr Boleslaw Posmyk Chair tbc 1

Andrew Carter Corporate Governance and

Risk Officer

tbc 1

Mary Bewley Head of Communications

and Engagement

tbc 1

Hilary Thompson Lay Member PPI (HAST CCG) tbc 1

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CONTENTS

For NHS Hartlepool and Stockton on Tees ..................................................................................... 1

Clinical Commissioning Group (CCG) ............................................................................................. 1

Purpose of this document .............................................................................................................. 5

Background ..................................................................................................................................... 5

Our Population ................................................................................................................................ 6

Legislative Framework and Best Practice ....................................................................................... 7

Our vision for the future................................................................................................................... 9

How we will deliver this strategy .................................................................................................... 10

Our stakeholders and audiences ................................................................................................... 11

Our principles for delivery ............................................................................................................. 12

how we will communicate .............................................................................................................. 14

Communications Objectives .......................................................................................................... 14

Public relations ............................................................................................................................. 15

National and trade media ...................................................................................................... 15

Crisis management ............................................................................................................... 16

Campaigns ............................................................................................................................ 16

Governing Body meetings ..................................................................................................... 17

CCG annual report ................................................................................................................ 17

CCG annual general meeting ................................................................................................ 17

Awards .................................................................................................................................. 17

Public affairs ................................................................................................................................. 17

Freedom of Information ......................................................................................................... 18

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Parliamentary briefings .......................................................................................................... 18

Digital communications ......................................................................................................... 18

engaging with our local communities............................................................................................. 20

The engagement cycle .................................................................................................................. 22

Our engagement and involvement objectives ............................................................................ 24

Partnership working .................................................................................................................. 25

Equality analysis ....................................................................................................................... 26

Evaluation ..................................................................................................................................... 26

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PURPOSE OF THIS DOCUMENT

This communication and engagement strategy is designed to support and enable the organisation

to reach its objectives and vision. It sets out our approach to communication and engagement,

both within the CCG and externally with our many stakeholders. It outlines a strategy for the year

2017 – 2018 to the Governing Body of NHS Hartlepool and Stockton-on-Tees Clinical

Commissioning Group (HAST CCG).

It also sets out how we will:

Communicate effectively with our members

Build public confidence in, and manage the reputation of the NHS in Hartlepool and

Stockton on Tees.

Develop close working relationships with our stakeholders to ensure there are meaningful

opportunities to influence our decision-making.

BACKGROUND

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group (CCG) are committed to

improving local health services, patient experiences and clinical outcomes. They recognise the

importance of the involvement of local people in decision making and to do this effectively they

launched an innovative new initiative in 2015 to appoint Community Health Ambassadors.

Ambassadors are recruited from the local community and help the CCG engage effectively

with a diverse population.

The CCG represents all 36 GP practices across the two boroughs and a population of almost

300,000. Their headquarters are at the heart of the communities they serve at Billingham

Health Centre, Queensway, Billingham.

The CCG is a clinically-led membership organisation made up of all the GP practices in

Hartlepool and Stockton-on-Tees. We are committed to creating an accessible health service

that provides safe, high quality care in the best place for patients.

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We believe that good healthcare is everybody’s business and we are dedicated to developing

effective working relationships with partners, stakeholders and the public to deliver joined-up

healthcare that will benefit everyone.

Our over-arching vision is to:

‘To develop outstanding, innovative and equitable health and social care

services, ensuring excellence and value in delivery of person centred care

working across both health and social care’

We will work with patients, carers, the public and stakeholders to:

Assure delivery of safety, quality and performance

Create joined up pathways across organisations to deliver seamless care

Deliver clinically led health services that are focused on the patient and based on evidence

This strategy and its associated action plans are designed to support the vision of NHS Hartlepool

and Stockton-on-Tees CCG and enable effective communications and engagement with all

stakeholders. It sets out our approach and demonstrates our commitment to involving people in

our decision making and engages them in honest ongoing conversations to really understand their

problems and issues they face in their day to day lives.

OUR POPULATION

In the Hartlepool and Stockton-on-Tees areas, health risks are high when compared with other

parts of the country. We have higher than average rates of smoking and alcohol consumption and

lower levels of exercise. Health inequality is also an issue across our region. For example, there

remain significant mortality differences between council wards, and emergency admissions for

heart disease are two–and-a-half times greater for residents living in our most deprived areas

compared with those in more affluent neighbourhoods.

In common with other areas of the UK, we have a growing elderly population, many of whom suffer

from a range of long-term conditions.

Set against these challenges, we worked closely with GPs, health professionals, stakeholders and

the public to identify our strategic priorities for improvement:

Bringing care closer to home Tackling health inequalities Caring for an ageing population

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Addressing our priority health conditions Improving quality in primary care Ensuring quality and patient safety Improving patient experience Seeking best value for money within budget

We have prioritised the following areas to reduce the negative impact of these diseases on the

health outcomes of our population:

Cardiovascular disease – including heart disease and strokes Cancer Smoking related illness Alcohol related illness Mental health including dementia

By working with our patients to promote and support healthy living, self-care and early intervention

where this can deliver better health outcomes, we are:

Involving service users, carers, staff, providers, partners and the public to develop services

and reduce health inequalities

Working in partnership to transform services

Working transparently and inviting feedback to ensure we meet patient needs

Driving service transformation and embracing opportunities to innovate

Commissioning sustainable services as close to home as possible

Planning and responding to the needs of residents

NHS Hartlepool and Stockton-on-Tees CCG has continued to listen carefully to the views of its

population including patients, carers, the general public, the voluntary and community sector and is

committed to acting on the feedback we receive.

This strategy and its associated action plans are designed to support the vision of NHS Hartlepool

and Stockton-on-Tees CCG and enable effective communications and engagement with all

stakeholders. It sets out our approach and demonstrates our commitment to involving people in

our decision making and engages them in honest ongoing conversations to really understand their

problems and the issues they face in their day to day lives.

LEGISLATIVE FRAMEWORK AND BEST PRACTICE

NHS Hartlepool and Stockton-on-Tees CCG is committed to working within the legislative

framework which significantly influences how this plan is delivered. National and local policy

guidelines acknowledges and promotes the need to improve involvement for the communities we

serve and as such we are developing involvement and engagement activities to ensure the active

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participation of the public, patients, carers, local communities and other stakeholders, as partners

in the design and commissioning process as identified within Better Health, Better Experience,

Better Engagement – why good commissioning needs patients and public at its heart (August

2011).

This strategy also takes account of Transforming Participation (NHS England 2013) which seeks to

help CCGs benchmark their individual participation, public participation and patient insight. It

includes information on legal duties for commissioners, suggested measures and some

commentary on health inequalities.

NHS Hartlepool and Stockton-on-Tees CCG recognises the importance of building relationships

with key partners, patients, the public and stakeholders. This strategy will ensure that the CCG has

a clear and up-to-date understanding of their views, needs and preferences. As identified in Patient

and public engagement in the new commissioning system (NHS Confederation, 2011).

This strategy supports Section 242 of the NHS Act 2006 (formerly section 11 Health and Social

Care Act 2001), which came into force in November 2008 and strengthened the statutory duty on

all NHS organisations to make arrangements to consult and involve patients and the public

(appendix 5). The Health and Social Care Act 2012 is clear in its ambition to put patients at the

heart of the NHS ‘nothing about me, without me’; to increase patient choice and control; strengthen

the collective voice of patients and to improve health outcomes. It also considers, and aims to

reflect the NHS Constitution and the requirements of the 2010 Equality Act: Public Sector Equality

Duty (appendix 6).

The recent The NHS belongs to the people: a call to action (July 2013) highlights that responsibility

belongs to us all to transform the NHS to ensure it is sustainability for the future.

In supporting this objective we will develop future engagement and consultation to incorporate the

principles of the ’call to action’:

• What is the best way to improve quality for the NHS?

• How can we plan to deliver everyone’s health care needs?

• How can we prepare for the financial challenge ahead?

• What must we do to build an excellent NHS now & for future generations?

Ensuring individual patients are actively involved in decisions about their care and treatment will

help us in driving forward strong engagement. In line with Transforming Participation we will

demonstrate that shared decision making is effective in improving patient’s satisfaction, reducing

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unwanted variation and sends the strong message that as commissioners, clinical leaders and

practicing clinicians we have patients at the heart of all aspects of health and health services.

CCG involvement and engagement practice as detailed in the supporting action plan, will seek to

adhere to the CCG’s action plan that seeks to respond to the Mid Staffordshire NHS Foundation

Trust Public Inquiry Report (Francis report). This will ensure the patient voice is considered at all

CCG committees meetings and appropriately affects CCG quality development systems, for

example: standard setting and commissioning for quality and innovation (CQUIN).

We know that our ambitions will not be achieved unless patients and the public are at the heart of

everything we do. Our aim to improve health and health services requires that we can understand,

and act on, what really matters to people and to bring them with us as active partners in decisions

about their health and health services. Everyone has a stake in the health of their community and

an engaged and supportive public can provide a powerful mandate and resource for our CCG as

we evolve.

OUR VISION FOR THE FUTURE

The CCG has a transformational five year strategic vision up to 2019 which is articulated through a

number of key strategies such as primary care, urgent care, cancer, dementia, end of life, learning

disabilities and mental health. All of these strategies have been reviewed against the Five Year

Forward View (FYFV) and demonstrate that they fit comfortably. All CCG strategies have been

cross-referenced to inform commissioning intentions for 16/17 and beyond. Plans are being

delivered in relation to strategies during 15/16 and are monitored on a monthly basis.

The CCG is clear that it cannot deliver the transformational change required in isolation. The CCG

works within a wide range of partnerships across Hartlepool and Stockton-on-Tees, the Tees

Valley and the wider North East Region and is engaged in a number of transformational projects:

Better Health Programme (BHP). This transformation programme is about how the NHS in

Darlington, Durham and Tees can improve outcomes and experience for patients when

they need care, especially in an emergency. All partners share an ambition to offer the

highest standards of emergency care and making sure there is access to a permanent

senior clinical workforce 24/7.

Children and Young People Transformation

Learning Disabilities Transformation

Hartlepool Plan – Hartlepool Health Matters

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Transformation with the acute sector cannot be sustainable without corresponding changes to

meet the needs of our growing elderly population. The CCG’s vision to develop outstanding,

innovative, equitable, excellent and value for money health and social care services for Frail Older

people is at the heart of Better Care Fund processes across Stockton-on-Tees and Hartlepool.

Alongside the above work the CCG will continue to implement its five year plan for Urgent Care,

which will aim to deliver a fully integrated 24/7, seamless urgent care provision across both

Hartlepool and Stockton-on-Tees. Following the previously mentioned pause the CCG will

commission integrated urgent services that incorporate GP Out Of Hours, Minor Injuries Unit and

Walk In Centre activity within a wider paradigm of 7 day General Practice delivering minor ailment

and injury services in hours.

The CCG has also begun to respond to the key messages of the NHS England Planning

Guidance Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21, which

was published in December. The CCG has begun development of a five year Sustainability

and Transformation Plan (STP) with the NHS in Durham, Darlington, Tees, Hambleton,

Richmondshire and Whitby, which will drive delivery of the Five Year Forward View via a

Trans-CCG unit of planning that will fit with the scope of the Better Health Programme.

Alongside these priorities the CCG has a number of key work areas such as:

Adults 25 – 64

Adults 65+

Primary care

Children and children’s mental health

Mental health and learning disability

HOW WE WILL DELIVER THIS STRATEGY

All NHS organisations, including CCGs, have an obligation to involve users when they are planning

the provision of health services; developing or considering proposals for changes in the way health

services are provided or making decisions that will affect the operation of a health service. To

achieve this we will:

build on existing arrangements to engage patients through members’ Practice Participation

Groups (PPGs) and also build a wide range of tools to ensure that it engages effectively.

We will use formal consultation process where appropriate but will also seek every

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opportunity to work with stakeholders and partners on day-to-day basis to achieve better

health outcomes.

will work with Healthwatch, as the independent consumer champion for health and social

care, to gather and respond to patient and public insights.

Increasing the number of people involved in the design, delivery and improvement of health

services, particularly in deprived areas, is more likely to lead to sustained lifestyle changes and

long-term health improvements. The health inequalities which prevail in our area mean that we

must make efforts to target and engage with those individuals and communities that are hardest to

reach and influence and people who are least able to act as advocates for themselves.

Communications is a key strategic management function that supports this process.

Our operational communication and engagement plan is available at Appendix 3.

At a strategic level, the main methods of delivery will be; public relations; public affairs, digital

communications; member communications and patient engagement and involvement.

OUR STAKEHOLDERS AND AUDIENCES

NHS Hartlepool and Stockon-on-Tees CCG has a wide range of stakeholders, who we must listen

to, engage and work with. Our stakeholders range from our provider partners with whom we

communicate on a daily basis, to very specialist groups with whom we may communicate

infrequently on very specific issues. Appendix 1 shows our full stakeholder matrix.

Building supportive and trusting relationships with our key stakeholders is critical to the

success of our strategy. It is crucial to understand who our key stakeholders are and their

importance to the delivery of the CCG’s vision and priorities.

Some of our key relationships are with:

Our patients

Our CCG - the member practices and practice staff who are our organisation

Our staff

The wider public across the Hartlepool and Stockton-on-Tees, including the press and

media

Our health partners across Hartlepool and Stockton-on-Tees, their leadership and staff

o NHS England

o NHS hospital trusts and foundation trusts

o Neighbouring CCGs

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Our political partners

o Members of Parliament

o Local councillors

Voluntary and community sector representatives; individuals and organisations that

represent patients, staff or healthcare organisations

o Stockton Healthwatch and Hartlepool Healthwatch

Influencers - individuals, committees and organisations whose opinions and views carry

considerable weight. This includes bodies that have a formal monitoring function, e.g.

o Health and Social Care Overview and Scrutiny Committees

o Health and Wellbeing Boards

o Local Medical Committee

o CQC

OUR PRINCIPLES FOR DELIVERY

NHS Hartlepool and Stockton on Tees CCG’s reputation will be the result of how we inform,

engage, listen, involve and interact with people. The way people respond and think about us is

shaped by positive engagement and good communications together with the everyday interactions

that people have with all aspects of the organisation. The national 360 degree stakeholder survey

will allow us to measure year, on year, how effectively we deliver this.

With all this in mind, the following set of principles will be applied to all communications and

engagement and we will ensure that we are always:

Accessible and inclusive, to all people in our community

Clear and professional, demonstrating pride and credibility

Targeted, to ensure people are getting the information they need

Open, honest and transparent

Accurate, fair and balanced

Timely and relevant

Sustainable, to ensure on-going mutually beneficial relationships

Two-way, we won’t just talk, we’ll listen

Cost effective, always demonstrating value for money

We plan to build our understanding of public views about the services we plan and pay for using

the input and feedback from a broad range of people across our area. We will use multi-channel,

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integrated communications to target our activities making sure the views of those who do not

readily engage are properly reflected in our decision-making.

We propose to:

• rationalise and maximise our existing channels to achieve greatest value

• broaden the reach of our digital channels including social media

• use robust market research methodologies to underpin our planning and decision-making

• regularise stakeholder briefings

• establish a forum in which we can listen to inform the views of people who rarely engage

with us.

The strategy focuses its efforts on reaching people and groups under-represented in our decision-

making, making and testing the assumption that those efforts will automatically touch those who

are easier to reach.

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HOW WE WILL COMMUNICATE

NHS Hartlepool and Stockton on Tees Clinical Commissioning Group is fully committed to being

accountable to local people and to be an organisation that listens to, and responds to, the views of

the people who use local health services or who may use them in the future.

The overarching aim of this strategy is to:

‘To develop outstanding, innovative and equitable health and social care

services, ensuring excellence and value in delivery of person centred care

working across both health and social care’

Through effective communications and engagement channels we aim to empower local people to

make better choices about their own health and wellbeing and as such, we will have open, honest

conversations with people about the challenges we face and work with them to find solutions.

The key aim of this strategy is to support and promote the following agreed CCG outcomes.

Outcomes

Involving service users, carers, staff, providers, partners and the public to develop services

and reduce health inequalities

Working in partnership to transform services

Working transparently and inviting feedback to ensure we meet patient needs

Driving service transformation and embracing opportunities to innovate

Commissioning sustainable services as close to home as possible

Planning and responding to the needs of residents

COMMUNICATIONS OBJECTIVES

Objective 1: Deliver effective communications: Build meaningful and sustainable two-way

communication mechanisms and processes with patients, the public, staff, member practices, the

wider GP body, stakeholders and partners (see appendix 1 for full stakeholder list and analysis).

Objective 2: Reputation management: To ensure the CCG plans effectively for any

announcements / decisions that may result in an adverse reaction from the media, key

stakeholders and the public. We will do this through developing excellent working relationships

with the local, regional, national and specialist media and embracing new technologies such as

social media and the development of a digital marketing strategy.

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PUBLIC RELATIONS

Every organisation, no matter how large or small, ultimately depends on its reputation for survival

and success. If we establish and maintain a good reputation, then our patients will feel confident

that we are doing the best job possible on their behalf. If our public trust us, they will be more likely

to work with us.

The NHS is one of the most trusted and recognised brands in the world. Organisations which carry

the NHS brand must understand that they have a responsibility, not only to their own organisation,

but also to the wider NHS family.

Hartlepool and Stockton on Tees CCG will develop and maintain a reputation which stays true to

our vision and promotes and protects the reputation of the NHS. Everyone involved with the CCG

must learn to live our values, and to help deliver our vision by building credibility and confidence

among our stakeholders.

The specific role of the communications team is to protect and enhance the reputation of the NHS

in Hartlepool and Stockton by promoting the work of the CCG. However, it fulfils another equally

important role, keeping the public informed of issues that may affect their health and wellbeing.

This can be achieved through effective public relations and media approach to:

Raise the profile of the CCG within the health and social care sector

Improve relationships with member practices by showcasing how the CCG is making a

difference

Strengthen the position of the CCG as an inclusive membership organisation with its

members

Telling the story of health in Hartlepool and Stockton-on-Tees

NATIONAL AND TRADE MEDIA

We work closely with local, regional and national media to get our message across. We are keen

to publicise our successes and good news stories, but we also work with the media to explain why

we make decisions and provide an honest and transparent response when we are scrutinised or

challenged about any aspect of our commissioning role.

How we are portrayed in the national and trade media will have an effect on our reputation

nationally with decision-makers and opinion leaders. It is crucial that we appear credible,

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innovative and transparent. Trade and national media are scanned by NHS policy makers,

influencers and decision-makers. We will ensure an effective relationship with such media.

CRISIS MANAGEMENT

The provision of healthcare is, by its very nature, risky. Incidents can occur which can quickly

become a focus for local and national media with the potential of impacting on the reputation of the

CCG. Often these can spring up without warning and require prompt, careful and effective

communication management to limit damage and provide the public with reassurance about the

ongoing safety and quality of the NHS.

Examples include:

Safeguarding issues

Healthcare-related deaths

Communicable diseases e.g. Tuberculosis, Ebola etc

Media investigations

Serious untoward incidents

Provider performance issues

Healthcare Acquired Infections e.g. MRSA, Clostridium difficile etc

Emergency preparedness, resilience and response (EPRR) events

For all crisis management situations, an appropriate spokesperson will receive the right level of

media training and will be fully supported by the communications team.

CAMPAIGNS

We will have a calendar of paid for and non-paid for marketing communications campaigns

throughout the year, which will focus on the CCGs priorities and particular needs. We will have a

creative and targeted approach to any campaign, which will always be evidence based. We will

look for opportunities to work at-scale across the North East and national level, where appropriate.

Any campaign activity will be evaluated and learning captured for any future work.

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GOVERNING BODY MEETINGS

Our Governing Body meets several times a year. The public are welcome to attend and observe

our Governing Body meetings. Following the meetings, there is an opportunity for members of the

public to ask questions. Meeting dates and papers are available to view on the CCG website or

paper copies are available on request by contacting the CCG Headquarters at Billingham Health

Centre.

CCG ANNUAL REPORT

We will produce a formal report as required by NHS England and meeting our statutory

requirements and this will be available in electronic format.

In addition, we will produce a ‘summary’ version which will be written in plain English, and made

available to all our patients.

CCG ANNUAL GENERAL MEETING

Our annual general meetings will be designed to be interactive and engaging as we recognise the

importance of fully involving our patients, the public and our partners.

AWARDS

We will have a planned approach to entering relevant health sector awards, including the

preparation of high-quality entries and case studies. This would also include the production of an

awards calendar.

PUBLIC AFFAIRS

Our role is to understand the political landscape, both nationally and locally, and work within that to

deliver the best healthcare possible for people in Hartlepool and Stockton-on-Tees. It is not

realistic to expect support from politicians at all times, however, transparent and proactive

engagement will improve the chances of the CCGs ability to deliver its objectives.

We will develop productive relationships with local politicians, engaging fully with formal structures

and committees such as the Hartlepool Health Overview and Scrutiny Committee, Stockton Health

Overview and Scrutiny Committee and liaising regularly with local MPs, Hartlepool Borough

Council’s lead member for Health and Social Care and other local councillors and equivalent for

Stockton Borough Council.

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We will continually and regularly communicate and engage, encouraging two-way communication,

with all MPs and councillors in Hartlepool and Stockton-on-Tees.

FREEDOM OF INFORMATION

Freedom of Information (FOI) requests are increasingly made by interested parties, including the

media, as a way of accessing detailed information about the NHS locally and nationally. As an

organisation that firmly believes in transparency we will publish information on our website.

However, in-line with our statutory responsibilities, we will respond to Freedom of Information

requests in-line with the legal requirements.

PARLIAMENTARY BRIEFINGS

We will respond to Parliamentary briefing requests in a timely way, ensuring a consistently high

quality response.

We will continue to compile one database of:

Complaints, Freedom of Information (FOI) requests, MP and councillor briefings, comments

and complaints

Serious untoward incidents, with suggestions from patients and the public

Feedback from engagement and consultation events and social media and other digital

platforms

The intelligence gained from this database will be used to improve customer service and

encourage providers to improve their customer service.

DIGITAL COMMUNICATIONS

NHS Hartlepool and Stockton on Tees CCG will continually develop and build new ways of

communicating and engaging with our audiences and stakeholders to develop strong, enduring

and mutually beneficial relationships.

Using a multi-platform approach will enable us to:

Be open and transparent about the work we are doing

Help to improve health and local healthcare through targeted marketing communications,

linked to our strategic priorities

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Engage with our partners by becoming more approachable. The informal nature of social

media should encourage more people to have a conversation with us, challenge us or

make their views known by attending our events or taking part in consultations

Encourage others to share our news by helping to increase our followers and attract new

interest from a wider and more diverse audience

OUR DIGITAL OBJECTIVES

We will effectively manage our digital media communication methods by linking them to our

strategic objectives and work streams.

Our main objectives will be to:

Build a strong community of patients and stakeholders online

Establish a relationship built on trust

Engage stakeholders in a two-way conversation about our work and their views

Encourage stakeholders to support our work by sharing our posts

Share partners’ health and social care messages

Encourage staff and members to support, promote and take part in our online

conversations

Review current digital channels and consider relevance of adding new ones

DIGITAL CHANNELS

We will continually review the channels that we currently use to ensure we are reaching a wide

demographic, with the aim of expanding our digital audience.

WEBSITE

Our website www.hartlepoolandstocktonccg.nhs.uk helps us to engage with our local population

and is regularly updated with news and important corporate information.

By using social media we will drive more people to the website for additional information. We will

encourage stakeholders to share the information on our web pages via social media, and their own

websites, as well as asking them to link to our site from their website.

FACEBOOK

We will develop our Facebook presence in order to reach a wider audience and encourage that

audience to share our posts. Using Facebook also enables us to have a two-way conversation with

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our stakeholders, encouraging them to ask us questions and for us to respond publically. We will

investigate using Facebook to live chat with members of the public and for paid for advertising

campaigns.

TWITTER

We are keen to enter into two-way dialogue with local people and our Twitter account @hastccg

not only allows us to share information about our work, but allows us to directly engage with our

growing band of over 200 followers.

We regularly update followers with details of what we are doing, increasing our followers, following

more relevant health and social care organisations and reposting their tweets. We will use Twitter

to start a two-way conversation with our partners and hear what they have to say about local

healthcare, as well as involving them in live chats on a regular basis.

ENGAGING WITH OUR LOCAL COMMUNITIES

NHS Hartlepool and Stockton-on-Tees CCG has continued to listen carefully to the views of

our population including patients, carers, the general public, the voluntary and community

sector and is committed to acting on the feedback we receive. By contributing their opinions

about our current services and future needs, the community can take a greater role in

decisions about healthcare provision in our area. During 2015/16 we have encouraged our

communities to get involved in a wide variety of ways:

Community Health Ambassadors: This is a new initiative which began in 2015. We have

recruited people from our local communities as health ambassadors to help us engage

effectively with local people. The Community Health Ambassadors are people with local

knowledge of Hartlepool and Stockton-on-Tees and the diverse population that lives in the

area. They have the ability to communicate and engage others in discussions about health-

related issues. Key issues the Community Health Ambassadors have been involved in are:

Co-development and input into the CCG’s primary care strategy Development of our Urgent Care specification – important issues for patients and questions Promotion of Community Health Ambassadors and CCG Promotion of the Winter Campaign GP IT – Access to online patient services and promotion of access Health Information Week – Event, stalls and community radio Health Survey – 505 surveys completed Development of CHA App and Website Feedback on discharge to assess process

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Patient participation groups (PPGs) take place in our member practices and take different

forms, from attending meetings to being part of a ‘virtual group’. These give local people a say

on how their local GP surgery services could be improved. The CCG actively encourages

practices to use their PPGs to comment on CCG ideas and initiatives.

Public events: The CCG holds regular events which are open to the general public,

stakeholders and partners.

My NHS: By signing up to My NHS, local people can influence decisions about their

healthcare, receive updates about local services and receive invitations to events. My NHS

currently has 754 members.

Governing Body and Annual General Meeting (AGM): We hold our Governing Body

meetings and our AGM in public. At each meeting we hold a ‘question time’ when members of

the public can ask questions and make comments on items on the agenda. In addition, our

Governing Body includes a lay member with responsibility for patient and public engagement

that ensures that the interests of patients, the public and community are included in the heart

of discussions.

Website: Our website includes up-to-date information on local news and campaigns, key

documents and objectives. The website also promotes opportunities for local people to have

their say via local events and surveys.

Attendance at events: The CCG actively engages with local community and voluntary groups

at local events, including local crime partnerships and welfare reform groups.

Social media: The CCG has a Facebook page and Twitter feed to keep our followers up to

date with health information and CCG information. Follow us on Facebook at

www.facebook.com/HASTCCG or on Twitter at @HaSTCCG

Patients and Families: Through the Commissioner Assurance Visits programme the CCG

also actively engages with patients, families and carers that are currently in receipt of services.

This valuable source of information is used to validate the Friends and Family Test information

as well as ensuring feedback in relation to information about quality and patient experience.

The five stages of engagement

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This model identifies five separate stages when the public should be engaged in decisions around

commissioning:

Community engagement to identify needs and aspirations

Public engagement to develop priorities, strategies and plans

Patient and carer engagement to improve services

Patient, carer and public engagement to procure services

Patient and carer engagement to monitor services

The Ladder of Engagement and Participation

The ‘Ladder of Engagement and Participation’ is a widely recognised model for understanding

different forms and degrees of patient and public involvement. Patient and public voice activity on

every step of the ladder is valuable, although participation becomes more meaningful at the top of

the ladder.

THE ENGAGEMENT CYCLE

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NHS England’s guidance for CCGs (Transforming Participation in Health and Care) focuses on

embedding communication and engagement at every stage of the commissioning cycle.

Hartlepool and Stockton on Tees CCG follows the principles as highlighted in the Engagement

Cycle when commissioning services. The cycle explains how patients, the public, staff and

stakeholders can work together throughout the commissioning cycle; and how patient, public and

stakeholder views can genuinely influence commissioning decisions on a daily basis.

Choosing appropriate engagement processes and activities at any stage of the commissioning

cycle requires clarity of the purpose of engagement and influence that can be achieved. The voice

of patients and their communities will inform:

Our decision-making throughout our organisation on an ongoing basis

Our quality improvement work by contributing towards needs assessments, strategy

development and service redesign; and

Our quality assurance work by highlighting patient, carer and community experience to

inform our monitoring and evaluation of existing services, care pathways, providers and

healthcare interventions.

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OUR ENGAGEMENT AND INVOLVEMENT OBJECTIVES

NHS Hartlepool and Stockton-on-Tees CCG has continued to listen carefully to the views of

our population including patients, carers, the general public, the voluntary and community

sector and is committed to acting on the feedback we receive.

By working with our patients to promote and support healthy living, self-care and early intervention

where this can deliver better health outcomes, we are:

Involving service users, carers, staff, providers, partners and the public to develop services

and reduce health inequalities.

Working in partnership to transform services

Working transparently and inviting feedback to ensure we meet patient needs

Driving service transformation and embracing opportunities to innovate

Commissioning sustainable services as close to home as possible

Planning and responding to the needs of residents

To help us achieve our objectives we will:

Ensure appropriate and proportional involvement from the third sector, community groups

and communities, when commissioning proposals affect them, by ensuring on-going and

effective conversations

We will understand the profile and needs of our population, to ensure we offer everyone the

opportunity to have a voice

We will continue to build on and create new links with the third sector and community

groups, via our Community Health Ambassadors and our close working relationship with

Catalyst Stockton and local Healthwatch groups. This will ensure that we use their

experience and strengths to regularly engage with those people whose views are seldom

heard.

We will produce an annual patient engagement and involvement report, including the

outcomes of any consultations and engagement activity, to demonstrate the work we have

carried out over the previous 12 month period.

Always ensure that we feedback to individuals and groups who’ve contributed and/or

provided us with feedback, in a timely way.

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PARTNERSHIP WORKING

North of Tees Partnership Board

Hartlepool and Stockton-on-Tees CCG, Hartlepool Borough Council, Durham Dales, Easington

and Sedgefield CCG and the two main local health providers – North Tees and Hartlepool NHS

Foundation Trust, and Tees, Esk and Wear Valleys NHS Foundation Trust, have continued to

work together as part of the North of Tees Partnership Board to:

• Oversee the successful development and delivery of the two and five year plans including the

Better Care Fund

• Oversee, facilitate and guide associated projects

• Oversee the successful delivery of the service changes that support the delivery of our

transformation plans and other required system changes

• Maintain high quality clinical, community and social care services whilst protecting the financial

stability of the local health and social care economy

• Co-ordinate and align all cross-organisational activities across the health and social care

economy aimed at delivering service change

• Raise awareness in relation to issues that might impact on the strategy and plans to deliver the

programme of work

• Agree contingency and risk management arrangements in the event that planned schemes do

not deliver to projections

• Co-ordinate and share how decisions will be taken within each of our organisations

Working in partnership, the CCG will not only more effectively bring together support for pressing

health issues but will also promote the reputation of the NHS as an active corporate partner. The

communications and engagement group involves the following organisations:

NHS Hartlepool and Stockton on Tees CCG

Hartlepool Borough Council

Stockton Borough Council

Tees, Esk and Wear Valley NHS Foundation Trust

North Tees and Hartlepool NHS Foundation Trust

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Catalyst Stockton

Stockton Healthwatch

Hartlepool Healthwatch

EQUALITY ANALYSIS

The CCG undertakes Equality Impact Assessment (EIA) on all of its key decision, policies, and

service re-designs, to ensure the impacts on protected groups are understood and adverse

impacts are mitigated. The EIA process will identify any protected or vulnerable groups for

consultation.

All consultations that occur on service re-designs and procurements will be reported into the

Governing Body, in order to monitor how effectively protected groups are engaged in these

decisions.

As part of the engagement process, we will undertake targeted engagement and develop

engagement structures with vulnerable groups using ‘in-reach’ approaches and will regularly

monitor engagement activity by equality groups. We seek out the views and opinions of our local

communities and stakeholders in lots of ways, including face to face meetings, events, press

releases, radio and TV broadcasts, interviews, and a range of digital channels.

We know that there are still some sections of our population we do not reach. With this in mind,

over the coming months and years we will extend the reach of existing mechanisms and employ

new ones wherever possible, including making good use of social media and solidifying the

relationships we have built with local voluntary and charity groups.

As a public sector organisation Hartlepool and Stockton CCG is required to ensure that equality,

diversity and human rights are embedded into all functions and activities as per the Equality Act

2010, the Human Rights Act 1998 and the NHS Constitution.

EVALUATION

The Communications Strategy exists to help stakeholders discover the CCG and it’s work,

encourage participation in its programmes and services, learn from the content it offers, and take

action on relevant issues. Although the impact of a successful communications strategy can’t be

fully measured and is quite ephemeral, there are metrics we can use to indicate successes and

provide pointers as to how the strategy can be improved.

Metrics:

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Precise press cuttings

Social sign in (social media impact data)

Customer satisfaction scores

Patient and public surveys

Attendance at events

Insights

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Appendix 1: Stakeholder Matrix and Analysis

Public facing

Patients / general public / local community

Patient / user/ carer support and representative groups

Relevant partnerships, forums, community and voluntary organisations/groups and carers’ organisations, including long term conditions groups, disability groups

Voluntary sector groups Patient Reference Groups Local Involvement Networks

(LINKs) Hartlepool Healthwatch Stockton Healthwatch

NHS organisations

North East Commissioning Support Unit

Public Health NHS England Clinical senate Department of Health

Independent contractor community

Member practices Practice staff Local Medical Committee (and

other local committees) Other independent contractors

and their staff – opticians, dentists, pharmacists

Political partners

Members of Parliament Member of European Parliament Local councillors and members Parish councils

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Detailed Stakeholder Analysis

Internal Stakeholders

Stakeholder Group Characteristics Challenges Engagement / Communications Priorities

Channels / Methods

Staff Key clinicians: CCG GP Chair CCG Clinical leads CCG Nursing leads CCG Member Practice GPs and clinicians Clinical leads in neighbouring CCGs Lead clinicians in provider organisations

High credibility with many other stakeholders High level of influence within the NHS May be perceived as leaders of the NHS High media profile on NHS issues.

Engaging clinicians to enable their input into policy, strategy and campaigning.

Demonstrate influence of stakeholder engagement in commissioning decisions and service development. Build understanding of new structure and establishing CCG’s reputation and capability as key player in the local NHS.

HAST CCG quality group NTHT & TEWV Clinical Quality Review Groups Clinical networks and representative bodies Individual correspondence More individualised forms of digital / social media Consultation/ formal decision making structures. Council of Members CCG bulletin to Practices

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External Stakeholders

Stakeholder Group Characteristics Challenges Engagement / Communications Priorities

Channels / Methods

Patients and carers Patients / public

May be dependent recipients of information. May not be involved or interested. Exposed to and expected to assimilate a range and variety of messages from a number of different sources on a daily basis. Will ignore or discard anything not immediately perceived as relevant. May be reached through GP or clinics.

Ensuring patients and the public become a more high interest and high influence group. Demonstrating how outcomes of engagement influence commissioning. Creating interest and relevance. Creating ‘call to action’ in use of services, lifestyle change, consultation.

Inform and consult. Build understanding of new structure and establishing CCG’s reputation and capability as key player in the local NHS. Build positive reputation in terms of improving services. Raise awareness and understanding of access to services and key health messages.

GP Patient forums / focus groups / CCG + practice websites / email / newsletters. E-bulletins CCG website Mass communication to large groups through local media ‘Above the line’ marketing campaigns using range of methods and materials. Social marketing to target identified groups.

Patient and long term condition groups

Groups of individuals who are highly aware and discriminating. Increasingly demanding of tailored engagement and flexible relationships, and seek increased control.

Developing ongoing interactive relationships. Developing effective use of social media. Increasing frequency and targeting of communications.

Inform, consult, involve and partner. Engagement in services changes and developments. Demonstrate influence of stakeholder engagement in commissioning decisions and service development. Build understanding of new structure and of CCG’s reputation as leading role in the local NHS.

Network based communication through public meetings, focus groups, listening events. Individual correspondence. More individualised forms of social media.

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Patients in nursing and residential homes

Increased likelihood of referrals to Urgent Care services and A&E.

Developing ongoing relationships with staff.

Raise awareness and understanding of access to services.

Targeted communication through stakeholder database.

Health partners Frontline / provider organisations: GP Federation (HASH) NTHT TEWV Mental Health

Foundation Trust / integrated teams

Hospice providers Local authority / integrated

teams Nursing and residential

home staff Local nursing agencies.

Affected by issues and have an effect. Diverse in terms of roles and grades. Once engaged, can engage other stakeholders. If disengaged, can disengage other stakeholders. Diverse in terms of ease of reach e.g. offsite, contracted, low levels of literacy.

Early engagement with incumbent and potential new providers over commissioning of services. Staff identifying with new ‘brand’ as CCG organisations develop. Informing and engaging across complex and substantial organisations. Measuring engagement and understanding. Developing protocols for communication with provider and CCG staff. Increasing use and reliance on e-comms / informal social media by staff e.g. not ‘top down’ and uncontrolled.

Build understanding of new structure and establishing CCG’s reputation and capability as key player in the local NHS. Provide an efficient news and communication channel, both to and between staff. Increase knowledge and information flow within the organisation. Provide a centralised resource for organisational information and knowledge. Develop support tools for organisational development and training. Guidelines for managing participation in social media.

Network events Clinical Quality Review Groups Well established, regular communications framework with tailored channels which will be regularly audited. Increasing emphasis on e-communications. Also team meetings, newsletters. Stakeholder briefings Focus groups to gather insights. Intranet – all staff will take responsibility for their use of the intranet. Staff usage will increase as this becomes the most trusted source of information.

Regulators and inspectorates High influence. Legitimate and objective regulatory relationship.

Managing stakeholder perception of NHS organisations’ performance benchmarking across clusters

Agree consensus in managing reputation of CCG across clusters.

High profile media management of reputation and performance. Direct liaison with regulators communications colleagues.

Private providers and Legitimate contractual Developing robust Build understanding of new Tailored communications

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independent contractors: CSU Community pharmacists Dental practices Optometrists Third sector providers Other potential commercial providers.

relationship. Direct link to patients / public. Can block or advance communications links. Seek to gain and maintain prestige contract with the CCG. Seek to increase customer base.

contractual relationships which ensures effective communications and engagement are delivered by all providers. Informing, collaborating and engaging across complex and specialist organisations, including profit-driven commercial providers.

structure and establishing CCG’s reputation and capability as key player in the local NHS. Manage the CCG brand and reputation through contractual relationship.

mechanisms which address contractor issues. Knowledge based solutions. Communications and engagement functions work closely with planning, performance, medical and commissioning colleagues.

Local authorities, Local Strategic Partnerships: HBC Chief Executive: Gill Alexander

Legitimate partnership relationship. High local profile as decision maker. Influences communications to local councillors. Political relationship with local MPs.

Ensuring public affairs management builds and maintains relationships on an ongoing basis.

Demonstrate that the CCG: - has significant influence on their decisions and actions - participates in the local health agenda - is an effective partner in delivering health objectives.

Managing public affairs to ensure existing networks and decision making processes are maximised to enable discussion. High quality standard of briefing materials. Advance planning of engagement with existing mechanisms.

NHS England, Department of Health, Secretary of State

Legitimate and objective accountability relationship.

Developing productive relationships of accountability.

Build understanding of new structure and establishing CCG’s reputation and capability as key player in the local NHS.

High quality public affairs through formal engagement routes.

Third sector groups / voluntary sector / major charities Catalyst Community Health Ambassadors

Specialist interest, potentially high influence over users. High media profile as political lobbyists.

Managing specific or single but high profile issues.

Build reputation as leader of the local NHS.

Public affairs management through consultation. Maximising opportunities for user involvement.

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Community Wider public

May be dependent recipients of information. May not be involved or interested. Exposed to and expected to assimilate a range and variety of messages from a number of different sources on a daily basis. Will ignore or discard anything not immediately perceived as relevant. Potentially wide socio-demographic range and characteristics. May be reached through individual GPs or clinics.

Creating and maintaining interest and relevance. Ensuring patients and the wider public are a high interest and high influence group. Demonstrating how engagement outcomes influence commissioning, Creating ‘call to action’ in use of services, lifestyle change and consultation.

Inform and consult. Build understanding of new structure and establishing CCG’s reputation and capability as key player in the local NHS. Build positive reputation in terms of improving services. Raise awareness of key health messages. Awareness and understanding of access to services.

- GP Practice Patient Forums - Media as outlined in media

section Approaches: focus groups / CCG + practice websites / email / newsletters. Mass communication to large groups through local media. ‘Above the line’ marketing campaigns using range of methods and materials Social marketing to target identified groups.

Hard to reach, marginalised and vulnerable groups: People whose first

language is not English People with poor literacy

skills (in English and/or own language)

Young people Young people in care –

secure unit, LA care, foster parents

Carers / young carers Single parents Offender population People with disabilities People with mental health

problems or learning disabilities

Older people

Disadvantaged and isolated groups who experience more difficulty in accessing mainstream services. A priority for engagement. May not have contact with the NHS e.g. take up of screening. Are otherwise no different to mainstream audiences. Exposed to and expected to assimilate a range and variety of messages from a number of different sources on a daily basis. Will ignore or discard anything not immediately perceived as relevant.

Informing, consulting, and involving. Creating highly targeted and specific communications and engagement, including bespoke formats and content. Developing interactive relationships. Working with partner organisations to support increased access.

Develop local contacts. Develop accessible mechanisms and provision. Raise awareness and understanding of access to services and key health messages. Accessible engagement in key developments. Tailor approach accordingly by being aware of different groups’ circumstances and preferences. Ensure communications and engagement is accessible to

Existing mechanisms: Alzeimers society NE Daisy Chain Age UK Teesside Hospice Teesside Lymphoma Support Group Hartlepool & District Hospice Hartlepool and East Durham MIND Hartlepool Carers Hartlepool Families First NCT Teesside Tees Valley YMCA Parent Partnership Services Hartlepool Transgender Support Group Stockton United for Change Tees Valley RCC The New Hartlepool MS Support

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Digitally excluded Deprived communities Geographically isolated Deaf people Visually impaired people BME Refugees Gypsy / Roma / travelling Roofless and homeless

people Faith groups.

Groups united by faith may not be homogenous. Will not receive door to door distributions.

range of language and literacy needs.

Group Teesside Stroke Club Ground Work Hartlepool Deaf Centre Alzheimer’s Society Breathe Easy – Hartlepool Support Group Hartlepool Special Needs Support Group Bipolar UK – Stockton support group Mind skills recovery college Stockton BECON (black minority ethnic community organisation network) Stockton Blind Veterans UK Bulls wheelchair rugby club Carers Support – hospital of god Clevearc Middlesbrough and Stockton Mind Epilepsy Action Stockton Fusion café Thornaby Over 50s Assembly Stockton Sanctuary Supported Living – Stockton Carers Service Stockton physically handicapped social group Stockton U3A Yarm Association for the widowed Young at Heart ULO Stockton [for more Hartlepool based groups please see directory of voluntary and community groups HVDA]

General approaches e.g.:

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Communications through existing networks and contacts. ‘Borrow’ communications channels and credibility from appropriate partners. Use advocates and specialist media. Talks at local meetings, dedicated meetings, focus groups, listening events. Social media and websites - targeted health messages through social marketing. Targeted communications through stakeholder database. Face to face interaction with local forums / representatives.

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Influencers Stakeholder Group Characteristics Challenges Engagement /

Communications Priorities Channels / Methods

Traditional Media High influence, high interest in terms of news value. Increasingly use citizen journalists and social media sources. Some constraints.

Maintaining quality and timeliness of information. Agreeing key messages to underpin all media activity

Establish relationships with key journalists Build understanding of new structures and positive reputation. Increase positive media coverage Analyse media coverage.

Targeting key local and regional journalists directly or via CSU communications team: Hartlepool Mail Northern Echo Middlesbrough Evening Gazette Sunderland Echo Darlington & Stockton Times BBC Look North Tyne Tees Star radio BBC Radio Tees

Campaign groups: Fighting for Hartlepool Hospital 999 Call for the NHS Need Group Teesside Solidarity Teesside Peoples Assembly Hartlepool Alert Momentum Teesside

Local, regional or national. Specialist and local interest, potentially high influence over users. May be linked to local political structures e.g. local councillors as members. High local media profile on key issues.

Managing specific or single but high profile issues.

Build understanding of new structure and establishing CCG’s reputation and capability as key player in the local NHS. Demonstrate influence of stakeholder engagement in commissioning decisions and service development.

Media management Public affairs management Consultation Maximising opportunities for user involvement Face to face interaction with local forums / representatives Individual correspondence More individualised forms of social media.

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Representing Stakeholder Group Characteristics Challenges Engagement /

Communications Priorities Channels / Methods

Parish councils High interest and high impact on esoteric issues Influence with local authority members and local communities

High number, maintaining local contact and focus

Grassroots communications to ensure local understanding of Hartlepool/Stockton-wide issues Incorporate onto mailing lists

Hartlepool/Stockton/Billingham/Thornaby Parish Councils

Professional bodies GMC BMA Local medical, dental,

pharmacy and ophthalmic committees

Royal Colleges.

Strong influence over clinicians. Clinician’s most trusted source of opinion and information. Indirect but powerful influence over service users, patients and public. Can lobby ministers and provide credible source of media comment.

Establishing ongoing dialogue channels alongside formal communications. Finding key ‘influencers’ among clinicians.

Build reputation as leader of the local NHS. Treat as key players and partners by prioritising communications re issues likely to affect members arising from commissioner/provider relationship.

Media management Public affairs management Consultation Face to face interaction with local representatives Individual correspondence.

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Appendix 2 – Channel Map

Channel Promotion via Purpose Audience Feedback mechanism

Public events Promoting CCG events via all communication channels – web news/press release/stakeholder newsletter/GP column

To provide good opportunities for open discussion.

All, open to the public On-site surveys will capture attendance, feedback and suggestions for

Additional agenda items

Additional venues

Feedback and suggestions will be posted on CCG website

Web All relevant leaflets, posters and via partner sites (stakeholders)

The primary source of information. Content updates will be made regularly to ensure that the public is informed in a timely fashion. The link to our site will be published on all relevant material

All, open to the public Responses and comments can be submitted via email

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Social media 2 tweets per day

2 facebook posts per week

Management of online community

Social media calendar

Links from CCG website

To publicise and create ‘buzz’ around events, to create an additional mechanism for two-way communication with a wider audience. Create genuine conversations from a wide variety of people across Hartlepool and Stockton-on-Tees

Any member of the public with a Twitter ‘handle’

Responses and retweets in the public arena

Media relations All local media channels Draft re-active statements to

inform the public of CCG position

All Press cuttings

Press releases All local media channels To inform members of the public about the positive work the CGG is doing to achieve its core aims

All Emails and letters from interested members of the audience

Regular columns by Dr Nick Timlin

Hartlepool Mail To inform on issues, events, meetings

All, open to the public Emails and letters from interested members of the audience

Collateral - leaflets, posters, other ‘hard copy’ e.g. Community Council recruitment pack and poster/pop up banners etc

n/a To promote services

To advertise events

To inform on service changes

To ask for feedback

Available in GP surgeries, care homes, support groups, charities

Direct correspondance to CCG

Leaflets may have a response form

Email address for correspondance to appear on all publications

Broadcast media Radio and TV interviews and advertisements

Local and national television and radio

All, open to the public Viewing figures and statistics on amount of correspondance

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Direct mail n/a To provide a conduit for complaints, comments and feedback direct to the CCG

All, open to the public In person

Corporate publications Four publications per year to include:

Annual report

Executive summary

Other two publications to be confirmed

Current information is published on our website. A publication schedule is available on our website

All, open to the public Responses and comments can be submitted via email

Newsletters and publications in Local Authority magazines, community magazines e.g. Hartbeat, Billingham Community News

n/a To inform a specific group on issues or events

Specific recipients Direct correspondance

Forward content to stakeholder newsletters

Catalyst, HBC, Healthwatch To inform and engage stakeholders with the quarterly activities of the CCG

Stakeholder list

Regional campaigns Flu

Winter planning

To inform members of the public on relevant issues via tailored communication plans

Members of the public As per campaign plans

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Governing body advertisements

All local media channels, CCG website and minutes made available to the public

To inform members of the public and encourage attendance

All, open to the public Direct questions and opportunities to feedback via website

Number of hits and downloads on the Governing Body section of the website

CCG Stakeholder meetings

Supporting CCG - email and letter invitation to stakeholders

To ensure that stakeholders and all interested parties, e.g. voluntary and community sector agencies are involved in all key issues

Internal and external stakeholders

Direct to CCG via internal channels, such as email or verbal during the meeting

Major changes will be published on CCG website

Patient Reference Group Meetings

CCG website

Posters / leaflets in GP practices

Potential for a ‘map+gap’ exercise to be carried out to establish where there are currently PRGs

To provide an open forum for patients to give their views

Invitation only for patients at a specific GP practice

Direct correspondance from GP to CCG

% practices with patient involvement groups

Development of a system to record and feed insights into CCG

Annual patient engagement survey

MP and councilllor correspondence / Parliamentary briefings

Research and draft appropriate CCG response

Respond to queries efficiently and effectively and provide sufficent information on request for any breifings

MPs/Councillors/members of the public

All correspondence logged

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Appendix 3 – C & E Plan

Operational communications and engagement plan

Background

NHS Hartlepool and Stockton on Tees CCG is involved with a range of partners in delivering a number of programmes for change and

transformation around health and wellbeing. This action plan has been developed to ensure that engagement around these is integrated and

aligned in order to deliver consistent messages and information (for example, around the reasons why change is needed) and to make the

most effective use of the networks, mechanisms and community based assets that enable engagement with patients and the public in

Hartlepool and Stockton-on-Tees.

The aim is to support the CCG’s Communications and Engagement Strategy alongside the communications and engagement strategies for

North Tees and Hartlepool NHS Foundation Trust, Tees Esk and Wear Valley NHS Foundation Trust, Hartlepool Borough Council and Stockton

Borough Council.

All activity will be framed within the overarching context of engagement around the Sustainable Transformation Plan.

Key transformation programmes and projects

Local

The CCG is making a significant contribution to key strands of the Health and Wellbeing Strategy developed by the North of Tees Partnership

Board including a number of transformational projects:

Children and Young People Transformation

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Appendix 3 – C & E Plan

Learning Disabilities Transformation

Hartlepool Plan

The CCG has a number of key project areas around which targeted engagement will be required including mental health and learning disability,

children and children’s mental health, adults 25 – 64, adults 65+, primary care.

Regional

Sustainable Transformation Plan (STP) - In 2014 NHS England published the Five Year Forward View – a national plan to improve the NHS.

This identified three challenges for health and care. These include how we:

Improve the health and wellbeing of the population

Improve the quality of care people receive

Ensure the efficiency of NHS services. This will help us make sure we are spending the public’s money on services that get good

outcomes for patients.

NHS organisations have been asked to develop plans to show what we are going to do to address these challenges in their local areas. These

are called Sustainability and Transformation Plans, or STPs. The CCG is part of the STP 2016-21 for Darlington, Durham Dales, Easington and

Sedgefield, Hambleton, Richmondshire and Whitby and South Tees which will drive delivery of the Five Year Forward View via a Trans-

CCG unit of planning that will fit with the scope of the Better Health Programme.

The CCG is also a partner in the Better Health Programme. This transformation programme is about how the NHS in Darlington, Durham and

Tees can improve outcomes and experience for patients when they need care, especially in an emergency. All partners share an ambition to

offer the highest standards of emergency care and making sure there is access to a permanent senior clinical workforce 24/7. Engagement

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Appendix 3 – C & E Plan

work on the programme is underway and the public in Hartlepool and Stockton are aware that the programme is likely to result in significant

changes to improve the way services are provided to patients.

Additional regional programmes include; Urgent Care Vanguard, Better Care Fund, Better Care Fund ICT Strategy, Integrated Personal

Commissioning – My Voice, My Choice

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Appendix 3 – C & E Plan

Action Plan

Objectives Actions Timescale Mechanisms

Communications

1. Deliver effective communications

Plan, develop and deliver campaigns such as winter, PPG recruitment, antibiotics awareness etc

Sep 2016 – Mar 2017

Use existing channels

Use the AGM to showcase the CCGs work Jul 2017 Planned and sustained media activity

Support the clinical leads to become key media spokespeople Ongoing Media training for clinical leads

Develop case studies to showcase the work of the CCG Ongoing Case studies

Increase media coverage across all channels with a blend of digital and traditional Monthly Monthly column across traditional and digital

Promote and increase Twitter followers Ongoing Develop strategy

Ensure partners are co-ordinated in keeping stakeholders up-to-date on key transformation programmes and projects

Monthly

Stakeholder bulletins MY NHS HBC magazine

Ensure Members are kept up-to-date. Weekly GP bulletins

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Appendix 3 – C & E Plan

Facilitate the distribution of key messages which are consistent and avoid duplication to support:

STP Better Health Programme Health and Wellbeing Strategy Children and Young Peoples Transformation Learning Disabilities Transformation Hartlepool Plan CCG key project areas

Monthly

HAST C & E working group Members: HBC SBC NTHT TEWV CCG Healthwatch Catalyst

2. Reputation management

Implement a robust and timely sign off procedure for all proactive and reactive media Ongoing Weekly meeting

Ensure alignment to national and regional programmes communications priorities Ongoing Attendance at national and regional meetings

Develop a pro-active media approach by liaising with key project groups and colleagues to develop a portfolio of positive work that the CCG is doing. Ongoing Traditional and

digital media

3. Help people to help themselves

Involving and informing the public of the work of the CCG through effective communications and linking in with public health BiMonthly

C & E task and finish group, digital channels and engagement through Healthwatch

Undertake a review of the CCGs patient involvement networks tbc Healthwatch to conduct an audit

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Appendix 3 – C & E Plan

4. Getting the public involved in our decision making

Undertake a joint baseline survey against the following evaluation criteria:

Stakeholders feel informed Stakeholders feel involved and are able to influence Stakeholders are engaged with change

tbc

Partner comms channels On street surveys Engagement lab Healthwatch engagement project

Review current arrangements with partners for engagement covering health and social care and identify opportunities to streamline engagement and fill gaps

tbc CHA HAST C & E group

Review and develop options for an on-line presence for health and social care across partners to ensure links, consistency and mechanisms.

tbc HAST C & E working group

How we scope opportunities and develop proposals for integrated engagement activities (e.g. engaging with the local public about priorities and services changes spanning health and social care).

tbc Meet with Healthwatch

Events calendar showing dates of:

CHA meetings PPG meetings STP/Better Health events

Ongoing Add to comms calendar

Undertake combined insight work with partners and STP/Better Health Programme tbc

Meet with STP/BHP comms lead to map out

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Appendix 3 – C & E Plan

5. Patient and public voice

Online survey tools to broaden participation – in place Review and develop use of My NHS – being adopted by the CCG Seek views from the community at local events or venues e.g. attending festivals, markets, schools, leisure centres, libraries etc.; Target other forthcoming events over a twelve month period – tie into campaigns/ consultations – mapping – add into comms calendar

tbc

Partnership working with HBC, SBC TEWV and NTHT

Promote public trust by ensuring feedback mechanism is in place for feeding back public insight and patient engagement.

Regular agenda item at Governing body meetings to review a patient story

Annual engagement report

Ensure feedback mechanism is in place for feeding back public insight and patient engagement.

Regular agenda item at Governing body meetings to review a patient story

Annual engagement report

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Appendix 4: Digital marketing strategy

NHS Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG) is keen to

develop its use of digital marketing for a number of reasons:

Digital marketing has the potential to transform people and patient’s health and care

as it allows access to information and services that are convenient to the user. Digital

marketing opens up communication channels and engages users but it’s also

important to remember that this medium needs to be integrated offline as well.

Digital marketing opens up the potential to have a two way conversation with the

target audience and this type of communications is measurable, meaning that we

will know how our efforts resonate with our audience.

Digital and social media remove the perceived barriers between the public and the

CCG resulting in an open dialogue, honest feedback, and the true voice of the user

being heard.

Social media is most commonly used by members of our community that have not

usually expressed views through more conventional means of engagement.

Objectives

To create genuine conversations from a diverse range of people across Hartlepool

and Stockton on Tees

Ensure that there is a month on month increase of followers on Twitter and likes on

Facebook

Encourage re-tweets where possible to increase reach

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Appendix 4: Digital marketing strategy

Please note that the different channels from the digital marketing strategy will be

monitored on a month by month basis and will be provided in the communication and

engagement workshop meetings.

Website

The digital touch points on the website include:

Email sign up – allows users of the site to sign up to receive email communications

(this will be linked to MY NHS)

Twitter feed – display recent Tweets on the home page and increases awareness of

social channels and engagement

Facebook integration – increases awareness of social channels and engagement

Social sharing buttons – each relevant piece of content should have social sharing

buttons to facilitate simple and effective syndication of content on social networks

Surveys and polls – use survey and poll widgets on the home page to encourage

feedback (if appropriate)

All of the above touch points support the wider digital marketing strategy as it enables the

CCG to give the tools with which to interact with individuals, facilitates engagement and

creates useful content. It also helps build an engagement community and increases reach

(the audience of each digital and social channel has the potential to grow exponentially –

with each communication comes the potential to reach a wider audience as the message is

viewed, interacted with and shared).

In implementing the digital marketing strategy, these digital touch points will be used to

enhance the opportunities for engagement with the public and patients.

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Appendix 4: Digital marketing strategy

Email

Email will be integrated with MY NHS.

How can email support the goals of the CCG?

Email can be used as a personalised, education communication tool, giving the public

and other stakeholders an insight into the CCG

Engagement with the public and patients

Support campaign messages

Share public health messages

How can this be achieved?

Integrate email sign up as part of the website

Encourage email sign up across offline touch points

Create email communication plan as part of individual communications and

engagement strategies

Segment database

Create email campaigns

Measure effectiveness in relation to objectives

Social media

General principles

Be accurate – check facts, check spelling, check grammar, check again

Be respectful - know when to take the conversation offline, don’t divulge or

encourage personally identifiable or sensitive information, treat others as you wish

to be treated

Be responsible - messages proliferate quickly – make sure you’re willing to take

responsibility for your content, act courteously and professionally

Be time sensitive and respond to messages in a contextually relevant manner

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Appendix 4: Digital marketing strategy

The recommended channels for Hartlepool and Stockton on Tees CCG are Twitter,

Facebook, YouTube (for posting videos), and LinkedIn (for stakeholders). Information about

the general principles, how often it should be used, typical audience, kind of content that

should be published and the golden rules for each platform are indicated below.

Twitter

Twitter is an online social networking and microblogging service. Users send and receive

tweets as well as read other tweets.

Twitter audience

Public

Councils

Health care professionals

Health care bodies

Stakeholders

Staff

Kind of content that should be published

Campaign messages - use hashtags appropriately

News stories

Interviews

Commentaries

Videos

Educational

Public outreach - message frequency should increase proportionately to message

importance

Surveys and polls

Disaster and crisis response

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Appendix 4: Digital marketing strategy

Intelligent discussion

Health promotion

North East Leadership Academy – Twitter guide for NHS professionals

Facebook

Facebook is an online social networking service and is open to anyone over 12 years old.

Facebook audience

Public

Councils

Health care professionals

Health care bodies

Stakeholders

Staff

Kind of content that should be published

Campaign messages

News stories

Interviews

Commentaries

Videos

Educational

Public outreach - Message frequency should increase proportionately to message

importance

Surveys and polls

Disaster and crisis response

Intelligent discussion

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Appendix 4: Digital marketing strategy

Health promotion

Golden rules

Facebook posts should be about quality, not quantity

- In order to become an authority and engage with our audience we must

provide relevant, quality content

Vary the content

- Facebook could be used as the primary content marketing vehicle for our

online content and campaign messages – links, polls, surveys, videos, images

etc. should all be considered for Facebook publication

Engage with our audience

- We should encourage an open dialogue – pose questions, ask for feedback,

ask for opinion, offer commentary

Monitor regularly

- We cannot allow messages or posts to go unseen and unanswered due to the

potentially sensitive and critical nature of some messages

Integrating digital marketing with offline communications

It is important that both online and offline communications are integrated. This will be

integrated as follows:

Promotion of digital and social channels – offline communications should reference

digital and social channels where appropriate

User feedback and quotes used on literature

Offline communications supported by online channels

Offline and online should form part of one overarching communications and engagement

strategy, intertwines and constantly evolving.

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Appendix 5: MP Queries

Members of Parliament (MP) and local councillors as democratically elected officials are

important representatives of the public. Hartlepool and Stockton on Tees CCG needs to

ensure that we deal with their letters and requests for parliamentary briefing effectively and

efficiently.

We have contracted with the North of England Commissioning Support (NECS)

communications and engagement team to provide communications support to the CCG.

The communications and engagement team work closely with the CCG to ensure a

professional and timely response to enquiries from politicians and others. As a general rule,

all requests received by the CCG and the responses provided will be recorded by the NECS

communications and engagement team.

MP and councillor correspondence

Letters and emails from MPs and councillors for information or for responses to issues

raised with them by constituents are likely to come into the CCG through different routes.

They may choose to go directly to the lead Directors or Chief Officer or they may contact

someone in NECS (particularly if they have had a working relationship with that person or

team during the life of the primary care trusts).

Any MP or councillor correspondence should be directed to the Strategic Head of Corporate

Affairs who will be responsible for ensuring that NECS are informed and that an appropriate

response is prepared.

If the request comes direct to NECS, then the Strategic Head of Corporate Affairs will be

advised that it has been received and a copy sent. NECS will also ensure that the Strategic

Head of Corporate Affairs is made aware of any similar correspondence to other CCGs.

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Appendix 5: MP Queries

For all MP/councillor correspondence, NECS will send a holding statement immediately, or

within two working days at the latest, to say that the matter is in hand and a full response

will be made as soon as possible.

Depending on the nature of the request, the NECS communications and engagement team

will decide whether other NHS organisations such as neighbouring CCGs (if there are shared

MP constituencies) or the NHS England Area Team should be informed.

The Strategic Head of Corporate Affairs will decide who needs to be contacted for briefing

to respond to the request and the degree of urgency for handling, for example:

Immediate/high priority response Response within 10 working days

the concern is about on-going patient

care and is an urgent request for

help/advice

it is something that could be damaging to

the reputation of the CCG

a routine request for information

All requests for information from the CCG will be issued and signed off by the CCGs

representatives. The actual signatory will depend on the nature of the letter but should be

a member of executive team or someone of suitable seniority within the staff.

Parliamentary business

Often requests for parliamentary briefing require a quick turn around with deadlines for

later the same day or the next day. It is vital that such deadlines are met as the information

is sometimes used in the House of Commons during a parliamentary debate or question

time, or by ministers in response to issues raised with them by MPs or members of the

public.

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Appendix 5: MP Queries

Requests for parliamentary briefing will come into NECS from the NHS Commissioning

Board. They will be sent to the Strategic Head of Corporate Affairs with a copy to the NECS

communications and engagement team who will then liaise to agree how it will be dealt

with.

Whoever, is nominated as responsible for compiling a draft response will collate the

appropriate information and this will usually involve discussion with either someone at

NECS or the CCG. All responses (other than very routine requests for information) will be

reviewed by the head of communications and engagement in NECS and the Strategic Head

of Corporate Affairs and then will be signed off by a member of the CCG executive team or

someone of suitable seniority within the CCG staff. The response will only then be sent to

the NHS Commissioning Board by NECS.

Key contacts:

Hartlepool and Stockton on Tees CCG

Andrew Carter

Corporate Governance and Risk Manager - Andrew.carter6@nhs.net Tel: 01642 745981

North of England Commissioning Support (NECS)

Mary Bewley Head of Communications and Engagement - mary.bewley1@nhs.net Tel: 0191 374 4171

Judith McGuinness Senior Communications Officer -– judith.mcguinness@nhs.net Tel: 07785 601944

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Appendix 6: Media Enquiries

Media enquiries

It’s important that NHS Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG) builds a

productive working relationship with the media. They can help us to engage with the public and get

key messages out. We also don’t want any member practices or CCG employees put in a difficult

position because of media enquiries or attention. Therefore some thought has been given to how we’d

like members and employees to deal with media enquiries.

We have contracted with the North of England Commissioning Support (NECS) communications and

engagement team to provide media handling support to the CCG. The communications and

engagement team work closely with the CCG to ensure a professional and timely response to enquiries

and to support profile raising through the media in line with the communications strategy. The team

will also provide advice on handling difficult stories and offers crisis media support.

Protocol

If you receive a general enquiry from the media for Harlepool and Stockton on Tees CCG please

redirect the call to the NECS communications and engagement team who will ensure that the CCG’s

Strategic Head of Corporate Affairs is also informed.

All press releases, statement and quotes in relation to the work of the CCG will be issued by the CCG

offices supported by the NECS communications and engagement team. We ask that no public

statements relating to CCG matters be released directly by member practices or employees. This in no

way affects the way that members deal with enquiries about their role as providers.

Please contact the Strategic Head of Corporate Affairs if you want to publicise a good news story. If

you need to discuss a media handling issue then the NECS team will be able to provide professional

advice.

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Out-of-hours media enquiries

Support outside of normal office hours (evenings and weekends) is also available. If you receive an

urgent media enquiry outside these hours please contact the communications team’s out of hours

media on call (contact details below).

Key points for responding to the media

Always refer journalists to the communications and engagement team.

Don’t feel under pressure to answer questions there and then.

If you are not sure whether the call is from a journalist, ask their name, the publication they are

working for and their deadline. You can pass this information to the communications and PR

team if you have time.

Be aware that you could get enquiries from local and national newspapers, national magazines

like Pulse and Health Service Journal (HSJ) as well as TV and radio news.

Please note: some enquiries from the media may be responded to through the Freedom of

Information process, depending upon the nature of the particular enquiry.

Key contacts:

Hartlepool and Stockton on Tees CCG

Andrew Carter Corporate Governance and Risk Officer - Andrew.carter6@nhs.net Tel: 01642 745981 North of England Commissioning Support (NECS)

Mary Bewley Head of Communications and Engagement - : mary.bewley1@nhs.net Tel: 0191 374 4171 Judith McGuinness Senior Communications Officer -– judith.mcguinness@nhs.net Tel: 07785 601944

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Appendix 7: Statutory Duty

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Clinical commissioning groups - meeting statutory requirements on the duty to involve and

consult

There are a number of requirements that must continue to be met when discussions are being

made about the development of services, particularly if any of these will impact on the way these

services can be accessed by patients. Such requirements include:

Section 242 of the NHS Act 2006

Section 244 of the NHS Act 2006

Section 234 of the Local Government and Public Involvement in Health Act 2007

The four ‘Nicholson tests’

The NHS Constitution

Section 242 of the NHS Act 2006, (previously section 11 of the Health and Social Care Act 2001)

places a duty on NHS bodies to involve patients and the public in the planning and development of

services, particularly if a proposal would have impact on:

The manner in which the services are delivered to users of those services, or

The range of health services available to those users.

Section 244 of the NHS Act requires health organisations to request the appropriate local

authority’s health overview and scrutiny committee to review and scrutinise proposals which result

in service change. Where such changes are considered to be ‘a substantial variation’ there is a

requirement to carry out a formal process of public consultation.

Section 234 of the Local Government and Public Involvement in Health Act 2007 requires health

bodies to (it states strategic health authorities and primary care trusts so it can be assumed that

this requirement also relates to specialised commissioning) to prepare a report:

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Page 2 of 3

on the consultation carried out, or proposed to be carried out, before a commissioning

decision is made, and

on the influence that the results of the consultation have on commissioning decisions.

During 2010 the NHS chief executive Sir David Nicholson said that before any service changes are

made, the relevant NHS bodies must ensure that the following four tests have been met:

support from GP commissioners

strengthened arrangements in place for public and patient engagement, including local

authorities

greater clarity about the clinical evidence base underpinning the proposals

account has been taken of the need to develop and support patient choice.

The duties to involve and consult were reinforced by the NHS Constitution which stated: ‘You have

the right to be involved directly or through representatives, in the planning of healthcare services,

the development and consideration of proposals for changes in the way those services are

provided, and in decisions to be made affecting the operation of those services’.

Actions that can be taken if requirements are not met

Failure to involve and consult adequately around service change can result in referral by an

overview and scrutiny committee to the Secretary of State for Health who can then refer contested

proposals to the Independent Reconfiguration Panel. (The panel was established in 2003 to provide

expert advice to the Secretary of State on contentious proposals for service change.)

An Overview and Scrutiny Committee may refer proposals to the Secretary of State if it is not

satisfied with the quality of consultation or if it is not satisfied that the proposals are based on

sound clinical evidence.

The Reconfiguration Panel will provide expert advice on whether the proposals will provide safe,

sustainable and accessible services for the local population, taking account of:

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Page 3 of 3

– clinical and service quality

– the current or likely impact of patients' choices and the rigour of public involvement and

consultation processes.

– the views and future referral needs of local GPs who commission services, the wider

configuration of the NHS and other services locally, including likely future plans

– other national policies, including guidance on NHS service change

– any other issues Ministers direct in relation to service reconfigurations generally or specific

reconfigurations in particular.

An organisation or individual who is unhappy with a decision relating to a proposed service change

may also seek to refer the matter to a judicial review. If such an application is successful a judge

reviews the lawfulness of a decision or actions taken by a public body. It is important to note that

the judge would not look at whether the decision was ‘right’ or ‘correct’ but whether there is the

correct legal basis for reaching the decision.

Reasons for referral to judicial review can include the following:

the decision maker does not have power to make the decision or is using the power for an

improper purpose

the decision is irrational

the procedure followed by the decision maker was unfair or biased

the decision was taken in breach of the Human Rights Act

the decision breaches European Community (EC) Law.

In addition to consideration of the actions that can be taken for failure to involve and consult

properly, note should also be taken of the level of negative media coverage, difficult discussions at

community and local authority meetings and the amount of parliamentary activity that can result

from challenges to proposals for service change. Sometimes as a result of such negativity and

opposition to proposals organisations adapt their proposals mid-way through a consultation.

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Working together to improve health and careOur Draft Sustainability and Transformation Plan 2016-21For Darlington, Durham Dales, Easington and Sedgefield, Hambleton, Richmondshire and Whitby, Hartlepool and Stockton-on-Tees and South Tees.

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HH

H

H

H

H

Barnard Castle

HeighingtonStaindrop

BishopAuckland

Darlington

Hartlepool Crook

Redcar Marske

Saltburn

Whitby

Danby

Stanhope

Spennymoor

PeterleeWearhead

Billingham

Thornaby Middlesbrough

Stockton

Northallerton

Richmond

Leyburn

Catterick

BainbridgeHawes

Yarm

Guisborough

Stokesley

Seaham

Newton Aycliffe

Sedgefield

Easington

Hurworthon-Tees

Key Durham County Council

Darlington Borough Council

Hartlepool Council

Middlesbrough Council

Redcar and Cleveland Council

Stockton Council

North Yorkshire County Council

Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby STP Boundary

Local Hospitals

Hospital with Major Trauma Centre*

Hospitals*H

H

Thirsk

*Affected by the Better Health Programme - see page 8

H

Durham Dales, Easingtonand Sedgefield CCG

Hambleton, Richmondshire and Whitby CCG

South Tees CCG

Darlington CCG

289,700

107,318

Hartlepool andStockton-on-Tees CCG 296,000

293,000

142,000

2 Working together to improve health and care

What is a Sustainability and Transformation Plan?

In 2014 NHS England published the Five Year Forward View – a national plan to improve the NHS.

This identified three challenges for health and care. These include how we:

• Improve the health and wellbeing of the population

• Improve the quality of care people receive

• Ensure the efficiency of NHS services. This will help us make sure we are spending the public’s money on services that get good outcomes for patients.

NHS organisations have been asked to develop plans to show what we are going to do to address these challenges in their local areas. These are called Sustainability and Transformation Plans, or STPs, and there are 44 of them across England.

Our STP describes some things that we are already doing and other things we plan to do. The STP brings these local plans together, and the organisations responsible for them, to make sure we have a clear picture of how they will improve health and care in our area over the next five years.

Over the next few months, more work will be done to develop our draft plan, working with local councils and other partners including the voluntary sector.

Our STP area

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Our Draft Sustainability and Transformation Plan 2016-21 3

Our STP: A vision for our local NHS

During 2016, NHS staff, including doctors and hospital consultants have been talking to local people about NHS services at over 50 events (see page 4).

What has been clear is how passionate people are about NHS services, and how much they value them.

But people also express their frustrations at the way some services work, and concerns about some of their experiences, including how some services are used.

The NHS in South Durham, Darlington, Tees, Hambleton, Richmondshire and Whitby has been working together looking at how we provide services.

Our STP identifies four areas for improvement:

1. Preventing ill health and increasing self-care This involves helping to stop people from becoming poorly and helping to manage their health and any medical problems they already have.

2. Health and care in communities and neighbourhoods Supporting people to stay well and independent for as long as possible by improving health and care services within their area.

3. Quality of care in our hospitals – “Better Health Programme” This is about improving the quality of care in hospital and reducing the distance you have to travel for routine appointments e.g. blood tests, but making sure that people get the best treatment and see the right specialist when they need to.

4. Use of technology in health care Using technology to improve our ability to determine what the problem is e.g. what is making you poorly, decide with you on any treatment you might need and to make sure this treatment or care is given to you in a convenient way.

This plan describes what we are going to do over the next five years.

We hope you will support us in this journey.

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What patients have been telling us

NHS staff have been visiting communities to talk about what the NHS does well, and where it could improve.

Many people were concerned about access to their local doctor and the national and local shortage of doctors. We are working on plans to improve our recruitment of doctors, and to develop new roles to support them in caring for their patients.

We are also looking at how GP practices and other services can work together more effectively. People were also concerned about access to mental health services, and felt that more support should be available locally.

We asked people what issues we should consider when services need to change.

They thought the most important issues were:

Another important theme was information and communication.

People didn’t feel they understood the services that were available, which they should use, and when. This was a problem in urgent care and emergency care. They also expressed frustration at the frequent need to retell the background to their illness and care when they came across a new professional.

People were surprised that hospitals did not have routine access to GP records that would provide this background – particularly in an emergency.

They were supportive of the NHS sharing their records, where this would improve their care, and with safeguards and opt-outs in place.

4 Working together to improve health and care

Improving the results for patients

Improving staffing, recruitment and retention, reducing temporary staff

Transport and travel by car, public transport or ambulance

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Our Draft Sustainability and Transformation Plan 2016-21 5

Priority 1: Preventing ill health and increasing self-care

We know that, in our area, people die younger than in the rest of the country. This is not acceptable. More people have strokes, heart problems and serious weight problems (obesity) and more people smoke than the England average.

The NHS is working with local councils to improve the health of the population, and we want to build on this.

Key areas for improvement• We want to help people look after themselves by providing them with information about

self-care and encouraging them to use services such as local pharmacies.

• We want to identify people who are at risk of becoming poorly and do something about it before problems occur, and offer better support to stay healthy and take care of their own health.

• There have been big improvements in cancer treatment and people surviving cancer, but too many people still die earlier than they should. We want people to get quicker access to tests and treatment.

Case Study – Childhood Illnesses

Research shows that parents are becoming less sure about what to do when their child is poorly.

The NHS across the North East is introducing an app and booklet aimed at parents and carers with children under five to give them advice and support. It has been developed by hospital specialists, doctors, health visitors and pharmacists across the North East.

Parent feedback: “The new NHS app is incredibly user-friendly. The well planned sections provide useful information and advice. My favourite section is the very clever ‘find the nearest Pharmacy’ function, which can be used on holiday, late at night or during bank holidays. The app is fantastic and a must for parents.”

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6 Working together to improve health and care

Priority 2: Health and care in communities and neighbourhoods

In the past, the majority of care was only provided in hospital. Thanks to improvements and changes, we can now manage many long-term health problems – such as heart or breathing problems, or diabetes – with fewer visits to hospital and fewer, shorter, hospital stays.

Over the last few years, NHS organisations have worked together with local councils on services to support people to live as independently as possible.

Key areas for improvement• NHS organisations will share things they have done that have worked well, so that other

neighbouring areas can learn from and benefit more people.

• We plan to increase the number of NHS services provided in the community so people can come home from hospital more quickly, and have their care needs assessed at home, rather than having to stay in hospital when they are well enough to go home.

• We plan to improve access to mental health support locally, including services such as talking therapies and greater involvement of the voluntary sector.

• We are improving access to services locally by developing community based care arrangements in Darlington, Durham and Tees. These will bring together local NHS services with social care and voluntary sector services to improve the range and convenience of services available locally.

• In Hambleton, Richmondshire and Whitby, we will be implementing the proposals for developing care outside hospital that have been consulted on in “Transforming our Communities”.

Here are some examples of the services we are already providing in some areas and that we want to ensure everyone has access to.

Mental health crisis support for children and young people in Hartlepool, Stockton-on-Tees and South Tees

In July 2015 a specialist ‘crisis and liaison’ service began operating 24/7 across Teesside.

Building on a model trialled in County Durham and Darlington, the nurse-led team give a rapid response for under-18s experiencing serious mental health difficulties, in hospitals or at home.

In one year the team carried out over 500 assessments in hospital and over 300 in the community. Admissions to hospital for overdose, treatment or further monitoring fell by 70% compared to the previous year.

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Our Draft Sustainability and Transformation Plan 2016-21 7

Bringing care professionals together in Darlington

Care for frail or vulnerable people hasn’t always been joined up, and patients experiencing problems have frequently ended up in A&E, or admitted to hospital.

Now, in Darlington there is a team made up of a number of different care professionals whose job it is to identify people who are frail or whose health is at risk of getting worse. The team develops a care plan for each person, providing better co-ordinated care and support for vulnerable people, as well as reducing 999 calls and unnecessary hospital stays.

Step-up/step-down bed in rural North Yorkshire

A pilot community NHS bed, also known as a ‘step-up/step-down’ bed in the North Yorkshire Dales has received its first patients.

The pilot facility based in Sycamore Hall extra care housing at Bainbridge, is not just a bed, but an entire flat funded by the CCG.

A patient who is referred there by their local GP is provided with a homely environment to both recover and recuperate, regaining strength and the confidence to undertake daily tasks in a safe place.

The scheme has been supported by Richmondshire District Council and local residents.

Diabetes service in Durham Dales, Easington and Sedgefield

A new diabetic service in Durham Dales, Easington and Sedgefield is helping people to manage their illness better and therefore reducing hospital visits and admissions.

In the past some patients were cared for by the doctor of nurse in their practice. For others, care involved more visits to hospital and sometimes repeated hospital stays. Now patients are invited and encouraged to attend a programme to help them to understand and manage their diabetes.

Dr Winny Jose, GP: “There’s been variation in how patients have been treated with diabetes. Some go to the hospital, some are cared for in the community. If we can provide that service closer to their home, I think they would be more than happy to receive that.”

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8 Working together to improve health and care

Priority 3: Quality of care in our hospitals – “Better Health Programme”

In the past, most hospitals could offer people the best treatment available at the time for most conditions.

Thanks to medical advances the way that people are cared for has improved greatly and the evidence we have now shows that if patients are seen in a specific specialist centre that sees lots of other people with similar problems then they have much better results. Cancer care and heart surgery have been delivered like this successfully for a number of years.

There is clinical evidence that people being seen at a specialist hospital also have better results in a life-threatening emergency.

Key areas for improvement• To make sure that most people can be seen at a hospital close to where they live for

routine care including outpatients appointments, tests, frail elderly assessment and childrens assessment and most care for those currently using A&E.

• To ensure that most of the care and treatments currently being accessed via A&E departments can continue to be provided locally.

• For situations where someone’s life is at risk people are cared for in a hospital that has specialist doctors and experienced teams of staff available 24 hours a day, 7 days a week, and see a large number of people with similar problems.

• Providing planned operations in dedicated facilities. These would be separate from the facilities dealing with patients whose life may be at risk but have access to intensive care if it is needed. This makes sure that patients don’t get appointments cancelled and have a better experience.

During 2016, NHS staff have been talking to local people and partners about the future of hospital services as part of the Better Health Programme.

We expect to carry out a formal public consultation on proposals from June 2017.

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Our Draft Sustainability and Transformation Plan 2016-21 9

Hospital at Home in Hartlepool and Stockton

Hospital at Home provides planned care for patients with breathing problems, avoiding often repeated 999 calls and hospital stays.

Now, patients diagnosed with Chronic Obstructive Pulmonary Disease, which causes serious breathing difficulties, are referred to the Hospital at Home team.

The team will contact the patient within two hours and arrange to come and see the person in their own home. The team cares for the patient at home and helps keep a close eye on how they are managing for four weeks. At week six they will have an appointment with a respiratory consultant. For urgent cases an appointment is available the next day. As a result, the patient doesn’t need a hospital stay.

Patient feedback: “I know if I have trouble breathing or get another chest infection they’re a phone call away and I just don’t like going in hospital. I just felt alone before. I got the tablets, got the steroids, took them and that was it. Where now I’ve got people behind me and it’s just smashing.”

Early supported discharge following stroke in South Tees

Until recently, someone who had a stroke would need to stay in hospital to have rehabilitation.

Now, thanks to the early supported discharge scheme, around 40% of patients are able to go home for their rehabilitation.

The stroke team decides whether a patient needs to stay in hospital for their rehabilitation, or whether they are well enough to go home. If a patient wants to go home, the therapy team will visit the patient at home and offer support and guidance to help patients recover.

Patient feedback: “I can honestly say I wouldn’t be where I am now if it wasn’t for the early supported discharge team. I will be forever grateful.”

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10 Working together to improve health and care

Priority 4: Use of technology in health care

Advances in technology have led to huge improvements in patient care.

Technology can now support people with long-term conditions to live more independent lives.

NHS organisations are working with partners to develop and then put in place new products and devices. These can be available in a person’s home or local community so that they will have better access to care, avoid long journeys and stay independent.

We now have some good examples of how technology is helping patients to carry out some simple tests and help to monitor their condition at home.

Key areas for improvement• Across the North East organisations including NHS, local councils and Newcastle University

are working together to develop the Great North Care Record, which will allow the NHS, and other care organisations to share patient records, securely and with the patient’s permission.

• We are looking at ways of using technology so that patients living in remote rural areas can have appointments using video technology.

Case Study – Warfarin testing

A new digital health screening service introduced by County Durham & Darlington NHS Foundation Trust, is transforming the lives of patients who take an anticoagulant medication known as Warfarin.

Anticoagulants are prescribed for people who have had a condition caused by a blood clot. Over 350 people across in the area now monitor their condition from home instead of going to a clinic.

Patient feedback: “I used to have to attend clinic every two weeks, sometimes weekly. My readings fluctuate unfortunately, meaning I need very regular monitoring and the new system works around my life, rather than the other way around.”

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Our Draft Sustainability and Transformation Plan 2016-21 11

FinanceThe financial pressures on the NHS and social care have been well publicised.

In our area, we spend around £2.4 billion on health care every year.

Given the increased demand on services, and increases in costs, we forecast that the local NHS could be over budget by around £281 million in 2021 (about 12% of our funding) if we do nothing.

Over the next five years, we therefore need to improve our efficiency dramatically. Individual organisations are already required to identify opportunities for improving efficiency every year, but we now need to look at how we do this across the whole system.

Our priority will be to invest in and protect high quality frontline services that deliver the best care for our patients.

What happens next?Over the next few months we will continue to talk to local people and colleagues in local councils and other organisations about our draft STP.

We have arrangements in place to involve staff from partner organisations in the more detailed development of plans, particularly around care outside hospital.

We are also carrying out detailed work to understand the impact of potential changes for local communities.

We plan to offer further opportunities for engagement and will share details of events on the Better Health Programme and other NHS websites, and promote them through the media and social media.

www.

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12 Working together to improve health and care

Find out moreYou can find out more about our Sustainability and Transformation Plan on your local Clinical Commissioning Group website:

www.durhamdaleseasingtonsedgefieldccg.nhs.uk

www.darlingtonccg.nhs.uk

www.hambletonrichmondshireandwhitbyccg.nhs.uk

www.hartlepoolandstocktonccg.nhs.uk

www.southteesccg.nhs.uk

Email: necsu.stp@nhs.net

To find out more about our programme of events see below:

www.nhsbetterhealth.org.uk

Facebook: www.facebook.com/nhsbetterhealthprogramme

Email: necsu.betterhealthprogramme@nhs.net

NHS organisations involved in our Sustainability and Transformation Plan

Commissioning Organisations: NHS Durham Dales, Easington and Sedgefield Clinical Commissioning Group NHS Darlington Clinical Commissioning Group NHS Hambleton, Richmondshire and Whitby Clinical Commissioning Group NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group NHS South Tees Clinical Commissioning Group

Provider Organisations: County Durham and Darlington NHS Foundation Trust North Tees and Hartlepool NHS Foundation Trust South Tees Hospitals NHS Foundation Trust Tees Esk and Wear Valleys Foundation Trust

Ambulance Services: North East Ambulance Service NHS Foundation Trust Yorkshire Ambulance Service NHS Trust

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 3.2

07/02/17

Title Summary of Hartlepool and Stockton-on-Tees Local Safeguarding Children Board Annual Reports 2015-2016

Purpose Approval ☐ Discussion ☐ Information ☒

Responsible CCG Member / Lead

Jean Golightly, Director of Nursing and Quality

Author of Report Trina Holcroft, Designated Nurse Safeguarding Children and Looked After Children

Recommendation(s) The Governing Body is asked to note the contents of the report.

Executive Summary

A summary report is provided of the two local safeguarding children board annual reports for Hartlepool and Stockton-on-Tees. The summary shares information of the work undertaken by both safeguarding children boards in the reporting period 2015-2016 STOCKTON LSCB ANNUAL REPORT 2015-2016 HARTLEPOOL LSCB ANNUAL REPORT 2015-2016

Clinical Engagement

N/A

Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

Has an Equality Analysis been completed?

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Attachments

Darlington CCG strategic objectives supported by this report

Domain Tick Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☒

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the CCG,

enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☐ 3. Delivery of financial balance including the 1% surplus and delivery of value

for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with partners,

including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☐ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☐ Other Committees/Meetings where this report has been presented Please

specify 260 of 570

Does this need to be reported to another Committee/Meeting? Please specify

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Summary of Hartlepool Safeguarding Children Board (HSCB) Annual Report 2015/2016

Introduction:

The board evaluates the effectiveness of services being provided to children and families by the authority of the board of which Hartlepool and Stockton-on-Tees CCG are members. The board looks at how partners are fulfilling their statutory obligations to safeguard children; quality assures practice and measures effectiveness of training. Where required the board commissions serious case reviews and disseminates learning from these reviews and other learning activities. On an annual basis the board will identify priorities for action for the forthcoming year to support children to grow up in an environment in which they are safe from harm.

Work undertaken in the reporting year:

• New ways of working to support thematic meetings based on priorities such as child sexual exploitation and neglect

• The development of a Tees performance management framework to produce a common data set across the Tees area, to identify what works, highlight areas of concern, consider themes and trends and improve outcomes for children

• Continued focus on tackling children missing from home and child sexual exploitation through the Vulnerable Exploited Missing and Trafficked strategic and practitioner groups-this has included the roll out of the Tees wide “In the wrong hands campaign”

• Continued work to address domestic abuse including the delivery of programmes in primary and secondary education settings on promoting healthy and respectful relationships

• Operation Encompass, a process where schools are informed of domestic abuse incidents where police have been called prior to the child starting their school day to allow school staff to offer support to the child

• Further exploration of root causes of child neglect undertaken by IMPower consultants (primarily domestic abuse, substance misuse and loss/bereavement)

• Piloting of the graded care profile 2, a tool to support the assessment of families where neglect is a feature

• Implementation of the Signs of Safety model in child protection work which uses a strength based approach

• Recognition of the need for parental mental health to link with domestic abuse and substance misuse sub group as it is a it is a significant factor in child neglect

• Focus on early help and the better child programme which has resulted in integrated locality teams

• Joint training programme delivered across Hartlepool and Stockton-on-Tees

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• The launch of the Stockton and Hartlepool Children’s hub (based in Hartlepool) which is a multi-agency team combining police, children’s social care and health to enable efficient and effective decision making to safeguard children

• Implementation of a Teeswide rapid response process to respond to unexpected deaths of children

• HSCB commissioned serious case reviews and a serious adult review following the murder of a vulnerable adult by two teenage girls

Involving young people:

• Children in care council supported the development of a new HSCB website • Focus group held involving primary school children presenting questions to the

HSCB business manager in the national Children’s commissioner take over challenge annual event

• Young inspectors designed safeguarding posters which are displayed in places across Hartlepool

• The youth council prepared a presentation for a successful child sexual exploitation conference in April 2016

• Young people have attended the board and scrutinised statutory section 11 audits which demonstrate how agencies are discharging their safeguarding responsibilities effectively

Board priorities:

• Increasing assessment and referral of early help • Addressing neglect through root causes:

domestic abuse, substance misuse parental mental health

• Child sexual exploitation and children who are vulnerable, exploited, missing and trafficked

Future Challenges:

• Increasing the assessment and referral for early help to promote the welfare of children and prevent them suffering harm and becoming a looked after child

• Tackling the significant factors which impact upon children particularly root causes of neglect such as domestic abuse, substance misuse, parental mental health

• To ensure learning from each sub group informs one another to allow for the wide dissemination of information to all practitioners to embed change

• Implementing and evidencing the Learning from the Serious case reviews which are due to be published later this year

Author: Trina Holcroft, Designated Nurse Safeguarding Children and Looked After Children

27th January 2017

HARTLEPOOL LSCB ANNUAL REPORT 2015-2016

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Summary of Stockton-on-Tees Safeguarding Children Board (SLSCB) Annual Report 2015/2016

Introduction:

The board evaluates the effectiveness of services being provided to children and families by the authority of the board of which Hartlepool and Stockton-on-Tees CCG are members. The board looks at how partners are fulfilling their statutory obligations to safeguard children; quality assures practice and measures effectiveness of training. Where required the board commissions serious case reviews and disseminates learning from these reviews and other learning activities. On an annual basis the board will identify priorities for action for the forthcoming year to support children to grow up in an environment in which they are safe from harm. Stockton board has adopted a structure of ensuring cooperation and co-ordination between agencies, effective challenge and scrutiny of policies and procedures and enabling change to improve outcomes.

The independent chair of SLSCB resigned in March 2016 and a new chair was appointed and commenced his role in April 2016.

Work undertaken in the reporting year:

• Improved engagement with schools to promote a robust representation from primary, secondary and independent sectors

• A continual review of data performance and how this informs future work • Contribution to the development of a Teeswide performance management framework

to produce a common data set across the Tees area, to identify what works, highlight areas of concern, consider themes and trends and improve outcomes for children

• The delivery of a joint (Stockton-on-Tees and Hartlepool) multi-agency training programme

• Explored ways of developing service interventions at the earliest opportunity with the successful bid to become an earlier adopter site for the graded care profile 2, a tool to support the assessment of families where neglect is a feature

• Operation encompass launched to improve the response of domestic abuse. Schools are informed of domestic abuse incidents where police have been called prior to the child starting their school day to allow school staff to offer support to the child

• Ensure proactive response to children identified as at risk of child sexual exploitation with the development of Vulnerable, Exploited, Missing and Trafficked (VEMT) pathways which includes return interviews for children who go missing

• Strengthening effective challenge through scrutiny of reports, learning reviews, audit and assurance reports and performance data

• The launch of the Stockton and Hartlepool Children’s hub (based in Hartlepool) which is a multi-agency team combining police, children’s social care and health to enable efficient and effective decision making to safeguard children

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• During 2015/16 seven cases were subject to consideration and review by the learning and improving practice sub group, none of which met the criteria for a serious case review and learning reviews were undertaken

• Implementation of the Signs of Safety model in child protection work which uses a strength based approach

• Focus on a new early help strategy, challenging partners in the take up of assessments

• Emotional well-being questionnaire in schools as part of the Child and Adolescent Mental Health Service (CAMHS) transformation plans

• External consultants commissioned to review child protection and looked after children plans and decision making

• ‘Chelsea’s choice’, a powerful drama was rolled out to secondary schools raising awareness of child sexual exploitation

Voice of the child:

• Partners led a project to audit the quality of approaches to capture the voice of the child, identify good practice and develop better ways of collecting, using and sharing information

• An annual review for the voice of the child was endorsed • Agreed the development of a multi-agency toolkit and portal • Support the greater use of IT to capture views of children

Board priorities:

• Preventing harm by tackling the root causes of neglect, focusing on domestic abuse, drug and alcohol misuse and parental mental health

• Protecting vulnerable children, reducing the number of children and young people who are vulnerable, exploited, missing and trafficked (VEMT) or are at risk of being VEMT

For each priority the boards’ role will be based on one of oversight and assurance, ensuring coordination, effective challenge and enabling change. The key elements to this approach will be:

Ensuring the voice of the child is continually embedded across all activity and agencies

Reviewing approaches to information sharing The learning and review framework will strengthen links between reviews,

performance data and training Review of the governance arrangements to address the national review,

(Woods review), structures of sub groups and the option to introduce an executive structure

Author: Trina Holcroft, Designated Nurse Safeguarding Children and Looked After Children

27th January 2017

STOCKTON LSCB ANNUAL REPORT 2015-2016

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 4.1.1

7th February 2017

Title Darlington CCG Constitution

Purpose Approval ☒ Discussion ☐ Information ☐

Responsible CCG Member / Lead

Ali Wilson, Chief Officer

Author of Report Andrew Carter, Governance and Risk Manager Recommendation(s) The Governing Body is requested to APPROVE the revised

Constitution.

Executive Summary

There are a number of minor corrections, however the key changes surround the alterations to the CCG governance structure and the strengthening of the registering and declaring interests part of the constitution. A summary of the changes is included at Appendix 1.

Clinical Engagement Via Executive Team Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

The Constitution is the CCG’s key Governance document

Has an Equality Analysis been completed?

Not Applicable

Attachments Summary of Changes to the constitution – Darlington CCG Darlington CCG Constitution v 192.4

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Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☒

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☒

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☒

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☒

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☒

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the

CCG, enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☐

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☐

3. Delivery of financial balance including the 1% surplus and delivery of value for money savings to enable the CCG to reinvest to deliver our strategic plans.

☐ 4. Identify commissioning opportunities, working in collaboration with

partners, including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☐

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☐ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☐ 7. Delivery of the CCG’s delegated functions including joint commissioning of

primary care and GPIT, whilst exploring and preparing for further opportunities

☐ Other Committees/Meetings where this report has been presented Executive Does this need to be reported to another Committee/Meeting? None

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Summary of Amendments to NHS Darlington CCG’s Constitution (as incorporated, marked as version 192.4)

Page/Paragraph Reference Description of amendment Reason for amendment 1. All Minor typographical and grammatical changes To ensure consistency 2. All NHS Commissioning Board references removed

and replaced with NHS England. As recommended by NHS England

3. All Change from referencing ‘the Group’ to ‘the CCG’ To ensure consistency 4. Page 2 Inclusion of document history section To ensure version control of the constitution. 5. Contents Amended to accurately reflect page numbering of

sections Changes to sections within the constitution have been made and contents has been amended to reflect these changes

6. Foreword, Pages 9-10 Updated of foreword to more accurately reflect CCG

To ensure the foreword reflects the changes in the CCG

7. Page 11 Addition of paragraph regarding make-up of the CCG

For transparency

8. Page 12 Insertion of sentence confirming that a copy of the constitution is available at the CCG’s headquarters

To ensure clarity on availability of the constitution

9. Page 13 Removal of sentence referencing membership at authorisation as this was 4 years ago

Sentence no longer relevant

10 Pages 20, 26, 31, 39, 41, 71, 76 Amendment from Governance, Audit and Risk Committee to Audit and Risk Committee.

Governance, Audit and Risk Committee have been replaced by Audit and Risk Committee

11. Pages 22, 24, 31, 39, 44, 75 Amendment from Quality and Innovation Committee to Quality, Performance and Finance Committee

Quality and Innovation Committee has been renamed Quality, Performance and Finance Committee

12. Pages 23, 25, 48 Amendment from Executive Committee to Executive

Executive Committee has been renamed to Executive

13. Pages 26, 46 Amendment of Better Health Programme Joint Committee to Sustainability and Transformation Plan Joint Committee

Better Health Programme has become a programme included within the overall arrangements for the Sustainability and Transformation Plan

14. Page 28 Insertion of new governance organogram To reflect the new governance arrangements 15. Page 30 Removal of reference to members assembly as

this is not a Committee of the CCG and right to establish committees is established elsewhere in the constitution

Sentence no longer relevant

16. Page 31, 39 Amendment of Better Health Programme Joint Committee to Sustainability and Transformation Plan Joint Committee

Better Health Programme has become a programme included within the overall arrangements for the Sustainability and Transformation Plan and

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membership has changed to include NHS Hambleton, Richmondshire and Whitby CCG and remove North Durham CCG.

17. Page 38. Clarification that Accountable Officer is known as Chief Officer

To ensure clarity

18. Page 39. Removal of Executive Team and Community Council from being committees of Governing Body

To reflect the new governance arrangements

19. Page 39 Removal of sentence regarding Governance, audit and risk committee including individuals who are not members of the Governing Body

To comply with the CCG regulations

20. Page 39 Removal of sentence regarding Community Council

To be included in their terms of reference

21 Page 40 Alteration to functions of Remuneration Committee

Remit should be include in their terms of reference not the constitution

22. Page 41 Alteration to functions of Audit and Risk Committee

Remit should be include in their terms of reference not the constitution

23. Page 44 Alterations to functions of Quality, Performance and Finance Committee

Remit should be include in their terms of reference not the constitution

24. Page 45 Removal of Finance Committee Incorporated into new Quality, Performance and Finance Committee

25. Page 55 to 59 Updated information regarding declaring and registering interests

CCG required to comply with statutory guidance regarding conflicts of interest

26. Appendix A – Definitions of Key Descriptions Used in this Constitution

Amendments to terms used to reflect updates to constitution

To ensure clarity

27. Appendix D, Scheme of Reservation and Delegation

Alterations on delegation of duties Scheme updated to reflect amendments made elsewhere in the constitution

28. Appendix E - Prime Financial Policies

Update to policies to include sections on security management, Remuneration and Terms of Service, Disposals and Condemnations, Losses and Special payments, payments to contractors

To ensure consistency

29. Appendix H – Checklist for a Clinical Commissioning Group’s Constitution

Appendix removed No longer relevant

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NHS DARLINGTON CLINICAL COMMISSIONING GROUP

CONSTITUTION

Version: 192.43

NHS EnglandCommissioning Board

Effective Date:01.04.176

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[Page left intentionally blank] Version Date Significant Changes

192.3 31/03/2013 Approved April 2016 version

192.4 01/04/2017 Revised constitution to incorporate minor changes to governance arrangements and scheme of delegation

Formatted Table

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CONTENTS

FOREWORD 9

1. INTRODUCTION AND COMMENCEMENT ...................................................................................... 11 1.1. Name ................................................................................................................................................ 11 1.2. Statutory Framework ............................................................................................................................ 11 1.3. Status of this Constitution .................................................................................................................... 12 1.4. Amendment and Variation of this Constitution .................................................................................. 12 2. AREA COVERED .................................................................................................................................. 13

3. MEMBERSHIP ....................................................................................................................................... 13

3.1. Membership of the Clinical Commissioning Group .......................................................................... 13 3.2. Eligibility ................................................................................................................................................ 13 3.3. Practice Representatives ..................................................................................................................... 13 3.4 Admission of New Members ................................................................................................................ 14 3.5 Election to Offices within the Group ................................................................................................... 14 3.6 Dispute Resolution ................................................................................................................................ 14 3.7 Terminating membership ..................................................................................................................... 15 4. MISSION, VALUES AND AIMS........................................................................................................... 16

4.1. Principles of Good Governance .......................................................................................................... 16 4.2. Accountability ......................................................................................................................................... 16 5. FUNCTIONS AND GENERAL DUTIES ............................................................................................. 18

5.1. Functions ................................................................................................................................................ 18 5.2. General Duties - in discharging its functions the CCG will: ............................................................ 19 6. DECISION MAKING: THE GOVERNING STRUCTURE ................................................................ 28

6.1. Authority to act ....................................................................................................................................... 28

6.2. Scheme of Reservation and Delegation40 ........................................................................................ 29 6.3. General ................................................................................................................................................ 29 6.4. Committees of the CCGGroup ............................................................................................................ 30 6.5 The Members Assembly....................................................................................................................... 31 6.6 Joint Arrangements ............................................................................................................................... 32 6.7 Joint commissioning arrangements with other Clinical Commissioning Groups .................. 32 6.8 Joint commissioning arrangements with NHS England for the exercise of CCG functions ....... 33 6.9 Joint commissioning arrangements with NHS England for the exercise of NHS England’s

functions ................................................................................................................................................ 35 6.10 The Governing Body ............................................................................................................................. 36 6.11 Primary Care Commissioning Committee ......................................................................................... 40 6.12 Remuneration and Terms of Service Committee ............................................................................. 40 6.13 Audit and Risk Committee ................................................................................................................... 41 6.14 Quality, Performance and Finance Committee ................................................................................. 44 6.15 Joint Committee of Clinical Commissioning Groups Sustainability and Transformation plans

(STP) 46 6.16 Transparency ......................................................................................................................................... 46 7 ROLES AND RESPONSIBILITIES ..................................................................................................... 48

7.1 Member Representatives ..................................................................................................................... 48

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7.2 Other GP and Primary Care Health Professionals ........................................................................... 49 7.3 All Members of the Group’s Governing Body.................................................................................... 49 7.4 The Chair of the Governing Body ....................................................................................................... 49 7.5 The Vice Chair of the Governing Body .............................................................................................. 51 7.6 Role of the Accountable Officer .......................................................................................................... 51 7.7 Role of the Chief Finance Officer ........................................................................................................ 52 7.8 Role of the Registered Nurse .............................................................................................................. 53 7.9 Role of the Secondary Care Doctor ................................................................................................... 53 7.10 Role of the 3 Lay Persons .................................................................................................................... 54 7.11 Joint Appointments with other Organisations .................................................................................... 54 8 APPOINTMENTS ................................................................................................................................. 54

9 STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST ..... 55

9.1 Standards of Business Conduct .......................................................................................................... 55 9.2 Conflicts of Interest ............................................................................................................................... 55 9.4 Managing Conflicts of Interest: general ............................................................................................. 60 9.5 Managing Conflicts of Interest: contractors and people who provide services to the Group..... 62 9.6 Transparency in Procuring Services .................................................................................................. 62 10 THE CCGAS AN EMPLOYER ............................................................................................................ 63

11 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS ....................................... 64

11.1 General ................................................................................................................................................ 64 11.2 Standing Orders .................................................................................................................................... 64 APPENDIX A 65

DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION .......................................... 65

APPENDIX B - LIST OF MEMBER PRACTICES ....................................................................................... 67

APPENDIX C – STANDING ORDERS ......................................................................................................... 68

1. STATUTORY FRAMEWORK AND STATUS .................................................................................... 68 2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KEY ROLES

AND APPOINTMENT PROCESS ....................................................................................................... 70 2.1. Members Assembly .................................................................................................................. 70

2.2. Composition of membership ................................................................................................... 70

2.3. Key Roles ................................................................................................................................... 70

3.1 Appointments ............................................................................................................................. 70

3.2 Removal from Office of an Elected Individual ...................................................................... 75

3.3 Removal from Office of an Appointed Individual .................................................................. 75

4. MEETINGS OF THE GOVERNING BODY ....................................................................................... 75 4.1 Role of the Governing Body .................................................................................................... 75

4.2 Calling meetings ........................................................................................................................ 76

4.3. Petitions 76

4.4. Chair of a meeting .................................................................................................................... 76

4.5. Chair's ruling .............................................................................................................................. 76

4.6. Decision Making ........................................................................................................................ 76

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4.7. Quorum 77

4.8. Emergency powers and urgent decisions ............................................................................. 78

4.9. Suspension of Standing Orders.............................................................................................. 78

4.10 Record of Attendance .............................................................................................................. 78

4.11. Admission of public and the press ......................................................................................... 78

4.12 General Disturbances .............................................................................................................. 79

4.13. Observers at CCG meetings ................................................................................................... 80

5. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES .................................................... 80 5.1. Appointment of committees and sub-committees ................................................................ 80

5.2. Terms of Reference .................................................................................................................. 80

5.3. Delegation of Powers by Committees to Sub-committees ................................................. 80

5.4. Approval of Appointments to Committees and Sub-Committees ...................................... 80

6. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES ............................................................................................................................................... 82

7. USE OF SEAL AND AUTHORISATION OF DOCUMENTS ........................................................... 82 7.1. Clinical Commissioning Group’s seal .................................................................................... 82

7.2. Execution of a document by signature .................................................................................. 82

8. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS .............................................................................................. 82

8.1. Policy statements: general principles .................................................................................... 82

APPENDIX D – SCHEME OF RESERVATION & DELEGATION ............................................................ 83

APPENDIX E – PRIME FINANCIAL POLICIES .......................................................................................... 81

1. INTRODUCTION ................................................................................................................................... 81 1.1. General 81

1.2. Overriding Prime Financial Policies ....................................................................................... 81

1.3. Responsibilities and delegation .............................................................................................. 82

1.4. Contractors and their employees ........................................................................................... 82

1.5. Amendment of Prime Financial Policies ................................................................................ 82

2. INTERNAL CONTROL ......................................................................................................................... 82 3. AUDIT 83 4. FRAUD AND CORRUPTION............................................................................................................... 83 5. EXPENDITURE CONTROL ................................................................................................................. 84

6. ALLOTMENTS54 .................................................................................................................................. 85

7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND MONITORING . 86 8. ANNUAL ACCOUNTS AND REPORTS ............................................................................................ 87 9. INFORMATION TECHNOLOGY ......................................................................................................... 87 10. ACCOUNTING SYSTEMS ................................................................................................................... 88 11. BANK ACCOUNTS ............................................................................................................................... 88 12. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER

NEGOTIABLE INSTRUMENTS. ......................................................................................................... 88

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13. TENDERING AND CONTRACTING PROCEDURE ........................................................................ 89 13.1. Duty to comply with SOs and Prime Financial Policies (PFPs) ......................................... 89

13.2. Legislation Governing Public Procurement ........................................................................... 89

13.3. Guidance on Procurement and Commissioning .................................................................. 90

13.4. OGC Gateway Review and Guidance ................................................................................... 90

13.5. Decisions to Tender and Exceptions to Requirement to Tender....................................... 90

13.6. Use of Framework Agreements .............................................................................................. 94

13.7. Tendering Procedure ............................................................................................................... 94

13.9. Evaluation of Tenders and Quotations .................................................................................. 99

13.10. Award of Contracts ................................................................................................................. 100

13.11. Form of Contract ..................................................................................................................... 101

14. COMMISSIONING .............................................................................................................................. 102 15. RISK MANAGEMENT AND INSURANCE ....................................................................................... 103 16. PAYROLL ............................................................................................................................................. 103 17. NON-PAY EXPENDITURE ................................................................................................................ 104 18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS .......... 105 19. RETENTION OF RECORDS ............................................................................................................. 105 APPENDIX F – THE NOLAN PRINCIPLES .............................................................................................. 109

APPENDIX G – NHS CONSTITUTION ...................................................................................................... 110

FOREWORD .................................................................................................................................................. 5

1. INTRODUCTION AND COMMENCEMENT ................................................................................................... 7 1.1. Name ........................................................................................................................................ 7 1.2. Statutory Framework ............................................................................................................... 7 1.3. Status of this Constitution........................................................................................................ 8 1.4. Amendment and Variation of this Constitution ....................................................................... 8 2. AREA COVERED .......................................................................................................................................... 9

3. MEMBERSHIP ............................................................................................................................................. 9

3.1. Membership of the Clinical Commissioning Group ................................................................. 9 3.2. Eligibility ................................................................................................................................... 9 3.3. Practice Representatives .......................................................................................................... 9 3.4 Admission of New Members .................................................................................................. 10 3.5 Election to Offices within the Group ...................................................................................... 10 3.6 Dispute Resolution ................................................................................................................. 10 3.7 Terminating membership....................................................................................................... 11 4. MISSION, VALUES AND AIMS ................................................................................................................... 12

4.1. Principles of Good Governance.............................................................................................. 12 4.2. Accountability ........................................................................................................................ 12 4.3 Aims ........................................................................................................................................ 13 5. FUNCTIONS AND GENERAL DUTIES .......................................................................................................... 14

5.1. Functions ................................................................................................................................ 14 5.2. General Duties - in discharging its functions the Group will: ................................................ 15 6. DECISION MAKING: THE GOVERNING STRUCTURE .................................................................................. 23

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6.1. Authority to act ...................................................................................................................... 23 6.2. Scheme of Reservation and Delegation ................................................................................. 24 6.3. General ................................................................................................................................... 24 6.4. Committees of the Group ...................................................................................................... 25 6.5 The Members Assembly ......................................................................................................... 26 6.6 Joint Arrangements ................................................................................................................ 27 6.7 Joint commissioning arrangements with other Clinical Commissioning ............................... 27 Groups. ................................................................................................................................... 27 6.8 Joint commissioning arrangements with NHS England for the exercise ..................................

of CCG functions..................................................................................................................... 28 6.9 Joint commissioning arrangements with NHS England for the exercise ..................................

of NHS England’s functions .................................................................................................... 30 6.10 The Governing Body ............................................................................................................... 31 6.11 Primary Care Commissioning Committee ............................................................................... 35 6.12 Remuneration and Terms of Service Committee ................................................................... 35 6.13 Governance, Audit and Risk Committee ................................................................................ 36 6.14 Quality, Performance and Innovation Committee ................................................................. 38 6.15 Finance Committee ................................................................................................................ 39 6.16 Better Health Programme Joint Committee ......................................................................... 40 6.17 Transparency .......................................................................................................................... 40

7 ROLES AND RESPONSIBILITIES.................................................................................................................. 41

7.1 Member Representatives ...................................................................................................... 41 7.2 Other GP and Primary Care Health Professionals .................................................................. 42 7.3 All Members of the Group’s Governing Body ........................................................................ 42 7.4 The Chair of the Governing Body ........................................................................................... 42 7.5 The Vice Chair of the Governing Body ................................................................................... 43 7.6 Role of the Accountable Officer ............................................................................................. 43 7.7 Role of the Chief Finance Officer ........................................................................................... 44 7.8 Role of the Registered Nurse ................................................................................................. 45 7.9 Role of the Secondary Care Doctor ........................................................................................ 45 7.10 Role of the 3 Lay Persons ....................................................................................................... 46 7.11 Joint Appointments with other Organisations ....................................................................... 46 8 APPOINTMENTS ....................................................................................................................................... 46

9 STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST .................................. 47

9.1 Standards of Business Conduct .............................................................................................. 47 9.2 Conflicts of Interest ................................................................................................................ 47 9.3 Declaring and Registering Interests ....................................................................................... 48 9.4 Managing Conflicts of Interest: general ................................................................................. 49 9.5 Managing Conflicts of Interest: contractors and people who provide services to the .............

Group ..................................................................................................................................... 51 9.6 Transparency in Procuring Services ....................................................................................... 51 10 THE GROUP AS EMPLOYER ....................................................................................................................... 52

11 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS ............................................................. 53

11.1 General ................................................................................................................................... 53 11.2 Standing Orders ..................................................................................................................... 53

APPENDIX A: DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION ............................................ 54

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APPENDIX B - LIST OF MEMBER PRACTICES ....................................................................................................... 56

APPENDIX C – STANDING ORDERS ..................................................................................................................... 57

APPENDIX D – SCHEME OF RESERVATION & DELEGATION ................................................................................ 70

APPENDIX E – PRIME FINANCIAL POLICIES ......................................................................................................... 81

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FOREWORD

Who we are

NHS Darlington Clinical Commissioning Group (CCG) was established in October 2011 in shadow form as part of changes to the NHS outlined in the white paper ‘Equity and Excellence: Liberating the NHS’ (DH, July 2010) and then formally in April 2013 in response to the Health and Social Care Act 2012. This legislation has provided a unique opportunity for front line clinicians to lead the commissioning and design of local services to meet the needs of local people.

NHS Darlington Clinical Commissioning Group (CCG) is made up of 11 GP member practices and represents a population of just over 100,000 people (ONS, 2012). The area covered by the CCG is predominately urban centered on the town of Darlington and is coterminous with Darlington Borough Council (DBC). Despite the compact nature of the area there are some marked differences in health between the various wards of the Borough.

Our new clinical commissioning organisation will builds upon initial experience as a practice based commissioning (PBC) group and then a pathfinder consortium and GP led commissioning group. The CCG’s clear purpose is to increase the health and well-being of people in Darlington. As a member organisation the CCG has responsibility for commissioning health and healthcare services for Darlington. This document outlines the CCG’s governance model and decision making processes at strategic level and, at a high level, the broad vision and principles of the CCG

What we are trying to change and why

As clinicians working with patients and providers of health care services every day, we feel that we have a real insight to what changes could be made to improve the health and experiences of our patients.

We have also accessed data from public health, service performance and financial experts to build up a picture of the challenges and opportunities that face us as a commissioning organisation:

We know that Darlington has an increasing and an ageing population which will bring an increased demand on healthcare from cancers, cardiovascular disease, stroke, dementia and long term conditions such as diabetes and chronic obstructive pulmonary disease (COPD). Cardiovascular disease and cancers already account for the majority of early deaths in Darlington. We need to do more to improve the overall quality of care and reduce clinical variation in health care in order to optimise health outcomes and overall patient experience for everyone.

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We know there are many more services now delivered in the community and closer to home for patients. We know however this shift needs to be accelerated through transformational change underpinned by redesign of pathways of care to give best outcomes from the resources available to us. Our plans now and in the future need to be built up from and reflect the contributions of all within the local health and social care communities, stimulating clinical engagement and improving quality within the finance available resources.

How we are going to change services To be an effective commissioning organisation for the people of Darlington, our CCG must develop and deliver ambitious, but practical plans to implement its strategies, developed with stakeholders and owned by its member practices and partner organisations.

We will work closely with our current hospital and community services whereby clinicians from a range of professions and a variety of settings are able to collectively shape services locally to best reflect our patients’ needs.

Equally importantly we will build a true partnership with Darlington Borough Council to support one another in tackling the common challenges that can only be solved, or outcomes optimised, by adopting a joined up approach across the health and social care pathway. This together with the coming together of organisations in the Darlington Partnership and its vision for Darlington expressed within “One Darlington Perfectly Placed” offers an early opportunity for our CCG to sit alongside our partners to share a common vision and influence an approach that defines health and well-being in its widest sense, taking into account the wider determinants of health.

We will also work in partnership with the two neighbouring clinical commissioning groups in North Durham and Durham Dales, Easington and Sedgefield when whole health economy working will help deliver our aims and make best use of available resources and effectively manage levels of risk.

The next five years will be both challenging and exciting, but we are committed to making a difference to the people of Darlington and we look forward to updating you with our progress in the future.

Andrea Jones Martin Phillips

Chair Chief Officer NHS Darlington CCG NHS Darlington CCG

Formatted: English (U.K.)

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1. INTRODUCTION AND COMMENCEMENT 1.1. Name

The name of this clinical commissioning group is NHS Darlington Clinical Commissioning Group (‘the Group’). (also referred to as the CCG)

1.2. Statutory Framework 1.2.1. Clinical commissioning groups are established under the Health and Social Care

Act 2012 (“the 2012 Act”).1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (“the 2006 Act”).2 The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision.3

1.2.2. The NHS Commissioning Board, also known as NHS England (and hereafter in

this document) for operational purposes is responsible for determining applications from prospective groups to be established as clinical commissioning groups4 and undertakes an annual assessment of each established group.5 It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.6

1.2.3. Clinical commissioning groups are clinically led membership organisations made up of providers of primary medical services, known as Member practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.7

1 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of clinical commissioning Groups to commission certain health services are set out in section 3

of the 2006 Act, as amended by section 13 of the 2012 Act 4 See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act 5 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 6 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 7 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012

Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued

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1.3. Status of this Constitution 1.3.1. This constitution is made between the members of the CCGGroup and has effect

from first day of April 2013, when NHS Commissioning Board (referred to as NHS England for the remainder of this document) established the Group.8 then subject to variations. The constitution is published on the CCGGroup’s website at www.darlingtonccg.nhs.uk or a copy is made available on request from the CCGs headquarters, Dr Piper House, King Street, Darlington, DL3 6J.

1.3.2. This constitution makes a commitment for the member practices of the CCG to

engage with the Local Medical Committee (LMC), as local statutory representatives of the profession, as appropriate.

1.4. Amendment and Variation of this Constitution 1.4.1. This constitution can only be varied in two circumstances.9

a) where the CCGGroup applies to NHS EnglandCommissioning Board and that application is granted; b) where in the circumstances set out in legislation NHS EnglandCommissioning Board varies the Group’s constitution other than on application by the CCG Group.

8 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act 9 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations

issued

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2. AREA COVERED

a) The geographical area covered by the Group is predominantly urban, centred on the town of Darlington and is coterminous with Darlington Borough Council (DBC). Despite the compact nature of the area there are some marked differences in health between the various wards of the Borough.

3. MEMBERSHIP 3.1. Membership of the Clinical Commissioning Group 3.1.1. The membership is membership at authorisation and reflects revisions made as

part of the constitution variation process. A schedule of member practices that comprise NHS Darlington Clinical Commissioning Group may be found at Appendix B. The C C G Group has consulted with the member practices about this constitution.

3.2. Eligibility 3.2.1. Practice Pproviders of primary medical services to a registered list of

patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of this Group10. Practices must be within the Group’s geographical area or must have a significant majority of its registered patients living within the Group’s geographical area.

3.3. Practice Representatives 3.3.1. Each Member shall nominate a Practice Representative and shall notify the

Governing Body of the name of its Practice Representative in writing. Each Member may remove and replace its Practice Representative at any time and from time to time, by notice in writing to the Governing Body.

3.3.2 Each Practice Representative shall represent the Member that has appointed it at

meetings of the Members Assembly.

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3.4 Admission of New Members 3.4.1 Requests to join the CCGGroup must be put in writing to the CCG Chair and

will be approved by the Members Assembly. 3.4.2 In the event of practices merging, there will be a requirement for the new practice

to nominate a representative. Any previous members representing their individual practices would be required to stand down as representatives.

Following authorisation of NHS Darlington Clinical Commissioning Group, successful applications to become a Member of the Group will be confirmed by letter from the Chair and documented by an addendum to this Constitution which must be signed by the new Member’s practice representative to confirm the Member’s acceptance to abide by this Constitution. Copies of all addenda to this Constitution must be available to the public in the same manner as this Constitution

3.5 Election to Offices within the Group 3.5.1 Individuals will be eligible for election if they meet the following criteria:

a) they work in Darlington as a GP principal or salaried GP; b) applicants will need to have a connection with and have the written

endorsement of at least one member practice, i.e. one Darlington GP practice, to apply to become a representative;

c) an individual shall not be eligible if they are, or subsequently are, retired from the practice or primary care services provider, suspended by either the GMC NHS England or any other successor body;

d) if the individual is a Sessional GP, he shall not be eligible in the event that he is suspended from his employment or subject to grievance or disciplinary proceedings; and

e) for those individuals (including those stated at (d) above) who are not party to direct contractual arrangements for the provision of primary medical services, they must be on a Performers List.

3.6 Dispute Resolution 3.6.1 Member Practices and the Group will endeavour to address disputes locally

where at all possible. In the event of a member practice wishing to further escalate a dispute, the process will be as follows:

a) The member practice to meet with the deputy lead clinician, whom, if

appropriate, may refer the matter to the executive; b) Referring the matter to the chair of the Governing Body; and finally c) Referring the matter to NHS EnglandCommissioning Board for further action.

Comment [CA1]: Who is this?

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3.6.2 If a member practice or those acting on behalf of a member practice fail to comply with the terms of the constitution, the Standing Orders or the terms of their delegated responsibility, or who act inconsistently with the strategic plans of the CCGGroup (as set out in the Clear and Credible Plan), the CCGGroup will be forced to take action in the interests of the CCGGroup as a whole. Every effort will be made by all concerned to avoid this by dealing with issues locally before escalation as follows:

a) First, where appropriate requiring the member practice representative or

person involved to meet with the deputy lead clinician; b) Referring the matter to the chair of the Governing Body; and finally c) Referring the matter to NHS EnglandCommissioning Board for further action.

The Group will involve the Local Medical Committee (LMC) at all stages in the event of such matters arising.

3.7 Terminating membership 3.7.1 Membership of the Group will not be terminated whilst member practices meet the

eligibility criteria set out in section 3.2.1. 3.7.2 A member practice ceases to be a member of the Group where the practice no

longer satisfies the eligibility criteria. 3.7.3 A member practice shall give written notice to the NHS Commissioning

BoardEngland and the Group Governing Body as soon as practicable in the event of any circumstances which may give rise to termination of membership, together with a formal request that this membership is terminated. Membership cannot be terminated by either NHS Darlington CCG or the Member Practice

10 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012. Regulations to be made

Formatted: Highlight

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4. MISSION, VALUES AND AIMS

The CCGGroup has developed a clear vision for its role as a commissioning organisation, with well-defined values and aims. Details of the vision, values and aims can be found in the CCGGroup’s Clear and Credible Plan.

The MISSION of the CCGGroup is

Working together to improve the health and well-being of Darlington

4.1. Principles of Good Governance 4.1.1. In accordance with section 14L (2) (b) of the 2006 Act,11 the Group CCG will

at all times observe “such generally accepted principles of good governance” in the way it conducts its business. These include:

a) the highest standards of propriety involving impartiality, integrity and

objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business;

b) The Good Governance Standard for Public Services;12

c) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’13

d) the seven key principles of the NHS Constitution;14

e) the Equality Act 2010.15

4.2. Accountability 4.2.1. The CCGGroup will demonstrate its accountability to its members, local

people, stakeholders and NHS EnglandCommissioning BoardNHS England in a number of ways, including by:

a) publishing its constitution; b) appointing independent lay members and non GP clinicians to its

Governing Body; c) holding meetings of its Governing Body in public (except where the Group

considers that it would not be in the public interest in relation to all or part of a meeting);

d) publishing annually a commissioning plan; e) complying with local authority health overview and scrutiny requirements;

11 Inserted by section 25 of the 2012 Act 12 The Good Governance Standard for Public Services, The Independent Commission on Good

Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004

13 See Appendix F 14 See Appendix G 15 See http://www.legislation.gov.uk/ukpga/2010/15/contents

Comment [CA2]: Still correct?

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f) meeting annually in public to publish and present its annual report (which must be published);

g) producing annual accounts in respect of each financial year which must be externally audited;

h) having a published and clear complaints process; i) complying with the Freedom of Information Act 2000; j) providing information to NHS Commissioning BoardNHS England as required.

4.2.2. In addition to these statutory requirements, the CCGGroup will demonstrate its

accountability by:

a) publishing organisational policies b) publishing its communication and engagement strategy c) disseminating appropriate information to its Members and to its local

population on a regular basis, b) holding engagement events to present and discuss service commissioning

proposals with the public as appropriate, and c) having on-going engagement with stakeholders.

4.2.3. The Governing Body of the CCGGroup will throughout each year have an on-

going role in reviewing the CCGGroup’s governance arrangements to ensure that the CCGGroup continues to reflect the principles of good governance.

4.3 Aims 4.3.1. The CCGGroup’s overall aim is to ensure that they do more to improve the overall

quality of care and reduce clinical variation in health care in order to optimise health outcomes and overall patient experience for the Darlington population. The group has a number of strategic aims:

a) to improve population health; b) to improve the care provided and the healthcare experience of individuals; and c) to consider and include any further strategic aims of the CCGGroup

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5. FUNCTIONS AND GENERAL DUTIES 5.1. Functions 5.1.1. The functions that the Group CCG is responsible for exercising are largely set

out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health’s Functions of Clinical Commissioning Groups: a working document. They relate to:

a) commissioning certain health services (where NHS EnglandCommissioning

Board is not under a duty to do so) that meet the reasonable needs of:

i) all people registered with member GP practices, and ii) people who are usually resident within the area and are not registered

with a member of any clinical commissioning group;

b) commissioning emergency care for anyone present in the Group’s CCG’s area; c) paying its employees’ remuneration, fees and allowances in accordance

with the determinations made by its Governing Body and determining any other terms and conditions of service of the CCGGroup’s employees;

d) determining the remuneration and travelling or other allowances of members of its Governing Body.

5.1.2. In discharging its functions the CCGGroup will:

a) act16, when exercising its functions to commission health services,

consistently with the discharge by the Secretary of State and NHS Commissioning Board of their duty to promote a comprehensive health service17 and with the objectives and requirements placed on NHS England through the mandate18 published by the Secretary of State before the start of each financial year by:

i) delegating responsibility to the CCGGroup’s Governing Body as per

Scheme of Delegation and Reservation. ii) ensuring that this duty is discharged on behalf of the Governing Body

by the CCGGroup’s executive committee in accordance with their Terms of Reference

b) meet its public sector equality duty19 by; i) embedding the Equality Act 2010 into its day to day workings.

ii) using the Equality Delivery System, developing an annual equality, diversity and human rights strategy describing how the CCG will deliver duties both specific and general in line with the Equality Act 2010

iii) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

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c) work in partnership with its local authority[ies] to develop a single needs assessment [joint strategic needs assessment]20 (SNA) and an area wide strategy [joint health and wellbeing strategy]21 (AWS) by: being pro-active members of the Darlington Health and Wellbeing Board, pro-actively supporting and contributing towards the development of the over-arching Health and wellbeing Strategy and SNA, ensuring that the strategic plans and commissioning intentions of the Group take account of both the Health and Wellbeing strategy and the information contained in the SNA, pro- actively contributing towards the development and implementation of a range of joint strategies for children and young people, older people, people with a learning disability, carers and people with mental health problems

5.2. General Duties - in discharging its functions the CCGGroup will:

5.2.1. Make arrangements to secure public involvement in the planning, development

and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements22 by:

a) Ensuring that patients and the public are consulted with and involved in

accordance with the relevant legislation. This will include publishing a strategy for communications and engagement.

b) The following Statement of Principles will be adopted: • Create an organisational culture that encourages and enables

involvement • Be inclusive and proactive in resolving barriers to effective

involvement and participation • Make clear the purpose of involvement and the extent to which people

can expect their views to influence development of local health services

• Recognise the importance of providing feedback to people who have made their views known

• Work in partnership with other agencies to avoid duplication where possible when approaching the public

• Build upon best practice and be open to innovative and proven approaches from within and out with the NHS

• Provide support and training to staff to equip them for this role

16 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act 17 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 18 See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act 19 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of

the 2012 Act

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c) In delivering the Statement of Principle the CCGGroup will: • Work in partnership with patients and the local community to secure

the best care for them • Adapt engagement activities to meet the specific needs of the different

patient groups and communities • Publish information about health services on the CCGGroup’s website

and through other media • Encourage and act on feedback • Identify how the Group will monitor and report its compliance against

this statement of principles • Secure the required capacity and capability through its officers and

otherwise assured third parties. d) the C C G Group will exercise this function by delegating responsibility to the

CCGGroup’s Governing Body

e) by ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

5.2.2. Promote awareness of, and act with a view to securing that health services are

provided in a way that promotes awareness of, and have regard to the NHS Constitution23 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) the CCGGroup’s values reflecting the values set out in the NHS Constitution c) all policies having regard to the NHS Constitution in their development d) ensuring that all decisions made by the Governing Body are assessed for

regard to the NHS Constitution e) promoting the NHS Constitution on the CCGroup’s website and internally

with all staff f) incorporating compliance with the NHS Constitution in all contracts with

commissioned services. 5.2.3. Act effectively, efficiently and economically24 by:

a) delegating responsibility to the CCGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer in accordance with the responsibilities of the role c) delegating responsibility to the Governing Body’s Governance, Audit and

Risk Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

d) delegating responsibility to the executive committee to assist in optimising the allocation and adequacy of the Group’s resources in accordance with its terms of reference

e) requiring progress of delivery of the duty to be monitored through the Group’s reporting mechanisms

20 See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by

section 192 of the 2012 Act 21 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by

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section 191 of the 2012 Act 22 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act

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5.2.4. Act with a view to securing continuous improvement to the quality of services25

by:

a) delegating responsibility to the Group’s CCG’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) delegating responsibility to the Governing Body’s Quality, P e r f o r m a n c e a n d F i n a n c e and Innovation Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

d) having a strategy which will set the framework for securing continuous improvements in the quality of commissioned services and outcomes for patients with regard to clinical effectiveness, safety and patient experience to contribute to improved patient outcomes across the NHS Outcomes Framework

e) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting

mechanisms f) working with Darlington Borough Council and other appropriate bodies, on

Safeguarding (Local Safeguarding Children’s Board and Safeguarding Adults Board)

5.2.5. Assist and support NHS England Commissioning Board in relation to the

Board’s duty to improve the quality of primary medical services26 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) having processes in place with the CCGGroup’s members to secure improvements in the quality of primary care with regard to clinical effectiveness, safety and patient experience in GP practices contributing to improved patient outcomes across the NHS Outcomes Framework

d) requiring progress of delivery of the duty to be monitored through the CCG Group’s reporting

mechanisms

23 See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health

Act 2009 (as amended by 2012 Act) 24 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 25 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act

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5.2.6. Have regard to the need to reduce inequalities27 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the CCGGroup’s executive committee in accordance with their Terms of Reference

c) developing an annual commissioning plan in accordance with the requirement of the Health and Social Care Act 2012 which sets out the CCGGroup’s role and plans in relation to reducing health inequalities

d) working with partners on the Health and Wellbeing Board, and through the Darlington Partnership Arrangements, to contribute to addressing the wider determinants of health and to contribute to implementing the Health and Wellbeing Strategy in relation to commissioning of health services

e) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting

mechanisms

5.2.7. Promote the involvement of patients, their carers and representatives in decisions about their healthcare28 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) ensuring that standards are contained within contracts with commissioned services requiring procedures to be in place in commissioned services to ensure patients, their carers and representatives are able to make informed decisions about their healthcare

d) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

5.2.8. Act with a view to enabling patients to make choices29 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) embodying the requirements of patient choice d) requiring progress of delivery of the duty to be monitored through the

CCGGroup’s reporting mechanisms

26 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 27 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act 28 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act 29 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act

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5.2.9. Obtain appropriate advice30 from persons who, taken together, have a broad range of professional expertise in healthcare and public health by:

a) delegating responsibility to the Governing Body to ensure that it obtains

appropriate advice in the exercise of its functions, either through individual members of the governing body, or where appropriate through invitation to individuals to attend as appropriate to provide advice on its functions, or by seeking advice through external bodies such as a Clinical Senate or other expert or independent organisation

b) delegating responsibility within their Terms of Reference to the Chair of each Committee or sub-committee to ensure that they obtain appropriate advice in the exercise of its functions, either through individual members of the Committee or sub-committee, through invitation to individuals to attend as appropriate to provide advice or by seeking advice through external bodies such as a Clinical Senate or other expert or independent organisation

5.2.10. Promote innovation31 by:

a) delegating responsibility to the Group’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) seeking out and adopting best practice, by supporting research and adopting and diffusing transformative, innovative ideas, products, services and clinical practice both within the Group and within its commissioned services, which add value in relation to quality and productivity.

d) sharing and spreading best practice from within member practices. 5.2.11. Promote research and the use of research32 by:

a) delegating responsibility to the Group’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) delegating responsibility to the Governing Body’s Quality, Performance and Finance and Innovation Committee to assist the Governing Body in regard to oversight of research governance and in accordance with the Group’s Terms of Reference

d) collaborating with key stakeholders such as Clinical Research Networks and academic institutions and commissioning where appropriate independent research and evaluation as a means of evaluating care pathways, evidence based practice and the translation of research evidence into clinical practice

e) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

------------------------ 30 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act 31 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act 32 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act

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5.2.12. Have regard to the need to promote education and training33 for persons who are employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty34 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) encouraging and supporting the continuous learning and development of its employees so that they are able to carry out their role confidently and effectively, achieve their individual potential and contribute fully to the objectives of the Group

d) engaging with strategic workforce development issues including the horizon scanning of NHS workforce capacity and capability

e) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

5.2.13. Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where the CCGGroup considers that this would improve the quality of services or reduce inequalities35 by:

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the CCGGroup’s executive committee in accordance with their Terms of Reference

c) developing an annual commissioning plan in accordance with the requirement of 14Z11 of the 2006 Act, as amended by the 2012 Act, and the duty to promote integration is set out at Section 14Z1 of the 2006 Act and which sets out the CCGGroup’s role and plans in relation to promoting integration

d) working in partnership with key partners e.g. the local authority and other commissioning providers to take forward plans so that pathways of care are seamless and integrated within and across organisations

e) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

33 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act 34 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act 35 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act

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5.3. General Financial Duties – the Group CCG will perform its functions so as to: 5.3.1. Ensure its expenditure does not exceed the aggregate of its allotments for the

financial year36 by

a) delegating responsibility to the CCGGroup’s Governing Body b) developing an annual commissioning plan (which incorporates the financial

plan) in accordance with the requirement of the Health and Social Care Act 2012

c) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Finance Officer in accordance with the responsibilities of the role

d) specifying Prime Financial Policies ( Appendix E) and detailed underpinning financial policies

e) delegating responsibility to the Governing Body’s Governance, Audit and Risk Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference delegating responsibility to the executive committee to assist in optimising the allocation and adequacy of the CCGGroup’s resources in accordance with its Terms of reference

f) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

5.3.2. Ensure its use of resources (both its capital resource use and revenue resource

use) does not exceed the amount specified by NHS Commissioning BoardEngland for the financial year37 by: a) delegating responsibility to the CCGGroup’s Governing Body b) developing an annual commissioning plan (which incorporates the financial

plan) in accordance with the requirement of the Health and Social Care Act 2012

c) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Finance Officer in accordance with the responsibilities of the role

d) specifying Prime Financial Policies (at Appendix E) and detailed underpinning financial policies

e) delegating responsibility to the Governing Body’s Governance,Audit and Risk Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference delegating responsibility to the executive committee to assist in optimising the allocation and adequacy of the CCGGroup’s resources in accordance with its Terms of reference

f) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

36 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act 37 See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act

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5.3.3. Take account of any directions issued by NHS EnglandCommissioning Board, in respect of specified types of resource used in a financial year, to ensure the Group does not exceed an amount specified by NHS EnglandCommissioning Board 38 by

a) delegating responsibility to the CCGGroup’s Governing Body b) developing an annual commissioning plan (which incorporates the financial

plan) in accordance with the requirement of the Health and Social Care Act 2012

c) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Finance Officer in accordance with the responsibilities of the role

d) delegating responsibility to the executive committee to assist in optimising the allocation and adequacy of the CCGGroup’s resources in accordance with its terms of reference

e) requiring progress of delivery of the duty to be monitored through the CCGGroup’s reporting mechanisms

5.3.4. Publish an explanation of how the CCGGroup spent any payment in respect of

quality made to it by NHS England Commissioning Board39 by

a) delegating responsibility to the CCGGroup’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by

the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) the explanation to be published on the CCG Group’s website at www.darlingtonccg.nhs.uk, available upon request for inspection at the CCGGroup’s headquarters, or upon application by post at Darlington Clinical Commissioning Group, Dr Piper House, King Street, Darlington, DL3 6JL or by e-mail at DARCCG.contact@nhs.net

5.4. Other Relevant Regulations, Directions and Documents

5.4.1. The CCGGroup will:

a) comply with all law and relevant regulations; b) comply with directions issued by the Secretary of State for Health or the

NHS EnglandCommissioning Board ; and c) take account, as appropriate, of documents issued by the NHS EnglandCommissioning Board.

5.4.2. The CCGGroup will develop and implement the necessary systems and

processes to comply with these regulations and directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant Group policies and procedures.

5.4.3. The CCGGroup will engage with County Durham and Darlington Local Medical

Committee as the local statutory representative for the medical profession as appropriate

38 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act

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39 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act

6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to act 6.1.1. The C C G Group is accountable for exercising its statutory functions. It

may grant authority to act on its behalf to:

a) any of its members; b) its Governing Body; c) its employees; d) a committee or sub-committee of the CCGGroup.

6.1.2 The C C G Group has established governance arrangements that embed

clinical leadership with patient involvement and effective management. These are set out briefly below:

STP JC

Governing Bodies Meeting In-Common

Remuneration Committee

Audit and Risk

Committee

Quality, Performance and

Finance Committee

Primary Care Commissioning

Committee

Members Assembly

South IFR Panel

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6.1.3 The extent of the authority to act of the respective bodies and individuals depends on the powers delegated to them by the CCGGroup as expressed through:

a) the CCGGroup’s scheme of reservation and delegation; and b) For committees, their terms of reference.

6.2. Scheme of Reservation and Delegation40

6.2.1. The CCGGroup’s scheme of reservation and delegation sets out:

a) those decisions that are reserved for the membership; b) those decisions that are the responsibilities of its Governing Body (and its

committees), the Group’s committees and sub-committees, individual members and employees.

6.2.2. The clinical commissioning group remains accountable for all of its functions,

including those that it has delegated. 6.3. General 6.3.1. In discharging functions of the CCGGroup that have been delegated to its Governing

Body (and its committees), committees, sub-committees and individuals must:

a) comply with the CCGGroup’s principles of good governance,41

b) operate in accordance with the CCGGroup’s scheme of reservation and delegation,42

c) comply with the CCGGroup’s standing orders and prime financial policies,43

d) comply with the CCGGroup’s arrangements for discharging its statutory duties,44

e) where appropriate, ensure that member practices have had the opportunity to contribute to the CCGGroup’s decision making process.

6.3.2. When discharging their delegated functions, committees and sub-committees

must also operate in accordance with their approved terms of reference. 6.3.3. Any:

• member of the CCGGroup’s Governing Body; • any employee of the CCGGroup; • any member of a committee of the CCGGroup; • any member of a committee of the CCGGroup’s Governing Body; and • any other individual acting under the direction of the CCGGroup or its

40 See Appendix D 41 See section 4.4 on Principles of Good Governance above 42 See Appendix D 43 See Appendix C 44 See chapter 5 above

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Governing Body, in the furtherance of their respective functions; who has acted honestly and in good faith shall not have to meet out of his or her own personal resources any costs arising from any personal civil liability that he/she incurs in the execution (or purported execution) of his or her functions, save where he or she has acted recklessly.

For the purposes of this indemnity, the term “committee” shall also include any sub-committee appointed by a committee in accordance with the powers delegated to it.

6.3.4. The Group CCG recognises and confirms that nothing in or referred to

in this constitution (including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the group, any of its governing body, any member of any of its committees or sub-committees or the committees or sub-committees of its governing body, or any employee of the group or of any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act.

6.3.5. Where delegated responsibilities are being discharged collaboratively, the joint

(collaborative) arrangements must:`

a) identify the roles and responsibilities of those clinical commissioning

groups who are working together; b) identify any pooled budgets and how these will be managed and reported

in annual accounts; c) specify under which clinical commissioning group’s scheme of

reservation and delegation and supporting policies the collaborative working arrangements will operate;

d) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties;

e) identify how disputes will be resolved and the steps required to terminate the working arrangements;

f) specify how decisions are communicated to the collaborative partners. 6.4. Committees of the CCGGroup 6.4.1 The Governing Body of the Group shall on its establishment: a) appoint a committee called the Members Assembly; b) may, on or after its establishment appoint such other committees as it considers appropriate.

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6.4.2 The following committees have been established by the Governing Body:

• Primary Care Commissioning Committee (accountable to the Governing Body)

• Remuneration and Terms of Service Committee (accountable to the Governing Body)

• Governance,A audit and Risk Committee (accountable to the Governing Body)

• Quality, Performance and FinanceInnovation Committee (accountable to the Governing Body)

• Finance Committee (accountable to the Governing Body) • Sustainability and Transformation Plan Joint Committee (accountable to the

Governing Body) • Better Health Programme Joint Committee (accountable to the Governing

Body) 6.4.3 Committees will only be able to establish their own sub-committees, to assist

them in discharging their respective responsibilities, if this responsibility has been delegated to them by the Governing Body or the committee they are accountable to.

6.4.4 A committee of the Governing Body may consist of or include persons other than

Members or employees of the GroupCCG. 6.4.5 An individual shall be ineligible for appointment to or shall otherwise

be disqualified from membership of a committee or subcommittee of the Governing Body if he or she is a person who is disqualified from membership of a clinical commissioning group’s Governing Body under Schedule 5 of the CCG Regulations.

6.4.6 All decisions taken in good faith at a meeting of any committee of the Governing

Body shall be valid even if there is any vacancy in its membership or it is discovered subsequently that there was a defect in the calling of the meeting or the appointment of any of the members of the committee attending the meeting.

6.5 The Members Assembly

a) The Members Assembly shall be comprised of the Practice Representatives as voting members.

b) The Members Assembly shall regulate its proceedings in accordance with the Standing Orders. The Members Assembly shall be responsible for the determination of its scope of responsibilities.

c) The following members of the Governing Body will attend, but shall not have a vote at the Members Assembly: i) Accountable Officer ii) Chair of the Governing Body iii) Registered Nurse iv) Chief Finance Officer

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6.6 Joint Arrangements 6.6.1 The Group CCG may from time to time enter into joint arrangements with other

clinical commissioning groups and local authorities: a) To determine commissioning for health gain policies and shared risk

arrangements. b) Joint arrangements for advice upon high cost care and treatments.

6.6.2 The Group will have the power to enter into joint committees as appropriate with:

a) Darlington Borough Council.

6.7 Joint commissioning arrangements with other Clinical Commissioning Groups. 6.7.1 The clinical commissioning group may wish to work together with other

CCGs in the exercise of its commissioning functions. 6.7.2 The CCGGroup may make arrangements with one or more CCGs in respect of:

[i] delegating any of the CCGGroup’s commissioning functions to another CCG; [ii] exercising any of the commissioning functions of another CCG; or

[iii] exercising jointly the commissioning functions of the CCGGroup and another CCG

6.7.3 For the purposes of the arrangements described at paragraph [6.7.2], the

CCGGroup may: [i] make payments to another CCG; [ii] receive payments from another CCG; [iii] make the services of its employees or any other resource available to

another CCG; or [iv] receive the services of the employees or the resources available to

another CCG 6.7.4. Where the CCGGroup makes arrangements which involve all the CCGs

exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions.

6.7.5 For the purposes of the arrangements described at paragraph [6.7.2] above,

the CCG Groupmay establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 6.7.2 iii above. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

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6.7.6 Where the CCGGroup makes arrangements with another CCG as described at paragraph [6.7.2] above, the CCGGroup shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning

functions; The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a

pooled fund and management of that fund; • Contributions from the parties, including details around assets,

employees and equipment to be used under the joint working arrangements.

6.7.7 The liability of the CCGGroup to carry out its functions will not be affected

where the Group enters into arrangements pursuant to paragraph [6.7.2] above.

6.7.8 The CCGGroup will act in accordance with any further guidance issued

by the NHS EnglandCommissioning Board on co-commissioning. 6.7.9 Only arrangements that are safe and in the interests of patients registered

with member practices will be approved by the governing body. 6.7.10 The governing body of the CCGGroup shall require, in all joint commissioning

arrangements, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.7.11 Should a joint commissioning arrangement prove to be unsatisfactory the

governing body of the CCGGroup can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year.

6.8 Joint commissioning arrangements with NHS EnglandCommissioning Board for the exercise of CCG functions

6.8.1 The CCGGroup may wish to work together with NHS Commissioning

BoardEngland in the exercise of its commissioning functions.

6.8.2 The CCGGroup and NHS England Commissioning Board may make arrangements to exercise any of the Group’s commissioning functions jointly.

6.8.3 The arrangements referred to in paragraph [6.8.2] above may include other CCGs.

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6.8.4 Where joint commissioning arrangements pursuant to [6.8.2] above are entered into, the parties may establish a joint committee to exercise the commissioning functions in question.

6.8.5 Arrangements made pursuant to [6.8.2] above may be on such terms and

conditions (including terms as to payment) as may be agreed between NHS EnglandCommissioning Board and the CCG Group.

6.8.6 Where the CCGGroup makes arrangements with NHS

EnglandCommissioning Board (and another CCG if relevant) as described at paragraph [6.8.2] above, the CCG Group shall develop and agree with NHS EnglandCommissioning Board a framework setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning

functions • The duties and responsibilities of the parties • How risk will be managed and apportioned between the parties • Financial arrangements, including, if applicable, payments towards a

pooled fund and management of that fund • Contributions from the parties, including details around assets,

employees and equipment to be used under the joint working arrangements

6.8.7 The liability of the CCG Group to carry out its functions will not be affected where the CCG

Group enters into arrangements pursuant to paragraph [6.8.2] above. 6.8.8 The CCGGroup will act in accordance with any further guidance issued

by NHS EnglandCommissioning Board on co-commissioning. 6.8.9 Only arrangements that are safe and in the interests of patients registered

with member practices will be approved by the governing body. 6.8.10 The governing body of the CCG Group shall require, in all joint

commissioning arrangements that the Chief Officer of the Group make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.8.11 Should a joint commissioning arrangement prove to be unsatisfactory the

governing body of the CCGGroup can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

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6.9 Joint commissioning arrangements with NHS EnglandCommissioning Board for the exercise of NHS EnglandCommissioning Board’s functions

6.9.1 The CCGGroup may wish to work with NHS EnglandCommissioning Board and, where applicable, other CCGs, to exercise specified NHS EnglandCommissioning Board functions.

6.9.2 The CCG Group may enter into arrangements with NHS

EnglandCommissioning Board and, where applicable, other CCGs to: Exercise such functions as specified by NHS

EnglandCommissioning Board under delegated arrangements; Jointly exercise such functions as specified with NHS

EnglandCommissioning Board. 6.9.3 Where arrangements are made for the CCG Group and, where applicable,

other CCGs to exercise functions jointly with NHS EnglandCommissioning Board a joint committee may be established to exercise the functions in question.

6.9.4 Arrangements made between NHS EnglandCommissioning Board and the

CCG Group may be on such terms and conditions (including terms as to payment) as may be agreed between the parties.

6.9.5 For the purposes of the arrangements described at paragraph [6.9.2] above,

NHS EnglandCommissioning Board and the CCG Group may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.9.6 Where the CCG Group enters into arrangements with NHS

EnglandCommissioning Board as described at paragraph [6.9.2] above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning

functions; The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties;

Financial arrangements, including payments towards a pooled fund and management of that fund;

Contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

6.9.7 The liability of NHS EnglandCommissioning Board to carry out its functions

will not be affected where it and the CCG Group enter into arrangements pursuant to paragraph [6.9.2] above.

6.9.8 The CCG Group will act in accordance with any further guidance issued

by NHS EnglandCommissioning Board on co-commissioning.

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6.9.9 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the governing body.

` 6.9.10 The governing body of the CCGGroup shall require, in all joint

commissioning arrangements that the Chief Officer of the CCGGroup make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.9.11 Should a joint commissioning arrangement prove to be unsatisfactory the

governing body of the CCGGroup can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

6.10 The Governing Body 6.10.1 Functions - the Governing Body has the following functions conferred on it

by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this constitution.45 The Governing Body also has functions of the CCGGroup delegated to it by the CCGGroup. The Governing Body’s responsibilities include:

a) ensuring that the CCGgroup has appropriate arrangements in place to

exercise its functions effectively, efficiently and economically and in accordance with the CCG Groups’ principles of good governance (its main function);

b) determining the remuneration, fees and other allowances payable to

employees or other persons providing services to the CCG Group and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;

c) approving any functions of the CCG Group that are specified in regulations;46

d) Promoting the involvement of all Members in the work of the CCG Group in

securing improvements in commissioning of care and services and developing the Mission, Values and ASims of the CCG Group in consultation with Members

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e) Reviewing and monitoring the arrangements for working in partnership with

the local authority to develop joint strategic needs assessments and joint health and well-being strategies and monitoring the delivery of the CCG Group’s responsibilities within such strategies;

f) Approving and publishing the CCG Groups’ public engagement strategy and

annual public involvement report; g) Ensuring effective arrangements are in place to secure health services in

such a way as promotes awareness of, and has regard to the NHS Constitution;

h) Assisting NHS England in its duty to improve the quality of primary medical

services by continuously increasing the capability, competence and capacity of primary care, and the proportion of health and social care provided by primary and community services;

i) Ensuring effective plans are in place to reduce inequalities across the

borough; j) Promoting the involvement of patients, their carers and representatives in

decisions about their healthcare; k) Ensuring effective systems to enable patients to make choices are in place

across its member practices and commissioned providers; l) Ensuring the CCG Group in its decision making obtains a advice from a

wide-range of professionals and stakeholders; m) Approving the organisational development plan including the principles by

which it will procure commissioning support; n) Exercising any other functions of the CCG Group which are not otherwise

reserved or delegated.

6.10.2 The Governing Body will provide the Group CCG with assurance that the

duties and responsibilities of the CCG Group are being discharged within the limit of the law, good practice and sound governance. The roles and responsibilities of Governing Body are set out at paragraph 6.9.3 and those of individual members at paragraph 7.

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6.10.3 The Governing Body has delegated the following functions to the executive: • Effective operational management of the CCG Group • Undertaking CCG Group commissioning activities • Delivering the financial plan • Implementation and delivery of strategic decisions • Development and delivery of the CCG Group’s plans

6.10.4 Composition of the Governing Body - Members of the Governing Body will be appointed by the CCG Group. These will comprise:

a) One clinical chair, b) Two clinical representatives of Members one of which will assume lead

responsibility for Clinical Quality, c) Three lay members:

One to lead on audit, risk and governance (Deputy Chair); One to lead on patient and public participation matters; One to lead on Finance, Quality and Innovation, Productivity and Prevention (QIPP)

d) One registered nurse, e) One secondary care doctor; f) A Cheifn accountable OofficerChief Officer; g) A chief finance officer;

In addition the following key partners will be invited to attend the Governing Body:

a) Director of Public Health b) Director with responsibility for Health and Social Care Services within

Darlington Borough Council

A representative of each of the following groups may attend meetings of the Governing Body:

a) the practice nurses group and b) the practice managers group

The Governing Body may invite other individuals to attend meetings of the Governing Body as it sees fit.

The Chair and representatives of members on the Governing Body will be nominated by the Members Assembly.

The appointment of the Ch ie f o f f ice r as Accountable Officer will be confirmed by NHS Commissioning BoardEngland following completion of the requisite assessment process.

45 See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act 46 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act

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6.10.5 Committees of the Governing Body - the Governing Body may appoint the following committees and sub-committees:

a) Clinical Leadership Group b) Governance, Audit and Risk Committee c) Remuneration and Terms of Service Committee d) Quality, Performance and Innovation Committee Finance Committee e) Finance Committee f) Executive Team g) Community Council of Patients Public and Carers h) Primary Care Commissioning Committee

a) i) Better Health Programme Joint Committee Sustainability and Transformation Plan Joint Committee

6.10.6 The full terms of reference for each of these committees can be found at the

following link to the Group’s website. Terms of Reference of CCG Committees

6.10.7 The Governing Body may appoint such other committees as it considers

appropriate but committees will only be able to establish their own sub- committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the Governing Body. Such Committee or sub-committee shall be made up of either members of the governing body, any consultants and/or employees, or any others approved by the Governing Body.

The Governance, Audit and Risk Committee may include individuals who are not members of the Governing Body.

6.10.8 Members of the Community Council of Patients, Public and Carers will be local

people registered with member practices. An individual shall be ineligible for appointment to or shall otherwise be disqualified from membership of a committee or subcommittee of the Governing Body if is he or she is a person who is disqualified from membership of a clinical commissioning group’s Governing Body under Schedule 5 of the CCG Regulations.

6.10.9 All decisions taken in good faith at a meeting of any committee or sub-committee

of the Governing Body shall be valid even if there is any vacancy in its membership or it is discovered subsequently that there was a defect in the calling of the meeting or the appointment of any of the members attending the meeting. Decisions taken at a meeting where a procedural flaw is identified can be ratified by a subsequent meeting of the committee/sub-committee in question.

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6.11 Primary Care Commissioning Committee 6.11.1 Accountable to the CCG’s Governing Body, the role of the Committee shall be to

carry out the functions relating to the commissioning of primary medical services. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS Darlington CCG. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act. 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. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions.

6.11.2 The full Terms of Reference for this committee are to be found at the following

link to the Group’s website. Terms of Reference of CCG Committees

6.12 Remuneration and Terms of Service 48Committee 6.12.1 the Remuneration Committee, which is accountable to the CCG’s Governing Body makes

recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The role of the Remuneration and Terms of Service Committee is to make recommendations to the governing body on pay and remuneration of senior employees of the Group and people who provide services to the Group and allowances under any pension scheme it might establish as an alternative to the NHS Pension scheme.

6.12.2 The remit will include the following functions: (i) Determining remuneration, fees, pensions, allowances payable to

employees providing services to the Group and conditions of service of senior employees

(ii) Reviewing the performance of the accountable officer and the senior team members and determining annual salary awards if appropriate.

(iii) Considering severance payments of the accountable officer or other senior staff, seeking HM Treasury approval as appropriate

(iv) Applying best practice in decision making processes including complying with current disclosure requirements, seeking independent advice and ensuring decisions are based upon clear and transparent criteria

(v) Observing the highest standards of propriety involving impartiality, integrity and objectivity in relation to the stewardship of public funds and management of the bodies concerned

(vi) Maximising value for money through ensuring services are delivered in the most efficient and economical way, within available resources and with independent validation of performance achieved wherever practicable

(vii) Commissioning any reports or surveys deemed necessary to hep it fulfil the remit above.

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6.12.3 The full Terms of Reference for this committee are to be found at the following

link to the Group’s website. Terms of Reference of CCG Committees 6.13 Governance, Audit and Risk Committee 6.13.1 The Audit and Risk Committee, which is accountable to the CCG’s Governing Body,

provides the Governing Body with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and directions governing the CCG including the risk management and assurance framework process. The Governing Body has approved and keeps under review the terms of reference for the audit and risk committee, which includes information on the membership of the audit and risk committee.The role of the Governance, Audit and Risk committee is to ensure the Group has appropriate arrangements in place to assure that the Group exercises its functions effectively, efficiently and economically and adheres to relevant principles of good governance, specifically that it has good systems and processes across all of its functions and statutory responsibilities.

6.13.2 The remit will include the following functions: (i) Reviewing the establishment and maintenance of an effective system of integrated

governance, risk management and internal control, across the whole of the Group’s activities that support its objectives

(ii) Providing the Governing Body with an independent and objective view of the Group’s financial systems, financial information and compliance with laws, regulations and directions in so far as they relate to finance.

(iii) Ability to review any decision where a GP or anyone else with a declared interest has agreed to continue to be involved in consequent discussion and potentially the decision

(iv) Dovetailing its work with that of the Quality and innovation Committee seeking assurance that robust clinical quality is in place to ensure safeguarding and mandatory training requirements are met

(v) Particularly reviewing the adequacy and effectiveness of: - All risk and control related disclosure statements (in particular the governance statement),

together with any appropriate independent assurances, prior to endorsement by the clinical commissioning group.

- The underlying assurance processes that indicate the degree of achievement of clinical commissioning group objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

- The policies for ensuring compliance with relevant regulatory, legal and code of

conduct requirements and related reporting and self-certification. - The policies and procedures for all work related to fraud and corruption as set

out in Secretary of State Directions and as required by the NHS Protect. (vi) In carrying out this work the governance, audit and risk committee will primarily utilise

the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from chief officers and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control,

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together with indicators of their effectiveness. (vii) This will be evidenced through the governance, audit and risk committee’s use of an

effective assurance framework to guide its work and that of the audit and assurance functions that report to it.

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(viii) Ensuring there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the committee, accountable officer and the Group. (ix) Reviewing the work and findings of the external auditors and consider the

implications and management’s responses to their work. (x) Reviewing the findings of other significant assurance functions, both

internal and external and consider the implications for the governance of the clinical commissioning group.

(xi) Seeking assurances and undertake more detailed scrutiny of the implementation of the programmes associated with delivery of Quality, Innovation, Productivity and Prevention (QIPP).

(xii) Satisfy itself that adequate arrangements are in place for countering fraud reviewing the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

(xiii) Requesting and reviewing reports and positive assurances from chief officers and managers on the overall arrangements for governance, risk management and internal control.

(xiv) Monitoring the integrity of the financial statements of the Group and any formal announcements relating to the Group’s financial performance

(xv) Ensuring systems for financial reporting to the Group, including those of budgetary control, are subject to review on completeness and accuracy of the information provided to the Group.

(xvi) Reviewing the annual report and financial statements before submission to the governing body and the Group

(xvii) Seeking assurance on all the activities of officers given the Caldicott Guardian Role, data protection, confidentiality, security, information quality, records management and Freedom of Information (FOI) responsibilities.

(xviii) Receiving information about and review incidents and breaches in relation to patient information (Caldicott Incidents) number received, number reviewed and number resolved and improvements plans developed

6.13.3 The full Terms of Reference for this committee are to be found at the

following link to the Group’s website. Terms of Reference of CCG Committees

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6.14 Quality, Performance and FinanceInnovation Committee 6.14.1 the Quality, Performance and Finance Committee, which is accountable to the

CCG’s Governing Body will ensure that the services the CCG commissions are able to demonstrate that they have in place an assurance framework which will satisfy compliance with the essential principles of quality and adults and children’s safeguarding. The Committee will also provide assurance on financial governance areas, and assurance that there are robust structures, processes and accountabilities in place for managing internal and external performance. The Governing Body has approved and keeps under review the terms of reference for the Quality, Performance and Finance Committee, which includes information on the membership of the Committee.

The Quality, Performance and Innovation Committee is accountable to the Group’s Governing Body. The Governing Body has approved and keeps under review the terms of reference for the Quality and Performance Committee, which includes information on the membership of the committee.

6.14.2 The quality, performance and innovation committee are driven by an

ambition of excellence in clinical quality, clinical effectiveness and patient experience, and the priorities for the Group to improve health outcomes and all associated risks or areas of quality improvement. It will lead innovation and embed best practice principles in commissioned services, always acting with a view to securing continuous improvements in the quality of care and services. The Committee will innovate and oversee research to deliver heath gain, improved patient safety and a better experience for patients.

6.14.3 The remit will include the following functions: Develop and oversee delivery of the Groups Quality Strategy that secures the Groups ambition for

excellence and improved outcomes for patients and benchmarking local against best practice.

ii) Seek assurance that the commissioning plans for the Group fully reflect all elements of quality (patient experience, effectiveness and patient safety), keeping in mind that those plans and response may need to adapt and change and ensure robust monitoring of performance of commissioned services and clinical governance and best practice in commissioned providers

Provide assurance that commissioned services are being delivered in a high quality and safe manner, ensuring that quality sits at the heart of everything the Group does and the five domains of quality set out in the Outcomes Framework. This extends to include jointly commissioned services.

iv) Oversee and be assured that effective management of risk in in place to manage clinical and other performance concerns and address clinical governance and performance issues. This will include assuring that effective arrangements are in place with other bodies to ensure the appropriate deployment of ‘soft’ intelligence to inform commissioning and otherwise protect patients

v) Have oversight of the process and compliance issues concerning serious incidents requiring investigation (SIRIs); being informed of all Never Events and informing the governing body of any escalation of sensitive issues in good time.

vi) Seek assurance on the performance of NHS organisations in terms of the Care Quality

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Commission, Monitor and any other relevant regulatory bodies. vii) Receive and scrutinise independent investigation reports relating to patient safety issues

and agree publication plans. viii) Ensure that patient information is used appropriately and safely through robust

information governance systems overseen by the senior information responsible officer and Caldicott Guardian.

ix) Ensure a clear escalation process including appropriate trigger points, is in place to enable appropriate engagement of external bodies on areas of concern.

x) Ensure that the Group programme of research and innovation is safely governed and aligned to the Groups priorities.

xi) Ensure the delivery of national and local targets as outlined in the national operating framework or Group delivery plan

xii) Recommend actions to the Executive associated with the non-delivery of national or local targets at Group level, focussing upon key national priorities which are now the responsibility of the Group

6.14.4 The full Terms of Reference for this committee are to be found at the

following link to the Group’s website.Terms of Reference of CCG Committees

6.15 Finance Committee 6.15.1 The Finance Committee will support the Group to deliver its statutory

financial duties of achieving financial balance, delivery of the Groups Clear and Credible Plan and annual Delivery Plan, including QIPP financial targets and financial performance objectives.

6.15.2 The remit will include the following functions:

i) Support the Executive in the effective monitoring of data at Group

and practice level in relation to contracted activity and devolved budgets.

ii) Identify variance to agreed contracted levels which impact upon financial performance and/or the delivery of access targets and to agree and recommend actions to the Executive to address variance to contracted levels of activity as identified above

iii) Support the Practice Variation work programme and monitor the impact of agreed actions at practice and Group level

iv) Ensure the delivery of national and local financial targets as outlined in the national operating framework or Group delivery plan

v) Recommend actions to the Executive associated with the non-delivery of national or local financial targets at Group level, focussing upon key national priorities which are now the responsibility of the Group

vi) Support the Executive in the effective planning and management of the annual planning and contracting cycle to ensure effective engagement at practice and CCG level

vii) Support the Executive in horizon scanning by the use of data and information to enable proactive commissioning which is person centred and evidence based

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viii) Facilitate the identification, monitoring and delivery of Quality, Innovation, Prevention and Productivity schemes to enable the Group to generate resource to invest in new initiatives

ix) Establish time limited task and finish groups to address non delivery of financial targets agreed at practice or Group level in agreement with the Executive

x) Oversee and be assured that effective management of risk in in place to manage financial concerns and address financial governance issues

6.15.3 The full Terms of Reference for this committee are to be found at the

following link to the Group’s website. Terms of Reference of CCG Committees

6.16 Joint Committee of Clinical Commissioning Groups Sustainability and Transformation plans (STP)

The Joint Committee is a joint committee of, NHS Darlington CCG , NHS Durham Dales, Easington and Sedgefield CCG, , NHS Hambleton, Richmondshire and Whitby CCG, NHS Hartlepool and Stockton-on-Tees CCG and NHS South Tees CCG. The primary purpose of the Joint Committee is to arrange the formal consultation and undertake the decisions on the issues which are the subject of the consultation in relation to the Better Health Programme.Better Health Programme Joint Committee

6.16.1 The Joint Committee is a joint committee of NHS North Durham CCG, NHS Durham Dales, Easington and Sedgefield CCG, NHS Darlington CCG, NHS Hartlepool and Stockton-on-Tees CCG and NHS South Tees CCG. The primary purpose of the Joint Committee is to arrange the formal consultation and undertake the decisions on the issues which are the subject of the consultation in relation to the Better Health Programme.

6.16.2 The full Terms of Reference for this committee are to be found at the following link to the Group’s website. Terms of Reference of CCG Committees

6.17 Transparency 6.17.1 In accordance with the National Health Service (Clinical Commissioning

Groups-Responsibilities) Regulations 2012, Regulation 16, the C C G Group will make the following arrangements to ensure transparency:

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a) publish papers considered at its meetings except where the governing body

considers that it would not be in the public interest to do so in relation to a particular paper or part of a paper

b) publish the following information relating to determinations made under subsection (3)(a) and (b) of section 14L of the 2006 Act (which relates to remuneration, fees and allowances payable under certain pension schemes)

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i) in relation to each senior employee of the CCGGroup, any determination of the employee’s salary (which need only specify a band of £5,000 into which the salary falls), or of any travelling and other allowances payable to the employee, including any allowances payable under a pension scheme established under paragraph 11(4) of Schedule 1A to the 2006 Act;

ii) any recommendation of the remuneration committee in relation to any such determination

c) in the event that the governing body consider that it would not be in the public

interest to publish such information, it will not publish the above information. 7 ROLES AND RESPONSIBILITIES 7.1 Member Representatives

Member representatives represent their appointing practice on the Members Assembly. The role of each member representative is to: a) Take a lead role in ensuring that commissioning decisions deliver high

quality, safe and appropriate services for the local population b) Facilitate understanding of clinical commissioning in the practice team c) Lead clinical and practice engagement d) Encourage input from all their practice clinicians/colleagues including

sessional/salaried GPs e) Improve the understanding and delivery of the CCGGroup’s strategic priorities f) Ensure all practice colleagues, both clinical and non-clinical, are kept up to

date with clinical commissioning decisions/outputs of meetings g) Act as coordinator for the practice for commissioning related activities i.e.

ensure input into commissioning process via commissioning intentions, prioritisation of CCGGroup’s initiatives etc.

h) Represent their practice at clinical commissioning group meetings, ensuring that discussions are kept at a population level and not at individual practice level

i) Ensure follow-up and proper accountability for agreed decisions and actions

j) Attend clinical commissioning group meetings with views/ decisions sought from practice colleagues beforehand and to be empowered to make decisions on behalf of all practice colleagues

k) Take a lead role in engaging the practice with monitoring of the practice budget and encouraging compliance with pathways etc.

l) Be responsible for the development and monitoring of practice specific action plans as required by the Group in relation to any performance issues related to practice specific budgets

m) Feed into the Clinical Leadership Group and\or Executive Team any practice/local issues to ensure two way communication is established

n) Be responsible for clinical and practice input into the performance monitoring of contracts with all providers

o) Attend and participate in the development programme for the CCG Group p) Keep up to date with commissioning matters locally/ nationally

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q) Adhere to and promote others’ adherence to integrated governance requirements including corporate, clinical and financial.

7.2 Other GP and Primary Care Health Professionals 7.2.1 In addition to the member representatives identified in section 7.1 above, the

Group CCG may identify a number of other GPs / primary care health professionals from member practices to either support the work of the Group and / or represent the Group CCG rather than represent their own individual practices.

7.3 All Members of the Group’s Governing Body

Guidance on the roles of members of the CCGGroup’s Governing Body is set out in a separate document47. In summary, each member of the Governing Body should share responsibility as part of a team to ensure that the Group exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this constitution. Each brings their unique perspective, informed by their expertise and experience.

7.4 The Chair of the Governing Body

The chair of the Governing Body is responsible for:

• leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this constitution;

• building and developing the CCGGroup’s Governing Body and its individual members;

• ensuring that the CCGGroup has proper constitutional and governance arrangements in place;

• ensuring that, through the appropriate support, information and evidence, the Governing Body is able to discharge its duties;

• supporting the accountable officer in discharging the responsibilities of the organisation;

• contributing to building a shared vision of the aims, values and culture of the organisation;

• leading and influencing to achieve clinical and organisational change to enable the CCGGroup to deliver its commissioning responsibilities;

• overseeing governance and particularly ensuring that the Governing Body and the wider Group behaves with the utmost transparency and responsiveness at all times;

• ensuring that public and patients’ views are heard and their expectations understood and, where appropriate as far as possible, met;

• ensuring that the organisation is able to account to its local patients, stakeholders and NHS EnglandCommissioning Board;

• Ensuring that the Group builds and maintains effective relationships, particularly with the individuals involved in overview and scrutiny from Darlington Borough Council or other relevant local authority and/or any other CCGs that the CCGGroup is working in partnership with.

47 Draft clinical commissioning Group Governing Body Members – Roles Attributes and Skills, NHS

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Commissioning Board Authority, March 2012

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7.5 The Vice Chair of the Governing Body

In circumstances where the Chair is a GP or other primary health professional the Vice Chair of the Governing Body, who will be a lay member, deputises for the Chair of the Governing Body where he or she has a conflict of interest or is otherwise unable to act.

7.6 Role of the Accountable Officer

The Accountable Officer of the Group is a member of the Governing Body.

This role of accountable officer has been summarised in a national document48

as: • being responsible for ensuring that the clinical commissioning Group fulfils

its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money;

• at all times ensuring that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems.

• working closely with the chair of the Governing Body, the accountable officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the Governing Body) of the organisation’s on-going capability and capacity to meet its duties and responsibilities. This will include arrangements for the on-going developments of its members and staff.

• exercising the functions delegated by the CCGGroup to the accountable officer as set out in this Constitution

• Ensuring the maintenance of registers of interest

In addition to the accountable officer’s general duties, where the accountable officer is also the senior clinical voice of the CCGGroup they will take the lead in interactions with stakeholders, including NHS EnglandCommissioning Board.

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7.7 Role of the Chief Finance Officer

The Chief Finance Officer is a member of the Governing Body and is responsible for providing financial advice to the clinical commissioning group and for supervising financial control and accounting systems

This role of chief finance officer has been summarised in a national document49

as: • being the Governing Body’s professional expert on finance and ensuring,

through robust systems and processes, the regularity and propriety of expenditure is fully discharged;

• making appropriate arrangements to support, monitor on the CCGGroup’s finances;

• overseeing robust audit and governance arrangements leading to propriety in the use of the Group’s resources

• being able to advise the Governing Body on the effective, efficient and economic use of the CCGGroup’s allocation to remain within that allocation and deliver required financial targets and duties; and

• producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHS EnglandCommissioning Board;

• exercising the functions delegated by the CCGGroup to the Chief Finance Officer as set out in this Constitution.

48 See the latest version of the NHS Commissioning Board Authority’s Clinical commissioning Group

governing body members: Role outlines, attributes and skills 49 See the latest version of the NHS Commissioning Board Authority’s Clinical commissioning Group

governing body members: Role outlines, attributes and skills

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7.8 Role of the Registered Nurse

The registered nurse (chief nurse) brings a broader view, (as outlined further in national guidance 48) from their perspective as a registered nurse, on health and care issues to underpin the work of the CCGGroup especially the contribution of nursing to patient care. The chief nurse role will:

• provide strategic and professional leadership for clinical quality and

patient safety throughout the CCGGroup, deploying knowledge and expertise across the five clinical domains of the NHS outcomes framework;

• promote and develops improvement and innovation in the delivery of care and services for local people;

• ensure and assure that the CCGGroup delivers its duties to safeguard vulnerable people;

• secure the effective development of primary care services

• ensure the CCGGroup performs its functions in a way which provides good value for money and

• ensure that the CCGGroup commissions services that are of high quality and are clinically effective.

7.9 Role of the Secondary Care Doctor

As an independent member of the CCG Group‘s governing body the secondary care clinician will share responsibility as part of the Governing Body to ensure that the CCGGroup exercises its functions effectively, efficiently, economically, with good governance and in accordance with the terms of the CCGGroup’s constitution as agreed by its members, (as outlined further in national guidance 48). They will bring their unique perspective, informed by their expertise and experience. This will support decisions made by the governing body as a whole and will help ensure that:

• a new culture is developed that ensures the voice of the member practices

is heard and the interests of patients and the community remain at the heart of discussions and decisions;

• the governing body and the wider CCGGroup act in the best interests of the health of the local population at all times;

• the CCGGroup commissions the highest quality services with a view to securing the best possible outcomes for their patients within their resource allocation and maintains a consistent focus on quality, integration and innovation;

• decisions are taken with regard to securing the best use of public money; • the CCG Group, when exercising its functions, acts with a view to

securing that health services are provided in a way which promotes the NHS Constitution, that it is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and when we cannot fully recover, to stay as well as we can to the end of our lives;

• the CCG Group is responsive to the views of local people and promotes

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self-care and shared decision-making in all aspects of its business; and • good governance remains central at all times

7.10 Role of the 3 Lay Persons

The Group has three lay persons on the Governing Body. One with expertise of audit, risk and governance, the second has a lead role in championing patient and public involvement and the third has a lead role in Finance and QIPP. The Deputy Chair is drawn from these lay persons. These roles support decisions made by the governing body as a whole and will help ensure that: • a new culture is developed that ensures the voice of the member practices

is heard and the interests of patients and the community remain at the heart of discussions and decisions;

• the governing body and the wider CCGGroup act in the best interests of the health of the local population at all times;

• the CCGGroup commissions the highest quality services with a view to securing the best possible outcomes for their patients within their resource allocation and maintains a consistent focus on quality, integration and innovation;

• decisions are taken with regard to securing the best use of public money; • the CCGGroup, when exercising its functions, acts with a view to

securing that health services are provided in a way which promotes the NHS Constitution, that it is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and when we cannot fully recover, to stay as well as we can to the end of our lives;

• the CCGGroup is responsive to the views of local people and promotes self-care and shared decision-making in all aspects of its business; and good governance remains central at all times.

7.11 Joint Appointments with other Organisations

The CCGGroup may make joint appointments with other organisations as it considers appropriate.

Any joint appointments will be supported by a memorandum of understanding between the organisations who are party to these joint appointments.

8 APPOINTMENTS

The arrangements for the appointment and selection of individuals to the Governing Body are set out in detail in the Standing Orders in Appendix C.

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9 STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST

9.1 Standards of Business Conduct 9.1.1 Employees, members, committee and sub-committee members of the CCGGroup

and members of the Governing Body (and its committees) will at all times comply with this constitution and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the CCGGroup and should follow the Seven Principles of Public Life set out by the Committee on Standards in Public Life (the Nolan Principles) The Nolan Principles are incorporated into this constitution at Appendix F.

9.1.2 They must comply with the CCGGroup’s policy on managing conflicts of interest

and standards of business conduct., including the requirements set out in the policy for managing conflicts of interest. This policy will be available on the Group’s website at www.darlingtonccg.nhs.uk, available upon request for inspection at the CCGGroup’s headquarters, or upon application by post at Darlington Clinical Commissioning Group, Dr Piper House, King Street, Darlington, DL3 6JL or by e-mail at DARCCG.contact@nhs.net

9.1.3 Individuals contracted to work on behalf of the CCGGroup or otherwise

providing services or facilities to the CCG Group will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

9.2 Conflicts of Interest 9.2.1 As required by section 14O of the 2006 Act, as inserted by section 25 of the

2012 Act, the Group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCGGroup will be taken and seen to be taken without any possibility of the influence of external or private interest.

9.2.2 Where an individual, i.e. an employee, CCGGroup member, member of the

Governing Body, or a member of a committee or a sub-committee of the CCGGroup or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the CCGGroup considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this constitution.

9.2.3 A conflict of interest will include:

a) a direct pecuniary interest: where an individual may financially benefit from

the consequences of a commissioning decision (for example, as a provider of services);

b) an indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from

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the consequences of a commissioning decision;

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c) a non-pecuniary interest: where an individual holds a non-remunerative or not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision (for example, where an individual is a trustee of a voluntary provider that is bidding for a contract);

d) a non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequence of a commissioning decision which cannot be given a monetary value (for example, a reconfiguration of hospital services which might result in the closure of a busy clinic next door to an individual’s house);

e) where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories.

9.2.4 If in doubt, the individual concerned should assume that a potential conflict

of interest exists. 9.3 Declaring and Registering Interests 9.3.1 The Group will maintain one or more registers of the interests of:

• the members of the Group • the member representatives of the Group; • the members of its Governing Body; • the members of its committees or sub-committees and the committees or

sub-committees of its Governing Body; • its employees

9.3.2 The registers will be published on the Group’s website at

www.darlingtonccg.nhs.uk, available upon request for inspection at the Group’s headquarters, or upon application by post at Darlington Clinical Commissioning Group, Dr Piper House, King Street, Darlington, DL3 6JL or by e-mail at DARCCG.contact@nhs.net

9.3.3 Individuals will declare any interest that they have, in relation to a decision to be

made in the exercise of the commissioning functions of the Group, in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware.

9.3.4 Where an individual is unable to provide a declaration in writing, for example, if a

conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.

9.3.5 The Accountable Officer leading on conflict of interest matters will ensure that

the register(s) of interest are reviewed regularly, and updated as necessary.` 8.3.1 The CCG will maintain one or more registers of the interests of:

• All CCG employees, including: • All full and part time staff; • Any staff on sessional or short term contracts; • Any students and trainees (including apprentices);

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• Agency staff; and • Seconded staff In addition, any self-employed consultants or other individuals working for the CCG under a contract for services should make a declaration of interest in accordance with this policy, as if they were CCG employees. Members of the governing body: All members of the CCG’s committees, sub-committees/sub-groups, including: • Co-opted members; • Appointed deputies; and • Any members of committees/groups from other organisations. Where the CCG is participating in a joint committee alongside other CCGs, any interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG. All members of the CCG (i.e., each practice) This includes each provider of primary medical services which is a member of the CCG under Section 14O (1) of the 2006 Act. Declarations should be made by the following groups: • GP partners (or where the practice is a company, each director); • Any individual directly involved with the business or decision-making of the CCG.

8.3.2 The CCG will need to ensure that, as a matter of course, declarations of interest are made and regularly confirmed or updated. All persons referred to above must declare any interests as soon as reasonable practicable and by law within 28 days after the interest arises. Further opportunities include;

• On appointment:

Applicants for any appointment to the CCG or its governing body or any committees should be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests should again be made and recorded.

• Six Monthly: Declarations of interest should be obtained from all relevant individuals every six months and where there are no interests or changes to declare, a “nil return” should be recorded.

• At meetings: All attendees should be asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent. Even if an interest

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is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interest and action taken to manage that conflict of interest at the meeting should be recorded in minutes of meetings.

• On changing role, responsibility or circumstances: Whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests (e.g., where an individual takes on a new role outside the CCG or enters into a new business or relationship), a further declaration should be made to reflect the change in circumstances as soon as possible, and in any event within 28 days. This could involve a conflict of interest ceasing to exist or a new one materialising.

8.3.4 Individuals will declare any interest that they have, in relation to a decision to be made

in the exercise of the commissioning functions of the CCG, in writing to the Chief Officer, as soon as they are aware of it and in any event no later than 28 days after becoming aware. The CCG must record the interest in the appropriate registers as soon as the CCG becomes aware of it.

8.3.5 The CCG must ensure that, when members declare interests, this includes the

interests of all relevant individuals within their own organisations (e.g. partners in a GP practice), who have a relationship with the CCG and who would potentially be in a position to benefit from the CCG’s decisions.

8.3.6 Where an individual is unable to provide a declaration in writing, for example, if a

conflict becomes apparent in the course of a meeting, they will make an oral declaration, and provide a written declaration as soon as possible thereafter.

8.3.7 The Chief Officer will ensure that the registers of interest are reviewed six-monthly and

updated as necessary. 8.3.8 In addition, all CCG Governing Body and Executive members’ appointments are

offered on the understanding that they subscribe to the “Codes of Conduct and Accountability in the NHS”.

8.3.9 The Declaration of Interest proforma for completion by members of the group,

Governing Body members, members of a committee or sub-committee of the group or Governing Body, and employees within the CCG is available at Appendix D.

8.3.10 Failure to notify the CCG of an appropriate conflict of interest, additional employment

or business may lead to disciplinary action against the member of staff and/or criminal action (including prosecution) under the relevant legislation.

8.3.11 An interest should remain on the public register for a minimum of six months after the

interest has expired and the CCG will retain a private record of historic interests for a minimum of 6 years after the date on which it expired. The published register will state that historic interests are retained by the CCG for the specified timeframe and details of whom to contact to request this information.

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9.4 Managing Conflicts of Interest: general 9.4.1 Individual members of the CCGGroup, the Governing Body, committees or sub-

committees, the committees or sub-committees of its Governing Body and employees will comply with the arrangements determined by the CCGGroup for managing conflicts or potential conflicts of interest.

9.4.2 The lay member leading on conflict of interest matters will ensure that for every interest declared, either in writing or by oral declaration and arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the CCGGroup’s decision making processes.

9.4.3 Arrangements for the management of conflicts of interest are to be determined

by the Accountable Officer and will include the requirement to put in writing to the relevant individual arrangements for managing the conflict of interests or potential conflicts of interests, within a week of declaration. The arrangements will confirm the following:

a) when an individual should withdraw from a specified activity, on a

temporary or permanent basis; b) monitoring of the specified activity undertaken by the individual, either by a

line manager, colleague or other designated individual. 9.4.4 Where an interest has been declared, either in writing or by oral declaration, the

declarer will ensure that before participating in any activity connected with the CCGGroup’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the lay member leading on conflict of interest matters.

9.4.5 Where an individual member, employee or person providing services to the

CCGGroup is aware of an interest which:

a) has not been declared, either in the register or orally, they will declare this

at the start of the meeting; b) has previously been declared, in relation to the scheduled or likely business

of the meeting, the individual concerned will bring this to the attention of the chair of the meeting, together with details of arrangements which have been confirmed for the management of the conflict of interests or potential conflict of interests.

9.4.6 The chair of the meeting will then determine how this should be managed and

inform the member of their decision. Where no arrangements have been confirmed, the chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual will then comply with these arrangements, which must be recorded in the minutes of the meeting.

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9.4.7 Where the chair of any meeting of the CCGGroup, including committees, sub- committees, or the Governing Body and the Governing Body’s committees and sub-committees, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one.

9.4.8 Any declarations of interests, and arrangements agreed in any meeting of the

clinical commissioning group, committees or sub-committees, or the Governing Body, the Governing Body’s committees or sub-committees, will be recorded in the minutes.

9.4.9 Where more than 50% of the members of a meeting are required to withdraw

from a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the chair (or deputy) will determine whether or not the discussion can proceed.

9.4.10 In making this decision the chair will consider whether the meeting is quorate, in

accordance with the number and balance of membership set out in the Group’s standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall consult with the Accountable Officer on the action to be taken.

9.4.11 This may include:

a) requiring another of the CCGGroup’s committees or sub-committees,

the CCGGroup’s Governing Body or the Governing Body’s committees or sub- committees (as appropriate) which can be quorate to progress the item of business, or if this is not possible,

b) inviting on a temporary basis one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that the Group can progress the item of business:

i. a member of the clinical commissioning group who is member practice representative;

ii. an individual appointed by a member to act on its behalf in the dealings between it and the clinical commissioning group;

iii. a member of a relevant Health and Wellbeing Board; iv. a member of a Governing Body of another clinical commissioning

group.

9.4.12 These arrangements must be recorded in the minutes.

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9.4.13 In any transaction undertaken in support of the CCGGroup’s exercise of its

commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the lay member leading on conflict of interest matters of the transaction.

9.4.14 The Accountable Officer leading on conflict of interest matters will take such

steps as deemed appropriate, and request information deemed appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared.

9.5 Managing Conflicts of Interest: contractors and people who provide services to

the Group 9.5.1 Anyone seeking information in relation to procurement, or participating in

procurement, or otherwise engaging with the CCGGroup in relation to the potential provision of services or facilities to the CCGGroup, will be required to make a declaration of any relevant conflict / potential conflict of interest.

9.5.2 Anyone contracted to provide services or facilities directly to the clinical

commissioning group will be subject to the same provisions of this constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

9.6 Transparency in Procuring Services 9.6.1 The CCGGroup recognises the importance in making decisions about the

services it procures in a way that does not call into question the motives behind the procurement decision that has been made. The CCGGroup will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

9.6.2 The CCGGroup will publish a register of procurement decisions on the

CCGGroup’s website at www.darlingtonccg.nhs.uk, available upon request for inspection at the CCGGroup’s headquarters, or upon application by post at Darlington Clinical Commissioning Group, Dr Piper House, King Street, Darlington, DL3 6JL or by e-mail at DARCCG.contact@nhs.net

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10 THE CCGROUP AS AN EMPLOYER 10.1 The CCGGroup recognises that its most valuable asset is its people. It will

seek to enhance their skills and experience and is committed to their development in all ways relevant to the work of the CCGGroup.

10.2 The CCGGroup will seek to set an example of best practice as an employer

and is committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.

10.3 The CCGGroup will ensure that it employs suitably qualified and experienced

staff who will discharge their responsibilities in accordance with the high standards expected of staff employed by the CCGGroup. All staff will be made aware of this constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

10.4 The CCGGroup will maintain and publish policies and procedures (as

appropriate) on the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCGGroup will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters

10.5 The CCGGroup will ensure that its rules for recruitment and management of

staff provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.

10.6 The CCGGroup will ensure that employees' behaviour reflects the values,

aims and principles set out above. 10.7 The CCGGroup will ensure that it complies with all aspects of employment law.

10.8 The CCGGroup will ensure that its employees have access to such expert

advice and training opportunities as they may require in order to exercise their responsibilities effectively.

10.9 All senior managers of the CCGGroup will adopt the NHS Code of Conduct for

Senior Managers and will maintain and promote effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced.

10.10 Copies of the NHS Code of Conduct for Senior Managers, together with the

other policies and procedures outlined in this chapter, will be available on the CCGGroup’s website at www.darlingtonccg.nhs.uk, available upon request for inspection at the Group’s headquarters, or upon application by post at Darlington Clinical Commissioning Group, Dr Piper House, King Street, Darlington, DL3 6JL or by e-mail at DARCCG.contact@nhs.net

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11 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS 11.1 General 11.1.1 The CCGGroup will publish annually a commissioning plan and an annual report,

presenting the CCGGroup’s annual report to a public meeting. 11.1.2 Key communications issued by the CCGGroup, including the notices of

procurements, public consultations, Governing Body meeting dates, times, venues, and certain papers will be published on the CCGGroup’s website at www.darlingtonccg.nhs.uk.

11.1.3 The CCGGroup may use other means of communication, including

circulating information by post, or making information available in venues or services accessible to the public.

11.2 Standing Orders 11.2.1 This constitution is also informed by a number of documents which provide

further details on how the Group will operate. They are the CCGGroup’s:

a) Standing orders (Appendix C) – which sets out the arrangements for meetings and the appointment processes to elect the CCGGroup’s representatives and appoint to the CCGGroup’s committees, including the Governing Body

b) Scheme of reservation and delegation (Appendix D) – which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the Group’s Governing Body, the Governing Body’s committees and sub-committees, the CCGGroup’s committees and sub-committees, individual members and employees;

c) Prime financial policies (Appendix E) – which sets out the arrangements for managing the CCGGroup’s financial affairs.

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APPENDIX A

DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2006 Act National Health Service Act 2006

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

Accountable officer an individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by NHS Commissioning BoardEngland, with responsibility for ensuring the Group: • complies with its obligations under:

o sections 14Q and 14R of the 2006 Act (as inserted by section 26 of the 2012 Act),

o sections 223H to 223J of the 2006 Act (as inserted by section 27 of the 2012 Act),

o paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as inserted by Schedule 2 of the 2012 Act), and

o any other provision of the 2006 Act (as amended by the 2012 Act) specified in a document published by the Board for that purpose;

• exercises its functions in a way which provides good value for money.

Area the geographical area that the Group has responsibility for, as defined in Chapter 2 of this constitution

Chair of the Governing Body

the individual appointed by the Group to act as chair of the Governing Body

Chief finance officer the qualified accountant employed by the Group with responsibility for financial strategy, financial management and financial governance

Clinical Commissioning Group

a body corporate established by NHS Commissioning BoardEngland in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act)

Clinical Leadership Group

A committee of the Governing Body to ensure and support effective clinical leadership.

Committee a committee or sub-committee created and appointed by: • the membership of the Group • a committee / sub-committee created by a committee created / appointed

by the membership of the Group • a committee / sub-committee created / appointed by the Governing Body

Executive Team A committee of the Governing Body to ensure effective management of the groups delegated resources and responsibilities

Financial year this usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a clinical commissioning group is established until the following 31 March

Group NHS Darlington Clinical Commissioning Group, whose constitution this is

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Governing Body the body appointed under section 14L of the NHS Act 2006 (as inserted by section 25 of the 2012 Act), with the main function of ensuring that a clinical commissioning group has made appropriate arrangements for ensuring that it complies with:

• its obligations under section 14Q under the NHS Act 2006 (as inserted by section 26 of the 2012 Act), and

• such generally accepted principles of good governance as are relevant to it.

Governing Body member

any member appointed to the Governing Body of the Group

Lay member a lay member of the Governing Body, appointed by the Group. A lay member is an individual who is not a member of the Group or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations

Member a provider of primary medical services to a registered patient list, who is a member of this Group (see tables in Chapter 3 and Appendix B)

Member representatives

an individual appointed by a practice (who is a member of the Group) to act on its behalf in the dealings between it and the Group, under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act)

Members Assembly a committee of the Group comprising a member selected by each individual member practice of the Group

Registers of interests registers a Group is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of: • the members of the Group; • the members of its Governing Body; • the members of its committees or sub-committees and committees or sub-

committees of its Governing Body; and • its employees.

Sessional GP A sessional GP is an umbrella term for GPs whose work is organised on a sessional basis, as opposed to GP partners.

Stakeholders An individual, group or organisation that may be affected by the decisions or actions of the group.

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APPENDIX B - LIST OF MEMBER PRACTICES

Practice Name Address Blacketts Medical Practice 63-65 Bondgate, Darlington, Co. Durham. DL3 7JR Carmel Medical Practice Nunnery Lane, Darlington, Co. Durham. DL3 8SQ Clifton Court Medical Centre

Victoria Road, Darlington, Co. Durham. DL1 5JN

Felix House Surgery Middleton Lane, Middleton St George, Darlington, Co. Durham. DL2 1AA

Moorlands Surgery 139a Willow Road, Darlington, Co. Durham. DL3 9JP Neasham Road Surgery 186, Neasham Road, Darlington, Co. Durham. DL1 4YL Orchard Court Surgery Orchard Road, Darlington, Co. Durham. DL3 6HZ Parkgate Surgery Park Place, Darlington, Co. Durham. DL1 5LW The Surgery Denmark Street, Darlington, Co. Durham. DL3 0PD The Surgery Rockliffe Court, Hurworth Place, Darlington, Co. Durham. DL2

2DS Whinfield Surgery Whinbush Way, Darlington, Co. Durham. DL1 3RT

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APPENDIX C – STANDING ORDERS

1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction

1.1.1. These standing orders have been drawn up to regulate the proceedings of the

NHS Darlington Clinical Commissioning Group so that the CCGGroup can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations . They are effective from the date the Group is established.

1.1.2. The standing orders, together with the CCGGroup’s scheme of reservation and

delegation49 and the CCGGroup’s prime financial policies50, provide a procedural framework within which the CCGGroup discharges its business. They set out:

a) the arrangements for conducting the business of the CCGGroup; b) the appointment of member practice representatives; c) the procedure to be followed at meetings of the GroupCCG, the Governing

Body and any committees or sub-committees of the GroupCCG or the Governing Body;

d) the process to delegate powers, e) the declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate51 of any relevant guidance.

1.1.3. The standing orders, scheme of reservation and delegation and prime financial

policies have effect as if incorporated into the GroupCCG’s constitution. GroupCCG members, employees, members of the Governing Body, members of the Governing Body’s committees and sub-committees, members of the GroupCCG’s committees and sub-committees and persons working on behalf of the GroupCCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal.

1.1.4. The 2006 Act (as amended by the 2012 Act) provides the groupCCG with

powers to delegate the groupCCG’s functions and those of the Governing Body to certain bodies (such as committees) and certain persons. The groupCCG has decided that certain decisions may only be exercised by the groupCCG in formal session. These decisions and also those delegated are contained in the groupCCG’s scheme of reservation and delegation (see Appendix D).

49 See Appendix D 50 See Appendix E

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51 Under some legislative provisions the GroupCCG is obliged to have regard to particular guidance but under other circumstances guidance is issued as best practice guidance.

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2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS

2.1. Members Assembly

The GroupCCG is a member organisation. The Members Assembly has been established as a committee comprising an individual selected by each member practice. The individual selected has authority to represent the practice’s views and to act on its behalf in its dealings between the practice and the GroupCCG.

The Members Assembly will have two representatives that will sit on the Governing Body, representing the views of member practices.

2.2. Composition of membership 2.2.1. Chapter 3 of the GroupCCG’s constitution provides details of the membership of the

GroupCCG (also see Appendix B). 2.2.2. Chapter 6 of the GroupCCG’s constitution provides details of the governing

structure used in the GroupCCG’s decision-making processes, whilst Chapter 7 of the constitution outlines certain key roles and responsibilities within the GroupCCG and its Governing Body, including the role of practice representatives.

2.3. Key Roles

Schedule 5 of the CCG regulations sets out how the GroupCCG will appoint individuals to key roles. Any individual who is ineligible under these regulations cannot be appointed to serve on the GroupCCG’s Governing Body.

3. APPOINTMENTS TO THE GOVERNING BODY

3.1 Appointments

3.1.1 The Chair as listed in paragraph 6.10.4 of the GroupCCG’s constitution, is

subject to the following appointment process:

a) Nominations: Invited by application. b) Eligibility: Preference will be given to applicants who live or work in the

Darlington area, and who comply with section 13 (1) of The National Health Service (Clinical Commissioning Groups) Regulations 2012.

c) Appointment process: Appointments will be made through a selection process approved by the Governing Body.

d) Term of office: Successful candidates will normally serve for a maximum of 3 years only.

e) Eligibility for reappointment: Serving Chairs may be considered for further terms, subject to consistently good performance and the needs of the organisation. This must be confirmed at a meeting of the Members

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Assembly f) Grounds for removal from office:

i) Disqualified from membership under the 2012 regulations ii) No longer meets eligibility for role iii) Exclusion from the Performers List or GMC Register iv) Breach of Nolan Principles (as determined by majority vote by

Governing Body members) v) Significant reputational damage to GroupCCG vi) Majority of no-confidence by Members Assembly vii) Has become ineligible to stand as a result of the declaration of

any overriding conflict of interest g) Notice period: Three months. h) Suspension from Governing Body: Suspension from the Performers List or

GMC register will result in an immediate review of the post holder’s position on the Governing Body.

3.1.2 The GP’s or other primary care health professionals who have been asked to

take on roles across the GroupCCG, as listed in paragraph 6.10.4 of the GroupCCG’s constitution, are subject to the following appointment process:

a) Nominations: Members will be nominated and selected by their individual

practices. b) Eligibility: Not disqualified from membership of a CCG under the 2012 Regulations; practicing within a member practice; meets person specification for the role c) Appointment process: Not applicable. d) Term of office: Successful candidates will serve for a maximum of 3 years. e) Eligibility for reappointment: Serving members may be considered for

further terms, subject to consistently good performance and the needs of the organisation, which will be determined by the Governing Body. • Notice period: Three months

g) Grounds for removal from office: Disqualified from membership under the 2012 regulations

• No longer meets eligibility for role • Exclusion from the Performers List or GMC Register • Breach of Nolan principles (as determined by majority vote by GB

members) • Significant reputational damage to GroupCCG • Majority vote of no-confidence by Members Assembly • Has become ineligible to stand as a result of the declaration of any

overriding conflict of interest. h) Suspension from Governing Body: Suspension from the Performers List or

GMC register will result in an immediate review of the post holder’s position on the Governing Body.

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3.1.3 The Lay members as listed in paragraph 6.10.4 of the GroupCCG’s constitution are subject to the following appointment process:

a) Nominations: Invited by application via open advertisement b) Eligibility: Not disqualified from membership of a CCG under 2012

Regulations. Meets person specification and criteria for role. Preference will be given to applicants who live or work in the Darlington area.

c) Appointment process: Appointments will be made through a selection process approved by the Governing Body.

d) Term of office: For up to three years. On the establishment of the GroupCCG the Lay member leading on audit, risk and governance will have a term of office of one year, and the Lay member leading on Public and patient involvement and remuneration will have a term of office of two years for the initial term of office;

e) Eligibility for reappointment: Serving lay members may be considered for further terms, subject to consistently good performance and the needs of the organisation.

f) Grounds for removal from office: i) Disqualified from membership under the 2012 regulations ii) No longer meets eligibility for role iii) Exclusion from the Performers List or GMC Register iv) Breach of Nolan Principles (as determined by majority vote by

Governing Body members) v) Significant reputational damage to GroupCCG vi) Majority of no-confidence by Members Assembly vii) Has become ineligible to stand as a result of the declaration of any

overriding conflict of interest g) Notice period: Three months.

The Lay member leading on Governance/Audit must have appropriate financial and audit experience sufficient to enable them to competently engage with financial management and reporting in the organisation and associated assurances

3.1.4 The Registered Nurse, as listed in paragraph 6.10.4 of the GroupCCG’s

constitution, is subject to the following appointment process:

a) Nominations: Invited by application via open advertisement. b) Eligibility: a registered nurse not falling within regulation 12(1) of the 2012

Regulations. Not disqualified from membership under the 2012 Regulations. Relevant experience and qualifications as set out in the person specification.

c) Appointment process: Appointments will be made through a selection process approved by the Governing Body.

d) Term of office: Not applicable. e) Eligibility for reappointment: Eligibility criteria must continue to be met. f) Grounds for removal from office: In accordance with NHS Darlington CCG

human resources policies. g) Notice period: Three months.

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3.1.5 The Secondary Care Doctor, as listed in paragraph 6.10.4 of the

GroupCCG’s constitution, is subject to the following appointment process:

a) Nominations: Invited by application via open advertisement. b) Eligibility: Is a secondary care specialist within the meaning of the 2012

Regulations and does not fall within regulation 12(1) of the 2012 Regulations Not disqualified from membership of a CCG under the 2012 Regulations Meets person specification and criteria for role approved by the Governing

Body Meets requirements of 2012 Regulations for Governing Body membership. Relevant professional qualifications as set out in the person specification.

c) Appointment process: Appointments will be made through a selection process approved by the Governing Body.

d) Term of office: Maximum of three years. e) Eligibility for reappointment: Eligibility criteria must continue to be met.. f) Grounds for removal from office: In accordance with NHS Darlington CCG

human resources policies. The individual is no longer eligible to be a secondary care specialist member of a CCG Governing Body under the 2012 Regulations. Disqualified from membership of a CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. Failure to meet eligibility criteria for role. Breach of Nolan principles (as determined by majority vote by Governing Body members). Significant reputational damage to CCG (as determined by majority vote by Governing Body members). Simple majority vote of no-confidence by Clinical Council of Members Failure to meet 2012 Regulations for Governing Body membership. Failure to meet eligibility criteria for role. Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest.

• Notice period: Three months. • Suspension from governing Body: Suspension from the registered

professional body will result in an immediate review of the post holder’s position on the Governing Body.

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3.1.6 The Accountable Officer, as listed in paragraph 6.10.4 of the GroupCCG’s constitution, is subject to the following appointment process:

a) Nominations: Invited by application

via open advertisement. b) Eligibility: i) Is eligible to be the Accountable Officer under the 2006 Act, as amended by

the 2012 Act. Not disqualified from membership of a CCG under the 2012 Regulations. Approved/accredited by any national assessments process stipulated for the role. Meets person specification and criteria for role approved by the Governing Body

c) Appointment process: .NHS commissioning BoardEngland is responsible for appointing the Accountable Officer, following nomination by the CCG

d) Term of office: As per contract of employment. e) Eligibility criteria must continue to be met. f) Grounds for removal from office: No longer eligible to be the

Accountable Officer under the 2006 Act, as amended by the 2012 Act. Disqualified from membership of a CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. Breach of Nolan principles (as determined by majority vote by Governing Body members). Significant reputational damage to CCG (as determined by majority vote by Governing Body members). Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest. Has their employment terminated by resignation, redundancy or as a result of disciplinary proceedings.

g) Notice period: Immediately if removed from office on any of the ground set out above but otherwise the notice period shall be in accordance with his or her contract of employment and/or statutory employment rights.

3.1.7 The Chief Finance Officer as listed in paragraph 6.10.4 of the

GroupCCG’s constitution, is subject to the following appointment process:

a) Nominations: Invited by application

via open advertisement. b) Eligibility: Not disqualified from membership of a CCG under the 2012

Regulations. Holds a qualification of one of the individual CCAB bodies or CIMA. Meets person specification and criteria for role approved by the Governing Body

c) Appointment process: Appointments will be made through a selection process approved by the Governing Body.

d) Term of office: As per contract of employment. e) Eligibility for reappointment: Eligibility criteria must continue to be met. f) Grounds for removal from office: Disqualified from membership of a

CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. No longer holds qualification of one of the individual CCAB bodies or CIMA; and /or in accordance with his/her contract of employment. Breach of Nolan principles (as determined by majority vote by Governing Body members).

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Significant reputational damage to CCG (as determined by majority vote by Governing Body members). Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest. Has their employment terminated by resignation, redundancy or as a result of disciplinary proceedings.

g) Notice period: Immediately if removed from office on any of the ground set

out above but otherwise the notice period shall be in accordance with his or her contract of employment and/or statutory employment rights.

3.1.8 The roles and responsibilities of each of these key roles are set out either in

paragraph 6.10.4 or Chapter 7 of the GroupCCG’s constitution. 3.1.9 Detailed information on specific role outlines will be found in the job descriptions

for the Clinical Chair, GP leads, lay members, registered nurse, secondary care specialist doctor, chief officer\accountable officer, chief finance officer.

3.2 Removal from Office of an Elected Individual

The Governing Body will ensure that a robust process is in place for the removal from office of those individuals who are elected into specific roles.

3.3 Removal from Office of an Appointed Individual Individuals who are appointed into specific roles will, where necessary, be

removed from office in accordance with the GroupCCG’s human resources policies.

4. MEETINGS OF THE GOVERNING BODY 4.1 Role of the Governing Body

The main function is to ensure that the groupCCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with the principles of good governance.

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4.1.1 Remit

The remit of the Governing Body is to:-

a) Lead the setting of vision and strategy. b) Approve commissioning plans. c) Monitor operational and financial performance against plans. d) Provide assurance of strategic risk

4.2 Calling meetings

Ordinary meetings of the Governing Body shall be held at regular intervals at such times and places as the Governing Body may determine.

4.3. Petitions Where a petition has been received by the GroupCCG, the chair of the

Governing Body shall include the petition as an item for the agenda of the next meeting of the Governing Body.

4.4. Chair of a meeting 4.4.1. At any meeting of the GroupCCG or its Governing Body or of a committee or

sub- committee, the chair of the GroupCCG, Governing Body, committee or sub- committee, if any and if present, shall preside. If the chair is absent from the meeting, the deputy chair, if any and if present, shall preside.

4.4.2. If the chair is absent temporarily on the grounds of a declared conflict of interest

the deputy chair, if present, shall preside. If both the chair and deputy chair are absent, or are disqualified from participating, or there is neither a chair or deputy, a member of the GroupCCG, Governing Body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.

4.5. Chair's ruling 4.5.1. The decision of the chair of the Governing Body on questions of order, relevancy

and regularity and their interpretation of the constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.

4.6. Decision Making

4 . 6 . 1 Chapter 6 of the GroupCCG’s constitution, together with the scheme of

reservation and delegation, sets out the governing structure for the exercise of the GroupCCG’s statutory functions. Generally it is expected that at Governing Body meetings decisions will be reached by consensus. Should this not be possible then a vote of members will be required, the process for which is set out

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below:

a) Eligibility – members of the Governing Body or their elected delegated deputy will be eligible to vote.

b) Form of vote – at the discretion of the chair any question put to a vote shall be by oral expression or by a show hands, unless the Chair directs otherwise, or it is proposed, seconded and carried that a vote be taken by paper ballot.

c) Majority necessary to confirm a decision - the decision will be determined by the majority of the votes cast by members present;

d) Casting vote - in the case of an equal vote, the person presiding (i.e. the Chair of the meeting) will have a second, and casting vote;

e) Dissenting views - members taking a dissenting view but losing a vote may have their dissent recorded in the minutes.

4.6.2. Should a vote be taken the outcome of the vote, and any dissenting views, must

be recorded in the minutes of the meeting.

4.6.3. For all other of the GroupCCG’s committees and sub-committees, including the Governing Body’s committees and sub-committee, the details of the process for holding a vote are set out in the appropriate terms of reference.

4.7. Quorum

4.7.1. a) No business shall be transacted at the meeting unless at least one-third of the whole number of Governing Body members (including the chair or one clinical member, the accountable officer or chief finance officer and one of the remaining statutory members) are present. b) A member may, if the Chair agrees in advance of the meeting and in exceptional circumstances, participate in the meeting by way of conferencing. In the exceptional circumstances of the chair participating by tele-conference, the vice chair will preside at the meeting c) If the quorum is lost due to a member or members being disqualified from taking part in a vote or discussion due to a declared interest the chair of the meeting will determine the action to be taken in accordance with paragraphs 9.4.9 and 9.4.10 of the Constitution.

4.7.2. For all other of the GroupCCG’s committees and sub-committees, including the

Governing Body’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference

Comment [CA3]: Half?

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4.8. Emergency powers and urgent decisions

4.7.4 The powers which are reserved to the Governing Body within the scheme of delegation may in emergency or for an urgent decision be exercised by the Chair and the Accountable Officer, after having consulted with at least two other members which will ordinarily include one of the Lay members. The exercise of such powers by the Chair and the Accountable Officer shall be reported to the next formal meeting of the Governing Body in public session for formal ratification. If the exercise of the function relates to a matter which is not in the public interest to be disclosed under SO paragraph 3.12 the exercise of the powers will be reported in private to the Governing Body.

4.9. Suspension of Standing Orders 4.9.1. Except where it would contravene any statutory provision or any direction made

by the Secretary of State for Health or NHS Commissioning BoardEngland, any part of these standing orders may be suspended at any meeting, provided at least two- thirds of the GroupCCG members are in agreement.

4.9.2. A decision to suspend standing orders together with the reasons for doing so

shall be recorded in the minutes of the meeting. 4.9.3 A separate record of matters discussed during the suspension shall be kept.

These records shall be made available to the Governing Body’s audit committee for review of the reasonableness of the decision to suspend standing orders.

4.10 Record of Attendance 4.101. The names of all members of the meeting present at the meeting shall be

recorded in the minutes of the GroupCCG’s meetings. The names of all members of the Governing Body present shall be recorded in the minutes of the Governing Body meetings. The names of all members of the Governing Body’s committees / sub-committees present shall be recorded in the minutes of the respective Governing Body committee / sub-committee meetings.

4.11. Admission of public and the press 4.11.1. Admission and exclusion on grounds of confidentiality of business to be

transacted

4.11.2 The public and representatives of the press may attend all meetings of the Governing Body, but shall be required to withdraw upon resolution of the Governing Body, as follows:

‘that representatives of the press, and other members of the public, be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, paragraph 8(3) of schedule 1A of the 2006 Act, as amended by the 2012 Act.

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4.11.3 Guidance should be sought from the GroupCCG’s Information Governance Lead

to ensure correct procedure is followed on matters to be included in the exclusion.

4.12 General Disturbances

4.12.1 The Chairman (or Vice-Chairman if one has been appointed) or the person presiding over the meeting shall give such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that the Governing Body’s business shall be conducted without interruption and disruption and, without prejudice to the power to exclude on grounds of the confidential nature of the business to be transacted, the public will be required to withdraw upon the Governing Body resolving as follows:

• `That in the interests of public order the meeting adjourn for (the period to

be specified) to enable the Governing Body to complete its business without the presence of the public'. Section 1(8) Public Bodies (Admissions to Meetings) Act l960.

4.12.2. Business proposed to be transacted when the press and public have been

excluded from a meeting

4.12.4.1 Matters to be dealt with by the Governing Body following the exclusion of representatives of the .press, and other members of the public, as provided in (i) and (ii) above, shall be confidential to the members of the Governing Body.

4.12.4.2 Members and Officers or any employee of the GroupCCG in attendance

shall not reveal or disclose the contents of papers marked 'In Confidence' or minutes headed 'Items Taken in Private' outside of the GroupCCG, without the express permission of the GroupCCG or its Governing Body. This prohibition shall apply equally to the content of any discussion during the Governing Body meeting which may take place on such reports or papers.

4.12.4.3 Use of Medical or Electrical Equipment for Recording or Transmission of

Meeting

4.12.4.4 Nothing in these Standing Orders shall be construed as permitting the introduction by the public, or press representatives, of recording, transmitting, video or similar apparatus into meetings of the GroupCCG or Committee thereof. Such permission shall be granted only upon resolution of the GroupCCG or its Governing Body.

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4.13. Observers at GroupCCG meetings 4.13.1. The GroupCCG or its Governing Body will decide what arrangements and terms

and conditions it feels are appropriate to offer in extending an invitation to observers to attend and address any of the GroupCCG’s meetings and may change, alter or vary these terms and conditions as it deems fit.

5. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES 5.1. Appointment of committees and sub-committees 5.1.1. The GroupCCG may appoint committees and sub-committees of the GroupCCG,

subject to any regulations made by the Secretary of State52, and make provision for the appointment of committees and sub-committees of its Governing Body. Where such committees and sub-committees of the GroupCCG, or committees and sub- committees of its Governing Body, are appointed they are included in Chapter 6 of the GroupCCG’s constitution.

5.1.2. Other than where there are statutory requirements, such as in relation to the

Governing Body’s Governance, Audit and Risk Committee or Remuneration Committee, the GroupCCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the GroupCCG.

5.1.3. The provisions of these standing orders shall apply where relevant to the

operation of the Governing Body, the Governing Body’s committees and sub- committee and all committees and sub-committees unless stated otherwise in the committee or sub-committee’s terms of reference.

5.2. Terms of Reference 5.2.1. Terms of reference for all committees and sub-committees will be held in a

separate document, and will have their functions; duties and powers set out in the terms of reference and reviewed from time to time by the Governing Body.

5.3. Delegation of Powers by Committees to Sub-committees 5.3.1. Where committees are authorised to establish sub-committees they may not

delegate executive powers to the sub-committee unless expressly authorised by the GroupCCG.

5.4. Approval of Appointments to Committees and Sub-Committees 5.4.1. The GroupCCG shall approve the appointments to each of the committees and

sub- committees which it has formally constituted including those of the Governing Body. The GroupCCG shall agree such travelling or other allowances as it considers appropriate.

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See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act

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6. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS AND PRIME FINANCIAL POLICIES

6.1. If for any reason these standing orders are not complied with, full details of the

non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the GroupCCG and staff have a duty to disclose any non-compliance with these standing orders to the accountable officer as soon as possible.

7. USE OF SEAL AND AUTHORISATION OF DOCUMENTS 7.1. Clinical Commissioning Group’s seal 7.1.1. The GroupCCG may have a seal for executing documents where necessary. The

following individuals or officers are authorised to authenticate its use by their signature:

a) the Accountable Officer; b) the Chair of the Governing Body; c) the Chief Finance Officer;

7.2. Execution of a document by signature 7.2.1. The following individuals are authorised to execute a document on behalf of the

GroupCCG by their signature.

a) the Accountable Officer b) the Chair of the Governing Body c) the Chief Finance Officer

8. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS

8.1. Policy statements: general principles 8.1.1. The GroupCCG will from time to time agree and approve policy

statements / procedures which will apply to all or specific Groups of staff employed by NHS Darlington Clinical Commissioning Group. The decisions to approve such policies and procedures will be recorded in an appropriate GroupCCG minute and will be deemed where appropriate to be an integral part of the GroupCCG’s standing orders.

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APPENDIX D – SCHEME OF RESERVATION & DELEGATION

1. Schedule of Matters Reserved to the Clinical Commissioning Group and

Scheme of Delegation 1.1. The arrangements made by the Cl in ical Commissioning Group (the

GroupCCG)as set out in this scheme of reservation and delegation of decisions shall have effect as if incorporated in the GroupCCG’s constitution.

1.2. The GroupCCG remains accountable for all of its functions, including those that it

has delegated. 2. Schedule of matters reserved to the GroupCCG and the scheme of

reservation and delegation 2.1 The 2006 Act (as amended by the 2012 Act) provides the GroupCCG with

powers to delegate the GroupCCG’s functions and those of the Governing Body to certain bodies (such as committees) and certain persons. The GroupCCG has decided that certain decisions may only be exercised by the GroupCCG in formal session. These decisions and also those delegated are contained in the GroupCCG’s scheme of reservation and delegation.

The GroupCCG may determine any matter, for which it has delegated or statutory authority, it wishes in full session within its statutory powers, and will include:

a) Regulations and Control

i) Approval of Standing Orders (SOs), a schedule of matters reserved to the GroupCCG and Standing Financial Instructions for the regulation of its proceedings and business.

ii) Suspension of SOs. iii) Variation or amendment of SOs. iv) Approval of a scheme of delegation of powers from the GroupCCG to the

Governing Body and other committees. v) Approval of Terms of Reference of the committees established by the

GroupCCG. vi) Require and receive the declaration of GroupCCG’s members’

interests which may conflict with those of the GroupCCG and, taking account of any waiver which the Secretary of State for Health may have made in any case, determining the extent to which that member may remain involved with the matter under consideration.

vii) Approve any urgent decisions, linked to non-delegated statutory functions taken by the Chairman of the GroupCCG and Chairman of the Governing Body for ratification by the GroupCCG in public session

viii) Formalise delegation of powers to committees or sub-committees and approval of their constitution and terms of reference.

ix) Subscribe to the NHS Code of Conduct.

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x) Ensure the GroupCCG’s members share corporate responsibility for all decisions of the GroupCCG.

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xi) Ensure that the GroupCCG engages with its local community and leads the engagement with local clinicians on its plans and performance and that these are responsive to the community’s needs.

b) Appointments and Dismissals

i) Appoint the Chairman of the Governing Body. ii) Appoint the Vice-Chairman of the Governing Body. iii) Approve membership of the Governing Body. iv) Ratify appointment of members of the Governance, Audit and Risk

Committee. v) Ratify appointment of the Chairman and members of the

Remuneration and Terms of Service Committee. vi) Approve appointments to the committees which it has formally

constituted.

c) Annual Reports and Accounts i) Receipt and approval of Annual Report and Accounts.

d) Non-Delegable Functions

i) Not applicable.

e) Monitoring i) Request such reports as the GroupCCG sees fit from the Governing

Body and other committees and sub-committees in respect of its exercise of powers delegated. The committees and sub-committees have a duty to respond to these requests.

f) Authorities and Duties Delegated to the Governing Body, Committees

and Sub-committees i) To carry out its functions in accordance with its Terms of Reference.

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Scheme of Reservation and Delegation

Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

REGULATION AND

CONTROL

Determine the arrangements by which the members of the GroupCCG approve those decisions that are reserved for the membership.

√ √

REGULATION AND CONTROL

Consideration and approval of applications to NHS Commissioning BoardEngland on any matter concerning changes to the GroupCCG’s constitution, including terms of reference for the GroupCCG’s Governing Body, its committees, membership of committees, the overarching scheme of reservation and delegated powers, arrangements for taking urgent

√ √

REGULATION AND CONTROL

Receipt and Approve Constitution √

REGULATION AND CONTROL

Exercise or delegation of those functions of the clinical commissioning group which have not been retained as reserved by the GroupCCG, delegated to the Governing Body or other committee or sub- committee or [specified] member or

√

REGULATION AND CONTROL

Prepare the GroupCCG’s overarching scheme of reservation and delegation, which sets out those decisions of the GroupCCG’s reserved to the membership and those delegated to the

• The GroupCCG’s Governing Body

√

√

Formatted Table

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

• its members or employees and sets out those decisions of the Governing Body reserved to the Governing Body and those delegated to the

• Governing Body’s committees and sub- committees,

• members of the Governing Body,

• an individual who is member of the GroupCCG but not the Governing Body or a specified person for inclusion in the GroupCCG’s constitution.

REGULATION AND

CONTROL

Approval of the GroupCCG’s overarching scheme of reservation and delegation.

√

REGULATION AND CONTROL

Prepare the GroupCCG’s operational scheme of delegation, which sets out those key operational decisions delegated to individual employees of the clinical commissioning group, not for inclusion in the GroupCCG’s constitution.

√

REGULATION AND CONTROL

Approval of the GroupCCG’s operational scheme of delegation that underpins the GroupCCG’s ‘overarching scheme of reservation and delegation’ as set out in its constitution.

√

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

REGULATION AND

CONTROL

Prepare detailed financial policies that underpin the clinical commissioning groupCCG’s prime financial policies.

√

REGULATION AND CONTROL

Approve Prime financial policies √

REGULATION AND CONTROL

Approve detailed financial policies. √ Governance Audit & Risk Committee

REGULATION AND CONTROL

Approve arrangements for managing exceptional funding requests.

√

REGULATION AND CONTROL

Approve exceptional funding requests (within financial delegated limits).

√ Individual members appointed by the CCG to the Individual Funding Request Panel to make decisions on behalf of the GroupCCG via joint commissioning arrangements.

REGULATION AND CONTROL

Set out who can execute a document by signature / use of the seal

√ In approving

Standing Orders

√ To authorise specific senior managers to execute a document by signature /use of the seal

PRACTICE MEMBER REPRESENTATIVES

Approve the arrangements for • identifying practice members to

represent practices in matters concerning the work of the GroupCCG; and

• appointing clinical leaders to represent the GroupCCG’s membership on the

√

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

Governing Body, for example through election (if desired).

PRACTICE MEMBER REPRESENTATIVES

Approve the appointment of Governing Body members, the process for recruiting and removing non-elected members to the Governing Body (subject to any regulatory requirements) and succession planning.

√

PRACTICE MEMBER REPRESENTATIVES

Approve arrangements for identifying the GroupCCG’s proposed accountable officer.

√

STRATEGY AND PLANNING

Agree the vision, values and overall strategic direction of the GroupCCG.

√ Having regard to the views of the

Members Assembly

STRATEGY AND PLANNING

Approval of the GroupCCG’s operating structure.

√

STRATEGY AND PLANNING

Approval of the GroupCCG’s commissioning plan.

√ Having regard to the views of the

Members Assembly

STRATEGY AND PLANNING

Approval of the GroupCCG’s corporate budgets that meet the financial duties as set out in section 5.3 of the main body of the constitution.

√

STRATEGY AND

PLANNING

Approval of variations to the approved budget where variation would have a significant impact on the overall approved levels of income and

√

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

expenditure or the GroupCCG’s ability to achieve its agreed strategic aims.

ANNUAL REPORTS AND ACCOUNTS

Approval of the GroupCCG’s annual report

√

ANNUAL REPORTS

AND ACCOUNTS

Approval of the arrangements for discharging the GroupCCG’s statutory financial duties.

√ In approving Constitution

HUMAN RESOURCES

Approve the arrangement for determining the terms and conditions, remuneration and travelling or other allowances for Governing Body members, including pensions and gratuities.

√ In approving

Terms of reference of

Remuneration & Terms of Service

Committee

HUMAN RESOURCES

Approve the terms and conditions, remuneration and travelling or other allowances for Governing Body members, including pensions and gratuities.

√

HUMAN RESOURCES

Approve terms and conditions of employment for all employees of the GroupCCG including, pensions, remuneration, fees and travelling or other allowances payable to employees and to other persons providing services to the GroupCCG.

√

HUMAN

RESOURCES

Approve any other terms and conditions of services for the GroupCCG’s employees.

√

HUMAN RESOURCES

Determine the terms and conditions of employment for all employees of the GroupCCG.

√

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

HUMAN RESOURCES

Determine pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the

√

HUMAN RESOURCES

Recommend pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the GroupCCG.

√

Remuneration & Terms of Service

Committee

HUMAN RESOURCES

Approve disciplinary arrangements for employees, including the accountable officer (where he/she is an employee or member of the clinical commissioning group) and for other persons working on behalf of the GroupCCG.

√

HUMAN RESOURCES

Review disciplinary arrangements where the accountable officer is an employee or member of another clinical commissioning group

√

HUMAN

RESOURCES

Approval of the arrangements for discharging the GroupCCG’s statutory duties as an employer.

√ In approving Constitution

HUMAN RESOURCES

Approve human resources policies for employees and for other persons working on behalf of the GroupCCG

√

HR Grievance policy

HR Disciplinary Policy Sickness

and absence policy

√

Executive

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

Whistleblowing Policy

QUALITY AND SAFETY

Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes.

√ √ Oversight and Scrutiny

to Quality Performance

and Finance& Innovation Committee

√ Function discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

QUALITY AND SAFETY

Approve arrangements for supporting NHS Commissioning BoardEngland in discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services.

√ √ Oversight

and scrutiny to Quality Performance

and Finance CommitteeQuality &

Innovation Committee

√ Function discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

OPERATIONAL AND RISK MANAGEMENT

Prepare and recommend an operational scheme of delegation that sets out who has responsibility for operational decisions within the GroupCCG.

√

OPERATIONAL AND RISK MANAGEMENT

Approve an operational scheme of delegation that sets out who has responsibility for operational decisions within the GroupCCG.

√

OPERATIONAL AND RISK MANAGEMENT

Approve the GroupCCG’s counter fraud and security management arrangements.

√ Governance Audit &

Risk Committee

OPERATIONAL AND RISK MANAGEMENT

Approval of the GroupCCG’s risk management arrangements.

√ Through approval Risk Management

Policy and Strategy

√

Determination, and Oversight and scrutiny by the

Governance Audit & Risk Committee

including scrutiny of the Risk

Management Policy and Strategy.

OPERATIONAL AND RISK MANAGEMENT

Approve arrangements for risk sharing and or risk pooling with other organisations (for example arrangements for pooled funds with other clinical commissioning groups or pooled budget arrangements under section 75 of the NHS Act 2006).

√

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

OPERATIONAL AND RISK MANAGEMENT

Approval of a comprehensive system of internal control, including budgetary control that underpins the effective, efficient and economic operation of the GroupCCG.

√

√

Finance Committee

OPERATIONAL AND RISK MANAGEMENT

Approve arrangements for action on litigation against or on behalf of the clinical commissioning group.

√ Governance Audit &

Risk Committee

√

OPERATIONAL AND RISK MANAGEMENT

Approve the GroupCCG’s arrangements for business continuity and emergency planning.

√ Approval of Major Incident Plan and Business continuity Plan

√ Determination, and

Oversight and scrutiny by the

Governance Audit & Risk Committee

OPERATIONAL AND RISK MANAGEMENT

Approve the GroupCCG’s arrangements for handling complaints.

√ Approval of

Complaints Policy

√ Approval of

Complaints Policy by the Governance

Audit & Risk Committee

INFORMATION GOVERNANCE

Approval of the arrangements for Information Governance, ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data.

√

Approval of Information Governance Strategy

√ (Approval of underpinning Information Governance

policies)

Determination, and Oversight and scrutiny by the

Governance Audit & Risk Committee of

the IG Strategy

√

Function discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

(Senior Information Risk Owner and Caldicott guardian)

TENDERING AND CONTRACTING

Approval of the GroupCCG’s contracts for any commissioning support.

√

TENDERING AND CONTRACTING

Approval of the GroupCCG’s contracts for corporate support (for example finance provision).

√

PARTNERSHIP WORKING

Approve decisions that individualmembers or employees of the GroupCCG participating in joint arrangements on behalf of the GroupCCG can make. Such delegated decisions must be disclosed in this scheme of reservation and delegation.

√

√ Executive

PARTNERSHIP

WORKING

Approve decisions delegated to joint committees established under section 75 of the 2006 Act.

√

√

COMMISSIONING AND CONTRACTING

FOR CLINICAL SERVICES

Approval of the arrangements for discharging the GroupCCG’s statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation.

√

Exercise of the Functions discharged

on behalf of the Membership

where named in paragraph 5.1.2 and paragraph 5.2 in the

Constitution

√

Exercise of the Functions discharged

on behalf of the Governing Body, by

the Committee where named in paragraph 5.1.2 and paragraph

5.2 in the Constitution

√

Exercise of the Functions discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

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Policy Area

Decision

Reserved to the Membership

Reserved or delegated to Governing Body

Delegated to a Committee or Sub- Committee

Accountable Officer

Chief Finance Officer

COMMISSIONING

AND CONTRACTING FOR CLINICAL

SERVICES

Approve arrangements for coordinating the commissioning of services with other GroupCCGs and or with the local authority(ies), where appropriate

√

COMMISSIONING

AND CONTRACTING FOR CLINICAL

SERVICES

Make decisions and approve actions in relation to the commissioning of primary care services in partnership with NHS Commissioning BoardEngland; operating within agreed terms of reference for the

√

Primary Care Commissioning CommitteeJoint Commissioning

COMMISSIONING

AND CONTRACTING FOR CLINICAL

SERVICES

Make decisions and approve actions in relation to the commissioning of primary care services operating within agreed terms of reference for the committee.

√

Primary Care Commissioning

Committee

COMMISSIONING AND CONTRACTING FOR CLINICAL SERVICES

Make decisions and approve actions in relation to the Better Health Programme operating within agreed terms of reference for the committee.

Sustainability and Transformation

Plan Joint CommitteeBetter Health Programme

COMMUNICATIONS

Approving arrangements for handling Freedom of Information requests.

√ Approval of

Information Access Policy

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COMMUNICATIONS

Determining arrangements for handling Freedom of Information requests.

√ Determination, and

Oversight and scrutiny by the

Governance Audit & Risk Committee

√ Function

discharged on behalf of the

Governing Body by the

Accountable Officer and the specific lead

officer delegated by the

Accountable Officer to oversee

its discharge

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APPENDIX E – PRIME FINANCIAL POLICIES 1. INTRODUCTION

1.1. General 1.1.1. These prime financial policies and supporting detailed financial policies shall

have effect as if incorporated into the GroupCCG’s constitution. 1.1.2. The prime financial policies are part of the GroupCCG’s control environment for

managing the organisation’s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration; lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the accountable officer and chief finance officer to effectively perform their responsibilities. They should be used in conjunction with the scheme of reservation and delegation found at Appendix D.

1.1.3. In support of these prime financial policies, the GroupCCG has prepared more detailed policies, approved by the Chief Finance Officer, known as detailed financial policies. The GroupCCG refers to these prime and detailed financial policies together as the clinical commissioning group’s financial policies.

1.1.4. These prime financial policies identify the financial responsibilities which apply to everyone working for the GroupCCG and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The Chief Finance Officer is responsible for approving all detailed financial policies.

1.1.5. A list of the GroupCCG’s detailed financial policies will be published and maintained on the GroupCCG’s website at www.darlingtonccg.nhs.uk and will be made available on request.

1.1.6. Should any difficulties arise regarding the interpretation or application of any of the prime financial policies then the advice of the Chief Finance Officer must be sought before acting. The user of these prime financial policies should also be familiar with and comply with the provisions of the GroupCCG’s constitution, standing orders and scheme of reservation and delegation.

1.1.7. Failure to comply with prime financial policies and standing orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.

1.2. Overriding Prime Financial Policies 1.2.1. If for any reason these prime financial policies are not complied with, full details

of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Governing Body’s audit committee for referring action or ratification. All of the GroupCCG’s members and employees have a duty to disclose any non-compliance with these prime financial policies to the chief finance officer as soon as possible.

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1.3. Responsibilities and delegation 1.3.1. The roles and responsibilities of GroupCCG’s members, employees, members

of the Governing Body, members of the Governing Body’s committees and sub- committees, members of the GroupCCG’s committee and sub-committee (if any) and persons working on behalf of the GroupCCG are set out in chapters 6 and 7 of this constitution.

1.3.2. The financial decisions delegated by members of the GroupCCG are set out in the

GroupCCG’s scheme of reservation and delegation (see Appendix D). 1.4. Contractors and their employees 1.4.1. Any contractor or employee of a contractor who is empowered by the

GroupCCG to commit the GroupCCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the accountable officer to ensure that such persons are made aware of this.

1.5. Amendment of Prime Financial Policies 1.5.1. To ensure that these prime financial policies remain up-to-date and relevant, the

chief finance officer will review them at least annually. Following consultation with the accountable officer and scrutiny by the Governing Body’s audit committee, the chief finance officer will recommend amendments, as fitting, to the Governing Body for approval. As these prime financial policies are an integral part of the GroupCCG’s constitution, any amendment will not come into force until the GroupCCG applies to NHS Commissioning BoardEngland and that application is granted.

2. INTERNAL CONTROL

2.1. The Governing Body is required to establish an audit committee with terms of

reference agreed by the Governing Body (see paragraph 5.2.3 of the GroupCCG’s constitution for further information).

2.2. The accountable officer has overall responsibility for the GroupCCG’s

systems of internal control. 2.3. The chief finance officer will ensure that:

a) financial policies are considered for review and update annually; b) a system is in place for proper checking and reporting of all breaches of

financial policies; and c) a proper procedure is in place for regular checking of the adequacy and

effectiveness of the control environment.

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3. AUDIT

3.1. In line with the terms of reference for the Governing Body’s Governance, Audit

and Risk committee, the person appointed by the GroupCCG to be responsible for internal audit and the appointed external auditor will have direct and unrestricted access to audit committee members and the chair of the Governing Body, accountable officer and chief finance officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.2. The person appointed by the GroupCCG to be responsible for internal audit

and the external auditor will have access to the Governance, Audit and Risk committee and the accountable officer to review audit issues as appropriate. All Governance, Audit and Risk committee members, the chair of the Governing Body and the accountable officer will have direct and unrestricted access to the head of internal audit and external auditors.

3.3. The chief finance officer will ensure that:

a) the GroupCCG has a professional and technically competent internal

audit function; and b) the Governing Body approves any changes to the provision or delivery of

assurance services to the GroupCCG. 4. FRAUD AND CORRUPTION

4.1. The Governing Body’s G o v e r n a n c e , Audit a n d R i s k committee will

satisfy itself that the GroupCCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

4.2. The Governing Body’s G o v e r n a n c e , Audit and Risk committee will

ensure that the GroupCCG has arrangements in place to work effectively with NHS Protect.

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SECURITY MANAGEMENT

5.1 In line with their responsibilities, the CCG Accountable Officer will monitor and ensure compliance with Directions issued by the Secretary of State for Health on NHS security management.

5.2 The CCG shall nominate a suitable person to carry out the duties of the Local Security Management Specialist (LSMS) as specified by the Secretary of State for Health guidance on NHS Security Management.

5.3 The CCG shall nominate a person to oversee the NHS Security Management service who will report to the Governing Body.

5.4 The Accountable Officer has overall responsibility for controlling and coordinating security. However, key tasks are delegated to the Security Management Director (SMD) and the appointed Local Security Management Specialist (LSMS).

5. EXPENDITURE CONTROL

5.1. The GroupCCG is required by statutory provisions53 to ensure that its

expenditure does not exceed the aggregate of allotments from NHS Commissioning Board and any other sums it has received and is legally allowed to spend.

5.2. The accountable officer has overall executive responsibility for ensuring that the

GroupCCG complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money.

5.3. The chief finance officer will:

a) provide reports in the form required by NHS

Commissioning Board; b) ensure money drawn from NHS England is required for approved

expenditure only, is drawn down only at the time of need and follows best practice;

c) be responsible for ensuring that an adequate system of monitoring financial performance is in place to enable the GroupCCG to fulfil its statutory

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responsibility not to exceed its expenditure limits, as set by direction of NHS EnglandCommissioning Board.

6. ALLOTMENTS54

6.1. The GroupCCG’s chief finance officer will:

a) periodically review the basis and assumptions used by NHS

Commissioning Board for distributing allotments and ensure that these are reasonable and realistic and secure the GroupCCG’s entitlement to funds;

b) prior to the start of each financial year submit to the Governing Body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and

c) regularly update the Governing Body on significant changes to the initial allocation and the uses of such funds.

53 See section 223H of the 2006 Act, inserted by section 27 of the 2012 Act

54 See section 223(G) of the 2006 Act, inserted by section 27 of the 2012 Act.

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7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL

AND MONITORING

7.1. The accountable officer will compile and submit to the Governing Body a

commissioning strategy which takes into account financial targets and forecast limits of available resources.

7.2. Prior to the start of the financial year the chief finance officer will, on behalf of the

accountable officer, prepare and submit budgets for approval by the Governing Body.

7.3. The chief financial officer shall monitor financial performance against budget and

plan, periodically review them, and report to the Governing Body. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial plans or budgets.

7.4. The accountable officer is responsible for ensuring that information relating to the

GroupCCG’s accounts or to its income or expenditure, or its use of resources is provided to NHS EnglandCommissioning Board as requested.

7.5. The Governing Body will approve consultation arrangements for the GroupCCG’s

commissioning plan55.

55 See section 14Z13 of the 2006 Act, inserted by section 26 of the 2012 Act

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8. ANNUAL ACCOUNTS AND REPORTS

8.1. The chief finance officer will ensure the GroupCCG:

a) prepares a timetable for producing the annual report and accounts and

agrees it with external auditors and the Governance, Audit and Risk Committee;

b) prepares the accounts according to the timetable approved by the Governance, Audit and Risk Committee

c) complies with statutory requirements and relevant directions for the publication of the annual report;

d) considers the external auditor’s management letter and fully addresses all issues within agreed timescales; and

e) publishes the external auditor’s management letter on the GroupCCG’s website at www.darlingtonccg.nhs.uk which will be made available on request.

9. INFORMATION TECHNOLOGY

9.1. The chief finance officer is responsible for the accuracy and security of the

GroupCCG’s computerised financial data and shall:

a) devise and implement any necessary procedures to ensure adequate (reasonable) protection of the GroupCCG's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998;

b) ensure that adequate (reasonable) controls exist over data entry, processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;

c) ensure that adequate controls exist such that the computer operation is separated from development, maintenance and amendment;

d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the chief finance officer may consider necessary are being carried out.

9.2. In addition the chief finance officer shall ensure that new financial systems and

amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

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10. ACCOUNTING SYSTEMS 10.1. The chief finance officer will ensure:

a) the GroupCCG has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of NHS Commissioning Board;

b) that contracts for computer services for financial applications with another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes.

10.2. Where another health organisation or any other agency provides a computer

service for financial applications, the chief finance officer shall periodically seek assurances that adequate controls are in operation.

11. BANK ACCOUNTS

11.1. The chief finance officer will:

a) review the banking arrangements of the GroupCCG at regular

intervals to ensure they are in accordance with Secretary of State directions56, best practice and represent best value for money;

b) manage the GroupCCG's banking arrangements and advise the GroupCCG on the provision of banking services and operation of accounts;

c) prepare detailed instructions on the operation of bank accounts. 11.2. The Governance, Audit and Risk Committee shall approve the banking

arrangements. 12. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES

AND OTHER NEGOTIABLE INSTRUMENTS.

12.1. The Chief Financial Officer is responsible for:

a) designing, maintaining and ensuring compliance with systems for the

proper recording, invoicing, and collection and coding of all monies due; b) establishing and maintaining systems and procedures for the secure

handling of cash and other negotiable instruments; c) approving and regularly reviewing the level of all fees and charges other

than those determined by NHS Commissioning Board or by statute. Independent professional advice on matters of valuation shall be taken as necessary;

d) for developing effective arrangements for making grants or loans.

56 See section 223H(3) of the NHS Act 2006, inserted by section 27 of the 2012 Act

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13. TENDERING AND CONTRACTING PROCEDURE 13.1. Duty to comply with SOs and Prime Financial Policies (PFPs) 13.1.1. The procedure to be followed by the GroupCCG in relation to opportunities

with the GroupCCG and for awarding all contracts with the GroupCCG shall comply with these SOs and PFPs (except where SO No. 3.9 Suspension of SOs is applied)

13.1.2. This section of the PFPs is structured in the following sections:

a) This section: Legislation and Policy Framework, referring to the main

requirements of law and policy. This section is not definitive and other guidance may also be applicable to any decision or procurement (PFP 14.1 to 14.4 inclusive)

b) The decision to tender and exceptions to the requirements to tender (PFP 14.5 to 14.6)

c) Tendering Procedure where a decision is made to tender pursuant to PFP 14.5 and PFP 14.6 (PFP 14.7)

d) Quotations where no tender process (PFP 14.8) e) Evaluation of tenders and quotations (PFP 14.9) f) Award of contracts (PFP 14.10) g) Form of Contract (PFP 14.11)

13.2. Legislation Governing Public Procurement 13.2.1. The GroupCCG shall comply with the Public Contracts Regulations 2006 (the

“Regulations”) and any EU Directives relating to EU procurement law having direct effect in England (the “Directives”) and any other duties derived from the EU Treaty (“Treaty Obligations”) and any duties derived from the UK common law (“Common Law Duties”) (the Regulations, Directives, Treaty Obligations and Common Law Duties together are referred to elsewhere in these SFIs as “Procurement Legislation”). The Procurement Legislation as from time to time amended shall have effect as if incorporated in the SOs and PFPs.

13.2.2. The GroupCCG should consider obtaining support from the NHS Supply Chain

and/or the Office of Government Commerce where relevant and/or any suitably qualified professional advisor (including, where appropriate, legal advisors) to ensure compliance with Procurement Legislation when engaging in tendering procedures.

13.2.3. The GroupCCG shall consider the application of any applicable duty to consult

or engage the public or any relevant Overview and Scrutiny Committee of a Local Authority prior to commencing any procurement process for a contract opportunity.

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13.3. Guidance on Procurement and Commissioning 13.3.1. The GroupCCG should have regard to all relevant guidance issued by NHS

Commissioning Board in relation to the conduct of procurement practice and the commissioning of health care services, including but not limited to:

a) the CCG Procurement Guide for Health Services (NHS ENGLNAD: May

2008) or any successor guide issued by NHS COMMISSIONING BOARD b) the Principles and Rules for Cooperation and Competition attached at

Annex D to the Operating Framework for 2008/09 or any successor to such principles and rules issued by NHS COMMISSIONING BOARD

c) the NHS COMMISSIONING BOARD’S “Capital Investment Manual” and “Estate code” in respect of capital investment and estate and property transactions, save where either has been superseded by later published guidance to which the GroupCCG should have regard

d) in the case of management consultancy contracts NHS COMMISSIONING BOARD guidance “The Procurement and Management of Consultants within the NHS” or any successor guidance issued by NHS COMMISSIONING BOARD

e) policies and procedures in place for the control of all tendering activity carried out through Reverse Auctions. For further guidance on Reverse eAuctions refer to www.ogc.gov.uk

13.4. OGC Gateway Review and Guidance 13.4.1. The GroupCCG should consider the applicability of the Office of Government

Commerce (OGC) Gateway review process (see www.dh.gov.uk/gatewayreviews) to each procurement process undertaken to provide assurance that the procurement is conducted in accordance with best practice

13.5. Decisions to Tender and Exceptions to Requirement to Tender 13.5.1. Presumption to Tender

Where: a) a contract opportunity that is required to be tendered under the Regulations

(i.e. the contract opportunity is governed by the Regulations and the value of the contract opportunity as calculated pursuant to the Regulations exceeds the relevant financial threshold for the requirement to run a formal tender process); or

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b) the contract would pass the Cross Border Test. The Cross Border Test is

passed (subject to any subsequent judicial precedent in the UK Courts or the European Court of Justice) if the contract opportunity under consideration would be (whatever the value of the contract and whether or not the contract opportunity is a Part B service under the Regulations, or falls outside the requirement to tender under the Regulations) of certain interest to anybody located in a member state of the European Union other than the United Kingdom Then subject to PFP 14.5.5 the GroupCCG shall ensure that contract opportunities with the GroupCCG are advertised in accordance with

PFP 14.7.3 and where more than one response is received that competitive tenders are invited in accordance with PFP 14.7.4 for: i) the supply of goods, materials and manufactured articles ii) the rendering of services including all forms of management

consultancy services iii) for the design, construction and maintenance of building and

engineering works (including construction and maintenance of grounds and gardens)

13.5.2. Commissioning Health Care Services: Decision to Tender

Health care services are classed as Part B Services under the Regulations. As such, no requirement to advertise arises by virtue of PFP 14.5.1(a) above, but may do under SFI 14.5.1(b) and each contract opportunity should be assessed against the Cross Border Test.

13.5.3. In-house Services: Decision to Tender Services

The Accountable Officer shall be responsible for ensuring that best value for money can be demonstrated for all services provided on an in-house basis. The CCG may also determine from time to time that in-house services should be market tested by competitive tendering.

13.5.4. Exceptions and instances where formal tendering need not be applied

Where a contract opportunity is required to be tendered under PFP 17.5.1, such contract opportunity need not be advertised and tendered and formal tendering procedures need not be applied where: a) the estimated expenditure or income does not, or is not reasonably

expected to, exceed £50,000; or b) the requirement can be met under an existing contract without infringing

Procurement Legislation, including, without limitation any contract opportunity falling within the exclusivity arrangements granted to a LIFT provider under any LIFT scheme to which the GroupCCG is a party;

c) the GroupCCG is entitled to call off from a Framework Agreement and the requirements of PFP 14.6 (Use of Framework Agreements) have been followed;

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d) a consortium arrangement is in place and a lead organisation has been

appointed to carry out tendering activity on behalf of the GroupCCG; or e) an exception permitting the use of the negotiated procedure without notice

validly applies under regulation 14 of the Regulations.

Formal tendering procedures may be waived in the following circumstances:

a) in very exceptional circumstances where the Accountable Officer decides that formal tendering procedures would not be practicable or the estimated expenditure or income would not warrant formal tendering procedures, and the circumstances are detailed in an appropriate GroupCCG record and reviewed by the Governance, Audit and Risk Committee

b) where the timescale genuinely precludes competitive tendering for reasons of extreme urgency brought about by events unforeseeable by the GroupCCG and not attributable to the GroupCCG. Failure to plan the work properly is not a justification for waiving the requirement to conduct a formal tendering procedure

c) where the works, services or supply required are available from only one source for technical or artistic reasons or for reasons connected with the protection of exclusive rights

d) when the goods required by the GroupCCG are a partial replacement for, or in addition to, existing goods and to obtain the goods from a supplier other than the supplier who supplied the existing goods would oblige the GroupCCG to acquire goods with different technical characteristics and this would result in: • compatibility with the existing goods; or • disproportionate technical difficulty in the operation and maintenance

of the existing goods; but no such contract may be entered in to for a duration of more than three years.

e) when works or services required by the GroupCCG are additional to works or services already contracted for but for unforeseen circumstances such additional works or services have become necessary and that such additional works or services: i) cannot for technical or economic reasons be carried out separately

from the works or services under the original contract without major inconvenience to the GroupCCG; or

ii) can be carried out or provided separately from the works or services under the original contract but are strictly necessary to the latest stages of performance of the original contract provided that the value of such additional works or services does not exceed 50% of the value of the original contract

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f) for the provision of legal advice and/or services provided that any provider

of legal advice and/or services commissioned by the GroupCCG is regulated by the Solicitors Regulation Authority for the conduct of their business (or by the Bar Council for England and Wales in relation to the obtaining of Counsel’s opinion) and are generally recognised as having sufficient expertise in the area of work for which they are commissioned.

The Chief Finance Officer will ensure that any fees paid are reasonable and within commonly accepted rates for the costing of such work.

13.5.5. Monitoring and Audit of Decision to Tender

The waiving of competitive tendering procedures should not be used with the object of avoiding competition or solely for administrative convenience or subject to PFPss 14.5.5 (b) to (j) to award further work to a provider originally appointed through a competitive procedure.

Where it is decided that competitive tendering need not be applied or should be waived, the fact of the waiver and the reasons should be documented and recorded in an appropriate GroupCCG record and reported to the Governance, Audit and Risk Committee at each meeting.

Where the GroupCCG proposes not to conduct a tender process in relation to a contract opportunity for a new health care service or a significantly changed health care service then the GroupCCG shall consider such proposal at a meeting of the Governing Body as recommended by the CCG Procurement Guide.

13.5.6. Contracts which subsequently breach thresholds after original approval not to

tender

Contract opportunities estimated to be below the financial limits set out in SFI 17 or below the threshold for the application of the requirement to tender under the Regulation, for which formal tendering procedures are not used which subsequently prove to have a value above such limits shall be reported to the Chief Officer, and be recorded in an appropriate GroupCCG record and reported to the Governance, Audit and Risk Committee.

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13.6. Use of Framework Agreements

The GroupCCG may utilise any available framework agreement to satisfy its requirements for works, services or goods but only if it complies with the requirements of Procurement Legislation in doing so, which include (but are not limited to) ensuring that: a) the framework agreement was procured on its behalf. The GroupCCG

should satisfy itself that the original procurement process included the GroupCCG within its scope

b) the framework agreement includes the GroupCCG’s requirement within its scope.

The GroupCCG should satisfy itself that this is the case c) where the framework agreement is a multi-operator framework agreement,

the process for the selection of providers to be awarded call-off contracts under the framework agreement is followed

d) the call-off contract entered into with the provider contains the contractual terms set out by the framework agreement.

13.7. Tendering Procedure 13.7.1. Equality of Treatment

The GroupCCG shall ensure that no sector of any market (public, private, third sector/social enterprise) is given an unfair advantage in the design or conduct of any tender process.

13.7.2. Non-Discrimination

a) The subject matter and the scope of the contract opportunity should be

described in a non-discriminatory manner. The GroupCCG should utilise generic and/or descriptive terms, rather than the trade names of particular products or processes or their manufacturers or their suppliers.

b) All participants in a tender process should be treated equally and all rules governing a tender process must apply equally to all participants.

13.7.3. Where advertisement of a contract opportunity is required under PFP 14.5.1

then:

a) where a contract opportunity falls within the Regulations and a process compliant with the Regulations is required, an OJEU Notice should be utilised

b) without prejudice to PFP 14.7.3(c) below where a contract opportunity does not fall within the Regulations the GroupCCG shall utilise a form of advertising for such contract opportunity that is sufficient to enable potential providers (including providers in members states of the EU other than the UK) to access appropriate information about the contract opportunity so as to be in a position to express an interest

c) in relation to any contract opportunity for health care services the GroupCCG shall as a minimum advertise on www.supply2health.nhs.uk, the

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CCG procurement portal operated by NHS Commissioning Board. 13.7.4. Choice of Procedure

a) where a contract opportunity falls within the Regulations and a process

compliant with the Regulations is required then the GroupCCG shall utilise an available tender procedure under the Regulations.

b) in all other cases the GroupCCG shall utilise a tender procedure proportionate to the value, complexity and risk of the contract opportunity and shall ensure that invitations to tender are sent to a sufficient number of providers to provide fair and adequate competition (in any event no less than three where the GroupCCG is able to identify three providers within the relevant market).

c) when exercising its obligations under PFP 14.7.4 (a) and (b) above, and to the extent that such a process complies with the requirements set out in this PFP 14, the GroupCCG may use an e-tendering process (including the use of reverse e-auctions) for the tendering of contract opportunities.

13.7.5. Invitation to Tender

a) All invitations to tender shall state the date and time as being the latest time

for the receipt of tenders. b) All invitations to tender shall state that no tender will be accepted unless:

i) all tender documents are returned, addressed to the Chief Officer of the GroupCCG, to a common point at GroupCCG premises by a particular date and time.

ii) include provisions for labelling to include a unique tender reference number

iii) instructions that the tender is not to be opened at the point of collection

iv) there should be no Tenderer’s identifying information on the packaging.

v) the invitation or documents issued in response to enquiry following advertisement shall also require that a “Master” copy of the Tender documentation (in paper format and/or electronic media) and at least one full duplicate set shall be included in each tender

c) Every invitation to tender must require each bidder to give a written undertaking, not to engage in collusive tendering or other restrictive practice and not to engage in canvassing the GroupCCG, its employees or officers concerning the contract opportunity tendered.

13.7.6. Receipt and Safe Custody of Tenders

The Accountable Officer or his/her nominated representative (who may not be from the department that sponsored or commissioned the relevant invitation to tender, referred to as the “Originating Department” for the remainder of PFP 14) will be responsible for the receipt, endorsement and safe custody of tenders received until the time appointed for their opening. The date and time of receipt

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of each tender shall be endorsed on the tender envelope/package by the Chief Officer or their nominated representative.

13.7.7. Opening tenders and Register of Tenders

a) As soon as practicable after the date and time stated as being the latest

time for the receipt of tenders, they shall be opened by two senior officers/managers designated by the Chief Officer (who may not be from the Originating Department). A Designated officer should be Band 7 or above and be accompanied by another member of staff who can also be shown to be fully impartial and objective.

b) A member of the GroupCCG Governing Body or delegated representative from Commissioning Support Service will be required to be one of the two approved persons present for the opening of tenders estimated to be of a value above £100,000. The rules relating to the opening of tenders will need to be read in conjunction with any delegated authority set out in the GroupCCG’s Scheme of Delegation.

c) Subject to PFP 14.7.11 the involvement of Finance Directorate staff in the Originating Department’s preparation of an invitation to tender will not preclude the Chief Finance Officer or any approved Senior Manager from the Finance Directorate from serving as one of the two senior managers to open tenders.

d) The designated Officer will be authorised to open tenders regardless of whether they are from the Originating Department provided that the other authorised person opening the tenders with them is not from the Originating Department.

e) Every tender received shall be marked with the date of opening and initialled by those present at the opening.

f) A register shall be maintained by the Chief Officer, or a person authorised by him, to show for each competitive invitation to tender despatched: i) the names of all organisations/ individuals invited; ii) the names of all organisations/ individuals from which tenders have

been received; iii) the date the tenders were received and opened; iv) the persons present at the opening; v) the price shown on each tender; and vi) a note where price alterations have been made on the tender and

suitably initialled.

Each entry to this register shall be signed by those present at the opening of the relevant tenders. A note shall be made in the register if any one tender price has had so many alterations that it cannot be readily read or understood.

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13.7.8. Admissibility of Tenders

If for any reason the designated officers are of the opinion that the tenders received are not sufficient to demonstrate competition (for example, because their numbers are insufficient or any are amended, incomplete or qualified) no contract shall be awarded without the approval of the Accountable Officer.

Where only one tender is sought and/or received, the Accountable Officer and Chief Finance Officer shall, as far practicable, ensure that the price to be paid is fair and reasonable and will ensure best value for the CCG.

13.7.9. Late Tenders

Tenders received after the due time and date, but prior to the opening of the other tenders, may be considered only if the Accountable Officer or his/her nominated officer decides that there are exceptional circumstances i.e. despatched in good time but delayed through no fault of the tenderer.

Only in the most exceptional circumstances will a tender be considered which is received after the opening of the other tenders and only then if the tenders that have been duly opened have not left the custody of the Accountable Officer or his/her nominated officer or if the process of evaluation and adjudication has not started.

While decisions as to the admissibility of late, incomplete or amended tenders are under consideration, the tender documents shall be kept strictly confidential, recorded, and held in safe custody by the Accountable Officer or his/her nominated officer.

Accepted late tenders will be reported to the Governing Body.

13.7.10. Electronic Tenders (alternative to paper submission)

In place of the Manual processes in part 1, the GroupCCG may choose to receive directly or indirectly through an outsourced procurement service tenders in electronic format, subject to equivalent processes and safeguards being adopted at every stage in each case. a) Suppliers are invited to respond to tenders using electronic process b) Completed electronic tenders are returned to a secure Trust specific

e-mail address (referred to as a safe) c) Completed tenders cannot be opened or accessed until the specified

submission / completion date and time d) The safe to be opened by two senior officers/managers designated by the

Accountable Officer. A Designated officer should be Band 7 or above and be accompanied by another member of staff who can also be shown to be fully impartial and objective. A senior officer of the Procurement service may be designated in place of a member of staff of the GroupCCG as having delegated authority to open tenders

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e) The two nominated officers will have separate individual passwords. And

tenders are unable to be accessed until both nominated officers have opened the safe.

f) Tenders can only be opened by the authorised Tender Opening Officers g) The two nominated officers only have permissions to open the safe, no

other permissions are allowed. (if required other Trust nominated officers can be assigned this permission)

h) All actions are recorded electronically to include date, time and individual i) An electronic register of tenders will be maintained by the Procurement

Department j) Procurement staff will process the Tenders once opened as laid down by

OJEU and Trust procedures k) A full audit trail is maintained electronically l) Notwithstanding the terminology used above, any method of electronic

receipt storage and opening of Tenders that is functionally equivalent in delivering a secure process with the same controls will be acceptable

The GroupCCG shall have a standing operating procedure in place for the control of all tendering activity carried out through dynamic purchasing systems and electronic auctions if such mechanisms are to be utilised by the GroupCCG for tendering any contract opportunity. Further guidance on dynamic purchasing systems or electronic auctions refer to www.ogc.gov.uk.

13.8. Quotations Competitive and non-competitive

13.8.1. General Position on Quotations

a) Subject to PFPI 14.8.1(b) and PFP 14.8.1(c) quotations are required for all

contract opportunities where formal tendering procedures are not adopted and where the intended expenditure or income exceeds, or is reasonably expected to exceed £[15,000] but not exceed £[50,000] provided that the quotation demonstrates best value

b) Competitive quotations are not required where a contract opportunity need not be advertised and tendered under PFP 14.5.5(b) to (f) inclusive

c) Competitive quotations are not required where the requirement to advertise and tender a contract opportunity has been waived under PFP 14.5.5(g) to (l) inclusive

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13.8.2. Competitive Quotations

Where competitive quotations are required under PFP 14.8.1: i) quotations should be obtained from at least [3] organisations/individuals

based on specifications or terms of reference prepared by, or on behalf of, the GroupCCG or

ii) quotations should be obtained in writing unless the Accountable Officer or his nominated officer determines that it is impractical to do so in which case quotations may be obtained by telephone. Confirmation of telephone quotations in writing should be obtained as soon as possible and the reasons why the telephone quotation was obtained should be set out in an appropriate GroupCCG record

iii) all quotations should, subject to compliance with the provisions of the Freedom of Information Act 2000, be kept confidential and should be retained for six months from the date of receipt for inspection

iv) the Accountable Officer or his nominated officer (who shall not be from the Originating Department) should evaluate each quotation received applying evaluation criteria in accordance with PFP 14.9 and select the quote which gives the best value for money.

13.8.3. Non-Competitive Quotations

a) Subject to PFP 14.8.3(b) below non-competitive quotations in writing must

be obtained for any contract opportunity where formal tendering procedures are not adopted and where competitive quotations are not required under PFP 14.8.1

b) Where competitive tendering or a competitive quotation is not required, the GroupCCG shall use the NHS Supply Chain for procurement of all goods unless the Accountable Officer or nominated officers deem it inappropriate. The decision to use alternative sources must be documented in an appropriate GroupCCG record.

13.8.4. Quotations to be within Financial Limits

No quotation shall be accepted by the GroupCCG which will commit expenditure in excess of that which has been allocated by the GroupCCG except with the authorisation of either the Accountable Officer or Chief Finance Officer.

13.9. Evaluation of Tenders and Quotations 13.9.1. Overriding duty to achieve best value

The GroupCCG shall ensure that it seeks to obtain best value for each contract opportunity.

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13.9.2. Choice of Evaluation Methodology

The GroupCCG must for each contract opportunity which is subject to a tender or a competitive quotation choose to adopt evaluation criteria based on either: a) the most economically advantageous tender, based on criteria linked to the

subject matter of the contract opportunity including but not limited to some or all of: i) quality;ii) price; iii) technical merit; iv) aesthetic and functional characteristics; v) environmental characteristics; vi) running costs; vii) cost effectiveness; viii) after sales service; ix) technical assistance; x) delivery date; xi) delivery period; and/or xii) period of completion.

Or b) the lowest price

13.9.3. Each invitation to tender or invitation to supply a competitive quotation must state

the evaluation criteria to be used to evaluate the tender or quotation and the relative weightings of each such criterion.

13.10. Award of Contracts 13.10.1. Acceptance of Formal Tenders

a) Any discussions with a tenderer which are deemed necessary to clarify

technical aspects of his/her tender before the award of a contract will not disqualify the tender

b) Incomplete tenders (i.e. those from which information necessary for the adjudication of the tender is missing) and amended tenders (i.e. those amended by the tenderer upon his own initiative either orally or in writing after the due time for receipt) should be dealt with in the same way as late tenders (see PFP 14.7.9 above)

c) Where examination of tender reveal errors which would affect the tender figure, the tenderer may be given details of such errors and afforded the opportunity of confirming or withdrawing his offer

d) No tender shall be accepted by the GroupCCG which will commit expenditure in excess of that which has been allocated by the GroupCCG except with the authorisation of the Accountable Officer

e) No tender shall be accepted by the GroupCCG which is obtained contrary to these SFIs except with the authorisation of the Accountable Officer or Chief Finance Officer

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f) All tenders should, subject to compliance with the provisions of the

Freedom of Information Act 2000, be kept confidential and should be retained for 12 months from the date set for the receipt of tenders for inspection.

13.10.2. Authorisation of Tenders and Competitive Quotations

Providing all the conditions and circumstances set out in these Prime Financial Policies have been fully complied with, formal authorisation and awarding of a contract may be decided by the following staff to the value of the contract as follows:

Head of Service £50k Chief Finance Officer £100k Accountable Officer £150k Accountable Officer and Chief Finance Officer £200k Chair and Accountable Officer £250k Governing Body above £250k

These levels of authorisation may be varied or changed and need to be read in conjunction with the GroupCCG Governing Body’s Scheme of Delegation. Once a contract has been awarded, appropriate staff may authorise invoices against the contract value in accordance with Financial Procedure Notes. Formal authorisation must be put in writing. In the case of authorisation by the GroupCCG Governing Body this shall be recorded in their minutes.

13.10.3. Tender reports to the GroupCCG Governing Body

Reports to the GroupCCG Governing Body will be made on an exceptional circumstances basis only.

13.11. Form of Contract 13.11.1. Form of contract: General

The GroupCCG shall consider the most applicable form of contract for each contract opportunity (including to the extent appropriate any NHS standard contract conditions available) and should consider obtaining support from a suitably qualified professional advisor (including, where appropriate, legal advisors).

13.11.2. Contracts for Health Care Services

Where a mandatory requirement of NHS Commissioning Board, the GroupCCG shall utilise the most relevant NHS commissioning contract for the commissioning of health care services, or where a mandatory requirement of NHS Commissioning Board include standard provisions.

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13.11.3. Employment, Agency and Consultants Contracts

The Accountable Officer shall nominate officers with delegated authority to enter into permanent and temporary contracts of employment and other contracts for agency staff or persons engaged on a consultancy basis.

13.11.4. Compliance Requirements for all Contracts

The GroupCCG may only enter into contracts within the statutory powers delegated to it by the Secretary of State or otherwise derived from Statute and each such contract shall: a) comply with the GroupCCG’s Standing Orders and Prime Financial Policies; b) comply with the requirements of all EU Directives directly enforceable in the

UK and all other statutory provisions; c) require (where applicable) the standards set out in the Standards for Better

health (as issued by NHS Commissioning Board from time to time) to be followed;

d) embody substantially the same terms and conditions of contract as were the basis on which tenders or quotations were invited;

e) be entered into and managed to obtain best value; f) have an officer nominated by the Accountable Officer to oversee and

manage each contract on behalf of the GroupCCG. 14. COMMISSIONING

14.1. The GroupCCG will coordinate its work with NHS Commissioning

Board, other Clinical Commissioning Groups, and local providers of services, local authority (ies), including through Health & Wellbeing Boards, patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans.

14.2. The accountable officer will establish arrangements to ensure that regular

reports are provided to the Executive Team detailing actual and forecast expenditure and activity for each contract.

14.3. The chief finance officer will maintain a system of financial monitoring to ensure

the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality.

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15. RISK MANAGEMENT AND INSURANCE 15.1. The GroupCCG will put arrangements in place for evaluation and management

of its risks. The GroupCCG will develop a risk management strategy which describes the GroupCCG’s approach to the managment of risk, how risk will be assessed consistently and how the effectiveness of these ystems will be assessed.

15.2 The GroupCCG will, on an annual basis, identify its strategic risks and develop

an assurance framework.This will be reviewed by the Governing Body. 15.3 The Governance, Audit and Risk Committee will assess the effectiveness of

the GroupCCG’s arrangements for risk management. 16. PAYROLL

16.1. The chief finance officer will ensure that the payroll service selected:

a) is supported by appropriate (i.e. contracted) terms and conditions; b) has adequate internal controls and audit review processes; c) has suitable arrangements for the collection of payroll deductions and

payment of these to appropriate bodies. 16.2. In addition the chief finance officer shall set out comprehensive procedures

for the effective processing of payroll. 1. REMUNERATION AND TERMS OF SERVICE (see overlap with SO)

18.1 The CCG will pay allowances to the Chair and non-officer members of the Governing Body

in accordance with instructions issued by the Secretary of State for Health.

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18.2 Funded Establishment 18.2.1 The manpower plans incorporated within the annual budget will form the funded

establishment. 18.2.2 The funded establishment of any department may not be varied without the approval of

the Accountable Officer. 18.3 Staff Appointments 18.3.1 No officer, or Member of the CCG Governing Body or employee may engage, re-engage, or

re-grade employees, either on a permanent or temporary nature, or hire agency staff, or agree to changes in any aspect of remuneration:

(a) unless authorised to do so by the Accountable Officer; and (b) within the limit of their approved budget and funded establishment.

18.4 Contracts of Employment 18.4.1 The Governing Body shall delegate responsibility to an officer for:

(a) ensuring that all employees are issued with a Contract of Employment in a form

approved by the Governing Body and which complies with employment legislation; and

(b) dealing with variations to, or termination of, contracts of employment.

17. NON-PAY EXPENDITURE

17.1. The Governing Body will approve the level of non-pay expenditure on an annual

basis and the accountable officer will determine the level of delegation to budget managers

17.2. The accountable officer shall set out procedures on the seeking of professional

advice regarding the supply of goods and services. 17.3. The chief finance officer will:

a) advise the Governing Body on the setting of thresholds above which

quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the scheme of reservation and delegation;

b) be responsible for the prompt payment of all properly authorised accounts

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and claims; c) be responsible for designing and maintaining a system of verification,

recording and payment of all amounts payable. 18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY

OF ASSETS

18.1. The accountable officer will:

a) ensure that there is an adequate appraisal and approval process in place

for determining capital expenditure priorities and the effect of each proposal upon plans;

b) be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

c) shall ensure that the capital investment is not undertaken without confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges;

d) be responsible for the maintenance of registers of assets, taking account of the advice of the chief finance officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.

18.2. The chief finance officer will prepare detailed procedures for the disposals of

assets. 19. RETENTION OF RECORDS

19.1. The Accountable Officer shall:

a) be responsible for maintaining all records required to be retained in

accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance;

b) ensure that arrangements are in place for effective responses to Freedom of Information requests;

c) publish and maintain a Freedom of Information Publication Scheme. 20. TRUST FUNDS AND TRUSTEES

The chief finance officer shall ensure that each trust fund which the Group is responsible for managing is managed appropriately with regard to its purpose and to its requirements.

23. DISPOSALS AND CONDEMNATIONS, LOSSES AND SPECIAL

PAYMENTS

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23.1. Procedures

23.1.1 The chief finance officer must prepare detailed procedures for the disposal of assets including condemnations, and ensure that these are notified to managers.

23.1.2 When it is decided to dispose of a CCG asset, the chief finance officer will determine the estimated market value of the item, taking account of professional advice where appropriate.

23.1.3 All unserviceable articles shall be:

(a) condemned or otherwise disposed of by an employee authorised for that purpose by the chief finance officer;

(b) recorded by the Condemning Officer in a form approved by the chief finance officer which will indicate whether the articles are to be converted, destroyed or otherwise disposed of. All entries shall be confirmed by the countersignature of a second employee authorised for the purpose by the chief finance officer.

23.1.4 The Condemning Officer shall satisfy himself as to whether or not there is evidence of negligence in use and shall report any such evidence to the chief finance officer who will take the appropriate action.

23.2 Losses and Special Payments Procedures

23.2.1 The chief finance officer must prepare procedural instructions on the recording of and accounting for condemnations, losses, and special payments.

23.2.2 Any employee or officer discovering or suspecting a loss of any kind must immediately inform the Accountable Officer or the Chief Finance Officer. Where a criminal offence is suspected, the Chief finance officer must immediately inform the police if theft or arson is involved. In cases of fraud and corruption or of anomalies

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which may indicate fraud or corruption, the chief finance officer must inform the relevant LCFS and Operational Fraud Team (OFT) in accordance with Secretary of State for Health’s Directions.

24. PAYMENTS TO CONTRACTORS

24.1 Role of the CCG

24.1.1 The CCG will approve additions to, and deletions from, approved lists of contractors, taking into account the health needs of the local population, and the access to existing services. All applications and resignations received shall be dealt with equitably, within any time limits laid down in the contractors NHS terms and conditions of service.

24.2 Duties of the Accountable Officer

24.2.1 The Accountable Officer shall:

(a) ensure that lists of all contractors, for which the CCG is responsible, are maintained in an up to date condition;

(b) ensure that systems are in place to deal with applications, resignations, inspection of premises, etc, within the appropriate contractor's terms and conditions of service.

24.3 Duties of the Chief Finance Officer

24.3.1 The Chief Finance Officer shall:

(a) ensure that contractors who are included on a Clinical Commissioning Group's approved lists receives payments;

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(b) maintain a system of payments such that all valid contractors' claims are paid promptly and correctly, and are supported by the appropriate documentation and signatures;

(c) ensure that regular independent verification of claims is undertaken, to confirm that:

(i) rules have been correctly and consistently applied;

(ii) overpayments are detected (or preferably prevented) and recovery initiated;

(iii) suspicions of possible fraud are identified and subsequently dealt with in line with the Secretary of State for Health’s Directions on the management of fraud and corruption.

(d) ensure that arrangements are in place to identify contractors receiving exceptionally high, low or no payments, and highlight these for further investigation; and

(e) ensure that a prompt response is made to any query raised by either the Prescription Pricing Division or the Dental Practice Division of the NHS Business Services Authority, regarding claims from contractors submitted directly to them.

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APPENDIX F – THE NOLAN PRINCIPLES The ‘Nolan Principles’ set out the ways in which holders of public office should behave in discharging their duties. The seven principles are:

a) Selflessness – Holders of public office should act solely in terms of the

public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

b) Integrity – Holders of public office should not place themselves under any

financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

c) Objectivity – In carrying out public business, including making public

appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

d) Accountability – Holders of public office are accountable for their

decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

e) Openness – Holders of public office should be as open as possible about

all the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

f) Honesty – Holders of public office have a duty to declare any private

interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

g) Leadership – Holders of public office should promote and support these

principles by leadership and example.

Source: The First Report of the Committee on Standards in Public Life (1995)57

57 Available at http://www.public-standards.gov.uk/

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APPENDIX G – NHS CONSTITUTION

The NHS Constitution sets out seven key principles that guide the NHS in all it does:

1. The NHS provides a comprehensive service, available to all - irrespective of gender, race,

disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to Groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population

2. Access to NHS services is based on clinical need, not an individual’s ability to pay -

NHS services are free of charge, except in limited circumstances sanctioned by Parliament. 3. The NHS aspires to the highest standards of excellence and professionalism - in the

provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.

4. NHS services must reflect the needs and preferences of patients, their families and

their carers - patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.

5. The NHS works across organisational boundaries and in partnership with other

organisations in the interest of patients, local communities and the wider population - the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being

6. The NHS is committed to providing best value for taxpayers’ money and the most cost-

effective, fair and sustainable use of finite resources - public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves

7. The NHS is accountable to the public, communities and patients that it serves - the NHS

is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose.

Source: The NHS Constitution: The NHS belongs to us all (March 2012)58

58 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961

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APPENDIX H – CHECKLIST FOR A CLINICAL COMMISSIONING GROUP’S CONSTITUTION Essential/ Optional

Content Included

Essential The constitution must specify: • the name of the clinical commissioning group; • the members of the Group; and • the area of the Group The name of the Group must comply with such

Essential The constitution must specify the arrangements made by the clinical commissioning group for the discharge of its functions (including its functions in determining the terms and conditions of its

Optional The arrangements may include provision: • for the appointment of committees or sub-committees of the clinical commissioning group; and • for any such committees to consist of or i l d h h b l

Optional The arrangements may include provision for any functions of the clinical commissioning group to be exercised on its behalf by: • any of its members or employees; • its Governing Body; or

Essential The constitution must specify the procedure to be followed by the clinical commissioning group in making

Essential The constitution must specify the arrangements made by the clinical commissioning group for discharging its duties in respect of registers of interest and management of conflicts of interest as specified

d ti 14O(1) t (4) f th 2006 A t

Essential The constitution must also specify the arrangements made by the clinical commissioning group for securing that there is transparency about the decisions of the Group and the manner in which they are made The provisions made above must secure that there is effective participation by each member of the

Essential The constitution must specify the arrangements made by the clinical commissioning group for the discharge of the functions of its Governing Body

Essential The arrangements must include: • provision for the appointment of the audit committee and remuneration committee of the

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Essential/ Optional

Content Included

Optional The arrangements may include: • provision for the audit committee (but not the remuneration committee) to include individuals who are not members of the Governing Body • provision for the appointment of other committees or sub- committees of the Governing Body. These may include provision for a committee or sub-committee to include individuals who are not members of the Governing Body but are:

Optional The arrangements may include provision for any functions of the Governing Body to be exercised on its behalf by: • any committee or sub-committee of the Governing Body, • a member of the Governing Body;

Essential The constitution must specify the procedure to be followed by the

Essential The constitution must also specify the arrangements made by the clinical commissioning group for securing that there is transparency about the decisions of the Governing Body and the manner in which they are made This provision must include provision for meetings of governing bodies to be open to the public, except where the clinical commissioning group

Essential In its constitution, the clinical commissioning group must describe the arrangements which it has made and include a statement of the principles which it will follow in implementing those arrangements, to secure that individuals to whom health services are being or may be provided pursuant to its commissioning arrangements are involved (whether by being consulted or provided with information or in other ways): • in the planning of the commissioning arrangements by the Group; • in the development and consideration of

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NHS Darlington Clinical Commissioning Group and

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Governing Body

Public

Agenda Item: 4.1.2

7th February 2017

Title Hartlepool and Stockton-on-Tees CCG Constitution

Purpose Approval ☐ Discussion ☐ Information ☒

Responsible CCG Member / Lead

Ali Wilson, Chief Officer

Author of Report Andrew Carter, Governance and Risk Manager Recommendation(s) The Governing Body is requested to NOTE the revised

Constitution.

Executive Summary

There are a number of minor corrections, however the key changes surround the alterations to the CCG governance structure including the changes from 11 members of the Governing Body to 12 and the strengthening of the registering and declaring interests part of the constitution. A summary of the changes is included at Appendix 1. Governing Body members are reminded that any constitution changes are to be approved by the Council of Members.

Clinical Engagement Via Executive Team Does this report provide evidence of assurance for the Assurance Framework and / or mitigate risk included on the CCG’s Risk Register?

The Constitution is the CCG’s key Governance document

Has an Equality Analysis been completed?

Not Applicable

Attachments Summary of Changes to the constitution – HaST CCG HaST CCG Constitution v4

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Darlington CCG strategic objectives supported by this report Domain Tick

Well-led Organisation To be well-led and governed ensuring continuous development of the CCG ☐

Delegated Functions Delivery of the CCG’s delegated functions including joint commissioning of primary care and GPIT, whilst exploring and preparing for further opportunities

☐

Financial Management Delivery of financial balance including the 1% surplus, value for money and efficiencies to enable the CCG to reinvest to deliver our strategic plans

☐

Performance Ensuring measurable improvement of the quality and safety of the services that we commission

☐

Planning Identify commissioning opportunities and working in collaboration with partners, including Local Health and care providers and the voluntary sector to improve the health and wellbeing of patients and communities and to reduce health inequalities.

Delivery of innovative and new models of care

To demonstrate system leadership across the health and social care economy

☐

HaST CCG strategic objectives supported by this report

Objective Tick 1. To be well-led and governed ensuring continuous development of the

CCG, enabling the CCG to deliver its statutory functions including engagement with patients and the wider public and ensuring that all member practices have the opportunity to actively engage with and influence the work of the CCG.

☒

2. Ensuring measurable improvement in the quality and safety of the services that we commission including performance of services and the experiences of those who use them including delivery of constitutional standards.

☒

3. Delivery of financial balance including the 1% surplus and delivery of value for money savings to enable the CCG to reinvest to deliver our strategic plans.

☒ 4. Identify commissioning opportunities, working in collaboration with

partners, including Local, health care providers and voluntary sector to improve the health and wellbeing of patients and communities and reduce health inequalities.

☒

5. Delivery of innovative and new models of care, aspiring to maximise provision in a community setting where possible and providing the best possible hospital services where necessary.

☒ 6. To demonstrate system leadership across the health and social care

economy and to provide strategic leadership to partner agencies ☒ 7. Delivery of the CCG’s delegated functions including joint commissioning

of primary care and GPIT, whilst exploring and preparing for further opportunities

☒ Other Committees/Meetings where this report has been presented Executive Does this need to be reported to another Committee/Meeting? Council of

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Summary of Amendments to NHS Hartlepool and Stockton-on- Tees CCG’s Constitution (as incorporated, marked as version 4)

Page/Paragraph Reference Description of amendment Reason for amendment 1. Contents Amended to accurately reflect page

numbering of sections Changes to sections within the constitution have been made and contents has been amended to reflect these changes

2. Pages 16, 22, 26, 31, 58, 59, 64, 66, 73, 75, 77, 80, 82, 90, 91, 92, 93, 98, 102, 103,

Amendment from Audit to Audit and Risk Committee.

Audit Committee and Governance and Risk Committee have been replaced by a single Audit and Risk Committee

3. Page 18 Removal of discharge of responsibility to act effectively, efficiently and economically to the Governance and Risk Committee

Governance and Risk Committee no longer carrying out this duty, now delegated to Chief officer as per point a

4. Page 21 Removal of promote research and the use of research to the Governance and Risk Committee

Governance and Risk Committee no longer carrying out this duty, now delegated to Executive

5. Page 26 Removal of Governance and Risk Committee from list of committees

Audit Committee and Governance and Risk Committee have been replaced by a single Audit and Risk Committee

6. Pages 26 Amendment of Better Health Programme Joint Committee to Sustainability and Transformation Plan Joint Committee

Better Health Programme has become a programme included within the overall arrangements for the Sustainability and Transformation Plan

7. Page 31 Amendment of number of Governing Body members from 11 to 12

CCG required to recruit additional lay member in order to comply with statutory guidance regarding conflicts of interest.

8. Page 32 Removal of Governance and Risk Committee

Audit Committee and Governance and Risk Committee have been replaced by a single Audit and Risk Committee

9. Page 33 Amendment of Better Health Programme Joint Committee to Sustainability and Transformation Plan Joint Committee

Better Health Programme has become a programme included within the overall arrangements for the Sustainability and Transformation Plan and membership has changed to include NHS Hambleton, Richmondshire and Whitby CCG and remove North Durham CCG.

10. Page 38 Insertion of and standards of business conduct

To clarify that the policy is known as the policy for managing conflicts of interest and standards of business conduct

11. Page 39 to 41 Updated information regarding declaring and registering interests

CCG required to comply with statutory guidance regarding conflicts of interest

12. Pages, 47 to 49, Appendix A – list of member practices

Practice information updated Whole appendix revised and amended to include up-to-date, accurate information of member practices.

11. Page 64, Appendix C, Decisions/Duties delegated by the Council of members to, and

Approve management policies including HR, Information Governance and other corporate policies

Removal of Governance and Risk Committee means this is no longer delegated.

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reserved by the Governing Body 12. Page 66, Appendix C,

Decisions/Duties delegated by the Governing Body to Committee (Audit and RiskCommittee)

Description of the functions delegated to the Audit and Risk

Additional responsibilities to be undertaken by Audit and Risk Committee

13. Pages 67-68, Appendix C, Decisions/Duties delegated by the Governing Body to Committee (Governance and Risk Committee.)

Removal of Governance and Risk Committee

Audit Committee and Governance and Risk Committee have been replaced by a single Audit and Risk Committee

14. Pages 69-71, Appendix C, Decisions/Duties delegated by the Governing Body to Committee (Joint Committee of Clinical Commissioning Groups Sustainability and Transformation Plans)

Description of the functions delegated to the Committee.

Better Health Programme has become a programme included within the overall arrangements for the Sustainability and Transformation Plan

15. Page 126, Appendix H, section Audit Committee

Insertion of revised Terms of Reference for the Audit Committee

To include latest ToR as they are reviewed and amended to be fit for purpose by the Committee on an annual basis.

16. Page 133, Appendix H, section Remuneration Committee

Insertion of revised Terms of Reference for the Remuneration Committee

To include latest ToR as they are reviewed and amended to be fit for purpose by the Committee on an annual basis.

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NHS HARTLEPOOL AND STOCKTON-ON-TEES CLINICAL COMMISSIONING GROUP

CONSTITUTION

Version: 4 FINAL as Amended, February 2017

NHS England Effective Date: 01.04.17

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Document History Version Date Significant Changes

V1.16 31/03/2013 Original approved version

V1.17 01/12/2013 Minor changes made

V2 01/02/2015 Revised constitution to incorporate minor changes and primary care co-commissioning arrangements

V3 01/02/2016 Revised constitution to incorporate minor changes including member practices and primary care commissioning arrangements

V4 01/02/2017 Revised constitution to incorporate minor changes to governance arrangements and scheme of delegation

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CONTENTS Part Description Page Foreword 5 Definitions of Key Descriptions used in this Constitution 6 1 Introduction and Commencement 8 1.1 Name 8 1.2 Statutory framework 8 1.3 Status of this constitution 8 1.4 Amendment and variation of this constitution 9 2 Area Covered 9 3 Membership 10 3.1 Membership of the clinical commissioning group 10 3.2 Eligibility 10 3.3 Definition of membership 10 3.4 Responsibilities of members 10 3.5 Process for becoming a member 11 3.6 Termination of membership 11 4 Mission, Values and Aims 12 4.1 Mission 12 4.2 Values 12 4.3 Aims 12 4.4 Principles of good governance 13 4.5 Accountability 13 4.6 Managing Disputes 14 4.7 Concerns regarding the Governing Body 15 4.8 Vote of No Confidence 15 5 Functions and General Duties 15 5.1 Functions 15 5.2 General duties 17 5.3 General financial duties 22 5.4 Other relevant regulations, directions and documents 23 6 Decision Making: The Governing Structure 24 6.1 Authority to act 24 6.2 Scheme of reservation and delegation 24 6.3 General 24 6.4 Committees of the clinical commissioning group 26 6.5 Joint and collaborative commissioning arrangements 26 6.6 The Governing Body 30 6.7 Transparency 33 7 Roles and Responsibilities 33 7.1 Member practice representatives 33

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Part Description Page 7.2 All members of the clinical commissioning group’s Governing Body 34 7.3 The Chair of the Governing Body 34 7.4 The Deputy Chair of the Governing Body 35 7.5 Role of the lay members 35 7.6 Role of the Accountable Officer 35 7.7 Role of the Chief Finance Officer 36 7.8 Role of the Nurse 36 7.9 Role of the Secondary Care Doctor 36 7.10 Selection, election and appointment 37 7.11 Joint appointments with other organisations 37 8 Standards of Business Conduct and Managing Conflicts of Interest 37 8.1 Standards of business conduct 37 8.2 Conflicts of interest 38 8.3 Declaring and registering interests 39 8.4 Managing conflicts of interest: general 39 8.5 Managing conflicts of interest: contractors and people who provide

services to the clinical commissioning group 42

8.6 Transparency in procuring services 42 9 The Clinical Commissioning Group as Employer 42 10 Transparency, Ways of Working and Standing Orders 43 10.1 General 43 10.2 Standing orders 43

Appendix Description Page A List of Member Practices 45 B Standing Orders 48 C Scheme of Reservation and Delegation 60 D Prime Financial Policies 84 E The Nolan Principles 115 F The Seven Key Principles of the NHS Constitution 116 G Dispute Resolution Procedure 118 H Statutory Committees Terms of Reference

• Audit and Risk Committee • Remuneration Committee

119 119 125

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FOREWORD NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group (CCG) are pleased to present our Constitution which sets out how we will conduct ourselves whilst delivering our ambitious strategy for improving health services and health outcomes for the Hartlepool and Stockton-on-Tees communities. We aspire to lead improvements which are appropriate to the health needs of the local population and importantly, improvements that will reduce inequality and be sustainable. For this reason, they must be transformational in nature and will ensure financial sustainability and probity. Partnership working is vitally important to us and colleagues within general practice, both clinical and administrative have positively responded to the challenge that has been set before us and we have seen a significant increase in the level of engagement which has allowed our CCG to meet this challenge. The CCG has worked hard to develop its relationships with key stakeholders ranging from service providers to patient groups and these relationships will be critical in ensuring we commission high quality effective services that meet the needs of our communities. Working within this Constitutional framework we will ensure good governance and proper stewardship of public resources in the pursuit of our commissioning goals and in meeting our duties to commission and ensure the delivery of high quality healthcare for local people. As a member organisation, we bring together a wealth of knowledge and experience gained from our member practices and local patient populations; collectively we will work together, listening to and challenging each other to continuously improve the commissioning and delivery of high quality health services across Hartlepool and Stockton-on-Tees.

Dr Boleslaw Posmyk Chair, NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group

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DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2006 Act National Health Service Act 2006

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

2012 Regulations The National Health Service (Clinical Commissioning Groups) Regulations 2012

Accountable Officer An individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by NHS England, with responsibility for ensuring the CCG: • complies with its obligations under:

o sections 14Q and 14R of the 2006 Act (as inserted by section 26 of the 2012 Act),

o sections 223H to 223J of the 2006 Act (as inserted by section 27 of the 2012 Act),

o paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as inserted by Schedule 2 of the 2012 Act), and

o any other provision of the 2006 Act (as amended by the 2012 Act) specified in a document published by the Board for that purpose;

• exercises its functions in a way which provides good value for money. In this CCG, the Accountable Officer role is undertaken by the Chief Officer and any reference to either title within this Constitution relates to the same individual.

Area the geographical area that the CCG has responsibility for, as defined in Chapter 2 of this constitution

The CCG NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group

Chair of the Governing Body

the individual appointed by the CCG to act as chair of the Governing Body

Chief Finance Officer The qualified accountant employed by the CCG with responsibility for financial strategy, financial management and financial governance

Clinical commissioning group

a body corporate established by NHS England in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act) Member practices working collectively form the clinical commissioning group

Committee a committee or sub-committee created and appointed by: • the membership of the CCG • a committee / sub-committee created by a committee created / appointed

by the membership of the CCG • a committee / sub-committee created / appointed by the Governing Body

Council of Members the group of Member Practice Representatives

Financial year this usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a clinical commissioning group is established until the following 31 March

Governing Body the body appointed under section 14L of the NHS Act 2006 (as inserted by section 25 of the 2012 Act), with the main function of ensuring that a clinical commissioning group has made appropriate arrangements for ensuring that it complies with:

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• its obligations under section 14Q under the NHS Act 2006 (as inserted by section 26 of the 2012 Act), and

• such generally accepted principles of good governance as are relevant to it.

Governing Body Member

any member appointed to the Governing Body.

Lay member a lay member of the Governing Body, appointed by the CCG. A lay member is an individual who is not a member of the CCG or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations

Local Medical Committee (LMC)

the body statutorily recognised by successive NHS Acts as the professional organisation representing individual NHS GPs and GPs as a whole in the Health Authority. An LMC is structured to support all NHS GPs whatever their contractual status, including GMS, PMS and APMS GPs, sessional and freelance GPs and GP Registrars.

Member Practice a provider of primary medical services to a registered patient list, who is a member of this group (see tables in Chapter 3 and Appendix A)

Member practice representative

an individual appointed by a member practice to act on its behalf in the dealings between it and the CCG, under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act)

NHS England Nationally accountable for the outcomes achieved by the NHS, NHS England will provide leadership for the new commissioning system. It will provide the support and direction necessary to improve quality and patient outcomes and safeguard the core values of the NHS. It will directly commission a range of services including primary care and specialised services and have a key role in improving broader public health outcomes.

Partners Organisation that the CCG works with to achieve its aims e.g. Local Authorities

Population Refers to practice (registered) AND CCG population as a whole

Registers of Interests Registers a CCG is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of: • the members of the CCG; • the members of its Governing Body; • the members of its committees or sub-committees and committees or sub-

committees of its Governing Body; and • its employees.

Stakeholders an individual, group or organisation that may be effected by the decisions or actions of the CCG

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1. INTRODUCTION AND COMMENCEMENT 1.1. Name 1.1.1. The name of this clinical commissioning group is NHS Hartlepool and Stockton-on-

Tees Clinical Commissioning Group (also referred to as the CCG). 1.2. Statutory Framework 1.2.1. Clinical commissioning groups are established under the Health and Social Care

Act 2012 (“the 2012 Act”).1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (“the 2006 Act”).2 The duties of clinical commissioning groups to commission certain health services are set out in section 3 of the 2006 Act, as amended by section 13 of the 2012 Act, and the regulations made under that provision.3

1.2.2. The NHS Commissioning Board, known as NHS England for operational purposes,

is responsible for determining applications from prospective CCGs to be established as clinical commissioning groups4 and undertakes an annual assessment of each established CCG.5 It has powers to intervene in a clinical commissioning group where it is satisfied that a CCG is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.6

1.2.3. Clinical commissioning groups are clinically led membership organisations made up

of providers of primary medical services, known as Member practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a constitution.7

1.3. Status of this Constitution 1.3.1. This constitution is made between the members of NHS Hartlepool and Stockton-

on-Tees Clinical Commissioning Group and has effect from 1st day of April 2013, when the NHS Commissioning Board (referred to as NHS England for the

1 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of clinical commissioning groups to commission certain health services are set out in section 3

of the 2006 Act, as amended by section 13 of the 2012 Act 4 See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act 5 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 6 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 7 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012

Act and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued

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remainder of this document) established the CCG.8 The constitution is published on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

1.4. Amendment and Variation of this Constitution 1.4.1. This constitution can only be varied in two circumstances.9

a) where the CCG applies to NHS England and that application is granted;

b) where in the circumstances set out in legislation the NHS Commissioning Board varies the CCG’s constitution other than on application by the CCG.

2. AREA COVERED

2.1. The geographical area covered by NHS Hartlepool and Stockton-on-Tees Clinical

Commissioning Group is coterminous with two Local Authorities: Hartlepool Borough Council and Stockton-on-Tees Borough Council.

8 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act 9 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations

issued

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3. MEMBERSHIP 3.1 Membership of the Clinical Commissioning Group 3.1.1 Details of the member practices which comprise the membership of NHS Hartlepool

and Stockton-on-Tees Clinical Commissioning Group can be found in Appendix A. 3.2 Eligibility

3.2.1 Providers of primary medical services to a registered list of patients with a practice

population within the geographical area covered by NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract, will be eligible to apply for membership of this CCG10.

3.3 Definition of membership

3.3.1 The Governing Body acts on behalf of its membership through delegated

arrangements. 3.3.2 Membership is defined by and is reliant upon a mutual accountability between the

CCG Governing Body and its member practices. The Governing Body is required to hold member practices to account for use of NHS resources for the care of their patients however the Governing Body is required to demonstrate to member practices that it is adhering to the purpose and values as stated in the NHS Constitution in its deployment of resources and operations11.

3.4. Responsibilities of members 3.4.1 Members of the Clinical Commissioning Group will be responsible for:

a) holding the Governing Body to account for the discharge of delegated

statutory duties and upholding the principles of the NHS Constitution; b) representing the population’s interest; c) applying specialist knowledge of their practice population to inform the work of

the CCG, regularly seeking patients’ views and contributing to the commissioning decisions made;

d) sharing information and the outcomes of debate between the member practice and the CCG, regularly seeking wider member views;

e) identifying risks to patients, clinicians, member practices and the wider health economy emerging from the work of or proposals developed by the CCG whilst maintaining their responsibility to their appropriate professional regulator and acting in accordance with their code of practice for individual patients; and

10 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012. Regulations to be made 11 See Good Governance for Clinical Commissioning Groups. An Introductory Guide The Kings Fund

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f) taking forward decisions made by majority in the best interests of the wider CGG patient population and in accordance with the CCG’s purpose and values.

3.4.2 Members of the Clinical Commissioning Group can expect the Governing Body to:

a) ensure the delivery of delegated statutory duties within resource allocation

and uphold the principles of the NHS Constitution; b) support and develop its members to contribute to commissioning; c) listen and take into account member practices’ views when commissioning

services on behalf of patients across Hartlepool and Stockton-on-Tees; d) engage and consult with its members using a variety of methods, to enable a

broad spectrum of participation; e) provide information in a timely and meaningful way which enables members to

influence decision making; f) commission services to improve the quality, safety and health outcomes; g) uphold the principles of openness and transparency by sharing details of the

rationale for decisions made by the Governing Body and its sub-committees; h) remunerate members for engagement in commissioning activities; i) recognising member practices need to maintain their responsibility to their

appropriate professional regulator and acting in accordance with their code of practice for individual patients

j) empower member practices to commission services on behalf of their patients; and

k) hold member practices to account for use of NHS resources.

3.5. Process for becoming a member

3.5.1 All eligible practices (in line with section 3.2.1) with a practice population within the geographical area covered by NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group will be members of the CCG. This geographical area is at the time of establishing this Constitution co-terminus with local authorities. A practice’s membership of the CCG will be confirmed in the signing of this Constitution.

3.5.2 Any changes to details of CCG membership as described in section 3.1.1 will be

through application to and approval by NHS England (in line with section 1.2.2).

3.6. Terminating membership

3.6.1 Membership of the CCG will not be terminated whilst member practices meet the eligibility criteria set out in section 3.2.1.

3.6.2 A member practice ceases to be a member of the CCG where the practice no

longer satisfies the eligibility criteria. 3.6.3 A member practice shall give written notice to NHS England and the CCG

Governing Body as soon as practicable in the event of any circumstances which

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may give rise to termination of membership, together with a formal request that this membership is terminated.

4. MISSION, VALUES AND AIMS

4.1 Mission

4.1.1 The mission of NHS Hartlepool and Stockton-on-Tees Clinical Commissioning

Group is ‘To build 21st century health services for and with the Hartlepool and Stockton-on-Tees communities so that health inequalities reduce and wellbeing continuously improves’.

4.1.2 The CCG will promote good governance and proper stewardship of public

resources in pursuance of its goals and in meeting its statutory duties.

4.2 Values

4.2.1 Good corporate governance arrangements are critical to achieving the CCG’s objectives.

4.2.2 The values that lie at the heart of the CCG’s work are:

• Patient focussed – the needs of patients, carers and families will inform all that we do

• Engagement – we will engage with our communities, our members, our partners and our stakeholders and apply what we learn when commissioning services for local people

• Quality – we will be driven by our commitment to continuously improving the quality and safety of services

• Value – we will ensure the services we commission represent best value • Efficiency – we will be ensure we are responsive and efficient in our

approach to commissioning • Affordability - we will ensure we commission wisely to maximise use of

NHS resources discriminating between “needs” and “wants” to ensure our plans are realistic and affordable

• Transparency – we will share the rational underpinning our commissioning decisions with our communities, our members, our partners and our stakeholders

We will also champion the principles within the NHS Constitution

4.3 Aims

4.3.1 The CCG’s aims are to:

a) work with our patients to promote and support healthy living and self care b) involve service users, carers, staff, providers, partners and the public to

develop services and reduce health inequalities

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c) work in partnership to transform services and ensure transparency through inclusion of all partners and stakeholders to meet patient needs

d) make use of and contribute to the evidence-base driving service transformation, embracing opportunities to innovate;

e) commission sustainable services in the most appropriate setting; f) ensure services are safe, high quality and cost effective; and g) plan and respond to the identified needs at a locality level for the residents of

Hartlepool and Stockton-on-Tees.

4.4 Principles of Good Governance

4.4.1 In accordance with section 14L(2)(b) of the 2006 Act,12 the CCG will at all times observe “such generally accepted principles of good governance” in the way it conducts its business. These include:

a) the highest standards of propriety involving impartiality, integrity and

objectivity in relation to the stewardship of public funds, the management of the organisation and the conduct of its business;

b) The Good Governance Standard for Public Services;13

the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’14

c) the seven key principles of the NHS Constitution;15 d) the Equality Act 2010.16

4.5 Accountability

4.5.1 The clinical commissioning group will demonstrate its accountability to its members,

local people, stakeholders and NHS England in a number of ways, including by:

a) publishing its constitution; b) appointing independent lay members and non GP clinicians to its Governing

Body as well as GP representatives; c) holding meetings of its Governing Body in public (except where the CCG

considers that it would not be in the public interest in relation to all or part of a meeting);

d) publishing annually a commissioning plan;

12 Inserted by section 25 of the 2012 Act 13 The Good Governance Standard for Public Services, The Independent Commission on Good

Governance in Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004

14 See Appendix E 15 See Appendix F 16 See http://www.legislation.gov.uk/ukpga/2010/15/contents

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e) complying with local authority health overview and scrutiny process requirements;

f) meeting annually in public to publish and present its annual report (which must be published);

g) producing annual accounts in respect of each financial year which must be externally audited;

h) having a published and clear complaints process (ie CCG Complaints Policy); i) complying with the Freedom of Information Act 2000; j) providing information to NHS England as required; k) jointly publishing a Health and Wellbeing Strategy for each locality.

4.5.2 In addition to these statutory requirements, the CCG will demonstrate its

accountability by operating within mechanisms that ensure engagement of member practices and stakeholders.

4.5.3. The Governing Body of the clinical commissioning group will throughout each year

have an ongoing role in reviewing the clinical commissioning group’s governance arrangements to ensure that the clinical commissioning group continues to reflect the principles of good governance.

4.6 Managing Disputes

4.6.1 It is almost inevitable that on occasions member practices will disagree with

decisions made by their commissioning group or in some cases, actions taken by other member practices that impact on them. It is important that all member practices have the ability to appeal against any such decisions and have the right to request that any dispute is resolved by means of an agreed Dispute Resolution Procedure.

4.6.2 If a dispute arises between the Governing Body and a member practice or between

member practices, then all parties are required to follow the CCG’s Dispute Resolution Procedure (Appendix G).

4.6.3 Stage 1 of the process is informal resolution which helps develop and sustain a

partnership approach between member practices and between member practices and the Governing Body.

4.6.4 Stage 2 of the process consists of a Local Dispute Resolution Panel and will seek

the involvement of the LMC.

4.6.5 Other than in cases, which in the opinion of the Accountable Officer and following consultation with the LMC, are considered to be frivolous or vexatious, a Local Dispute Resolution Panel (LDRP) will be convened to hear the dispute and make a determination.

4.6.6 The Panel will agree its own Chair and will consist of:

• A clinical member of the Governing Body

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• A GP conciliator (from a Panel to be established by the LMCs). • An LMC representative (from a different part of Teesside). • Panel Secretary (non-voting).

4.6.7 It is envisaged that the Stage 2 Formal Process will be used in the main to deal with

disputes between individual member practices and the Governing Body. In cases where the dispute is between member practices and it is an issue that warrants formal dispute resolution, then the same process and timescales will apply. The only proposed change is that the LMC representative on the LDRP will be a representative from an LMC outside of the Cleveland LMC.

4.6.8 If either party disputes the decision of the LDRP, and all forms of local resolution

have been exhausted, advice will be sought from NHS England. 4.7 Concerns regarding the Governing Body 4.7.1 If there is a significant concern or dissatisfaction with the actions of the Governing

Body, the Council of Members reserves the right to call an extra ordinary meeting of the Council, to be chaired by a lay member or by a member practice representative appointed by the Council.

4.7.2 In calling an extraordinary meeting of the Council of Members, at least 10% of

member practices must propose an issue for discussion, and a majority of all member practices must agree there is a need to convene.

4.8 Vote of No Confidence 4.8.1 A vote of no confidence could occur when the Council of Members move that the

business of the CCG be suspended to allow a vote on a question of confidence in the Governing Body or a decision taken by the Governing Body.

4.8.2 In calling a vote of no confidence at least 10% of member practices must propose

the vote, and a majority of all member practices must agree there is a need to convene an extraordinary meeting of the Council of Members.

5. FUNCTIONS AND GENERAL DUTIES

5.1. Functions

5.1.1 The functions that the CCG is responsible for exercising are largely set out in the

2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health’s Functions of clinical commissioning groups: a working document. They relate to:

a) commissioning certain health services (where NHS England is not under a

duty to do so) that meet the reasonable needs of: i) all people registered with member GP practices, and ii) People who are usually resident within the area and are not registered

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with a member of any clinical commissioning group

b) commissioning emergency care for anyone present in the CCG’s area; c) paying its employees’ remuneration, fees and allowances in accordance with

the determinations made by its Governing Body and determining any other terms and conditions of service of the CCG’s employees;

d) determining the remuneration and travelling or other allowances of members

of its Governing Body through its Remuneration Committee.

5.1.2 In discharging its functions the CCG will through delegation to its Governing Body:

a) act17, when exercising its functions to commission health services, consistently with the discharge by the Secretary of State and NHS England of their duty to promote a comprehensive health service18 and with the objectives and requirements placed on NHS England through the mandate19 published by the Secretary of State before the start of each financial year by:

i) ensuring that this duty is discharged on behalf of the Governing Body by

the CCG’s Audit and Risk Committee in accordance with their Terms of Reference

ii) developing an annual commissioning plan in accordance with the requirement of the Health and Social Care Act 2012

iii) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

iv) annually publishing a clear and credible plan that sets out how the CCG will deliver these duties

b) meet the public sector equality duty20 by:

i) ensuring that there is an Equality and Diversity Strategy approved by the

Governing Body that demonstrates its commitment ii) using the Equality Delivery System, developing an annual equality,

diversity and human rights strategy describing how the CCG will deliver duties both specific and general in line with the Equality Act 2010

iii) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

iv) publish, at least annually, sufficient information to demonstrate compliance with this general duty across CCG functions

c) work in partnership with its local authorities to develop joint strategic needs

assessments21 and joint health and wellbeing strategies22 by:

17 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act 18 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 19 See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act 20 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of

the 2012 Act

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i) working in partnership with the Hartlepool and Stockton-on-Tees Health

and Wellbeing Boards of which the Clinical Commissioning Group is a member

ii) requiring progress of the delivery strategies to be monitored through the CCG’s reporting mechanisms

5.2. General Duties - in discharging its functions the CCG will through delegation to its

Governing Body:

5.2.1. Make arrangements to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements23 by:

a) ensuring that patients and the public are consulted with and involved in accordance with the relevant legislation, including publishing a strategy for communications, involvement and engagement. b) delegating responsibility to the group’s governing body c) ensuring that this duty is discharged on behalf of the governing body by the

Accountable Officer

d) adopting the following Statement of Principles: • Create an organisational culture that encourages and enables

involvement • Be inclusive and proactive in resolving barriers to effective involvement

and participation • Make clear the purpose of involvement and the extent to which people

can expect their views to influence development of local health services • Recognise the importance of providing feedback to people who have

made their views known • Work in partnership with other agencies to avoid duplication where

possible when approaching the public • Build upon best practice and be open to innovative and proven

approaches from within and outwith the NHS • Provide support and training to staff to equip them for this role

e) In delivering the Statement of Principle the CCG will

• working in partnership with patients and the local community to secure the best care for them

21 See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by section 192 of the 2012 Act

22 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by section 191 of the 2012 Act

23 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act

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• adapting engagement activities to meet the specific needs of the different patient CCGs and communities • publishing information about health services on the CCG’s website

and through other media • encouraging and acting on feedback • monitor and report compliance against this statement of principles

through the Governing Body

5.2.2. Promote awareness of, and act with a view to securing that health services are provided in a way that promotes awareness of, and have regard to the NHS Constitution24 by:

a) delegating responsibility to the CCG’s Governing Body b) ensuring the CCG’s values reflect the values set out in the NHS Constitution c) ensuring policies having regard to the NHS Constitution in their development d) ensuring that all decisions made by the Governing Body are assessed for

regard to the NHS Constitution e) promoting the NHS Constitution on the CCG’s website and internally with all

staff f) incorporating compliance with the NHS Constitution within contracts for

commissioned services

5.2.3. Act effectively, efficiently and economically25 by:

a) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Officer in accordance with the responsibilities of the role

b) delegating responsibility to the Governing Body’s Governance and Risk Management Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

c) delegating responsibility to the Quality, Performance and Finance Committee to assist in optimising the allocation and adequacy of the CCG’s resources in accordance with its Terms of Reference

d) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.2.4. Act with a view to securing continuous improvement to the quality of

services26 by:

a) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Officer and the specific lead officer delegated by the Chief Officer to oversee its discharge

b) delegating responsibility to the Governing Body’s Quality, Performance and Finance Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

24 See section 14P of the 2006 Act, inserted by section 26 of the 2012 Act and section 2 of the Health Act 2009 (as amended by 2012 Act)

25 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 26 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act

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c) establishing a framework for ensuring continuous improvements in the quality of commissioned services and outcomes for patients with regard to clinical effectiveness, safety and patient experience including adult and children’s safeguarding, contributing to improved patient outcomes across the domains within the NHS Outcomes Framework

d) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.2.5. Assist and support NHS England in relation to the Board’s duty to improve the

quality of primary medical services27 by:

a) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Officer and the specific lead officer delegated by the Chief Officer to oversee its discharge

b) delegating responsibility to the Governing Body’s Quality, Performance and Finance Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

c) establishing a framework for ensuring continuous improvements in the quality of commissioned services and outcomes for patients with regard to clinical effectiveness, safety and patient experience including adult and children’s safeguarding, contributing to improved patient outcomes across the domains within the NHS Outcomes Framework

d) engage with primary care representative groups such as the LMC e) requiring progress of delivery of the duty to be monitored through the CCG’s

reporting mechanisms 5.2.6. Have regard to the need to reduce inequalities28 by:

a) ensuring that this duty is discharged on behalf of the Governing Body by the

CCG’s Quality, Performance and Finance Committee in accordance with their Terms of Reference

b) developing an annual commissioning plan in accordance with the requirement of the Health and Social Care Act 2012 which sets out the CCG’s role and plans in relation to reducing health inequalities

c) working with partners on the Health and Wellbeing Boards to contribute to addressing the wider determinants of health and to contribute to implementing the Health and Wellbeing Strategies in relation to commissioning of health services

d) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.2.7. Promote the involvement of patients, their carers and representatives in decisions

about their healthcare29 by:

a) delegating responsibility to the CCG’s Governing Body

27 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act 28 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act 29 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act

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b) ensuring that this duty is discharged on behalf of the Governing Body by the Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) delivering the CCG’s Communication and Engagement Strategy and the Equality Delivery Scheme

d) ensuring through contracts with commissioned services procedures are established enabling patients, their carers and representatives to make informed decisions about their healthcare

e) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.2.8. Act with a view to enabling patients to make choices30 by:

a) delegating responsibility to the CCG’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by the

Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) delivering the CCG’s Communication and Engagement Strategy d) ensuring through contracts with commissioned services procedures are

established enabling patients, their carers and representatives to exercise informed choice about their healthcare

e) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.2.9. Obtain appropriate advice31 from persons who, taken together, have a broad

range of professional expertise in healthcare and public health by:

a) delegating responsibility to the CCG’s Governing Body b) creating a culture in which a broad range of professional expertise is valued

and actively sought c) ensuring systems are in place to identify the need for and securing

appropriate advice to inform CCG decision making from both within the CCG’s membership or beyond e.g. through Clinical Senates and Clinical Networks

d) delegating responsibility within their Terms of Reference to the Chair of each Committee or sub committee to ensure that they obtain appropriate advice in the exercise of its functions

5.2.10. Promote innovation32 by:

a) delegating responsibility to the CCG’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by the

Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) creating a culture in which innovation is valued and at the heart of the CCG’s ambition

30 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act 31 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act 32 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act

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d) contributing to and utilising the results of innovation gained through research and best practice evidence to transform and continuously improve the quality, effectiveness and efficiency of healthcare

5.2.11. Promote research and the use of research33 by:

a) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Officer and the specific lead officer delegated by the Chief Officer to oversee its discharge b) delegating responsibility to the ExecutiveGoverning Body’s Governance and Risk Management Committee to assist the Governing Body with oversight of research governance and in accordance with the CCG’s Terms of Reference

c)b) collaborating with key stakeholders such as Clinical Senates, Clinical Networks, Clinical Research Networks, and academic institutions; commissioning where appropriate independent research and evaluation as a means of evaluating care pathways, evidence based practice and the translation of research evidence into clinical practice

d)c) creating a culture in which research and its implementation is valued e)d) contributing to and utilising the results of research and other robust evidence

of best practice and effectiveness to transform and continuously improve healthcare services

f)e) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.2.12. Have regard to the need to promote education and training34 for persons who are

employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty35 by:

a) delegating responsibility to the CCG’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by the

Accountable Officer and the specific lead officer delegated by the Accountable Officer to oversee its discharge

c) creating a culture in which education, training and continuing professional development at all levels within the organisation is valued and understood to be key to achieving the CCG’s vision

d) enabling individuals who are employed in an activity which involves or is connected with the provision of services as part of the health service in England to engage in continuing professional development

e) engaging with Local Education and Training Boards 5.2.13. Act with a view to promoting integration of both health services with other health

services and health services with health-related and social care services where the

33 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act 34 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act 35 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act

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CCG considers that this would improve the quality of services or reduce inequalities36 by:

a) ensuring that this duty is discharged on behalf of the Governing Body by the

CCG’s Quality, Performance and Finance Committee in accordance with their Terms of Reference

b) developing an annual commissioning plan in accordance with the requirement of the Health and Social Care Act 2012 which sets out the CCG’s role and plans in relation to promoting integration

c) working in partnership with partners to implement plans ensuring that pathways of care are seamless and integrated, within and across organisations

d) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms.

5.3. General Financial Duties

The CCG will perform its functions through delegation to its Governing Body:

5.3.1. Ensure its expenditure does not exceed the aggregate of its allocations for the

financial year37by

a) developing an annual commissioning plan (incorporating the financial plan) in accordance with the requirement of the Health and Social Care Act 2012

b) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Finance Officer in accordance with the responsibilities of the role

c) specifying Prime Financial Policies (at Appendix D) and detailed underpinning financial policies

d) delegating responsibility to the Governing Body’s Audit and Risk Committee to assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

e) delegating responsibility to the Quality, Performance and Finance Committee to assist in optimising the allocation and adequacy of the CCG’s resources in accordance with its Terms of Reference

f) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.3.2. Ensure its use of resources (both its capital resource use and revenue resource

use) does not exceed the amount specified by NHS England for the financial year38by

a) delegating responsibility to the Governing Body’s Audit and Risk Committee to

assist the Governing Body in regard to discharge of the duty and in accordance with the Committee’s Terms of Reference

36 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act 37 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act 38 See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act

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b) ensuring that this duty is discharged on behalf of the Governing Body by the Chief Finance Officer in accordance with the responsibilities of the role

c) specifying Prime Financial Policies (at Appendix D) and detailed underpinning financial policies

d) delegating responsibility to the Quality, Performance and Finance Committee to assist in optimising the allocation and adequacy of the CCG’s resources in accordance with its Terms of reference

e) developing an annual commissioning plan (incorporating the financial plan) in accordance with the requirement of the Health and Social Care Act 2012

f) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms

5.3.3. Take account of any directions issued by NHS England, in respect of specified types of resource use in a financial year, to ensure the CCG does not exceed an amount specified by NHS England 39by

a) developing an annual commissioning plan (incorporating the financial plan) in

accordance with the requirement of the Health and Social Care Act 2012 b) ensuring that this duty is discharged on behalf of the Governing Body by the

Chief Finance Officer in accordance with the responsibilities of the role c) specifying Prime Financial Policies (at Appendix D) and detailed underpinning

financial policies d) delegating responsibility to the Quality, Performance and Finance Committee

to assist in optimising the allocation and adequacy of the CCG’s resources in accordance with its Terms of Reference

e) requiring progress of delivery of the duty to be monitored through the CCG’s reporting mechanisms.

5.3.4. Publish an explanation of how the CCG spent any payment in respect of

quality made to it by NHS England40by

a) delegating responsibility to the CCG’s Governing Body b) ensuring that this duty is discharged on behalf of the Governing Body by the

Accountable Officer and Chief Finance Officer delegated by the Accountable Officer to oversee its discharge

c) ensuring an accessible summary of the explanation is published on the CCG’s website at and is available upon request in a range of formats

5.4. Other Relevant Regulations, Directions and Documents

5.4.1. The CCG will

a) comply with all relevant legislation and Regulations; b) comply with Directions issued by the Secretary of State for Health or NHS

England; and

39 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act 40 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act

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c) take account, as appropriate, of documents issued by NHS England.

5.4.2. The CCG will develop and implement the necessary systems and processes to

comply with these Regulations and Directions, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant CCG policies and procedures.

6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to act 6.1.1. The clinical commissioning group is accountable for exercising the statutory

functions of the CCG. It may grant authority to act on its behalf to:

a) any of its members; b) its Governing Body; c) employees; d) a committee or sub-committee of the group.

6.1.2. The extent of the authority to act of the respective bodies and individuals depends

on the powers delegated to them by the CCG as expressed through:

a) the CCG’s scheme of reservation and delegation; and b) for committees, their terms of reference.

6.2. Scheme of Reservation and Delegation41 6.2.1. The CCG’s scheme of reservation and delegation sets out:

a) those decisions that are reserved for the membership as a whole;

b) those decisions that are the responsibilities of its Governing Body (and its committees), the CCG’s committees and sub-committees, individual members and employees.

6.2.2. The clinical commissioning group remains accountable for all of its functions,

including those that it has delegated.

6.3. General

6.3.1. In discharging functions of the CCG that have been delegated to its Governing Body (and its committees), committees, joint committees, sub committees and individuals must:

a) comply with the CCG’s principles of good governance,42

41 See Appendix C

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b) operate in accordance with the CCG’s scheme of reservation and delegation,43

c) comply with the CCG’s standing orders,44 d) comply with the CCG’s arrangements for discharging its statutory duties,45 e) where appropriate, ensure that member practices have had the opportunity to

contribute to the CCG’s decision making process.

6.3.2. When discharging their delegated functions, committees, sub-committees and joint committees must also operate in accordance with their approved terms of reference.

6.3.3 Any:

• member of the CCG’s Governing Body; • any employee of the CCG; • any member of a committee of the CCG; • any member of a committee of the CCG’s Governing Body; and • any other individual acting under the direction of the CCG or its Governing

Body, in the furtherance of their respective functions; who has acted honestly and in good faith shall not have to meet out of his or her own personal resources any costs arising from any personal civil liability that he/she incurs in the execution (or purported execution) of his or her functions, save where he or she has acted recklessly.

For the purposes of this indemnity, the term “committee” shall also include any sub-committee appointed by a committee in accordance with the powers delegated to it.

6.3.4 The Group recognises and confirms that nothing in or referred to in this constitution

(including in relation to the issue of any press release or other public statement or disclosure) will prevent or inhibit the making of any protected disclosure (as defined in the Employment Rights Act 1996, as amended by the Public Interest Disclosure Act 1998) by any member of the group, any of its governing body, any member of any of its committees or sub-committees or the committees or sub-committees of its governing body, or any employee of the group or of any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act.

6.3.5 Where delegated responsibilities are being discharged collaboratively, the joint

(collaborative) arrangements must:

a) identify the roles and responsibilities of those clinical commissioning groups who are working together;

b) identify any pooled budgets and how these will be managed and reported in annual accounts;

42 See section 4.4 on Principles of Good Governance above 43 See appendix C 44 See appendix B 45 See chapter 5 above

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c) specify under which clinical commissioning group’s scheme of reservation and delegation and supporting policies the collaborative working arrangements will operate;

d) specify how the risks associated with the collaborative working arrangement will be managed between the respective parties;

e) identify how disputes will be resolved and the steps required to terminate the working arrangements;

f) specify how decisions are communicated to the collaborative partners.

6.4. Committees of the CCG 6.4.1. The following committees have been established by the CCG:

a) Remuneration Committee (which is accountable to the Governing Body); b) Audit and Risk Committee (accountable to the Governing Body) c) Governance and Risk Management Committee (accountable to the Governing

Body) d)c) Quality, Performance and Finance Committee (accountable to the Governing

Body) e)d) Funding Panel (accountable to the Governing Body). f)e) Primary Care Commissioning Committee (accountable to the Governing

Body). g)f) Sustainability and Transformation PlanBetter Health Programme Joint

Committee (accountable to the Governing Body) 6.4.2. Committees will only be able to establish their own sub-committees, to assist them in

discharging their respective responsibilities, if this responsibility has been delegated to them by the group or the committee they are accountable to.

6.5. Joint and Collaborative Commissioning Arrangements

6.5.1 Joint commissioning arrangements with other Clinical Commissioning Groups 6.5.1.1 The clinical commissioning group (CCG) may wish to work together with other

CCGs in the exercise of its commissioning functions. 6.5.1.2 The CCG may make arrangements with one or more CCG in respect of:

• delegating any of the CCG’s commissioning functions to another CCG; • exercising any of the commissioning functions of another CCG; or • exercising jointly the commissioning functions of the CCG and another CCG

6.5.1.3 For the purposes of the arrangements described at paragraph 6.5.1.2, the CCG

may: • make payments to another CCG; • receive payments from another CCG; • make the services of its employees or any other resources available to

another CCG; or

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• receive the services of the employees or the resources available to another CCG.

6.5.1.4 Where the CCG makes arrangements which involve all the CCGs exercising any of their commissioning functions jointly, a joint committee may be established to exercise those functions.

6.5.1.5 For the purposes of the arrangements described at paragraph 6.5.1.2 above, the

CCG may establish and maintain a pooled fund made up of contributions by any of the CCGs working together pursuant to paragraph 6.5.1.2. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.5.1.6 Where the CCG makes arrangements with another CCG as described at paragraph

6.5.1.2 above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a pooled

fund and management of that fund; • Contributions from the parties, including details around assets, employees and

equipment to be used under the joint working arrangements. 6.5.1.7 The liability of the CCG to carry out its functions will not be affected where the CCG

enters into arrangements pursuant to paragraph 6.5.1.2 above. 6.5.1.8 The CCG will act in accordance with any further guidance issued by NHS England

on co-commissioning. 6.5.1.9 Only arrangements that are safe and in the interests of patients registered with

member practices will be approved by the governing body. 6.5.1.10 The governing body of the CCG shall require, in all joint commissioning

arrangements, that the lead clinician and lead manager of the lead CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.5.1.11 Should a joint commissioning arrangement prove to be unsatisfactory the

governing body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year.

6.5.2 Joint commissioning arrangements with NHS England for the exercise of CCG

functions

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6.5.2.1 The CCG may wish to work together with NHS England in the exercise of its commissioning functions.

6.5.2.2 The CCG and NHS England may make arrangements to exercise any of the CCG’s

commissioning functions jointly. 6.5.2.3 The arrangements referred to in paragraph 6.5.2.2 above may include other CCGs. 6.5.2.4 Where joint commissioning arrangements pursuant to 6.5.2.2 above are entered

into, the parties may establish a joint committee to exercise the commissioning functions in question.

6.5.2.5 Arrangements made pursuant to 6.5.2.2 above may be on such terms and

conditions (including terms as to payment) as may be agreed between NHS England and the CCG.

6.5.2.6 Where the CCG makes arrangements with NHS England (and another CCG if

relevant) as described at paragraph 6.5.2.2 above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including, if applicable, payments towards a pooled

fund and management of that fund; and • Contributions from the parties, including details around assets, employees and

equipment to be used under the joint working arrangements. 6.5.2.7 The liability of the CCG to carry out its functions will not be affected where the CCG

enters into arrangements pursuant to paragraph 6.5.2.2 above. 6.5.2.8 The CCG will act in accordance with any further guidance issued by NHS England

on co-commissioning. 6.5.2.9 Only arrangements that are safe and in the interests of patients registered with

member practices will be approved by the governing body. 6.5.2.10 The governing body of the CCG shall require, in all joint commissioning

arrangements that the primary care co-commissioning joint committee of the CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.5.2.11 Should a joint commissioning arrangement prove to be unsatisfactory the

governing body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the

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beginning of the next new financial year after the expiration of the six months’ notice period.

6.5.3 Joint commissioning arrangements with NHS England for the exercise of NHS

England’s functions 6.5.3.1 The CCG may wish to work with NHS England and, where applicable, other CCGs,

to exercise specified NHS England functions. 6.5.3.2 The CCG may enter into arrangements with NHS England and, where applicable,

other CCGs to: • Exercise such functions as specified by NHS England under delegated

arrangements; • Jointly exercise such functions as specified with NHS England.

6.5.3.3 Where arrangements are made for the CCG and, where applicable, other CCGs to

exercise functions jointly with NHS England a joint committee may be established to exercise the functions in question.

6.5.3.4 Arrangements made between NHS England and the CCG may be on such terms

and conditions (including terms as to payment) as may be agreed between the parties.

6.5.3.5 For the purposes of the arrangements described at paragraph 6.5.3.2 above, NHS

England and the CCG may establish and maintain a pooled fund made up of contributions by the parties working together. Any such pooled fund may be used to make payments towards expenditure incurred in the discharge of any of the commissioning functions in respect of which the arrangements are made.

6.5.3.6 Where the CCG enters into arrangements with NHS England as described at

paragraph 6.5.3.2 above, the parties will develop and agree a framework setting out the arrangements for joint working, including details of:

• How the parties will work together to carry out their commissioning functions; • The duties and responsibilities of the parties; • How risk will be managed and apportioned between the parties; • Financial arrangements, including payments towards a pooled fund and

management of that fund; and • Contributions from the parties, including details around assets, employees and

equipment to be used under the joint working arrangements. 6.5.3.7 The liability of NHS England to carry out its functions will not be affected where it

and the CCG enter into arrangements pursuant to paragraph 6.5.3.2 above. 6.5.3.8 The CCG will act in accordance with any further guidance issued by NHS England

on co-commissioning. 6.5.3.9 Only arrangements that are safe and in the interests of patients registered with

member practices will be approved by the governing body.

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6.5.3.10 The governing body of the CCG shall require, in all joint commissioning

arrangements that the primary care co-commissioning committee of the CCG make a quarterly written report to the governing body and hold at least annual engagement events to review aims, objectives, strategy and progress and publish an annual report on progress made against objectives.

6.5.3.11 Should a joint commissioning arrangement prove to be unsatisfactory the

governing body of the CCG can decide to withdraw from the arrangement, but has to give six months’ notice to partners, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

6.5.4 The Group will have the power to enter into joint committees as appropriate with:

a) Hartlepool Borough Council b) Stockton-on-Tees Borough Council

6.6. The Governing Body

6.6.1. Functions - the Governing Body has the following functions conferred on it by

sections 14L(2) and (3) of the 2006 Act, inserted by section 25 the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this constitution.46 The Governing Body has functions of the clinical commissioning group delegated to it by the CCG. Where the CCG has conferred additional functions on the Governing Body connected with its main functions, or has delegated any of the CCG’s functions to its Governing Body, these are set out from paragraph 6.6.1(d) below. The Governing Body has responsibility for:

a) ensuring that the CCG has appropriate arrangements in place to exercise its

functions effectively, efficiently and economically and in accordance with the CCG’s principles of good governance47 (its main function);

b) identifying strategic risks and developing an Assurance Framework c) approving the commissioning strategy which takes into account financial

targets and forecast limits of available resources d) approving consultation arrangements for the CCG’s commissioning plan e) engaging with partners and stakeholders f) reviewing compliance against the public involvement Statement of Principles g) approving the level of non-pay expenditure on an annual basis h) approving reports showing the total financial allocations received and their

proposed distribution including any sums to be held in reserve including regular updates on significant changes

i) receiving and reviewing monitoring reports on financial performance against budget and plan, including explanations for variances

46 See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act 47 See section 4.4 on Principles of Good Governance above

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j) receiving reports detailing actual and forecast expenditure and activity for contracts

k) receiving reports which outline the reasons for seeking tenders from firms not previously pre-qualified to provide goods/services

l) determining the remuneration, fees and other allowances payable to employees or other persons providing services to the CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;

m) approving a timetable for producing the annual report and accounts n) approving any functions of the CCG that are specified in regulations;48

6.6.2. Composition of the Governing Body - the Governing Body shall not have fewer

than 121 members and comprises of:

a) the GP chair; b) four GP representatives of member practices; c) threewo lay members:

• one to lead on audit, remuneration and conflict of interest matters, • one to lead on patient and public participation matters; • one to lead on primary acre commissioning matters;

d) one registered nurse; e) one secondary care specialist doctor; f) the Accountable Officer; g) the chief finance officer;

6.6.3. Committees of the Governing Body - the Governing Body has appointed the

following committees and sub-committees:

a) Audit and Risk Committee – the Audit and Risk Committee, which is accountable to the CCG’s Governing Body, provides the Governing Body with an independent and objective view of the CCG’s financial systems, financial information and compliance with laws, regulations and directions governing the CCG including the risk management and assurance framework process. The Governing Body has approved and keeps under review the terms of reference for the audit and risk committee, which includes information on the membership of the audit and risk committee.

b) Remuneration Committee – the Remuneration Committee, which is

accountable to the CCG’s Governing Body makes recommendations to the Governing Body on determinations about the remuneration, fees and other allowances for employees and for people who provide services to the CCG and on determinations about allowances under any pension scheme that the CCG may establish as an alternative to the NHS pension scheme. The Governing Body has approved and keeps under review the terms of reference

48 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act

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for the remuneration committee, which includes information on the membership of the remuneration committee49.

c) Quality, Performance and Finance Committee – the Quality, Performance

and Finance Committee, which is accountable to the CCG’s Governing Body will ensure that the services the CCG commissions are able to demonstrate that they have in place an assurance framework which will satisfy compliance with the essential principles of quality and adults and children’s safeguarding. The Committee will also provide assurance on financial governance areas, and assurance that there are robust structures, processes and accountabilities in place for managing internal and external performance. The Governing Body has approved and keeps under review the terms of reference for the Quality, Performance and Finance Committee, which includes information on the membership of the Committee.

d) Funding Panel – the Funding Panel, which is accountable to the CCG’s

Governing Body will consider all Individual Funding Requests and decide whether to support or not support these individual requests on the basis of the information provided with the request to the Committee. It will develop and agree protocols for accessing services or treatment not within contract, either for NHS or non-NHS providers where a service level agreement or contract does not exist. The Governing Body has approved and keeps under review the terms of reference for the Funding Panel which includes information on the membership of the Committee.

e) Governance and Risk Management Committee – The Governance and Risk Management Committee which is accountable to the CCG’s Governing Body, provides the Governing Body with assurance that the internal control systems of the CCG including Assurance Framework, Risk Register and processes for complaints, are effective, as well as monitoring the outputs of governance and risk management systems.

ef) Primary Care Commissioning Committee – Accountable to the CCG’s

Governing Body, the role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services. In accordance with its statutory powers under section 13Z of the National Health Service Act 2006 (as amended), NHS England has delegated the exercise of the functions specified in Schedule 2 to these Terms of Reference to NHS Hartlepool and Stockton-on-Tees CCG. NHS England has delegated to the CCG authority to exercise the primary care commissioning functions set out in Schedule 2 in accordance with section 13Z of the NHS Act. 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. Arrangements made under section 13Z do not affect the liability of NHS England for the exercise of any of its functions.

49 See Appendix H for the terms of reference of the remuneration committee

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fg) Joint Committee of Clinical Commissioning Groups Sustainability and Transformation plans (STP)Better Health Programme Joint Committee - The Joint Committee is a joint committee of NHS North Durham CCG, NHS Darlington CCG , NHS Durham Dales, Easington and Sedgefield CCG, NHS Darlington CCG, NHS Hambleton, Richmondshire and Whitby CCG, NHS Hartlepool and Stockton-on-Tees CCG and NHS South Tees CCG. The primary purpose of the Joint Committee is to arrange the formal consultation and undertake the decisions on the issues which are the subject of the consultation in relation to the Better Health Programme.

Such Committees shall be made up of either members of the governing body, any consultants and/or employees, or any others approved by the Governing Body, and the membership of each Committee shall be set out in its terms of reference. The terms of reference of each of the CCG’s Committees can be found at http://www.hartlepoolandstocktonccg.nhs.uk/governing-body/papers/

6.6.4 The Governing Body may appoint such other committees as it considers appropriate but committees will only be able to establish their own sub-committees, to assist them in discharging their respective responsibilities, if this responsibility has been delegated to them by the Governing Body. Such Committee or sub-committee shall be made up of either members of the governing body, any consultants and/or employees, or any others approved by the Governing Body.

6.7 Transparency

6.7.1 In accordance with the National Health Service (Clinical Commissioning Groups – Responsibilities) Regulations 2012, Regulation 16, the CCG will make the following arrangements to ensure transparency: a) publish papers considered at its meetings except where the governing body considers that it would not be in the public interest to do so in relation to a particular paper or part of a paper b) publish the following information relating to determinations made under subsection (3)(a) and (b) of section 14L of the 2006 Act (which relates to remuneration, fees and allowances payable under certain pension schemes) – (i) in relation to each senior employee of the CCG, any determination of the employee’s salary (which need only specify a band of £5,000 into which the salary falls), or of any travelling and other allowances payable to the employee, including any allowances payable under a pension scheme established under paragraph 11(4) of Schedule 1A to the 2006 Act; (ii) any recommendation of the remuneration committee in relation to any such determination c) in the event that the governing body consider that it would not be in the public interest to publish such information, it will not publish the above information.

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7. ROLES AND RESPONSIBILITIES 7.1. Member Practice Representatives 7.1.1. Member practice representatives represent their practice’s and patients views and

act on behalf of the member practice in matters relating to the CCG. It is anticipated that Member Practice Representatives will act on behalf of the member practice in commissioning matters in accordance with local partnership agreements or other arrangements governing decision making on behalf of the member practice The role of each member practice representative is to:

a) engage with, listen to and represent the best interests of their patient

population sharing outcomes with the CCG b) engage with, listen to and represent member practice colleagues sharing

outcomes with the CCG c) contribute to and represent the CCG’s mission, values, aims, objectives and

priorities d) identify and declare actual and/or perceived conflicts of interest e) ensure that the Governing Body makes open and transparent decisions f) continue to act in accordance with their professional duty of care to individual

patients and in line with medical profession regulators 7.2. All Members of the CCG’s Governing Body 7.2.1. The core duties of all Governing Body members includes the criteria specified in

national guidance for these roles50. 7.2.2. Each member of the Governing Body should share responsibility as part of a team

to ensure that the CCG exercises its functions effectively, efficiently and economically ensuring continual improvements in quality and safety, with good governance and in accordance with the terms of this constitution. Each brings their unique perspective, informed by their expertise and experience.

7.3. The Chair of the Governing Body 7.3.1. The chair of the Governing Body is responsible for:

a) leading the Governing Body, ensuring it remains continuously able to

discharge its duties and responsibilities as set out in this constitution; b) building and developing the CCG’s Governing Body and its individual

members; c) ensuring that the CCG has proper constitutional and governance

arrangements in place; d) ensuring that, through the appropriate support, information and evidence, the

Governing Body is able to discharge its duties;

50 Draft clinical commissioning group Governing Body Members – Roles Attributes and Skills, NHS Commissioning Board Authority, March 2012

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e) supporting the Accountable Officer in discharging the responsibilities of the

organisation; f) contributing to building a shared vision of the aims, values and culture of the

organisation; g) leading and influencing to achieve clinical and organisational change to

enable the CCG to deliver its commissioning responsibilities; h) overseeing governance and particularly ensuring that the Governing Body and

the wider CCG behaves with the utmost transparency and responsiveness at all times;

i) ensuring that public and patients’ views are heard and their expectations understood and, where appropriate as far as possible, met;

j) ensuring that the organisation is able to account to its local patients, partners and stakeholders and NHS England;

k) ensuring that the CCG builds and maintains effective relationships with all partners and stakeholders, particularly with the individuals involved in overview and scrutiny from the relevant local authorities.

7.3.2. The chair of the Governing Body is a GP and the senior clinical voice of the CCG

and as such they will lead interactions with stakeholders, including NHS England. 7.4. The Deputy Chair of the Governing Body 7.4.1. The Deputy Chair of the Governing Body deputises for the Chair of the Governing

Body where he or she has a conflict of interest or is otherwise unable to act. 7.4.2. As the Chair of the Governing Body is the senior clinical voice of the CCG, a lay

member will be Deputy Chair. 7.5. Role of the lay members 7.5.1 Lay members bring specific expertise and experience, as well as their knowledge as

a member of the local community, to the work of the Governing Body 7.5.2 They will help to ensure that, in all aspects of the CCG’s business the public voice of

the local population is heard and that opportunities are created and protected for patient and public empowerment in the work of the CCG.

7.6. Role of the Accountable Officer 7.6.1. The Accountable Officer of the CCG is a member of the Governing Body. 7.6.2. This role of Accountable Officer has been summarised in a national document51 and

includes:

51 See the latest version of NHS England Authority’s Clinical commissioning group Governing Body members: Role outlines, attributes and skills

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a) being responsible for ensuring that the clinical commissioning group fulfils its duties to exercise its functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money;

b) at all times ensuring that the regularity and propriety of expenditure is

discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems.

c) working closely with the chair of the Governing Body, the Accountable Officer

will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the Governing Body) of the organisation’s ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the ongoing developments of its members and staff.

d) the Accountable Officer will ensure the CCG exercises the functions as set out

in paragraph 5.1.2 a) to c) e) exercise the duties as delegated by the clinical commissioning group to the

Accountable Officer relating to the clinical commissioning group’s General Duties as set out in paragraphs 5.2.1 and 5.2.13

f) ensure the maintenance of registers of interest

7.7. Role of the Chief Finance Officer

7.7.1. The Chief Finance Officer is a member of the Governing Body and is responsible

for providing financial advice to the clinical commissioning group and for supervising financial control and accounting systems

7.7.2. This role of Chief Finance Officer has been summarised in a national document52

as:

a) being the Governing Body’s professional expert on finance and ensuring, through robust systems and processes, the regularity and propriety of expenditure is fully discharged;

b) making appropriate arrangements to support, monitor on the CCG’s finances; c) overseeing robust audit and governance arrangements leading to propriety in

the use of the CCG’s resources;

d) being able to advise the Governing Body on the effective, efficient and economic use of the CCG’s allocation to remain within that allocation and deliver required financial targets and duties; and

52 See the latest version of NHS England Authority’s Clinical commissioning group Governing Body members: Role outlines, attributes and skills

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e) producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to NHS England;

f) The chief finance officer will also exercise the functions as delegated by the clinical commissioning group to the Chief Finance Officer relating to the clinical commissioning group’s General Financial Duties as set out in paragraphs 5.3.1 to 5.3.4

7.8. Role of the Executive Nurse

7.8.1 The Executive Nurse brings a broader view, from their perspective as a registered

nurse, on health and care issues to underpin the work of the CCG especially the contribution of nursing to patient care and particularly quality of care and safeguarding.

7.9. Role of the Secondary Care Doctor

7.9.1 This clinical member of the Governing Body will bring a broader view, on health and care issues to underpin the work of the CCG. In particular, they will bring to the Governing Body an understanding of patient care in the secondary care setting.

7.10 Selection, election and appointment 7.10.1 The following Governing Body posts will be subject to a process requiring election

prior to appointment

a) GP Chair b) GP representatives from across the CCG membership

7.10.2 A Nominations Panel will be established by the Council of Members to select

suitable candidates against specific criteria for the role. All candidates deemed suitable by the panel will be eligible for election by member practices into any vacant GP roles.

7.10.3 The following Governing Body posts will be subject to a process requiring selection

prior to appointment (either locally or nationally)

a) Accountable (Chief) Officer b) Chief Finance Officer c) Executive Nurse d) Secondary Care Doctor e) Lay Members

7.10.4 An Appointments Panel will be established by the Council of Members to

recommend appointment of other members to the Governing Body which will be reported to the next meeting of the Governing Body for approval.

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7.10.5 Further details of selection, election and appointment can be found in the CCG’s Standing Orders, Appendix B.

7.11 Joint Appointments with other Organisations

7.11.1 From time to time the CCG may enter into joint arrangements with other

organisations including joint appointments for specific areas, wherever this is the case a memorandum of understanding (MoU) will be in place.

8 STANDARDS OF BUSINESS CONDUCT AND MANAGING

CONFLICTS OF INTEREST 8.1 Standards of Business Conduct 8.1.1 Employees, member practices, committee and sub-committee members of the

CCG and members of the Governing Body (and its committees) will at all times comply with this policy and be aware of their responsibilities as outlined in it. They should act in good faith and in the interests of the CCG and should follow the Seven Principles of Public Life, set out by the Committee on Standards in Public Life (the Nolan Principles; Appendix E).

8.1.2. They must comply with the CCG’s policy on business conduct, including the

requirements set out in the policy for managing conflicts of interest and standards of business conduct. This policy will be available on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

8.1.3 Individuals contracted to work on behalf of the CCG or otherwise providing services

or facilities to the CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

8.2 Conflicts of Interest 8.2.1 As required by section 14O of the 2006 Act, as inserted by section 25 of the 2012

Act, the clinical commissioning group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by the CCG will be taken and seen to be taken without any possibility of the influence of external or private interest.

8.2.2. Where an individual, i.e. an employee, member practice, member of the Governing

Body, or a member of a committee or a sub-committee of the Governing Body or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of the CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this constitution.

8.2.3 A conflict of interest will include:

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a) a direct pecuniary interest: where an individual may financially benefit from the consequences of a commissioning decision (for example, as a provider of services);

b) an indirect pecuniary interest: for example, where an individual is a partner,

member or shareholder in an organisation that will benefit financially from the consequences of a commissioning decision;

c) a non-pecuniary interest: where an individual holds a non-remunerative or not-

for profit interest in an organisation, that will benefit from the consequences of a commissioning decision (for example, where an individual is a trustee of a voluntary provider that is bidding for a contract);

d) a non-pecuniary personal benefit: where an individual may enjoy a qualitative

benefit from the consequence of a commissioning decision which cannot be given a monetary value (for example, a reconfiguration of hospital services which might result in the closure of a busy clinic next door to an individual’s house);

e) where an individual is closely related to, or in a relationship, including

friendship, with an individual in the above categories.

8.2.4 If in doubt, the individual concerned should assume that a potential conflict of interest exists.

8.3 Declaring and Registering Interests 8.3.1 The CCG will maintain one or more registers of the interests of:

• All CCG employees, including: • All full and part time staff; • Any staff on sessional or short term contracts; • Any students and trainees (including apprentices); • Agency staff; and • Seconded staff In addition, any self-employed consultants or other individuals working for the CCG under a contract for services should make a declaration of interest in accordance with this policy, as if they were CCG employees. Members of the governing body: All members of the CCG’s committees, sub-committees/sub-groups, including: • Co-opted members; • Appointed deputies; and • Any members of committees/groups from other organisations.

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Where the CCG is participating in a joint committee alongside other CCGs, any interests which are declared by the committee members should be recorded on the register(s) of interest of each participating CCG. All members of the CCG (i.e., each practice) This includes each provider of primary medical services which is a member of the CCG under Section 14O (1) of the 2006 Act. Declarations should be made by the following groups: • GP partners (or where the practice is a company, each director); • Any individual directly involved with the business or decision-making of the

CCG.

a) members of the group ; b) the members of its Governing Body; c) the members of its decision making committees or sub-committees and the

committees or sub-committees of its Governing Body; and d) its employees where appropriate (eg senior staff) and where interests exist.

8.3.2 The CCG will need to ensure that, as a matter of course, declarations of interest are made and regularly confirmed or updated. All persons referred to above must declare any interests as soon as reasonable practicable and by law within 28 days after the interest arises. Further opportunities include;

• On appointment:

Applicants for any appointment to the CCG or its governing body or any committees should be asked to declare any relevant interests. When an appointment is made, a formal declaration of interests should again be made and recorded.

• Six Monthly: Declarations of interest should be obtained from all relevant individuals every six months and where there are no interests or changes to declare, a “nil return” should be recorded.

• At meetings: All attendees should be asked to declare any interest they have in any agenda item before it is discussed or as soon as it becomes apparent. Even if an interest is declared in the register of interests, it should be declared in meetings where matters relating to that interest are discussed. Declarations of interest and action taken to manage that conflict of interest at the meeting should be recorded in minutes of meetings.

• On changing role, responsibility or circumstances: Whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests (e.g., where an individual takes on a new role outside the CCG or enters into a new business or relationship), a further declaration should be made to reflect the change in circumstances as soon as possible, and in any event within 28 days. This could involve a conflict of interest ceasing to exist or a new one materialising.

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8.3.4 Individuals will declare any interest that they have, in relation to a decision to be

made in the exercise of the commissioning functions of the CCG, in writing to the Chief Officer, as soon as they are aware of it and in any event no later than 28 days after becoming aware. The CCG must record the interest in the appropriate registers as soon as the CCG becomes aware of it.

8.3.5 The CCG must ensure that, when members declare interests, this includes the

interests of all relevant individuals within their own organisations (e.g. partners in a GP practice), who have a relationship with the CCG and who would potentially be in a position to benefit from the CCG’s decisions.

8.3.6 Where an individual is unable to provide a declaration in writing, for example, if a

conflict becomes apparent in the course of a meeting, they will make an oral declaration, and provide a written declaration as soon as possible thereafter.

8.3.7 The Chief Officer will ensure that the registers of interest are reviewed six-monthly

and updated as necessary. 8.3.8 In addition, all CCG Governing Body and Executive members’ appointments are

offered on the understanding that they subscribe to the “Codes of Conduct and Accountability in the NHS”.

8.3.9 The Declaration of Interest proforma for completion by members of the group,

Governing Body members, members of a committee or sub-committee of the group or Governing Body, and employees within the CCG is available at Appendix D.

8.3.10 Failure to notify the CCG of an appropriate conflict of interest, additional employment

or business may lead to disciplinary action against the member of staff and/or criminal action (including prosecution) under the relevant legislation.

8.3.11 An interest should remain on the public register for a minimum of six months after the

interest has expired and the CCG will retain a private record of historic interests for a minimum of 6 years after the date on which it expired. The published register will state that historic interests are retained by the CCG for the specified timeframe and details of whom to contact to request this information.

8.3.2 The registers in the cases of b and c listed above will be published on the CCG’s

website at www.hartlepoolandstocktonccg.nhs.uk. 8.3.3 Individuals will declare any interest that they have, in relation to a decision to be

made in the exercise of the commissioning functions of the CCG, in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware.

8.3.4 Where an individual is unable to provide a declaration in writing, for example, if a

conflict becomes apparent in the course of a meeting, they will make an oral declaration before witnesses, and provide a written declaration as soon as possible thereafter.

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8.3.5 8.3.12 The Accountable Officer will ensure that the registers of interest are reviewed regularly, and updated as necessary. 8.4 Managing Conflicts of Interest: general 8.4.1 Individual members of the CCG, the Governing Body, committees or sub-

committees, the committees or sub-committees of its Governing Body and employees will comply with the arrangements determined in line with national guidance for managing conflicts or potential conflicts of interest.

8.4.2 The Accountable Officer will ensure that for every interest declared, either in writing

or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the CCGs decision making processes.

8.4.3 Arrangements for the management of conflicts of interest are to be determined by

the Accountable Officer and will include the requirement to put in writing to the relevant individual arrangements for managing the conflict of interests or potential conflicts of interests, within a week of declaration. The arrangements will confirm the following:

a) when an individual should withdraw from a specified activity, on a temporary

or permanent basis; b) monitoring of the specified activity undertaken by the individual, either by a

line manager, colleague or other designated individual. 8.4.4 Where an interest has been declared, either in writing or by oral declaration, the

declarer will ensure that before participating in any activity connected with the CCG’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Accountable Officer.

8.4.5 Where an individual member, employee or person providing services to the CCG is

aware of an interest which: a) has not been declared, either in the register or orally, they will declare this at

the start of the meeting; b) has previously been declared, in relation to the scheduled or likely business of

the meeting, the individual concerned will bring this to the attention of the chair of the meeting, together with details of arrangements which have been confirmed for the management of the conflict of interests or potential conflict of interests.

8.4.6 The chair of the meeting will then determine how this should be managed and

inform the member of their decision. Where no arrangements have been confirmed,

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the chair of the meeting may require the individual to withdraw from the meeting or part of it. The individual will then comply with these arrangements, which must be recorded in the minutes of the meeting.

8.4.7 Where the chair of any meeting of the CCG, including committees, sub-committees,

or the Governing Body and the Governing Body’s committees and sub-committees, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the deputy chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the deputy chair may require the chair to withdraw from the meeting or part of it. Where there is no deputy chair, the members of the meeting will select one.

8.4.8 Any declarations of interests, and arrangements agreed in any meeting of the

clinical commissioning CCG, committees or sub-committees, or the Governing Body, the Governing Body’s committees or sub-committees, will be recorded in the minutes.

8.4.9 Where more than 50% of the members of a meeting are required to withdraw from

a meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the chair (or deputy) will determine whether or not the discussion can proceed.

8.4.10 In making this decision the chair will consider whether the meeting is quorate, in

accordance with the number and balance of membership set out in the CCG’s standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall consult with the Accountable Officer on the action to be taken.

8.4.11 This may include:

a) requiring another of the CCG’s committees or sub-committees, the CCG’s Governing Body or the Governing Body’s committees or sub-committees (as appropriate) which can be quorate to progress the item of business, or if this is not possible,

b) inviting on a temporary basis one or more of the following to make up the

quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that the CCG can progress the item of business:

i) a member of the clinical commissioning group who is a member practice

representative;

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ii) an individual appointed by a member to act on its behalf in the dealings

between it and the clinical commissioning group; iii) a member of a relevant Health and Wellbeing Board; iv) a member of a Governing Body of another clinical commissioning group. v) These arrangements must be recorded in the minutes.

8.4.12 In any transaction undertaken in support of the clinical commissioning group’s

exercise of its commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Accountable Officer of the transaction.

8.4.13 The Accountable Officer will take such steps as deemed appropriate, and request

information deemed appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared

8.5 Managing Conflicts of Interest: contractors and people who provide services

to the CCG

8.5.1 Anyone seeking information in relation to a procurement, or participating in a procurement, or otherwise engaging with the clinical commissioning group in relation to the potential provision of services or facilities to the CCG, will be required to make a declaration of any relevant conflict / potential conflict of interest.

8.5.2 Anyone contracted to provide services or facilities directly to the clinical commissioning group will be subject to the same provisions of this constitution in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

8.6 Transparency in Procuring Services 8.6.1 The CCG recognises the importance in making decisions about the services it

procures in a way that does not call into question the motives behind the procurement decision that has been made. The CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

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8.6.2 The CCG will publish a register of procurement decisions ondecisions on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

9 THE CCG AS EMPLOYER 9.1 The CCG recognises that its most valuable asset is its people. It will seek to

enhance their skills and experience and is committed to their development in all ways relevant to the work of the CCG.

9.2 The CCG will seek to set an example of best practice as an employer and is

committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.

9.3 The CCG will ensure that it employs suitably qualified and experienced staff who will

discharge their responsibilities in accordance with the high standards expected of staff employed by the CCG. All staff will be made aware of this constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

9.4 The CCG will maintain and publish policies and procedures (as appropriate) on the

recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. The CCG will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters

9.5 The CCG will ensure that its rules for recruitment and management of staff provide

for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.

9.6 The CCG will ensure that employees' behaviour reflects the values, aims and

principles set out above. 9.7 The CCG will ensure that it complies with all aspects of employment law. 9.8 The CCG will ensure that its employees have access to such expert advice and

training opportunities as they may require in order to exercise their responsibilities effectively.

9.9 The CCG will adopt a Code of Conduct for staff and will maintain and promote

effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced.

9.10 Copies of this Code of Conduct, together with the other policies and procedures

outlined in this chapter, will be available on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

10 TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS

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10.1 General 10.1.1 The CCG will publish annually a commissioning plan and an annual report,

presenting the CCG’s annual report to a public meeting. 10.1.2 Key communications issued by the CCG, including the notices of procurements,

public consultations, Governing Body meeting dates, times, venues, and certain papers will be published on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

10.1.3 The CCG may use other means of communication, including circulating information

by post, or making information available in venues or services accessible to the public.

10.2 Standing Orders 10.2.1 This constitution is also informed by a number of documents which provide further

details on how the CCG will operate. They are the CCG’s:

a) Standing orders (Appendix B) – which sets out the arrangements for meetings and the appointment processes to elect the CCG’s representatives and appoint to the CCG’s committees, including the Governing Body;

b) Scheme of reservation and delegation (Appendix C) – which sets out

those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of the CCG’s Governing Body, the Governing Body’s committees and sub-committees, the CCG’s committees and sub-committees, individual members and employees;

c) Prime financial policies (Appendix D) – which sets out the arrangements for

managing the CCG’s financial affairs.

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APPENDIX A - LIST OF MEMBER PRACTICES AS AT 31ST DECEMBER 2016

Practice

Code Member Practice

Address Representative on behalf of the

member practice

Signed on behalf of the

member practice

Date of Signature

A81067 Alma Medical Practice

Nolan Place, Stockton-on-Tees, TS18 2BP

A81007 Bank House Surgery

One Life Centre Hartlepool, Park Road, Hartlepool, TS24 7PW

A81632 Birchtree Practice

The Health Centre, Lawson Street, Stockton-

on-Tees, TS18 1HU

A81011 Chadwick Practice

One Life Centre Hartlepool, Park Road, Hartlepool, TS24 7PW

A81001 Densham Surgery

Dr Williams & Oliver, Lawson Street Health

Centre, Stockton-on-Tees, TS18 1HU

A81602 Dr S Rasool Abbey Health Centre, Finchdale Avenue,

Billingham, Stockton-on-Tees, TS23 2DG

A81060 Drs Koh and Trory

Victoria Road, Hartlepool, TS26 8DB

A81039 Eaglescliffe Medical Practice

Sunningdale Drive, Eaglescliffe, Stockton-on-

Tees, TS16 9EA

A81608 Elm Tree Medical Centre

51 Westbury Street Thornaby

Stockton-on-Tees, TS17 6NP

A81622 Gladstone House Surgery

46 Victoria Rd, Hartlepool, TS26 8DD

A81041 Hart Medical Practice

The General Medical Centre, Surgery Lane,

Wells Avenue, Hartlepool, TS24 9DN

Y02501 Hartsfields Medical Practice

Hartfields Medical Practice Hartfields Manor,

Hartlepool, TS26 0US

A81031 Havelock Grange Practice

One Life Centre Hartlepool, Park Road, Hartlepool, TS24 7PW

A81613 Journee Victoria Road, Hartlepool,

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Practice Code

Member Practice

Address Representative on behalf of the

member practice

Signed on behalf of the

member practice

Date of Signature

Medical Practice

TS26 8DB

A81057 Kingsway Medical Practice

Kingsway, Bilingham, Stockton-on-Tees TS23

2LS

A81040 Marsh House Medical Centre

Abbey Health Centre, Finchdale Avenue,

Billingham, Stockton-on-Tees, TS23 2DG

A81044 McKenzie House

McKenzie House, 17 Kendal Road, Hartlepool,

TS25 1QU

A81056 Melrose Surgery

38 Melrose Ave, Billingham, Stockton-on-

Tees TS18 2EP

A81036 Norton Medical Centre

Billingham Road, Norton, Stockton-on-Tees, TS20

2UZ

A81066 Park Lane Surgery

Stillington, Stockton-on-Tees, TS21 1JS

A81002 Queens Park Medical Centre

Farrer Street, Stockton, RTS18 2AW

A81014 Queenstree Practice

The Health Centre, Queensway, Billingham, Stockton-on-Tees TS23

2LA

A81629 Riverside Medical Practice

Alma Street, Stockton-on-Tees, TS18 2AP

A81066 Roseberry Practice

Abbey Health Centre, Finchdale Avenue,

Billingham, Stockton-on-Tees, TS23 2DG

A81612 Seaton Surgery Station Lane, Seaton Carew, Hartlepool, TS25

1AX

Y00527 Stockton NHS Health Care

Centre

Tithebarn House, High Newham Road, Hardwick, Stockton-on-Tees, TS19

8RH

A81006 Tennant Street Medical Practice

Tennant Street, Stockton-on-Tees, TS18 2AT

A81634 The Arrival Medical

Endurance House, Clarence Street, Stockton-

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Practice Code

Member Practice

Address Representative on behalf of the

member practice

Signed on behalf of the

member practice

Date of Signature

Practice on-Tees, TS18 2EP

A81025 The Dovecot Surgery

The Health Centre, Lawson Street, Stockton-

on-Tees, TS18 1HU

Y02597 The Fens Medical Centre

434 Catcote Road, Fens Estate, Hartlepool, TS25

2LS

A81063 The Headland Medical Centre

2 Grove Street, The Headland, Hartlepool,

TS24 0NZ

A81034 Thornaby & Barwick

Medical Group

Thornaby Medical Centre, Trenchard Avenue,

Thornaby, Stockton-on-Tees TS17 0EE

A81003 Victoria Medical Group

The Health Centre, Victoria Road, Hartlepool,

TS26 8DB

A81631 West View Millennium

Surgery

West View Road, Hartlepool, TS24 9LJ

A81017 Woodbridge Practice

The Medical Centre, Trenchard Avenue,

Thornaby, Stockton-on-Tees, TS17 0EE

A81046 Woodlands Family Medical

Centre

106 Yarm Lane, Stockton-on-Tees, TS18 1YE

A81070 Wynyard Road Primary Care

Centre

Wynyard Road, Hartlepool, TS25 3DQ

A81027 Yarm Medical Centre

1 Worsall Road, Yarm, Stockton-on-Tees TS15

9DD

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APPENDIX B – STANDING ORDERS

1. STATUTORY FRAMEWORK AND STATUS Introduction 1.1 These standing orders have been drawn up to regulate the proceedings of the NHS

Hartlepool and Stockton-on-Tees Clinical Commissioning Group so that CCG can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date the CCG is established.

1.1.1 The standing orders, together with the CCG’s scheme of reservation and

delegation53 and the CCG’s prime financial policies54, provide a procedural framework within which the CCG discharges its business. They set out:

a) the arrangements for conducting the business of the CCG;

b) the appointment of member practice representatives;

c) the procedure to be followed at meetings of the CCG, the Governing Body and any committees or sub-committees of the CCG or the Governing Body;

d) the process to delegate powers,

e) the declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate55 of any relevant guidance.

1.1.2. The standing orders, scheme of reservation and delegation and prime financial

policies have effect as if incorporated into the CCG’s constitution. CCG members, employees, members of the Governing Body, members of the Governing Body’s committees and sub-committees, members of the CCG’s committees and sub-committees and persons working on behalf of the CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders, scheme of reservation and delegation and prime financial policies may be regarded as a disciplinary matter that could result in dismissal.

53 See Appendix C 54 See Appendix D 55 Under some legislative provisions the CCG is obliged to have regard to particular guidance but under

other circumstances guidance is issued as best practice guidance.

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1.2. Schedule of matters reserved to the clinical commissioning group and the scheme of reservation and delegation

1.2.1 The 2006 Act (as amended by the 2012 Act) provides the CCG with powers to

delegate the CCG’s functions and those of the Governing Body to certain bodies (such as committees) and certain persons. The CCG has decided that certain decisions may only be exercised by the CCG in formal session. These decisions and also those delegated are contained in the CCG’s scheme of reservation and delegation (see Appendix C).

2. THE CLINICAL COMMISSIONING GROUP: COMPOSITION OF

MEMBERSHIP, KEY ROLES AND APPOINTMENT PROCESS

2.1. Composition of membership

Chapter 3 of the CCG’s constitution provides details of the membership of the CCG (also see Appendix A).

Chapter 6 of the CCG’s constitution provides details of the governing structure used in the CCG’s decision-making processes, whilst Chapter 7 of the constitution outlines certain key roles and responsibilities within the CCG and its Governing Body, including the role of member practice representatives (section 7.1 of the constitution).

2.2. Key Roles

2.2.1. Paragraph 6.6.2 of the CCG’s constitution sets out the composition of the CCG’s Governing Body whilst Chapter 7 of the CCG’s constitution identifies certain key roles and responsibilities within the CCG and its Governing Body. These standing orders set out how the CCG appoints individuals to these key roles.

Chair of Governing Body Nominations Self-nomination or nomination by Governing Body member/s Eligibility Not disqualified from membership of a CCG or from being a CCG Governing

Body Chair under the 2012 Regulations Approved/accredited by any national assessment criteria stipulated for role. As the Chair is a GP, they must be practicing within a member CCG practice. Meets person specification for the role approved by the Governing Body

Appointment Process

The Chair will be elected by Governing Body members from the total number of GPs elected by member practices to the Governing Body.

Term of Office Two years with option for reappointment Eligibility for reappointment

Election by member practices. Eligibility criteria must continue to be met.

Grounds for removal from office

Disqualified from membership of a CCG Governing Body or from being a Chair of a CCG Governing Body under the 2012 Regulations No longer meets eligibility criteria for role. Exclusion from the Performers List or GMC register Breach of Nolan principles (as determined by majority vote by Governing Body members)

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Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Majority vote of no-confidence by Clinical Council of Members Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest. The Chair may be asked to step down from office, on a temporary basis, while any investigation into the Chair’s conduct is on-going. In this event the Deputy Chair will assume the role of chair for the relevant period.

Notice period Three months but immediately if the GP is removed from office on any of the ground set out above.

Suspension from Governing Body

Suspension from the Performers List or GMC register will result in an immediate review of the post holders position on the Governing body.

GP members of Governing Body Nominations Self-nomination or nomination by member practices Eligibility Not disqualified from membership of a CCG under the 2012 Regulations

Practicing within a member practice. Meets person specification for the role approved by the Governing Body

Appointment Process

A Nominations Panel will be established by the Council of Members to undertake selections to Governing Body GP posts, followed by an election by member practices. If there remains more candidates than roles on the Governing Body, an election by member practices will take place until there are no vacancies.

Term of Office A minimum of 2 and maximum of 3 years with option for reappointment Eligibility for reappointment

Eligibility criteria must continue to be met.

Grounds for removal from office

Disqualified from membership of a CCG Governing Body under the 2012 regulations. No longer meets eligibility criteria for role. Exclusion from the Performers List or GMC register Breach of Nolan principles (as determined by majority vote by Governing Body members) Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest.

Notice period Three months but immediately if the GP is removed from office on any of the ground set out above.

Suspension from Governing Body

Suspension from the Performers List or GMC register will result in an immediate review of the post holders position on the Governing body.

Lay Members Nominations Recruitment via open advert Eligibility Not disqualified from membership of a CCG under the 2012 Regulations

Meets person specification and criteria for role approved by the Governing Body

Appointment Process

The Council of Members will establish an Appointments Panel who will make a recommendation of appointment to the Governing Body

Term of Office 2 terms Eligibility for reappointment

Eligibility criteria must continue to be met.

Grounds for removal from

Disqualified from membership of a CCG Governing Body under the 2012 regulations.

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office Breach of Nolan principles (as determined by majority vote by Governing Body members) Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest.

Notice period Three months but immediately if removed from office on any of the ground set out above.

Accountable Officer Nominations Recruitment via open advert Eligibility Is eligible to be the Accountable Officer under the 2006 Act, as amended by the

2012 Act. Not disqualified from membership of a CCG under the 2012 Regulations Approved/accredited by any national assessments process stipulated for the role Meets person specification and criteria for role approved by the Governing Body

Appointment Process

NHS England is responsible for appointing the Chief Officer, following nomination by the CCG. The Council of Members will establish an Appointments Panel who will make a recommendation of appointment to NHS England.

Term of Office The Chief Officer’s term of office shall be stated in his or her contract of employment.

Eligibility for reappointment

Eligibility criteria must continue to be met.

Grounds for removal from office

No longer eligible to be the Accountable Officer under the 2006 Act, as amended by the 2012 Act. Disqualified from membership of a CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. Breach of Nolan principles (as determined by majority vote by Governing Body members) Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest. Has their employment terminated by resignation, redundancy or as a result of disciplinary proceedings.

Notice period Immediately if removed from office on any of the ground set out above but otherwise the notice period shall be in accordance with his or her contract of employment and/or statutory employment rights.

Chief Finance Officer Nominations Recruitment via open advert Eligibility Not disqualified from membership of a CCG under the 2012 Regulations

Holds a qualification of one of the individual CCAB bodies or CIMA. Meets person specification and criteria for role approved by the Governing Body

Appointment Process

The Council of Members will establish an Appointments Panel who will make a recommendation of appointment to the Governing Body

Term of Office The Chief Finance Officer’s term of office shall be stated in his or her contract of employment

Eligibility for Eligibility criteria must continue to be met.

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reappointment Grounds for removal from office

Disqualified from membership of a CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. No longer holds qualification of one of the individual CCAB bodies or CIMA; and /or in accordance with his/her contract of employment. Breach of Nolan principles (as determined by majority vote by Governing Body members) Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest. Has their employment terminated by resignation, redundancy or as a result of disciplinary proceedings.

Notice period Immediately if removed from office on any of the ground set out above but otherwise the notice period shall be in accordance with his or her contract of employment and/or statutory employment rights.

Executive Nurse Nominations Recruitment via open advert Eligibility A registered nurse not falling within Regulation 12(1) of the 2012 Regulations.

Not disqualified from membership of a CCG under the 2012 Regulations Meets person specification and criteria for role approved by the Governing Body

Appointment Process

The Council of Members will establish an Appointments Panel who will make a recommendation of appointment to the Governing Body

Term of Office The term of office shall be stated in his or her contract of employment Eligibility for reappointment

Eligibility criteria must continue to be met.

Grounds for removal from office

The individual is no longer eligible to be a register nurse member of the CCG Governing Body under the 2012 Regulations Disqualified from membership of a CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. Failure to meet eligibility criteria for role. Breach of Nolan principles (as determined by majority vote by Governing Body members) Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest. Has their employment terminated by resignation, redundancy or as a result of disciplinary proceedings.

Notice period Immediately if removed from office on any of the ground set out above but otherwise the notice period shall be in accordance with his or her contract of employment and/or statutory employment rights.

Suspension from Governing Body

Suspension from the NMC register will result in an immediate review of the post holders position on the Governing body.

Secondary Care Doctor Nominations Recruitment via open advert Eligibility Is a secondary care specialist within the meaning of the 2012 Regulations and

does not fall within regulation 12(1) of the 2012 Regulations Not disqualified from membership of a CCG under the 2012 Regulations Meets person specification and criteria for role approved by the Governing Body Meets requirements of 2012 Regulations for Governing Body

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membership.

Appointment Process

The Council of Members will establish an Appointments Panel who will make a recommendation of appointment to the Governing Body

Term of Office Minimum of two years and maximum of three. Eligibility for reappointment

Eligibility criteria must continue to be met.

Grounds for removal from office

The individual is no longer eligible to be a secondary care specialist member of a CCG Governing Body under the 2012 Regulations Disqualified from membership of a CCG Governing Body under the 2012 regulations and/or in accordance with his/her contract of employment. Failure to meet eligibility criteria for role. Breach of Nolan principles (as determined by majority vote by Governing Body members) Significant reputational damage to CCG (as determined by majority vote by Governing Body members) Simple majority vote of no-confidence by Clinical Council of Members Failure to meet 2012 Regulations for Governing Body membership. Failure to meet eligibility criteria for role. Has become ineligible to stand for the position as a result of the declaration of any overriding conflict of interest.

Notice period Three months but immediately if removed from office on any of the ground set out above

Suspension from Governing Body

Suspension from the registered professional body will result in an immediate review of the post holders position on the Governing body.

2.2.2. The roles and responsibilities of each of these key roles are set out either in paragraph 6.6.2 or Chapter 7 of the CCG’s constitution.

3. MEETINGS OF THE CLINICAL COMMISSIONING GROUP

3.1. Calling meetings

3.1.1. Ordinary meetings of the CCG shall be held at regular intervals at such times and places as the CCG may determine.

3.1.2 In calling an extraordinary meeting of the Clinical Council of Members, at least 10% of member practices must propose an issue for discussion, and a majority of all member practices must agree there is a need to convene.

3.2. Agenda, supporting papers and business to be transacted

3.2.1. Items of business to be transacted for inclusion on the agenda of a meeting

need to be notified by Members of the Council to the Chair at least 15 working days (i.e. excluding weekends and bank holidays) before the meeting takes place. Supporting papers for such items need to be submitted at least 10 working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least 5 working days before the date the meeting will take place.

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3.2.2. Agendas and certain papers for the CCG’s Governing Body – including details about meeting dates, times and venues - will be published on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

3.3. Petitions

3.3.1. Where a petition has been received by the CCG, the chair of the Governing

Body shall include the petition as an item for the agenda of the next meeting of the Governing Body.

3.4. Chair of a meeting

3.4.1. Meetings of the CCG will be chaired by the Governing Body Chair. If the

Chair is absent from the meeting the Deputy Chair shall preside.

3.4.2. If the Chair is absent temporarily on the grounds of a declared conflict of interest the deputy chair, if present, shall preside. If both the Chair and Deputy Chair are absent, or are disqualified from participating, or there is neither a chair or deputy a member of the CCG, Governing Body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.

3.5. Chair's ruling

3.5.1. The decision of the Chair of the Governing Body on questions of order, relevancy and regularity and their interpretation of the constitution, standing orders, scheme of reservation and delegation and prime financial policies at the meeting, shall be final.

3.6. Quorum

3.6.1. Meetings of the Governing Body will be quorate only when a minimum of half of all members are present (balanced up to the nearest figure where this is not a whole number), including at least three GPs and, the Accountable Officer or, Chief Financial Officer and a lay member. In circumstances where the elected members of the Governing Body (i.e. the GPs) are unable to participate in decision-making because of a conflict of interest, the requirement for a quorum is at least half of the remaining members of the Governing Body, including the Deputy Chair (acting as Chair and with a casting vote), the Accountable Officer or Chief Financial Officer and the Executive Nurse or Secondary Care Consultant.

3.6.2. For all other of the CCG’s committees and sub-committees, including the Governing Body’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference

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3.7. Decision making

3.7.1. Chapter 6 of the CCG’s constitution, together with the scheme of reservation and delegation, sets out the governing structure for the exercise of the CCG’s statutory functions. Generally it is expected that at the CCG’s / Governing Body’s meetings decisions will be reached by consensus. Should this not be possible then a vote of members will be required, the process for which is set out below:

3.7.2. Eligibility

a) At the discretion of the Chairman all questions put to the vote shall be

determined by oral expression or by a show of hands, unless the Chairman directs otherwise, or it is proposed, seconded and carried that a vote be taken by paper ballot

b) All members will have voting rights. Decisions required as part of a

meeting of the Governing Body will be determined by simple majority vote.

c) All potential and actual conflicts of interest must be disclosed according

to the Conflicts of Interest and Standards of Business Conduct Policy. A Register of Interests will be maintained and brought to every meeting of the Committees.

d) Where there is not a majority then the Chair will have the casting vote.

3.7.3 Should a vote be taken the outcome of the vote, and any dissenting views,

must be recorded in the minutes of the meeting.

3.7.4 For all other of the CCG’s committees and sub-committees, including the Governing Body’s committees and sub-committee, the details of the process for holding a vote are set out in the appropriate terms of reference.

3.8. Emergency powers and urgent decisions

3.8.1. The powers which the NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group has reserved to itself within standing orders may in an emergency or for an urgent decision be exercised by the Accountable Officer and the Chair after having consulted at least two (ideally lay) members, one of which must be a lay member. The exercise of such powers by the Accountable Officer and the Chair shall be reported to the next formal meeting of the Governing Body for formal ratification.

3.9. Suspension of Standing Orders

3.9.1. Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or NHS England, any part of these

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standing orders may be suspended at any meeting, provided at least two thirds of the whole number of members are in agreement.

3.9.2. A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting.

3.9.3. A separate record of matters discussed during the suspension shall be kept.

These records shall be made available to the Governing Body’s Audit and Risk Committee for review of the reasonableness of the decision to suspend standing orders.

3.10. Record of Attendance

3.10.1. The names of all members of the meeting present at the meeting shall be

recorded in the minutes of the CCG’s meetings. The names of all members of the Governing Body present shall be recorded in the minutes of the Governing Body meetings. The names of all members of the Governing Body’s committees / sub-committees present shall be recorded in the minutes of the respective Governing Body committee / sub-committee meetings.

3.11. Minutes

3.11.1. The minutes of the proceedings of a meeting shall be drawn up by the designated secretary for each Governing Body meeting, Committee or group and submitted for agreement at the next meeting where they will be confirmed as a true record by the Chair and others present at the meeting under discussion.

3.11.2. The minutes of the Governing Body will be made available to the public on

the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk. 3.12. Admission of public and the press 3.12.1. The public and the press will be invited to attend the NHS Hartlepool and

Stockton-on-Tees Clinical Commissioning Group’s Annual General Meeting (AGM).

3.12.2. Questions from the public and the press for the Governing Body when

meeting in public will be at the discretion of the Chair. 3.12.3. The public and representatives of the press may attend all meetings of the

Governing Body but shall be required to withdraw upon the Clinical Commissioning Group resolving as follows:

(i) 'that representatives of the press, and other members of the public, be

excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which

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would be prejudicial to the public interest’, paragraph 8 (3) of schedule 1A of the 2006 Act, as amended by the 2012 Act.

(ii) Guidance should be sought from Information Governance specialists to ensure correct procedure is followed on matters to be included in the exclusion.

3.12.5 The Chairman (or Vice-Chairman if one has been appointed) or the person

presiding over the meeting shall give such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that the Clinical Commissioning Group’s business shall be conducted without interruption and disruption and, without prejudice to the power to exclude on grounds of the confidential nature of the business to be transacted, the public will be required to withdraw upon the Governing Body resolving as follows:

`that in the interests of public order the meeting adjourn for (the period

to be specified) to enable the Governing Body to complete its business without the presence of the public'. Section 1(8) Public Bodies (Admissions to Meetings) Act l960.

3.12.6 Matters to be dealt with by the Governing Body following the exclusion of

representatives of the press, and other members of the public, as provided in (i) and (ii) above, shall be confidential to the members of the Governing Body.

3.12.7 Members and Officers or any employee of the Clinical Commissioning Group

in attendance shall not reveal or disclose the contents of papers marked 'In Confidence' or minutes headed 'Items Taken in Private' outside of the Clinical Commissioning Group, without the express permission of the Clinical Commissioning Group. This prohibition shall apply equally to the content of any discussion during the meeting which may take place on such reports or papers.

4. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES

4.1. Appointment of committees and sub-committees

4.1.1. The CCG may appoint committees and sub-committees of the CCG, subject to any regulations made by the Secretary of State56, and make provision for the appointment of committees and sub-committees of its Governing Body. Where such committees and sub-committees of the CCG, or committees and sub-committees of its Governing Body, are appointed they are included in Chapter 6 of the CCG’s constitution.

4.1.2. Other than where there are statutory requirements, such as in relation to the Governing Body’s Audit and Risk Committee or remuneration committee, the

56 See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act

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CCG shall determine the membership and terms of reference of committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the CCG.

4.1.3. The provisions of these standing orders shall apply where relevant to the

operation of the Governing Body, the Governing Body’s committees and sub-committee and all committees and sub-committees unless stated otherwise in the committee or sub-committee’s terms of reference.

4.2. Terms of Reference

4.2.1. Terms of reference will be available for all committees.

4.3. Delegation of Powers by Committees to Sub-committees

4.3.1. Where committees are authorised to establish sub-committees they may not

delegate executive powers to the sub-committee unless expressly authorised by the CCG.

4.4. Approval of Appointments to Committees and Sub-Committees

4.4.1. The CCG shall approve the appointments to each of the committees and sub-committees which it has formally constituted including the Governing Body. The CCG shall agree such travelling or other allowances as it considers appropriate.

5. DUTY TO REPORT NON-COMPLIANCE WITH STANDING

ORDERS AND PRIME FINANCIAL POLICIES

5.1. If for any reason these standing orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of the CCG and staff have a duty to disclose any non-compliance with these standing orders to the Accountable Officer as soon as possible.

6. USE OF SEAL AND AUTHORISATION OF DOCUMENTS

6.1. Clinical Commissioning Group’s seal

6.1.1. The CCG may have a seal for executing documents where necessary. The following individuals or officers are authorised to authenticate its use by their signature:

a) the Accountable Officer;

b) the Chair of the Governing Body;

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c) the Chief Finance Officer;

6.2. Execution of a document by signature

6.2.1. The following individuals are authorised to execute a document on behalf of

the CCG by their signature.

a) the Accountable Officer

b) the Chair of the Governing Body

c) the Chief Finance Officer

7. OVERLAP WITH OTHER CLINICAL COMMISSIONING GROUP POLICY STATEMENTS / PROCEDURES AND REGULATIONS

7.1. Policy statements: general principles

7.1.1. The CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group. The decisions to approve such policies and procedures will be recorded in an appropriate group minute and will be deemed where appropriate to be an integral part of the CCG’s standing orders.

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APPENDIX C SCHEME OF RESERVATION AND DELEGATION

THE COUNCIL OF MEMBERS

DECISIONS RESERVED TO THE COUNCIL OF MEMBERS

THE COUNCIL OF MEMBERS

General Enabling Provision The Council of Members may determine any matter, for which it has delegated or statutory authority, it wishes in full session within its statutory powers.

THE COUNCIL OF MEMBERS

Annual Reports and Accounts

Receipt of the CCG's Annual Report and Annual Accounts

THE COUNCIL OF MEMBERS

NHS Hartlepool and Stockton-on-Tees CCG Constitution

Receipt and approval of the constitution

THE COUNCIL OF MEMBERS

Standing Orders 1. Approve Standing Orders (SOs), a schedule of matters reserved to the Governing Body and Standing

Financial Instructions for the regulation of CCG proceedings and business. 2. Vary or amend the Standing Orders.

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GOVERNING BODY DECISIONS DELEGATED BY THE COUNCIL OF MEMBERS TO, AND RESERVED BY, THE GOVERNING BODY

GOVERNING BODY Regulations and Control 1. Suspend Standing Orders. 2. Approve a scheme of delegation of powers from the Governing Body to the and other committees. 3. Require and receive the declaration of Governing Body members’ interests which may conflict with those of the

CCG and, taking account of any waiver which the Secretary of State for Health may have made in any case, determining the extent to which that member may remain involved with the matter under consideration.

4. Require and receive the declaration of officers’ interests that may conflict with those of the CCG. 5. Adopt the organisation structures, processes and procedures to facilitate the discharge of business by the CCG

and to agree modifications thereto. 6. Receive reports from committees including those that the CCG is required by the Secretary of State or other

regulation to establish and to action appropriately. 7. Confirm the recommendations of the CCG’s committees where the committees do not have executive powers. 8. Establish terms of reference and reporting arrangements of all committees and sub-committees that are

established by the Governing Body. 9. Authorise use of the seal. 10. Discipline members of the Governing Body or employees who are in breach of statutory requirements or SOs. 11. Approve any urgent decisions taken by the Chairman of the CCG and Accountable Officer for ratification by the

CCG in accordance with SO 5.2.

GOVERNING BODY Appointments/ Dismissal 1. Appoint the Chair of the Governing Body 2. Appoint the Vice Chair of the Governing Body. 3. Appoint and dismiss other committees (and individual members) that are directly accountable to the Governing Body. 4. Appoint, discipline and dismiss officer members (subject to SO 2.2). 5. Confirm appointment of members of any committee of the CCG as representatives on outside bodies. 6. Approve proposals of the Remuneration Committee regarding senior employees.

GOVERNING BODY Strategy, Commissioning Plan and Budgets 1. Define the strategic aims and objectives of the CCG. 2. Identify the key strategic risks, evaluate them and ensure adequate responses are in place and are monitored

via the Governing Body Assurance Framework. 3. Approve plans in respect of the application of available financial resources to support the agreed Commissioning

Plan (CP).

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4. Approve proposals for ensuring quality and developing clinical governance in services provided by the CCG or its constituent member practices, having regard to any guidance issued by the Secretary of State.

5. Approve (with any necessary appropriate modification) the CCG annual commissioning strategy or plan. 6. Approve annually (with any necessary appropriate modification) the CCG Clear and Credible Plan 7. Approve the CCG’s strategy for the management of risk. 8. Approve Outline and Final Business Cases for Capital Investment if this represents a variation from the Plan. 9. Approve budgets. 10. Approve CCG’s proposed organisational development strategy. 11. Approve the opening of bank accounts. 12. Approve ’s proposals on individual contracts (other than NHS organisations) of a capital or revenue nature

amounting to, or likely to amount to over £250,000 over a 3 year period or the period of the contract if longer. 13. Approve proposals in individual cases for the write off of losses or making of special payments above the limits

of delegation to the Accountable Officer and Chief Finance Officer(for losses and special payments) previously approved by the Governing Body.

14. Approve individual compensation payments. 15. Approve proposals for action on litigation against or on behalf of the CCG. 16. Approve proposals for CCG or practice incentive schemes, having regard to guidance by the Secretary of

State. 17. Approve Annual Report and Accounts.

GOVERNING BODY Policy Determination 1. Delegate the approval of management policies including HR, Risk, Information Governance and other corporate

policies to the Governance and Risk Committee.

Policies so adopted shall be reported to the Governing Body via the minutes of the Governance and Risk Committee

2. Approve management policies including HR, Information Governance and other corporate policies.

GOVERNING BODY Audit 1. Receive the annual management letter received from the External Auditor taking account of the advice, where

appropriate, of the Audit and Risk Committee. 2. Delegate responsibility to the NHS Hartlepool and Stockton-on-Tees CCG Audit and Risk Committee to receive

an annual report from the Internal Auditor and agree action on recommendations where appropriate. This would be reported to the Governing Body via the minutes of the NHS Hartlepool and Stockton-on-Tees CCG Audit and Risk Committee.

GOVERNING BODY Monitoring 1. Receipt of such reports as the Governing Body sees fit from the and other committees in respect of its

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exercise of powers delegated.

GOVERNING BODY Responsibility for commissioned services

The Governing Body will ensure that commissioned services, through its relevant Committees:

• secure delivery of safe, effective services through contracts with independent and NHS providers

• ensure those contracts entered into with providers are delivered according to contract specification

• review the delivery of services and test previous delivery models through external procurement and market testing

• manage the local service delivery market, ensuring contracted providers meet the challenges identified in service specifications, secure new entrants to the market through external procurement, and review the continued delivery of services provided by organisations that fail to meet contract requirements

• continually review the effectiveness and cost effectiveness of service models and delivery mechanisms, implementing revised arrangements to secure improvements.

Will delegate responsibility relating to Individual Funding Requests to the relevant committee.

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DECISIONS/DUTIES DELEGATED BY THE GOVERNING BODY TO COMMITTEES

COMMITTEE DECISIONS/DUTIES DELEGATED BY THE GOVERNING BODY TO COMMITTEES AND BY THE TO ITS SUB COMMITTEES

AUDIT AND RISK COMMITTEE The Committee will: 1. Advise the Governing Body on internal and external audit services; 2. The Committee shall review the establishment and maintenance of an effective system of integrated

governance, risk management and internal control, across the whole of the organisation’s activities (both clinical and non-clinical), that supports the achievement of the organisation’s objectives;

3. Monitor compliance with Constitution, Standing Orders and Prime Financial Policies; 4. Review schedules of losses and compensations and making recommendations to the Governing Body; 5. Review and recommend for approval by the Governing Body the annual financial statements, annual report and

the Annual Governance Statement.

6. Provide an assurance to the Governing Body that there are robust structures, processes and accountabilities in place for identifying and managing significant risks facing the organisation.

7. Provide assurance on the effective management of governance areas

The Audit and Risk Committee is a committee of the Governing Body, the Terms of Reference of the Committee set out the membership, quoracy and voting, committee structures and other governance issues.

The Governing Body will delegate: 5.8. Ratification or otherwise, instances of failure to comply with Standing Orders brought to the AO’s attention in

accordance with SO 5.6. 6.9. Review individual cases for the write off of losses or making special payments above the limits of delegation of

the AO and Chief Finance Officer

Under the Local Audit and Accountability Act 2014 CCGs are required to ensure there is sufficient scrutiny and oversight of the CCG’s relationship with its external auditors by having an auditor panel chaired by an independent member, who is not part of the management structure, such as a lay member of the governing body. In order to

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COMMITTEE DECISIONS/DUTIES DELEGATED BY THE GOVERNING BODY TO COMMITTEES AND BY THE TO ITS SUB COMMITTEES

meet these requirements the Audit and Risk Committee shall also perform the role of the Auditor Panel for the CCG. The Auditor Panel shall:

• advise the CCG on the maintenance of an independent relationship with external auditors; • advise the CCG on the selection and appointment of external auditors; • if asked advise the CCG on any proposal to enter into a limited liability agreement.

REMUNERATION COMMITTEE The Committee will 1. Advise the Governing Body about appropriate remuneration and terms of service for the Accountable Officers,

other Executive Directors and relevant senior management posts including: a. all aspects of salary or allowance b. provisions for other benefits, including pensions and cars(where appropriate) c. arrangements for termination of employment and other contractual items, including severance

packages 2. Make such recommendations to the Governing Body on the remuneration and terms of service of relevant

senior managers to ensure they are fairly rewarded for their individual contribution to the CCGs, having proper regard to the CCGs’ circumstances and performance and to the provisions of any national arrangements for such staff where appropriate.

3. Monitor and evaluate the performance of individual relevant Senior Managers 4. Advise on and oversee appropriate contractual arrangements for the AOs and other relevant Senior Managers,

including the proper calculation and scrutiny of termination payments taking account of such national guidance as appropriate.

5. ensure that probity and corporate governance is maintained, in matters relating to remuneration and terms of service.

The Remuneration and Terms of Service Committee is a committee of the Governing Body, the Terms of Reference of the Committee set out the membership, quoracy and voting, committee structures and other governance issues.

Governance and Risk Committee

The Governance and Risk Committee will be established as a committee of the Governing Body that exists to:

a) Provide an assurance to the Governing Body that there are robust structures, processes and accountabilities in place for identifying and managing significant risks facing the organisation.

b) Provide assurance on the effective management of governance areas

c) Approve policies and procedures for the management of risk and information governance The Governing Body will delegate:

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COMMITTEE DECISIONS/DUTIES DELEGATED BY THE GOVERNING BODY TO COMMITTEES AND BY THE TO ITS SUB COMMITTEES

a) Review and approval of policies for the management of risk.

b)a) approval of management policies including HR, Information Governance and other corporate policies to the committee.

Quality, Performance and Finance Committee

The main functions of the Quality, Performance and Finance Committee are as follows:

• To ensure that the services NHS Hartlepool and Stockton-on-Tees CCG commissions are able to demonstrate that they have in place an assurance framework which will satisfy compliance with the essential principles of quality.

• To ensure NHS Hartlepool and Stockton-on-Tees CCG is able to fulfil its statutory obligations in relation to this Committee.

• To provide assurance that NHS Hartlepool and Stockton-on-Tees CCG maintains focused attention on improving and safeguarding quality during the transition

• The preparation of proposals to develop and monitor clinical standards in services commissioned by the CCG

• Review annually, draft plans in respect of the application of available financial resources to support the Annual Operating framework

• Monitor and review proposals for CCG or Practice Incentive Schemes • Receive and approve a schedule of contracts • To receive reports from the funding panel

Funding panel • Will consider all Individual Funding Requests and decide whether to support or not support these individual requests on the basis of the information provided

• Will develop and agree protocols for accessing services or treatment not within contract, either for NHS or non-NHS providers where a service level agreement or contract does not exist.

• The Nominated GP Member has delegated authority to act on behalf of the CCG in the joint arrangements which have been set up for handling Individual Funding Requests, with the Governing Body retaining liability.

• Will provide regular reports to the QPF Committee. Primary Care Commissioning Committee

The role of the Committee shall be to carry out the functions relating to the commissioning of primary medical services under section 83 of the NHS Act, except those relating to individual GP performance management, which have been reserved to NHS England. This includes the following activities:

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COMMITTEE DECISIONS/DUTIES DELEGATED BY THE GOVERNING BODY TO COMMITTEES AND BY THE TO ITS SUB COMMITTEES

(a) GMS, PMS and APMS contracts, including:-

• the design of PMS and APMS contracts; • monitoring of contracts; • taking contractual action such as issuing breach/remedial notices; • removing a contract;

(b) Directed Enhanced Services; (c) Design of GP services as alternatives to the Quality Outcomes Framework [QOF]; (d) Approving practice mergers, boundary changes and list closures; (e) Decision making on whether to establish new GP practices in an area; (f) Making decisions on “discretionary” payment [eg returner/retainer schemes]

Better Health Programme Joint Committee Joint

Committee of Clinical Commissioning Groups

Sustainability and Transformation plans

(STP)

The Joint Committee’s primary purpose is to arrange and undertake the formal public consultation and then make decisions on the issues relating to reconfiguration.

The role of the Joint Committee therefore shall be to carry out the functions relating to making decisions about future acute service configuration and service change, undertaking formal public consultation and making decisions on the issues which are the subject of the consultation in relation to the STP.

This includes the following key responsibilities:

• Determine the options appraisal process, including agreeing the evaluation criteria and weighting of the criteria • Determine the method and scope of the engagement and consultation process • Act as the formal body in relation to the public consultation with the Joint Overview and Scrutiny Committees

established for it by the relevant Local Authorities • Make any necessary decisions arising from a Pre-Consultation Business Case (and the decision to run a

formal consultation process) • Approve the Consultation Plan • Approve the text and issues on which the views of the public are sought in the Consultation Document • Take or arrange for all necessary steps to be taken to enable the CCGs to comply with their public sector

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COMMITTEE DECISIONS/DUTIES DELEGATED BY THE GOVERNING BODY TO COMMITTEES AND BY THE TO ITS SUB COMMITTEES

equality duties • Approve the formal report on the outcome of the consultation that incorporates all of the representations

received in response to the consultation document in order to reach a decision • Make decisions about future service configuration and service change, taking into account all of the

information collated and representations received in relation to the consultation process. This should include consideration of any recommendations made by the Programme Board or views expressed by the Joint Health Overview and Scrutiny Committee or any other relevant organisations. It should also include consideration of the implications of the decisions in relation to potential risk to the sustainability and viability of the Foundation Trusts included in the remit of the Programme.

NB: It is the responsibility of each member CCG to ensure that their Governing Body is appropriately briefed and clear on what is delegated to the Joint Committee 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 role of the Committee shall be to to arrange the formal consultation and undertake the decisions on the issues which are the subject of the consultation in relation to the Better Health programme. This includes the following activities:

• Determine the options appraisal process, including agreeing the evaluation criteria and weighting of the criteria

• Determine the method and scope of the consultation process • Act as the formal body in relation to the public consultation with the Joint Overview and Scrutiny

Committees established for it by the relevant Local Authorities • Make any necessary decisions arising from a Pre-Consultation Business Case (and the decision to run a

formal consultation process) • Approve the Consultation Plan • Approve the text and issues on which the public’s views are sought in the Consultation Document • Take or arrange for all necessary steps to be taken to enable the CCGs to comply with their public sector

equality duties • Approve the formal report on the outcome of the consultation that incorporates all of the representations

received in response to the consultation document in order to reach a decision • Make decisions about future service configuration and service change, taking into account all of the

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information collated and representations received in relation to the consultation process. This should include consideration of any recommendations made by the Programme Board or views expressed by the Joint Health Overview and Scrutiny Committee or any other relevant organisations.

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SCHEME OF DELEGATION DERIVED FROM THE ACCOUNTABLE OFFICER MEMORANDUM

DELEGATED TO DUTIES DELEGATED

CHIEF OFFICER (CO) Accountable through NHS Accountable Officer Memorandum to Parliament for stewardship of CCG resources.

CO AND CHIEF FINANCE OFFICER(CFO)

Ensure the accounts of the CCG are prepared under principles and in a format directed by the Secretary of State. Accounts must disclose a true and fair view of the CCG’s income and expenditure and its state of affairs.

Sign the accounts on behalf of the Governing Body.

CO Sign a statement in the accounts outlining responsibilities as the Accountable Officer.

Sign a statement in the accounts outlining responsibilities in respect of Internal Control.

CO Ensure effective management systems that safeguard public funds and assist CCG Chairman to implement requirements of integrated governance including ensuring managers:

• have a clear view of their objectives and the means to assess achievements in relation to those objectives;

• be assigned well defined responsibilities for making best use of resources;

• have the information, training and access to the expert advice they need to exercise their responsibilities effectively.

CHAIR Implement requirements of corporate governance

CO Achieve value for money from the resources available to the CCG and avoid waste and extravagance in the organisation's activities.

Follow through the implementation of any recommendations affecting good practice as set out in reports from such bodies as the Audit Commission and the National Audit Office (NAO).

Use to best effect the funds available for commissioning healthcare, developing services and promoting health to meet the needs of the local population.

CFO Operational responsibility for effective and sound financial management and information.

CO Primary duty to see that CFO discharges this function.

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DELEGATED TO DUTIES DELEGATED

CO Ensuring that expenditure by the CCG complies with Parliamentary requirements

CO The Codes of Conduct and Accountability incorporated in the Corporate Governance Framework issued to NHS Governing Body’s by the Secretary of State are fundamental in exercising their responsibilities for regularity and probity. As a Governing Body member they have explicitly subscribed to the Codes; and should promote observance by all staff.

CO and CFO Accountable Officer, supported by Chief Finance Officer, to ensure appropriate advice is given to the Governing Body on all matters of probity, regularity, prudent and economical administration, efficiency and effectiveness.

CO If AO considers the Governing Body and/or the Chair is doing something that might infringe probity or regularity, he/she should set this out in writing to the Chair and the Governing Body. If the matter is unresolved, he/she should ask the Audit and Risk Committee to investigate and if necessary refer the matter to NHS England and Department of Health.

CO If the Governing Body is contemplating a course of action that raises an issue not of formal propriety or regularity but affects the CO’s responsibility for value for money, the CO should draw the relevant factors to the attention of the Governing Body. If the outcome is that the CO is overruled it is normally sufficient to ensure that your advice and the overruling of it are clearly apparent from the papers. Exceptionally, the CO should inform NHS England. In such cases, the CO should as a member of the Governing Body vote against the course of action rather than merely abstain from voting.

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SCHEME OF DELEGATION DERIVED FROM THE CODES OF CONDUCT AND ACCOUNTABILITY

DELEGATED TO AUTHORITIES/DUTIES DELEGATED

GOVERNING BODY Approve procedure for declaration of hospitality and sponsorship

GOVERNING BODY Ensure proper and widely publicised procedures for voicing complaints, concerns about maladministration, breaches of Code of Conduct, and other ethical concerns.

ALL GOVERNING BODY MEMBERS

Subscribe to Code of Conduct

GOVERNING BODY Governing Body members share corporate responsibility for all decisions of the Governing Body.

CHAIR AND NON- OFFICER MEMBERS

Chair and non-officer members are responsible for monitoring the executive management of the organisation and are responsible to the SofS for the discharge of those responsibilities.

GOVERNING BODY The Governing Body has six key functions for which it is held accountable by NHS England on behalf of the Secretary of State:

1. to ensure effective financial stewardship through value for money, financial control and financial planning and strategy;

2. to ensure that high standards of integrated governance and personal behaviour are maintained in the conduct of the business of the whole organisation;

3. to appoint, appraise and remunerate senior executives; 4. , to ratify the strategic direction of the organisation within the overall policies and priorities of the

Government and the NHS, define its annual and longer term objectives and agree plans to achieve them; 5. to oversee the delivery of planned results by monitoring performance against objectives and ensuring

corrective action is taken when necessary; 6. to ensure that the Governing Body leads an effective dialogue between the organisation and the local

community on its plans and performance and that these are responsive to the community's needs.

GOVERNING BODY It is the Governing Body’s duty to: 1. act within statutory financial and other constraints;

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

2. be clear what decisions and information are appropriate to the Governing Body and draw up Standing Orders, a Schedule of Decisions Reserved to the Governing Body and Standing Financial Instructions to reflect these;

3. ensure that management arrangements are in place to enable responsibility to be clearly delegated to senior executives for the main programmes of action and for performance against programmes to be monitored and senior executives held to account;

4. establish performance and quality measures that maintain the effective use of resources and provide value for money;

5. specify its requirements in organising and presenting financial and other information succinctly and efficiently to ensure the Governing Body can fully undertake its responsibilities;

6. establish Audit and Risk and Remuneration Committees on the basis of formally agreed terms of reference which set out the membership of the sub-committee, the limit to their powers, and the arrangements for reporting back to the main Governing Body.

CHAIR It is the Chair's role to: 1. provide leadership to the Governing Body; 2. enable all Governing Body members to make a full contribution to the Governing Body's affairs and ensure that

the Governing Body acts as a team; 3. ensure that key and appropriate issues are discussed by the Governing Body in a timely manner; 4. ensure the Governing Body has adequate support and is provided efficiently with all the necessary data on

which to base informed decisions; 5. lead non-executive Governing Body members through a formally-appointed Remuneration Committee of the

main Governing Body on the appointment, appraisal and remuneration of the Accountable Officer and (with the latter) other executive Governing Body members;

6. appoint non-executive Governing Body members to an Audit and Risk Committee of the main Governing Body; 7. advise the Secretary of State through the regional member of the Policy Governing Body on the performance

of non-executive Governing Body members.

CO The Accountable Officer is accountable to the Chairman and non-executive members of the Governing Body for ensuring that its decisions are implemented, that the organisation works effectively, in accordance with Government policy and public service values and for the maintenance of proper financial stewardship. The Accountable Officer should be allowed full scope, within clearly defined delegated powers, for action in fulfilling the decisions of the Governing Body. The other duties of the Accountable Officer as Accountable Officer are laid out in the Accountable Officer Memorandum.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CHAIR AND GOVERNING BODY MEMBERS

Declaration of conflict of interests.

GOVERNING BODY Governing Body must comply with legislation and guidance issued by the Department of Health on behalf of the Secretary of State, respect agreements entered into by themselves or on their behalf and establish terms and conditions of service that are fair to the staff and represent good value for taxpayers' money.

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SCHEME OF DELEGATION FROM STANDING ORDERS

DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CHAIR Final authority in interpretation of Standing Orders.

CHAIR Calling meetings.

CHAIR Give final ruling in questions of order, relevancy and regularity of meetings.

CHAIR Having a second or casting vote.

GOVERNING BODY Suspension of Standing Orders.

AUDIT AND RISK COMMITTEE Audit and Risk Committee to review every decision to suspend Standing Orders (power to suspend Standing Orders is reserved to the Governing Body).

THE GOVERNING BODY The Governing Body shall approve the appointments to each of the committees which it has formally constituted

CHAIR & CO The powers which the Governing Body has retained to itself within these Standing Orders may in emergency be exercised by the Chair and Accountable Officer after having consulted at least two non-officer members

ALL Disclosure of non-compliance with Standing Orders to the Accountable Officer as soon as possible.

CO Maintain Register(s) of Interests.

CHAIR OF A MEETING To ensure all members make a declaration on a declared interest.

ALL STAFF Comply with national guidance contained in HSG 1993/5 “Standards of Business Conduct for NHS Staff” and the Code of Conduct for NHS Managers 2002.

ALL Disclose of relationship between self and candidate for staff appointment. (AO to report the disclosure to the Governing Body)

CO OR NOMINATED REPRESENTATIVE

Keep seal in safe place and maintain a register of sealing.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CO OR NOMINATED REPRESENTATIVE

Approve and sign all documents which will be necessary in legal proceedings.

* Nominated officers and the areas for which they are responsible should be incorporated into the CCG’s Scheme of Delegation document.

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SCHEME OF DELEGATION FROM STANDING FINANCIAL INSTRUCTIONS

DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CFO Approval of all financial procedures.

CFO Advice on interpretation or application of SFIs.

ALL MEMBERS OF THE GOVERNING BODY AND

EMPLOYEES

Have a duty to disclose any non-compliance with these Standing Financial Instructions to the Chief Finance Officer as soon as possible.

CO

Responsible as the Accountable Officer to ensure financial targets and obligations are met and have overall responsibility for the System of Internal Control.

CO&CFO Accountable for financial control but will, as far as possible, delegate their detailed responsibilities.

CO To ensure all Governing Body members, officers and employees, present and future, are notified of and understand Standing Financial Instructions.

CFO Responsible for: a) Implementing the CCG’s financial policies and co-coordinating corrective action; b) Maintaining an effective system of financial control including ensuring detailed financial procedures and systems

are prepared and documented; c) Ensuring that sufficient records are maintained to explain CCG’s transactions and financial position; d) Providing financial advice to members of Governing Body and staff; e) Maintaining such accounts, certificates etc as are required for the CCG to carry out its statutory duties; f) The design, implementation and supervision of systems of internal control.

ALL MEMBERS OF THE GOVERNING BODY AND

EMPLOYEES

Responsible for security of the CCG’s property, avoiding loss, exercising economy and efficiency in using resources and conforming to Standing Orders, Standing Financial Instructions and financial procedures.

CO Ensure that any contractor or employee of a contractor who is empowered by the CCG to commit the CCG to expenditure or who is authorised to obtain income are made aware of these instructions and their requirement to comply.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

AUDIT AND RISK COMMITTEE Provide independent and objective view on internal control and probity.

CHAIR Raise the matter at the Governing Body meeting where Chair of the Audit and Risk Committee considers there is evidence of ultra vires transactions or improper acts.

CFO a) Ensure an adequate internal audit service, for which he/she is accountable, is provided (and involve the Audit and Risk Committee in the selection process when/if an internal audit service provider is changed.) b) Ensure the annual audit report is prepared for consideration by the Audit and Risk Committee.

CFO Decide at what stage to involve police in cases of misappropriation and other irregularities not involving fraud or corruption.

HEAD OF INTERNAL AUDIT Review, appraise and report in accordance with NHS Internal Audit Standards and best practice.

AO & CFO Monitor and ensure compliance with SofS Directions on fraud and corruption including the appointment of the Local Counter Fraud Specialist.

CO Monitor and ensure compliance with Directions issued by the Secretary of State for Health on NHS security management including appointment of the Local Security Management Specialist.

CO Has overall responsibility for the CCG’s activities and ensuring the CCG stays within its resource limit.

CFO Will provide monthly reports to the SofS, ensure draw down is for approved expenditure and timely and follows best practice in Cash Management.

CFO Ensure monitoring systems are in place to enable the CCG not to exceed its limits.

CFO Periodically review assumptions, submit a report to the CCG annually showing total allocations received and their proposed distribution.

CFO Regularly update the CCG on significant changes to the initial allocation and the uses of such funds

CO Compile and submit to the Governing Body a Commissioning Plan which takes into account financial targets and forecast limits of available resources. The plan will contain:

• a statement of the significant assumptions on which the plan is based; • details of major changes in workload, delivery of services or resources required to achieve the plan.

CFO Submit budgets to the Governing Body for approval. Monitor performance against budget; submit to the Governing Body financial estimates and forecasts.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CFO Ensure adequate training is delivered on an ongoing basis to budget holders.

CO Delegate budget to budget holders.

CO & BUDGET HOLDERS Must not exceed the budgetary total or virement limits set by the Governing Body.

CFO Devise and maintain systems of budgetary control.

BUDGET HOLDERS Ensure that:

a) no overspend or reduction of income that cannot be met from virement is incurred without priorconsent of the

Governing Body;

b) approved budget is not used for any other than specified purpose subject to rules of virement; c) no permanent employees are appointed without the approval of the CE other than those provided for within

available resources and manpower establishment.

CO Identify and implement cost improvements and income generation activities in line with the Commissioning Plan.

CO Submit monitoring returns.

CO Preparation of annual accounts and reports.

CO Managing banking arrangements, including provision of banking services, operation of accounts, preparation of instructions and list of cheque signatories.

(Governing Body approves arrangements.)

CFO Income systems, including system design, prompt banking, review and approval of fees and charges, debt recovery arrangements, design and control of receipts, provision of adequate facilities and systems for employees whose duties include collecting or holding cash.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

ALL EMPLOYEES Duty to inform Chief Finance Officerof money due from transactions which they initiate/deal with.

CO Tendering and contracting procedure.

CO Waive formal tendering procedures.

CO Report waivers of tendering procedures to the Audit and Risk Committee.

CFO Where a supplier is chosen that is not on the approved list the reason shall be recorded in writing to the Ao.

NOMINATED REPRESENTATIVE Responsible for the receipt, endorsement and safe custody of tenders received.

NOMINATED REPRESENTATIVE Shall maintain a register to show each set of competitive tender invitations despatched.

NOMINATED REPRESENTATIVE Where one tender is received will assess for value for money and fair price.

NOMINATED REPRESENTATIVE Responsible for treatment of ‘late tenders’.

CO No tender shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with these Instructions except with the authorisation of the CO..

NOMINATED REPRESENTATIVE Shall ensure that appropriate checks are carried out as to the technical and financial capability of those firms that are invited to tender or quote.

NOMINATED REPRESENTATIVE Nominated officer should evaluate the quotation and select the quote which gives the best value for money.

NOMINATED REPRESENTATIVE No quotation shall be accepted which will commit expenditure in excess of that which has been allocated by the CCG and which is not in accordance with these Instructions except with the authorisation of the CO.

ACCOUNTABLE OFFICER CO The Accountable OfficerCO shall demonstrate that the use of private finance represents value for money and genuinely transfers risk to the private sector.

GOVERNING BODY All PFI proposals must be agreed by the Governing Body.

CO The CO shall nominate an officer who shall oversee and manage each contract on behalf of the CCG.

CO The CO shall nominate officers with delegated authority to enter into contracts of employment, regarding staff, agency staff or temporary staff service contracts.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CO The CO shall nominate officers to commission service agreements with providers of healthcare in line with a commissioning plan approved by the Governing Body.

CO The CO shall be responsible for ensuring that best value for money can be demonstrated for all services provided on an in-house basis.

CO Must ensure the CCG enters into suitable Service Level Agreements (SLAs) / Contracts with service providers for the provision of NHS services and Commissioning Support.

CO As the Accountable Officer, ensure that regular reports are provided to the Governing Body detailing actual and forecast expenditure against the SLA/Contracts.

CO As the Accountable Officer, ensure secondary services are commissioned in line with the Commissioning Plan and reach the required standards.

CO As the Accountable Officer, ensure regular reports are provided to the Governing Body detailing actual and forecast expenditure for each SLA/Contract.

CFO Will maintain a system of control to ensure effective accounting of expenditure against SLAs/Contracts.

CFO Must account for Out of Area Treatments/Non Contract Activity in accordance with national guidelines. CO Approval of variation to funded establishment

CO Approval of appointment of staff, including agency staff, appointments and re-grading within approved budget and funded establishment.

CFO Payroll: a) specifying timetables for submission of properly authorised time records and other notifications; b) final determination of pay and allowances; c) making payments on agreed dates; d) agreeing method of payment; e) issuing instructions.

NOMINATED OFFICER* Where appropriate, submit time records in line with timetable;

Complete time records and other notifications in required form;

Submitting termination forms in prescribed form and on time.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CFO Ensure that the chosen method for payroll processing is supported by appropriate (contracted) terms and conditions, adequate internal controls and audit review procedures and that suitable arrangements are made for the collection of payroll deductions and payment of these to appropriate bodies.

NOMINATED OFFICER* Ensure that all employees are issued with a Contract of Employment in a form approved by the Governing Body and which complies with employment legislation; Deal with variations to, or termination of, contracts of employment.

GOVERNING BODY The Governing Body will approve the level of non-pay expenditure on an annual basis.

CO Determine, and set out, level of delegation of non-pay expenditure to budget managers, including a list of managers authorised to place requisitions, the maximum level of each requisition and the system for authorisation above that level.

CO Set out procedures on the seeking of professional advice regarding the supply of goods and services.

REQUISITIONER* In choosing the item to be supplied (or the service to be performed) shall always obtain the best value for money for the CCG. In so doing, the advice of the CCG's adviser on supply shall be sought.

CFO Shall be responsible for the prompt payment of accounts and claims.

CFO a) Advise the Governing Body regarding the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in standing orders and regularly reviewed;

b) Prepare procedural instructions [where not already provided in the Scheme of Delegation or procedure notes for budget holders] on the obtaining of goods, works and services incorporating the thresholds;

c) Be responsible for the prompt payment of all properly authorised accounts and claims; d) Be responsible for designing and maintaining a system of verification, recording and payment of all amounts

payable; e) Be responsible for ensuring that payment for goods and services is only made once the goods and services are

received.

APPROPRIATE EXECUTIVE DIRECTOR

Make a written case to support the need for a pre-payment.

CFO Approve proposed pre-payment arrangements.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

BUDGET HOLDER Ensure that all items due under a prepayment contract are received (and immediately inform CFO if problems are encountered).

MANAGERS AND OFFICERS Ensure that they comply fully with the guidance and limits specified by the Chief Finance Officer.

CO & CFO Ensure that the arrangements for financial control and financial audit of building and engineering contracts and property transactions comply with the guidance contained within CONCODE and ESTATECODE. The technical audit of these contracts shall be the responsibility of the relevant Director.

CFO Lay down procedures for payments to local authorities and voluntary organisations made under the powers of section 28A of the NHS Act.

CFO Ensure that Governing Body members are aware of the Financial Framework and ensure compliance

CO Capital investment programme: a) ensure that there is adequate appraisal and approval process for determining capital expenditure priorities and the

effect that each has on plans; b) responsible for the management of capital schemes and for ensuring that they are delivered on time and within

cost; c) ensure that capital investment is not undertaken without availability of resources to finance all revenue

consequences; d) ensure that a business case is produced for each proposal.

CFO Certify professionally the costs and revenue consequences detailed in the business case for capital investment.

CO Issue procedures for management of contracts involving stage payments.

CFO Issue procedures for the regular reporting of expenditure and commitment against authorised capital expenditure.

CO Shall issue to the manager responsible for any scheme specific authority to commit expenditure, proceed to tender and accept a successful tender.

CO Issue a scheme of delegation for capital investment management in accordance with Standing Orders.

CFO Issue procedures governing financial management, including variation to contract, of capital investment projects and valuation for accounting purposes.

CFO Demonstrate that the use of private finance represents value for money and genuinely transfers significant risk to the private sector.

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CO Maintenance of asset registers (on advice from CFO)

CFO Approve procedures for reconciling balances on fixed assets accounts in ledgers against balances on fixed asset registers.

CFO Calculate and pay capital charges in accordance with Department of Health requirements.

CO Overall responsibility for fixed assets.

CFO Approval of fixed asset control procedures.

GOVERNING BODY, AND ALL SENIOR STAFF

Responsibility for security of CCG assets including notifying discrepancies to CFO and reporting losses in accordance with CCG procedure.

CO Delegate overall responsibility for control of stores (subject to CFO responsibility for systems of control). Further delegation for day-to-day responsibility subject to such delegation being recorded. (Good practice to append to the scheme of delegation document.)

CFO Responsible for systems of control over stores and receipt of goods.

NOMINATED OFFICERS* Security arrangements and custody of keys.

CFO Approve alternative arrangements where a complete system of stores control is not justified.

CO Identify persons authorised to requisition and accept goods from NHS Supplies stores.

CFO Prepare detailed procedures for disposal of assets including condemnations and ensure that these are notified to managers.

CFO Prepare procedures for recording and accounting for losses, special payments.

ALL STAFF Discovery or suspicion of loss of any kind must be reported immediately to either head of department or nominated officer. The head of department / nominated officer should then inform the CO and CFO.

CFO Where a criminal offence is suspected CFO must inform the police if theft or arson is involved. In cases of fraud and corruption CFO must inform the relevant Local Counter Fraud Specialist (LCFS) and NHS Counter Fraud Service (NHS CFS) Operational Fraud Team in line with SofS directions.

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

CFO Notify CFSMS, LCFS and External Audit of all frauds.

CFO Notify Governing Body and External Auditor of losses caused theft, arson, neglect of duty or gross carelessness (unless trivial).

CFO Consider whether any insurance claim can be made.

CFO Maintain losses and special payments register.

CFO Responsible for accuracy and security of computerised financial data.

CFO Ensure that new financial systems and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

CHIEF FINANCE OFFICER Shall publish and maintain a Freedom of Information Scheme and act as Senior Information Risk Officer (SIRO) for the organisation.

RELEVANT OFFICERS Send proposals for general computer systems to CFO.

CFO Ensure that contracts with other bodies for the provision of computer services for financial applications clearly define responsibility of all parties for security, privacy, accuracy, completeness and timelines of data during processing, transmission and storage and allow for audit review. Seek periodic assurances from the provider that adequate controls are in operation.

CFO Where computer systems have in impact on corporate financial systems satisfy himself that: a) systems acquisition, development and maintenance are in line with corporate policies; b) data assembled for processing by financial systems is adequate, accurate, complete and timely, and that a

management rail exists; c) CFO and staff have access to such data; d) Such computer audit reviews are being carried out as are considered necessary.

CFO Shall ensure that each trust fund which the CCG is responsible for managing is managed appropriately.

CFO Ensure all staff are made aware of the CCG policy on the acceptance of gifts and other benefits in kind by staff.

CO Ensure lists of all contractors are maintained up to date and systems are in place to deal with applications,

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DELEGATED TO AUTHORITIES/DUTIES DELEGATED

resignations, inspection of premises etc. within contractors’ terms of service.

CFO Ensure only contractors included on the CCG lists receive payments; maintain a system of control to ensure prompt and accurate payments and validation of same.

CO Retention of document procedures in accordance with Department of Health guidance.

CO Ensure the CCG has appropriate arrangements in place for the management of risk.

GOVERNING BODY Approve and monitor risk management strategy

GOVERNING BODY Decide whether the CCG will use the risk pooling schemes administered by the NHS Litigation Authority or self-insure for some or all of the risks (where discretion is allowed). Decisions to self-insure should be reviewed annually.

CFO Where the Governing Body decides to use the risk pooling schemes administered by the NHS Litigation Authority the Chief Finance Officer shall ensure that the arrangements entered into are appropriate and complementary to the risk management programme. The Chief Finance Officer shall ensure that documented procedures cover these arrangements. Where the Governing Body decides not to use the risk pooling schemes administered by the NHS Litigation Authority for any one or other of the risks covered by the schemes, the Chief Finance Officer shall ensure that the Governing Body is informed of the nature and extent of the risks that are self insured as a result of this decision. The Chief Finance Officer will draw up formal documented procedures for the management of any claims arising from third parties and payments in respect of losses that will not be reimbursed.

* Nominated officers and the areas for which they are responsible should be incorporated into the CCG’s Scheme of Delegation document.

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APPENDIX D – PRIME FINANCIAL POLICIES

1. INTRODUCTION

1.1. General

1.1.1. These prime financial policies and supporting detailed financial policies shall have effect as if incorporated into the CCG’s constitution.

1.1.2. The prime financial policies are part of the CCG’s control environment for

managing the organisation’s financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration, lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Accountable Officer and chief finance officer to effectively perform their responsibilities. They should be used in conjunction with the scheme of reservation and delegation found at Appendix C.

1.1.3. In support of these prime financial policies, the CCG has prepared more

detailed policies, approved by the chief finance officer –, known as detailed financial policies. The CCG refers to these prime and detailed financial policies together as the clinical commissioning CCG’s financial policies.

1.1.4. These prime financial policies identify the financial responsibilities which

apply to everyone working for the CCG and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The chief finance officer is responsible for approving all detailed financial policies.

1.1.5. A list of the CCG’s detailed financial policies will be published and maintained on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

1.1.6. Should any difficulties arise regarding the interpretation or application of any

of the prime financial policies then the advice of the chief finance officer must be sought before acting. The user of these prime financial policies should also be familiar with and comply with the provisions of the CCG’s constitution, standing orders and scheme of reservation and delegation.

1.1.7. Failure to comply with prime financial policies and standing orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.

1.2. Overriding Prime Financial Policies

1.2.1. If for any reason these prime financial policies are not complied with, full

details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance shall be reported to the next formal meeting of the Governing Body’s audit and risk committee for referring

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action or ratification. All of the CCG’s members and employees have a duty to disclose any non-compliance with these prime financial policies to the chief finance officer as soon as possible.

1.3. Responsibilities and delegation

1.3.1. The roles and responsibilities of CCG’s members, employees, members of the Governing Body, members of the Governing Body’s committees and sub-committees, members of the CCG’s committee and sub-committee (if any) and persons working on behalf of the CCG are set out in chapters 6 and 7 of this constitution.

1.3.2. The financial decisions delegated by members of the CCG are set out in the

CCG’s scheme of reservation and delegation (see Appendix C).

1.4. Contractors and their employees

1.4.1. Any contractor or employee of a contractor who is empowered by the CCG to commit the CCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Accountable Officer to ensure that such persons are made aware of this.

1.5. Amendment of Prime Financial Policies

1.5.1. To ensure that these prime financial policies remain up-to-date and relevant,

the chief finance officer will review them at least annually in accordance with the review of the CCG Constitution. Following consultation with the Accountable Officer and scrutiny by the Governing Body, the chief finance officer will recommend amendments, as fitting, to the Council of Members for approval. As these prime financial policies are an integral part of the CCG’s constitution, any amendment will not come into force until the CCG applies to NHS England and that application is granted.

2. INTERNAL CONTROL

2.1. The Governing Body is required to establish an audit and risk committee with terms of reference agreed by the Governing Body (see paragraph 6.6.3(a) of the CCG’s constitution for further information).

2.2. The Accountable Officer has overall responsibility for the CCG’s systems of

internal control.

2.3. The chief finance officer will ensure that:

a) financial policies are considered for review and update annually;

b) a system is in place for proper checking and reporting of all breaches of financial policies; and

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c) a proper procedure is in place for regular checking of the adequacy and

effectiveness of the control environment.

3. AUDIT

3.1. In line with the terms of reference for the Governing Body’s Audit and Risk Committee, the person appointed by the CCG to be responsible for internal audit and the appointed external auditor will have direct and unrestricted access to Audit and, Risk and Governance committee members and the chair of the Governing Body, Accountable Officer and chief finance officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.2. The person appointed by the CCG to be responsible for internal audit and the

external auditor will have access to the Audit and Risk Committee and the Accountable Officer to review audit issues as appropriate. All Audit and Risk Committee members, the chair of the Governing Body and the Accountable Officer will have direct and unrestricted access to the head of internal audit and external auditors.

3.3 The chief finance officer will ensure that the Governing Body’s audit and risk committee approves any changes to the provision or delivery of assurance services to the CCG.

3.4 The chief finance officer will ensure that there is an Internal Audit function

which is an independent and objective appraisal service within the CCG which provides:

a) an independent and objective opinion to the Accountable Officer, the

Governing Body, and the Audit and Risk Committee on the degree to which risk management, control and governance, support the achievement of the organisation’s agreed objectives;

b) an independent and objective consultancy service specifically to help line

management improve the organisation’s risk management, control and governance arrangements.

3.4.1 Internal Audit will review, appraise and report upon policies, procedures and

operations in place to:

a) establish and monitor the achievement of the organisation’s objectives; ; b) identify, assess and manage the risks to achieving the organisation’s

objectives; c) ensure the economical, effective and efficient use of resources; d) ensure compliance with established policies (including behavioural and

ethical expectations), procedures, laws and regulations;

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e) safeguard the organisation’s assets and interests from losses of all kinds, including those arising from fraud, irregularity or corruption

f) ensure the integrity and reliability of information, accounts and data, including internal and external reporting and accountability processes.

3.4.2 The Head of Internal Audit will provide to the Audit and Risk Committee;

a) A risk-based plan of internal audit work, agreed with management and

approved by the Audit and Risk Committee, based upon the Assurance Framework that will enable the auditors to collect sufficient evidence to give an opinion on the adequacy and effective operation of the organisation;

b) Regular updates on the progress against plan; c) Reports of management’s progress on the implementation of action

agreed as a result of internal audit findings; d) An annual opinion, based upon and limited to the work performed, on the

overall adequacy and effectiveness of the organisation’s risk management, control and governance processes (i.e. the organisation’s system of internal control). This opinion is used by the Governing Body to inform the Annual Governance Statement and by NHS England as part of its performance management role;

e) Additional reports as requested by the Audit and Risk Committee.

3.4.3 Whenever any matter arises which involves, or is thought to involve,

irregularities concerning cash, stores, or other property or any suspected irregularity in the exercise of any function of a pecuniary nature, the chief finance officer must be notified immediately.

3.4.4 The Head of Internal Audit will normally attend Audit and Risk Committee

meetings and has a right of access to all Audit and Risk Committee members, the Chairman and Accountable Officer of the CCG.

3.4.5 The Head of Internal Audit reports to the Audit and Risk Committee. The

reporting system for Internal Audit shall be agreed between the chief finance officer, the Audit and Risk Committee and the Head of Internal Audit. The agreement shall be in writing and shall comply with the guidance on reporting contained in the NHS Internal Audit Standards. The reporting system shall be reviewed at least every three years.

3.4.6 The appointment and termination of the Head of Internal Audit and/or the Internal Audit Service must be approved by the Audit and Risk Committee.

3.5 The External Auditor is appointed by the Audit Commission and paid for by

the CCG. The Audit and Risk Committee must ensure a cost-efficient

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service. If there are any problems relating to the service provided by the External Auditor, then this should be raised with the External Auditor and referred on to the Audit Commission if the issue cannot be resolved.

4. FRAUD AND CORRUPTION

4.1. The Governing Body’s Audit and Risk Committee will satisfy itself that the

CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

4.2. The Governing Body’s Audit and Risk Committee will ensure that the CCG

has arrangements in place to work effectively with NHS Protect.

5. SECURITY MANAGEMENT

5.1 In line with their responsibilities, the CCG Accountable Officer will monitor and ensure compliance with Directions issued by the Secretary of State for Health on NHS security management.

5.2 The CCG shall nominate a suitable person to carry out the duties of the Local Security Management Specialist (LSMS) as specified by the Secretary of State for Health guidance on NHS Security Management.

5.3 The CCG shall nominate a person to oversee the NHS Security Management service who will report to the Governing Body.

5.4 The Accountable Officer has overall responsibility for controlling and coordinating security. However, key tasks are delegated to the Security Management Director (SMD) and the appointed Local Security Management Specialist (LSMS).

6. EXPENDITURE CONTROL

6.1. The CCG is required by statutory provisions57 to ensure that its expenditure

does not exceed the aggregate of allocations from NHS England and any other sums it has received and is legally allowed to spend.

6.2. The Accountable Officer has overall executive responsibility for ensuring that the CCG complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money.

6.3. The chief finance officer will:

57 See section 223H of the 2006 Act, inserted by section 27 of the 2012 Act

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a) provide reports in the form required by NHS England;

b) ensure money drawn from NHS England is required for approved expenditure only is drawn down only at the time of need and follows best practice;

c) be responsible for ensuring that an adequate system of monitoring

financial performance is in place to enable the CCG to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of NHS England.

7. ALLOCATIONS58

7.1. The CCG’s chief finance officer will:

a) periodically review the basis and assumptions used by NHS England for

distributing allocations and ensure that these are reasonable and realistic and secure the CCG’s entitlement to funds;

b) prior to the start of each financial year submit to the Governing Body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and

c) regularly update the Governing Body on significant changes to the initial

allocation and the uses of such funds. 8. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY

CONTROL AND MONITORING

8.1. The Accountable Officer will compile and submit to the Governing Body a commissioning strategy which takes into account financial targets and forecast limits of available resources.

8.2. Prior to the start of the financial year the chief finance officer will, on behalf of

the Accountable Officer, prepare and submit budgets for approval by the Governing Body.

8.3. The chief financial officer shall monitor financial performance against budget and plan, periodically review them, and report to the Governing Body. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial or budgets.

8.4. The Accountable Officer is responsible for ensuring that information relating to the CCG’s accounts or to its income or expenditure, or its use of resources is provided to NHS England as requested.

58 See section 223(G) of the 2006 Act, inserted by section 27 of the 2012 Act.

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8.5. The Governing Body will approve consultation arrangements for the CCG’s commissioning plan59.

8.6. The Accountable Officer may delegate the management of a budget to permit the performance of a defined range of activities. This delegation must be in writing and be accompanied by a clear definition of: a) the amount of the budget; b) the purpose(s) of each budget heading; c) individual and group responsibilities; d) authority to exercise virement; e) achievement of planned levels of service; f) the provision of regular reports.

8.7. The Accountable Officer and delegated budget holders must not exceed the budgetary total or virement limits set by the Governing Body.

8.8. Any budgeted funds not required for their designated purpose(s) revert to the immediate control of the Accountable Officer, subject to any authorised use of virement.

8.9. Non-recurring budgets should not be used to finance recurring expenditure without the authority in writing of the Accountable Officer, as advised by the Chief Finance Officer. Budgetary Control and Reporting

8.10. The Chief Finance Officer will devise and maintain systems of budgetary control. These will include: a) monthly financial reports to the Governing Body in a form approved by

the Governing Body containing:

i) income and expenditure to date showing trends and forecast year-end position;

ii) movements in working capital; iii) movements in cash and capital; iv) capital project spend and projected outturn against plan;

59 See section 14Z13 of the 2006 Act, inserted by section 26 of the 2012 Act

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v) explanations of any material variances from plan; vi) details of any corrective action where necessary and the

Accountable Officer's and/or Chief Finance Officer's view of whether such actions are sufficient to correct the situation;

b) the issue of timely, accurate and comprehensible advice and financial

reports to each budget holder, covering the areas for which they are responsible;

c) investigation and reporting of variances from financial, workload and manpower budgets; d) monitoring of management action to correct variances; e) arrangements for the authorisation of budget transfers.

8.11. Each Budget Holder is responsible for ensuring that: a) any likely overspending or reduction of income which cannot be met by

virement is not incurred without the prior consent of the Governing Body;

b) the amount provided in the approved budget is not used in whole or in

part for any purpose other than that specifically authorized, subject to the rules of virement;

c) no permanent employees are appointed without the approval of the

Accountable Officer other than those provided for within the available resources and manpower establishment as approved by the Governing Body .

8.12. The Accountable Officer is responsible for identifying and implementing cost

improvements and income generation initiatives in accordance with the requirements of the Commissioning Plan and a balanced budget.

9. ANNUAL ACCOUNTS AND REPORTS

9.1. The chief finance officer will ensure the CCG:

a) prepares a timetable for producing the annual report and accounts and

agrees it with external auditors and the Governing Body;

b) prepares the accounts according to the timetable approved by the Governing Body;

c) complies with statutory requirements and relevant directions for the

publication of annual report;

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d) considers the external auditor’s management letter and fully address all

issues within agreed timescales; and

e) publishes the external auditor’s management letter on the CCG’s website at www.hartlepoolandstocktonccg.nhs.uk.

10. INFORMATION TECHNOLOGY

10.1. The chief finance officer is responsible for the accuracy and security of the CCG’s computerised financial data and shall

a) devise and implement any necessary procedures to ensure adequate

(reasonable) protection of the CCG's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998;

b) ensure that adequate (reasonable) controls exist over data entry,

processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;

c) ensure that adequate controls exist such that the computer operation is

separated from development, maintenance and amendment;

d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the chief finance officer may consider necessary are being carried out.

10.2. In addition the chief finance officer shall ensure that new financial systems

and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

11. ACCOUNTING SYSTEMS

11.1. The chief finance officer will ensure:

a) the CCG has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of NHS England;

b) that contracts for computer services for financial applications with

another health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission

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and storage. The contract should also ensure rights of access for audit purposes.

11.2. Where another health organisation or any other agency provides a computer

service for financial applications, the chief finance officer shall periodically seek assurances that adequate controls are in operation.

12. BANK ACCOUNTS

12.1. The chief finance officer will:

a) review the banking arrangements of the CCG at regular intervals to ensure they are in accordance with Secretary of State directions60, best practice and represent best value for money;

b) manage the CCG's banking arrangements and advise the CCG on the

provision of banking services and operation of accounts;

c) prepare detailed instructions on the operation of bank accounts.

12.2. The Audit and Risk Committee shall approve the banking arrangements.

13. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS.

13.1. The Chief Financial Officer is responsible for:

a) designing, maintaining and ensuring compliance with systems for the

proper recording, invoicing, and collection and coding of all monies due;

b) establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments;

c) approving and regularly reviewing the level of all fees and charges other

than those determined by NHS England or by statute. Independent professional advice on matters of valuation shall be taken as necessary;

d) for developing effective arrangements for making grants or loans.

14. TENDERING AND CONTRACTING PROCEDURE

14.1 Duty to comply with SOs and SFIs 14.1.1 The procedure to be followed by the CCG in relation to opportunities with the CCG

and for awarding all contracts with the CCG shall comply with these SOs and SFIs (except where SO No. 3.9 Suspension of SOs is applied).

60 See section 223H(3) of the NHS Act 2006, inserted by section 27 of the 2012 Act

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14.1.2 This section of the SFIs is structured in the following sections:

• This section: Legislation and Policy Framework, referring to the main requirements of law and policy. This section is not definitive and other guidance may also be applicable to any decision or procurement (SFIs 14.1 to 17.4 inclusive);

• The decision to tender and exceptions to the requirements to tender (SFI 14.5 to 14.6);

• Tendering Procedure where a decision is made to tender pursuant to SFI 14.5 and SFI 14.6 (SFI 14.7)

• Quotations where no tender process (SFI 14.8); • Evaluation of competitive and non-competitive quotations (SFI 14.9); • Award of contracts (SFI 14.10); and • Form of Contract (SFI 14.11);

14.2 Legislation Governing Public Procurement

14.2.1 The CCG shall comply with the Public Contracts Regulations 2006 (the “Regulations”) and any EU Directives relating to EU procurement law having direct effect in England (the “Directives”) and any other duties derived from the EU Treaty (“Treaty Obligations”) and any duties derived from the UK common law (“Common Law Duties”) (the Regulations, Directives, Treaty Obligations and Common Law Duties together are referred to elsewhere in these SFIs as “Procurement Legislation”). The Procurement Legislation as from time to time amended shall have effect as if incorporated in the SOs and SFIs.

14.2.2 The CCG should consider obtaining support from the NHS Supply Chain and/or the office of Government Commerce where relevant and/or any suitably qualified professional advisor (including, where appropriate, legal advisors) to ensure compliance with Procurement Legislation when engaging in tendering procedures.

14.2.3 The CCG shall consider the application of any applicable duty to consult or

engage the public or any relevant Overview and Scrutiny Committee of a Local Authority prior to commencing any procurement process for a contract opportunity.

14.3 Guidance on Procurement and Commissioning 14.3.1 The CCG should have regard to all relevant guidance issued by the Department

of Health in relation to the conduct of procurement practice and the commissioning of health care services, including but not limited to: (a) the CCG Procurement Guide for Health Services (Department of Health:

May 2008) or any successor guide issued by the Department of Health;

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(b) the Principles and Rules for Cooperation and Competition attached at Annex D to the Operating Framework for 2008/09 or any successor to such principles and rules issued by the Department of Health;

(c) the Department of Health’s “Capital Investment Manual” and “Estatecode” in

respect of capital investment and estate and property transactions, save where either has been superseded by later published guidance to which the CCG should have regard;

(d) in the case of management consultancy contracts the Department of Health

guidance “The Procurement and Management of Consultants within the NHS” or any successor guidance issued by the Department of Health; and

(e) policies and procedures in place for the control of all tendering activity

carried out through Reverse Auctions. For further guidance on Reverse eAuctions refer to www.ogc.gov.uk .

14.4 OGC Gateway Review and Guidance

14.4.1 The CCG should consider the applicability of the Office of Government

Commerce (OGC) Gateway review process (see www.dh.gov.uk/gatewayreviews) to each procurement process undertaken to provide assurance that the procurement is conducted in accordance with best practice.

14.5 Decisions to Tender and Exceptions to Requirement to Tender

14.5.1 Presumption to Tender

Where: (a) a contract opportunity that is required to be tendered under the Regulations

(i.e. the contract opportunity is governed by the Regulations and the value of the contract opportunity as calculated pursuant to the Regulations exceeds the relevant financial threshold for the requirement to run a formal tender process); or

(b) the contract would pass the Cross Border Test. The Cross Border Test is

passed (subject to any subsequent judicial precedent in the UK Courts or the European Court of Justice) if the contract opportunity under consideration would be (whatever the value of the contract and whether or not the contract opportunity is a Part B service under the Regulations, or falls outside the requirement to tender under the Regulations) of certain interest to any body located in a member state of the European Union other than the United Kingdom;

Then subject to SFI 14.5.4 the CCG shall ensure that contract opportunities with

the CCG are advertised in accordance with SFI 14.7.3 and where more than one

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response is received that competitive tenders are invited in accordance with SFI 14.7.4 for: • the supply of goods, materials and manufactured articles; • the rendering of services including all forms of management consultancy

services; and • for the design, construction and maintenance of building and engineering

works (including construction and maintenance of grounds and gardens);

14.5.2 Commissioning Health Care Services: Decision to Tender

Health care services are classed as Part B Services under the Regulations. As such, no requirement to advertise arises by virtue of SFI 14.5.1(a) above, but may do under SFI 14.5.1(b) and each contract opportunity should be assessed against the Cross Border Test.

14.5.3 In-house Services: Decision to Tender Services

The Accountable Officer shall be responsible for ensuring that best value for money can be demonstrated for all services provided on an in-house basis. The CCG may also determine from time to time that in-house services should be market tested by competitive tendering.

14.5.4 Exceptions and instances where formal tendering need not be applied

Where a contract opportunity is required to be tendered under SFI 14.5.1, such contract opportunity need not be advertised and tendered and formal tendering procedures need not be applied where: (a) the estimated expenditure or income does not, or is not reasonably

expected to, exceed £50,000; or (b) any disposals falling within within SFI 24.1.3; (c) the requirement can be met under an existing contract without infringing

Procurement Legislation, including, without limitation any contract opportunity falling within the exclusivity arrangements granted to a LIFT provider under any LIFT scheme to which the CCG is a party;

(d) the CCG is entitled to call off from a Framework Agreement and the

requirements of SFI 14.6 (Use of Framework Agreements) have been followed;

(e) a consortium arrangement is in place and a lead organisation has been

appointed to carry out tendering activity on behalf of the CCG; or (f) an exception permitting the use of the negotiated procedure without notice

validly applies under regulation 14 of the Regulations.

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Formal tendering procedures may be waived in the following circumstances:

(g) in very exceptional circumstances where the Accountable Officer decides

that formal tendering procedures would not be practicable or the estimated expenditure or income would not warrant formal tendering procedures, and the circumstances are detailed in an appropriate CCG record and reviewed by the Audit and Risk Committee;

(h) where the timescale genuinely precludes competitive tendering for reasons

of extreme urgency brought about by events unforeseeable by the CCG and not attributable to the CCG. Failure to plan the work properly is not a justification for waiving the requirement to conduct a formal tendering procedure;

(i) where the works, services or supply required are available from only one

source for technical or artistic reasons or for reasons connected with the protection of exclusive rights;

(j) when the goods required by the CCG are a partial replacement for, or in

addition to, existing goods and to obtain the goods from a supplier other than the supplier who supplied the existing goods would oblige the CCG to acquire goods with different technical characteristics and this would result in:

• incompatibility with the existing goods; or • disproportionate technical difficulty in the operation and maintenance of

the existing goods;

but no such contract may be entered in to for a duration of more than three years.

(k) when works or services required by the CCG are additional to works or

services already contracted for but for unforeseen circumstances such additional works or services have become necessary and that such additional works or services:

• cannot for technical or economic reasons be carried out separately from

the works or services under the original contract without major inconvenience to the CCG; or

• can be carried out or provided separately from the works or services under the original contract but are strictly necessary to the latest stages of performance of the original contract;

Provided that the value of such additional works or services does not exceed 50% of the value of the original contract;

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(l) for the provision of legal advice and/or services provided that any provider of legal advice and/or services commissioned by the CCG is regulated by the Solicitors Regulation Authority for the conduct of their business (or by the Bar Council for England and Wales in relation to the obtaining of Counsel’s opinion) and are generally recognised as having sufficient expertise in the area of work for which they are commissioned.

The Chief finance officer will ensure that any fees paid are reasonable and

within commonly accepted rates for the costing of such work.

14.5.5 Monitoring and Audit of Decision to Tender

The waiving of competitive tendering procedures should not be used with the object of avoiding competition or solely for administrative convenience or subject to SFIs 14.5.4 (b) to (j) to award further work to a provider originally appointed through a competitive procedure.

Where it is decided that competitive tendering need not be applied or should be

waived, the fact of the waiver and the reasons should be documented and recorded in an appropriate CCG record and reported to the Audit and Risk Committee at each meeting.

Where the CCG proposes not to conduct a tender process in relation to a

contract opportunity for a new health care service or a significantly changed health care service then the CCG shall consider such proposal at a meeting of the Governing Body as recommended by the CCG Procurement Guide.

14.5.6 Contracts which subsequently breach thresholds after original approval not to tender

Contract opportunities estimated to be below the financial limits set out in SFI 14 or below the threshold for the application of the requirement to tender under the Regulation, for which formal tendering procedures are not used which subsequently prove to have a value above such limits shall be reported to the Accountable Officer, and be recorded in an appropriate CCG record and reported to the Audit and Risk Committee.

14.6 Use of Framework Agreements

The CCG may utilise any available framework agreement to satisfy its requirements for works, services or goods but only if it complies with the requirements of Procurement Legislation in doing so, which include (but are not limited to) ensuring that: (a) the framework agreement was procured on its behalf. The CCG should

satisfy itself that the original procurement process included the CCG within its scope;

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(b) the framework agreement includes the CCG’s requirement within its scope. The CCG should satisfy itself that this is the case;

(c) where the framework agreement is a multi-operator framework agreement,

the process for the selection of providers to be awarded call-off contracts under the framework agreement is followed; and

(d) the call-off contract entered into with the provider contains the contractual

terms set out by the framework agreement.

14.7 Tendering Procedure

14.7.1 Equality of Treatment

The CCG shall ensure that no sector of any market (public, private, third sector/social enterprise) is given an unfair advantage in the design or conduct of any tender process.

14.7.2 Non-Discrimination (a) The subject matter and the scope of the contract opportunity should be

described in a non-discriminatory manner. The CCG should utilise generic and/or descriptive terms, rather than the trade names of particular products or processes or their manufacturers or their suppliers.

(b) All participants in a tender process should be treated equally and all rules

governing a tender process must apply equally to all participants.

14.7.3 Advertisement of Contract Opportunities

Where advertisement of a contract opportunity is required under SFI 14.5.1 then: (a) where a contract opportunity falls within the Regulations and a process

compliant with the Regulations is required, an OJEU Notice should be utilised; or

(b) without prejudice to SFI 14.7.3(c) below where a contract opportunity does

not fall within the Regulations the CCG shall utilise a form of advertising for such contract opportunity that is sufficient to enable potential providers (including providers in members states of the EU other than the UK) to access appropriate information about the contract opportunity so as to be in a position to express an interest; and

(c) in relation to any contract opportunity for health care services the CCG shall

as a minimum advertise on www.supply2health.nhs.uk, the CCG procurement portal operated by the Department of Health.

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14.7.4 Choice of Procedure (a) where a contract opportunity falls within the Regulations and a process

compliant with the Regulations is required then the CCG shall utilise an available tender procedure under the Regulations.

(b) in all other cases the CCG shall utilise a tender procedure proportionate to

the value, complexity and risk of the contract opportunity and shall ensure that invitations to tender are sent to a sufficient number of providers to provide fair and adequate competition (in any event no less than three where the CCG is able to identify three providers within the relevant market).

(c) when exercising its obligations under SFI 14.7.4 (a) and (b) above, and to

the extent that such a process complies with the requirements set out in this SFI 14, the CCG may use an e-tendering process (including the use of reverse e-auctions) for the tendering of contract opportunities.

14.7.5 Invitation to tender

(a) All invitations to tender shall state the date and time as being the latest time

for the receipt of tenders. (b) All invitations to tender shall state that no tender will be accepted unless:

all tender documents are returned, addressed to the Accountable Officer of the CCG, to a common point at CCG premises by a particular date and time.

include provisions for labelling to include a unique tender reference

number instructions that the tender is not to be opened at the point of collection

there should be no Tenderer’s identifying information on the packaging.

The invitation or documents issued in response to enquiry following

advertisement shall also require that a “Master” copy of the Tender documentation (in paper format and/or electronic media) and at least one full duplicate set shall be included in each tender

(c) Every invitation to tender must require each bidder to give a written

undertaking, not to engage in collusive tendering or other restrictive practice and not to engage in canvassing the CCG, its employees or officers concerning the contract opportunity tendered.

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14.7.6 Receipt and safe custody of tenders

The Accountable Officer or his/her nominated representative (who may not be from the department that sponsored or commissioned the relevant invitation to tender, referred to as the “Originating Department” for the remainder of SFI 14) will be responsible for the receipt, endorsement and safe custody of tenders received until the time appointed for their opening.

The date and time of receipt of each tender shall be endorsed on the tender envelope/package by the Accountable Officer or their nominated representative.

14.7.7 Opening tenders and Register of tenders (a) As soon as practicable after the date and time stated as being the latest

time for the receipt of tenders, they shall be opened by two senior officers/managers designated by the Accountable Officer (who may not be from the Originating Department). A Designated officer should be Band 7 or above and be accompanied by another member of staff who can also be shown to be fully impartial and objective.

(b) A member of the CCG Governing Body or delegated representative from

the Commissioning Support Service will be required to be one of the two approved persons present for the opening of tenders estimated to be of a value above £100,000. The rules relating to the opening of tenders will need to be read in conjunction with any delegated authority set out in the CCG’s Scheme of Delegation.

(c) The involvement of Finance staff in the Originating Department’s

preparation of an invitation to tender will not preclude the Chief finance officer or any approved Senior Manager from Finance from serving as one of the two senior managers to open tenders.

(d) The designated Officer will be authorised to open tenders regardless of

whether they are from the Originating Department provided that the other authorised person opening the tenders with them is not from the Originating Department.

(e) Every tender received shall be marked with the date of opening and

initialed by those present at the opening. (f) A register shall be maintained by the Accountable Officer, or a person

authorised by them, to show for each competitive invitation to tender despatched:

• the names of all organisations/ individuals invited;

• the names of all organisations/ individuals from which tenders have

been received;

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• the date the tenders were received and opened;

• the persons present at the opening;

• the price shown on each tender; and

• a note where price alterations have been made on the tender and

suitably initialed. Each entry to this register shall be signed by those present at the opening

of the relevant tenders. A note shall be made in the register if any one tender price has had so

many alterations that it cannot be readily read or understood.

14.7.8 Admissibility of Tenders If for any reason the designated officers are of the opinion that the tenders

received are not sufficient to demonstrate competition (for example, because their numbers are insufficient or any are amended, incomplete or qualified) no contract shall be awarded without the approval of the Accountable Officer.

Where only one tender is sought and/or received, the Accountable Officer and Chief finance officer shall, as far practicable, ensure that the price to be paid is fair and reasonable and will ensure best value for the CCG.

14.7.9 Late tenders

Tenders received after the due time and date, but prior to the opening of the

other tenders, may be considered only if the Accountable Officer or his/her nominated officer decides that there are exceptional circumstances i.e. despatched in good time but delayed through no fault of the tenderer.

Only in the most exceptional circumstances will a tender be considered which is received after the opening of the other tenders and only then if the tenders that have been duly opened have not left the custody of the Accountable Officer or his/her nominated officer or if the process of evaluation and adjudication has not started.

While decisions as to the admissibility of late, incomplete or amended tenders are under consideration, the tender documents shall be kept strictly confidential, recorded, and held in safe custody by the Accountable Officer or his/her nominated officer.

Accepted late tenders will be reported to the Governing Body.

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14.7.10 Electronic Tenders (alternative to paper submission)

In place of the Manual processes in part 1, the CCG may choose to receive directly or indirectly through an outsourced procurement service tenders in electronic format, subject to equivalent processes and safeguards being adopted at every stage in each case. a. Suppliers are invited to respond to tenders using electronic process. b. Completed electronic tenders are returned to a secure Trust specific e-mail

address (referred to as a safe). c. Completed tenders cannot be opened or accessed until the specified

submission / completion date and time. d. The safe to be opened by two senior officers/managers designated by the

Accountable Officer. A Designated officer should be Band 7 or above and be accompanied by another member of staff who can also be shown to be fully impartial and objective. A senior officer of the Procurement service may be designated in place of a member of staff of the CCG as having delegated authority to open tenders

e. The two nominated officers will have separate individual passwords. And

tenders are unable to be accessed until both nominated officers have opened the safe.

f. Tenders can only be opened by the authorised Tender Opening Officers. g. The two nominated officers only have permissions to open the safe, no

other permissions are allowed. (if required other Trust nominated officers can be assigned this permission)

h. All actions are recorded electronically to include date, time and individual.

i. A electronic register of tenders will be maintained by the Procurement

Department.

j. Procurement staff will process the Tenders once opened as laid down by OJEU and Trust procedures.

k. A full audit trail is maintained electronically.

l. Notwithstanding the terminology used above, any method of electronic

receipt storage and opening of Tenders that is functionally equivalent in delivering a secure process with the same controls will be acceptable.

The CCG shall have a standing operating procedure in place for the control of all

tendering activity carried out through dynamic purchasing systems and electronic

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auctions if such mechanisms are to be utilised by the CCG for tendering any contract opportunity. Further guidance on dynamic purchasing systems or electronic auctions refer to www.ogc.gov.uk.

14.8 Quotations: Competitive and non-competitive

14.8.1 General Position on quotations (a) Subject to SFI 14.8.1(b) and SFI 14.8.1(c) quotations are required for all

contract opportunities where formal tendering procedures are not adopted and where the intended expenditure or income exceeds, or is reasonably expected to exceed £25,000 but not exceed £100,000 provided that the quotation demonstrates best value.

(b) Competitive quotations are not required where a contract opportunity need

not be advertised and tendered under SFI 14.5.4 (b) to (f) inclusive. (c) Competitive quotations are not required where the requirement to advertise

and tender a contract opportunity has been waived under SFI 14.5.4(g) to (l) inclusive.

14.8.2 Competitive Quotations

Where competitive quotations are required under SFI 14.8.1:

i) quotations should be obtained from at least [3] organisations/individuals

based on specifications or terms of reference prepared by, or on behalf of, the CCG or .

(ii) quotations should be obtained in writing unless the Accountable Officer or

his nominated officer determines that it is impractical to do so in which case quotations may be obtained by telephone. Confirmation of telephone quotations in writing should be obtained as soon as possible and the reasons why the telephone quotation was obtained should be set out in an appropriate CCG record.

(iii) all quotations should, subject to compliance with the provisions of the

Freedom of Information Act 2000, be kept confidential and should be retained for six months from the date of receipt for inspection.

(iv) the Accountable Officer or his nominated officer (who shall not be from the

Originating Department) should evaluate each quotation received applying evaluation criteria in accordance with SFI 14.9 and select the quote which gives the best value for money.

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14.8.3 Non-Competitive Quotations (a) Subject to SFI 14.8.3(b) below non-competitive quotations in writing must

be obtained for any contract opportunity where formal tendering procedures are not adopted and where competitive quotations are not required under SFI 14.8.1.

(b) Where competitive tendering or a competitive quotation is not required, the

CCG shall use the NHS Supply Chain for procurement of all goods unless the Accountable Officer or nominated officers deem it inappropriate. The decision to use alternative sources must be documented in an appropriate CCG record.

14.8.4 Quotations to be within Financial Limits

No quotation shall be accepted by the CCG which will commit expenditure in excess of that which has been allocated by the CCG except with the authorisation of either the Accountable Officer or Chief finance officer.

14.9 Evaluation of Tenders and Quotations 14.9.1 Overriding duty to achieve best value

The CCG shall ensure that it seeks to obtain best value for each contract opportunity.

14.9.2 Choice of Evaluation Methodology The CCG must for each contract opportunity which is subject to a tender or a competitive quotation choose to adopt evaluation criteria based on either: (a) the most economically advantageous tender, based on criteria linked to the

subject matter of the contract opportunity including but not limited to some or all of:

• quality; • price; • technical merit; • aesthetic and functional characteristics; • environmental characteristics; • running costs; • cost effectiveness; • after sales service; • technical assistance; • delivery date; • delivery period; and/or • period of completion.

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Or (b) the lowest price;

14.9.3 Each invitation to tender or invitation to supply a competitive quotation must state the evaluation criteria to be used to evaluate the tender or quotation and the relative weightings of each such criteria.

14.10 Award of Contracts 14.10.1 Acceptance of formal tenders

(a) Any discussions with a tenderer which are deemed necessary to clarify

technical aspects of his/her tender before the award of a contract will not disqualify the tender.

(b) Incomplete tenders (i.e. those from which information necessary for the

adjudication of the tender is missing) and amended tenders (i.e. those amended by the tenderer upon his own initiative either orally or in writing after the due time for receipt) should be dealt with in the same way as late tenders (see SFI 14.7.9 above).

(c) Where examination of tender reveal errors which would affect the tender

figure, the tenderer may be given details of such errors and afforded the opportunity of confirming or withdrawing his offer.

(d) No tender shall be accepted by the CCG which will commit expenditure in

excess of that which has been allocated by the CCG except with the authorisation of the Accountable Officer.

(e) No tender shall be accepted by the CCG which is obtained contrary to

these SFIs except with the authorisation of the Accountable Officer or Chief finance officer.

(f) All tenders should, subject to compliance with the provisions of the

Freedom of Information Act 2000, be kept confidential and should be retained for 12 months from the date set for the receipt of tenders for inspection.

14.10.2 Authorisation of Tenders and Competitive Quotations

Providing all the conditions and circumstances set out in these Standing Financial Instructions have been fully complied with, formal authorisation and awarding of a contract may be decided by the following staff to the value of the contract as follows: Head of Service £50k Chief Finance Officer £100k

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Accountable Officer £150k Accountable Officer and Chief finance officer £200k Chair and Accountable Officer £250k Governing Body above £250k These levels of authorisation may be varied or changed and need to be read in conjunction with the CCG Governing Body’s Scheme of Delegation. Once a contract has been awarded, appropriate staff may authorise invoices against the contract value in accordance with Financial Procedure Notes. Formal authorisation must be put in writing. In the case of authorisation by the CCG Governing Body this shall be recorded in their minutes.

14.10.3 Tender reports to the CCG Governing Body Reports to the CCG Governing Body will be made on an exceptional circumstances basis only.

14.11 Form of Contract

14.11.1 Form of contract: General The CCG shall consider the most applicable form of contract for each contract opportunity (including to the extent appropriate any NHS standard contract conditions available) and should consider obtaining support from a suitably qualified professional advisor (including, where appropriate, legal advisors).

14.11.3 Contracts for Health Care Services Where a mandatory requirement of NHS England, the CCG shall utilise the most relevant NHS commissioning contract for the commissioning of health care services, or where a mandatory requirement of NHS England include standard provisions.

14.11.5 Employment, Agency and Consultants Contracts The Accountable Officer shall nominate officers with delegated authority to enter into permanent and temporary contracts of employment and other contracts for agency staff or persons engaged on a consultancy basis.

14.11.6 Compliance Requirements for all Contracts The CCG may only enter into contracts within the statutory powers delegated to it by the Secretary of State or otherwise derived from Statute and each such contract shall: (a) comply with the CCG’s Standing Orders and Standing Financial

Instructions;

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(b) comply with the requirements of all EU Directives directly enforceable in the

UK and all other statutory provisions; (c) require (where applicable) the standards set out in the Standards for Better

health (as issued by the Department of Health from time to time) to be followed;

(d) embody substantially the same terms and conditions of contract as were

the basis on which tenders or quotations were invited; (e) be entered into and managed to obtain best value; (f) have an officer nominated by the Accountable Officer to oversee and

manage each contract on behalf of the CCG.

15. COMMISSIONING

15.1. The CCG will coordinate its work with NHS England, other clinical commissioning CCGs, local providers of services, local authorities,( including Health & Wellbeing Boards), patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans.

15.2. The Accountable Officer will establish arrangements to ensure that regular reports are provided to the Governing Body detailing actual and forecast expenditure and activity for each contract.

15.3. The chief finance officer will maintain a system of financial monitoring to ensure the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality.

15.4. The Accountable Officer, is responsible for ensuring the CCG enters into suitable

contracts and for considering the extent to which any NHS standard contract conditions are mandatory for contracts for the commissioning of NHS services.

15.5. All contracts should aim to implement the agreed priorities contained within the Clear and Credible Plan and wherever possible, be based upon integrated care pathways to reflect expected patient experience. In discharging this responsibility, the Accountable Officer should take into account: • the standards of service quality expected; • the relevant national service framework (if any); • the provision of reliable information on cost and volume of services; • the NHS National Performance Assessment Framework; • that contracts build where appropriate on existing Joint Investment Plans; • that contracts are based on integrated care pathways.

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15.6. A good contract will result from a dialogue of clinicians, users, carers, public health professionals and managers. It will reflect knowledge of local needs and inequalities. This will require the Accountable Officer to ensure that the CCG works with all partner agencies involved in both the delivery and the commissioning of the service required. The contract will apportion responsibility for handling a particular risk to the party or parties in the best position to influence the event and financial arrangements should reflect this. In this way the CCG can jointly manage risk with all interested parties.

16. RISK MANAGEMENT AND INSURANCE

16.1. The NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group will

develop a risk management strategy which describes the CCG’s approach to the management of risk; how risk will be assessed consistently; and, how the effectiveness of these systems will be assessed.

16.2. The NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group will on

an annual basis identify its strategic risks and develop an Assurance Framework. The management of strategic risk as reflected in the Assurance Framework will be reviewed at least quarterly by the Governing Body.

16.3. The Audit Committee will assess the effectiveness of the NHS Hartlepool and

Stockton-on-Tees Clinical Commissioning Group’s arrangements for risk management.

17. PAYROLL

17.1. The chief finance officer will ensure that the payroll service selected:

a) is supported by appropriate (i.e. contracted) terms and conditions; b) has adequate internal controls and audit review processes;

c) has suitable arrangements for the collection of payroll deductions and

payment of these to appropriate bodies. 17.2. In addition the chief finance office shall set out comprehensive procedures for

the effective processing of payroll

18. REMUNERATION AND TERMS OF SERVICE (see overlap with SO)

18.1 The CCG will pay allowances to the Chair and non-officer members of the Governing Body in accordance with instructions issued by the Secretary of State for Health.

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18.2 Funded Establishment 18.2.1 The manpower plans incorporated within the annual budget will form the funded

establishment. 18.2.2 The funded establishment of any department may not be varied without the

approval of the Accountable Officer. 18.3 Staff Appointments 18.3.1 No officer, or Member of the CCG Governing Body or employee may engage, re-

engage, or re-grade employees, either on a permanent or temporary nature, or hire agency staff, or agree to changes in any aspect of remuneration:

(a) unless authorised to do so by the Accountable Officer; and (b) within the limit of their approved budget and funded establishment.

18.4 Contracts of Employment 18.4.1 The Governing Body shall delegate responsibility to an officer for:

(a) ensuring that all employees are issued with a Contract of Employment

in a form approved by the Governing Body and which complies with employment legislation; and

(b) dealing with variations to, or termination of, contracts of employment. 19. NON-PAY EXPENDITURE

19.1. The Governing Body will approve the level of non-pay expenditure on an annual

basis and the Accountable Officer will determine the level of delegation to budget managers

19.2. The Accountable Officer shall set out procedures on the seeking of professional advice regarding the supply of goods and services.

19.3. The chief finance officer will:

a) advise the Accountable Officer on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the scheme of reservation and delegation;

b) be responsible for the prompt payment of all properly authorised accounts and claims;

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c) be responsible for designing and maintaining a system of verification, recording and payment of all amounts payable.

20. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND SECURITY OF ASSETS

20.1. The Accountable Officer will a) ensure that there is an adequate appraisal and approval process in place for

determining capital expenditure priorities and the effect of each proposal upon plans;

b) be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

c) shall ensure that the capital investment is not undertaken without

confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges;

d) be responsible for the maintenance of registers of assets, taking account of

the advice of the chief finance officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.

20.2. The chief finance officer will prepare detailed procedures for the disposals of

assets.

21. RETENTION OF RECORDS

21.1. The Accountable Officer shall:

a) be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance;

b) ensure that arrangements are in place for effective responses to Freedom of

Information requests;

c) publish and maintain a Freedom of Information Publication Scheme.

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22. STORES AND RECEIPT OF GOODS 22.1 General position 22.1.1 Stores, defined in terms of controlled stores and departmental stores (for immediate use) should be: (a) kept to a minimum; (b) subjected to annual stock take; (c) valued at the lower of cost and net realisable value. 22.2 Control of Stores, Stocktaking, condemnations and disposal 22.2.1 Where a complete system of stores control is not justified, alternative arrangements shall require the approval of the Chief finance officer. 22.2.2 The designated Manager shall be responsible for a system approved by the Chief finance officer for a review of slow moving and obsolete items and for condemnation, disposal, and replacement of all unserviceable articles. The designated Officer shall report to the Chief finance officer any evidence of significant overstocking and of any negligence or malpractice (see also overlap with SFI No. 24 Disposals and Condemnations, Losses and Special Payments). Procedures for the disposal of obsolete stock shall follow the procedures set out for disposal of all surplus and obsolete goods. Goods supplied by NHS Logistics 22.3.1 For goods supplied via the NHS Logistics central warehouses, the Accountable Officer shall identify those authorised to requisition and accept goods from the store. The authorised person shall check receipt against the delivery note before forwarding this to the Chief finance officer who shall satisfy himself that the goods have been received before accepting the recharge. 23. DISPOSALS AND CONDEMNATIONS, LOSSES AND SPECIAL

PAYMENTS 23.1. Procedures 23.1.1 The chief finance officer must prepare detailed procedures for the disposal of

assets including condemnations, and ensure that these are notified to managers. 23.1.2 When it is decided to dispose of a CCG asset, the chief finance officer will

determine the estimated market value of the item, taking account of professional advice where appropriate.

23.1.3 All unserviceable articles shall be:

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(a) condemned or otherwise disposed of by an employee authorised for that purpose by the chief finance officer;

(b) recorded by the Condemning Officer in a form approved by the chief finance

officer which will indicate whether the articles are to be converted, destroyed or otherwise disposed of. All entries shall be confirmed by the countersignature of a second employee authorised for the purpose by the chief finance officer.

23.1.4 The Condemning Officer shall satisfy himself as to whether or not there is evidence

of negligence in use and shall report any such evidence to the chief finance officer who will take the appropriate action.

23.2 Losses and Special Payments Procedures 23.2.1 The chief finance officer must prepare procedural instructions on the recording of

and accounting for condemnations, losses, and special payments. 23.2.2 Any employee or officer discovering or suspecting a loss of any kind must

immediately inform the Accountable Officer or the Chief Finance Officer. Where a criminal offence is suspected, the Chief finance officer must immediately inform the police if theft or arson is involved. In cases of fraud and corruption or of anomalies which may indicate fraud or corruption, the chief finance officer must inform the relevant LCFS and Operational Fraud Team (OFT) in accordance with Secretary of State for Health’s Directions.

24. PAYMENTS TO CONTRACTORS 24.1 Role of the CCG 24.1.1 The CCG will approve additions to, and deletions from, approved lists of

contractors, taking into account the health needs of the local population, and the access to existing services. All applications and resignations received shall be dealt with equitably, within any time limits laid down in the contractors NHS terms and conditions of service.

24.2 Duties of the Accountable Officer 24.2.1 The Accountable Officer shall:

(a) ensure that lists of all contractors, for which the CCG is responsible, are maintained in an up to date condition;

(b) ensure that systems are in place to deal with applications, resignations,

inspection of premises, etc, within the appropriate contractor's terms and conditions of service.

24.3 Duties of the Chief Finance Officer

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24.3.1 The Chief Finance Officer shall:

(a) ensure that contractors who are included on a Clinical Commissioning Group's

approved lists receives payments; (b) maintain a system of payments such that all valid contractors' claims are paid

promptly and correctly, and are supported by the appropriate documentation and signatures;

(c) ensure that regular independent verification of claims is undertaken, to confirm

that: (i) rules have been correctly and consistently applied; (ii) overpayments are detected (or preferably prevented) and recovery

initiated; (iii) suspicions of possible fraud are identified and subsequently dealt with in

line with the Secretary of State for Health’s Directions on the management of fraud and corruption.

(d) ensure that arrangements are in place to identify contractors receiving

exceptionally high, low or no payments, and highlight these for further investigation; and

(e) ensure that a prompt response is made to any query raised by either the

Prescription Pricing Division or the Dental Practice Division of the NHS Business Services Authority, regarding claims from contractors submitted directly to them.

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APPENDIX E – THE NOLAN PRINCIPLES

The ‘Nolan Principles’ set out the ways in which holders of public office should behave in discharging their duties. The seven principles are:

a) Selflessness – Holders of public office should act solely in terms of the

public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

b) Integrity – Holders of public office should not place themselves under any

financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

c) Objectivity – In carrying out public business, including making public

appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

d) Accountability – Holders of public office are accountable for their decisions

and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

e) Openness – Holders of public office should be as open as possible about all

the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

f) Honesty – Holders of public office have a duty to declare any private

interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

g) Leadership – Holders of public office should promote and support these

principles by leadership and example. Source: The First Report of the Committee on Standards in Public Life (1995)61

61 Available at http://www.public-standards.gov.uk/

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APPENDIX F – THE SEVEN KEY PRINCIPLES OF THE NHS CONSTITUTION

The NHS Constitution sets out seven key principles that guide the NHS in all it does: 1. The NHS provides a comprehensive service, available to all irrespective of

gender, race, disability, age, sexual orientation, religion, belief, gender reassignment, pregnancy and maternity or marital or civil partnership status. The service is designed to diagnose, treat and improve both physical and mental health. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.

2. Access to NHS services is based on clinical need, not an individual’s ability to pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

3. the NHS aspires to the highest standards of excellence and professionalism - in the provision of high-quality care that is safe, effective and focused on patient experience; in the people it employs, and in the support, education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to promotion, conduct and use of research to improve the current and future health and care of the population. Respect, dignity, compassion and care should be at the core of how patients and staff are treated not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported.

4. The NHS aspires to put patients at the heart of everything it does. It should support individuals to promote and manage their own health. NHS services must reflect, and should be coordinated around and tailored to, the needs and preferences of patients, their families and their carers. Patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment. The NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services.

5. The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population. The NHS is an integrated system of organisations and services bound together by the principles and values reflected in the Constitution. The NHS is committed to working jointly with other local authority services, other public sector organisations and a wide range of private and voluntary sector organisations to provide and deliver improvements in health and wellbeing.

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6. The NHS is committed to providing best value for taxpayers’ money and the most cost-effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves

7. The NHS is accountable to the public, communities and patients that it serves.

The NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose.

Source: The NHS Constitution for England 201362

62 http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Documents/2013/the-nhs-constitution-for-england-2013.pdf

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APPENDIX G – DISPUTE RESOLUTION PROCEDURE

Disputes between member practices

Disputes between member practices and the Governing

Body

Stage 1 Informal local resolution between

practices

Stage 1 Informal local resolution

Stage 1 Escalation to Chair and Locality

Lead

Stage 1 Council of Members to consider

requirement to hold Council meeting

Resolved

Not Resolved

Full Meeting required

Locality Meeting required

Stage 2 Formal local resolution via Local

Disputes Resolution Panel (LDRP)

Stage 2 Council of Members to hold Council

meeting to discuss concerns with Governing Body

Resolved

Not Resolved

Vexatious

Non-Vexatious

Stage 2 Local Disputes Resolution Panel

• A clinical member of the Governing Body • A GP conciliator (from a Panel to be

established by the LMCs). • An independent representative eg LMC

(from a different part of Teesside). • Panel Secretary (non-voting).

Stage 3 Referral to NHS England

Resolved

Not Resolved

NB All parties reserve the right to seek independent advice and support for all stages of the disputes resolution process

Meeting not

required

Stage 1 Locality Council of Members

meeting

Full Meeting now required

Meeting not required

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APPENDIX H – STATUTORY COMMITTEES TERMS OF REFERENCE

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Audit Committee

Terms of Reference 1. Constitution 1.1 The audit committee (the committee) is established in accordance with the NHS

Hartlepool and Stockton-on-Tees Clinical Commissioning Group’s (the CCG) constitution. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the constitution.

2. Membership 2.1 The committee shall be appointed by the CCG as set out in the CCG’s constitution

and shall be made up of at least two lay members and another member of the Governing Body.

2.2 The lay member on the Governing Body, with a lead role in overseeing key elements

of governance, will Chair the audit committee. 2.3 The Chair of the Governing Body will not be a member of the Committee. 3. Attendance 3.1 The CCG Chief Finance Officer and appropriate Internal and External Audit

representatives shall normally attend meetings. At least once a year the committee should meet privately with the External and Internal Auditors.

3.2 The CCG Chief (Accountable) Officer should be invited to attend and should discuss

at least annually with the committee the process for assurance that supports the Statement on Internal Control. The Chief Officer should also attend when the committee considers the draft internal audit plan and the annual accounts.

3.3 Other nominated officers may be invited to attend, particularly when the committee is

discussing areas of risk or operation that are the responsibility of the nominated officer.

3.4 The Chair of the Governing Body may also be invited to attend one meeting each

year in order to form a view on, and understanding of, the committee’s operations. 4. Secretary 4.1 The Corporate Secretary, or whoever covers these duties, shall be Secretary to the

committee and shall attend to take minutes of the meeting and for drawing the

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committee’s attention to best practice, national guidance and other relevant documents are appropriate.

5. Quorum 5.1 A quorum shall be two members. 6. Frequency and notice of meetings 6.1 The committee must consider the frequency and timing of meetings needed to allow

it to discharge all of its responsibilities. A benchmark of five meetings per annum at appropriate times in the reporting and audit cycle is suggested. The external auditors or Head of Internal Audit may request a meeting if they consider that one is necessary.

6.2 The Audit Committee Chair can request a meeting at any time. 6.3 The Corporate Secretary shall maintain a register of attendance which will be

published within the CCG’s Annual Report. 7. Authority 7.1 The committee is authorised by the CCG Governing Body to investigate any activity

within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the committee. The committee is authorised by the Governing Body to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers necessary.

8. Remit and responsibilities of the Committee 8.1 The committee shall critically review the CCG’s financial reporting and internal

control principles and ensure an appropriate relationship with both internal and external auditors is maintained. In addition the committee is driven by the priorities identified by the clinical commissioning group and the associated risks. The duties of the Committee can be categorised as follows:

8.1.1 Integrated governance, risk management and internal control

The committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities that support the achievement of the clinical commissioning group’s objectives. Its work will dovetail with the other CCG Committees, eg Quality, Performance and Finance Committee particularly to seek assurance that robust processes are in place particularly in relation to clinical quality.

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In particular, the committee will review the adequacy and effectiveness of: • All risk and control related disclosure statements (in particular the annual

governance statement), together with any appropriate independent assurances, prior to endorsement by the clinical commissioning group.

• The underlying assurance processes that indicate the degree of achievement of clinical commissioning group objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

• The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

• The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by the NHS Counter Fraud and Security Management Service.

• Review the processes and format of the Assurance framework to ensure that these remain relevant and effective for the organisation.

In carrying out this work the committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness.

8.1.2 Internal audit

The committee shall ensure that there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the audit committee, Accountable Officer and CCG. This will be achieved by: • Consideration of the provision of the internal audit service, the cost of the audit

and any questions of resignation and dismissal. • Review and approval of the internal audit strategy, operational plan and more

detailed programme of work, ensuring that this is consistent with the audit needs of the organisation, as identified in the assurance framework.

• Considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between the internal and external auditors to optimise audit resources.

• Ensuring that the internal audit function is adequately resourced and has appropriate standing within the CCG.

• An annual review of the effectiveness of internal audit. 8.1.3 External audit

The committee shall review the work and findings of the external auditors and consider the implications and management’s responses to their work. This will be achieved by:

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• Consideration of the performance of the external auditors, as far as the rules governing the appointment permit.

• Discussion and agreement with the external auditors, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.

• Discussion with the external auditors of their local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee.

• Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the CCG and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

8.1.4 Other assurance functions

The audit committee shall review the findings of other significant assurance functions, both internal and external and consider the implications for the governance of the CCG. These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the Care Quality Commission and NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).

8.1.5 Counter fraud

The committee shall satisfy itself that the CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

8.1.6 Anti-Bribery

The Audit Committee will satisfy itself that the CCG has adequate arrangements in place to ensure compliance with the Bribery Act 2010, established to prevent and tackle bribery and corruption in both public and private sectors.

As a public sector organisation the Audit Committee will ensure that good business practice is followed within the CCG and that there are appropriate controls in place to prevent bribery. It will ensure that areas such, as though not exclusively, procurement and sponsorship in particular, are fully compliant with CCG policies and procedures.

8.1.7 Management

The committee shall request and review reports and positive assurances from directors and managers on the overall arrangements for governance, risk management and internal control.

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The committee may also request specific reports from individual functions within the CCG as they may be appropriate to the overall arrangements.

8.1.8 Financial reporting

The audit committee shall monitor the integrity of the financial statements of the CCG and any formal announcements relating to the CCG’s financial performance. The committee shall ensure that the systems for financial reporting to the CCG, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided to the CCG. The audit committee shall review the annual report and financial statements before submission to the Governing Body and the CCG, focusing particularly on: • The wording in the governance statement and other disclosures relevant to the

terms of reference of the committee; • Changes in, and compliance with, accounting policies, practices and estimation

techniques; • Unadjusted mis-statements in the financial statements; • Significant judgements in preparing of the financial statements; • Significant adjustments resulting from the audit; • Letter of representation; and • Qualitative aspects of financial reporting. 8.1.9 Auditor Panel Regulations have been laid under the Local Audit and Accountability Act 2014 that require CCGs to ensure there is sufficient scrutiny and oversight of the CCG’s relationship with its external auditors by having an auditor panel chaired by an independent member, who is not part of the management structure, such as a lay member of the governing body. In order to meet these requirements the Audit Committee shall also perform the role of the Auditor Panel for the CCG. The Chair and members of the Audit Committee will also be the Chair and members of the Auditor Panel. The Auditor Panel shall: • advise the CCG on the maintenance of an independent relationship with external auditors; • advise the CCG on the selection and appointment of external auditors; • if asked advise the CCG on any proposal to enter into a limited liability agreement. To ensure the activities of the Auditor Panel are distinctive to the other activities of the Audit Committee the Chair of the Auditor Panel shall arrange separate Auditor Panel meetings as required, ensure minutes of meetings are formally recorded and

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submitted to the Governing Body and provide a separate annual report to the Governing Body of the panel’s activities and decisions.

9. Relationship with Governing Body 9.1 The minutes of Audit Committee meetings shall be formally recorded by the

Corporate Secretary and submitted to the Governing Body. Members of the Committee should state any updates to listed conflicts of interest and any conflicts relating to specific items and the Company Secretary should minute them accordingly. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require disclosure to the relevant statutory body, or require executive action.

9.2 The Committee will report to the Governing Body at least annually on its work in

support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embeddedness of risk management in the organisation, the integration of governance arrangements.

10. Conduct of the committee 10.1 The Committee shall conduct its business in accordance with national guidance,

relevant codes of practice including the Nolan Principles and the Conflict of Interest policy.

10.2 An annual report will of its performance, membership and terms of reference will be

submitted to the Governing Body. 11. Managing Conflicts of Interest 11.1 As required by section 14O of the National Health Service Act 2006, as inserted by

section 25 of the Health and Social Care Act 2012, and set out in the Group’s Constitution the clinical commissioning group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made will be taken and seen to be taken without any possibility of the influence of external or private interest.

11.2 Where a member of the Committee has an interest, or becomes aware of an interest

which could lead to a conflict of interests in the event of the Committee considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of the CCG processes for Standards of Business Conduct and Managing Conflicts of Interest.

11.3 A conflict of interest will include:

• a direct pecuniary interest: where an individual may financially benefit from the consequences of a decision;

• an indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from the consequences of a decision;

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• a non-pecuniary interest: where an individual holds a non-remunerative or not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision;

• a non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequence of a decision which cannot be given a monetary value;

• where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories.

11.4 If in doubt, the individual concerned should assume that a potential conflict of

interest exists and consult the CCG’s Standards of Business Conduct and Managing Conflicts of Interest.

12 Annual General Meeting

The Chair of the Committee or nominated representative will attend the Annual General Meeting prepared to respond to any questions on the Committee’s activities.

Reviewed; 1 December 2015 Approved: 2 February 2016 Review: December 2016

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NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group Remuneration Committee

Terms of Reference

1. Introduction 1.1 The remuneration committee (the committee) is established in accordance with

NHS Hartlepool and Stockton-on-Tees Clinical Commissioning Group’s constitution, standing orders and scheme of delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the c l i n i c a l c o m m i s s i o n i n g group’s constitution and standing orders.

2 Membership 2.1 The committee shall be appointed by the clinical commissioning group from

amongst its Governing Body members. Only members of the Governing Body may be members of the remuneration committee.

2.2 The Chair of the committee will be a Lay Member of the Governing Body who is

not the Audit Chair. 2.3 In addition to the committee Chair, the membership will comprise a further Lay

Member, the Chair of the Governing Body and a non-GP member of the Governing Body.

2.4 Other nominated officers may be invited to attend, such as the Accountable

Officer, HR lead or external advisers, for all or part of any meeting as and when appropriate.

3 Secretary 3.1 The Corporate Secretary, or whoever covers these duties, shall be Secretary to

the committee and shall attend to take minutes of the meeting and for drawing the committee’s attention to best practice, national guidance and other relevant documents are appropriate.

4 Quorum 4.1 To ensure transparency and independence in decision making, quorum must

consist of one lay member and a non-GP Governing Body member. The non-GP Governing Body member can be the Audit Lay member.

4.2 In the rare event that conflicts of interest emerge which prevent both Lay Members

from participating in a discussion and/or agreeing recommendations for the Governing Body e.g. on matters relating to Remuneration of Lay Members, as an exception decision making shall proceed at the discretion of the Governing Body Chair.

4.3 When the Lay Chair is unable to Chair the meeting, the non-GP Governing Body

member will Chair. In the event of the non-GP Governing Body member being

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required to chair in the absence of the PPI Lay member, the Chair of the Governing Body would be required to chair the meeting.

5 Frequency and notice of meetings 5.1 The committee must consider the frequency and timing of meetings needed to

allow it to discharge all of its responsibilities. It is suggested that meeting are called as and when required.

5.2 The Chair can request a meeting at any time.

6 Remit and responsibilities of the committee

6.1 The committee shall make recommendations to the Governing Body on

determinations about pay and remuneration for employees of the clinical commissioning group and people who provide services to the clinical commissioning group and allowances under any pension scheme it might establish as an alternative to the NHS pension scheme.

6.2 In addition the committee will be responsible for

a) determining the remuneration and conditions of service for the senior team

b) reviewing the performance of the Accountable Officer and other senior team

members and determining annual salary awards, if appropriate

c) considering the severance payments of the Accountable Officer and usually of other senior staff, seeking HM Treasury approval as appropriate in accordance with the guidance ‘Managing Public Money’

d) receiving the output of the Governing Body appraisal process.

7 Relationship with Governing Body

7.1 The minutes of Remuneration Committee meetings shall be formally recorded by

the Company Secretary and submitted to the Confidential section of the Governing Body meetings. The Chair of the Committee shall draw to the attention of the Governing Body any issues that require disclosure to the relevant statutory body, or require executive action.

8 Policy and best practice

8.1 The committee will apply best practice in decision making processes and

will: Comply with current disclosure requirements for remuneration On occasion seek independent advice about remuneration for individuals, and Ensure that decisions are based on clear and transparent criteria

9 Conduct of the committee

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9.1 The Committee shall conduct its business in accordance with national guidance, relevant codes of practice including the Nolan Principles and the Conflict of Interest policy.

9.2 An annual review of the committee’s performance, membership and terms of reference will be undertaken and submitted to the Governing Body. 10. Managing Conflicts of Interest

10.1 As required by section 14O of the National Health Service Act 2006, as inserted

by section 25 of the Health and Social Care Act 2012, and set out in the Group’s Constitution the clinical commissioning group will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made will be taken and seen to be taken without any possibility of the influence of external or private interest.

10.2 Where a member of the Committee has an interest, or becomes aware of an

interest which could lead to a conflict of interests in the event of the Committee considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of the CCG processes for Standards of Business Conduct and Managing Conflicts of Interest.

10.3 A conflict of interest will include:

a direct pecuniary interest: where an individual may financially benefit from the consequences of a decision;

an indirect pecuniary interest: for example, where an individual is a partner, member or shareholder in an organisation that will benefit financially from the consequences of a decision;

a non-pecuniary interest: where an individual holds a non-remunerative or not-for profit interest in an organisation, that will benefit from the consequences of a commissioning decision;

a non-pecuniary personal benefit: where an individual may enjoy a qualitative benefit from the consequence of a decision which cannot be given a monetary value;

where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories.

10.4 If in doubt, the individual concerned should assume that a potential conflict of

interest exists and consult the CCG’s Standards of Business Conduct and Managing Conflicts of Interest.

Reviewed: 14 July 2015 Ratified by Governing Body: 28 July 2015

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Confirmed Minutes of the NHS Hartlepool & Stockton-On-Tees

Clinical Commissioning Group

Governance and Risk Committee

Held on Tuesday 13 September 2016 at 1.30 pm In Boardroom, Billingham Health Centre

Present Mrs Hilary Thompson Lay Member (Public & Patient Involvement) (Chair) Dr David Hodges GP Governing Body Member Mr. Graeme Niven Chief Finance Officer In Attendance Mr. Andrew Carter Corporate Governance and Risk Officer Mrs Sarah Cook-Smith Corporate Secretary (Minute taker) Mrs Liane Cotterill Senior Governance Manager, North of England Commissioning

Support (NECS) Mrs Catherine Gilburt HR Business partner, North of England Commissioning Support

(NECS) GR/37/16 Apologies for Absence There were no apologies for absence. GR/38/16 Declarations of Interest Mr Niven declared an interest in relation HR policies due to them directly affecting

terms and conditions of employment. The Committee agreed that Mr Niven could contribute to the discussion but not the decision.

GR/39/16 Pre-Critique of the Governance and Risk Committee 39.1 The chair advised that there was a particularly busy agenda due to the number of

policies due to be ratified. The Chair reminded the Committee that discussions should be focused and members should be courteous to other members and challenge constructively.

GR/40/16 Draft Minutes of the Governance and Risk Committee held on Tuesday 21st

June 2016 40.1 The minutes of the previous meeting held on 21st June 2016 were accepted as a

true record. GR/41/16 Action Log 41.1 The Committee reviewed the action log and discussed the open actions from the

previous meeting in turn;

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41.2 Action GR/26/15 – CCG HR Policies - Mr Niven queried if there was a need to localise these policies as they were developed before the CCG’s authorization in 2013 and these policies should be specific to NHS Hartlepool and Stockton-on-Tees CCG. Dr Hodges questioned whether there was a need to put in place a system to review these non-legislative policies such as the appraisal policy and induction policy earlier than two years as the current policies didn’t seem to reflect CCG operation in practice. Mr Carter responded that the CCG could focus on those policies it considers organisational policies first and review these before the 2 years review date of May 2017. The Governance and Risk Committee agree to roll forward the 26 policies as detailed within the report but that a rolling programme of policies for review was developed going forward and that the first of these policies be presented back to the Committee in 6 months’ time. 15/03/2016 Mr Carter confirmed the update that the Appraisal Policy has been moved to the June 2016 meeting as there has been no meeting of the HR Partnership Forum. 21/06/2016 Mr Carter requested that the action remain open. There has not been a meeting of the HR Forum since the last Governance & Risk Committee meeting. Action to remain open.

Mr Carter confirmed that the review of the appraisal policy was on hold in light of the

proposed shared management structure. Action to remain open. 41.3 Action GR/34/15 – Maternity leave Policy - Mr. Carter presented the policy

explaining the key changes to the policy, that the application form had been amended and that clarity had been provided in relation to time off for ante-natal and post-natal care. Mr. Niven queried why the policy and the application form did not contain any information in relation to shared maternity leave. Mr. Carter stated he would contact HR and clarify whether shared maternity leave should be included in the policy and the form. 15/03/2016 Mr Carter confirmed he had contacted HR who were reviewing the policy and that this would be presented to the next HR Partnership Forum but that none had yet occurred in 2016. 21/06/2016 Mr Carter requested that the action remain open. There has not been a meeting of the HR Forum since the last Governance & Risk Committee meeting. Action to remain open.

Mr Carter clarified that the policy was on the Governance and Risk Committee

agenda for this meeting. Agreed action to be closed. 41.4 Action GR/03/16 - Business Continuity Plan - Mrs Cotterill added that due to

absence in the NECS governance team it had not been possible to fully review the business continuity plan process before this Committee meeting but that a refreshed business continuity plan that was fully compliant with the NHS Business continuity management Toolkit would be presented to the Committee in June 2016. 31/05/2016 NHS Business continuity management Toolkit update not yet been released, added to Novembers agenda. 09/06/2016 Ms Tunney advised that Mrs Elliott and Mr Carter have reviewed BCP requirements updated BCP to be presented at next meeting. 14/06/2016 Mrs Cook-Smith has moved the BCP to Septembers agenda as per Mr Carters request. 21/06/2016 Action to remain open.

Mr Carter stated that the plan was on the Governance and Risk Committee agenda

for this meeting. Agreed action to be closed. 41.5 Action GR/04/16 - Business Continuity Plan - The Chair queried whether the list of

key stakeholders as detailed in the Business continuity Plan was complete, suggesting that Darlington CCG should be added to the list and that Healthwatch should detail both Healthwatch Hartlepool and Healthwatch Stockton-on-Tees. Mr

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Niven queried the interdependencies section which stated that a final copy of the NECS business continuity plan was awaited; Mr Carter responded that a final copy had been received and he would update both the stakeholder list and the interdependencies sections of the plan before submission for the IG Toolkit. 14/06/2016 Mrs Cook-Smith has moved the BCP to September’s agenda as per Mr Carters request. 21/06/2016 Action to remain open.

Mr Carter stated that the plan was on the Governance and Risk Committee agenda

for this meeting. Agreed action to be closed. 41.6 Action GR/09/16 - The Chair queried the description of Forced marriage (page 50 in

the papers), Mrs Holcroft advised this is the definition. Mrs Holcroft was asked to add quotation and italic writing to represent quote.

Mrs Cook-Smith informed the Committee that no update had been received and that

this would be followed up. Action to remain open. 41.7 Action GR/12/16 - Mr Carter briefed the committee on the CCG Equality Objectives

plan in relation to engagement and complaint process improvements. Mr Carter advised that a reminder will be issued to staff with outstanding training asking for this to be completed before September 2016. The Chair requested mandatory training to be covered in a Governing Body Development session. 01/09/2016 Mandatory Training has been added to the 25th October 2016 Development Session.25/10/2016 E&D Mandatory Training has been moved to the GB Development session on 20th December 2016.

Action to remain open. 41.8 Action GR/13/16 - Mr Niven queried risk 1488 which is in relation to DoLs. Mr Niven

asked of the risk should be updated as the DoLs policy was due to be brought to this June Committee meeting. Mr Carter advised that policy was pulled from the Committee on 1st June. Mr Niven highlighted that this is now a high risk as there is no up to date DoLs policy in place. The Committee discussed the residual risk to be 16 and requested this to be added as a gap in assurance. The Committee requested an update regarding the policy from Mrs Potter.

The Governance and Risk Committee discussed this and Action GR/17/16 together. Action GR/17/16 - The Chair queried if the Committee wanted to request a deep

dive to be added to the agenda for the next meeting. The Committee agreed that Mrs Potter will be requested to provide a deep dive in relation to the DoLS policy.

The Committee discussed progress in relation to these actions and queried why

Deprivation of Liberty deep dive was not on the agenda as had been previously been requested. In response, Mr Carter apologised for the confusion and stated that the deep dive had been rescheduled to the next meeting due to Mrs Potter’s availability and the finance deep dive included in the annual cycle of business. The Committee were dissatisfied that an update had not been provided in relation to Deprivation of Liberty and requested that this was escalated by the Committee Chair to the next Governing Body and a request be made to Ms Golightly and Mrs Potter for an immediate update.

ACTION: GR/19/16 (Mrs Thompson)

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Mrs Cotterill advised that this issue was a prevalent issue for a number of CCG’s and Mr Niven informed the Committee this was as a result of the Cheshire West Case.

Mr Carter and Mrs Cotterill offered to meet with Mrs Potter with an update to this action being provided to the committee by the end of September

41.9 Action GR/15/16 - The Committee were advised that in relation to serious incidents,

NHSE’s expectation is where a data processer such as CSU, is working for another organization such as the CCG, the CCG would be expected to report an incident for the CSU as data controller. Mrs Cotterill informed NECS of this and is awaiting NHSE to confirm when this process will be put into the reporting procedure and make live. Mrs Cotterill will inform CCGS formally once notification is received from NHSE via a communication. Mr Carter requested that this be rolled out to all North East CCG Governance staff at the same point.

Mrs Cotterill confirmed that the communication had been issued. Agreed action to

be closed. 41.10 Action GR/16/16 - Mrs Cotterill highlighted a theme of risks table advising that to

enable the production of a risk thematic review across all CCGs, a new risk theme field within SIRMS was introduced in 2015 and a review of risk themes across the North East CCGs’ has now been undertaken. Mrs Cotterill informed the Committee that the report had been issued, Mr Carter advised that he was unsure if this had been received. The Committee requested Mr Carter check that he has this report and if not for this to be obtained.

Mr Carter and Mrs Cotterill confirmed the report had been received. Agreed action

to be closed. 41.11 Action GR/18/16 - Mrs Cotterill queried section 2.3.5 as this wasn’t in line with the

HSCIC procedure, Mrs Cotterill advised that levels 2-5 have to be reported. Mrs Ross was asked to clarify section2.3.4 and 2.3.5 within the SIs policy.

Mrs Cook-Smith informed the Committee that no update had been received and that

this would be followed up. Action to remain open. 41.12 The Following completed actions were agreed for closure:

• GR/08/16 • GR/10/16 • GR/11/16 • GR/12/16 • GR/14/16

GR/42/16 Business Continuity Plan 42.1 Mr Carter informed the Committee that the business continuity plan has been

revised to ensure that it fully reflects the CCG’s business continuity arrangements. A full review of the Business Continuity Planning process has been undertaken in line with the “NHS Business Continuity Management Toolkit (2014)”, published under Gateway 00999. Mr Carter informed the Committee that to follow best practice and to make the plan more robust, the CCG’s revised business continuity policy includes a revised process and activation plan. Mr Carter advised the Committee that the plan is focussed on continuity of service and the business impact assessments have been removed as this was background information.

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42.2 Mr Carter drew the Committee’s attention to section 6.0 service priorities and

advised that the areas had been graded in line with the business impact assessments. Mr Niven queried why MP letters were a high priority function,; in response Mr Carter confirmed that this was due to the CCG having an agreed acknowledgement response time of 3 days for MP letters.

42.3 Mr Niven queried why payroll was not included in the key CCG contacts; in

response Mr Carter stated that this was an oversight and this information would be added to the plan

ACTION: GR/20/16 (Mr Carter)

42.4 Mr Niven highlighted the joint arrangements that were currently in place with Darlington CCG and requested that these be added into the plan as possible alternative accommodation.

ACTION: GR/21/16 (Mr Carter)

42.5 The Committee discussed the practicalities regarding staff who had been issued laptops were taking them home and whether they could practically work from home or another base. Mrs Cotterill suggested a quality impact assessment be carried out for the working from other bases section to assess access. Mr Carter suggested that the Business continuity plan needed to be tested and that perhaps this could form the basis for a test of the Business Continuity Plan. The Committee agreed and requested that a test of the business continuity plan, especially in relation to working from home and other locations be undertaken.

ACTION: GR/22/16 (Mr Carter)

The Governance & Risk Committee APPROVED the Business Continuity Plan 14:09pm ~ Mrs Gilburt joined the meeting GR/43/16 CCG HR Policies for ratification ~ 43.1 Mrs Gilburt was introduced to the Committee. Mrs Gilburt queried whether the

Committee wished to go through each policy individually or whether they were happy to focus on areas of the policies where there was change and any queries. The committee agreed to go through all of the HR policies as one item.

43.2 Mrs Gilburt informed the Committee that each of these seven policies had been through HR links groups and there had been no major changes to these policies and any changes have been to reflect change in legislation. The Committee were provided an overview: HR06 Change Management Policy Policy expired. No change to content. Proposal is for policy to roll over for 2 years to July 2018. HR09 Flexible Working Policy Policy expired. No change to content. Proposal is for policy to roll over for 3 years to July 2019. HR17 Maternity Leave Policy Approved by CCG Partnership Forum 23/10/2015. Reason for change: Amended maternity application form & the introduction of shared parental leave.

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HR22 Paternity Leave Policy Reason for change: Change in legislation re antenatal appointments time off, cessation of additional paternity leave & introduction of shared parental leave. HR34 Travel & Expenses Policy Reason for change: Detail of AFC mileage rates removed and references to AFC handbook added instead. HR37 Incremental Pay Progression Policy expired. No change to content. Proposal is for policy to roll over for 3 years to July 2019.

HR39 Shared Parental Leave Policy New policy reflecting new legislation.

43.3 Mrs Cotterill highlighted to the Committee that the equality impact assessments in

the policies are the old versions and that she had contacted Mrs McGuiness in HR advising that the policies would be to approve pending the update.

ACTION: GR/23/16 (Mrs Cotterill/ Mrs Gilburt)

43.4 Mrs Cotterill asked if there was an intention to merge the maternity and paternal

policies; in response Mrs Gilbert advised that these were covered by separate legislation and that the proposal was to maintain separate policies.

43.5 Mr Niven questioned the incremental pay progression policy and the processes in place to implement the policy. Mr Niven stated that if there is no system of review process in place then staff receive an automatic increment: Mrs Gilburt confirmed this was accurate. Mr Niven therefore asked if there is a plan to add a process for increments to be approved. Mr Carter advised that this would be aligned to the appraisal policy and process. The Committee requested that the executive team be asked to review the incremental pay progression policy and clarify what approach they would like and then implement this.

ACTION: GR/24/16 (Mr Carter)

The Governance & Risk Committee APPROVED the HR Policies, HR06 Change Management Policy, HR09 Flexible Working Policy, HR17 Maternity Leave Policy, HR22 Paternity Leave Policy, HR34 Travel & Expenses Policy, HR37 Incremental Pay Progression, HR39 Shared Parental Leave Policy SUBJECT TO the inclusion of up to date equality impact assessments.

14:22pm ~ Mrs Gilbert left the meeting GR/44/16 Antifraud and corruption policy 44.1 Mrs Cotterill presented the revised anti-fraud, bribery and corruption policy to the

Committee highlighting that the overall aims of this policy are to:

• outline the CCG’s responsibilities in terms of delivering a comprehensive approach to managing related risks

• improve understanding of engaged work undertaken at the CCG to systematically counter economic crime

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• support a broadly based, transparent and supportive anti-fraud culture where staff feel able to raise legitimate concerns sensibly and responsibly

• ensure that all suspected economic crime is referred appropriately in accordance with specified reporting lines & that enquiries are always conducted solely by professionally accredited NHS Counter Fraud Specialists or the Police

• enable all parallel criminal, disciplinary & civil (triple track) sanction disposal options to be properly & consistently considered in the course of investigations; as an essential requirement for fairness & optimising deterrence

44.2 Mr Niven advised that as Chief Finance Officer he had already reviewed and signed

off the policy with counter fraud. The Chair queried 3.9 in relation to personal use of IT; in response Mr Niven confirmed that staff had been advised that they can use IT for personal use such as news sites and shopping in personal time.

The Governance & Risk Committee APPROVED the Antifraud and corruption policy

GR 45/16 Complaints Policy

45.1 Mr Carter presented the revised complaints policy to the Committee. The Committee were informed that the policy and procedure sets out how the NHS complaints procedure will be implemented locally and must be followed by all staff employed or hosted by the CCG. Mr Carter outlined the amendments: • Addition of actions required in relation to complaints containing Safeguarding

concerns. (Section 5.21.3 / Section 5.21.4 / Section 5.21.5 / Section 5.21.6) • Addition of update with regard to unplanned, face to face meetings with

complainants

45.2 Mr Niven queried what the process was with regards to complainants who turn up at the business buildings. Mr Carter explained that currently if unexpected complainants turned up then Mr Carter was usually able to discuss the concerns as appropriate. However, the Committee suggested that a standard operating procedure for the reception staff to be added to reception area.

ACTION: GR/25/16 (Mr Carter) The Governance & Risk Committee APPROVED the complaints policy

GR46/16 Information Governance Strategy

46.1 Mrs Cotterill presented to the Committee the 2016/17 information governance strategy. Mrs Cotterill informed the Committee that there was a limited number of changes to the strategy; the key changes being a revised equality impact assessment and at 5.4.2 and the insertion at 6.3 with regards to the undertaking of monitoring checks within the CCG.

46.2 The Chair queried the statement at 5.3 that ‘The impact of this strategy is subject to an on-going process of review which is closed by the formal Equality Impact Assessment when the strategy is due to be reviewed.’ Mrs Cotterill clarified that

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whilst the equality impact assessment was closed, this did not mean it could not be altered going forward.

The Governance & Risk Committee RECOMMENDED the Information Governance Strategy for approval by the Governing Body

GR/47/16 SIRO Report 47.1 The Committee were informed that this item had been removed from the agenda.

GR/48/16 Caldicott Issues Log 48.1 Mr Carter advised that Dr Sander was unable to attend the Committee, however the

Caldicott Issues Log was provided to the Committee. Mr Carter explained that there was only 2 issues on the log.

48.2 Service retirement email, Mr Niven explained that closing down clinical systems

requires 3 authorisations from Chief Officer, Caldicott Guardian and a clinical executive to ensure protection of the patient data.

48.3 Mr Carter explained that an issue which will be picked up next quarter in the

governance assurance report in relation to sending GPs an email where some addresses were not NHS.net addresses. Mr Carter confirmed he had reported this as a level 1 IG incident as Dr Sander advised the CCG that they should not be sending to non NHS.net email accounts. Mr Niven asked if contact lists have been updated and Mr Carter advised have been looked at since and are no longer being used.

The Governance & Risk Committee NOTED the Caldicott Issues Log

GR/49/16 Assurance Framework 49.1 Mr Carter provided the Committee with a verbal update that the assurance

framework is still under review. Mr Carter is currently developing the framework and will be brought to the appropriate meeting.

ACTION: GR/26/16 (Mr Carter)

The Governance & Risk Committee NOTED the Assurance Framework update GR/50/16 Governance Assurance Report 50.1 Mrs Cotterill presented the quarter 1 governance assurance report to the

Committee. The Committee was informed that 2 requests for access to legal services were received in quarter 1 and that there had been 4 in the year to date. Mr Carter queried why the two requests in July 2016 were included in the quarter 1 report, Mrs Cotterill stated that this was an error.

50.2 Mrs Cotterill highlighted to the Committee that a number of polices were scheduled

for the December 2016 meeting including the majority of health and safety policies. The Chair queried what evacuation training was being arranged, Mr Carter responded that fire wardens had received training but it was felt other members of staff also required this training.

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50.3 Mrs Cotterill drew the Committee’s attention to section 8.2, that compliance for Equality and Diversity training was 80%. Mr Carter responded that all staff had been reminded of their responsibility to comply with mandatory training requirements but that a further reminder would be sent.

ACTION: GR/27/16 (Mr Carter)

50.4 Mrs Cotterill informed the Committee that 67 FoI requests were received within quarter 1. The Chair queried how many of these were round robin requests; in response Mrs Cotterill stated that she did not have the actual number with her but that they happen often and the vast majority of FoI’s were round robin type requests.

50.5 Mrs Cotterill presented to the Committee the results of the quarter 1 2016/17 CCG

IG confidentiality audit compliance checklist. The Committee discussed the results of this audit and asked what action had been taken to correct the identified faults; in response Mr Carter replied that appropriate actions had been taken as a result of this audit including a reminder to all staff to lock screens, ensure keys are removed from cupboards and to wear ID badges at all times.

50.6 Mrs Cotterill outlined to the Committee that as at 4 July 2016, 17% only of CCG

staff had completed their mandatory IG training. The Committee discussed how to further raise awareness with staff. Mrs Cotterill advised staff being emailed, Mr Niven requested line managers be copied in. Mr Carter responded that this could be included in a wider e-mail to staff about mandatory training as discussed previously at 50.3.

50.7 The Chair queried why the health and safety audit for 2016/17 had not yet been

undertaken; in response Mr Carter advised that the audit had been undertaken but that this had not yet been reported to the Committee due to ongoing actions to improve the audit score.

The Governance & Risk Committee NOTED the Governance Assurance

Report GR/51/16 Risk Register 51.1 Mr Carter provided the Committee with an update on the CCG’s management of

risk since its last meeting on the 15th March 2016. The number of risks against each strategic objective were provided in Appendix a. In total the CCG currently has 18 identified strategic risks, there were no proposed risks for closure, but no new risks identified. Mr Carter advised that there is a number of risks outside the required review period and apologised as time had not been available to meet with executives to discuss their updates.

51.2 The Committee discussed why some risks do not have an action plan, Mr Carter

advised if a control of a risk in in place then the risk is mitigated but the risk will not be removed as if the control falls down then the risk is live again.

The Governance & Risk Committee RECIEVED and NOTED the Risk Register update

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GR/52/16 Deep dive – Finance 52.1 Mr Niven explained the process to developing financial risks, with the CCG’s

financial plan which is risk assessed and signed off by GB; risk assessment is low, medium and high and planned against medium risk. Monitoring is completed monthly and reported against the plan and reported to execs and committees. Variance, actions and mitigations are reported. Forecasting is also evaluated and completed monthly and assessed against the plans, the mitigation is looked at.

52.2 Mr Niven went on to explain that reporting is made monthly to NHSE where risk

mitigation is explained. If headroom is not apparent then further investigation would take place.

52.3 In relation to independent assurance, Mr Niven informed the Committee that the

CCG is audited through internal audit and performance assurance. At year end there is an external review of accounts to provide confidence that the previous audit was sound and informed.

52.4 Mr Niven described to the Committee that as part of the risk management process a

separate finance committee as a subcommittee of QPF was being considered. This was particularly pertinent in relation to the shared management arrangement with Darlington CCG which increases the financial risk.

52.5 Dr Hodges asked what the main elements in QIPP are currently; in reply, Mr Niven

advised that they were the Better Care Fund, prescribing work programme, grey list for items of prescription, CHC risks as growth was 15% but forecasting 2.5m overspend. Weekly monitoring now in place and additional actions taking place due to the 25% growth. Independent company review for high packages of care. 1:1 with CCG budget holders and managers.

52.6 Dr Hodges queried how delivery of the GP QIPP programme was proceeding. Mr

Niven advised that progress was slow and Mr Niven will be attending cluster groups and looking into a grey list.

The Governance & Risk Committee NOTED the Finance Deep Dive GR/53/16 IG Toolkit Update 53.1 Mrs Cotterill and Mr Carter presented the Information Governance Toolkit update.

Mr Carter took the committee through some of the level 3 requirements, advising that some progress could be made to obtaining for level 3 in a number of areas. Mrs Cotterill added that if a requirement cannot be met, the rationale can be explained and this would suffice as evidence.

53.2 Mr Niven asked if there are any barriers to delivering the IG Toolkit, Mr Carter

advised no barriers brought to committee currently but that as it was September there was still a long time period in which to gather the evidence. However, Mr Carter asked if the Committee would support him in a request that privacy impact assessments (PIA) are requested for each project. The PIA can be onerous but beneficial to a project, which would help to gain the evidence.

53.3 Mr Carter informed the Committee of a possible level 2 information governance

incident. As part of urgent care procurement, the specification requirements were put on the internet; staff details for TUPE staff were part of this procurement. Mr Carter outlined that information including staff names had been published and that

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organisations had accessed this information. Mr Carter informed the Committee that these organisations were asked to destroy this information, and it has been confirmed that the information has been destroyed.

53.4 Mr Carter explained to the Committee that legal advice had been sought as the data

controller and that the CCG has reported the breach. The provider of the information was contacted and requested to contact the affected staff whose details were released to ensure they were informed.

53.5 Mrs Cotterill advised that the NECS IG team had run the details through the toolkit

and believed that this was a level 1 incident. Mr Carter responded that legal advice had been sought which contradicted this. Mrs Cotterill noted that it had been a judgement call for the CCG. The Committee agreed that this was a serious breach but that it had been handled sensitively and appropriately.

The Governance & Risk Committee NOTED the IG Toolkit Update GR/54/16 Research and Development Quarter 1 Report The Governance & Risk Committee NOTED the Research and Development

Quarter 1 Report GR/55/16 Any other business There were no items of any other business GR/56/16 Post-Critique of the Governance and Risk Committee Meeting The Chair sought critique of the meeting from the members; the committee felt the

meeting was managed in a timely manner, with the correct amount of time allocated for each item, allowing good discussion.

GR/57/16 Date, Time and Venue of Next Meeting

It was noted that the next meeting was scheduled to take place on Tuesday 6th

December 2016 at 2.00pm in the Board room at CCG Offices, Billingham Health Centre.

Meeting closed at 3.55pm Signature: ………………………………………………………….. Date: ……………………….. Mrs Hilary Thompson Chair of Governance and Risk Committee

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The meeting commenced at 10.00 am in the Civic Centre, Hartlepool

Present: Councillor C Akers-Belcher, Leader of Council (In the Chair) Prescribed Members: Elected Members, Hartlepool Borough Council – Councillors Buchan and Clark Representative of Hartlepool and Stockton-on-Tees Clinical Commissioning Group – Alison Wilson Director of Public Health, Hartlepool Borough Council - Louise Wallace Director of Child and Adult Services, Hartlepool Borough Council – Sally Robinson Representatives of Healthwatch – Ruby Marshall and Margaret Wrenn Other Members: Representative of the NHS England – Dr Butler Representative of Tees Esk and Wear Valley NHS Trust – David Brown Representative of Cleveland Police – Temporary Assistant Chief Constable Ciaron Irvine Observer – Statutory Scrutiny Representative, Hartlepool Borough Council, Councillor Tennant Also in attendance:- Fiona Anderson, Hartlepool & Stockton Health, GP Federation representative L Allison, J Gray, E Leck - Healthwatch Hartlepool Borough Council Officers: Nicole Ahmed, Public Health Registrar Joan Stevens, Scrutiny Manager Amanda Whitaker, Democratic Services Team

19. Apologies for Absence Councillor Thomas

20. Declarations of interest by Members

HEALTH AND WELLBEING BOARD

MINUTES AND DECISION RECORD

17th October 2016

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Councillor C Akers-Belcher reaffirmed an interest that he had declared previously that in accordance with the Council’s Code of Conduct, a personal interest as Manager for the Local HealthWatch, as a body exercising functions of a public nature, including responsibility for engaging in consultation exercises that could come before the Health and Wellbeing Board. He advised that where such consultation takes place (or where there is any connection with his employer), as a matter of good corporate governance, he would ensure that he left the meeting for the consideration of such an item to ensure there was no assertion of any conflict of interest

21. Minutes (i) The minutes of the meeting held on 19 September 2016 were confirmed.

(ii) The minutes of the meeting of the Children’s Strategic Partnership held on 28 June 2016 were received.

22. ‘Hartlepool Matters’ (Independent Chair) The ‘Hartlepool Matters’ report was presented to the Health and Wellbeing

Board by Professor Colin-Thome. The Board was advised that Hartlepool Borough Council on the 12th March 2015 had resolved that a Working Group be established, in partnership with NHS Hartlepool and Stockton on Tees Clinical Commissioning Group (CCG). The purpose of the Working Group was to identify health and social care planning priorities, to inform the development of a Plan for the delivery of integrated health and social care services across Hartlepool, including the University Hospital of Hartlepool (UHH) site. In recognition of the importance of having in place an independent Chair for the Working Group, Full Council had approved Professor Colin-Thome’s appointment on the 6th August 2015. The Working Group had met on five occasions, between October 2015 and March 2016, with each meeting exploring an agreed theme. Evidence presented, and issues raised during the course of the meetings, had resulted in the formulation of the report, entitled ‘Hartlepool’s Matters’. A copy of the report had been available on the Council’s web site and copies were available at the meeting. The Board received a presentation by Professor Colin-Thome during which he presented his report’s recommendations and highlighted the salient issues included in his report. The implementation of the report was highlighted as a key consideration and it was suggested that the public should be included in the accountability of that process. Discussion followed on issues associated with the communication process including varying consultation models. The Chair advised the Board that the Council’s Chief Executive had advised that she would Chair the implementation group. The Chair advised that he would be writing to Groups who had been involved to seek their views prior to determining the composition of the implementation group. The Chair opened the meeting for public questions. Professor Colin-Thome responded to questions relating to the reasons for the closure of the Accident and Emergency Department in Hartlepool hospital in terms of local and

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national considerations. Following concern expressed in relation to perceived contradictions arising from myths highlighted in the report, the Chair proposed that statistics behind the myths both locally and nationally, be submitted to a future meeting of the Board. Members of the public reiterated concerns expressed earlier in the meeting in relation to communication issues which were accepted by Board Members. The Professor responded to a question raised in relation to a shortage of GPs in the town in terms of short, medium and long term solutions. The Chair advised the public that following concerns expressed by the Board in relation to Sustainability and Transformation Plans (STPs), a letter had been sent to NHS England which he was content to share with interested individuals. The Chair would also be working with the Council’s communications team to ensure that the concerns which had been expressed were communicated to the public. A further report relating to STPs would be submitted to a future meeting of the Board. The Chief Officer, Hartlepool and Stockton-on-Tees Clinical Commissioning Group, provided assurances in relation to the STP and highlighted the component parts of the plans which included a local STP element. Mike Hill, Regional Organiser/Regional Political Lead, Unison Northern Region addressed the meeting and encouraged those present to move forward together. He advised that he represented staff in hospitals and considered there to be an opportunity to bring wards back to Hartlepool hospital particularly for elderly residents. Mr Hill highlighted that concerns had been expressed that patients were being kept in hospitals, outside of the town, for longer than necessary waiting for care packages. The Chair highlighted that this Council had not been responsible for any delayed discharges.

Decision

i) The report entitled ‘Hartlepool Matters’ was received by the Board and its recommendations were referred to Full Council and Hartlepool and Stockton on Tees Clinical Commissioning Group’s Governing Body for approval. The Board expressed appreciation to Professor Colin-Thome;

ii) It was agreed that an action plan be formulated, in partnership with

the CCG, for the implementation of the report’s recommendations and an Implementation Group created; and

iii) The implementation of the report’s recommendations, and progress

against the Action Plan, be monitored through this Health and Wellbeing Board.

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23. Better Care Fund: 2016/17 Q1 Return (Director of Child and Adult Services)

A report presented by the Director of Child and Adult Services provided the

Board with an update on implementation of the Better Care Fund Plan. The 2016/17 Quarter 1 return which was appended to the report had been submitted prior to the deadline of 9 September 2016. The Quarter 1 return indicated that all national conditions were being achieved. It was noted that local performance indicators had been used to evidence the impact of the Better Care Fund. Plans for 2016/17 aimed to build on achievements in 2015/16, with a particular focus on admission prevention and closer working with primary care, and were summarised in a document appended to the report. Work was underway to review services that were currently funded by the BCF and to clarify their impact. Further information would be reported to the Health & Wellbeing Board along with the Q2 return in January 2017.

Decision

The Board noted the 2016/17 Q1 return, which was submitted on behalf of the

Board using delegated authority as agreed previously.

Meeting concluded at 11.20 a.m. CHAIR

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The meeting commenced at 10.00 am in the Civic Centre, Hartlepool

Present: Dr Timlin, Hartlepool and Stockton-on-Tees Clinical Commissioning Group (In the Chair) Prescribed Members: Elected Members, Hartlepool Borough Council – Councillor Buchan Representative of Hartlepool and Stockton-on-Tees Clinical Commissioning Group – Alison Wilson Director of Public Health, Hartlepool Borough Council - Louise Wallace Director of Child and Adult Services, Hartlepool Borough Council – Sally Robinson Representatives of Healthwatch – Ruby Marshall and Margaret Wrenn Other Members: Representative of Hartlepool Borough Council - Councillor Carl Richardson (as substitute for Councillor Steve Thomas) Representative of Tees Esk and Wear Valley NHS Trust – David Brown Observer – Statutory Scrutiny Representative, Hartlepool Borough Council, Councillor Tennant Also in attendance:- Representatives of the NHS England – Ben Clark and Glen Wilson Representative of Cleveland Police – Chief Superintendent Gordon Lang Observer, Hartlepool Borough Council - Councillor Brenda Harrison Representative of Teeswide Safeguarding Adults Board – Ann Baxter Hartlepool Borough Council Officers: Joan Stevens, Scrutiny Manager Denise Wimpenny, Democratic Services Team

24. Apologies for Absence Councillors C Akers-Belcher and Thomas, Hartlepool Borough Council, Dr

Tim Butler, NHS England, Colin Martin, Tees Esk and Wear Valley, Cairon Irvine, Cleveland Police and Fiona Anderson, Hartlepool & Stockton Health, GP Federation representative.

HEALTH AND WELLBEING BOARD

MINUTES AND DECISION RECORD

5 December 2016

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25. Declarations of interest by Members None

26. Minutes (i) The minutes of the meeting held on 17 October 2016 were

confirmed. (ii) The minutes of the meeting of the Children’s Strategic Partnership

held on 28 June 2016 were received.

27. Teeswide Safeguarding Adults Board Annual Report 2015-16 (Teeswide Safeguarding Adults Board)

28. Teeswide Safeguarding Adults Board Strategic Business Plan 2016/17 (Teeswide Safeguarding Adults Board)

The Chair of the Teeswide Safeguarding Adults Board, presented the

Teeswide Safeguarding Adults Board Annual Report 2015/16 and Strategic Business Plan 2016/17, copies of which were appended to the report. The Annual Report considered the activities of the Board against its five strategic aims over the past year. It provided a summary of work undertaken across Tees to protect the most vulnerable people in the community, and highlighted the challenges faced. The Strategic Business Plan summarised the priorities identified throughout the consultation process, informing the development of the 2016-17 objectives and actions. The Board looked forward to working with current partners and developing new relationships to ensure the safeguarding arrangements helped and protected adults. Following presentation of the reports, Board Members expressed their support for the report and whilst they were pleased to note the work that had been undertaken to date to improve communication and engagement, it was noted that further work was needed to improve awareness of adult safeguarding issues. Members discussed the most appropriate methods of raising awareness of this issue, particularly with hard to reach groups and the need to increase integration with BME groups was highlighted. Board Members welcomed the Teeswide approach in terms of sharing information locally with a number of partner agencies, the benefits of which were discussed.

Decision

The Board endorsed the Teeswide Safeguarding Adults Board Annual Report

2015/16 and Strategic Business Plan 2016/17.

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29. Health Protection Update (Director of Public Health) The Director of Public Health introduced the report which provided

background information to the statutory duties placed on Public Health England, NHS England and local authorities to protect the health of the population. The Board was referred to a plan, appended to the report, which provided details of the key activities that contributed to managing risk and responding to incidents. Given the Board’s decision to undertake a more in depth consideration of immunisation and screening, a representative from NHS England had been invited to the meeting to provide a presentation in relation to immunisation in Hartlepool. The representative provided a detailed and comprehensive presentation which included latest statistics and trend analysis in relation to take up of immunisation. The key factors arising from the presentation were summarised as follows:- • The two public health interventions with the greatest impact are the

provision of clean water and immunisation • No measures had saved more lives than immunisation • Immunisation is a highly cost effective public health intervention • Governance and assurance structure • Details of childhood immunisations by type including statistics and

trends in Hartlepool as a comparator with the North East and England • Details of adult immunisations Following the presentation, a number of examples were shared with the Board in relation to the side effects experienced by individuals following vaccinations, particularly the flu vaccination. In response to clarification sought on the side effects of vaccinations of this type, the NHS England representative advised that any side effects were reported to the Health Care Worker and monitored accordingly. Assurances were provided that whilst the flu jab could cause a localised reaction and some individuals may feel unwell, this would not give individuals the flu. The potential reasons for low take up of the flu jab were discussed and emphasis was placed upon the need to publicise the message that the flu jab would not result in illness. With a view to increasing take up of immunisation, a query was raised as to whether any particular groups should be targeted. Board Members were advised that potentially BME groups should be targeted, given the low level of take up. The Chair reiterated the benefits of the flu jab and and expressed support in this regard. A member of the public commented on a research paper on the alternatives to immunisation. It was suggested that this information be forwarded to the Director of Public Health following the meeting. Another member of the

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public, who was also invited to speak, referred to a report on the links between the MMR immunisation and autism. Board Members responded to further issues raised in relation to the presentation.

Decision

(i) The Board noted the activities relating to protecting the health of the

population as outlined in the plan. (ii) The Board confirmed it had assured plans and arrangements in place to protect the health of the population in keeping with the requirements under the Health and Social Care Act 2012. (iii) That the contents of the presentation and comments of Board Members be noted.

30. Health and Wellbeing Board – Terms of Reference Review (Director of Public Health)

The Scrutiny Manager presented a report which provided an opportunity for

the Board, to review their Terms of Reference, sub-structure and non-statutory membership. To assist the Board in the review of the sub-structure, a Development Day had been held on 17 October 2016 during which Members considered three key questions, a summary of which was outlined in appendices to the report. Based upon the outcome of the Development Session, it was suggested that the Board should, in the coming year, focus on the following:- (a) Holding themed meetings to help the Board focus on two priority themes inviting relevant experts and involving the appropriate sub groups where not effective. Themed priorities discussed as options were:-

(i) Veterans Health (ii) Offender Health (iii) Refugee/Asylum Seeker Health

(b) Statutory/other business to be looked at during separate themed meetings, including:

(i) Implementation of the Hartlepool Matters Plan (ii) Monitoring implementation of the Healthy Weight: Healthy Lives Strategy (iii) Update and monitoring of the Health and Wellbeing Strategy to be monitored through sub groups, with issues escalated to the Health and Wellbeing Board, as and when necessary. (iv) Completion of a GAP analysis (v) Identification of an indicator to show progression

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(vi) Achieving more quick wins and intermediate outcomes.

Other comments/suggestions identified at the Development Session were provided together with details of proposed sub-groups as set out in the report. Members were referred to the revised Terms of Reference attached at Appendix A. With regard to the decision taken to remove the North Tees and Hartlepool Foundation Trust from membership of the Board, it was suggested that the South Tees NHS Foundation Trust be contacted again to encourage take up of a place on the Board. The Scrutiny Manager made reference to a letter from the Home Office, a copy of which was tabled at the meeting, which highlighted the Home Office’s support and important benefits that could be realised through closer collaboration between policing and health partners. The Scrutiny Manager was pleased to report that the Council had already taken on board a number of the recommendations suggested by the Home Office with strong collaborative working arrangements already in place with the police with representations on the Health and Wellbeing Board and regular attendance by the Police and Crime Commissioner. The Council had also signed up to the Care Concordat Triage arrangements. In considering the revised Terms of Reference for the Board, issues were discussed regarding: - The number of proposed Sub Groups under the Board - Given the

potential for duplication, it was suggested that existing groups should be utilised where possible.

- The suggested themes for future meetings of the Board – Support was expressed for the principle of themed meetings to focus the activities of the Board. However, Members were unsure if the suggested themed priorities of veteran’s health, offender health and refugee/asylum seeker health were the most appropriate. Whilst it was recognised that the suggested areas were important, it was considered that there should be more focus upon areas like obesity and groups disproportionately affected as this would result in a greater impact.

Decision

(i) The Board agreed that its future meeting programme would be planned to

include separate themed and statutory / other business meetings. The basis of each being:

a) Themed meetings, to focus on two priority themes each year, inviting

relevant experts and involving appropriate sub groups.

b) Statutory/other business meeting - to focus on issues including:-

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(i) Implementation of the Hartlepool Matters Plan; (ii) Monitoring implementation of the Healthy Weight: Healthy Lives Strategy;

c) Updating of the Health and Wellbeing Strategy. d) Completion of a GAP analysis and identification of an indicator to

show progression / performance. (ii) The Board Agreed that from an operational perspective:

(a) A review be undertaken of the format of its minutes and layout of its reports to include reference to all sub groups and how the issue affects them.

(b) Information provided to include more relatable statistics / informatics (i.e. use of figures rather than statistics i.e. Hartlepool as a town info graphic in the Hartlepool Matters Plan).

(c) A Health and Wellbeing Board newsletter be introduced.

iii) That the revised Terms of Reference, attached at Appendix A, be agreed, with the following amendments / exceptions:-

Amendment (a) That reference to the inclusion of an NHS Foundation Trust

Representative to the ‘Other Members’ section of the Board membership (Page 5), be amended to read NHS (Acute) Foundation Trust (1).

Exception (b) That approval of proposed amendments to Section 8.10 in relation to

the creation of sub-groups and task and finish groups be deferred, in light of capacity and duplication concerns, and a further report outlining revised proposals brought to the Board.

(c) That approval of proposed amendments to Section 9.1, in relation to

engaging with other bodies be deferred, pending further discussions with Stockton Borough Council as to the role, format and benefit of an annual joint meeting of Stockton and Harltepool’s Health and Wellbeing Boards.

iv) The Board requested that the CCG approach the South Tees NHS Trust again to explore the potential of them filling the (acute) NHS Foundation Trust vacancy on the Board. v) That a further report be presented to the Board to identify two topics / priorities, as alternatives to those identified in the report, to form the basis of the Board’s future themed meetings.

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31. Age Related Dual Sensory Loss (Director of Child and Adult Services )

A report presented by the Director of Child and Adult Services provided the

Board with information regarding residents of Hartlepool who were living with age related dual sensory loss. The support of the Board was sought for a proposal to improve awareness and equip key organisations with the skills and training necessary to identify and support people with dual sensory loss. It was reported that in Hartlepool it was estimated that there were at least 520 people living with age related dual sensory loss, of which 36 so far had been identified. The prevalence of co-occurring sight and hearing problems increased with age. In Good Hands (IGH) was a Big Lottery funded project managed by SCENE enterprises CIC and was working with all 12 local authorities and all care providers in the North East to deliver free training and advice to staff. Their ambition was to support key stakeholders to improve uptake of training and build their capacity to identify and support these older people in communities. IGH would like to roll out the free training to all key stakeholders, including the NHS, emergency services and key voluntary organisations to ensure people had the right information advice and guidance necessary to support people with age related dual sensory loss.

Decision

That the proposal to support and encourage key organisations to sign up to

dual sensory loss training be supported. Meeting concluded at 11.45 am. CHAIR

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Health & Wellbeing Board A meeting of Health & Wellbeing Board was held on Wednesday, 26th October, 2016. Present: Cllr Jim Beall (Chairman), Cllr Mrs Ann McCoy(Vice-Chairman), Cllr Lynn Hall, Cllr Gillian Corr (substitute for Cllr David Harrington), Cllr Di Hewitt, Tony Beckwith, Sarah Bowman-Abouna, David Brown, Barry Coppinger, Martin Gray (substitute for Jane Humphreys), Alan Foster, Cllr Paul Rowling (substitute for Cllr Sonia Bailey), Ali Wilson, Paul Williams Officers: Michael Henderson (SBC), Donna Owens, Jo Heaney (CCG) Also in attendance: Mike Maguire (DDT LPN - Pharmacy) Apologies: Cllr Sonia Bailey, Cllr David Harrington, Sheila Lister, Steve Rose, Jane Humphreys

HWB 48/16

Declarations of Interest There were no declarations of interest.

HWB 49/16

Minutes of the Board held on 28 September 2016 The minutes of the meeting held on 28 September 2016 were confirmed as a correct record.

HWB 50/16

Partnership Minutes CYP - 21 September 2016 The minutes of the Children and Young People's Partnership held on 16 February 2016.

HWB 51/16

Commissioning Group Children and Young People Health and Wellbeing Commissioning Group minutes 11 July 2016 The minutes of the Children and Young People's Health and Wellbeing Commissioning Group were noted. During consideration it was noted that each of the topic leads relevant to Children and Young People were responsible for keeping their section of the JSNA up to date, in consultation with partners. It was noted that the SEND team was leading this for SEND issues. Following the above discussion the Chairman highlighted the need for the Board to look at reviewing the Joint Strategic Needs Assessment (JSNA). This needed to be flagged up for future meetings of the Board.

HWB 52/16

Pharmacies Members received a presentation provided by Mike Maguire, who chaired the Durham, Darlington and Tees Local Professional Network (LPN) (Pharmacy)

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Steering Group. Members noted: - that the main role of the LPN was to advise Commissioners and key stakeholders about opportunities that would benefit patients, the public and the NHS. - Pharmacists were the third largest group of healthcare professionals after Nurses and Doctors. - 89% of the population could access a community pharmacy, within a 20 minute walk from their home. This statistic rose to 99.8% of people living in the most deprived areas. - A pilot of Pharmacy Emergency Rescue Medication Supply Service (PERMSS) had indicated that significant savings could be made. - A study of 12 months of data, in the North East, had suggested that referral into Community Pharmacies, for low acuity conditions, would divert 51,000 people away from A&E, walk in centres and out of hours surgeries. - the Tees Healthy Living Pharmacies were focusing on the Health and Wellbeing of every customer, getting people to take responsibility for their health. Members discussed the presentation and asked a number of questions. This discussion could be summarised as follows: - Pharmacist were commissioned by NHS England, however other enhanced services such as stop smoking and weight management were commissioned by local authorities. - Loss of income for pharmacies may effect the provision of free services, like delivery services. The most vulnerable members of the community would suffer as a result of such cuts. - could pharmacies link with social care in terms of any safeguarding concerns they observed? - Pharmacies worked collectively across patches in some services e.g. end of life medication, but other services could be included. It was accepted that each pharmacy didn't have to provide every service, as long as there was coverage within a geographical area. - Pharmacies could diversify and provide other community services . Currently, services such as physiotherapy and chiropody were provided at some pharmacies. It was suggested that NHS England would provide a briefing report, to the Board, on Government proposals around the transformation of community pharmacies.

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RESOLVED that 1. the presentation be noted 2.NHS England provide a report on the Transformation of Community Pharmacies to a future meeting of the Board.

HWB 53/16

Sustainability Transformation Plan Members received an update relating to the Sustainability and Transformation Plan, including the Better Health Programme. Members noted: - that North Durham would be part of the Northumberland Tyne and Wear STP. - that no decisions had been made about where services would be provided. - possible scenarios for hospital services. The current configuration was not an option. - features of a specialist hospitals. - that there were no plans to close any hospitals, but they would be used in a different way. - patients would see specialist to get the best possible treatment, around the clock, every day. - that there was a shortage of GPs, so there was a need to transform the workforce, using GP assistants, more practice nurses, develop new roles outside the hospital. - a potential model of care for out of office services - a timetable leading to consultation in June 2017. - details of stakeholder and public engagement events. Members discussed the presentation and it was agreed that any new model would rely on adequate and consistent levels of services in social care. Some of the proposals may not be achievable within current budgets. Engagement with local authorities was a fundamental part of developing the Plan. RESOLVED that the update be noted.

HWB 54/16

Learning Disability Transforming Care Members received an update on progress regarding the North East and Cumbria Fast Track Learning Disability Transforming Care Programme. Particular reference was made to an identified shortfall in the funding of the Transformation Programme of £8.3 million.

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It had been acknowledged that there would need to be a significant shift in both resources and culture to meet the needs of people more effectively in the community. This would involve the de-commissioning of inpatient beds and the expertise of some specific skill areas being focused on supporting people in the community. Care and support organisations would need to provide more intensive individualised responses for people that traditionally would have had their needs met in inpatient care. The investment required for this new model of care was identified as being in excess of what could be released from current commissioned services. Significant work was also being undertaken across the region to understand the implications of the inpatient dowry, which was designed to support the on-going care and support needs of eligible inpatients in the community. The financial model to underpin this was being worked through jointly with CCGs and Local Authorities. Working with social care providers and supporting people whose needs were complex was a key priority for the CCG and Local Authorities and Commissioners continued to work together to develop the community infrastructure to enable the implementation of a new model of care for people with a learning disability. Members considered the report and their discussion has been summarised below: - in Stockton there were 3 people within inpatient care that were the responsibility of the CCG. There were 12 patients that may come back to area, depending on circumstances. - there was a willingness to support people in communities, who could be, but in order for this to happen resource allocation needed to shift. - not all beds could be released and some had to be maintained for people who may need long term or occasional support. - people needed to be in the correct settings but this was complex and had a significant cost associated with it. - issues around Ordinary Residence and out of areas cost were discussed and the Chair indicated that he could arrange for a legal view, from the Local Authorities' perspective to be provided. - moving people from hospital under the Mental Health Act into the community would increase Deprivation of Liberty applications. The Chair highlighted that whilst the Board had agreed to receive updates, and it would help resolve any issues it was able to, it had not agreed to have overall responsibility for the Transformation Programme. - the Chair also highlighted that the Tees-wide Adult Safeguarding Committee

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had raised safety concerns associated with the Programme and had agreed to send a letter to Tim Rideout in this regard. RESOLVED that the update be noted and a further update be presented to the Board in 6 months.

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Children and Young People’s Mental Health and Wellbeing Transformation Plan 2015-2020 (2016 refresh) Members received an report on the refresh of the Hartlepool and Stockton on Tees Children and Young People's Mental Health and Wellbeing Transformation Plan 2015 - 20. CCG priorities within the Plan included: - Perinatal Mental Health - Development and implementation of a pilot for intensive home treatment - improving access and treatment for children and young people with Autistic Spectrum Disorder - Improving Access to Psychological Therapies for children and young people. - ability to deliver concordant care for people who were experiencing the first episode of psychosis Specific Stockton priorities included: - research/intelligence gathering activity - Emotional Resilience Offer - Therapeutic Support for Carers - Family therapeutic support Members noted funding allocations for the eating disorders service 2016/17 was £166,000 and £657,353 for Future in Mind. During consideration of the Plan members noted that: - in terms of NHS England assurance, this was likely to be a self assessment process and fairly light touch. - funding was not ring-fenced but there was a commitment for the next 12 months. - the eating disorders service had previously been accessed through specialist services but it was now a self referral service. Members were extremely supportive of the plan and agreed that a positive press release should be considered. RESOLVED that: 1. the refreshed priorities and financial allocation within the updated Children and Young people's Mental Health and Wellbeing Transformation Plan 2015 - 2020 be endorsed.

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2. consideration be given to a positive press release being issued.

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GP Federation Update Members received an update on the GP Federation: Members were reminded that the GP Federation (Hartlepool and Stockton Health) was an organisation owned by, and representing, the 24 GP practices in Stockton and 12 in Hartlepool. The Federation wanted to be the leader of a sustainable primary care system, responding to the challenges of the future and developing new models of care outside of hospital. The Federation presented a single organisation that could provide leadership, services that could be commissioned, a single point of contact. The Board noted some of the new initiatives the Federation was currently involved in: - there were 20 care coordinators, working in all practices, with a cohort of 4,000 patients who had been identified by GPs as being most likely to end up in hospital in the next year. These patients were working with the coordinator and their GP to plan their care. - placing pharmacists in practices to try and shift workloads and improve the quality of medicines management, helping the CCG with some of the huge costs of the prescribing budget - use of technology using 'eConsult'. Patients may be diverted to self help or be assisted by the GP, without the need of a face to face consultation. - training some 'non-doctor' health workers in primary care - GP will be open over Christmas and the New Year to take off pressure on urgent care - helping Practices to be more resilient, reducing variations in access and quality of care - looking to develop future partnerships with social care, mental health, voluntary and community sector etc. During consideration of the update it was noted that services to older people had been identified as a potential area of integration and this would be the subject of discussion at the Adults' Health and Wellbeing Partnership. Paul Williams indicated that he would be happy to be involved in any discussion at the Partnership on this matter. RESOLVED that the update be noted and a further update be provided to a future meeting.

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Members' Updates During Members' Updates it was noted that:

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- A Terms of Reference and Rules of Procedure document for the Tees Valley Health and Wellbeing Chairs' Network was being developed and would be shared with relevant organisations when finalised. The Domestic Abuse Steering Group was up and running and had held 2 meetings. Current work included looking at potential new approaches/initiatives relating to tackling Domestic Abuse. The minutes of this Group would be provided to the Board.

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Forward Plan Members considered the Board's Forward Plan.

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Action Tracker Members considered the Board's Action Tracker.

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Health & Wellbeing Board A meeting of Health & Wellbeing Board was held on Wednesday, 30th November, 2016. Present: Cllr Jim Beall (Chairman), Cllr Mrs Ann McCoy, Cllr Sonia Bailey, Tony Beckwith, Cllr Gillian Corr (Substitute for Cllr David Harrington), Cllr Di Hewitt, Saleem Hassan, Jane Humphreys, Sarah Bowman-Abouna, David Brown, Alan Foster, Sheila Lister, Steve Rose, Karen Hawkins (Substitute for Ali Wilson), Ann Workman Officers: Michael Henderson, Peter Acheson (SBC) Gemma Clifford (Catalyst) Also in attendance: Apologies: Barry Coppinger, Cllr Lynn Hall, Cllr David Harrington, Paul Williams, Ali Wilson HWB 60/16

Declarations of Interest There were no declarations of interest.

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Minutes of the meeting held on 26 October 2016 The minutes of the meeting held on 26 October 2016 were confirmed as a correct record.

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Health and Wellbeing - Minutes of Partnerships, Groups etc Members considered the minutes of the following meetings. - Children and Young People's Partnership - 19 October 2016 - Domestic Abuse Steering Group - 2 August 2016 - Children and Young People's Joint Commissioning Group - 5 October 2016 - Adults' Health and Wellbeing Joint Commissioning Group - 24 October 2016 - Tees Valley Health and Wellbeing Chairs' Network - 26 September 2016 During consideration of the Children's Partnership meeting it was agreed that a report relating to children and young people with special educational needs and/or disabilities (SEND) should be submitted to the March/April meeting of the Board. During consideration of the Adults' Health and Wellbeing Joint Commissioning Group the Chair made reference to an issue that the Group had discussed, during its consideration of an item entitled 'Tees Valley Sexual Service Review and Procurement.' The Group had asked that the issue be raised with the Board to seek Partners' agreement to a principle of working. The Chair read out an extract of the relevant minute that captured the principle: ' ...when there was a high value and complex programme of work, particularly where there was more than one commissioner, it was important that organisations were committed to providing appropriate employee capacity to undertake the work, in order that it was recognised as a priority and was supported in practice. Where one organisation was identified as leading the commissioning / procurement of services, it should be acknowledged that there was a significant commitment by that lead organisation, in terms of legal, process and administrative responsibility. Such input incurred costs that needed

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to be recognised. It was agreed that this should be highlighted with the Health and Wellbeing Board with a view to receiving appropriate commitment from relevant organisations, for future projects.' Members agreed the principle detailed above. In terms of raising this principle with other Tees Valley authorities, the Chair agreed that he would refer to it at the Tees Valley Health and Wellbeing Board Chairs' Network in January. RESOLVED that: 1. the minutes detailed above be noted. 2. that the principle detailed above be agreed. 3. the Chair raise the principle, with other Tees Valley authorities via the Tees Valley Health and Wellbeing Chairs' Network.

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Role of the VCS - Potential to improve Health and Wellbeing - Presentation Members were provided with a presentation that described work that was on-going within the Voluntary, Community and Social Enterprise (VCSE) Sector to improve Health and Wellbeing in the Borough. The presentation also considered further potential in this regard. Members noted ; - the anatomy of the VCSE in Stockton - on - Tees - the social prescribing model - the positive independent evaluation of the impact of the VCSE's Health Initiatives. - an overview of some of the Health projects provided by the VCSE and the value they had delivered. The Board discussed the presentation and the discussion could be summarised as follows: - there was a mature, positive relationship amongst all partners in the Borough and an excellent understanding of each others limitations and challenges. - with regard to the Health Ambassadors initiative it was suggested that this could be broadened to include social care and it was requested that this be considered further. - difficult to reach groups were well catered for within the VCSE. - there was a bottom up approach to issues, where needs were identified and services were shaped to meet those needs. The 'A Fairer Start' initiative was a good example of this. - members noted that an evaluation report would be presented to a future

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meeting. RESOLVED that: 1. the presentation and discussion be noted. 2. consideration be given to broadening the Community Health Ambassadors initiative to social care.

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CCG Operational Plans Members received a presentation that set out an overview of the NHS Planning Process for 2017/18 and 2018/19. Members noted the requirements that guidance placed on Clinical Commissioning Group (CCG). Members noted some of the challenges facing the CCG: - There would be aggregated financial activity and workforce plans at STP level, underpinned by financial control totals, and CCG operational plans would need to reflect those aggregated plans - Accountability for delivery would sit with individual organisations but they would need to demonstrate how their organisational plans aligned with STP objectives and planning assumptions. - CCG and provider plans would need to be agreed by NHS England and NHS Improvement, with a clear expectation that they would be fully aligned in local contracts. - First draft of plans had been provided 24th November with final plans to besubmitted by 23rd December. The Board received details of some of the CCG's Planning Ambitions and how these were aligned with the STP. A brief note on the Better Care Fund was provided and it was explained that CCGs and Council's needed to agree a joint plan to deliver the requirements of BCF for 2017/18 and 2018/19. CCGs would be advised of a minimum amount that they were required to pool. Funding had to explicitly support reductions in unplanned admissions and hospital delayed transfers of care. Members discussed the presentation: - local Plans were aligned with the STP and there was nothing new that the CCG's local plans hadn't already being heading towards. The integration priorities identified by the Health and Wellbeing Board i.e. Older People, SEND and Domestic Abuse, were all captured in plans. - the Planning Ambitions provided to the Board were a high level overview and many actions sat underneath those ambitions. - there was a commitment to an integrated approach to Care and Domestic

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Abuse but more work was needed between partners to work up detail in these areas. - There would be no specific funding allocation to Domestic Abuse. Prevention was an important strategic aim of the CCG and in terms of Domestic Abuse there would need to be an understanding of how work might reduce spend in primary and acute services before resources were reallocated. - it was accepted that Domestic Abuse created spend across the whole system. - BCF Plans would need to be refreshed in line with new guidance which was expected soon. RESOLVED that the presentation be noted.

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Annual Health Protection Report Member received a report that provided a summary of health protection arrangements and delivery for Stockton on Tees. It also provided a range of activity data for 2015/16 in terms of key communicable diseases and reports on levels of protection, such as immunisation rates. Members discussed the report and this could be summarised as follows: - food safety star ratings were not advertised sufficiently but scores were available on websites. - notifications from GPs, of notifiable diseases was low and it was suggested that this wasn't giving the true picture in this area. It was noted that a notification form would be sent to Dr. Saleem Hassan who would highlight it with GP colleagues. - whooping cough vaccination was improving but there was room for further improvement. - incidents of scarlet fever were increasing nationally but no vaccine currently existed. - there was a request for a report to a future meeting about how to improve uptake of flu vaccinations amongst workforces. There would be discussion outside the meeting about this. RESOLVED that: 1. the report be noted. 2. the notifiable diseases form be passed to Dr Hassan who would highlight it to other GPs. 3. a report on uptake of the flu vaccination, within local workforces, be presented to a future meeting of the Board.

HWB Integrated Personal Commissioning Updates

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Members received an update relating to the Integrated Personal Commissioning Programme (IPC). Specific reference was made to the NESTA 100 Day Challenge and it was explained that Stockton on Tees Demonstrator site had been approached by NHS England to be part of a radical transformation programme delivered by NESTA. The National IPC team requested that 2 sites work with NESTA on an intense programme of work to look at integrating frontline teams and to challenge how IPC could be delivered at scale. Stockton on Tees was chosen as the only site to take part in this due to our commitment to IPC but also due to it being the site furthest ahead nationally in developing and delivering IPC. The challenge had enabled us to again align IPC and BCF together to address integration across the over 65s with a particular focus on LTCs, frailty and the Discharge to Assess Model. A Leadership team had been established and the challenge would be launched in January 2017. RESOLVED that the update be noted and a further report be provided in 6 months

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Sustainability and Transformation Plan There was a brief update around the Sustainability and Transformation Plan (STP) and that update has been summarised below. - the draft STP had been formally published. - there would continue to be engagement to develop the plan. Engaging with local authorities was a priority. - there was a commitment to working together across all organisations. Funding would continue to be challenging in the future. - the STP would need to be delivered, taking account of what was needed locally. - there were issues around the communication of the STP message and a perception that it was about cuts rather than improving quality and getting more value. RESOLVED that the update be noted.

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Members' Updates The Chair referred to a letter he had received from David Mowat MP, Parliamentary Under Secretary of State for Community Health and Care requesting that Health and Wellbeing Boards develop and strengthen relationships with general practice services. The Chair had responded explaining the position in Stockton and highlighted how well general practice was represented on the Board and its supporting structures.

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The Chair indicated that he would circulate the letter and his response, for members' information. It was explained that contract award letters would be issued, today, for the Integrated Urgent Care Service, that the CCG commissioned. A formal communication would be issued to Partners. The contract had been awarded to North Tees and Hartlepool Trust, in collaboration with North East Ambulance Service and Hartlepool and Stockton Health Federation. It was agreed that a summary of what the service would look like would be submitted to a future meeting of the Board. RESOLVED that the update be noted and a report on the Integrated Urgent Care Service be presented to the Board's meeting, in February.

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Forward Plan Members considered and agreed the Forward Plan

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Action Tracker There were no actions on the tracker.

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