Governing Body

MINUTES OF THE PUBLIC GOVERNING BODY MEETING Thursday, 9 January 2020, 10.00am – 12.30pm

Council Chamber, Ground Floor, Runcorn Town Hall, WA7 5TD Members in Attendance: David Merrill Interim Chair NHS Halton CCG Ruth Austen-Vincent Lay Member NHS Halton CCG Dr Claire Forde GP Representative NHS Halton CCG Michelle Creed Chief Nurse NHS Halton CCG and

NHS Warrington CCG Leigh Thompson Chief Commissioner NHS Halton CCG Dr Andy Davies Chief Clinical Officer NHS Halton CCG and

NHS Warrington CCG Dr David Wilson

Federation Representative GP Health Connect Ltd

David Cooper Chief Finance Office NHS Halton CCG and NHS Warrington CCG

Gareth Hall Lay Member NHS Halton CCG Dr Latha Meda Federation Representative Widnes Highfield Health

Ltd Kath Parker Chair Halton Healthwatch Halton Healthwatch

In Attendance Louise Murtagh Senior Committee Administrator NHS Halton CCG Rebecca Knight Head of Assurance and Risk NHS Warrington CCG Kath Parker Chair (Healthwatch) Healthwatch Halton Chris Carlin Project Manager Well Halton Jackie Smith Community Shop Employee The Community Shop

Halton Apologies: Dr Julie Langton Secondary Care Doctor NHS Halton CCG Shahzad Tahir Lay Member NHS Halton CCG Eileen O’Meara Director of Public Health Halton Borough Council

1. Welcome, Introductions, Declarations and Apologies David Merrill welcomed all members and other attendees to the meeting. Specifically David Merrill welcomed Jackie Smith from The Community Shop, Runcorn. The Chair reminded attendees of their obligation to declare any interest they may have on any issues arising at the meeting which might conflict with the business of the CCG. For the purposes of this meeting, a conflict of interest was defined as “a set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold”. Declarations made by members of the Governing Body were listed in the CCGs Register of Interests. The Register was available on the CCG website. No further declarations were made during the meeting.

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It was noted that the meeting was quorate. Ten members including the Chair or Deputy, two clinicians, one lay member and one of either the Chief Officer, the Chief Finance Officer or the Chief Nurse were present. Apologies were noted as per the table above. 2. Patient Story – Sew Halton and The Community Shop, Runcorn Chris Carlin introduced Jackie Smith who had benefitted greatly from a number of Well Halton schemes. Well Halton was part of a wider regional programme called Well North. The aim was to positively impact the wider determinates of health, such as like poverty, isolation, employment etc. Jackie explained that she had been practically housebound for 14 years following an accident. She attended a course at Sew Halton, a Well Halton project that used machine sewing as a platform to build confidence, increase skills and reduce fabric waste. The course had a profound effect on Jackie, so much so that she wanted to get back into work. She successfully applied for a job at the newly opened Community Shop. The Community Shop took surplus food from manufacturers and supermarkets and sold it at 30% rrp. The Shop was a membership organisation and people on benefits could become members and access. It did not operated like a food bank and members were supported with training, volunteering opportunities and much more. The Shop had a cafe area serving affordable high quality meals and there was a meeting/training area in the building. Jackie described the positive affect the shop had in the community and gave an example of the Christmas party that they had held recently. Not only did local people receive a three course meal, they also had the opportunity to make new friends. When you are not working it is sometimes hard to make and retain friends so this was a new chance for many residents. This was also true of Sew Halton. Jackie explained that at the end of the short course that she attended she had kept in touch with most of the other attendees, they are now friends. Without these Well Halton schemes she felt as though she would still be socially isolated and unemployed. Not only had she benefitted from the programmes, she was now helping others. Leigh Thompson explained that it had taken five years to bring The Community Shop to Halton and it was down to the persistence and hard work of the team that it was open. It was now key to show that it could be a success in the borough. Jackie confirmed that the shop was exceeding its targets on a daily basis and was reaching the 750 membership maximum that The Company Shop recommended. The café was well used and it was hoped that courses would start running from the training area very shortly. Members asked questions around how the shop operated, which communities it served and if the café was open for anyone to attend. All present at the Governing Body meeting thanked the team for their hard work and congratulated Chris and Jackie on the success to date. The Chair advised that connected to Item 7. Chief Commissioner’s Report, was the Social Value Charter that had been sent under separate cover. The Governing Body considered this report next 7. Social Value Charter Leigh Thompson introduced the report by explaining that four years ago the CCG had signed up to the Cheshire and Merseyside Social Value Charter. It was timely to review the benefits of the schemes to date and consider if the CCG should sign and adopt the updated Charter.

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Chris Carlin explained that the Charter was about taking the Halton £1 and making it worth more than just £1 value. It was about how the CCG bought and delivered things. The report provided many examples of projects that had been delivered in Halton. Also detailed in the report was the Halton CCG Social Prescribing Review. Social Prescribing was non-medical support that can occur in the community, it can cover a wide range of issues such as loneliness, debt problems or confidence issues. There were already significant contracts in place with local VCSE providers including Citizen’s Advice Bureau, Halton & St Helen’s VCA, Wellbeing Enterprises, Runcorn & Widnes Cancer Support and the Stroke Association. The social prescribing offer was being reviewed and it was hoped to deliver even more social value by developing a model that nurtured new community organisations, adding to the local social health ecosystem. Members discussed the reports and passed their thanks to Chris for his hard work. Ruth Austen-Vincent agreed that this was a really good new story for Halton and asked Chris to bring the report to the Engagement and Involvement Group and then on to Quality Committee. Governing Body agreed to adopt the Charter. ACTION: Chris to take the Cheshire and Merseyside Social Value Charter to the Engagement and Involvement Group and then on to Quality Committee. 3. Minutes and Actions from 7 November 2019 (GB36-19) The minutes of the meeting held on the 7 November 2019 were reviewed and agreed as a correct record. The action log from the previous meeting was discussed and updated as follows: 7/11/19 2. Patient Story – Healthwatch Halton – Halton Advocacy Hub Gill Valentine to send anonymised example cases to the E&IG. Louise Murtagh emailed Gill Valentine Des Chow so reports could be sent to the E&I Group directly. Update - Kath Parker advised that she would chase this up and report to the next Governing Body meeting. Action to remain open. 7/11/19 9. Committee Key Issues (KIs) & Associated Reports from Chairs (GB35-19) Key Issues from the Audit Committee and the Performance and Finance Committee both held on 31 October 2019 would be presented at the Governing Body in January 2019. Shahzad Tahir & Gareth Hall January 2020. Update - On agenda at Item 11 therefore close action. 4. Assurance Map – Assurances to Mitigate Risk (GB37-19) The report provided an overview of the assurance presented to date to Committees and Governing Body. The mapping of this information highlighted the reports provided to support mitigation of each strategic risk and also indicated where further assurance may be required. Rebecca Knight explained that the information had been collected through a sample review of reports that Committees and Governing Body had reviewed during the year. For future reference all reports would include a cover sheet that clearly identified the strategic risk that the report provided assurance for. This process had identified that Committees and the Governing Body were not receiving sufficient assurances for the following strategic risks: B3 - Failure to deliver digitally enhanced care (4 reports identified) C7 - Failure to reduce CCG running costs by 20% (in real terms) for 2020/21 onwards (2) D1 - Failure to continuously develop the organisational culture, that meets the changing need of our

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workforce (3) D2 - Failure to ensure that a health and care infrastructure is in place, including a Joint Committee, which retains the local needs based commissioning approach (4) David Cooper referred to C7 as an example in that the CCG had probably received more than 2 reports on the matter during the year, but they had probably been badged differently. Rebecca Knight explained that this was why correctly completely cover reports were so important. Dr Andy Davies agreed, highlighting the presentation that had been received in the private section of the Governing Body. This had contained elements of C7 but this did not have a cover sheet so would not have been picked-up by the review. Kath Parker commented that from a public perspective the split in terms of the number of reports reviewed in each area felt right. Perhaps it was correct that the CCG allocated more of its time to quality, safety, patient experience and statutory duties for example. The report also highlighted the sheer number of documents that committees and the Governing Body had considered over the year. Comments were also received around Committee Terms of Reference and how important these were in identifying where risks should be reviewed, giving B3 as an example. Rebecca Knight advised that officers responsible for risks receiving scores below 10 would be asked to provide evidence that the control measures were effective or there was an action plan in place to ensure that the risk was being mitigated. It was also proposed that a document was developed for 2020/21 which outlined the expectations of the CCG in relation to assurances received and the methods of receipt. A new cover sheet was being developed for use for Governing Body and all Committees in 2020/21 to ensure that report writers identified the relevant risk that the report provides assurance for. The Governing Body: Received assurance that there is a robust process in place to manage strategic risk Approved the recommendation that owners of identified strategic risks provide an assurance report to the next Committee or Governing Body meeting. 5. Clinical Chief Officer’s Report (GB38-19) Dr Andy Davies’ report provided highlights on key corporate issues, an update on any key national and local issues relevant to the CCG and a summary of key activities that supported delivery of the CCGs strategic objectives. From the report Dr Andy Davies highlighted information on progress on commissioning at scale and One Halton. Members discussed the recovery plan submitted to NHSE in August 2019. The scope of the recovery plan was to achieve financial sustainability in the NHS (health only) and following direction from NHSE, four organisations were identified as system leads with responsibility for delivering the Halton & Warrington plan; Halton CCG, Warrington CCG, Bridgewater Trust and Warrington and Halton Hospitals Trust. A shared programme office was being established, drawing on existing resources in the health economy. This would operate as a virtual team, using a matrix management style. This would introduce a system wide process to manage and track delivery of the projects within the Recovery Plan from initiation to benefits realisation and closure. Members discussed the huge amount of work carried out to date and the progress in terms of finding savings. Dr Claire Forde advised that from a GP perspective there were plenty more efficiencies that could be realised. This could also be applied to community pharmacies and the extra services they could offer to

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assist with the system re-design and efficiencies. Comments were also made around how individual organisations such as the CCG were expected to hit their saving requirements but in doing so could not use traditional contract levers when providers (in the system) over-performed or did not meet targets. This seemed unfair. Members noted the content of the report. 6. Chief Nurse’s Report (GB39-19) Michelle Creed’s report provided an update and assurance position in respect of quality, safety and experience of services commissioned by the CCG. Highlights included: • No further ‘never events’ had been reported by any Halton CCG commissioned services. • NHSE/I had established a system wide strategic group to explore all HCAI and the impact on the system.

The CCG Deputy Chief Nurse was co-chairing this group. An action plan and outcomes were in development, following the completion of a gap analysis across commissioners and providers.

• There was a system concern about the rise in C.Diff cases in year however, Halton CCG was currently within its annual trajectory. Michelle Creed advised that the issue highlighted related more to Whiston Hospital.

• November and December 2019 had seen an outbreak of Influenza A and Norovirus, both in schools and care homes. Public Health colleagues had worked with the Infection Control Teams and the Quality Team to contain the outbreaks, treat the Influenza A in care homes with anti-virals where appropriate. This issue would be further monitored through Quality Committee.

• At the last Governing Body members were advised of the changes to the LeDeR programme from January 2020. The CCG had held the first quality assurance panel, all cases had been allocated for review and the CCG was on target to meet the NHSE/I trajectory for completion of reviews by the end March 2020. Learning events were scheduled for February 2020 to share learning across Primary and Community Care.

• Ofsted had responded to the Joint Targeted Area Inspection action plan with 2 outstanding actions for the CCG to continue with implementation. The first was in regard to multi agency assessment of risk for a proportionate response to child protection and the second was in relation to more specific detailed outcome measures to be included in the action plan.

• Child Protection Medicals Performance Notice remained in place until March 2020 whilst the voluntary suspension continued. The Royal College Action Plan had been via the Trusts internal governance and a draft action plan had been developed. The Trust remained on Enhanced Surveillance for Community Paediatric Services. There was an executive meeting on 3 January 2020 to discuss future model of provision.

• Neonatal CQC Update - The CQC wrote to the (WHHFT) Trust on 14 November 2019 to request further information regarding maternity outlier alert for neonatal non-elective readmissions within 28 days of delivery at Warrington and Halton NHS Foundation Trust.

• The Quality Team had supported WHHFT at a recent Multi-Agency Discharge Event. This was organised to assist with patient flow and discharge home.

• At NWB there was a risk to safe delivery and quality care on inpatient wards due to high number of vacancies of staff.

Governing Body noted the update. 7. Chief Commissioners Report (GB40-19)

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Leigh Thompson introduced her Commissioning Report by advising that many of the entries detailed were covered in Item 5, 6 and 9 on the agenda. Areas covered during the meeting were: Halton Integrated Frailty Team – Members were advised that it had proven hard to mobilise the service. The provider had attended Clinical Advisory Group to explain its proposal to the CCG and the clinicians questioned the offer. Following this the model was agreed in November 2019 with the service starting to provide specialist support and assessment to complex frail and multiple–morbidity patients from early December 2019. As at 9 January 2020, 17 patients had been seen and numbers would need to rise to make it an effective service. Details of the roll-out programme were included in the report. Targeted Lung Health Checks - Liverpool Heart and Chest Hospital initiated a soft-launch of the targeted lung health check pilot, for 50 patients in Knowsley who were already known to the Community Respiratory Service. Knowsley CCG would act as the coordinating commissioner for the national pilot and will commence recruitment and mobilisation for the full service in January 2020. Respiratory Conditions – There had been lengthy discussions at Clinical Advisory Group on this topic leading to the need for a Task and Finish Group to develop a Respiratory Plan. Cancer - The rapid diagnostic centre pilot was to start in January 2020 with the 2 local acute providers for upper and lower GI cancer pathways. Further details would be available for the next Governing Body meeting. It had been noted in Commissioning Oversight Group that there had been an increase in urgent requests (2-week waits) and there was the need for a Deep Dive to understand the reasons why. Diabetes – this topic had been discussed at Clinical Advisory Group a number of times. Practices were being asked to change their Impaired Glucose Regulation (IGR) referral process, whereby instead of patients being referred initially to the Local Authority IGR Service, all newly identified IGR patients from Monday 2 December 2019 would need to move towards a direct practice clinical referral to the NDPP provider (Ingeus) using the support of the practice administrative teams. Halton High Intensity Users (HIU) Service – this new service was now live. The cohort had been identified and positive feedback received. The CCG would continue to monitor performance. Intermediate Care (IC) Services Review - The formal review process concluded in early November following which a Senior Task and Finish Group had met to draft an IC action plan. A further meeting was planned for 9 January 2020 to discuss the Halton IC action plan in more detail, agree next steps and future intentions. GP Out of Hours – procurement for this service had started. It was anticipated that the Governing Body would be required to approve a contract award in March 2020 subject to adherence to the procurement timeline. It may be that nearer the time the Governing Body will be asked to consider delegating the approval of the contract award in order to meet the timescales. Personal Medical Services (PMS) – The current national re-alignment of PMS funding ended on 31 March 2020 at which point all practices would receive the same level of funding. ADHD – Members were verbally updated on the position relating to ADHD provision from North West Boroughs. Notice had been served two months ago. There was an interim agreement in place until 31 March 2020. A report was being prepared for IMT and Performance and Finance Committee consideration Leigh Thompson also advised Governing Body that the Operation Plan was being updated and this also

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would be presented at the March 2020 meeting. Kath Parker questioned the District Nurse Liaison Service (DNLO) and asked what the mitigations were around delayed transfers of care and discharges. Leigh Thompson confirmed that this was being handled by the joint integrated discharge team process. When other commissioners pulled out of the service, or part of the service, it left a shortfall for Halton. However, Bridgewater had received adequate temporary funding to cover the service until new permanent plans were in place. Ruth Austen-Vincent confirmed that the Quality Committee would be picking-up this issue. Governing Body noted the report. ACTION: Leigh Thompson to present the Operational Plan at the March Governing Body meeting 8. Joint Auditor Panel (GB41-19) David Cooper updated Members on the ongoing work undertaken by the CCG’s External Auditors and the role of the Joint Auditor Panel in assuring that the CCG was monitoring this contract and ensuring delivery of the Key Performance Indicators. The Governing Body was asked to note this analysis and approve an extension of the contract to 2021/22. The contract to employ Grant Thornton was managed by the CCGs jointly and the process agreed for this was that each CCG Audit Committee Chair, supported by CFOs, would meet twice yearly to review contract performance and agree any actions. The Terms of Reference required the Chair of the Joint Auditor Panel to report to each CCG following the meeting. Gareth Hall advised Governing Body that as Chair of the Audit Committee he had no major issues to report from the joint meeting and supported the recommendation to re-appoint Grant Thornton. Governing Body approved Grant Thornton as the External Auditor for NHS Halton CCG to 2021/22. 9. Chief Finance Officer’s Report (GB42-19) David Cooper advised the Governing Body of deterioration in the financial position during the month 8 period with a £3.8m year to date deficit reported, and adverse position to the plan (£0.6m) of £3.2m. This was attributable to elements previously reported as risks now crystallising in the financial position, including acute based performance; non-delivery of planned efficiencies (QIPP); and the financial consequences of the abandoned Urgent Treatment Centre procurement. David Cooper explained that CCGs had received guidance from NHS North West regarding its expectations on any changes to the agreed control total within financial reporting. Changes to the forecast year end position could only take place at the end of each quarter and only then in exceptional circumstances. This unexpected mid-year change had been discussed at the Performance and Finance Committee in November 2019. At the start of the year the CCG reported to NHSE that funding was insufficient and that savings of £10m were required. This plan was signed off by the CCG and NHSE. Targets for Quarter 1-3 were reached and the CCG was able to access Commissioner Sustainability Funding for the periods. In reaching the targets the CCG quickly used reserves and listed that most QIPP savings would be achieved in Quarter 4. The latest forecast QIPP delivery was £2.5m against target of £7.2m. This was the CCG’s most significant financial risk. In addition to this other material financial risk such as increased costs in Mental Health

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Services and prescribing were also discussed. David Cooper finished by explaining that there was currently an overall system deficit of £17m and asked Governing Body how it would like to proceed. Members discussed the mid-year change in reporting to NHSE and the consequences of reporting a revised forecast outturn position during month 9 or at year end. The Governing Body : • Noted the financial position at the end of November 2019; • Acknowledged the contributing factors within position, in particular the level of unmitigated financial risk;

and • Agreed that the CCG revised its forecast outturn (Net Risk position) during the month 9 period. 10. Updated Committee Terms of Reference (GB43-19) Rebecca Knight explained to Governing Body that the Terms of Reference presented were for Audit Committee, Quality Committee and Performance and Finance Committee. These had been discussed either at the respective committee meeting or virtually by email in the case of Performance and Finance Committee. Members were asked to note that the position of Performance and Finance Committee Deputy Chair was to be picked up at the next Committee meeting. Rebecca Knight advised that if approved, the new documents would be implemented with immediate effect and run until 1 April 2020. The Governing Body approved the amended Terms of Reference for Audit Committee, Quality Committee and Performance and Finance Committee. 9. Committee Key Issues (KIs) & Associated Reports from Chairs (GB44-19) Members were provided with the following information covering CCG Committees held since the last Governing Body meeting: Clinical Advisory Group (CAG) – 13 November and 11 December 2019. Dr Claire Forde explained that key issues from the two meetings were as listed in the report and were self-explanatory. Many items had been covered earlier in the meeting in the Chief Commissioner’s Report. Primary Care Commissioning Committee – 21 November 2019. Leigh Thompson asked Members to take the report as read and welcomed questions. There were no questions raised. Quality Committee – 19 December 2019. Ruth Austen-Vincent asked Members to take the report as read and welcomed questions. It was noted that the key issues from the November Quality Committee meeting were not included in the pack and that these would presented at the next Governing Body in March 2020. Audit Committee – 31 October 2019. Gareth Hall asked Members to take the report as read and welcomed questions. There were no questions raised although Committee members did congratulate Gareth Hall on his first Halton CCG Audit Committee as Chair. Performance and Finance Committee – 31 October 2019. Members were asked to take the report as read. There were no questions raised. Governing Body noted the report.

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ACTION: the key issues from the Quality Committee of 28 November 2019 would be presented at the Governing Body in March 2020.

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Governing Body

Key for Action Log entries

Green Action is on track to be completed by its due date Red Action is overdue and not started

Amber Action is in progress but due date has been revised Blue Action is completed.

Action Log Public Governing Body Meeting – 9 January 2020

Reference

Meeting & Minute No:

Action Responsible

Officer

Date Due Status/Update

7 November 2019 2. Patient Story - Healthwatch Halton – Halton Advocacy Hub

GV to send anonymised example cases to the E&IG

Kath Parker March 2020 LM emailed GV and Des Chow so reports could be sent to the E&I Group directly

Update: Kath Parker to chase this with Gill Valentine.

9 January 2020 GP40-19 7. Social Value Charter

Chris Carlin to take the C&M Social Value Charter to the Engagement and Involvement Group and then on to Quality Committee

Chris Carlin March 2020

9 January 2020 GP40-19. Chief Commissioners Report

Leigh Thompson to present the Operational Plan at the March Governing Body meeting

Leigh Thompson

March 2020

9 January 2020 GP42-19 9. Committee Key Issues (KIs) & Associated Reports from Chairs

The key issues from the Quality Committee of 28 November 2019 would be presented at the Governing Body in March 2020

Ruth Vincent-Austen

March 2020

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Governing Body

Key for Action Log entries

Green Action is on track to be completed by its due date Red Action is overdue and not started

Amber Action is in progress but due date has been revised Blue Action is completed.

Closed Actions

7 November 2019 9. Committee Key Issues (KIs) & Associated Reports from Chairs (GB35-19)

Key Issues from the Audit Committee and the Performance and Finance Committee both held on 31 October 2019 would be presented at the Governing Body in January 2019.

Shahzad Tahir & Gareth Hall

January 2020 On agenda at Item 11

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Governing Body Report

Date: 5th March 2020

Report title: Report of the Clinical Chief Officer

Lead Executive Dr Andrew Davies, Clinical Chief Officer

Purpose:

The purpose of the report is to provide members of the Governing Body with: • An update on any key corporate issues that members

need to be appraised and aware of • An update on any key national and local issues relevant

to the CCG • A summary of key activities that support delivery of the

CCGs strategic objectives (not referred to elsewhere in the Governing Body papers)

The Governing Body is asked to:

Receive the report.

This Report supports the following CCG Strategic Objectives Objective one: To commission services which continually improve the health and wellbeing of Halton residents Objective two: Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements Objective three: To deliver our statutory duties in respect of commissioning, quality, equality, safeguarding, consultation and engagement and finance including QIPP Objective four: To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders. Commissioning Plan Implications None Financial Implications None Board Assurance Framework and Corporate Risk Register The report provides updates on key areas of work relating to the strategic objectives of the CCG. National Policy, Guidance, Standards, Targets or Legislation N/A Equality and Diversity and Human Rights Throughout the development of this paper and the policies and processes cited NHS Halton CCG has: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

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Report to Governing Body – March 2020

The purpose of this report is to provide Members of the Governing Body with:

a) information on key issues that may have not been covered elsewhere in an individual

report. b) information in respect of relevant local and national initiatives and priorities. c) information on the activities undertaken by the Clinical Chief Officer and senior team since

the last report; and d) if appropriate, ratify agreements made and seek the approval of the Governing Body for

actions to be taken

a) Conflict of Interest Training Event

The CCG held a training event on Wednesday 12th February led by Emma Stockwell, Governance Partner at Hill Dickinson Solicitors regarding Conflict of Interest. This training was in addition to the required mandatory training programme to explore practical implications and handling of conflict of interest matters in the changing healthcare landscape. The CCG takes its role as custodians of taxpayers’ money very seriously. Decisions involving the use of NHS funds should never be influenced by outside interests or expectations of private gain, however it is recognised that conflicts of interest are unavoidable in complex systems. This training aimed to help colleagues feel empowered to use good judgement in managing conflicts of interest effectively and be safeguarded to continue to work innovatively with partners whilst also providing transparency to the taxpayer.

b) 2020/21 Planning Requirements and Timescales Each year NHS organisations receive national planning guidance in relation to the plan-setting process for the oncoming financial year. The national planning guidance for 2020/21 sets out the NHS requirements and timetable for submission of plans for year one (2020/21) of the five-year plan. The national NHS Operational Planning and Contracting Guidance for 2020/21 was released by NHS England on the 31st January 2020. Working with local providers, Warrington and Halton CCGs need to prepare local system plans to meet the national requirements and the submission timetable. There is a requirement for finance, activity and performance plans and a system-led narrative to be produced and submitted. Details of the planning requirements can be viewed here: https://www.england.nhs.uk/operational-planning-and-contracting/ Detailed proposals from finance, contracts and performance teams regarding the collation of the plans were reviewed by Integrated Management Team on 10th February. The first draft submission of the activity, finance, performance and narrative is due on the 5th March.

c) Coronavirus (Covid-19) Latest advice and guidance continue to be updated on the national website, which can be accessed at:

1) Purpose

2) Updates for Governing Body – Local Matters

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https://www.gov.uk/guidance/wuhan-novel-coronavirus-information-for-the-public Links to the guidance can be found on the CCG website to ensure that the latest updates can be accessed by our local population. The guidance provides up to date information about:

- The situation in the UK - Information about the virus - Advice for travellers - Summary of action taken - Diagnosis and analysis - Further information

The CCG is also taking part in the regular and ongoing webinars held by the Department of Health and Public Health England to ensure that it is fully informed of any changes to advice and guidance. Any changes or updates are regularly communicated to all NHS providers to ensure that we work in a co-ordinated and integrated manner.

d) One Halton Update

One Halton Plan The One Halton Summary document is now available online here: https://onehalton.uk/docs/onehaltonsum.pdf This highlights the overarching priorities and plans for 2020/21. A pocket size version was shared at the last Health and Wellbeing Board and signed off on the 15th January 2020. The pocket size version has been well received; however, the intention is for A4 size documents to be printed and shared as the public facing document. One Halton is working with the Engagement and Involvement Group, PPG+ and Councillors to define the best mechanism to share the plan and the messages relating to One Halton. One Halton Forum The next meeting of the One Halton Forum will take place on 4th March 2020. Reports are currently being produced to provide a status update for the One Halton Delivery Plan to be created. Consideration as to system-working in relation to CVD and Cancer is currently being scoped. One Halton Programmes Collaborative work continues to progress with regards to Place Based Integration, Urgent Treatment Centres, Primary Care Networks, Workforce, Population Health and Leadership Development.

e) Organisational Development

Please see updates on organisational development and workforce in a separate report to Governing Body.

3) Meetings attended by the Clinical Chief Officer on behalf of the CCG

Since the last report, Dr Andrew Davies as Clinical Chief Officer for the Clinical Commissioning Group, has attended the following meetings:

Date Meeting Detail 03/01/20 Bridgewater Children’s Services Review Meeting 03/01/20 Chief Executive Oversight Group Meeting 07/01/20 Halton Borough Council Joint Management Team Meeting 08/01/20 Hospital Trust Core 24 Meeting 09/01/20 Halton CCG GB Meeting

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09/01/20 Meeting with David Merrill, Interim Chair Halton CCG 10/01/20 Chief Executive Oversight Group Meeting 13/01/20 Integrated Management Team Meeting 14/01/20 Meeting with Ian Davies, Liverpool CCG 15/01/20 Meeting with Steven Broomhead, CEO of Warrington Borough Council 15/01/20 Halton Health & Wellbeing Board 17/01/20 Cheshire & Merseyside CCG Accountable Officers Meeting 20/01/20 Integrated Management Team Meeting 20/01/20 Meeting with Eileen O’Meara, Interim Director of Public Health 21/01/20 Meeting with Sarah O’Brien, St Helens CCG 21/01/20 Staff Development Session 22/01/20 Place and Programme Community of Practice Event 23/01/20 Warrington & Halton and Bridgewater Finance System Meeting 27/01/20 Integrated Management Team Meeting 29/01/20 Meeting with Gina Lawrence and Mel Connell, Widnes Primary Care Network 29/01/20 Governance Meeting with Halton Member Practices 30/01/20 Urgent & Emergency Care Network Board 30/01/20 HTU Visioning Meeting 03/02/20 Integrated Management Team Meeting 03/02/20 Executive to Executive Meeting with St Helens CCG 04/02/20 Halton Borough Council Joint Management Team 05/02/20 Intensive Support Conference, London 06/02/20 Governing Body Development Session – Primary Care Network Awareness Session 06/02/20 Meeting with David Merrill, Interim Chair, Halton CCG 07/02/20 Youth Justice Health Work Plan Refresh 2020-21 Meeting 07/02/20 Chief Executive Oversight Group 10/02/20 Integrated Management Team Meeting 14/02/20 Cheshire & Merseyside Bi-Monthly Joint Provider CEO and CCG Accountable Officers

Forum 14/02/20 Chief Executive Oversight Group 17/02/20 Integrated Management Team Meeting 18/02/20 Joint Staff Development Session 18/02/20 Meeting with Derek Twigg MP and Mike Amesbury MP 19/02/20 Acute Sustainability Programme Board 21/02/20 Chief Executive Oversight Group 25/02/20 Cheshire’s CONTEST Board Meeting 25/02/20 Lead Safeguarding Partners Meeting 02/03/20 NHSE/I System Support Meeting 03/03/20 St Helens & Knowsley System Assurance Meeting 03/03/20 Warrington & Halton System Assurance Meeting 03/03/20 Meeting with Colin Scales, CEO Bridgewater 03/03/20 CCG/HBC Joint Management Team 05/03/20 Halton CCG Governing Body Meeting 05/03/20 Youth Justice Service Health Subgroup 05/03/20 Chief Executive Oversight Group

4) National Briefings and Updates

Governing Body Members are asked to note the following national updates and links to relevant documentation received from January and February 2020:

New national campaign on older people’s mental health An awareness campaign has been launched with NHS England, NHS Improvement and Age UK on the benefit of talking therapy for older people. In an open letter, GPs and IAPT services have been asked for help in increasing referrals to talking therapies for older people. Regional and STP/CCG mental health leads have been asked to support the campaign on social media (#TalkingHelps).

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For a greener NHS Climate change poses a major threat to health as well as to the planet. This is why the NHS has launched For a greener NHS, to work with staff, hospitals and patients to help the health service become net zero as soon as possible. Share your ideas by midnight Sunday 22nd March on how the NHS can become greener. Submissions are welcomed from anyone with an interest in healthcare or carbon reduction, whether NHS staff, patients, carers, members of the public or experts in a related field. Join the conversation across social media and share good practice using #greenernhs.

New cervical screening test to save hundreds of lives every year Experts say cervical cancer could potentially be eradicated thanks to the NHS screening programme’s new and more sensitive test, combined with the effectiveness of the human papillomavirus (HPV) vaccine. The test looks for traces of high-risk HPV, which causes nearly all cases of cervical cancer. HPV positive tests are checked for abnormal changes of the cervix, so any sign of infection will be spotted earlier, before it could develop into cancer.

Improving picture of women’s experiences of maternity services Women’s experiences of interacting with staff in maternity services have significantly improved, according to the Care Quality Commission’s maternity services survey 2019. Find out more.

NHS support sees people lose the weight of 43 ambulances Almost 90,000 people have completed the world leading NHS Diabetes Prevention programme, losing a combined weight of 185,051kg – the equivalent of 43 ambulances. The programme is the first of its kind to achieve a full national rollout. With expert advice on dieting, exercise and healthy lifestyle, the programme will double in size to treat around 200,000 people every year as part of the NHS Long Term Plan.

Improved NHS headache and migraine care to reduce hospital stays People who experience headaches and migraines will benefit from better diagnosis and care as part of the NHS Long Term Plan, avoiding up to 16,500 emergency hospital admissions every year. Controlling migraines and headaches leads to better sleep, less restriction on daily activities, better attendance at work and improves family life. Health experts believe more use of headache diaries to help patients record the frequency and pattern of their attack, alongside fast access to specialist advice for family doctors, will improve the quality of life for many of the 10 million migraine sufferers aged between 15 and 69 in the UK and those who experience headaches.

NHS to fast-track access to cannabis-based medicine for children with severe epilepsy Thousands of people, including children with severe epilepsy, will be able to access potentially life-changing, seizure-preventing cannabis-based treatment on the NHS. Doctors will be able to prescribe Epidyolex with Clobazam for eligible children with two types of severe epilepsy – Lennox Gastaut syndrome and Dravet syndrome – which can cause multiple seizures a day. Following our agreement with GW Pharma, NICE has recommended the treatment, with access fast-tracked and available from 6th January 2020.

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NHS fighting back against rising tide of gambling ill health The NHS is facing a rising tide of gambling-related ill health as more people than ever before who are addicted to betting are being taken to hospital. New data shows a record number of admissions last year related to gambling addiction, including care for severe mental ill health conditions like psychosis. The steady rise in admissions has prompted the NHS to commit to opening 14 new problem gambling clinics by 2023/24, alongside the first ever gambling clinic aimed at young people last year as part of the Long Term Plan.

Coaching for patient and public voice partners Coaching is available to patient and public voice (PPV) partners who are either involved in our work or supporting health and care system transformation programmes – for example, sustainability and transformation partnerships, integrated care systems, primary care networks, clinical commissioning groups, NHS trusts or NHS foundations trusts. The coaching is aimed at PPV partners who are supporting major changes in health and care services and who would like to further develop their strategic or practical skills. Further information about this development opportunity is on our Involvement Hub. For an application form and guide, email england.ppve-learning@nhs.net.

Changes to the infant vaccine schedule The schedule for the pneumococcal conjugate vaccine (PCV) is changing for babies born from 1st January 2020. On advice from the Joint Committee on Vaccination and Immunisation, infants will follow a 1+1 PCV schedule with a single priming dose of PCV offered with the other routine infant vaccinations at 12 weeks and a booster dose at one year (on or after the first birthday). The change means that instead of three injections at the eight and 16-week appointments (and one at 12 weeks), babies will receive only two injections at each appointment, plus rotavirus by mouth at eight and 12 weeks. More information is available on the gov.uk website.

Guidance on changes in the law for personal health budgets A change in the law means two new groups have a legal right to a personal health budget. This includes people eligible for after-care services under section 117 of the Mental Health Act and people eligible for an NHS wheelchair (who have a right to a personal wheelchair budget). This guidance is available to support clinical commissioning groups and other bodies to meet their duties in line with the new rights. For more information and to find out about other support available visit the NHS England website.

Raising awareness of self-care An e-learning programme has been developed with Health Education England and the Self Care Forum to help GPs, nurses and community pharmacists advise patients and carers on managing and treating minor health conditions themselves.

NHS staff morale improves NHS staff say they are happier and more likely to recommend their organisation as a place to work than last year, but too many still experience unacceptable abuse from patients and the public. 569,000 employees in 300 separate organisations responded to this year's NHS Staff Survey, with the results showing better staff morale across the NHS.

5) Recommendations

Members of the Governing Body are asked to:

a) Note the contents of this report

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Dr Andrew Davies Clinical Chief Officer NHS Halton CCG

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Governing Body

Date: 5th March 2020

Report title: Chief Nurses’ Report

Lead Clinician and/or Lead Manager: Michelle Creed

Purpose: To give assurance to the Governing body with regard to Quality Surveillance

The Governing body is asked to: Note the contents of the Report and request further evidence for assurance if required.

This Report supports the following CCG Strategic Objectives Objective one: To commission services which continually improve the health and wellbeing of Halton residents Objective two: Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements Objective three: To deliver our statutory duties in respect of commissioning, quality, equality, safeguarding, consultation and engagement and finance including QIPP Objective four: To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders. Commissioning Plan Implications None Financial Implications Does this require financial support? No Board Assurance Framework and Corporate Risk Register Continually improve the quality of the services we commission ensuring compliance with NHS constitutional requirements To deliver our statutory duties in respect of commissioning, quality, equality, safeguarding, consultation and engagement and finance including QIPP National Policy, Guidance, Standards, Targets or Legislation 1. CCG Improvement and Assessment Framework (IAF) 2016/17 2. National Quality Board: How to make your quality surveillance effective. NHS England (2014)

Equality and Diversity and Human Rights Throughout the development of this paper and the policies and processes cited NHS Halton CCG has: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

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1 PURPOSE

The purpose of the paper is to provide assurance from the Chief Nurse to the Governing Body with regard to the quality, safety and patient experience in services commissioned by NHS Halton CCG.

2 QUALITY, SAFETY AND EXPERIENCE

2.1 NEVER EVENTS AND SERIOUS INCIDENTS

At the time of writing this report there has been no further ‘never events’ reported by any NHS Halton CCG commissioned services.

2.2 LEARNING DISABILITY MORTALITY REVIEW (LeDER)

The Governing Body will be aware from the last Chief Nurse report of the Learning Disabilities Mortality Review (LeDeR) programme and the changes to the programme from January 2019 to ensure LeDeR is sustainable within local processes and becomes threaded through existing mortality reviews and governance. NHS Halton & Warrington CCG’s held two joint ‘Sharing the Learning’ Conferences attended by over 100 people. Utilising AFTA thought training to bring patient stories to life. The focus was on annual health checks, prevention, early detection and communication. A video of the event is being produced to continue to share the learning.

2.3 SAFEGUARDING

In January 2018 Ofsted launched the ‘Inspection of Local Authority Children’s Services’ or ILACS, its new, flexible framework for inspecting children’s services for local authorities. The ILACS replaces the Single Inspection Framework (or the SIF), which was in use 2013 - 2018. Halton Borough Council were notified on 24th February 2020 and given 2 weeks’ notice that they were to receive an ILACS Inspection. We will fully support the Local Authority as part of our safeguarding partnership arrangements.

2.4 CANCER THEMATIC REVIEW RESPONSE

Cheshire & Merseyside QSG requested each CCG to provide 5 initiatives underway that focus on the quality, safety and experience of service users. This will give system oversight of any thematic issues or trends that will become a focal point for action. Halton CCG has a number of work streams to meet the requirement of the Cancer plan. 5 current key areas of work to address local issues are:

• Requirement: Improve % of cancers diagnosed at stage 1 & 2 to progress ambition of 75%

cancers diagnosed at stage 1 & 2 by 2028/29. • The CCG is working with the Cancer Alliance and local providers to reduce 31 day

diagnostic target to 28 days by improving pathways and efficiencies in processes within cancer services.

• Requirement: Support the rollout of FIT in the bowel cancer screening programme. • Requirement: Delivery of all eight cancer waiting times standards remain a priority.

2.5 NHS Halton & NHS Warrington Quality Surveillance & Improvement Framework 2020 -

2024

The above framework was approved at Quality Committee in February 2020. It sets out how Halton and Warrington CCG’s aim to always commission a high level of service provision and

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delivery, the aims, objectives and quality surveillance that will be used to ensure this is enacted in line with our statutory duties. The quality of services received by our local population is an important factor in how we operate. With increasing pressure on health and social care services nationally, there is need to ensure high standards of care are maintained, and that improvements are evidenced.

Where providers experience quality concerns, our CCGs will be responsive in how they work with partners to support positive outcomes. CCGs must ensure that Frameworks are in place to safeguard people who use services where there is disruption to service provision or where significant quality concerns are identified. As well as framing the process for routine quality assurance and improvement, this paper describes the process for managing escalating quality concerns and risks, usually associated with decreasing assurance. The paper also outlines the necessary steps to follow where providers of concern are identified. The Framework covers NHS Providers (acute, community and mental health), Independent Providers (In Patient Learning Disability Services), Primary Care, Hospice and Care Homes, the framework also incorporates the new published NHS England & NHS Improvement Host Commissioner Guidance.

3 NHS PROVIDERS 3.1 BRIDGEWATER COMMUNITY HEALTH NHS FOUNDATION TRUST 3.1.1 Bridgewater Community Health Foundation Trust (BCHFT) continues to be subject to one

Contract Performance Notices for Halton CCG in regard to Child Protection Medicals. The Contract Performance Notice for Child Protection Medicals has been open since November 2018. The prolonged timeframe is due to the service being voluntarily suspended with the service being provided by Warrington and Halton Teaching Hospital Trust. BCHFT are working with the CCG Designated Doctor and the Hospital Trust to develop and support competence within the medical team and also to develop the model going forward. This is also in line with the Royal College of Paediatricians Independent Review. There is a Community Paediatric Service Model redesign commencing across the Halton and Warrington System.

3.1.2 A discussion has taken place with the Provider concerning the future provision of Maternity

Services as currently they are not able to provide a continuity of care ‘end to end’ service. The commissioning team are working with Providers to address this issue and formal notice has been given on this service being provided in its current form from the 1st April 2020 (6 months’ notice in line with NHS Standard contract).

3.1.3 The Provider reported an inability to deliver a resilient GP Out of Hours (OOH) service and meet

contractual requirements, due to issues with workforce, increase in demand and issues with clinical prioritisation which has caused a lack of resilience. Actions to mitigate risk are in place including a Standard Operating procedure (SOP) to support proactive recruitment with an additional use of regular staffing wherever possible to provide continuity. A Team Leader and Clinical Director post have been recruited to. The Team Leader has developed SOPs to support nurse triage.

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3.2 BRITISH PREGNANCY ADVISORY SERVICE (BPAS)

As reported in the Governing Body the British Pregnancy Advisory Service settings in Liverpool, Merseyside and Chester; have received CCG Quality Visits and a subsequent action plan is in place with close monitoring.

The Provider continues to work with the CCG in increasing the quality of their Serious Incident reporting and there has been no issues recorded. The Deputy Chief Nurse discussed Serious Incidents with the NHSE/I Medical Director as agreed at the last QSG to highlight if the issues reported are a whole organisation issue or whether this was a local issue. The Medical Director has discussed this with the National Lead, Dr Mike Prentice, and there does not appear to be any wider issues however this will continue to be a focus of our monitoring locally.

3.3 WARRINGTON & HALTON TEACHING HOSPITALS NHS FOUNDATION TRUST

3.3.1 Warrington and Halton Teaching Hospitals NHS Foundation Trust (WHHT) Senior Executive

Team are now establishing themselves with Dr Alex Crowe appointed as the new Medical Director, which is a joint role with Bridgewater Community Health Foundation Trust (BCHT). Dr Crowe has met with the Chief Nurse to discuss current issues within both WHHT and BCHT from a CCG perspective, with particular reference to BCHT Community Paediatric Services.

3.3.2 Key areas of concern for the Trust are in regard to meeting the A&E performance target as they

are below trajectory for December 2019 with performance at 75.89%, this is a similar position to December 2018, the Trust are continually monitoring performance and all quality measures are being monitored via the CQPG. CCG Quality Team has attended 2 Multi Agency Discharge Events (MADE). There have been no identified quality issues at time of reporting.

3.3.3 The Trust has shared a comprehensive Learning from Disability Action Plan with a report which

evidenced that significant work had been progressed to meet the improvement measures. The Trust had recruited to an LD post to support and meet the requirements of the NHS Long Term Plan and a LD national audit had commenced which will be reported quarterly to CQFG. The CCGs offered support to help address any of the challenges where possible which was appreciated by the Trust

4 INDEPENDENT PROVIDER 4.1 Following the publication of the Host Commissioner guidance, the Chief Nurse met with the

Elysium Director of Nursing, to highlight Quality requirements going forward in terms of process. Of the 8 Independent Providers I the Cheshire & Merseyside area 5 are within Halton and Warrington Boroughs. It is planned, that as there are 3 Elysium Providers within the Warrington locality, and 1 Elysium Provider in the Halton locality that the surveillance would be managed by a single Clinical Quality Performance Group (CPQG) with the pertinent individual issues reported separately. The first Clinical Quality Performance Group will be in April 2020.

Alternative Futures and Krinvest meetings are in the dairy to establish the same format of quality surveillance, discussions are underway with St Helens CCG, Knowsley CCG and West Cheshire CCG to mirror this model.

4.2 VANCOUVER HOUSE 4.2.1 Vancouver House is an independent provider providing individualised care to patients with

complex needs particularly pertaining to Acquired Brain Injury located in Liverpool. Alerts were raised on the 14th February 2020 to both Halton and Warrington Local Authority in relation to

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safeguarding concerns with a Strategy meeting being held on the 18th February 2020. NHS Halton CCG attended the Strategy meeting and created an SBAR (situaltion, background, assessment and recommendations) briefing due to allegatioins of abuse to residents by existing members of staff. There is currently one Halton resident in Vancouver House, an assessment has been completed and there are no concerns raised.

A Police investigation is underway, CQC have been informed. Admisisons are currently suspended, pending the investigation. Liverpool Local Authority are leading the strategy meetings.

4.3.2 NHS Halton CCG and NHS Warrington CCG have reviewed their patients and plans are being

developed should a new placement be required. 5 PUBLIC HEALTH INFECTION MANAGEMENT 5.1 CORONAVIRUS. A system planning meeting took place on Friday 21st February 2020 to

ensure the NHS Halton and NHS Warrington CCG geography were system ready should there be an incidence or outbreak of Covoid 19. All system providers; CCG Quality and commissioning teams; and Local Authorities shared and aligned processes to ensure seamless provision. This was led by the Director of Public Health. It was agreed that a local simulation event needs to take place to test the system for any potential learning or amendments.

6 PRIMARY CARE PROVIDERS 6.1 NHS Halton CCG has no Primary Care providers on enhanced surveillance. There are no

additional risks or issues regarding primary care since the last report and work continues with local providers regarding ensuring sustainability of high quality General Practice services.

The CCGs quality, contracting monitoring and transformation monitoring process is continuing; Following submission of the completed Practice monitoring packs, practices visits have been prioritised and are currently underway.

7 HEALTHWATCH Healthwatch Halton continues with their programme of enter and view visits; service user

engagement; and advisory service. Healthwatch Halton has nothing to report at time of reporting, however a number of reports are due at March Quality Committee and the Chair has requested an adequate timeslot to consider the reports.

8 CONCLUSION

The governing body should be assured that the system surveillance process is in place to identify best practise and sport early warning signs of system failure. However, this system and process will need to be reviewed in light of changing organisational forms, the financial recovery climate and engagement and involvement public requirements.

The Chief Nurse will submit a bi-monthly report to the Governing Body for consideration and challenge.

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Committee Reporting

Governing Body

Date: 5th March 2020 Report title: NHS Halton CCG 2019/20 Financial Position

Lead Clinician and/or Lead Manager:

David Cooper – Chief Finance Officer

Purpose: This report updates the Governing Body on the current financial position and forecast outturn for the 2019/20 financial year.

The Governing Body is asked to:

The Governing Body is asked to:

• Note the financial position at the end of January 2020; • Acknowledge the revised submitted forecast outturn position

at Month 10; • Acknowledge the contributing factors within position, in

particular, the non-delivery of QIPP savings; and • Note the application of the NHS Northwest protocol for

deviations from assigned control totals during the month 10 reporting period.

This Report supports the following CCG Strategic Objectives One: To commission services which continually improve the health and wellbeing of Halton residents.

Three: To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations.

Four: To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Commissioning Plan Implications The delivery of NHS Halton CCG’s Quality, Innovation, Productivity and Prevention (QIPP) plan is a fundamental part of the 2019/20 Commissioning Plan; this includes delivery against all appropriate national standards and priorities set out in the local joint Health & Wellbeing Strategy. This plan must be delivered, within allocated resources, to ensure that the CCG achieves its control total for the financial year. Financial Implications

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Committee Reporting

Does this require financial support? No If Yes - Is there currently a budget for this? Not applicable Board Assurance Framework and Corporate Risk Register Does this report link to either the Board Assurance Framework (BAF) or Corporate Risk Register (CRR) or both? YES BAF 373 National Policy, Guidance, Standards, Targets or Legislation Delivering The Forward View: NHS planning guidance 2016/17 to 2020/21, NHSE, December 2015

Equality and Diversity and Human Rights None identified which specifically arise from this report although individual QIPP schemes would need to assess the impact on equality and diversity and human rights issues.

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NHS Halton CCG Financial Position Financial Monitoring Statements

Period Ending 31st January 2020 (Month 10)

David Cooper Chief Finance Officer

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1 • Executive Summary

2 • Financial Plan Run Rate (Incl. CSF)

3 • Financial Outturn Scenarios

4 • Summary of Financial Position (Year to date & forecast)

5 • Sector Highlights

6 • Acute Trust performance

7 • QIPP Savings

8 • CCG Risks

9 • Conclusion

Contents

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1. Executive Summary

The financial position at month 10 is a deficit position of £6.12m against the planned expenditure budgets. This is attributable to elements previously reported as risks now crystallising in the financial position, including acute based performance; non delivery of planned efficiencies (QIPP); and the financial consequences of the abandoned Urgent Treatment Centre procurement. This places a significant risk against the delivery of the CSF expectations for Q3 and Q4 (£1.3m) as, although a balanced forecast position was held at month 9, the year to date performance has deteriorated from CSF trajectory. All available reserves have been utilised to support non delivery of QIPP for periods to date. This position has been reported to NHS England and NHS Improvement through the System Recovery Plan and a revised forecast outturn trajectory has been reflected at Month 10 to reflect a planned year-end deficit of £7.3m. Material financial impacts (greater than £0.250m) reflected in the outturn position in 2019/20 are as follows: QIPP Savings: The latest forecast QIPP delivery is £2.5m against a target of £9.7m. Acute Sector: The Warrington & Halton Hospitals NHS Teaching Foundation Trust Sustainability Contract performance is forecast to be above plan by £1.05m based on month 9 data, which is applied against the thresholds within the contract. The St Helens & Knowsley Teaching Hospitals NHS Trust contract has an adverse position within month 9 data, which is largely attributable to the blended payment arrangement for Non Elective care. The Royal Liverpool and Broadgreen University Hospitals NHS Trust contract has presented a more stable position when compared to the month 9 reported position. All other contracts are cumulatively performing in line with planned levels. Non delivery of planned QIPP against this sector continues to be the material financial risk against the delivery of the financial plan. The abandoned Urgent Treatment Centre procurement has resulted in further non delivery of planned QIPP aligned to this with a corresponding £1.2m detrimental impact. Mental Health : Inflation rates have been set by the council in respect of out of area mental health services, this has led to a pressure of circa £0.5m to the forecast outturn. Work has also been undertaken across the Mersey footprint to review rehab and ABI beds which has caused a pressure for NHS Halton CCG during 2019/20. Prescribing: Non delivery of planned levels of QIPP, impact of Category M price increases, NCSO impact and assumptions regarding Pregabalin rebate are reflected within the outturn position.

Financial Position Overall Risk Rating : Red

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2. Financial Plan Run rate (incl. CSF) Overall Risk Rating :

Red

• Cumulative Planned Deficit Profile

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3. Financial Outturn Scenarios Overall

Risk Rating :

Red

• Financial Outturn Scenarios at month 10

-167 -333 -500 -667 -834 -1,000 -1,167 -1,335 -1,502 -1,669 -1,836 -2,000

-167 -333 -500 -467 -633 -800 -466 -633 -800

-366 -534 -

-6,211 -6,574

-7,300

-5,216

-6,811 -7,174

-8,600

-10,000

-9,000

-8,000

-7,000

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

£'00

0

NHS Halton CCG 2019/20 Financial Outturn Scenarios

Plan Cumulative Defict Plan Revised Cumulative Deficit with CSF

Plan Net Risk Trajectory Reported Position

Projected Financial Poistion Projected Financial Poistion (incl loss of CSF)

Plan Net Risk Trajectory following CSF achieved

Q1&Q2 CSF £700k Q1-Q3 CSF £1,300k

Q1-Q4CSF £2,000k

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4. Summary of Financial Position • Financial Position

At month 10 the CCG reported a deficit position of £6.12m for periods to date against a planned deficit of £0.97m. Non Delivery of QIPP is impacting on the planned position for the CCG with an adverse variance of £4.5m for periods to date, a detailed breakdown of this is reported separately on page 10. Please note the CCG still has unidentified QIPP of £2.118m.

• Key Highlights

Areas of Financial Deterioration

Acute Sector Performance £4.67m: QIPP Non Delivery £2.4m

WHHFT £1.1m YTD adverse position STHKT £0.5m YTD adverse (NEL Blended)

Mental Health £0.9m: High Cost packages of care / placements

Impact of new ABI contract arrangements

Prescribing £0.4m: Revised forecast expenditure to capture

Category M price concession impact, continued NCSO, and QIPP non delivery.

Overall Risk Rating : Red

Plan Actual Variance Variance£m £m £m %

Acute Services (ISFE) 102.71 107.47 (4.76) -4.6%Mental Health Services (ISFE) 18.17 19.11 (0.94) -5.2%Community Health Services (ISFE) 15.71 15.63 0.08 0.5%Continuing Care Services (ISFE) 8.91 9.06 (0.15) -1.7%Primary Care Services (ISFE) 4.77 4.67 0.10 2.1%Prescribing 19.21 20.00 (0.78) -4.1%Primary Care Co-Commissioning (ISFE) 15.76 15.77 (0.00) 0.0%Other Programme Services (ISFE) 10.46 10.13 0.33 3.1%TOTAL COMMISSIONING SERVICES 195.69 201.84 (6.14) -3.1%Running Costs (ISFE) 2.50 2.48 0.02 0.0%TOTAL CCG NET EXPENDITURE 198.19 204.31 (6.12) -3.1%

IN YEAR UNDERSPEND / (DEFICIT) (0.97) (7.09) (6.12) -3.1%

CCG EXPENDITURE ANALYSISYear to Date Net Expenditure

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5. Sector Highlights

Acute

• Highlights: There is a an adverse variance of £4.7m across the Acute sector at month 10. This includes £2.4m of QIPP non delivery against planned levels, the remaining balance relates to over performance on local acute contracts including Warrington & Halton Hospitals NHS Teaching FT and St Helens & Knowsley Hospitals Teaching Trust. The short stay admissions audit has reached a conclusion and the CCG has profiled £0.521m of the adverse impact into the position in this period. This adverse position to plan has been offset by savings delivered through a review of discretionary budgets in the same period.

• Key Impacts: Adverse variances to planned levels / cost of activity, particularly at St Helens & Knowsley Hospitals Teaching Trust, with the impact of the blended tariff arrangements for urgent care. Under delivery of QIPP schemes. UCC procurement abandonment has contributed to adverse performance against contract plans.

Mental Health

• Highlights: Pooled budgets including Section 117 have been set based upon last years budget plus inflation, pooled budget contributions are agreed. In 2019/20 rehab (incl. Acquired Brian Injury (ABI)) activity is paid for solely based on usage. NHS Halton CCG has commissioned additional capacity and seen an increase in utilisation which is causing a cost pressure.

• Key Impacts: Inflation rates on out of area Mental health placements higher than anticipated, and activity in respect of rehab and acquired brain injury beds (ABI).

Primary care • Highlights: The CCG is reporting a year to date adverse position to plan of £0.686m, with a projected outturn

adverse variance of £0.978m due to increase Cat M costs, NCSO and profiling of QIPP schemes on prescribing.

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Continuing Care

•Highlights: Currently reporting an over performance of £0.155m which is net of the pool budgets over performance against savings with CHC assessment support team (staff vacancies) and lower than expected children's CHC activity. The latest financial forecast from Council has identified increased costs in CHC, work is on-going to verify the data provided. •Key Impacts: Inflation on CHC higher than budgeted and additional packages of care in year higher than anticipated.

Community

•Highlights: Slight under performance of £0.01m due to reduce costs and better financial management in respect of purchasing long term conditions equipment.

Other •Highlights: Slight under performance against plan due to delayed recruitment of clinical leads and staff vacancies within the safeguarding team.

Running Costs

•Highlights: Running costs is currently on plan but there is still an outstanding credit budget of £0.131m within reserves which is anticipated to be cleared by the end of the financial year.

5. Sector Highlights

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6. Acute Trust Performance

The collective reported financial position for acute contracts at month 10 is an adverse variance to plan of £4.76m. This performance is determined based on 9 months worth of data. These figures now include a profiled impact of the prior year activity challenges and non delivery of planned QIPP. The month 10 position has profiled unidentified QIPP into the position. The QIPP profiled during quarter 4 is not anticipated to be delivered and therefore is factored into the outturn projections for the CCG.

Key Highlights

Plan Actual Variance Variance£000's £000's £000's %

Warrington & Halton FT 42,248 43,403 (1,154) -3%St Helens and Knowsley Trust 40,400 40,924 (524) -1%Royal Liverpool & Broadgreen Trust 3,724 3,694 30 1%Countess of Chester FT 1,264 1,223 41 3%Liverpool Womens FT 1,127 1,033 93 8%Aintree Hospitals FT 1,449 1,539 (89) -6%Alder Hey 1,219 1,404 (185) -15%Wirral 198 199 (1) 0%WWL 259 244 14 6%LHCH 633 803 (170) -27%

Other Acute Trusts (inc AQP) 4,435 4,536 (100) -2%Non NHS Acutes 3,197 4,075 (877) -27%QIPP Achievement (2,357) 0 (2,357) 100%Other Acutes 1,228 1,053 175 14%Ambulance 4,891 4,886 5 0%TOTAL COMMISSIONING SERVICES 102,708 107,473 (4,765) -5%

Expenditure analysis

Year to Date Net Expenditure

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7. QIPP Position

• QIPP Position

Acute sector QIPP achievement is based on activity available up to month 8 projected up to month 10. Overall QIPP savings reported at month 10 are £2.475m which is resulting in an adverse variance of £4.508m against the planned level of QIPP of £6.983m. A £7.121m adverse position is the forecast against all schemes. Acute contract activity is below planned levels in recent periods, which could have a positive impact on QIPP position going forward. Non elective activity is under-performing against planned levels with blended payment impacting on this under performance. A number of the Acute Sector schemes were due to impact during the latter half of the financial year but due to this not materialising this has been reflected within the forecast outturn.

Key Highlights

Overall Risk Rating : Red

£m £m £m % £m £m £m %UTC procurement 0.418 0.033 (0.385) 8% 0.610 0.033 (0.577) 5%CHC fully funded 0.423 0.422 (0.001) 100% 0.508 0.507 (0.001) 100%Prescribing savings 2.315 1.383 (0.933) 60% 2.804 1.383 (1.421) 49%Acute Trust savings 2.358 0.189 (2.169) 8% 2.830 0.189 (2.642) 7%Running Costs 0.113 0.110 (0.003) 97% 0.136 0.133 (0.003) 98%High Intensity users (A&E avoidance) 0.009 0.005 (0.004) 56% 0.014 0.009 (0.005) 64%Short stay at STHK 0.464 0.153 (0.311) 33% 0.557 0.153 (0.404) 27%Unidentified Programme 0.883 0.181 (0.702) 20% 2.118 0.181 (1.938) 9%Unidentified Running Costs - - - 0.131 - (0.131) 0%

6.983 2.475 (4.508) 35% 9.708 2.586 (7.121) 27%

CCG EFFICIENCY PLANS

Year to Date Forecast

Plan Actual Variance%

Achieved Plan Actual Variance%

Achieved

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8. CCG Risks

• Risks

Overall Risk Rating : Red

(0.80)

(0.60)

(0.40)

(0.20)

-

0.20

0.40

0.60

0.80

£m

Risks Mitigations Net Risk (Unmitigated Risk)

Risks are limited at month 10 considering the majority of risks are now factored into the position. The CCG is still reporting £1.3m as a risk which is a combination of acute over performance alongside potential pooled budget overspends, these are over and above what is factored into the forecast outturn position. The CCG expects this risk to be fully mitigated therefore no impact is anticipated within the overall outturn position reported.

Page 36 of 222

9. Conclusion

The development of financial plans, across the North West footprint, for the 2019/20 financial year to meet both the expectations outlined within planning guidance and to secure the designated control totals proved a collective challenge. There was also the emphasis on commissioners supporting providers to access all of the available sustainability resources (FRF/PSF/MRET) to optimise the system position. For NHS Halton CCG, this resulted in a financial plan being submitted with outlined risks of £5.6m against the delivery of the control total of £2.0m planned deficit. The largest proportion of the risk outlined at the planning stage was in relation to the level of QIPP that had been included (£9.8m, or 8.4% of amenable budgets) with a significant level unidentified at the planning stage. In consideration against that target, the Sustainability Contract arrangement has partially prohibited the application of cashable savings with Warrington & Halton Hospitals NHS Teaching Foundation Trust where the arrangements do not also reduce the cost of provision (i.e. win-win scenarios). Most system based opportunities are aligned to pathway redesign (RightCare / GIRFT / Model Hospital) and the systems’ agreed priorities have recently been outlined as Frailty; Coronary Heart Disease; Chronic Pain; and Liver Disease. These prioritised schemes are not anticipated to deliver cashable savings to the commissioner(s) within the first year of the programme. The Governing Body is asked to: • Note the financial position at the end of January 2020; • Acknowledge the revised submitted forecast outturn position at Month 10; • Acknowledge the contributing factors within position, in particular the non delivery of QIPP savings; and • Note the application of the NHS Northwest protocol for deviations from assigned control totals during the

month 10 reporting period.

Page 37 of 222

Committee Reporting

Governing Body

Date: 5th March 2020 Report title: Month 10 (Feb) 2019/20 Corporate Performance Report

Lead Clinician and/or Lead Manager:

Mike Shaw

Purpose: To inform the Governing Body of the CCG’s performance against local, national and constitutional performance standards.

The Governing Body is asked to:

The Governing Body is asked to:

• Note the content of the report and any associated improvement plans.

This Report supports the following CCG Strategic Objectives One: To commission services which continually improve the health and wellbeing of Halton residents.

Three: To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations.

Four: To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Commissioning Plan Implications Information in this report may determine where future areas of commissioning need to be focussed, especially where underperformance is evident. Financial Implications Does this require financial support? No If Yes - Is there currently a budget for this? Not applicable Board Assurance Framework and Corporate Risk Register Does this report link to either the Board Assurance Framework (BAF) or Corporate Risk Register (CRR) or both? YES BAF 36, 43 & 41.

Page 38 of 222

Committee Reporting

National Policy, Guidance, Standards, Targets or Legislation

• The NHS Outcomes Indicator Set of the NHS Outcomes Framework for 2015/16 • The NHS Constitution operational standards • Quality Premium Indicators (both local and national)

Equality and Diversity and Human Rights None identified which specifically arise from this report although individual QIPP schemes would need to assess the impact on equality and diversity and human rights issues.

Page 39 of 222

CORPORATE PERFORMANCE REPORT

FEBRUARY 2020

Page 40 of 222

Red

Green

unknown

Achieving targetAdverse variance to targetNo target set

1 NHS HALTON & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

EXECUTIVE SUMMARY

KEY

Actual performance Target Long term trend

Introduction This report provides the CCG with information on the key strategic and operational issues and developments related to the CCG's statutory requirements. Detailed reports can be seen at each relevant Committee with corresponding actions, risks and mitigations. Achievement of recovery milestones for access standards remains a priority for 2019/20. Standards relating to A&E and ambulance waits, referral to treatment, 62-day cancer waits (including securing adequate diagnostic capacity) along with mental health access standards account for four of the nine National ‘must dos’ The data reported here is as defined and reported in the NHS operational plan, there may be some differences between the activity levels reported in the plan and those agreed in the contracts with providers due to differing technical guidance.

Overall Assessment Urgent care services are under severe pressure with all but one activity plans being missed for both Warrington and Halton CCG's and almost all performance standards also being missed. The one exception is delayed transfers of care. Increases in type 1 A&E attendances at the same time as reductions in type 3 UCC attendances accompanied by worsening A&E waits and ambulance response times are continuing from 2018/19 into 2019/20. With respect to planned care, Warrington Trust is performing well against the national standards, outperforming the national average, however capacity issues at the Royal Liverpool and Liverpool Heart & Chest are impacting on Halton and Warrington CCG residents, creating delays and causing the CCG to breach waiting time standards. These capacity issues have been addressed however it may take some time for the backlog of patients to be treated and, in the short term, further breaches of these standards may occur. The Cancer standards are being achieved YTD from a Trust perspective, however previous breast and dermatology capacity issues at STHK mean that Halton CCG is failing both two week wait standards. Small number effects are also apparent in other cancer metrics. Cancer Commissioning and clinical leads are in regular dialogue with local trusts to discuss individual breaches however some issues remain in Merseyside providers. Whilst performance against the Dementia standards remains strong, performance against IAPT standards is below the national standard and below that achieved last year for both CCG's. This is the subject of ongoing discussions with the provider, however recruitment and retention difficulties means that any improvement may not be seen until towards the end of 2019/20 and no improvement is expected in the short term.

67%

33%

Headline Assessment - Performance

Halton Warrington CCG

Warrington Trust

48%

52%

40%

60%

The percentage of measures achieving plan YTD

Headline Assessment - Activity The percentage of actual activity achieving plan YTD

Halton Warrington CCG

Warrington Trust

44%

56%

67%

33%

11%

89%

Page 41 of 222

Year To Date Overview

2 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

URGENT CARE AT A GLANCE

NHS Halton CCG and NHS Warrington CCG are committed to ensuring that performance against constitutional measures and outcomes are consistently and rigorously maintained. It should be noted that not all of the indicators are reflected in the Corporate Performance Report.

Emergency admissions v plan non-elective admissions have increased in both CCG's and WHHFT, most noticeable however in Warrington, Activity growth exceeds expected levels for all emergency admissions, with zero length of stay impacted by FAU & increased assessment area capacity at local providers. Actions Discussions are being held with the local trust to determine the main drivers for the activity and whether the trend is anticipated to continue. The opening of a new combined assessment unit at WHHFT may increase numbers further in future months

Ambulance Response Time Trust performance over Christmas was good, however significant pressures remained at Whiston & Arrowe Park, some issues remain with allocating calls to vehicles with the average time for C2 calls at 19 minutes. Although see and convey journeys are up 1% at a Trust level there has been a 6.5% increase in Halton. The Rota redesign has gone well, with no major objections from staff or unions and is expected to be in place in May. Ambulance turnaround times have been very poor at Whiston caused with average turnaround times 1 1/2 hours at one point. NHSE directed NWAS to use paramedics for corridor care at Whiston, this was an unpopular decision and may have resulted in unforeseen consequences. There may also be some correlation between reconfiguration of services at the Royal Liverpool and increases at Whiston and movement of stoke patients between Whiston and Warrington with possible repatriation delays. Actions NWAS have been asked for clarity on the policy around the use of RRV's for C2 calls. NWAS have been asked to look into the data around the trauma/ orthopaedic/ ENT reconfiguration at the Royal, and the stroke issue at Whiston/Warrington. A&E Waiting times The pattern of deteriorating waiting time performance seen nationally is also visible in Halton and Warrington. Warrington CCG and Warrington & Halton Trust figures closely correlate which is to be expected and due to patient flow. Halton performance is significantly higher due to the number of residents using the UCC's in Widnes and Runcorn with much shorter waiting times Actions Both Warrington and Halton CCG's have active social media campaigns through their own website, Facebook and twitter highlighting the alternatives to A&E including self-care and the UCC's.

Halton CCG Warrington CCG

Trust

A&E attendances v plan

Emergency admissions (NEL) v plan

Admissions for urgent care sensitive conditions

Delayed Transfers of Care

Ambulance Response Times - Category 1

A&E Waiting time performance

Page 42 of 222

TARGET

07:00

TARGET

18:00

TARGET

95.0%

Dec-19 10:08 09:15 07:29

Dec-19 33:12 32:49 31:36

Dec-19 82.1% 73.7% 76.0%

3 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

Category 1 average response time

Category 2 average response time

Percentage pf patients admitted, transferred or discharged from A&E in 4-hours

URGENT CARE

Halton CCG Warrington CCG NWAS Trust

Trust performance over Christmas was good, however significant pressures remained at Whiston & Arrowe Park. Ambulance turnaround times have been very poor at Whiston caused with average turnaround times 1 1/2 hours at one point. NHSE directed NWAS to use paramedics for corridor care at Whiston, this was an unpopular decision and may have resulted in unforeseen consequences.

Trend

Warrington CCG Halton CCG NWAS Trust Trend

Some issues remain with allocating calls to vehicles with the average time for C2 calls at 19 minutes. NWAS have been asked for clarity on the policy around the use of RRV's for C2 calls.

Warrington CCG Halton CCG Warrington Trust Trend

The pattern of deteriorating waiting time performance seen nationally is also visible in Halton and Warrington. Warrington CCG and Warrington & Halton Trust figures closely correlate which is to be expected and due to patient flow. Halton performance is significantly higher due to the number of residents using the UCC's in Widnes and Runcorn with much shorter waiting times

AMBULANCE RESPONSE TIMES

AMBULANCE RESPONSE TIMES:

4-HOUR A&E WAITS: 127C

04:19

05:46

07:12

08:38

10:05

11:31

12:58

Halton CCG Warrington CCG

NWAS

14:24

21:36

28:48

36:00

43:12

Halton CCG Warrington CCG

NWAS

07:00

09:54

08:37

08:49

Target

17/18

18/19

19/20 YTD

07:00

07:59

08:02

08:09

Target

17/18

18/19

19/20 YTD

18:00

30:39

24:33

24:46

Target

17/18

18/19

19/20 YTD

18:00

22:50

23:07

22:43

Target

17/18

18/19

19/20 YTD

95.0%

93.0%

90.1%

85.9%

Target

17/18

18/19

19/20 YTD

95.0%

85.1%

80.5%

78.1%

Target

17/18

18/19

19/20 YTD 60%

80%

100%

Halton CCG -Local calculationNHS Warrington CCG - Local calculationWarrington Trust

95.0%

88.0%

82.3%

80.5%

Target

17/18

18/19

19/20 YTD

07:00

07:54

07:57

07:23

Target

17/18

18/19

19/20 YTD

18:00

24:15

24:26

25:08

Target

17/18

18/19

19/20 YTD

Page 43 of 222

TARGET

Various

TARGET

Various

TARGET

Various

Dec-19 1740 2394 3188

Dec-19 3173 5314 6654

Dec-19 4947 1269 2169

4 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

Number of attendances at Type 1 A&E Department

Number of attendances at Type 3 & 4 A&E Departments

Total non-elective FFCEs in General & Acute Specialties

URGENT CARE

Halton CCG Warrington CCG Warrington Trust

The long term A&E (Type 1) Attendances trend continue to increase, however the rate of increase has been falling and some reductions in attendances for Warrington CCG patients has been seen.

Trend

Warrington CCG Halton CCG Warrington Trust Trend

The reduction in type 3 (Urgent Care Centre) attendances appears to have halted, particularly for Halton CCG. Elsewhere patient numbers remain flat.

Warrington CCG Halton CCG Warrington Trust Trend

Increases in Non-elective admissions have been witnessed in both CCG's and the Trust, this is most marked in the zero day length of stay admissions at Warrington Hospital which are most apparent in the Warrington CCG figures.

A&E (Type 1) ATTENDANCES

A&E (Type 3 ) ATTENDANCES

NON ELECTIVE ADMISSIONS

0

1,000

2,000

3,000

4,000

Halton CCG Warrington CCG

Warrington Trust

2,837

2,604

2,739

3,173

Dec 19 Target

Dec-17

Dec-18

Dec-19

5,012

3,956

4,755

5,314

Dec 19 Target

Dec-17

Dec-18

Dec-19

6,607

4,687

5,839

6,654

Dec 19 Target

Dec-17

Dec-18

Dec-19 0

5,000

10,000

Halton CCG totalNHS Warrington CCG totalWARRINGTON TRUST

4,998

5,344

4,429

4,947

Dec 19 Target

Dec-17

Dec-18

Dec-19

1,427

1,156

1,239

1,269

Dec 19 Target

Dec-17

Dec-18

Dec-19

0

2,443

2,366

2,169

Dec 19 Target

Dec-17

Dec-18

Dec-19-2,000

0

2,000

4,000

6,000

Halton CCG total Warrington

Warrington Trust

15,078

13,402

14,282

14,967

Target

17/18 YTD

18/19 YTD

19/20 YTD

19,667

19,719

18,522

22,095

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

25,247

22,945

27,492

Target

17/18 YTD

18/19 YTD

19/20 YTD

Page 44 of 222

TARGET

Various

TARGET

Various

Dec-19 692 1083 1454

Dec-19 1048 1311 1734

4 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

Total non-elective FFCEs in General & Acute Specialties with a 0 day LOS

Total non-elective FFCEs in General & Acute Specialties with a 1+ day LOS

URGENT CARE

Halton CCG Warrington CCG Warrington Trust

Warrington CCG have seen a 7% increase in the number of zero day non elective admissions and are 22% over plan. Halton has seen a more modest increase and are slightly under plan. This is attributed to a large increase being witnessed in 18/19 at Whiston which has not been repeated in 2019/20.

Trend

Warrington CCG Halton CCG Warrington Trust Trend

Although a 7% increase in zero day length of stay admissions was seen in Warrington CCG, only a 2% increase has been seen for 1+ day admissions. Halton CCG has witnessed flat activity for 1+ non-elective admissions.

NON ELECTIVE ADMISSIONS 0 LOS

NON ELECTIVE ADMISSIONS 1+ LOS

0

500

1,000

1,500

2,000

Halton CCG NHS Warrington CCG

Warrington Trust

0

500

1,000

1,500

2,000

Halton CCG NHS Warrington CCG

Warrington Trust

6,359

5,611

6,111

6,278

Target

17/18 YTD

18/19 YTD

19/20 YTD

8,218

0

9,373

10,012

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

11,304

9,599

12,850

Target

17/18 YTD

18/19 YTD

19/20 YTD

8,719

8,388

8,664

8,689

Target

17/18 YTD

18/19 YTD

19/20 YTD

11,449

11,811

12,083

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

13,943

13,346

14,642

Target

17/18 YTD

18/19 YTD

19/20 YTD

Page 45 of 222

ENG AVE

2497

ENG AVE

2211

ENG AVE

982

19/20 Q2 1,136 1,228

19/20 Q2 3581 3103

19/20 Q2 2752 3134

5 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

Rate of unplanned hospital admissions for urgent care sensitive conditions, per 100,000 registered patients.

Difference in age and sex standardised rate of unplanned hospitalisation for chronic ambulatory care sensitive conditions per 100,000 population, between the most and least deprived LSOAs

Total length of all emergency admissions per 1,000 population, adjusted for age, sex and need.

URGENT CARE

Halton CCG Warrington CCG

NHSE have corrected the erroneously published data from January, this has had no material impact on the CCG's position compared to the national average however the step change witnessed has now been removed. Both CCGs' show a deteriorating position in relation to Urgent Care Sensitive Condition admissions.

Trend

Warrington CCG Halton CCG Trend

NHSE have corrected the erroneously published data from January, this has had no material impact on the CCG's position compared to the national average however the step change witnessed has now been removed. Warrington CCG has seen in increase in the inequality of unplanned admissions over the last 12 months compared to a decrease seen in Halton, to the extent that the inequality is now greater in Warrington CCG for the first time.

Warrington CCG Halton CCG Trend

Both CCG's have seen an improvement in the use of hospital beds following admission, this is due to the increasing number of zero day length of stay admissions.

ADMISSIONS FOR UCSC: 127B

INEQUALITY IN UNPLANNED ADMISSIONS: 106A

USE OF HOSPITAL BEDS FOLLOWING ADMISSION: 127F

2,497

3,818

3,786

3,422

3,581

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

2,497

3,228

3,350

2,736

3,103

Eng Ave

16/17 Q2

17/18 Q2

18/19 Q2

19/20 Q2

0

1000

2000

3000

4000

5000

15/16Q4

16/17Q1

16/17Q2

16/17Q3

16/17Q4

17/18Q1

17/18Q2

17/18Q3

17/18Q4

18/19Q1

18/19Q2

18/19Q3

18/19Q4

19/20Q1

19/20Q2

Halton Warrington England Ave

2,211 3,584

3,793 3,238

2,752

Eng Ave16/17 Q217/18 Q218/19 Q219/20 Q2

2,211 3,385

3,190 2,533

3,134

Eng Ave16/17 Q217/18 Q218/19 Q219/20 Q2

0

1000

2000

3000

4000

5000

15/16Q4

16/17Q1

16/17Q2

16/17Q3

16/17Q4

17/18Q1

17/18Q2

17/18Q3

17/18Q4

18/19Q1

18/19Q2

18/19Q3

18/19Q4

19/20Q1

19/20Q2

Halton Warrington England Ave

982 1,139 1,147 1,199

1,136

Eng Ave16/17 Q217/18 Q218/19 Q219/20 Q2

982 1,195 1,170

1,249 1,228

Eng Ave16/17 Q217/18 Q218/19 Q219/20 Q2

500

700

900

1100

1300

1500

15/16Q4

16/17Q1

16/17Q2

16/17Q3

16/17Q4

17/18Q1

17/18Q2

17/18Q3

17/18Q4

18/19Q1

18/19Q2

18/19Q3

18/19Q4

19/20Q1

19/20Q2

Halton Warrington England Ave

Page 46 of 222

ENG AVE

22.70

ENG AVE

N/A

Nov-19 12.70 8.90

Nov-19 389 447 466

6 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

Average Delayed transfers of care (delayed days) per day for all reasons per 100,000 population .

Total number of Delayed Transfer of Care days

URGENT CARE

Halton CCG Warrington CCG

Halton and Warrington CCG's have similar levels of performance, are both below the England average and in the interquartile range in their respective peer groups. Both CCG's report fewer delayed transfers of care days than the same period last year and are below the individual target set by NHS England.

Warrington CCG Halton CCG Trend

Not all plan data has been loaded. The CCG is assessed on the DTOC rate, however internally the actual number of days is used operationally. This demonstrates the size of the reduction in DTOC days from the same period last year and the reducing trend over time.

DELAYED TRANSFERS OF CARE: 127E

DELAYED TRANSFERS OF CARE - DAYS:

22.70

16.30

21.00

12.70

Nov 19 Target

Nov-17

Nov-18

Nov-19

12.40

15.00

18.80

9.30

Oct 19 Target

Nov-17

Oct-18

Oct-19

Halton Benchmark Warrington Benchmark

Warrington Trust

423

673

389

Nov 19 Target

Nov-17

Nov-18

Nov-19

0

743

828

447

Nov 19 Target

Nov-17

Nov-18

Nov-19

0

829

840

466

Nov 19 Target

Nov-17

Nov-18

Nov-190

500

1,000

1,500

2,000

2,500

Halton LA Warrington UA

Warrington Trust

Page 47 of 222

Year To Date Overview

7 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PLANNED CARE AT A GLANCE

NHS Halton CCG and NHS Warrington CCG are committed to ensuring that performance against constitutional measures and outcomes are consistently and rigorously maintained. It should be noted that not all of the indicators are reflected in the Corporate Performance Report.

Planned Care Waiting List NHS England demand that waiting lists for March 2020 are no larger than March 2019 Halton CCG is below the target figure following two months of reducing waiting list, Warrington CCG are now 9% above plan, following both increases in the waiting list and reductions in the plan figure. Actions

18 Week RTT Warrington CCG and Warrington & Halton Trust have seen reductions in performance since 2018/19 but still, for the most part, achieve the RTT standard. Halton CCG continues to miss the standard. Actions The area of biggest pressure for RTT is long waits relating to spinal surgery at Liverpool University Hospitals. This is part of the Cheshire & Mersey Spinal Services review looking at a single provider relocated to the Aintree / Walton Site. There are a number of long waiters (40+ weeks) for ENT at Warrington Trust. The service has previously reported capacity issues however no 52 week breaches have been reported or are expected. 52-Week Breaches Warrington CCG saw a single 52-week breach for General Surgery at the Countess of Chester Actions Previous 52-week Gynaecology breaches at the Liverpool Women's have been resolved at both Halton and Warrington CCG's. The single 52-week breach for Warrington CCG at the Countess of Chester is being investigated. 6-Week Diagnostic Waits Warrington & Halton Trust and the Warrington CCG both comfortably achieve the national standard for diagnostic waits. Halton is missing the standard due to the long waiting times for CT's and MRI's at Liverpool Heart & Chest. Actions Additional machines were operational from November, however the Trust is working through a backlog and improvements may not be seen until January 2020

Halton CCG Warrington CCG

Warrington

18- Week RTT

52-Week Breaches

6-Week Diagnostics

Planned Care Waiting list

Page 48 of 222

TARGET

92%

TARGET

Various

TARGET

1.00%

Dec 19 1.86% 0.42% 0.18%

Dec-19 91.30% 92.10% 92.46%

Dec-19 10452 16199

8 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The percentage of patients waiting to start non-emergency consultant led treatment who were waiting 18 weeks or less - Trust data 1 month behind CCG data

.

The total number of incomplete RTT pathways at the end of the reporting period

The number of patients waiting six weeks or more for a diagnostic test as a percentage of the total number of patients waiting

PLANNED CARE

Halton CCG Warrington CCG

Warrington CCG and Warrington & Halton Trust have seen reductions in performance since 2018/19 but still, for the most part achieve the RTT standard. Halton CCG continues to miss the standard.

Warrington CCG Halton CCG

Halton CCG has witnessed a small reduction in the waiting list in the lat two months, this, accompanied by an increase in the plan figure means that Halton CCG is on plan to achieve the RTT waiting list. Warrington CCG continues to see increases in its waiting list, accompanied by a reducing plan means that Warrington CCG is now 9% over target.

Warrington CCG Halton CCG

Warrington & Halton Trust and the Warrington CCG both comfortably achieve the national standard for diagnostic waits. Halton is missing the standard due to the long waiting times for CT's and MRI's at Liverpool Heart & Chest. Additional machines were operational from November, however the Trust is working through a backlog and improvements may not be seen until January2020.

18 WEEK REFERRAL TO TREATMENT (RTT): 129A

RTT WAITING LIST 124B

6 WEEK DIAGNOSTIC WAIT: 133A

Warrington Trust

92.00%

93.20%

93.28%

92.32%

Target

17/18

18/19

19/20 YTD

92.00%

92.68%

92.45%

92.20%

Target

17/18

18/19

19/20 YTD

92.00%

92.73%

91.79%

91.76%

Target

17/18

18/19

19/20 YTD

Trend

90%

91%

91%

92%

92%

93%

93%

94%

94%

95%

95%

Halton CCG TargetWarrington CCG WHHFT

Trend

10,501

9,629

10,505

10,452

Target Dec-19

Dec-17

Dec-18

Dec-19

14,881

14,628

15,598

16,199

Target Dec-19

Dec-17

Dec-18

Dec-19 0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Halton CCG Warrington CCG Halton plan Warrington Plan

Warrington Trust

1.00%

0.67%

1.26%

1.17%

Target17/1818/19

19/20 YTD

1.00%

0.77%

0.97%

0.47%

Target17/1818/19

19/20 YTD

1.00%

0.41%

0.77%

0.14%

Target

17/18

18/19

19/20 YTD

Trend

0%

1%

1%

2%

2%

3%

3%

Halton CCG Target

Warrington CCG Warrington Trust

Page 49 of 222

TARGET

Various

TARGET

Various

TARGET

Various

Dec-19 2249 3610 4506

Dec-19 3592 5097 6386

Dec-19 192 288 295

9 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT –FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

GP written referrals for a first outpatient appointment in G&A specialties (MAR) - Provider data 1 month behind Commissioner Data .

All first outpatient activity G&A specialties (MAR) - Provider data 1 month behind

Commissioner Data

Total ordinary elective admissions in general & Acute specialties - Provider data 1

month behind Commissioner Data

PLANNED CARE

Halton CCG Warrington CCG

Both Warrington and Halton CCG's and Warrington Trust data suggest a reduction in GP referrals.

Warrington CCG Halton CCG

Warrington CCG and Warrington & Halton Trust figures show little or no growth in first outpatient appointments, However Halton is considerably over plan due to a low plan figure set. This low plan figure was based on significant reductions in activity to be achieved through QIPP transformation schemes which has not materialised.

Warrington CCG Halton CCG

CCG figures show reductions in Elective overnight admissions. considerably so at Warrington CCG.

GP REFERRALS

FIRST OUTPATIENT APPOINTMENTS

ELECTIVE ORDINARY ADMISSIONS

Warrington Trust Trend

0

1,000

2,000

3,000

4,000

5,000

6,000

Halton CCG Warrington CCGWarrington Trust

Trend

Warrington Trust Trend

0

100

200

300

400

500

Halton CCG Warrington CCG

Warrington Trust

25,658

23,471

24,849

24,835

Target

17/18 YTD

18/19 YTD

19/20 YTD

42,497

39,171

42,032

40,551

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

37,268

36,691

36,678

Target

17/18 YTD

18/19 YTD

19/20 YTD

Warrington Trust

35,666

34,382

36,838

37,833

Target

17/18 YTD

18/19 YTD

19/20 YTD

53,735

51,628

52,664

52,207

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

53,906

51,462

51,519

Target

17/18 YTD

18/19 YTD

19/20 YTD 0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Halton CCG Warrington CCGWarrington Trust

1,967

2,318

2,124

1,841

Target

17/18 YTD

18/19 YTD

19/20 YTD

3,766

3,560

3,549

2,846

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

2,697

2,633

2,503

Target

17/18 YTD

18/19 YTD

19/20 YTD

Page 50 of 222

TARGET

Various

Dec-19 1313 1848 2547

10 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

A patient admitted electively during the course of a day who does not require the use of a bed overnight and who returns home as scheduled .

PLANNED CARE

Halton CCG Warrington CCG

The number of Daycase admissions has increased for both Halton and Warrington CCG's and at Warrington Trust. This increase is slightly higher than the decreases seen overnight electives.

DAYCASE ADMISSIONS

Warrington Trust Trend

0

500

1,000

1,500

2,000

2,500

3,000

Halton CCG Warrington CCG

Warrington Trust

12,575

12,828

12,654

13,200

Target

17/18 YTD

18/19 YTD

19/20 YTD

18,377

17,990

17,142

18,749

Target

17/18 YTD

18/19 YTD

19/20 YTD

0

19,934

18,375

18,729

Target

17/18 YTD

18/19 YTD

19/20 YTD

Page 51 of 222

Year To Date Overview

11 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

CANCER AT A GLANCE

NHS Halton CCG and NHS Warrington CCG are committed to ensuring that performance against constitutional measures and outcomes are consistently and rigorously maintained. It should be noted that not all of the indicators are reflected in the Corporate Performance Report.

62-Day Treatment Warrington Trust consistently achieves the standard, however both Warrington and Halton CCG's are missing the target YTD. 7 breaches were reported for Warrington CCG in December and 4 in Halton CCG. Actions Most of the breaches are 'unavoidable' and are attributed to the patient being unfit for treatment or the patient choosing to delay treatment, however both CCG's commissioning leads discuss all cancer breaches with the local providers.

2 Week Wait This metric is not formally reported nationally due to Warrington & Halton Trust being part of the pilot for the 28 day faster diagnosis standard, however unofficial local report suggests that the two week wait standard continues to be achieved. The breaches at Halton CCG are due to seasonal deteriorations in Dermatology due to increases in referrals in the summer months to STHK Trust. Actions Warrington CCG and Warrington & Halton Hospitals Foundation Trust both consistently achieve the national standard The Dermatology breaches at St Helens have been raised by the Halton CCG cancer commissioning lead with STHK Trust. Halton CCG have introduced a local dermatology service which is reducing overall referrals for Dermatology 31 Day Treatment YTD standards were consistently achieved, until December 19 where Halton CCG witnessed an exceptionally low level of performance which has brought down the YTD figure. The 89.4% for Halton in December consisted of 5 patient breaches, 2 at ST Helens, 1 at Clatterbridge and 2 at Liverpool University Hospital Actions Two of the five breaches were unavoidable, however the two at Liverpool Hospital University are both Head & Neck and are both reported as 'elective capacity inadequate' this is being raised by the CCG cancer commissioner.

Halton CCG Warrington CCG

Warrington

Two Week Waits

Two Week Waits - Breast Symptoms

31 Day Treatment

62 Day Treatment

Page 52 of 222

TARGET

93.0%

TARGET

93.0%

TARGET

96.0%

94.2%

89.4%Dec-19 98.6%

Dec-19 95.8%

Dec-19 90.6% 96.2%

95.7%

96.9%

96.2%

12

NHS HALTON CCG & NHS WARRINGTON CCG CORPORATE PERFORMANCE REPORT –FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN

The % patients seen within two weeks for an urgent GP referral for suspected cancer

93.0%

94.2%

92.3%

91.5%

Target

17/18

18/19

19/20 YTD

Two week wait standard for patients referred with breast symptoms not covered by two week wait for breast cancer

93.0%

94.4%

93.6%

91.1%

Target

17/18

18/19 YTD

19/20 YTD

The % of patients receiving their first definitive treatment within one month of diagnosis

96.0%

96.0%

97.5%

95.8%

Target

17/18

18/19

19/20 YTD

CANCER

Halton CCG Warrington CCG

93.0%

94.1%

94.7%

94.3%

Target

17/18

18/19

19/20 YTD

Warrington Trust

93.0%

94.0%

93.8%

93.7%

Target

17/18

18/19

19/20 YTD

This metric is not formally reported nationally due to Warrington & Halton Trust being part of the pilot for the 28 day faster diagnosis standard, however unofficial local report suggests that the two week wait standard continues to be achieved. The breaches at Halton CCG are due to seasonal deteriorations in Dermatology due to increases in referrals in the summer months to STHK Trust. This is being raised by the Halton CCG cancer commissioning lead with STHK Trust.

Trend

Warrington CCG Halton CCG Warrington Trust Trend

93.0%

91.1%

92.6%

92.0%

Target

17/18

18/19 YTD

19/20 YTD

93.0%

91.2%

92.8%

94.2%

Target

17/18

18/19 YTD

19/20 YTD

YTD performance is improving following the deterioration seen in June and July 2019. This deterioration was due to a loss of capacity across the system but most markedly at STHK Trust due to lack of consultant availability. This has now been rectified and performance has returned to normal levels. Should this level of performance continue through to March 2020 then it is possible that both Halton and Warrington CCG may achieve the required standard.

Warrington CCG Halton CCG Warrington Trust

96.0%

97.2%

96.8%

96.6%

Target

17/18

18/19

19/20 YTD

96.0%

98.1%

99.0%

99.2%

Target

17/18

18/19

19/20 YTD

Trend

YTD standards were consistently achieved, until December 19 where Halton CCG witnessed an exceptionally low level of performance which has brought down the YTD figure. The 89.4% for Halton in December consisted of 5 patient breaches, 2 at ST Helens, 1 at Clatterbridge and 2 at Liverpool University Hospital, 2 of the five breaches were unavoidable, however the two at Liverpool Hospital University are both Head & Neck and are both reported as 'elective capacity inadequate' this is being raised by the CCG cancer commissioner.

TWO WEEK WAITS:

TWO WEEK WAIT - BREAST:

31 DAY TREATMENT:

85%

90%

95%

100%

Halton CCG Warrington CCG

Warrington Trust

70%

75%

80%

85%

90%

95%

100%

Halton CCG Warrington CCG

Warrington Trust

90%

92%

94%

96%

98%

100%

Halton CCG Warrington CCG

Warrington Trust

Page 53 of 222

TARGET

85.0%

Eng Ave

8.8

TARGET

52.2%

Dec-19 83.3% 86.8% 87.0%

2018 8.75 8.76

2017 52.3% 51.0%

13 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT –FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The % of patients receiving 1st definitive treatment for cancer within 2 months (62 days)

85.0%

80.1%

85.9%

82.4%

Target

17/18

18/19

19/20 YTD

Average score given to the question “Overall, how would you rate your care?” on a scale from 0 (very poor) to 10 (very good)

New cases of cancer diagnosed at stage 1 and 2 as a proportion of all new cases of cancer diagnosed

CANCER

Halton CCG Warrington CCG

85.0%

83.6%

85.4%

83.4%

Target

17/18

18/19

19/20 YTD

Warrington Trust

85.0%

83.3%

86.8%

86.9%

Target

17/18

18/19

19/20 YTD

Despite Warrington & Halton Trust consistently achieving the standard both Halton and Warrington CCG's fail to achieve 85%. Due to the small numbers of patients, large month on month variations can be seen. Warrington CCG had 7 breaches in December, 5 of these at Warrington Trust. Halton CCG had 4 breaches including 1 at Warrington Trust. Both CCG's commissioning leads discuss all cancer breaches with the local providers.

Trend

Warrington CCG Halton CCG

This measure is included in the NHS Oversight Framework. Both Warrington and Halton CCG perform very close to the England average (no statistically significant difference) Both CCG's rating is also close the their respective peer group average.

Warrington CCG Halton CCG

The most recent available data for this metric is for 2017. Halton CCG achieved the required standard. Warrington was slightly below the standard but remained interquartile both nationally and with their peer group.

62 DAY TREATMENT WAIT 122B

CANCER EXPERIENCE 122D

EARLY CANCER DIAGNOSIS 122A

70%

75%

80%

85%

90%

95%

100%

Halton CCG Warrington CCG

Warrington Trust

8.80

8.98

8.77

8.75

England Average

2016

2017

2018

8.80

8.57

8.69

8.76

England Average

2016

2017

2018

Halton Benchmark Warrington Benchmark

52.2%

50.0%

49.0%

52.3%

Eng. Ave

2015

2016

2017

Halton Benchmark Warrington Benchmark

52.2%

51.0%

48.0%

51.0%

Eng. Ave

2015

2016

2017

Page 54 of 222

TARGET

66.7%

ENG AVE

77.5%

TARGET

5.1%

19/20 YTD 72.2% 76.4%

17/18 78.6% 81.7%

Dec-19 4.2% 4.2%

14 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN Number of people aged 65 and over on the dementia register divided by the estimated prevalence rate

The percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months

The proportion of people that enter treatment against the level of need in the general population

MENTAL HEALTH

Halton CCG Warrington CCG

Both Warrington and Halton CCG's comfortably exceed the target of 66.7%, however Warrington CCG consistently achieves a higher diagnosis rate than Halton CCG and is placed in the top quartile of its peer group compared to inter-quartile for Halton CCG.

Warrington CCG Halton CCG

Both CCG's exceed the England average and both CCG's are in the top quartile of their respective peer groups. Warrington CCG does appear to show a step increase in performance in 17/18 (the latest nationally published data available)

Warrington CCG Halton CCG Trend

Whilst nationally the target is increasing, the performance at Warrington and Halton CCG's has shown a deterioration. Halton has seen an improvement in recent months from historically low levels. Appropriate capacity within the system appears to be limiting the number of

DEMENTIA DIAGNOSIS: 126A

DEMENTIA CARE PLANNING: 126B

IAPT ACCESS: 123B

0%

2%

4%

6%

8%

NHS Halton CCG Rolling Quarters - Local Data

NHS Warrington CCG Rolling Quarters - Local Data

71.5%

69.6%

73.6%

72.2%

Target

17/18

18/19

19/20 YTD

66.8%

71.0%

76.0%

76.4%

Target

17/18

18/19

19/20 YTD

Halton Benchmark Warrington Benchmark

77.5%

77.1%

79.9%

78.6%

Eng Ave

15/16

16/17

17/18

77.5%

78.0%

77.1%

81.7%

Eng Ave

15/16

16/17

17/18

Halton Benchmark Warrington Benchmark

5.1%

4.3%

5.3%

4.2%

Target

17/18 Q4

18/19 Q4

19/20 YTD

4.8%

4.3%

4.8%

4.2%

Target

17/18 Q4

18/19 Q4

19/20 YTD

Page 55 of 222

TARGET

50.0%

TARGET

75.0%

ENGLAND

159

Jul-19 0 3

Dec-19 47.8% 52.4%

Sep-19 75.0% 50.0%

15 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The percentage of people who finished treatment within the reporting period ... who are assessed as moving to recovery

The percentage of people referred to service experiencing first episode psychosis or at “risk mental state” that start care within 2 weeks

The rate of inappropriate Out of Area Placements (OAPs) in mental health services for adults in non-specialist acute inpatient care per 100,000 population

MENTAL HEALTH

Halton CCG Warrington CCG

Both Halton and Warrington CCG's have witnessed a reduction in IAPT recovery rates over 2019, however the reduction seen in Halton has been much more marked and the CCG is now significantly below the target level. The recovery rate seen in Warrington is achieving the national target and is significantly higher than that seen in Halton.

Warrington CCG Halton CCG

Small numbers of patients result in large swings in activity. Typically only 2-4 patients per month are counted. Both Halton and Warrington CCG have consistently achieved the Target YTD and continue to do so in 2019/20.

Warrington CCG Halton CCG

The numbers reported for Both Warrington and Halton CCG's are zero or close to zero, this is significantly below the national average and best quartile both nationally and in each respective peer group.

IAPT RECOVERY: 123A

PSYCHOSIS TWO WEEK WAIT: 123C

MH OOA PLACEMENTS: 123F

50.0%

51.4%

48.1%

47.8%

Target

17/18

18/19

19/20 YTD

50.0%

51.1%

52.9%

52.4%

Target

17/18

18/19

19/20 YTD

Trend

30%

40%

50%

60%

NHS Halton CCG Rolling Quarters - Local Data

NHS Warrington CCG Rolling Quarters - Local Data

75.0%

82.5%

80.0%

85.2%

Target

17/18

18/19

19/20 YTD

57.1%

78.4%

81.8%

80.6%

Target

17/18

18/19

19/20 YTD30%

50%

70%

90%

110%

Halton CCG NHS Warrington CCG

Trend

159

39

0

0

ENGLAND

Apr-18

Apr-19

Jul-19

159

0

0

3

ENGLAND

Apr-18

Apr-19

Jul-19

Halton Benchmark Warrington Benchmark

Page 56 of 222

ENG AVE

ENG AVE

51.4%

ENG AVE

0.49%

17/18 0.62% 0.46%

Oct-19

17/18 59.5% 54.2%

16 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The number of adult inpatients per million ONS resident adult population from the CCG (based on CCG of origin). .

Proportion of people with a learning disability on the GP register receiving an annual health check.

The Proportion of the population that are included on a GP register

LEARNING DISABILITIES

Halton CCG Warrington CCG

Data has not been populated yet

Warrington CCG Halton CCG

The most recent nationally published information is 2017/18. Both Warrington and Halton CCG's exceed the England average and both have seen year on year improvements since 2015/16. Halton CCG is in the top quartile of its peer group, Warrington is in the interquartile range of its peer group.

Warrington CCG Halton CCG

The most recent nationally published information is 2017/18. Both Halton and Warrington CCG are in the interquartile range of their respective CCG's . There is a very small range between the highest and lowest performing CCG's with Halton 0.13% higher than the England

SPECIALIST INPATIENT STAYS: 124A

LEARNING DISABILITY HEALTH CHECKS: 124B

COMPLETENESS OF THE LEARNING DISABILITY REGISTER: 124C

Halton Benchmark Warrington Benchmark

51.4%

35.2%

58.8%

59.5%

17/18 Eng Ave

15/16

16/17

17/18

51.4%

36.4%

49.3%

54.2%

17/18 Eng Ave

15/16

16/17

17/18

Halton Benchmark Warrington Benchmark

0.49%

0.62%

0.62%

17/18 Eng Ave

16/17

17/18

0.49%

0.47%

0.46%

17/18 Eng Ave

16/17

17/18

Halton Benchmark Warrington Benchmark

Page 57 of 222

ENG AVE

38.7%

ENG AVE

8.5%

ENGLAND

57.3%

2017/18 37.7% 39.4%

2017-18 0.8% 2.2%

2019 55.6% 59.6%

17 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The percentage of diabetes patients who have achieved all the NICE recommended treatment targets.

People with diabetes diagnosed less than a year who attend a structured education course

The proportion of carers with long term conditions who feel supported to manage their conditions

LONG TERM CONDITIONS

Halton CCG Warrington CCG

Warrington CCG consistently performs better than the National average albeit not significantly so and is in the interquartile range of its peer group. Halton CCG performs worse than the National average albeit not significantly but is in the bottom quartile of its peer group. It should be noted that the most recent nationally published data relates to 2017/18.

Warrington CCG Halton CCG

Both Halton and Warrington CCG's have historically performed significantly worse than the national average and either bottom quartile or close to bottom quartile when compared to their respective peer groups. However the most recent data published is from 2017/18. More recent local collection of data in Halton suggests that a ten-fold increase may be seen in 2019/20 data however this will not form part of

Warrington CCG Halton CCG

Warrington CCG have performed better than Halton CCG in the last two years, where proportionally more carers in Warrington report that they feel supported the proportion in Halton has fallen and is now below the National average. Despite Halton being below the national

DIABETES TREATMENT : 103A

DIABETES - STRUCTURED EDUCATION: 103B

SUPPORTED CARERS: 108A

Halton Benchmark Warrington Benchmark

Halton Benchmark Warrington Benchmark

38.7%

37.6%

39.8%

37.7%

ENGLAND

2015-16

2016-17

2017-18

38.7%

40.6%

41.0%

39.4%

ENGLAND

2015-16

2016-17

2017-18

8.5%

3.4%

0.8%

0.8%

ENGLAND

2015-16

2016-17

2017-18

8.5%

0.8%

0.6%

2.2%

ENGLAND

2015-16

2016-17

2017-18

Halton Benchmark Warrington Benchmark

57.3%

57.7%

55.6%

ENGLAND

2018

2019

57.3%

59.2%

59.6%

ENGLAND

2018

2019

Page 58 of 222

TARGET

6%

ENG AVE

34.2%

ENG AVE

2060

19/20 Q2 2881 2872

19/20 Q1 15.92% 11.32%

2015/16 - 17/18 38.35% 31.80%

18 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The Percentage of Women who were smokers at the time of delivery, out of the number of maternities .

Number of children in year 6 (aged 10 or 11) classified as overweight or obese in the National Child Measurement Programme (NCMP)

Age standardised rate of emergency hospital admissions for injuries due to falls for persons aged 65+ per 100,000 population

PREVENTING ILL HEALTH

Halton CCG Warrington CCG

Both Warrington and Halton CCG's are missing the National standard and perform in the middle of their respective peer groups. Warrington performs at or around the England average, Halton performs in the bottom quartile nationally. Small numbers produce large quarterly variations however the long term trend in both CCG's is for a reduction in line with the National reduction

Warrington CCG Halton CCG

Note: most recent data is for 2017/18. Warrington CCG performs exceptionally well with respect to the number of overweight or obese children, with the lowest rate in their peer group, a rate below the England average and growth either flat or a slower rate of growth than is seen nationally. Halton performs above the England average and the growth rate is higher than the rate seen nationally.

Warrington CCG Halton CCG

Note: although the data from 18/19Q2 to 19/20 Q2 appears to show a significant reduction this is a result in a change of how this m etric is calculated. Both Warrington and Halton CCG's have admission rates for falls much higher than the England average and in the top quartile of

MATERNAL SMOKING AT DELIVERY: 129D

OVERWEIGHT OR OBESE CHILDREN: 102A

INJURIES FROM FALLS: 104A

Trend

Trend

6.00%

10.40%

13.29%

16.62%

15.92%

TargetEng Ave

17/18 Q118/19 Q119/20 Q1

6.00%

10.40%

7.37%

7.56%

11.32%

TargetEng Ave

17/18 Q118/19 Q119/20 Q1

0%

5%

10%

15%

20%

25%

Halton Warrington

England Target

Halton Warrington Benchmark

34.20%

36.06%

37.61%

38.35%

Eng Ave

2013/14 - 15/16

2014/15 - 16/17

2015/16 - 17/18

34.20%

31.46%

31.18%

31.80%

Eng Ave

2013/14 - 15/16

2014/15 - 16/17

2015/16 - 17/1820%

25%

30%

35%

40%

Halton Warrington

England Ave

Halton Warrington

2,060

3,026

4,326

2,881

Eng Ave

2017/18 Q2

2018/19 Q2

2019/20 Q2

2,060

2,973

3,784

2,872

Eng Ave

2017/18 Q2

2018/19 Q2

2019/20 Q2

Halton Benchmark Warrington Benchmark

Page 59 of 222

TARGET

0.965

TARGET

10.0%

Sep-19 1.156 0.944

Sep-19 7.10% 7.40%

19 NHS HALTON CCG & NHS WARRINGTON CCG

CORPORATE PERFORMANCE REPORT – FEBRUARY 2020

PERFORMANCE AGAINST NHS OPERATIONAL PLAN The number of antibiotics prescribed in primary care divided by the Item based Specific Therapeutic Age-Sex related Prescribing Unit STAR_PU .

The number of co-amoxiclav, cephalosporins and quinolones as a percentage of the total number of selected antibiotics prescribed in primary care

PREVENTING ILL HEALTH

Halton CCG Warrington CCG

Following two years of substantial reductions in prescribing rates the rate of reduction has plateaued, Warrington CCG has achieved the National standard and has one of the lowest prescribing rates in their peer group. Halton CCG has not achieved the standard and performs at the average rate for their peer group. Halton has a unusual situation in that all antibiotics prescribed in the UCC's are attributable to Halton

Warrington CCG Halton CCG

Both Halton and Warrington CCG perform significantly below the National target and are interquartile in their respective peer groups. The re is little difference in the prescribing rates between the CCG's

APPROPRIATE PRESCRIBING OF ANTIBIOTICS IN PRIMARY CARE: 107a

BROAD SPECTRUM PRESCRIBING: 107B

Trend

Trend

0.800

1.000

1.200

1.400

HaltonWarringtonTarget

Halton Warrington Benchmark

6%

8%

10%

12%

HaltonWarringtonTarget

Halton Warrington

0.965

1.274

1.182

1.156

Target

2017/18

2018/19

2019 YTD

0.965

1.029

0.945

0.944

Target

2017/18

2018/19

2019 YTD

10.00%

7.21%

7.25%

7.10%

Target

2017/18

2018/19

2019 YTD

10.00%

7.43%

7.63%

7.40%

Target

2017/18

2018/19

2019 YTD

Page 60 of 222

KEY ISSUES

Audit Committee (including Committees in Common discussion) Agenda Item No:

Item Ref:

Item title:

Key issue and action identified:

Linked to Strategic Risk

3a. AC51-19 Strategic Risk Assurance Update An update was provided in relation to the assurances received to date in mitigation of all strategic risks. A small number of gaps were identified and reports providing additional information were considered by the Committee.

3b. AC52-19 Health and care infrastructure An update was provided in relation to the health and care infrastructure in place and discussion ensued about the governance arrangements. It was agreed that further work was required to review all arrangements to ensure that oversight of the work is being brought back into the CCG. The Chief of Corporate Services was requested to bring a paper to the Governing Body in relation to mid Mersey Joint Committee. The Chief Commissioner was requested to include an update on the Executive Partnership Board in her update report to the Governing Body

D2

4. AC53-19 Gifts and Hospitality Register The gifts and hospitality register was presented to the Committee for information. A small breach was identified relating to the acceptance of a gift from a provider under the value of £6. The actions taken were discussed by committee members. Issues relating to sponsorship of events by pharmaceutical companies was also discussed and the committee was advised that the existing policy is currently being reviewed

C2

5. AC54-19 Review of losses and special payments

The committee requested further detail about tender waivers that had been approved earlier in the year

C1, C5

6. AC55-19 Internal Audit Progress report An update was provided on two recent reviews relating to the finance shared service review and the combined financial systems review. Both reviews were awarded substantial assurance by Mersey Internal Audit Agency (MIAA)

C1, C2,C4, C5

7a. AC56-19 Counter Fraud Progress Report A report was provided to give an update on the work associated with counter fraud. The committee was advised that the counter fraud plan was on track to achieve all timeframes for actions identified

C2

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KEY ISSUES

Agenda Item No:

Item Ref:

Item title:

Key issue and action identified:

Linked to Strategic Risk

7b. AC56-20 Anti-Fraud, Bribery and Corruption Policy

An updated policy was presented for approval. It was agreed awareness raising of the policy would be put in place

C2

8. AC57-29 External Audit Progress report An update was provided on work to date undertaken by Grant Thornton, in relation to their plan. The committee was advised of an increase to the external audit fees, which was queried. In addition, it was agreed that updates provided by Grant Thornton would be regularly disseminated to the Integrated Management Team by the Chief of Corporate Services

C2

Committees in Common update

1. 1-19 Commissioning at Scale update A status update was provided in relation to commissioning at scale and the work undertaken to date to support the CCGs to deliver their responsibilities under the requirements of the Long-Term Plan. The committee agreed that the principles were in place and that the appropriate approach and methodology was in place to support the delivery required

C2

2. 2 Reduction of CCG running costs An update was provided detailing the work to date to meet the requirement for the reduction of running costs by 20%. This update also provided assurance in relation to the mitigation of the associated strategic risk

C7

3. 1 Update on governance arrangements

An update was provided on the work being undertaken to review and refresh the governance arrangements of both CCGs. The committee was advised of the timeline to update key governance documents (including the constitution) and the proposed ballots being shared across the memberships of both CCGs to inform the update

C2

4. 4 Delivery of digitally enhanced care

A detailed report was provided to provide assurance about the management of the strategic risk associated with the delivery of digitally enhanced care. The committee was also informed of the move of delivery of IT provision from St Helens & Knowsley Health Informatics to Cheshire & Merseyside Commissioning Support Unit

B3

5. 5 Organisational Development An update was provided on the organisational development work taking place in both CCGs, including the rollout of the Organisational Change Programme being implemented. The committee was

D1

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KEY ISSUES

Agenda Item No:

Item Ref:

Item title:

Key issue and action identified:

Linked to Strategic Risk

informed that following the close down of the Integrated Governance Committee, key areas of work were being reviewed to ensure they were captured as part of committee terms of reference and workplans. This update provided assurance relating to the mitigation of the associated strategic risk

6. 6 Review of Whistleblowing Arrangements

An update was provided in relation to the Whistleblowing Policy and that there had been no whistleblowing cases reported to date in 2019/20

C2

7. 7 Standards of Business Conduct including Conflicts of Interest Policy

A new policy was presented to the committees. Each committee recommended the policy for approval to the respective Governing Body of each CCG

C2

Key Issues Report Date Prepared by Rebecca Knight (Head of Assurance & Risk) 28/02/2020 NOTE: A copy of the approved Minutes from this Meeting or any papers referenced in this Key Issues Report will be made available to the Governing Body on request to the Committee Chair

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Governing Body Report

Date: 5th March 2020

Report title: Standards of Business Conduct including Conflicts of Interest Policy

Lead Manager: Rebecca Knight – Head of Assurance & Risk

Purpose: A new policy has been developed for use across NHS Halton CCG and NHS Warrington CCG

The Governing Body is asked to:

Approve the Standards of Business Conduct including Conflicts of Interest Policy

This Report supports the following CCG Strategic Objectives One - To commission services which continually improve the health and wellbeing of Halton residents. Two - To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations. Three - To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Four - To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders. Commissioning Plan Implications All staff involved in the commissioning or delivery of services should ensure that they have declared any interests which have or may have the potential to have any influence on the decision making about the commissioning of a service Financial Implications None Board Assurance Framework and Corporate Risk Register The policy aims to provide the relevant guidance to all staff to ensure that the CCG is fulfilling its statutory responsibilities in relation to the management of conflicts of interest. National Policy, Guidance, Standards, Targets or Legislation Best Practice Update on Conflicts of Interest – February 2019 Managing Conflicts of Interest: revised statutory guidance – June 2017 Equality and Diversity and Human Rights Throughout the development of this paper and any policies and processes cited, NHS Halton CCG has: • Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance

equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and

• Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

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Governing Body Report

UPDATED STANDARDS OF BUSINESS CONDUCT INCLUDING CONFLICTS OF INTEREST POLICY

BACKGROUND 1. Clinical Commissioning Groups have a statutory requirement to have arrangements in place

to manage conflicts of interest. Statutory guidance was issued by NHS England in 2017 which provided guidance regarding actions that must be taken to manage any interest appropriately.

2. A new policy has been developed for use across both NHS Halton CCG and NHS Warrington CCG and reflects the latest guidance issued by NHS England, including reference to new models of care and the management of interests in association to them.

PURPOSE 3. The purpose of this report is to present the updated Standards of Business Conduct

including Conflicts of Interest Policy for approval by the Governing Body.

KEY ISSUES TO NOTE 4. The draft Policy was presented to the Audit Committee on 5th February 2020. A Committees

in Common meeting was held for the Audit Committee of both CCGs. At this meeting, it was agreed by both CCG Audit Committees that they recommended the policy for approval.

RECOMMENDATION 5. The Governing Body is asked to:

a. Approve the Standards of Business Conduct including Conflicts of Interest Policy.

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STANDARDS OF BUSINESS CONDUCT INCLUDING CONFLICTS OF INTEREST POLICY

Version: 1.0 Ratified By: NHS Halton CCG and NHS Warrington

CCG Governing Bodies Date Ratified: Author Head of Assurance & Risk Date Issue Review Date April 2022 Policy Reference Number CORP001 Intended Audience See section 8

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Contents

1 Policy Statement on Business Conduct ................................................................... 3

2 Scope ...................................................................................................................... 3

3 Policy Statement ..................................................................................................... 4

4 Introduction ............................................................................................................. 6

5 Purpose ................................................................................................................... 7

6 Key definitions ......................................................................................................... 7

7 Interests .................................................................................................................. 8

8 Staff ......................................................................................................................... 8

9 Roles and Responsibilities ...................................................................................... 9

10 Privileged Information .......................................................................................... 12

11 Decision making staff .......................................................................................... 12

12 Identification, declaration and review of interests (including gifts and hospitality) 13

13 Records and Publication ..................................................................................... 14

14 Management of interests – general ..................................................................... 15

15 Management of interests – common situations ................................................... 16

16 Management of interests – advice in specific contexts ........................................ 22

17 Procurement ........................................................................................................ 23

18 Dealing with breaches ......................................................................................... 23

19 Review ................................................................................................................ 25

20 Monitoring ........................................................................................................... 25

21 Training ............................................................................................................... 25

22 Associated documentation .................................................................................. 26

Appendix A The Nolan Principles ............................................................................. 27

Appendix B: Declaration of interests form ................................................................ 28

Appendix C: Gifts and hospitality declaration form ................................................... 30

Appendix D: Guidance on new models of care ........................................................ 31

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1 Policy Statement on Business Conduct 1.1 This policy describes the standards and public service values which underpin

the work of the NHS and reflects current guidance and best practice which all NHS Halton CCG and NHS Warrington CCG staff must follow.

1.2 As publicly funded organisations, we have a duty to set and maintain the highest standards of conduct and integrity. We expect the highest standards of corporate behaviour and responsibility from Governing Body members and all officers. The NHS Constitution sets out some of the key responsibilities of NHS staff. All officers, regardless of their role, are expected to act in the spirit set out in the seven principles of public life: the ‘Nolan Principles’ (Appendix A).

1.3 It is a long and well-established principle that public-sector organisations must be impartial and honest in their business and that their officers must act with integrity.

1.4 As well as promoting the standards of business conduct expected of public bodies, this policy aims to protect our organisations and officers from any suggestion of corruption, partiality or dishonesty by providing a clear framework through which the organisation can provide guidance and assurance that its officers conduct themselves with honesty, integrity and probity. The policy should be read in conjunction with all relevant organisational policies which are developed and agreed in line with the principles set out in this policy.

2 Scope 2.1 All our staff, without exception, are included in the scope of this policy. This

applies to all who work for the CCGs, its’ member practices and Governing Body members, committee members as well as individuals who provide services to the CCGs.

2.2 This policy should be read in conjunction with:

• Relevant CCG Constitution • Relevant CCG Governance Manual • Relevant CCG organisational policies, such as, but not limited to, the

Whistleblowing Policy • Code of Conduct for NHS Managers 2002 • General Medical Council Good Medical Practice 2019

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2.3 Where an individual fails to comply with this Policy, disciplinary action may be taken, or the individual removed from office.

3 Policy Statement 3.1 Adhering to this policy will help to ensure that we use NHS money wisely,

providing best value for taxpayers and accountability to our patients for the decisions we take.

As a member of staff you should… As an organisation we will…

• Familiarise yourself with this policy and follow it. Refer to the guidance for the rationale behind this policy Managing Conflicts of Interest in the NHS

• Use your common sense and

judgement to consider whether the interests you have could affect the way taxpayers’ money is spent

• Regularly consider what interests you

have and declare these as they arise. If in doubt, declare.

• NOT misuse your position to further your own interests or those close to you

• NOT be influenced, or give the impression that you have been influenced by outside interests

• NOT allow outside interests you have to inappropriately affect the decisions you make when using taxpayers’ money

• Ensure that this policy and supporting processes are clear and help staff understand what they need to do.

• Identify a team or individual with

responsibility for: o Keeping this policy under review

to ensure they are in line with the guidance.

o Providing advice, training and support for staff on how interests should be managed.

o Maintaining register(s) of interests.

o Auditing this policy and its associated processes and procedures at least once every three years.

• NOT avoid managing conflicts of interest.

• NOT interpret this policy in a way which stifles collaboration and innovation with our partners

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4 Introduction

“If conflicts of interest are not managed effectively by CCGs, confidence in the probity of commissioning decisions and the integrity of clinicians involved could be seriously undermined. However, with good planning and governance, CCGs should be able to avoid these risks” RCGP and NHS Confederation: briefing paper on managing conflicts of interest. September 2011

4.1 NHS Halton CCG and NHS Warrington CCG (the ‘organisations’), and the

people who work with and for us, collaborate closely with other organisations, delivering high quality care for our patients.

4.2 These partnerships have many benefits and should help ensure that public

money is spent efficiently and wisely. But there is a risk that conflicts of interest may arise.

4.3 Providing best value for taxpayers and ensuring that decisions are taken

transparently and clearly, are both key principles in the NHS Constitution. Both CCGs are committed to maximising our resources for the benefit of the whole community. As two organisations and as individuals, we all have a duty to ensure that all our dealings are conducted to the highest standards of integrity and that NHS monies are used wisely so that we are using our finite resources in the best interests of patients.

4.4 It is important to manage conflicts of interest for the following reasons:

• To give confidence that commissioning decisions are robust, fair and offer value for money;

• To maintain public trust in the Clinical Commissioning Groups and the

NHS; • To protect healthcare professionals; and • Failure to manage conflicts of interest could lead to legal challenge and

criminal action. 4.5 The organisations, as commissioners of healthcare services, are both

committed to managing conflicts of interest in a way that demonstrates transparency, probity and accountability. This is particularly important when commissioning services that might be delivered by member practices as providers – ensuring that the approach taken does not affect or appear to affect the integrity of the organisations’ decision making.

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4.6 This will enable the organisations to withstand scrutiny and challenge and

also protect the CCGs, its staff and member practices from any perceptions of wrongdoing.

4.7 If in doubt, it is better to assume the existence of a conflict of interest

and manage it appropriately, rather than ignore it. 5 Purpose 5.1 Conflicts of interest are inevitable in public life. The purpose of this policy is to

ensure that best practice is followed in managing actual or potential conflicts of interest by:

• Safeguarding clinically led commissioning whilst ensuring objective

commissioning decisions; • Enabling the CCGs to demonstrate that they are acting fairly and

transparently and in the best interest in their patients and local populations; • Upholding the confidence and trust in the NHS; • Operating in the legal framework.

5.2 The policy sets out the governance framework for the management of

conflicts of interest by the CCG. 5.3 This policy will help our staff manage conflicts of interest risks effectively. It:

• Introduces consistent principles and rules • Provides simple advice about what to do in common situations.

• Supports good judgement about how to approach and manage interests

6 Key definitions 6.1 A ‘conflict of interest’ is:

“A set of circumstances by which a reasonable person would consider that an individual’s ability to apply judgement or act, in the context of delivering, commissioning, or assuring taxpayer funded health and care services is, or could be, impaired or influenced by another interest they hold.”

6.2 A ‘conflict of interest’ may be:

• Actual - there is a material conflict between one or more interests • Potential – there is a possibility of a material conflict between one or more

interests in the future

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6.3 Staff may hold interests for which they cannot see potential conflict. However, caution is always advisable because others may see it differently and perceived conflicts of interest can be damaging. All interests should be declared where there is a risk of perceived improper conduct.

7 Interests 7.1 Interests fall into the following categories:

• Financial interests - Where an individual may get direct financial benefit1 from the consequences of a decision they are involved in making.

• Non-financial professional interests - Where an individual may obtain a non-financial professional benefit from the consequences of a decision, they are involved in making, such as increasing their professional reputation or promoting their professional career.

• Non-financial personal interests - Where an individual may benefit personally in ways which are not directly linked to their professional career and do not give rise to a direct financial benefit, because of decisions they are involved in making in their professional career.

• Indirect interests - Where an individual has a close association2 with another individual who has a financial interest, a non-financial professional interest or a non-financial personal interest and could stand to benefit from a decision they are involved in making.

7.2 NHS England has produced a range of conflicts of interest case studies can

be found at Managing conflicts of interest: CCG case studies. Employees, members and governing body and committee members should refer to these examples of what might constitute a conflict of interest.

7.3 The above categories and examples are not exhaustive and the CCG will

exercise discretion on a case by case basis, having regard to the principles set out in the next section of this guidance, in deciding whether any other role, relationship or interest which would impair or otherwise influence the individual’s judgement or actions in their role within the CCG. If so, this should be declared and appropriately managed.

8 Staff 8.1 At NHS Halton CCG and NHS Warrington CCG we use the skills of many

different people, all of whom are vital to our work. This includes people on differing employment terms, who for the purposes of this policy we refer to as ‘staff’ and are listed below:

1 This may be a financial gain, or avoidance of a loss. 2 A common-sense approach should be applied to the term ‘close association’. Such an association might arise, depending on the circumstances, through relationships with close family members and relatives, close friends and associates, and business partners.

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• All salaried employees • All prospective employees, who are part way through recruitment • Agency staff, and • Governing Body, Committee, subcommittee and advisory group members

(who may not be directly employed or engaged by either CCG). 8.2 NHS England has issued some frequently asked questions for specific staff

groups on the issues posed and how the guidance applies to them. This guidance can be found at Managing conflicts of interest in the NHS

8.3 Additionally summary guides have been issued at Conflicts of interest

summary guides 8.4 The guidance included on the website above is directed at, but not limited to:

• GPs in commissioning roles • Conflict of Interest guardian • CCG governance leads • CCG lay members • Administration staff • Healthwatch members of CCG primary care committees

9 Roles and Responsibilities 9.1 Everyone in each CCG has responsibility to appropriately manage conflicts of

interest. Everyone is responsible for familiarising themselves with this policy and to comply with the provisions of it. The specific roles and responsibilities are set out below:

9.2 Governing Body and Audit Committee - Each CCG Governing Body, with

support from each CCG Audit Committee, will oversee this Policy and will ensure that there are systems and processes in place to support all member practices and individuals who hold positions of authority or who can make or influence decisions to:

• Declare their interest through a Register of Interests, which is made

available to the public via the relevant CCG website or on request to either CCG

• Declare any relevant interests through discussions and proceedings, so that any comments that are made are fully understood by all others in that context

• Appropriately manage the business to ensure that each CCG acts with integrity and probity.

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9.3 The Governing Body will take such steps as it deems appropriate, and request information it deems appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared.

9.4 The Governing Body will ensure that for every interest declared, either in

writing or by oral declaration, arrangements are put in place to manage the conflict of interest or potential conflict of interests to ensure the integrity of the CCG’s decision-making process.

9.5 Conflicts of Interest Guardian - The Chair of each Audit Committee has a

lead role as the Conflicts of Interest Guardian, in ensuring that the relevant Governing Body and the wider CCG behaves with the utmost probity at all times. The Conflicts of Interest Guardian will be supported in their role by the Head of Governance and Corporate Secretary.

9.6 The Conflicts of Interest Guardian will, in collaboration with the CCGs’ Head of

Governance and Corporate Secretary:

• Act as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest;

• Be a safe point of contact for employees or workers of the CCG to raise

any concerns in relation to this policy;

• Support the rigorous application of conflict of interest principles and policies;

• Provide independent advice and judgment where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation;

• Provide advice on minimising the risks of conflicts of interest.

• In their role as Chair of the Audit Committee, provide assurance to NHS England annually that the CCG has:

o Had due regard to the statutory guidance on managing conflicts of

interest; and o Implemented and maintained sufficient safeguards for the

commissioning of primary medical services. 9.7 Whilst the Conflicts of Interest Guardian has an important role within the

management of conflicts of interest, executive members of the CCG’s Governing Body have an on-going responsibility for ensuring the robust management of conflicts of interest.

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9.8 Governing Body Lay Members - Each Governing Body Lay Member plays a critical role in providing scrutiny, challenge and an independent voice in support of robust and transparent decision-making and management of conflicts of interest. The organisations recognise the lay members’ expanding role in primary care commissioning by appointing a Governing Body Lay Member as the Chair of each CCG Primary Care Commissioning Committee.

9.9 Primary Care Commissioning Committee (PCCC) - The PCCC has been

established as a committee of the Governing Body of each CCG. The committees are to carry out the functions and decisions relating to the commissioning of primary medical services in order to ensure a clear separation between those decisions that can be taken by the Governing Body including the GP Governing Body members and those where – due to actual or potential conflicts of interest - the GPs need to withdraw. The establishment of such a committee does not preclude GP participation in strategic discussions on primary medical care issues.

9.10 Each CCG will keep under consideration whether that committee has

sufficient clinical expertise that is not conflicted - taking into account the range of services being commissioned, for example, having a recently retired or out of area GP without an admitted or identified interest or perception of interest.

9.11 Chair of the PCCC - In order to manage any real or potential conflicts of

interest, the PCCC has a lay chair and deputy lay chair. The PCCC Chair and Deputy Chair will be supported in the management of conflicts of interest in the committee by the Head of Governance and Corporate Secretary.

9.12 To provide the necessary safeguards, the Audit Committee Chair, as Conflicts

of Interest Guardian will not hold the position of Chair or Deputy Chair of the PCCC.

9.13 Accountable Officer - has overall accountability for each CCG’s

management of conflicts of interest. The Accountable Officer has overall responsibility for this Policy, ensuring that a process for managing conflicts of interest is in place.

9.14 Head of Governance and Corporate Secretary is responsible for:

• The day-to-day management of conflicts of interest matters and queries; • Ensuring that appropriate systems and processes are in place to support

the management of conflicts of interest; • Supporting the Conflicts of Interest Guardian to enable them to carry out

their role effectively, ensuring they are well briefed on any matters arising and supported in investigating any potential breaches of the policy, as appropriate;

• Providing advice, support and guidance to the Accountable Officer, each CCG Chair, committee members, staff and each member practice on what

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might constitute a conflict of interest and how they should be managed; and

• Ensuring that anonymised details of breaches are published on each relevant CCG’s website to demonstrate learning and development.

9.15 Integrated Management Team - The role of the integrated management

team is to ensure they adhere to this policy in its entirety and that members of their staff are aware of this policy and associated processes.

9.16 All individuals are required to familiarise themselves with the contents of this

Policy and to comply with the provisions of it. 10 Privileged Information 10.1 No one should use confidential information, acquired in the pursuit of their

role, within either CCG to benefit themselves or another connected person, or create the impression of having done so.

10.2 Members of both CCGs, employees and each Governing Body should take

care not to provide any third party with a possible advantage by sharing privileged, personal or commercial information, or by providing information that may be commercially useful in advance of that information being made available public (such as by informing a potential supplier of an up and coming procurement in advance of other potential bidders), or any other information that is not otherwise available and in the public domain.

11 Decision making staff 11.1 Some staff are more likely than others to have a decision-making influence on

the use of taxpayers’ money, because of the requirements of their role. For the purposes of this guidance these people are referred to as ‘decision making staff.’

11.2 Decision making staff in these organisations are:

• Governing Body members • Members of staff at band 8d and above • Members of committees and advisory groups who contribute to direct or

delegated decision making on the commissioning or provision of taxpayer funded services

• Members of the Primary Care Commissioning Committee • Members of new care models joint provider / commissioner groups • Administrative and clinical staff who have the power to enter into contracts

on behalf of their organisations

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• Administrative and clinical staff involved in decision making concerning the commissioning of services, purchasing of goods, medicines, medical devices or equipment and formulary decisions

12 Identification, declaration and review of interests (including gifts and hospitality)

12.1 Identification and declaration - All staff should identify and declare material interests at the earliest opportunity (and in any event within 28 days). If staff are in any doubt as to whether an interest is material then they should declare it, so that it can be considered. Declarations should be made:

• On appointment with either CCG • When staff move to a new role or their responsibilities change significantly • At the beginning of a new project or piece of work • As soon as circumstances change and new interests arise (for example, in

a meeting when interests staff hold are relevant to the matters in discussion).

12.2 A declaration of interest form is available at:

https://nhswarringtonccg.mydeclarations.co.uk/home (for Warrington)

Website link to be inserted when confirmed by the host provider (for Halton)

12.3 Alternatively, in the event of any difficulties in accessing the above websites, a template can be found in Appendix B. As a minimum, each CCG is required to capture the following information:

• The returnee’s (person declaring the interest) name and their role within the organisation

• A description of the interest declared • Relevant dates relating to the interest • Space for comments (e.g. action taken to mitigate the conflict)

12.4 Members of staff within the corporate governance team (of the corporate services department) will be responsible for implementing this policy and guidance by:

• Reviewing policies to ensure they reflect the most up-to-date guidance in a timely manner;

• Providing advice, training and support for staff on how interests should be managed;

• Maintaining registers of interests; • Auditing the policy, process and procedures at least every three years.

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12.5 Any queries relating to conflict of interest matters should be directed in the first instance to warccg.halccgregisterofinterest@nhs.net

Any declarations of interest made via the template in Appendix B should be sent to the generic email address as shown above. Staff with specific roles relating to conflicts of interest are shown below:

Conflicts of Interest Guardian – Gareth Hall

Head of Governance and Corporate Secretary – Rebecca Knight

Risk and Assurance Co-ordinator – Lisa Woodall

12.6 After expiry, an interest will remain on register(s) for a minimum of 6 months

and a private record of historic interests will be retained for a minimum of 6 years.

12.7 Proactive review of interests. We will prompt decision making staff on an

annual basis to review declarations they have made. Decision making staff are required to update them or make a nil return.

12.8 Additional reminders will be circulated to all staff throughout the year, for

example, following periods when gifts may be more prevalent. All staff should not wait for any reminder but comply with the requirement to declare as outlined in this policy.

13 Records and Publication 13.1 CCGs have a statutory requirement to maintain one or more registers of

interest of: the members of the group, members of its governing body, members of its committees or sub-committees of its governing body, and its employees. CCGs must publish, and make arrangements, to ensure that members of the public have access to these registers on request.

13.2 Both CCGs will maintain a register of gifts and hospitality and a register of

interests (which contains all other interests with the exception of gifts and hospitality).

13.3 The Corporate Governance team (referenced previously in this policy and at

section 12.5) will maintain each register, ensuring that they are published at least annually on the public website of each CCG.

13.4 The Registers on the public website will contain interests declared by all

decision-making staff in each respective CCG. 13.5 When a new interest is declared via Declare (governance software), it will be

reviewed by the Head of Governance and Corporate Secretary, prior to any

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interests for decision making staff being made available on the public website. All declarations will be reviewed within ten working days.

13.6 If decision making staff have substantial grounds for believing that publication

of their interests should not take place then they should contact the Head of Governance and Corporate Secretary to explain why. In exceptional circumstances, for instance where publication of information might put a member of staff at risk of harm, information may be withheld or redacted on public registers. However, this would be the exception and information will not be withheld or redacted merely because of a personal preference.

13.7 Wider transparency issues. NHS Halton CCG and NHS Warrington CCG

fully support wider transparency initiatives in healthcare, and staff are encouraged to engage actively with these.

13.8 Relevant staff are strongly encouraged to give their consent for payments they

receive from the pharmaceutical industry to be disclosed as part of the Association of British Pharmaceutical Industry (ABPI) Disclosure UK initiative. These “transfers of value” include payments relating to:

• Speaking at and chairing meetings • Training services • Advisory board meetings • Fees and expenses paid to healthcare professionals • Sponsorship of attendance at meetings, which includes registration fees

and the costs of accommodation and travel, both inside and outside the UK

• Donations, grants and benefits in kind provided to healthcare organisations 13.9 Further information about the scheme can be found on the ABPI website: https://www.abpi.org.uk/our-ethics/disclosure-uk/ 14 Management of interests – general 14.1 If an interest is declared, but there is no risk of a conflict arising then no action

is warranted. However, if a material interest is declared then the general management actions that could be applied include:

• restricting staff involvement in associated discussions and excluding them

from decision making • removing staff from the whole decision-making process • removing staff responsibility for an entire area of work • removing staff from their role altogether if they are unable to operate

effectively in it because the conflict is so significant. 14.2 Each case will be different and context-specific, and NHS Halton CCG and

NHS Warrington CCG will always clarify the circumstances and issues with

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the individuals involved. The Head of Governance and Corporate Secretary will maintain a written audit trail of information considered and actions taken.

14.3 Staff who declare material interests should make their line manager or the

person(s) they are working to aware of their existence. 15 Management of interests – common situations 15.1 This section sets out the principles and rules to be adopted by staff in

common situations, and what information should be declared. 15.2 Gifts – staff should not accept gifts that may affect, or be seen to affect, their

professional judgement. Gifts from suppliers or contractors doing business (or likely to do business) with the organisation should be declined, whatever their value. Low cost branded promotional aids such as pens or post-it notes may, however, be accepted where they are under the value of £63 in total, and need not be declared

15.3 Gifts from other sources (patients, families, service users) – the following

guidance must be followed:

• Gifts of cash and vouchers to individuals should always be declined. • Staff should not ask for any gifts. • Gifts valued at over £50 should be treated with caution but should not be

accepted in a personal capacity. These should be declared by staff. (If in doubt, advice and guidance should be sought from the Corporate Services Team).

• Modest gifts accepted under a value of £50 do not need to be declared. • A common sense approach should be applied to the valuing of gifts (using

an actual amount, if known, or an estimate that a reasonable person would make as to its value).

• Multiple gifts from the same source over a 12-month period should be treated in the same way as single gifts over £50 where the cumulative value exceeds £50.

15.4 Acceptance of gifts – where gifts are accepted and are required to be

declared, the following information is required: • Staff name and their role within the CCG • A description of the nature and value of the gift, including the source • Date of receipt • Any other relevant information (e.g. circumstances surrounding the gift,

action taken to mitigate against a conflict, details of any approvals given to depart from the terms of this policy).

3 The £6 value has been selected with reference to existing industry guidance issued by the ABPI: http://www.pmcpa.org.uk/thecode/Pages/default.aspx

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15.5 Hospitality – staff should not ask for or accept hospitality that may affect, or

be seen to affect, their professional judgement. Hospitality must only be accepted when there is a legitimate business reason and it is proportionate to the nature and purpose of the event.

15.6 Particular caution should be exercised when hospitality is offered by actual or

potential suppliers or contractors. This can be accepted, and must be declared, if modest and reasonable. Approval from a senior manager from the Integrated Management Team must be obtained in the first instance.

15.7 Meals and refreshments – the following must be adhered to:

• Under a value of £25 may be accepted and does not need to be declared. • Of a value between £25 and £754 - may be accepted and must be

declared. • Over a value of £75 - should be refused unless (in exceptional

circumstances) senior management approval from a member of the Integrated Management Team is given. A clear reason should be recorded on the organisation’s register(s) of interest as to why it was permissible to accept.

• A common sense approach should be applied to the valuing of meals and refreshments (using an actual amount, if known, or a reasonable estimate).

15.8 Travel and accommodation – the following must be adhered to:

• Modest offers to pay some or all of the travel and accommodation costs related to attendance at events may be accepted and must be declared.

• Offers which go beyond modest or are of a type that the organisations might not usually offer, need approval by senior staff from the Integrated Management Team, should only be accepted in exceptional circumstances, and must be declared. A clear reason should be recorded on the organisations’ register(s) of interest as to why it was permissible to accept travel and accommodation of this type. A non-exhaustive list of examples includes:

o offers of business class or first-class travel and accommodation (including domestic travel)

o offers of foreign travel and accommodation. 15.9 Acceptance of hospitality - where hospitality is accepted and is required to

be declared, the following information is required:

• Staff name and their role within the CCG

4 The £75 value has been selected with reference to existing industry guidance issued by the ABPI http://www.pmcpa.org.uk/thecode/Pages/default.aspx

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• A description of the nature and value of the hospitality, including the source

• Date of receipt • Any other relevant information (e.g. circumstances surrounding the

hospitality, action taken to mitigate against a conflict, details of any approvals given to depart from the terms of this policy).

15.10 Outside employment – All staff should declare any existing outside

employment on appointment and any new outside employment when it arises. Where a risk of conflict of interest arises, the general management actions outlined in this policy should be considered and applied to mitigate risks. Where contracts of employment or terms and conditions of engagement permit, staff may be required to seek prior approval from the organisation to engage in outside employment.

15.11 If individuals have employment other than their employment with either CCG,

they must write to their Manager giving details of the hours and days worked and duties carried out, seeking agreement that this work will not be detrimental to their employment within the CCG.

15.12 The CCG reserves the right to refuse permission where it believes a

conflict will arise which cannot be effectively managed. In particular, it is unacceptable for pharmacy advisors or other advisors, employees or consultants to the CCG on matters of procurement, to themselves be in receipt of payments from the pharmaceutical or devices sector.

15.13 Employees should be advised not to engage in outside employment during

any periods of sickness absence from the CCG. To do so may lead to a referral being made to the Local Counter Fraud Specialist for investigation which may lead to criminal and/or disciplinary action in accordance with the CCGs’ Anti-Fraud Policy.

15.14 Shareholdings and other ownership issues. Staff should declare, as a

minimum, any shareholdings and other ownership interests in any publicly listed, private or not-for-profit company, business, partnership or consultancy which is doing, or might be reasonably expected to do, business with the organisation.

15.15 Where shareholdings or other ownership interests are declared and give rise

to risk of conflicts of interest then the general management actions outlined in this policy should be considered and applied to mitigate risks. There is no need to declare shares or securities held in collective investment or pension funds or units of authorised unit trusts.

15.16 Declaration of shareholdings or ownership interests should include the

following information:

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• Staff name and their role within the organisation • Nature of the shareholdings / ownership interests • Relevant dates

Other relevant information (e.g. action taken to mitigate against a conflict, details of any approvals given to depart from the terms of this policy).

15.17 Patents - Staff should declare patents and other intellectual property rights

they hold (either individually, or by virtue of their association with a commercial or other organisation), including where applications to protect have started or are ongoing, which are, or might be reasonably expected to be, related to items to be procured or used by the organisation.

15.18 Staff should seek prior permission from either organisation before entering

into any agreement with bodies regarding product development, research, work on pathways etc, where this impacts on the organisations’ own time, or uses its equipment, resources or intellectual property.

15.19 Where holding of patents and other intellectual property rights give rise to a

conflict of interest then the general management actions outlined in this policy should be considered and applied to mitigate risks.

15.20 Declaration of patents should include the following information:

• Staff name and their role within the organisation • Nature of the patent • Relevant dates • Other relevant information (e.g. action taken to mitigate against a conflict,

details of any approvals given to depart from the terms of this policy). 15.21 Loyalty - Loyalty interests should be declared by staff involved in decision

making where they:

• Hold a position of authority in another NHS organisation or commercial, charity, voluntary, professional, statutory or other body which could be seen to influence decisions they take in their NHS role.

• Sit on advisory groups or other paid or unpaid decision-making forums that can influence how an organisation spends taxpayers’ money.

• Are, or could be, involved in the recruitment or management of close family members and relatives, close friends and associates, and business partners.

• Are aware that their organisation does business with an organisation in which close family members and relatives, close friends and associates, and business partners have decision making responsibilities.

15.22 Donations - made by suppliers or bodies seeking to do business with either

organisation should be treated with caution and not routinely accepted. In

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exceptional circumstances they may be accepted but should always be declared. A clear reason should be recorded as to why it was deemed acceptable, alongside the actual or estimated value.

15.23 Staff should not actively solicit charitable donations unless this is a prescribed

or expected part of their duties for either organisation or is being pursued on behalf of the organisations’ own registered charity or other charitable body and is not for their own personal gain.

15.24 Staff must obtain permission from either organisation if in their professional

role they intend to undertake fundraising activities on behalf of a pre-approved charitable campaign for a charity other than the organisation’s own (where applicable).

15.25 Each organisation must maintain records in line with the above principles and

rules and relevant obligations under charity law. 15.26 Sponsored events - Sponsorship of events by appropriate external bodies

will only be approved if a reasonable person would conclude that the event will result in clear benefit to the organisations and the NHS. During dealings with sponsors there must be no breach of patient or individual confidentiality or data protection rules and legislation.

15.27 No information should be supplied to the sponsor from whom they could gain

a commercial advantage, and information which is not in the public domain should not normally be supplied. At the organisations’ discretion, sponsors or their representatives may attend or take part in the event, but they should not have a dominant influence over the content or the main purpose of the event.

15.28 The involvement of a sponsor in an event should always be clearly identified.

Staff within the CCGs involved in securing sponsorship of events should make it clear that sponsorship does not equate to endorsement of a company or its products and this should be made visibly clear on any promotional or other materials relating to the event. Staff arranging sponsored events must declare this to the organisation.

15.29 Sponsored research - Funding sources for research purposes must be

transparent. Any proposed research must go through the relevant health research authority or other approvals process. There must be a written protocol and written contract between staff, the organisation, and/or institutes at which the study will take place and the sponsoring organisation, which specifies the nature of the services to be provided and the payment for those services.

15.30 The study must not constitute an inducement to prescribe, supply, administer,

recommend, buy or sell any medicine, medical device, equipment or service. Staff should declare involvement with sponsored research to the organisation.

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The CCGs will retain written records of sponsorship of research, in line with the above principles and rules.

15.31 Sponsored posts - External sponsorship of a post requires prior approval

from the organisation. Rolling sponsorship of posts should be avoided unless appropriate checkpoints are put in place to review and withdraw if appropriate.

15.32 Sponsorship of a post should only happen where there is written confirmation

that the arrangements will have no effect on purchasing decisions or prescribing and dispensing habits. This should be audited for the duration of the sponsorship. Written agreements should detail the circumstances under which organisations have the ability to exit sponsorship arrangements if conflicts of interest which cannot be managed arise.

15.33 Sponsored post holders must not promote or favour the sponsor’s products,

and information about alternative products and suppliers should be provided. Sponsors should not have any undue influence over the duties of the post or have any preferential access to services, materials or intellectual property relating to or developed in connection with the sponsored posts.

15.34 The CCGs will retain written records of sponsorship of posts, in line with the

above principles and rules. Staff should declare any other interests arising as a result of their association with the sponsor, in line with the content in the rest of this policy.

15.35 Clinical private practice - Clinical staff should declare all private practice on

appointment, and/or any new private practice when it arises5 including:

• Where they practise (name of private facility). • What they practise (specialty, major procedures). • When they practise (identified sessions/time commitment).

15.36 Clinical staff should (unless existing contractual provisions require otherwise

or unless emergency treatment for private patients is needed):

• Seek prior approval of their organisation before taking up private practice. • Ensure that, where there would otherwise be a conflict or potential conflict

of interest, NHS commitments take precedence over private work.6 • Not accept direct or indirect financial incentives from private providers

other than those allowed by Competition and Markets Authority guidelines: CMA Private Healthcare Market Investigation Order 2014

5 Hospital Consultants are already required to provide their employer with this information by virtue of Para.3 Sch. 9 of the Terms and Conditions – Consultants (England) 2003: https://www.bma.org.uk/-/media/files/pdfs/practical advice at work/contracts/consultanttermsandconditions.pdf 6 These provisions already apply to Hospital Consultants by virtue of Paras.5 and 20, Sch. 9 of the Terms and Conditions – Consultants (England) 2003: https://www.bma.org.uk/-/media/files/pdfs/practical advice at work/contracts/consultanttermsandconditions.pdf)

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16 Management of interests – advice in specific contexts 16.1 Management of conflicts of interest throughout the commissioning

cycle

In common with other NHS bodies, NHS Halton CCG and NHS Warrington CCG uses a variety of different groups to make key strategic decisions about things such as: • Entering into (or renewing) large scale contracts. • Awarding grants. • Making procurement decisions. • Selection of medicines, equipment, and devices.

16.2 Conflicts of interest need to be managed appropriately throughout the whole

commissioning cycle. At the outset of a commissioning process, the relevant interests of all individuals involved will be identified and clear arrangements put in place to manage any conflicts of interest. This includes consideration as to which stages of the process a conflicted individual should not participate in, and, in some circumstances, whether that individual should be involved in the process at all.

16.3 The interests of those who are involved in the decision-making groups should

be well known so that they can be managed effectively. For the two organisations these groups include the Governing Body, Joint Committees, Audit Committees, Remuneration Committees, Primary Care Commissioning Committees, Quality Committee, Finance and Performance Committee and the local commissioning committee (in both Halton and Warrington).

16.4 These groups should adopt the following principles:

• Chairs should consider any known interests of members in advance and begin each meeting by asking for declaration of relevant material interests.

• Members should take personal responsibility for declaring material interests at the beginning of each meeting and as they arise.

• Any new interests identified should be added to the organisations’ register(s).

• The deputy chair (or other non-conflicted member) should chair all or part of the meeting if the chair has an interest that may prejudice their judgement.

16.5 If a member has an actual or potential interest the chair should consider the

following approaches and ensure that the reason for the chosen action is documented in minutes or records:

• Requiring the member to not attend the meeting.

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• Excluding the member from receiving meeting papers relating to their interest.

• Excluding the member from all or part of the relevant discussion and decision.

• Noting the nature and extent of the interest but judging it appropriate to allow the member to remain and participate.

• Removing the member from the group or process altogether. 16.6 The default response should not always be to exclude members with

interests, as this may have a detrimental effect on the quality of the decision being made. Good judgement is required to ensure proportionate management of risk.

17 Procurement 17.1 Procurement should be managed in an open and transparent manner,

compliant with procurement and other relevant law, to ensure there is no discrimination against or in favour of any provider. Procurement processes should be conducted in a manner that does not constitute anti-competitive behaviour - which is against the interest of patients and the public.

Those involved in procurement exercises for and on behalf of the organisation should keep records that show a clear audit trail of how conflicts of interest have been identified and managed as part of procurement processes. At every stage of procurement steps should be taken to identify and manage conflicts of interest to ensure and to protect the integrity of the process.

17.2 Further, more detailed information about the management of procurement can

be found in the Procurement Policy, located on each CCG’s public website. 18 Dealing with breaches 18.1 There will be situations when interests will not be identified, declared or

managed appropriately and effectively. This may happen innocently, accidentally, or because of the deliberate actions of staff or other organisations. For the purposes of this policy these situations are referred to as ‘breaches’.

18.2 Identifying and reporting breaches Staff who are aware about actual breaches of this policy, or who are

concerned that there has been, or may be, a breach, should report these concerns to the Head of Governance and Corporate Secretary. To ensure that interests are effectively managed staff are encouraged to speak up about actual or suspected breaches. Every individual has a responsibility to do this.

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For further information about how concerns should be raised, you should refer to the CCGs Whistleblowing Policy.

18.3 The organisations will investigate each reported breach according to its own

specific facts and merits and give relevant parties the opportunity to explain and clarify any relevant circumstances.

18.4 Following investigation, the organisations will:

• Decide if there has been or is potential for a breach and if so what the severity of the breach is.

• Assess whether further action is required in response – this is likely to involve any staff member involved and their line manager, as a minimum.

• Consider who else inside and outside the organisation should be made aware.

• Take appropriate action as set out in the next section. 18.3 Taking action in response to breaches

Action taken in response to breaches of this policy will be in accordance with the disciplinary procedures of each organisation and could involve organisational leads for staff support (e.g. Human Resources), fraud (e.g. Local Counter Fraud Specialists), members of the integrated management team and organisational auditors.

18.4 Breaches could require action in one or more of the following ways:

• Clarification or strengthening of existing policy, process and procedures. • Consideration as to whether HR/employment law/contractual action should

be taken against staff or others. • Consideration being given to escalation to external parties. This might

include referral of matters to external auditors, NHS Protect, the Police, statutory health bodies (such as NHS England, NHS Improvement or the Care Quality Commission), and/or health professional regulatory bodies.

18.5 Inappropriate or ineffective management of interests can have serious

implications for the organisations and staff. There will be occasions where it is necessary to consider the imposition of sanctions for breaches.

18.6 Sanctions should not be considered until the circumstances surrounding

breaches have been properly investigated. However, if such investigations establish wrong-doing or fault then the organisations can and will consider the range of possible sanctions that are available, in a manner which is proportionate to the breach. This includes:

• Employment law action against staff, which might include

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o Informal action (such as reprimand or signposting to training and/or guidance).

o Formal disciplinary action (such as formal warning, the requirement for additional training, re-arrangement of duties, re-deployment, demotion, or dismissal).

• Reporting incidents to the external parties described above for them to consider what further investigations or sanctions might be.

• Contractual action, such as exercise of remedies or sanctions against the body or staff which caused the breach.

• Legal action, such as investigation and prosecution under fraud, bribery and corruption legislation.

18.7 In the event of any breach of this policy, the matters to be investigated will be

considered first and foremost by the Conflicts of Interest Guardian and Head of Governance and Corporate Secretary.

18.8 Learning and transparency in relation to breaches

Reports on breaches, the impact of these, and action taken will be considered by each CCG’s Audit Committee. To ensure that lessons are learned, and management of interests can continually improve, anonymised information on breaches, the impact of these, and action taken will be prepared and published on the relevant CCG website as appropriate, or made available for inspection by the public upon request.

19 Review 19.1 This policy will be reviewed in three years unless an earlier review is required.

This will be led by the Head of Governance and Corporate Secretary. 20 Monitoring 20.1 The monitoring and compliance of this policy will be reported on a regular

basis to each Audit Committee. This is included in the annual workplan of each committee.

20.2 In addition, a section on arrangements for the management of conflicts of

interest is included within each CCG’s Annual Report. 21 Training 21.1 All staff included in Section 8 of this policy are required to complete the

annual mandatory training on the management of conflicts of interest. This is to ensure staff and others within the CCG understand what conflicts are, their responsibilities under the conflicts of interest policy, how to manage conflicts effectively and how to raise concerns about suspected or known breaches.

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21.2 Compliance with training is also reported on an annual and quarterly basis to NHS England and NHS Improvement under the Probity and Corporate Governance indicator (for leadership and workforce).

21.3 Appropriate HR policies should be cross referenced with the requirement to

be compliant with training to identify any action that may arise as a result of non-compliance.

22 Associated documentation

• NHS England, Managing Conflicts of Interest: Revised Statutory Guidance for CCGs (June 2017)

• NHS Halton Constitution (whichever is applicable) • NHS Warrington Constitution (whichever is applicable) • CCG Anti-Fraud, Bribery and Corruption Policy • CCG Procurement Policy • CCG Engagement and Experience Strategy • CCG Disciplinary Policy • CCG Equality and Diversity Policy • CCG Incremental Pay Progression Policy • CCG Learning and Development Policy • CCG Grievance and Disputes Policy • CCG Performance Management Policy • CCG Volunteer Policy • CCG Whistleblowing Policy • Freedom of Information Act 2000 • Standards for members of NHS Boards and CCG Governing Bodies in

England • Code of Conduct for NHS Managers 2002 • Ensuring Transparency and Probity, (2011) British Medical Association,

Managing Conflicts of interests in Clinical Commissioning Groups, Royal College of General Practitioners / NHS Confederation, (2011)

• Good Medical Practice, General Medical Council, 2019 • ABPI: The Code of Practice for the Pharmaceutical Industry (2014) • ABHI Code of Business Practice • NHS Code of Conduct and Accountability (July 2004)

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Appendix A The Nolan Principles The 7 principles of public life Selflessness Holders of public office should act solely in terms of the public interest. Integrity Holders of public office must avoid placing themselves under any obligation to people or organisations that might try inappropriately to influence them in their work. They should not act or take decisions in order to gain financial or other material benefits for themselves, their family, or their friends. They must declare and resolve any interests and relationships. Objectivity Holders of public office must act and take decisions impartially, fairly and on merit, using the best evidence and without discrimination or bias. Accountability Holders of public office are accountable to the public for their decisions and actions and must submit themselves to the scrutiny necessary to ensure this. Openness Holders of public office should act and take decisions in an open and transparent manner. Information should not be withheld from the public unless there are clear and lawful reasons for so doing. Honesty Holders of public office should be truthful. Leadership Holders of public office should exhibit these principles in their own behaviour. They should actively promote and robustly support the principles and be willing to challenge poor behaviour wherever it occurs.

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Appendix B: Declaration of interests form Name:

Position within, or relationship with, the CCG (or other organisation in the event of joint committees):

Detail of interests held (complete all that are applicable):

Type of Interest* *See section 7 and 15

Description of Interest (including for indirect interests, details of the relationship with the person who has the interest)

Date interest relates From & To

Actions to be taken to mitigate risk (to be agreed with line manager or a senior CCG manager)

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisation’s policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and, in the case of ‘decision making staff’ (as defined in the statutory guidance on managing conflicts of interest for CCGs) may be published in registers that the CCG holds.

I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, or internal disciplinary action may result. Decision making staff should be aware that the information provided in this form will be added to the CCG’s registers which are held in hardcopy for inspection by the public and published on the CCG’s website. Decision making staff must make any third party whose personal data they are providing in this form aware that the personal data will held in hardcopy for inspection by the public and published on the CCG’s website and must inform the third party that the CCG’s privacy policy is available on the CCG’s website. If you are not sure whether you are a ‘decision making’ member of staff, please speak to your line manager before completing this form. (Return to warccg.halccgregisterofinterest@nhs.net ) Signed Position Date Employee Manager

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Guidance notes for completion of declaration of interests form Name and role: Insert your name and role in relation to the organisation

you are working for Description of interest: Provide a description of the interest that is being

declared. This should contain enough information to be meaningful. That is, the information provided should enable a reasonable person with no prior knowledge to be able to read this and understand the nature of the interest.

See sections 7 and 15 for further information Relevant dates: Detail here when the interest arose and when it ceased (if

relevant) Comments: This section should detail any action taken to manage an

actual or potential conflict of interest. It might also detail any approvals or permissions to adopt a certain course of action.

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Appendix C: Gifts and hospitality declaration form Recipient name and signature

Position Date of Estimated value

Supplier name and nature of business

Details of previous offers by this supplier or acceptance by this supplier

Offer Receipt (if applicable)

Details of the officer reviewing and approving the declaration and signature

Date of review

Declined or accepted?

Reasons for declining or accepting

Other comments

The information submitted will be held by the CCG for personnel or other reasons specified on this form and to comply with the organisations’ policies. This information may be held in both manual and electronic form in accordance with the Data Protection Act 1998. Information may be disclosed to third parties in accordance with the Freedom of Information Act 2000 and in the case of ‘decision making staff’ (as defined in the statutory guidance on managing conflicts of interest for CCGs), may be published in registers that the CCG holds. I confirm that the information provided above is complete and correct. I acknowledge that any changes in these declarations must be notified to the CCG as soon as practicable and no later than 28 days after the interest arises. I am aware that if I do not make full, accurate and timely declarations then civil, criminal, professional regulatory or internal disciplinary action may result. (Return to warccg.halccgregisterofinterest@nhs.net )

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Appendix D: Guidance on new models of care Introduction

1. Conflicts of interest can arise throughout the whole commissioning cycle from needs assessment, to procurement exercises, to contract monitoring. They arise in many situations, environments and forms of commissioning.

2. Where CCGs are commissioning new care models7, particularly those that include primary medical services, it is likely that there will be some individuals with roles in the CCG (whether clinical or non-clinical), that also have roles within a potential provider, or may be affected by decisions relating to new care models. Any conflicts of interest must be identified and appropriately managed, in accordance with this statutory guidance.

3. This annex is intended to provide further advice and support to help CCGs to

manage conflicts of interest in the commissioning of new care models. It summarises key aspects of the statutory guidance which are of particular relevance to commissioning new care models rather than setting out new requirements. Whilst this annex highlights some of the key aspects of the statutory guidance, CCGs should always refer to, and comply with, the full statutory guidance.

Identifying and managing conflicts of interest 4. The statutory guidance for CCGs is clear that any individual who has a material

interest in an organisation which provides, or is likely to provide, substantial services to a CCG (whether as a provider of healthcare or provider of commissioning support services, or otherwise) should recognise the inherent conflict of interest risk that may arise and should not be a member of the governing body or of a committee or sub-committee of the CCG.

5. In the case of new care models, it is perhaps likely that there will be individuals

with roles in both the CCG and new care model provider/potential provider. These conflicts of interest should be identified as soon as possible, and appropriately managed locally. The position should also be reviewed whenever an individual’s role, responsibility or circumstances change in a way that affects the individual’s interests. For example where an individual takes on a new role outside the CCG, or enters into a new business or relationship, these new interests should be promptly declared and appropriately managed in accordance with the statutory guidance.

6. There will be occasions where the conflict of interest is profound and acute. In

such scenarios (such as where an individual has a direct financial interest 7 Where we refer to ‘new care models’ in this note, we are referring to any Multi-speciality Community Provider (MCP), Primary and Acute Care Systems (PACS) or other arrangements of a similar scale or scope that (directly or indirectly) includes primary medical services.

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which gives rise to a conflict, e.g., secondary employment or involvement with an organisation which benefits financially from contracts for the supply of goods and services to a CCG or aspires to be a new care model provider), it is likely that CCGs will want to consider whether, practically, such an interest is manageable at all.

7. CCGs should note that this can arise in relation to both clinical and non-clinical

members/roles. If an interest is not manageable, the appropriate course of action may be to refuse to allow the circumstances which gave rise to the conflict to persist. This may require an individual to step down from a particular role and/or move to another role within the CCG and may require the CCG to take action to terminate an appointment if the individual refuses to step down.

8. CCGs should ensure that their contracts of employment and letters of

appointment, HR policies, governing body and committee terms of reference and standing orders are reviewed to ensure that they enable the CCG to take appropriate action to manage conflicts of interest robustly and effectively in such circumstances.

9. Where a member of CCG staff participating in a meeting has dual roles, for

example a role with the CCG and a role with a new care model provider organisation, but it is not considered necessary to exclude them from the whole or any part of a CCG meeting, he or she should ensure that the capacity in which they continue to participate in the discussions is made clear and correctly recorded in the meeting minutes, but where it is appropriate for them to participate in decisions they must only do so if they are acting in their CCG role.

10. CCGs should take all reasonable steps to ensure that employees, committee

members, contractors and others engaged under contract with them are aware of the requirement to inform the CCG if they are employed or engaged in, or wish to be employed or engaged in, any employment or consultancy work in addition to their work with the CCG (for example, in relation to new care model arrangements).

11. CCGs should identify as soon as possible where staff might be affected by the

outcome of a procurement exercise, e.g., they may transfer to a provider (or their role may materially change) following the award of a contract. This should be treated as a relevant interest, and CCGs should ensure they manage the potential conflict. This conflict of interest arises as soon as individuals are able to identify that their role may be personally affected.

12. Similarly, CCGs should identify and manage potential conflicts of interest where

staff are involved in both the contract management of existing contracts, and involved in procurement of related new contracts.

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Governance arrangements 13. Appropriate governance arrangements must be put in place that ensure that

conflicts of interest are identified and managed appropriately, in accordance with this statutory guidance, without compromising the CCG’s ability to make robust commissioning decisions.

14. We know that some CCGs are adapting existing governance arrangements and

others developing new ones to manage the risks that can arise when commissioning new care models. We are therefore, not recommending a “one size fits” all governance approach, but have included some examples of governance models which CCGs may want to consider.

15. The principles set out in the general statutory guidance on managing conflicts

of interest (paragraph 19-23), including the Nolan Principles and the Good Governance Standards for Public Services (2004), should underpin all governance arrangements.

16. CCGs should consider whether it is appropriate for the Governing Body to take

decisions on new care models or (if there are too many conflicted members to make this possible) whether it would be appropriate to refer decisions to a CCG committee.

Primary Care Commissioning Committee 17. Where a CCG has full delegation for primary medical services, CCGs could

consider delegating the commissioning and contract management of the entire new care model to its Primary Care Commissioning Committee. This Committee is constituted with a lay and executive majority, and includes a requirement to invite a Local Authority and Healthwatch representative to attend (see paragraph 97 onwards of the CCG guidance).

18. Should this approach be adopted, the CCG may also want to increase the

representation of other relevant clinicians on the Primary Care Commissioning Committee when new care models are being considered. The use of the Primary Care Commissioning Committee may assist with the management of conflicts/quorum issues at governing body level without the creation of a new forum/committee within the CCG.

19. If the CCG does not have a Primary Care Commissioning Committee, the CCG

might want to consider whether it would be appropriate/advantageous to establish either:

a) A new care model commissioning committee (with membership

including relevant non-conflicted clinicians, and formal decision-making powers similar to a Primary Care Commissioning Committee (“NCM Commissioning Committee”); or

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b) A separate clinical advisory committee, to act as an advisory body to

provide clinical input to the Governing Body in connection with a new care model project, with representation from all providers involved or potentially involved in the new care model but with formal decision making powers remaining reserved to the governing body (“NCM Clinical Advisory Committee”).

NCM Commissioning Committee 20. The establishment of a NCM Commissioning Committee could help to provide

an alternative forum for decisions where it is not possible/appropriate for decisions to be made by the Governing Body due to the existence of multiple conflicts of interest amongst members of the Governing Body. The NCM Commissioning Committee should be established as a sub-committee of the Governing Body.

21. The CCG could make the NCM Commissioning Committee responsible for

oversight of the procurement process and provide assurance that appropriate governance is in place, managing conflicts of interest and making decisions in relation to new care models on behalf of the CCG. CCGs may need to amend their constitution if it does not currently contain a power to set up such a committee either with formal delegated decision-making powers or containing the proposed categories of individuals (see below).

22. The NCM Commissioning Committee should be chaired by a lay member and

include non-conflicted GPs and CCG members, and relevant non-conflicted secondary care clinicians.

NCM Clinical Advisory Committee 23. This advisory committee would need to include appropriate clinical

representation from all potential providers, but have no decision-making powers. With conflicts of interest declared and managed appropriately, the NCM Clinical Advisory Committee could formally advise the CCG Governing Body on clinical matters relating to the new care model, in accordance with a scope and remit specified by the Governing Body.

24. This would provide assurance that there is appropriate clinical input into

Governing Body decisions, whilst creating a clear distinction between the clinical/provider side input and the commissioner decision-making powers (retained by the Governing Body, with any conflicts on the Governing Body managed in accordance with this statutory guidance and constitution of the CCG).

25. From a procurement perspective the Public Contracts Regulations 2015

encourage early market engagement and input into procurement processes.

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However, this must be managed very carefully and done in an open, transparent and fair way. Advice should therefore be taken as to how best to constitute the NCM Clinical Advisory Committee to ensure all potential participants have the same opportunity. Furthermore it would also be important to ensure that the advice provided to the CCG by this committee is considered proportionately alongside all other relevant information. Ultimately it will be the responsibility of the CCG to run an award process in accordance with the relevant procurement rules and this should be a process which does not unfairly favour any one particular provider or group of providers.

26. When considering what approach to adopt (whether adopting an NCM

Commissioning Committee, NCM Clinical Advisory committee or otherwise) each CCG will need to consider the best approach for their particular circumstances whilst ensuring robust governance arrangements are put in place. Depending on the circumstances, either of the approaches in paragraph 17 above may help to give the CCG assurance that there was appropriate clinical input into decisions, whilst supporting the management of conflicts. When considering its options the CCG will, in particular, need to bear in mind any joint / delegated commissioning arrangements that it already has in place either with NHS England, other CCGs or local authorities and how those arrangements impact on its options.

Provider engagement 27. It is good practice to engage relevant providers, especially clinicians, in

confirming that the design of service specifications will meet patient needs. This may include providers from the acute, primary, community, and mental health sectors, and may include NHS, third sector and private sector providers. Such engagement, done transparently and fairly, is entirely legal.

28. However, conflicts of interest, as well as challenges to the fairness of the procurement process, can arise if a commissioner engages selectively with only certain providers (be they incumbent or potential new providers) in developing a service specification for a contract for which they may later bid. CCGs should be particularly mindful of these issues when engaging with existing / potential providers in relation to the development of new care models and CCGs must ensure they comply with their statutory obligations including, but not limited to, their obligations under the National Health Service (Procurement, Patient Choice and Competition) (No 2) Regulations 2013 and the Public Contracts Regulations 2015.

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Committee Reporting

Page 1 of 2

Date: 5th March 2020

Report title: Joint Healthcare Procurement Policy

Lead Clinician and/or Lead Manager: Chief Finance Officer

Purpose:

To set out a joint approach across Warrington & Halton Clinical Commissioning Groups to procuring healthcare services it needs for the i t s local populations in line with Procurement Patient Choice and Competition Regulations and Public Contracts Regulations.

The Governing Body is asked to:

Approve the contents of the Joint Healthcare Procurement Policy

This Report supports the following CCG Strategic Objectives Three - To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Commissioning Plan Implications Please detail if the report has gone through the Commissioning project management process. Date Group/Committee Approved/Comments If Not Applicable,

please state why? Clinical Advisory Group No Applicable as

policy is not directly related to clinical service delivery

Commissioning Oversight Group

Not applicable as policy is not directly related to clinical service delivery

Quality Committee Not applicable as policy is not directly related to clinical service delivery

Financial Implications

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Committee Reporting

Page 2 of 2

Does this require financial support? No Board Assurance Framework and Corporate Risk Register Does this report link to either the Board Assurance Framework (BAF) or Corporate Risk Register (CRR) or both? This policy addresses in part Risk 64 – Procurement on the CCGs Corporate Risk Register. National Policy, Guidance, Standards, Targets or Legislation The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 (2013 No.257) – Section 75 of Health and Social Care Act 2012

The NHS (Clinical Commissioning Group) Regulations 2012 No. 1631, June 2012

Securing Meaningful Choice for Patients, August 2016

Procurement briefings for Clinical Commissioning Groups, September 2012

Health and Social Care Act 2012 Clinical Commissioning Group, Standing Orders

Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups (NHS England, June 2016

Public Contracts Regulations 2015

The Public Contracts Regulations 2015 and NHS Commissioners, October 2016 Quality, Equality and Privacy Impact Assessments and Human Rights (Has a Quality Impact Assessment, Equality Impact Assessment and Privacy Impact Assessment been completed? If not please provide rationale.) No (What is the impact on Human Rights?) None Date Type of

Assessment Approved/Comments If Not Applicable, please state why?

QIA N/A The policy is not directly related to service provision and therefore is not subject to QIA/EQIA

EIA N/A As above

PIA N/A As above

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Health Care Procurement Policy

Policy Author(s): Head of Contracts & Procurement Accountable Manager(s): Chief Finance Officer Ratified by (Committee/Group): Governing Body Date Ratified: Target Audience: Governing Body, CCG Committees, CCG

Commissioning Staff Issue Date: Location: CCG Website Review Date: 31st March 2021

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VERSION HISTORY

Date Version No

Brief Description of Change

February 2020 1.0 Procurement Policy

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1. INTRODUCTION The purpose of this policy is to set out a joint approach across Warrington & Halton Clinical Commissioning Groups to procuring healthcare services it needs for the i t s local populations in line with the Procurement Patient Choice and Competition Regulations and Public Contracts Regulations 2015. This Policy does not cover the procurement of general goods and services which are subject to the requirements of the CCG’s Standing Orders and Standing Financial Instructions. This policy should be considered together with the CCGs’ Constitution and Standing Financial Instructions / Standing Orders. <Link to CCG Constitution> <Link to CCG Standing Financial Instructions / Standing Orders>

Current thresholds as at 2019, which are the value of the contract over the lifetime of the contracts specified by the Public Contract Regulations Directive, are as follows:

Description Detailed description Threshold Threshold for schedule 1 services

These are all services except specifically exempt amounts such as health and social care services

£181,113

Threshold for schedule 3 services float

These are service subject to a light touch regime and include most health and social care services

£615,278

Works contacts

Usually this applies contracts that are capital in nature £4,551,413

Clinical Commissioning Groups are responsible for securing health services to meet the needs of their patients. They can secure these services in three broad ways:

• Through contracts with existing providers and through future variations to those contracts;

• Through tendering for a provider or group of providers to take over an existing service or provide a new one depending on local circumstances, this may involve single tender or competitive tendering; or

• By establishing a framework contract (through competitive tendering) from which ‘qualified’ providers can be called upon to provide services and between which patients may choose

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2. POLICY CONTEXT – CHOICE AND COMPETITION 2.1 Competitive Procurement in the NHS In March 2013, NHS England published a statement on choice and competition in commissioning clinical services in the NHS, emphasizing the key principles that:

• patients and their interests always come first; • it is for commissioners to decide if and when to introduce choice and competition

when it is in the interests of patients, beyond the rights set out in the NHS Constitution;

• the introduction of choice and competition should be informed by the evidence, as it emerges over time, of where they can be used to help improve patient outcomes, rather than be regarded as an end in themselves; and,

• commissioners are expected to consider the full range of tools at their disposal to bring about improvement where services are underperforming, including giving due consideration to choice and competition where the evidence supports their introduction

This policy document provides direction on how the CCG will meet its procurement responsibilities within the context of relevant national, regional and local guidelines and strategies, including but not limited to: The National Health Service (Procurement, Patient Choice and Competition) Regulations 2013 (2013 No.257) – Section 75 of Health and Social Care Act 2012

The NHS (Clinical Commissioning Group) Regulations 2012 No. 1631, June 2012

Securing Meaningful Choice for Patients, August 2016

Procurement briefings for Clinical Commissioning Groups, September 2012

Health and Social Care Act 2012 Clinical Commissioning Group, Standing Orders

Managing Conflicts of Interest: Guidance for Clinical Commissioning Groups (NHS England, June 2016

Public Contracts Regulations 2015

The Public Contracts Regulations 2015 and NHS Commissioners, October 2016

2.2 EU and UK Procurement Regulations as they relate to healthcare services EU and UK procurement law is complex and could be affected by the exit of the UK from the European Union. The CCGs will decide on a case by case basis when it is appropriate to take further legal advice on the application of these Directives to Healthcare services.

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2.3 Public Contracts Regulations 2015 – Light Touch Regime

There were amendments from the previous directives which now apply to Healthcare Services. The key changes proposed for Health Services in the new Directive were:

• the distinction between the former “Part A” and “Part B” services will be removed

and instead, health, social and other specific services above a threshold of €750,000 (with the sterling threshold of £615,278 as of 1st January 2018) will be subject to a Light Touch Regime (LTR), which has been incorporated in UK law

• There are a number of former “Part B” services that do not fall under the LTR and Contracting Authorities have been advised to carefully check services that are to be procured. However, it is unlikely that the health care services that the CCG commission would not fall under the LTR.

• the full EU sanctions regime will come into play in relation to breaches of the procurement rules for health services, whereas before it was only limited

An area of significance is that the case law on the modification of existing contracts and when such a change will be regarded as “material” and so “a new award”, requiring a new procurement procedure, is being brought into the new Directive. 2.4 Light Touch Regime Principles The light-touch regime (LTR) is a specific set of rules for certain service contracts that tend to be of lower interest to cross-border competition. Those service contracts include certain social, health and education services, defined by Common Procurement Vocabulary (CPV) codes. The list of services to which the Light-Touch Regime applies is set out in Schedule 3 of the Public Contracts Regulations 2015 (Annex A). 2.5 Mandatory Requirements The main mandatory requirements in following the Light Touch Regime are:

• Official Journal of the European Union (OJEU) Advertising: The publication of a contract notice (CN) or prior information notice (PIN)

• The publication of a contract award notice (CAN) following each individual procurement, or if preferred, group such notices on a quarterly basis

• Compliance with Treaty principles of transparency and equal treatment • Conduct the procurement in conformance with the information provided in the

OJEU advert (CN or PIN) regarding: any conditions for participation; time limits for contacting/responding to the authority; and the award procedure to be applied

• Time limits imposed by authorities on suppliers, such as for responding to adverts and tenders, must be reasonable and proportionate. There are no stipulated minimum time periods in the LTR rules, however, using the benchmark of the PCR 2015 timescales would assist Commissioners in deciding these time limits

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2.6 Significant Flexibilities CCGs have the flexibility to use any process or procedure they choose to run the procurement, as long as it respects the other obligations above. There is no requirement to use the standard EU procurement procedures (Open, Competitive Dialogue, Innovation Partnership, etc.) that are available for other (non-LTR) contracts. CCGs can use those procedures if helpful, or tailor those procedures according to their own needs, or design their own procedures altogether. The LTR rules are flexible on the types of award criteria that may be used, but make clear that certain considerations can be taken into account, including: • the need to ensure quality, continuity, accessibility, affordability availability and

comprehensiveness of the services • the specific needs of different categories of users including disadvantaged and

vulnerable groups • the involvement and empowerment of users • innovation 3. PURPOSE AND KEY PRINCIPLES

This policy outlines the CCGs’ approach to ensure consistency with the overarching principles of public sector procurement, as required by The Public Contracts Regulations 2015, NHS England and NHS Improvement. In accordance with the above, the CCG will act to commission services in line with the following key principles:

Transparency

• Through publication of the CCGs’ Commissioning Strategies • In decisions made to tender or not to tender (tender waivers), including

publication of the outcome in the register of procurement decisions posted on the CCGs’ websites

• Through the use of sufficient and appropriate advertising of tenders where competitive procurement is chosen

• Ensuring clarity in all communications of procurement processes including full publication of evaluation and scoring criteria as part of tender exercises

• Via the declaration and separation of conflicts of interest Fairness

• Through treating every provider and potential provider in a fair and consistent manner

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Proportionality

• By ensuring procurement processes are proportionate to the value, complexity and risk of the services contracted

• By ensuring that potential providers are not effectively excluded through overly bureaucratic or burdensome procedures

Non-discrimination

• By ensuring that no provider / potential provider is unfairly discriminated against in any way

• Through ensuring service specifications do not discriminate against or unduly favour any provider or group of providers

• Through ensuring a consistent approach to decision making • Through the use of objective evaluation criteria

Equality of treatment

• Ensuring that all potential providers and sectors have equal opportunity to compete where appropriate

• That financial and due diligence checks apply equally and are proportionate to the services required

In making decisions about competitive procurement the CCGs will strive to provide:

• choice: commissioners and providers should offer choice to patients • competition: maintain a number of providers to encourage a degree of

competition within the health system to continuously improve quality and innovation; and with a view to increasing quality of services

• consistency: clinical safety, equity of access and quality of outcomes need to be ensured

4. PROCUREMENT ROUTE DETERMINATION AND AUTHORISATION

In making effective decisions on how to procure services the CCGs will follow the relevant guidance issued by NHS England and NHS Improvement and act in accordance with the CCGs Operational delegated limits. In doing so, the CCGs will review all areas of service delivery to ensure that there is a clear and auditable decision-making process in place to support its commissioning decisions. With reference to NHS England’s guidance the CCGs will consider how it commissions services in line with the decision making process outlined in Figure 1 and to ensure transparency and accountability will document and publish on its website, decisions for authorization will be taken in accordance with delegated limits as set out in the CCGs’ Standing Financial Instructions.

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FIGURE 1

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In following the process outlined and in order to determine the most appropriate procurement route, the CCG will undertake a number of actions:

• A full review of service requirements will be undertaken to establish the scope

and determine any improvements required to meet service user and the CCG’s financial requirements

• An appraisal of options will be conducted to look at all the service delivery and

procurement options available to ensure the CCG meets the health needs of the population. This will incorporate a risk assessment of the relevant options and their compliance with the regulations, together with an assessment of the impact on existing services

• Dependent upon the range of services that require commissioning, a

prioritisation exercise of all the potential procurement exercises may be undertaken to ensure that the CCGs’ focus is proportional to the requirements of the service and the available resources for the commissioning of health care

The CCGs will continue to work to embed and develop best practice, building on experience and lessons learnt. We will continue to review the services we need to commission. We will identify opportunities to improve efficiency, extend choice and access, improve the quality of outcomes, and enhance patient experience. This procurement policy helps support our approach, setting out the principles and rules with which we will comply and the methods by which we will deliver. The policy clearly outlines how and when it is appropriate to seek to introduce competition or to apply other commissioning levers, including working with our partners, to achieve the most beneficial and cost-effective models of delivery. 5. GOVERNANCE AND DELIVERY OF PROCUREMENT RESPONSIBILITIES

It is essential to have the appropriate infrastructure, capacity, training and governance in place to complement the procurement policy. The CCGs have identified a member of the Integrated Management Team who will have responsibility for procurement matters; this will be the Chief Finance Officer, who will ensure that the Governing Body understands the legal obligations of the CCG in respect of procurement and ensure that they are met. Decisions in regard to procurement will be made in accordance with this policy, taking into account the operational delegated limits described earlier, through the appropriate governance structures, and will be reported to the Governing Body. If the Governing Body is not assured that a full review of service requirements, risk assessment and options appraisal have been adequately completed they reserve the right to challenge a procurement decision made at a delegated level in line with the delegated approval limits.

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The CCG will secure procurement support that will:

• lead specific health service procurement projects

• be responsible for developing, and publishing in a timely manner, robust documentation to support procurement

• develop procurement project plans, assess procurement options and organize market management activities

• develop in conjunction with commissioning leads evaluation criteria that help deliver choice, the best quality, value for money and sustainable services

• provide advice and support to colleagues to ensure that procurement and commissioning decisions aid planning and delivery and comply with legislation and guidance

• ensure that all activities are carried out in a timely and effective manner to ensure compliance with relevant legislation and guidance and support the achievement of our targets and plans

• lead and/or participate in collaborative procurement activities with other key commissioning partners across health and social care sectors

• ensure engagement with all stakeholders throughout the procurement process

• interpret and respond to new guidance and policy directives to implement and embed agreed changes to our procurement and contracting arrangements, maintaining compliance and achieving best practice

• maintain a database of all healthcare contracts

• manage the review process for all commercial contracts, ensuring that reviews/re- procurement is effected within the required timescales

• support the management of conflict of interests – to protect the integrity of The CCG and member practices from any perception of wrongdoing. The CCG understands it is responsible for recognizing any potential conflicts of interest and where they arise, for managing them appropriately, in line with NHS England guidance

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6. MANAGING CONFLICTS OF INTEREST The involvement of clinicians and other stakeholders in commissioning decisions may give rise to potential conflicts of interest over time. The CCGs require that all potential conflicts of interest are requested and declared at any Governing Body or other committee meeting where contractual/procurement or other decisions which could give rise to financial or non-financial interests whether direct or indirect. In implementing, this procurement policy the CCGs will also adhere to the requirements as set out in its Conflicts of Interest Policy. <Link to CCG Conflicts of Interest Policy> At the outset and during any procurement process, those involved will be required to declare any conflicts of interest as soon as they are known. Conflicts of Interest and how these were managed will also be included in the Register of Procurement Decisions which will be published on the CCGs websites. 7. CONFIDENTIALITY All procurement activities must comply with CCG Standing Orders and Standing Financial Instructions and therefore to protect the integrity of the procurement/tendering process, all stages should be treated as commercially sensitive and confidential, unless the CCGs are required by statute to disclose pertinent information. 8. PROCUREMENT APPROACHES

The main procurement route options that the CCGs will consider are:

8.1 Competitive Procurement

Undertaking a competitive tender exercise to appoint one specific provider, a predetermined number of multiple providers, or a collaboration of providers.

8.2 Framework Contracts

Considering the use of ‘framework’ type agreements to facilitate local patient choice of provider.

8.3 Variation of an Existing Contract

Implementing effective contract management: when an existing contract is in place, in order to secure incremental changes/improvements to services or clinical pathway design, or to address underperformance within the originally awarded terms of the contract.

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8.4 Single Tender Action

Appoint a specific provider without putting that service out to open competition where there is a clear justification and the CCGs can demonstrate that their decision meets the requirements of the Public Contracts Regulations. 8.5 Trial or Pilot

Where commissioners want to test an idea, or consider whether there is a solution to a particular issue and/or develop a product, they may want to conduct a trial or pilot scheme with a provider. The CCG will decide whether to competitively procure a trial service, or use an existing contract(s) in line with this policy. 8.6 Contractual Form All contracts for healthcare services will be entered into using the NHS Standard Contract as updated by NHS England on an annual basis.

9. CONDUCTING A COMPETITIVE PROCUREMENT PROCESS In the event that a decision is taken to implement a competitive procurement exercise, the CCG will consider one of the following routes which are consistent with the Public Contracts Regulations (PCR) 2015 relevant to Healthcare:

• Open Competition;

• Restricted Competition;

• Competitive Dialogue;

• Innovation Partnership

• Framework Agreement;

• A process of the Commissioner’s own design and choosing as per the Light Touch Regime guidance of the PCR 2015.

The CCGs will at all times comply with the procurement stages, timelines and processes required under the regulations as they apply to healthcare. In instances where a competitive procurement process is to be undertaken, the CCGs will ensure that the process is conducted by an appropriately qualified and experienced procurement expert. The decision over where such advice is obtained will depend on the circumstances of the procurement – whether specific to the CCGs, in collaboration with other organisations, the degree of complexity and other factors such as price and availability. Sufficient time will be allowed to enable bidders to submit their tender in line with best practice and/or regulations/guidance that exists for commissioners, and

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dependent upon the value and complexity of the contract. The CCGs will also include an appropriate and proportionate contract implementation period in our procurement plans to allow sufficient time for the contractor to mobilise safely and effectively. The competitive procurement process will always be undertaken in full compliance with the PPCC and Public Contracts Regulations relevant to the procurement of Healthcare under the Light Touch Regime (LTR) 10. WAIVERS In circumstances where there is a genuine rationale for not undertaking a competitive procurement process, the CCGs will follow the Single Tender Waiver procedure within the financial thresholds set out in the CCGs’ Standing Financial Instructions.

For goods and services that are not required to be formally subject to tender, the following limits shall apply: Description Threshold No requirement to obtain quotations

Up to £20,000 value over the lifetime of the contract

3 written quotations required Goods and services exceeding £20,000 up to the amount set out in the Public Contract Regulations Directive over the lifetime of the contract

The CCGs will not waive competitive procurement procedures for services to avoid competition or for administrative convenience. When it is decided that a competitive procurement should be waived, the fact of the waiver and the rationale for the decision will be properly documented using the tender waiver form (see Appendix 1) and recorded in the register of procurement decisions to ensure transparency and accountability and will be reported to the next scheduled meeting of the CCGs Audit Committee. All waivers and associated documents will be retained in the CCGs Finance Department for review by the Accountable Officer, Governing Body and Auditors as required. Instances where tenders waivers may be applied are as follows:

• where the timescale genuinely precludes competitive tendering for reasons of extreme urgency brought about by events unforeseeable by the Clinical Commissioning Group(s) and not attributable to the Clinical Commissioning Group(s). Failure to plan work properly is not a justification for waiving the requirement to tender;

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• where the works, services or supply required are available from only one source for technical reasons or for reasons connected with the protection of exclusive rights;

• where the goods required by the Clinical Commissioning Group(s) are a partial

replacement for, or in addition to, existing goods and to obtain the goods from a supplier other than the original supplier would require the acquisition of goods with different technical characteristics which would result in:

- incompatibility with the existing goods; or - disproportionate technical difficulty in the operation and maintenance of the

existing goods; (No such contract may be entered into for duration of more than three years).

• where works or services required by the Clinical Commissioning Groups are additional to works or services already contracted but the 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 Clinical Commissioning Groups 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.

• the provision of legal advice and /or services provided that any provider of legal advice and/or services commissioned by the Clinical Commissioning Group(s) 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.

11. STAINABILITY AND SOCIAL VALUE The Public Services (Social Value) Act 2012 (the Act) came into force during 2013. The term ‘social value’ refers to approaches that seek to maximise the impact of expenditure and the additional benefit to the community from the commissioning or procurement process over and above the delivery of the actual service.

The Act introduces a statutory requirement for public authorities to have regard at pre- procurement stage to the themes of economic, social and environmental well-being in connection with ‘public services contracts’ within the meaning of the Public Contracts Regulations. The Act requires public bodies to consider how what is being procured might improve the well-being of the relevant area and how, in the

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procurement process, it might act with a view to achieving that improvement. Healthcare service contracts are captured under the act and therefore the CCG is required as part of a procurement process to ensure that sustainable healthcare is about designing and delivering services that support a healthy society, healthy environment and healthy economy without causing environmental harm, ensuring the can afford to deliver safe care in the future. As both sustainability and ‘social value’ factors should be considered at the pre- procurement stage of any process, the CCGs will demonstrate that they have considered these impacts to determine if they will be included as part of the overarching evaluation criteria for all procurement exercises. A record of this decision making process will be kept for audit purposes.

11. CONCLUSION This policy outlines NHS Halton and NHS Warrington CCGs’ commitment to ensuring that EU and UK procurement law is followed for the procurement of all healthcare services. This will ensure safe and best value healthcare services for the patients and residents of Warrington and Halton.

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APPENDIX 1

REQUEST FOR WAIVER OF FORMAL TENDERING & CONTRACTING SECTION 1: NOTES 1.1 This form is to be completed in all circumstances where the competitive quotation/tendering procedures required under the CCG’s Standing Orders are to be waived. 1.2 All sections of the form must be completed in full by the requisitioning officers before submitting for approval to an authorised officer. 1.3 The authorised waiver form should be forwarded to the Contracting / Procurement Team and Finance Team together with the requisition to enable the order to be raised SECTION 2: DETAILS OF REQUEST Department: Requisition Number: __________ Requisition Date: __________ Requisitioning Officer _______________________________________ Description of goods or services requested: Purchase Value: £ VAT: £ Total Value: £

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SECTION 3 - INFORMATION TO SUPPORT WAIVER REQUEST Key Reasons: SECTION 4 - SUBMISSION OF WAIVER REQUEST Request Submitted by: Declaration of Interest: Y/N If yes, please provide details and how conflict of interest has been mitigated: Signature: ____________________________ Date: __________________________ SECTION 5 - WAIVER AUTHORISED BY Authorised by: David Cooper, Chief Finance Officer Declaration of Interest: Y/N If yes, please provide details and how conflict of interest has been mitigated: Signature: ____________________________ Date: _________________________

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Governing Body Report

Page 1 of 3

Date: 5th March 2020

Report title: Updated Constitution

Lead Manager: Rebecca Knight – Head of Assurance & Risk

Purpose: The Constitution has been updated in line with the new model constitution for CCGs issued in September 2018

The Governing Body is asked to:

Approval of the updated Constitution for authorisation by NHS England

This Report supports the following CCG Strategic Objectives One - To commission services which continually improve the health and wellbeing of Halton residents. Two - To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations. Three - To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Four - To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders. Commissioning Plan Implications None Financial Implications None Board Assurance Framework and Corporate Risk Register The updated Constitution aligns with the model Constitution issued by NHS England in September 2018. Each CCG has a statutory responsibility to have a constitution in place, which reflects its governance arrangements. This provides assurance against the strategic risk relating to statutory duties and powers. National Policy, Guidance, Standards, Targets or Legislation Model Constitution for CCGs – issued by NHS England – September 2018 Supporting notes to the CCG Model Constitution – September 2018 Equality and Diversity and Human Rights Throughout the development of this paper and any policies and processes cited, NHS Halton CCG has: • Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance

equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and

• Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

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Governing Body Report

Page 2 of 3

UPDATED CONSTITUTION

BACKGROUND 1. CCGs are statutory bodies established under the NHS Act 2006 (the 2006 Act) as

amended by the Health and Social Care Act 2012 (the 2012 Act).

2. The legislation requires that each CCG publishes a constitution and requires that constitutions contain specific information. A CCG model constitution was updated and issued by NHS England in September 2018. The model constitution sets out the minimum requirements that constitutions must contain according to the legislation, as well as including reference to matters that NHS England expect to see included by way of good practice in governance.

3. This updated constitution has been developed and is aligned to the model

constitution. The new model takes account of all of the changes that have taken place over the past few years in the health and social care landscape including:

a. A Legislative Reform Order has been passed, introducing amendments to the

2006 Act that permit CCGs to work on a joint basis, including through forming joint committees with each other; and

b. Sustainability and Transformation Partnerships (STPs) are supporting collaboration and commissioning across larger footprints and different types of organisations and models of care are being developed, particularly integrated care systems; and

c. NHS England has refined its advice and guidance to CCGs; and d. The pace of change is increasing in many areas and CCGs are finding the

task of keeping everything in their constitution up to date to be onerous; and e. CCGs have matured as commissioning bodies and this has informed the way

that governance structures have developed.

4. The new model looks to the future and facilitates a greater degree of flexibility for CCGs at the same time as maintaining the high levels of transparency and accountability.

5. Whilst not compulsory, NHS England has recommended that CCGs adopt the new model constitution to account for the evolving landscape.

PURPOSE 6. This updated constitution aligns the existing constitution with the CCG model

constitution issued by NHS England in September 2018.

KEY ISSUES TO NOTE

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Governing Body Report

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7. The new model constitution is a shortened document which has removed the need to include some sections previously required and given the option to expand on other areas. These include:

a. Removal of non-statutory committees from the constitution (to be included in

the CCG Governance Handbook) b. Removal of the Scheme of Reservation and Delegation from the constitution

(to be included in the CCG Governance Handbook) c. Inclusion of a paragraph about proposal to minor amendments to the

constitution and clarity regarding material changes d. Inclusion of an optional clause regarding the CCG position on liability and

indemnity of members, former members, member practices, officers and employees

e. Inclusion of an optional clause regarding speaking, writing or acting in the name of the CCG

8. Engagement with Membership practices has taken place which commenced with a

member forum in January 2020, followed by a ballot of all member practices to allow some decisions to be made to inform the update of the constitution.

9. The ballot was facilitated by the Local Medical Committee and the outcome shared with member practices on 27th February 2020. The outcome of the ballot has supported the update of the constitution with the outcome of the vote being reflected in the Standing Orders section of the constitution.

10. The model constitution gives clear guidance about who should be a member of a

Governing Body with voting rights and who might be an attendee of the Governing Body. The updated constitution reflects this guidance.

11. The terms of reference for all of the statutory committees are included in the

constitution and the Governing Body is asked to note and approve the following: a. Remuneration Committee (updated terms of reference, as approved by the

Committee on 27th February 2020); and b. Primary Care Commissioning Committee (one change to the membership to

add an additional lay member to the membership, who will act as Deputy Chair from April 2020 onwards).

12. The Standing Financial Instructions (SFIs) which are included at Appendix 4 of the

constitution were presented for review to the Performance & Finance Committee on 27th February 2020.

RECOMMENDATION 13. The Governing Body is asked to:

a. Approve the updated Constitution for authorisation by NHS England.

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NHS HALTON

CLINICAL COMMISSIONING GROUP

CONSTITUTION

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NHS Halton Clinical Commissioning Group Constitution

Version Effective Date Changes V1 August 2018 Standard model V1.1 February 2020 Model updated to reflect local arrangements

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CONTENTS

1 Introduction ....................................................................................................... 5

1.1 Name ............................................................................................................... 5

1.2 Statutory Framework ....................................................................................... 5

1.3 Status of this Constitution ................................................................................ 6

1.4 Amendment and Variation of this Constitution ................................................. 6

1.5 Related documents .......................................................................................... 7

1.6 Accountability and transparency ...................................................................... 7

1.7 Liability and Indemnity ..................................................................................... 9

2 Area Covered by the CCG .............................................................................. 10

3 Membership Matters ....................................................................................... 11

3.1 Membership of the Clinical Commissioning Group ........................................ 11

3.2 Nature of Membership and Relationship with CCG ....................................... 13

3.3 Speaking, Writing or Acting in the Name of the CCG .................................... 13

3.4 Members’ Rights ............................................................................................ 13

3.5 Members’ Meetings ....................................................................................... 14

3.6 Practice Representatives ............................................................................... 14

4 Arrangements for the Exercise of our Functions. ........................................ 15

4.1 Good Governance ......................................................................................... 15

4.2 General .......................................................................................................... 16

4.3 Authority to Act: the CCG .............................................................................. 16

4.4 Authority to Act: the Governing Body ............................................................. 16

5 Procedures for Making Decisions ................................................................. 17

5.1 Scheme of Reservation and Delegation ........................................................ 17

5.2 Standing Orders ............................................................................................ 17

5.3 Standing Financial Instructions (SFIs) ........................................................... 17

5.4 The Governing Body: Its Role and Functions ................................................ 18

5.5 Composition of the Governing Body ............................................................. 20

5.6 Additional Attendees at the Governing Body Meetings .................................. 20

5.7 Appointments to the Governing Body ............................................................ 21

5.8 Committees and Sub-Committees ................................................................. 21

5.9 Committees of the Governing Body ............................................................... 22

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5.10 Collaborative Commissioning Arrangements ............................................. 23

5.11 Joint Commissioning Arrangements with Local Authority Partners ............ 24

5.12 Joint Commissioning Arrangements – Other CCGs ................................... 25

5.13 Joint Commissioning Arrangements with NHS England ............................ 27

6 Provisions for Conflict of Interest Management and Standards of Business Conduct ................................................................................................................... 30

6.1 Conflicts of Interest ........................................................................................ 30

6.2 Declaring and Registering Interests ............................................................... 30

6.3 Training in Relation to Conflicts of Interest .................................................... 31

6.4 Standards of Business Conduct .................................................................... 31

Appendix 1: Definitions of Terms Used in This Constitution ............................. 33

Appendix 2: Committee Terms of Reference ....................................................... 36

Audit Committee ......................................................Error! Bookmark not defined. Remuneration Committee ..................................................................................... 44

Primary Care Commissioning Committee ............................................................. 48

Appendix 3: Standing Orders ................................................................................ 55

Appendix 4: Standing Financial Instructions ...................................................... 68

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1 Introduction

1.1 Name

The name of this clinical commissioning group is NHS Halton Clinical Commissioning Group (“the CCG”).

1.2 Statutory Framework

1.2.1 CCGs are established under the NHS Act 2006 (“the 2006 Act”), as amended by the Health and Social Care Act 2012. The CCG is a statutory body with the function of commissioning health services in England and is treated as an NHS body for the purposes of the 2006 Act. The powers and duties of the CCG to commission certain health services are set out in sections 3 and 3A of the 2006 Act. These provisions are supplemented by other statutory powers and duties that apply to CCGs, as well as by regulations and directions (including, but not limited to, those issued under the 2006 Act).

1.2.2 When exercising its commissioning role, the CCG must act in a way that is consistent with its statutory functions. Many of these statutory functions are set out in the 2006 Act but there are also other specific pieces of legislation that apply to CCGs, including the Equality Act 2010 and the Children Acts. Some of the statutory functions that apply to CCGs take the form of statutory duties, which the CCG must comply with when exercising its functions. These duties include things like:

a) Acting in a way that promotes the NHS Constitution (section 14P of

the 2006 Act); b) Exercising its functions effectively, efficiently and economically

(section 14Q of the 2006 Act); c) Financial duties (under sections 223G-K of the 2006 Act); d) Child safeguarding (under the Children Acts 2004,1989); e) Equality, including the public-sector equality duty (under the Equality

Act 2010); and f) Information law, (for instance under data protection laws, such as the

EU General Data Protection Regulation 2016/679, and the Freedom of Information Act 2000).

1.2.3 Our status as a CCG is determined by NHS England. All CCGs are required to have a constitution and to publish it.

1.2.4 The CCG is subject to an annual assessment of its performance by NHS England which has powers to provide support or to intervene where it is satisfied that a CCG is failing, or has failed, to discharge any of our functions or that there is a significant risk that it will fail to do so.

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1.2.5 CCGs are clinically led membership organisations made up of general practices. The Members of the CCG are responsible for determining the governing arrangements for the CCG, including arrangements for clinical leadership, which are set out in this Constitution.

1.3 Status of this Constitution

1.3.1 This CCG was first authorised on 01 April 2013.

1.3.2 Changes to this constitution are effective from the date of approval by NHS England. NHS England approved this constitution on [insert date of approval]

1.3.3 The constitution is published on the CCG website at www.haltonccg.nhs.uk

1.4 Amendment and Variation of this Constitution

1.4.1 This constitution can only be varied in two circumstances:

a) where the CCG applies to NHS England and that application is granted; and

b) where in the circumstances set out in legislation NHS England varies the constitution other than on application by the CCG.

1.4.2 The following amendments are reserved to the Membership:

• Amendments giving effect to delegations outside of the CCG, where these have not already been discussed and approved by the members.

• Changes to the way that members are involved in the CCG, including for instance a change in the number of practice member representatives on the Governing Body.

• Any changes to the Governing Body, such as changes to the membership of the Governing Body.

• Changes relating to the role of the clinical chair.

1.4.3 If the changes being proposed are not material changes, the internal approval of the changes will be delegated to the member practice representatives of the Governing Body and other Governing Body members.

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1.4.4 A material change is considered to be anything that changes the make-up of the governing body or its powers or anything that limits the GP voice in decision making.

1.4.5 The membership will routinely be asked at each Annual General Meeting to confirm the current constitution.

1.5 Related documents

1.5.1 This Constitution is also informed by a number of documents which provide further details on how the CCG will operate. With the exception of the Standing Orders (Appendix 3) and the Standing Financial Instructions (Appendix 4), these documents do not form part of the Constitution for the purposes of 1.4 above. They are the CCG’s:

a) Standing orders – which set out the arrangements for meetings and the selection and appointment processes for the CCG’s Committees, and the CCG Governing Body (including Committees).

b) The Scheme of Reservation and Delegation – sets out those decisions that are reserved for the membership as a whole and those decisions that have been delegated by the CCG or the Governing Body.

c) Prime financial policies – which set out the arrangements for managing the CCG’s financial affairs.

d) Standing Financial Instructions – which set out the delegated limits for financial commitments on behalf of the CCG.

e) The CCG Governance Handbook – which includes: • Committee terms of reference. • The Scheme of Reservation and Delegation (SoRD). • Standing Financial Instructions (SFIs). • Standing orders (SOs). • Roles and responsibilities. • Prime Financial Policies. • Committee administration guide and templates.

1.6 Accountability and transparency 1.6.1 The CCG will demonstrate its accountability to its members, local people,

stakeholders and NHS England in a number of ways, including by being transparent. We will meet our statutory requirements to:

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a) publish our constitution and other key documents including that outline our intentions, operating procedures and ways for member practices, members of the public and staff to be informed by.

b) appoint independent lay members and non-GP clinicians to our

Governing Body. c) manage actual or potential conflicts of interest in line with NHS

England’s statutory guidance Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017 and expected standards of good practice (see also part 6 of this constitution).

d) hold Governing Body and Primary Care Commissioning Committee

meetings in public (except where we believe that it would not be in the public interest, in relation to all or part of a meeting).

e) publish an annual commissioning strategy that takes account of priorities in the health and wellbeing strategy of Halton Borough Council, and which are informed by the Joint Strategic Needs Assessment published for the local authority area.

f) procure services in a manner that is open, transparent, non-

discriminatory and fair to all potential providers and publish a Procurement Policy.

g) involve the public, in accordance with its duties under section 14Z2 of

the 2006 Act (in relation to public involvement and consultation), and as set out in more detail in the CCG’s strategic plan, associated operational plans and engagement strategy.

h) When discharging its duties under section 14Z2, the CCG will ensure

that it follows the principle of openness, early and active involvement, fairness and non-discrimination.

i) comply with local authority health overview and scrutiny requirements. j) meet annually in public to present an annual report which is then

published. k) produce annual accounts which are externally audited. l) publish a clear complaints process. m) comply with the Freedom of Information Act 2000 and with the

Information Commissioner Office requirements regarding the publication of information relating to the CCG.

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n) provide information to NHS England as required; and o) be an active member of the local Health and Wellbeing Board.

1.6.2 In addition to these statutory requirements, the CCG will demonstrate its accountability by establishing and supporting both clinical and patient/public advisory forums to the Governing Body and CCG.

1.6.3 The Governing Body of the CCG will throughout each year have an ongoing role in reviewing the CCG’s governance arrangements to ensure that the CCG continues to observe the principles of good governance.

1.7 Liability and Indemnity 1.7.1 As the CCG is a body corporate established and existing under the 2006

Act, all financial or legal liability for decisions or actions of the CCG resides with the CCG as a public statutory body and not with its member practices.

1.7.2 No member or former member, nor any person who is at any time a proprietor, officer or employee of any member or former member, shall be liable (whether as a member or as an individual) for the debts, liabilities, acts or omissions, howsoever caused by the CCG in discharging its statutory functions.

1.7.3 No member or former member, nor any person who is at any time a proprietor, officer or employee of any member or former member, shall be liable on any winding-up or dissolution of the CCG to contribute to the assets of the CCG, whether for the payment of its debts and liabilities or the expenses of its winding-up or otherwise.

1.7.4 The CCG may indemnify any member practice representative or other officer or individual exercising powers or duties on behalf of the CCG in respect of any civil liability incurred in the exercise of the CCGs’ business, provided that the person indemnified shall not have acted recklessly or with gross negligence.

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2 Area Covered by the CCG 2.1.1 The area covered by the CCG is fully coterminous with the boundaries of

Halton Borough Council.

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3 Membership Matters 3.1 Membership of the Clinical Commissioning Group 3.1.1 The CCG is a membership organisation.

3.1.2 All practices who provide primary medical services to a registered list of patients under a General Medical Services, Personal Medical Services or Alternative Provider Medical Services contract in our area are eligible for membership of this CCG.

3.1.3 The practices which make up the membership of the CCG are listed below.

Practice Name Address

Appleton Village Surgery

2 – 6 Appleton Village, Widnes, WA8 6DZ

Bevan Group Practice

Bevan W ay, Widnes, WA8 6TR

Beeches Medical Centre

20 Ditchfield Road, W idnes, WA8 8QS

Brookvale Practice

Hallwood Health Centre, Hospital W ay, Runcorn, WA7 2UT

Castlefields Health Centre

The Village Square, Castlefields, Runcorn, WA7 2HY

Grove House Partnership

St Paul’s Health Centre, High Street, Runcorn, WA7 1AB

Hough Green Health Park

Hough Green Road, W idnes, WA8 4NJ Murdishaw Health Centre

Gorsewood Road, Murdishaw, Runcorn, WA7 6ES

Newtown Health Care Centre

W idnes HCRC, Oaks Place, Caldwell Road, Widnes, WA8 7GD

Oaks Place Surgery

W idnes HCRC, Oaks Place, Caldwell Road, W idnes, WA8 7GD

Peelhouse Medical Plaza

Peelhouse Lane, W idnes, WA8 6TN Tower House Practice

St Paul’s Health Centre, High Street, Runcorn, WA7 1AB

Upton Rocks Primary Care

W idnes RUFC Car Park, Heath Road, Widnes, W A8 7NU

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3.1.4 Providers of primary medical services to a registered list of patients under a General Medical Services (GMS), Personal Medical Services (PMS) or Alternative Provider Medical Services contract (APMS), will be eligible to apply for membership of this group1. Members must be contiguous with the existing boundary of the CCG.

3.1.5 Applications for membership. No practice shall become a member of the

CCG unless that practice: a) is eligible to become a member

b) has completed an application for membership in a form required by the governing body c) has had its application approved by the governing body d) has been entered into the Register of Members.

3.1.6 Paragraph 3.1.5 is without prejudice to the general power of the NHS

Commissioning Board to add practices as members of the CCG in accordance with the 2012 Act (including in particular under Section 14F of the 2006 Act as amended by the 2012 Act) and any such practice shall be admitted as a member when so directed by the NHS Commissioning Board.

3.1.7 Membership of the group is not transferrable. 3.1.8 Termination of Membership. A member practice will cease to be a member

of the group, with immediate effect, if it ceases to provide primary medical services under a GMS, PMS or APMS contract or any subsequent primary care contract.

3.1.9 The membership has the right to propose the removal of a member to NHS

England. 3.1.10 NHS England has the power to remove a member from the membership of

the CCG. 3.1.11 Voluntary Withdrawal. A member may give not less than three months’

written notice of its desire to cease being a member of the CCG and the CCG will agree to this change in membership, subject to receiving prior approval from NHS England.

3.1.12 The CCG will apply to NHS England, during the notice period, to make the

relevant change to its Constitution, with effect from the end of the notice period, and if this is approved, the practice will cease to be a member from the relevant date.

1 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012.

Weavervale Practice Hallwood Health Centre, Hospital Way, Runcorn, WA7 2UT

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3.1.13 If a practice leaves the group and then wishes to re-join, it will go through the

application process set out in paragraph 3.1.5 of the constitution as if it were a practice that had no previous relationship with the group.

3.1.14 Changes to the Membership. Any changes to the membership of the group,

including variation, mergers or dissolution are subject to the approval of NHS England.

3.2 Nature of Membership and Relationship with CCG

3.2.1 The CCG’s Members are integral to the functioning of the CCG. Those exercising delegated functions on behalf of the Membership, including the Governing Body, its committees and sub-committees remain accountable to the Membership.

3.2.2 The CCG regards General Practice as a fundamental building block of the local health and care system and the CCG relates closely to our general practice community through its membership arrangements in support of the CCG’s commissioning function.

3.2.3 The CCG also recognises that the Mid Mersey Local Medical Committee (LMC) is the statutory body representing General Medical Practitioners in the locality of the CCG. The CCG makes a commitment that its Governing Body will engage with the LMC, as appropriate, as local statutory representatives of the profession.

3.3 Speaking, Writing or Acting in the Name of the CCG

3.3.1 Members are not restricted from giving personal views on any matter. However, members should make it clear that personal views are not necessarily the view of the CCG.

3.3.2 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 CCG, any member of its Governing Body, any member of its Committees of its Governing Body, or any employee of the CCG or any of its members, nor will it affect the rights of any worker (as defined in that Act) under that Act.

3.4 Members’ Rights

3.4.1 Members’ rights, as agreed via engagement with all member practices are included in the Standing Orders, Scheme of Reservation and Delegation and CCG Governance Handbook, where appropriate.

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3.5 Members’ Meetings

3.5.1 Paragraph 6 of Schedule 1A of the 2006 Act requires that CCGs secure effective participation by each member.

3.5.2 Meetings of the Membership may be held at regular intervals (up to three times a year) and at such times and places as the Member Representatives may determine. An Annual General Meeting of the CCG will be held in public, where Member Representatives will be invited to attend and speak, where appropriate.

3.6 Member Practice Representatives

3.6.1 Each Member practice has a nominated lead healthcare professional who represents the practice in the dealings with the CCG.

3.6.2 The role of each Member Practice Representative is to:

i. Act on behalf of the relevant Member Practice as a member of key decision-making processes.

ii. Ensure the relevant Member Practice is actively engaged and involved with the work of the CCG.

iii. Ensure that all Member Practice staff are fully informed and engaged via internal systems.

iv. Attend appropriate meetings to enable engagement and involvement in decision-making for the Member Practice in the CCG.

v. Use all reasonable endeavours to identify and nominate in writing a deputy to attend on their behalf at any meeting of the CCG for which they cannot be present, who wherever possible should be a clinician.

vi. Work to support the CCG in discharging its duties effectively.

3.6.3 Where a Member Practice wishes to change their nominated Representative, this should be informed to the CCG, in order that records and circulation lists can be updated.

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4 Arrangements for the Exercise of our Functions.

4.1 Good Governance

4.1.2 In accordance with section 14L(2)(b) of the 2006 Act2 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 adoption of standards and procedures that facilitate speaking out and

the raising of concerns, including the appointment of a freedom to speak up guardian in the CCG;

c) Use of the governance toolkit for CCGs (www.ccggovernance.org); d) Undertaking regular reviews of CCG governance and decision making

structures; e) Proactive promotion of standards and procedures that enable ‘freedom to

speak up’ in the interests of patients or the public; f) The Good Governance Standard for Public Services;3

g) the standards of behaviour published by the Committee on Standards in Public Life (1995) known as the ‘Nolan Principles’4

h) the seven key principles of the NHS Constitution;5 i) the Equality Act 2010;6 j) the standards set out in the Professional Standard Authority’s guidance

“Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England”.

2 Inserted by section 25 of the 2012 Act

3 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

4 See https://www.gov.uk/government/publications/the-7-principles-of-public-life/the-7-principles-of-public-life--2

5 See https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england#principles-that-guide-the-nhs

6 See http://www.legislation.gov.uk/ukpga/2010/15/contents

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4.2 General

4.2.1 The CCG will:

a) comply with all relevant laws, including regulations; b) comply with directions issued by the Secretary of State for Health or

NHS England; c) have regard to statutory guidance including that issued by NHS

England; and d) take account, as appropriate, of other documents, advice and

guidance.

4.2.2 The CCG will develop and implement the necessary systems and processes to comply with (a)-(d) above, documenting them as necessary in this constitution, its scheme of reservation and delegation and other relevant policies and procedures as appropriate.

4.3 Authority to Act: the CCG

4.3.1 The CCG is accountable for exercising its statutory functions. It may grant authority to act on its behalf to:

a) any of its members or employees; b) its Governing Body; c) a Committee or Sub-Committee of the CCG.

4.3.2 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 (SoRD); and

b) approved terms of reference for committees.

4.4 Authority to Act: The Governing Body

4.4.1 The Governing Body may grant authority to act on its behalf to: a) any Member of the Governing Body; b) a Committee or Sub-Committee of the Governing Body; c) a Member of the CCG who is an individual (but not a Member of the

Governing Body); and d) any other individual who may be from outside the organisation and

who can provide assistance to the CCG in delivering its functions.

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5 Procedures for Making Decisions

5.1 Scheme of Reservation and Delegation

5.1.1 The CCG has agreed a scheme of reservation and delegation (SoRD) which is published in full at www.haltonccg.nhs.uk (and contained within the CCG’s Governance Handbook).

5.1.2 The CCG’s SoRD sets out:

a) those decisions that are reserved for the membership as a whole; b) those decisions that have been delegated by the CCG, the Governing

Body or other individuals. 5.1.3 The CCG remains accountable for all of its functions, including those that it

has delegated. All those with delegated authority, including the Governing Body, are accountable to the Members for the exercise of their delegated functions.

5.2 Standing Orders

5.2.1 The CCG has agreed a set of standing orders which describe the processes that are employed to undertake its business. They include procedures for:

• conducting the business of the CCG; • the appointments to key roles including Governing Body members; • the procedures to be followed during meetings; and • the process to delegate powers.

5.2.2 A full copy of the standing orders is included in Appendix 3. The standing

orders form part of this constitution.

5.3 Standing Financial Instructions (SFIs)

5.3.1 The CCG has agreed a set of SFIs which include the delegated limits of financial authority set out in the SoRD.

5.3.2 A copy of the SFIs is included at Appendix 4 and form part of this constitution.

5.4 General Procedures

5.4.1 Any person or body discharging delegated responsibilities on behalf of the CCG, the Governing Body or its committees must:

a) comply with the CCG’s principles of good governance (section 4.1);

b) Operate in accordance with the CCG’s Scheme of Delegation and Reservation (contained within the CCG Governance Handbook);

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c) Comply with the CCG’s standing orders (Appendix 3);

d) Comply with the CCG’s arrangements for discharging its statutory duties;

e) Where appropriate, ensure that member practices have had the opportunity to contribute to the CCG’s decision-making process.

5.4.2 When discharging their delegated functions, committees, sub-committees and any joint committees must operate in accordance with the approved terms of reference.

5.4.3 Where delegated responsibilities are being discharged collaboratively, the joint collaborative arrangements must:

a) identify the roles and responsibilities of those organisations that are working together;

b) Identify any pooled budgets and how these will be managed and reported in annual accounts;

c) specify under which organisation’s scheme of reservation and delegation and supporting policies, the collaborative working operates;

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.

5.5 The Governing Body: Its Role and Functions

5.5.1 The Governing Body has functions conferred on it by sections 14L(2) and (3) of the 2006 Act, inserted by section 25 of the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this constitution.

5.5.2 The Governing Body has statutory 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 governance (its main function);

b) 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 established;

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c) approving any functions of the CCG that are specified in regulations

made under section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act;

d) with the exception of those functions reserved to the CCGs

membership, to discharge all of the CCGs remaining statutory functions.

5.5.3 The CCG has also delegated the following additional functions to the

Governing Body which are also set out in the SoRD. Any delegated functions must be exercised within the procedural framework established by the CCG and primarily set out in the Standing Orders and SFIs:

a) Approving the operational scheme of delegation that underpins the Scheme of Reservation and Delegation within the Constitution;

b) Approving and monitoring the CCG’s Commissioning Plan and its consultation arrangements;

c) Approving and monitoring the CCG’s Financial Strategy and Annual Budget and any variations to the approved budgets where variation would impact on approved levels of income and expenditure;

d) Overseeing and monitoring performance e) Overseeing and monitoring quality improvement: f) Overseeing risk assessment and seeking assurance actions to

mitigate identified strategic risks g) Promoting a culture of strong engagement with patients, their carers,

Members, the public and other stakeholders about the activity and progress of the CCG;

h) Ensuring good governance and leading a culture of good governance throughout the CCG

i) 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 CCGs responsibilities within such strategies;

j) Ensuring effective plans are in place to reduce inequalities across the borough;

k) Ensuring the group in its decision making obtains advice from a wide-range of professionals;

l) Ensuring effective systems are in place to promote innovation; m) Approving the organisational development plan including the

principles by which it will procure commissioning support ; and n) Exercising any other functions of the CCG which are not otherwise

reserved or delegated.

5.5.4 The detailed procedures for the Governing Body, including voting arrangements, are set out in the standing orders.

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5.6 Composition of the Governing Body

5.6.1 This part of the constitution describes the make-up of the Governing Body roles. Further information about the individuals who fulfil these roles can be found on our website www.haltonccg.nhs.uk

5.6.2 The National Health Service (Clinical Commissioning Groups) Regulations 2012 set out a minimum membership requirement of the Governing Body of:

a) The Chair b) The Accountable Officer (Clinical Chief Officer) c) The Chief Finance Officer d) A Secondary Care Specialist; e) A registered nurse (Chief Nurse) f) Two lay members:

• one who has qualifications expertise or experience to enable them to lead on audit matters; and another who

• has knowledge about the CCG area enabling them to express an informed view about discharge of the CCG functions

5.6.3 The CCG has agreed the following additional members:

a) A third lay member who is the Chair of the Primary Care Commissioning Committee.

b) A fourth lay member who has qualifications expertise or experience to enable them to lead on finance matters.

c) GPs drawn from member practices.

d) One GP practice manager drawn from member practices.

5.7 Additional Attendees at the Governing Body Meetings

5.7.1 The CCG Governing Body may invite other person(s) to attend all or any of its meetings, or part(s) of a meeting, in order to assist it in its decision-making and in its discharge of its functions as it sees fit. Any such person may be invited by the chair to speak and participate in debate but may not vote.

5.7.2 The CCG Governing Body will regularly invite the following individuals to attend any or all of its meetings as attendees:

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a) Director of Public Health or a senior Public Health representative from Halton Borough Council;

b) A representative from HealthWatch; c) A local patient representative; and d) Senior Managers from the Integrated Management Team, including

their deputies where appropriate.

5.8 Appointments to the Governing Body

5.8.1 The process of appointing GPs to the Governing Body, the selection of the Chair, and the appointment procedures for other Governing Body Members are set out in the standing orders (Appendix 3)

5.8.2 Also set out in standing orders are the details regarding the tenure of office for

each role and the procedures for resignation and removal from office.

5.8.3 National guidance on the eligibility, roles and expected duties of members of the group’s Governing Body is set out in a separate document7 and the information in this section should be read in conjunction with this national guidance. Eligibility for and exemptions for these positions are also outlined in the NHS Clinical Commissioning Group Regulations 2012.8

5.9 Committees and Sub-Committees

5.9.1 The CCG may establish Committees and Sub-Committees of the CCG. 5.9.2 The Governing Body may establish Committees and Sub-Committees. 5.9.3 Each Committee and Sub-Committee established by either the CCG or the

Governing Body operates under terms of reference and membership agreed by the CCG or Governing Body as relevant. Appropriate reporting and assurance mechanisms must be developed as part of agreeing terms of reference for Committees and Sub-Committees.

5.9.4 With the exception of the Remuneration Committee, any Committee or Sub-Committee established in accordance with clause 5.8 may consist of or include persons other than Members or employees of the CCG.

5.9.5 All members of the Remuneration Committee will be members of the CCG

Governing Body.

7 Clinical commissioning group Governing Body Members – Roles, Attributes and Skills, NHS Commissioning Board Authority, October 2012 https://www.england.nhs.uk/wp-content/uploads/2012/09/ccg-members-roles.pdf 8 http://www.legislation.gov.uk/uksi/2012/1631/regulation/11/made

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5.9.6 Committees in Common: These refer to committees which meet at the same time, in the same location as similar committees from another CCG. It is the nature of the functions exercised, the place and time that are in common, but each committee remains as a standalone CCG committee and the committees do not form a joint committee. Any decision taken is individual to each CCG committee. It is not a joint decision.

5.10 Committees of the Governing Body

5.10.1 The Governing Body will maintain the following statutory or mandated Committees:

5.10.2 Audit Committee: This Committee is accountable to the Governing Body and

provides the Governing Body with an independent and objective view of the CCG’s compliance with its statutory responsibilities. The Committee is responsible for arranging appropriate internal and external audit.

5.10.3 The Audit Committee will be chaired by a Lay Member who has qualifications, expertise or experience to enable them to lead on finance and audit matters.

5.10.4 The Terms of Reference for Audit Committee can be found in Appendix 3

(standing orders) to this Constitution and form part of the Constitution.

5.10.5 Remuneration Committee: This Committee is accountable to the Governing Body and makes recommendations to the Governing Body about the remuneration, fees and other allowances (including pension schemes) for employees (non-agenda for change) and other individuals who provide services to the CCG.

5.10.5 The Remuneration Committee will be chaired by a lay member other than the Audit Committee chair and only members of the Governing Body may be members of the Remuneration Committee.

5.10.6 The Terms of Reference for Remuneration Committee can be found in Appendix 3 (standing orders) to this Constitution and form part of the Constitution.

5.10.7 Primary Care Commissioning Committee: This Committee is required by the terms of the delegation from NHS England in relation to primary care commissioning functions. The Primary Care Commissioning Committee reports to the Governing Body and to NHS England. Membership of the Committee is determined in accordance with the requirements of Managing Conflicts of Interest: Revised statutory Guidance for CCGs 2017. This includes the requirement for a Lay Member Chair and a Lay Member Deputy Chair.

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5.10.8 The Terms of Reference for Primary Care Commissioning Committee can be found in Appendix 3 (standing orders) to this Constitution and form part of the Constitution.

5.10.9 Audit Committee, Remuneration Committee and Primary Care Commissioning

Committee may not operate on a joint committee basis with another CCG(s). However, the CCG is permitted to establish committees in common for Audit and Remuneration Committees (see section 5.9.6).

5.10.11The Governing Body has also established a number of other Committees to assist it with the discharge of its functions. These Committees are set out in the SoRD and further information about these Committees, including terms of reference, are published in the CCG Governance Handbook.

5.11 Collaborative Commissioning Arrangements

5.11.1 The CCG wishes to work collaboratively with its partner organisations in order to assist it with meeting its statutory duties, particularly those relating to integration. The following provisions set out the framework that will apply to such arrangements.

5.11.2 In addition to the formal joint working mechanisms envisaged below, the Governing Body may enter into strategic or other transformation discussions with its partner organisations, on behalf of the CCG.

5.11.3 The Governing Body must ensure that appropriate reporting and assurance mechanisms are developed as part of any partnership or other collaborative arrangements. This will include:

• reporting arrangements to the Governing Body, at appropriate intervals; • engagement events or other review sessions to consider the aims,

objectives, strategy and progress of the arrangements; and • progress reporting against identified objectives.

5.10.4 When delegated responsibilities are being discharged collaboratively, the

collaborative arrangements, whether formal joint working or informal collaboration, must:

a) identify the roles and responsibilities of those CCGs or other partner organisations that have agreed to work together and, if formal joint working is being used, the legal basis for such arrangements;

b) specify how performance will be monitored and assurance provided to

the Governing Body on the discharge of responsibilities, so as to enable the Governing Body to have appropriate oversight as to how system integration and strategic intentions are being implemented;

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c) set out any financial arrangements that have been agreed in relation to the collaborative arrangements, including identifying any pooled budgets and how these will be managed and reported in annual accounts;

d) specify under which of the CCG’s supporting policies the collaborative

working arrangements will operate; e) specify how the risks associated with the collaborative working

arrangement will be managed and apportioned between the respective parties;

f) set out how contributions from the parties, including details around assets, employees and equipment to be used, will be agreed and managed;

g) identify how disputes will be resolved and the steps required to safely

terminate the working arrangements; h) specify how decisions are communicated to the collaborative partners.

5.11 Joint Commissioning Arrangements with Local Authority Partners

5.11.1 The CCG will work in partnership with its Local Authority partners to reduce health and social inequalities and to promote greater integration of health and social care.

5.11.2 Partnership working between the CCG and its Local Authority partners might include collaborative commissioning arrangements, including joint commissioning under section 75 of the 2006 Act, where permitted by law. In this instance, and to the extent permitted by law, the CCG delegates to the Governing Body the ability to enter into arrangements with one or more relevant Local Authority in respect of:

a) Delegating specified commissioning functions to the Local Authority;

b) Exercising specified commissioning functions jointly with the Local Authority;

c) Exercising any specified health related functions on behalf of the Local Authority.

5.11.3 For purposes of the arrangements described in 5.11.2, the Governing Body may:

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a) agree formal and legal arrangements to make payments to, or receive payments from, the Local Authority, or pool funds for the purpose of joint commissioning;

b) make the services of its employees or any other resources available

to the Local Authority; and c) receive the services of the employees or the resources from the Local

Authority.

d) where the Governing Body makes an agreement with one or more Local Authority as described above, the agreement will set 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, and the legal basis for such arrangements;

• 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 each party, including details of any assets, employees and equipment to be used under the joint working arrangements; and

• the liability of the CCG to carry out its functions, notwithstanding any joint arrangements entered into.

5.11.4 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 5.11.2 above.

5.12 Joint Commissioning Arrangements – Other CCGs

5.12.1 The CCG may work together with other CCGs in the exercise of its Commissioning Functions.

5.12.2 The CCG delegates its powers and duties under 5.12 to the Governing Body and all references in this part to the CCG should be read as the Governing Body, except to the extent that they relate to the continuing liability of the CCG under any joint arrangements.

5.12.3 The CCG may make arrangements with one or more other CCGs in respect of:

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a) delegating any of the CCG’s commissioning functions to another CCG;

b) exercising any of the Commissioning Functions of another CCG; or

c) exercising jointly the Commissioning Functions of the CCG and another CCG.

5.12.4 For the purposes of the arrangements described at 5.12.3, the CCG may:

a) make payments to another CCG;

b) receive payments from another CCG; or

c) make the services of its employees or any other resources available to another CCG; or

d) receive the services of the employees or the resources available to another CCG.

5.12.5 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.

5.12.6 For the purposes of the arrangements described above, the CCG may establish and maintain a pooled fund made up of contributions by all of the CCGs working together jointly pursuant to paragraph 5.12.3 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.

5.12.7 Where the CCG makes arrangements with another CCG as described at paragraph 5.12.3 above, the CCG shall develop and agree with that CCG an agreement setting out the arrangements for joint working including details of:

a) how the parties will work together to carry out their commissioning functions;

b) the duties and responsibilities of the parties, and the legal basis for

such arrangements; c) how risk will be managed and apportioned between the parties; d) financial arrangements, including payments towards a pooled fund

and management of that fund;

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e) contributions from the parties, including details around assets, employees and equipment to be used under the joint working arrangements.

5.12.8 The responsibility of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 5.12.1 above.

5.12.9 The liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 5.12.1 above.

5.12.10 Only arrangements that are safe and in the interests of patients registered with Member practices will be approved by the Governing Body.

5.12.11 The Governing Body shall require, in all joint commissioning arrangements, that the lead Governing Body Member for the joint arrangements:

a) make a regular written report to the Governing Body; b) hold at least one annual engagement event to review the aims,

objectives, strategy and progress of the joint commissioning arrangements; and

c) publish an annual report on progress made against objectives.

5.12.12 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 to allow for credible alternative arrangements to be put in place, with new arrangements starting from the beginning of the next new financial year after the expiration of the six months’ notice period.

5.13 Joint Commissioning Arrangements with NHS England

5.13.1 The CCG may work together with NHS England. This can take the form of joint working in relation to the CCG’s functions or in relation to NHS England’s functions.

5.13.2 The CCG delegates its powers and duties under 5.13 to the Governing Body and all references in this part to the CCG should be read as the Governing Body, except to the extent that they relate to the continuing liability of the CCG under any joint arrangements.

5.13.3 In terms of either the CCG’s functions or NHS England’s functions, the CCG and NHS England may make arrangements to exercise any of their specified commissioning functions jointly.

5.13.4 The arrangements referred to in paragraph 5.13.3 above may include other CCGs, a combined authority or a local authority.

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5.13.5 Where joint commissioning arrangements pursuant to 5.13.3 above are entered into, the parties may establish a Joint Committee to exercise the commissioning functions in question. For the avoidance of doubt, this provision does not apply to any functions fully delegated to the CCG by NHS England, including but not limited to those relating to primary care commissioning.

5.13.6 Arrangements made pursuant to 5.13.3 above may be on such terms and conditions (including terms as to payment) as may be agreed between NHS England and the CCG.

5.13.7 Where the CCG makes arrangements with NHS England (and another CCG if relevant) as described at paragraph 5.13.3 above, the CCG shall develop and agree with NHS England a framework setting out the arrangements for joint working, including details of:

a) how the parties will work together to carry out their commissioning functions;

b) the duties and responsibilities of the parties, and the legal basis for such arrangements;

c) how risk will be managed and apportioned between the parties;

d) financial arrangements, including, if applicable, payments towards a pooled fund and management of that fund;

e) contributions from the parties, including details around assets,

employees and equipment to be used under the joint working arrangements.

5.13.8 Where any joint arrangements entered into relate to the CCG’s functions, the liability of the CCG to carry out its functions will not be affected where the CCG enters into arrangements pursuant to paragraph 5.13.3 above. Similarly, where the arrangements relate to NHS England’s functions, the liability of NHS England to carry out its functions will not be affected where it and the CCG enter into joint arrangements pursuant to 5.13.

5.13.9 The CCG will act in accordance with any further guidance issued by NHS England on co-commissioning.

5.13.10 Only arrangements that are safe and in the interests of patients registered with member practices will be approved by the Governing Body.

5.13.11 The Governing Body of the CCG shall require, in all joint commissioning arrangements that the lead Governing Body Member for the joint arrangements make;

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a) make a regular written report to the Governing Body; b) hold at least one annual engagement event to review the aims,

objectives, strategy and progress of the joint commissioning arrangements; and

c) publish an annual report on progress made against objectives.

5.13.12 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 to allow for credible alternative arrangements to be put in place, 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 Provisions for Conflict of Interest Management and Standards of Business Conduct

6.1 Conflicts of Interest

6.1.1 As required by section 14O of the 2006 Act, the CCG has made 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 being unduly influenced by external or private interest.

6.1.2 The CCG has agreed policies and procedures for the identification and management of conflicts of interest.

6.1.3 Employees, Members, Committee and Sub-Committee members of the CCG and members of the Governing Body (and its Committees, Sub-Committees, Joint Committees) will comply with the CCG policy on conflicts of interest. Where an individual, including any individual directly involved with the business or decision-making of the CCG and not otherwise covered by one of the categories above, 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 and the Standards of Business Conduct Policy.

6.1.4 The CCG has appointed the Audit Committee Chair to be the Conflicts of Interest Guardian. Details on how to contact the Conflicts of Interest Guardian can be found on the CCG’s website at www.haltonccg.nhs.uk In collaboration with the CCG’s governance lead, their role is to:

a) Act as a conduit for GP practice staff, members of the public and healthcare professionals who have any concerns with regards to conflicts of interest;

b) Be a safe point of contact for employees or workers of the CCG to raise any concerns in relation to conflicts of interest;

c) Support the rigorous application of conflict of interest principles and policies;

d) Provide independent advice and judgment to staff and members where there is any doubt about how to apply conflicts of interest policies and principles in an individual situation

e) Provide advice on minimising the risks of conflicts of interest.

6.2 Declaring and Registering Interests

6.2.1 The CCG will maintain registers of the interests of those individuals listed in the CCG’s policy.

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6.2.2 The CCG will, as a minimum, publish the registers of conflicts of interest and gifts and hospitality of decision-making staff at least annually on the CCG website and make them available at our headquarters upon request.

6.2.3 All relevant persons for the purposes of NHS England’s statutory guidance Managing Conflicts of Interest: Revised Statutory Guidance for CCGs 2017 must declare any interests. Declarations should be made as soon as reasonably practicable and by law within 28 days after the interest arises. This could include interests an individual is pursuing. Interests will also be declared on appointment and during relevant discussion in meetings.

6.2.4 The CCG will ensure that, as a matter of course, declarations of interest are made and confirmed, or updated at least annually. All persons required to, must declare any interests as soon as reasonably practicable and by law within 28 days after the interest arises.

6.2.5 Where an individual is unable to make a declaration in writing, for example, if a conflict becomes apparent in the course of a meeting, they must make an oral declaration before witnesses and provide a written declaration as soon as possible thereafter.

6.2.6 Interests (including gifts and hospitality) of decision-making staff will remain on the public register for a minimum of six months. In addition, the CCG will retain a record of historic interests and offers/receipt of gifts and hospitality for a minimum of six years after the date on which it expired. The CCG’s published register of interests states that historic interests are retained by the CCG for the specified timeframe and details of whom to contact to submit a request for this information.

6.2.7 Activities funded in whole or in part by 3rd parties who may have an interest in CCG business such as sponsored events, posts and research will be managed in accordance with the CCG policy to ensure transparency and that any potential for conflicts of interest are well-managed.

6.3 Training in Relation to Conflicts of Interest

6.3.1 The CCG ensures that relevant staff and all Governing Body members receive training on the identification and management of conflicts of interest and that relevant staff undertake the NHS England Mandatory training.

6.4 Standards of Business Conduct

6.4.1 Employees, Members, Committee and Sub-Committee members of the CCG and members of the Governing Body (and its Committees, Sub-Committees, Joint Committees) will at all times comply with this Constitution and be aware of their responsibilities as outlined in it. They should:

a) act in good faith and in the interests of the CCG;

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b) follow the Seven Principles of Public Life; set out by the Committee

on Standards in Public Life (the Nolan Principles); c) comply with the standards set out in the Professional Standards

Authority guidance - Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England; and

d) comply with the CCG’s Standards of Business Conduct, including

the requirements set out in the policy for managing conflicts of interest which is available on the CCG’s website and will be made available on request.

6.4.2 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 and is also outlined in the CCG’s Standards of Business Conduct policy.

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Appendix 1: Definitions of Terms Used in This Constitution

2006 Act National Health Service Act 2006

Accountable Officer (AO)

an individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act, appointed by NHS England, with responsibility for ensuring the group:

complies with its obligations under:

sections 14Q and 14R of the 2006 Act,

sections 223H to 223J of the 2006 Act,

paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006, and

any other provision of the 2006 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 CCG has responsibility for, as defined in part 2 of this constitution

Chair of the CCG Governing Body

The individual appointed by the CCG to act as chair of the Governing Body and who is usually either a GP member or a lay member of the Governing Body.

Chief Finance Officer (CFO)

A qualified accountant employed by the group with responsibility for financial strategy, financial management and financial governance and who is a member of the Governing Body.

Clinical Commissioning Groups (CCG)

A body corporate established by NHS England in accordance with Chapter A2 of Part 2 of the 2006 Act.

Committee A Committee created and appointed by the membership of the CCG or the Governing Body.

Sub-Committee A Committee created by and reporting to a Committee.

Governing Body The body appointed under section 14L of the NHS Act 2006, with the main function of ensuring that a Clinical Commissioning Group has made appropriate arrangements

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for ensuring that it complies with its obligations under section 14Q under the NHS Act 2006, and such generally accepted principles of good governance as are relevant to it.

Governing Body Member Any individual appointed to the Governing Body of the CCG

Healthcare Professional

A Member of a profession that is regulated by one of the following bodies:

the General Medical Council (GMC)

the General Dental Council (GDC)

the General Optical Council;

the General Osteopathic Council

the General Chiropractic Council

the General Pharmaceutical Council

the Pharmaceutical Society of Northern Ireland

the Nursing and Midwifery Council

the Health and Care Professions Council

any other regulatory body established by an Order in Council under Section 60 of the Health Act 1999

Lay Member A lay Member of the CCG Governing Body, appointed by the CCG. A lay Member is an individual who is not a Member of the CCG or a healthcare professional (as defined above) or as otherwise defined in law.

Primary Care Commissioning Committee

A Committee required by the terms of the delegation from NHS England in relation to primary care commissioning functions. The Primary Care Commissioning Committee reports to NHS England and the Governing Body

Professional Standards Authority

An independent body accountable to the UK Parliament which help Parliament monitor and improve the protection of the public. Published Standards for Members of NHS Boards and Clinical Commissioning Group Governing Bodies in England in 2013

Member/ Member Practice

A provider of primary medical services to a registered patient list, who is a Member of this CCG.

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Member practice representative

Member practices appoint a healthcare professional to act as their practice representative in dealings between it and the CCG, under regulations made under section 89 or 94 of the 2006 Act or directions under section 98A of the 2006 Act.

NHS England The operational name for the National Health Service Commissioning Board.

Registers of interests

Registers a group is required to maintain and make publicly available under section 14O of the 2006 Act and the statutory guidance issues by NHS England, of the interests of:

the Members of the group;

the Members of its CCG Governing Body;

the Members of its Committees or Sub-Committees and Committees or Sub-Committees of its CCG Governing Body; and Its employees.

STP Sustainability and Transformation Partnerships – the framework within which the NHS and local authorities have come together to plan to improve health and social care over the next few years. STP can also refer to the formal proposals agreed between the NHS and local councils – a “Sustainability and Transformation Plan”.

Joint Committee Committees from two or more organisations that work together with delegated authority from both organisations to enable joint decision-making

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Appendix 2: Committee Terms of Reference Audit Committee

1.0 Constitution 1.1 The Audit Committee is a standing committee formally established by the CCG’s

Governing Body. 1.2 The Committee is a non-executive committee of the CCG and has no executive

powers, other than those specifically delegated in these terms of reference. 1.3 These terms of reference have been produced in line with the guidance

contained within the Healthcare Financial Management Association (HFMA) NHS Audit Committee Handbook (2018).

1.4 NHS Halton CCG and NHS Warrington CCG have each established their respective Audit Committees. Each CCG is responsible for fulfilling its own statutory responsibilities as CCGs. However, the two CCGs have identified common areas of interest and ways in which they will able to access joint knowledge and experience.

1.5 Accordingly, the CCGs have identified that there is merit in their respective Audit Committees meeting together as “Committees in Common”. Whilst each Committee will retain responsibility for its own functions and will remain accountable to its Governing Body, the CCGs believe that efficiencies may be achieved in establishing a “Committees in Common” approach, to share views and opinions on relevant issues and, where possible, to achieve consistency across the two CCGs.

1.6 Each Audit Committee will have its own Terms of Reference (setting out the membership, remit, responsibilities and reporting arrangements), quorum and administrative arrangements.

2.0 Membership and Quorum 2.1 The Committee will be appointed by the Governing Body from among the Lay

Members of the CCG and will consist of not less than three members. One of the members will have recent relevant financial experience.

2.2 A quorum will be two of the three members. 2.3 One of the lay members will be appointed Chair of the Audit Committee by the

Governing Body. The lay member for governance will chair the Audit Committee and must have qualifications, expertise or experience that enables them to express informed views about financial management and audit matters. The Chair of the Audit Committee will not chair any other CCG committee in order to retain independence.

2.4 The Chair of the CCG will not be a member of the Audit Committee and will not normally attend meetings, unless invited. This is outlined in Monitor’s Code of Governance

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3.0 Attendance at Meetings 3.1 The Chief Finance Officer and internal and external audit representatives will

normally attend meetings. The Deputy Chief Finance Officer will deputise for the Chief Finance Officer in the event that the Chief cannot attend.

3.2 The Head of Governance & Corporate Secretary will normally attend meetings, as will the Chief of Corporate Services.

3.3 The Clinical Chief Officer should be invited to attend to discuss at least annually with the Audit Committee the process for assurance that supports the Annual Governance Statement. The CCG Chair should also attend when the Committee considers the draft Annual Governance Statement and the annual report and accounts.

3.4 Other Executive Directors/managers should be invited to attend, particularly when the Committee is discussing areas of risk or operation that are the responsibility of that Director/manager.

3.5 The Local Counter Fraud Specialist will attend to report upon and discuss counter fraud matters.

3.6 Representatives from other organisations (e.g. NHS Counter Fraud Authority (NHS CFA)) and other individuals may be invited to attend on occasion.

3.7 The Secretary to the Committee will attend to take minutes of the meeting and provide appropriate support to the Chair and Committee members.

3.8 At least once a year, usually at its May meeting, members of the Committee will meet privately with the External and Internal Auditors. Other meetings will take place at the request of members or auditors.

4.0 Access The Head of Internal Audit, representatives of External Audit and the Local Counter Fraud Specialist have a right of direct access to the Chair of the Committee.

5.0 Frequency of Meetings 5.1 The Committee should meet five times per year at appropriate times in the audit

cycle to allow it to discharge all of its responsibilities in line with its annual work-plan. Additional meetings, including any focus working group, may be called as required. The Committee will review this annually.

5.2 The Accountable Officer, External Auditors and/or Head of Internal Audit may request a meeting if they consider that one is necessary.

6.0 Authority 6.1 The Committee is authorised by the 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.

6.2 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 this necessary.

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7.0 Responsibilities 7.1 The Committee supports the Governing Body by:

• Assessing the CCG’s overarching framework of governance, risk and control

• Obtaining assurances about the design and operation of internal controls • Seeking assurances about the underlying data (upon which assurances

are based) to assess their reliability and accuracy • Challenging poor and/or unreliable sources of assurance • Challenging relevant managers when controls are not working or data

are unreliable The duties/responsibilities of the Committee are categorised as follows:

7.2 Integrated Governance, Risk Management and Internal Control 7.2.1 The Committee will 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, that supports the achievement of the organisation’s objectives.

7.2.2 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 accompanying Head of Internal Audit Opinion, external audit opinion or other appropriate independent assurances, prior to submission to the Governing Body.

• The underlying assurance processes that indicate the degree of achievement of corporate 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-certifications.

• The policies and procedures for all work related to counter fraud and corruption as required by the NHS Counter Fraud Authority.

7.2.3 In carrying out this work the Committee will use 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.

7.2.4 This will be evidenced through the Committee’s use of an effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it.

7.2.5 As part of its integrated approach, the Committee will have effective relationships with other CCG Governing Body Sub Committees (which may include reciprocal membership) to provide an understanding of processes and linkages. This will include the exchange of Chair’s action logs and highlight reports to the CCG Governing Body.

7.3 Internal Audit

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The Committee will assure itself that there is an effective internal audit function that meets Public Sector Internal Audit Standards (PSIAS) and provides independent assurance to the Committee, Chief Executive and Governing Body. This will be achieved by:

• Considering the provision of the internal audit service and the costs involved

• Reviewing and approving the internal audit strategy, the annual internal audit plan and more detailed programme of work, that is consistent with the audit needs of the CCG 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 the use of audit resources

• Monitoring the implementation of agreed internal audit recommendations in line with agreed timescales, and where concerns exist in relation to the lack of implementation in a particular area the Committee can request the relevant operational manager to attend a meeting and give explanation

• Considering whether the internal audit function is adequately resourced and has appropriate standing within the organisation

• Reviewing the Internal Auditor’s annual report before its submission to the Governing Body

• Monitoring the effectiveness of internal audit and carrying out an annual review and obtaining independent assurance that Internal Audit complies with PSIAS

7.4 External Audit The Committee will review and monitor the External Auditor’s independence and objectivity and the effectiveness of the audit process. In particular, the Committee will 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:

• Assisting and advising the Governing Body in its appointment of the External Auditors (and make recommendations to the Governing Body when appropriate)

• Discussing and agreeing with the External Auditors, before the audit commences, the nature and scope of the audit as set out in the annual plan

• Discussing with the External Auditors their evaluation of audit risks and assessment of the organisation and the impact on the audit fee

• Reviewing all External Audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Governing Body and any work undertaken outside the annual audit plan, together with the appropriateness of management responses

• Establishing a clear policy for the engagement of external auditors to supply non-audit services

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7.5 Financial Reporting 7.5.1 The Committee will monitor the integrity of the financial statements of the CCG

and any formal announcements relating to its financial performance. 7.5.2 The Committee should ensure that the systems for financial reporting to the

Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided.

7.5.3 The Committee will review the annual report and financial statements before submission to the Governing Body, focusing particularly on:

• The wording in the Annual 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 preparation of the financial statements

• Significant adjustments resulting from the audit

• Letters of representation

• Explanations for significant variances 7.6 Risk Management 7.6.1 The Committee will request and review reports and assurance from directors

and managers as to the effectiveness of arrangements to identify and monitor risk. This will include:

• Inviting the CCG’s IT team to explain the organisation’s cyber security arrangements, in order to provide assurance to the Governing Body that the organisation is properly managing its cyber risk and has appropriate risk mitigation strategies

• Reviewing arrangements for new mergers and acquisitions, in order to seek assurance on processes in place to identify significant risks, risk owners and subsequent management of such risks

• Providing the Governing Body with assurance over developing partnership arrangements (e.g. accountable care organisations) and mitigation of risks which may arise at the borders between such organisations

7.6.2 The Governing Body will however retain the responsibility for routinely reviewing specific risks.

7.7 Counter Fraud and Security 7.7.1 The Committee will satisfy itself that the organisation has adequate

arrangements in place for counter fraud that meet the NHS CFA’s standards and will review the outcomes of work in these areas. The Committee will receive the annual report and annual work plan from the Local Counter Fraud Specialist and will also receive regular progress reports on counter fraud activities.

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7.8 Management 7.8.1 The Committee will request and review reports, evidence and assurances from

Directors and managers on the overall arrangements for governance, risk management and internal control.

7.8.2 The Committee may also request specific reports from individual functions within the organisation (e.g. clinical audit).

7.9 Other Assurance Functions 7.9.1 The Committee will review the findings of other significant assurance functions,

both internal and external to the organisation, and consider the implications for the governance of the organisation.

7.9.2 These will include, but not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (e.g. the Care Quality Commission, NHS Improvement, NHS Resolution, etc.) and professional bodies with responsibility for the performance of staff or functions (e.g. Royal Colleges, accreditation bodies, etc.).

7.9.3 In addition, the Committee will review the work of other committees within the CCG, whose work can provide relevant assurance to the Committee’s own areas of responsibility. The Committee will receive the action logs and highlight reports to the CCG Governing Body of the following Governing Body committees for information:

• Finance and Performance Committee

• Quality Committee

• Clinical Advisory Group

• Primary Care Commissioning Committee

• Remuneration Committee

• And any other committee formed by the Governing Body 7.9.4 The Committee will review Standing Financial Instructions, Scheme of

Delegation and those elements of the CCG Constitution (Standing Orders) that provide assurances on the internal management of procurement and financial matters. It will also review the CCG’s Standards of Business Conduct Policy.

8.0 Reporting 8.1 Minutes of each meeting will be submitted to the next meeting for formal

approval and signature by the Chair as a true record of that meeting. A Chair’s log and the minutes will be submitted to the next meeting of the Governing Body.

8.2 The Chair will draw to the attention of the Governing Body (via a highlight report) any issues that require disclosure to the Governing Body, or require executive action.

8.3 The Committee will report to the Governing Body 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

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arrangements, the appropriateness of the evidence that shows the organisations is fulfilling regulatory requirements relating to its existence as a functioning business and the robustness of the processes behind the quality accounts.

8.4 The annual report should also describe how the Committee has fulfilled its terms of reference and give details of any significant issues that the Committee considered in relation to the financial statements and how they were addressed. The report will also outline its work-plan for the coming year.

8.5 The Committee’s annual report and work-plan will also be submitted to the Governing Body for information.

9.0 Whistleblowing / Freedom to Speak Up Guardian 9.1 The Committee will review the effectiveness of the arrangements in place for

allowing staff to raise (in confidence) concerns about possible improprieties in financial, clinical or safety matters and ensures that any such concerns are investigated proportionately and independently.

9.2 The CCG’s Freedom to Speak Up Guardian, or his or her nominated deputy, will attend the Committee at least annually to provide assurance on the design and operation of the function.

10.0 Administrative Support 10.1 The agenda for the Committee will be approved by the Chair of the Committee

(or his or her nominated deputy). 10.2 Secretarial support (including distribution of agenda and papers to the

Committee and noting of apologies) will be arranged by the Chief Finance Officer (or his or her nominated deputy).

10.3 Agenda papers will be circulated to all members of the Committee no less than five working days prior to each meeting. Late papers may only be circulated, or tabled at the meeting, with the prior approval of the Chair.

11.0 Review 11.1 The Committee will review its Terms of Reference annually, or as necessary in

the intervening period, to ensure that they remain fit for purpose and best facilitate the discharge of its duties. It will recommend any changes to the CCG Governing Body for approval.

11.2 The Committee will carry out an annual self-assessment (Appendix A) that is based on the good practice guide found in the HFMA’s NHS Audit Committee Handbook.

12.0 Equality Act (2010) 12.1 The CCG is committed to promoting a pro-active and inclusive approach to

equality which supports and encourages an inclusive culture which values diversity.

12.2 The CCG is committed to building a workforce which is valued and whose diversity reflects the community it serves, allowing the CCG to deliver the best possible healthcare service to the community. In doing so, the CCG will enable

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all staff to achieve their full potential in an environment characterised by dignity and mutual respect.

12.3 The CCG aims to design and provide services, implement policies and make decisions that meet the diverse needs of our patients and their carers the general population we serve and our workforce, ensuring that none are placed at a disadvantage.

12.4 We therefore strive to ensure that in both employment and service provision no individual is discriminated against or treated less favourably by reason of age, disability, gender, pregnancy or maternity, marital status or civil partnership, race, religion or belief, sexual orientation or transgender (Equality Act 2010).

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Remuneration Committee 1.0 The Committee will advise the Governing Body on remuneration and

conditions of service matters. The Committee is established in accordance with NHS Halton Clinical Commissioning Group’s (the CCG’s) Constitution, Standing Orders and Scheme of Delegation.

1.1 The Remuneration Committee has the function of making recommendations to the Governing Body about the exercise of its functions in relation to:

• determining the remuneration, fees and allowances payable to employees (non-agenda for change employees) of the CCG and to other persons providing services to it; and

• determining allowances payable under pension schemes established by the CCG

1.2 NHS Halton CCG and NHS Warrington CCG have each established their

respective Remuneration Committees. Each CCG is responsible for fulfilling its own statutory responsibilities as CCGs. However, the two CCGs have identified common areas of interest and ways in which they will able to access joint knowledge and experience.

1.3 Accordingly, the CCGs have identified that there is merit in their respective Remuneration Committees meeting together as “Committees in Common”. Whilst each Committee will retain responsibility for its own functions and will remain accountable to its Governing Body, the CCGs believe that efficiencies may be achieved in establishing a “Committees in Common” approach, to share views and opinions on relevant issues and, where possible, to achieve consistency across the two CCGs.

1.4 Each Remuneration Committee will have its own Terms of Reference (setting out the membership, remit, responsibilities and reporting arrangements), quorum and administrative arrangements.

2. Membership The Committee shall be appointed by the Clinical Commissioning Group from amongst its Governing Body Members. The Committee shall comprise:

• Two Lay Members (in the roles of Chair and Deputy Chair) • Secondary Care Doctor • One Governing Body General Practitioner (who will not be the Clinical

Chair) 2.1 In attendance 2.2 The CCG Chief of Corporate Services will act as Lead Officer for the

Committee. The Senior HR Business Partner from the HR Service Provider (Midlands & Lancashire Commissioning Support Unit) will also attend the Committee to provide respective Human Resource advice and guidance to members in line with best practice, national guidance and other relevant documents as appropriate. Other officers of the CCG will be invited to attend as appropriate in line with Committee business.

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2.3 Any conflicts of interest (including matters in respect of personal remuneration, fees and allowances) will be handled by the Chair in line with the CCG Conflict of Interest policies and protocols. The Committee will submit recommendations to the Governing Body for approval.

3. Quorum Three of the four Governing Body members, including either the Chair or Deputy Chair.

4. Remit and responsibilities 4.1 The Committee will make recommendations to the Governing Body on

determinations about remuneration, fees and allowances. 4.2 The Committee is responsible for:

• Making recommendations to the Governing Body in respect of remuneration, fees and allowances for officers and employees (non-agenda for change employees). Remuneration packages will include the rates of pay for hours or sessions (whichever is appropriate) and the number of hours or sessions to be worked so that a view can be taken on the overall level of remuneration before making recommendations to the Governing Body

• Making recommendations to the Governing Body in respect of remuneration for people who provide services to the CCG, including Governing Body members and clinical leads

• Making recommendations to the Governing Body in respect of allowances under any pension scheme it might establish as an alternative to the NHS Pension Scheme

• Reviewing the performance of the chief officer and other senior management team members and making recommendations to the Governing Body in respect annual salary awards

• Making recommendations to the Governing Body on the policy for and scope of termination / redundancy payments whist ensuring they are in accordance with national guidelines

• Making recommendations to the Governing Body on any severance payments to the chief officer or to other senior management staff

• Scrutinise and make recommendations to the governing body on plans for orderly succession of appointments to the Governing Body of senior management and elected members in order to maintain an appropriate balance of skills and experience

• Approve the terms and conditions for all staff and workers not on national terms and conditions, ensuring payments made to workers are fairly rewarded, and that provision of any national arrangements or guidance are made where appropriate

• The Committee may at any time seek independent advice in respect of any remuneration packages prior to making recommendations to the Governing Body

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5. Decision making 5.1 Wherever possible members of the Committee will seek to make decisions

and recommendations based on consensus. Where this is not possible then the Chair of the meeting will ask for members to vote.

5.2 In the event of a formal vote, the Chair will clarify what members are being asked to vote on. Subject to the meeting being quorate a simple majority of members present will prevail. In the event of a tied vote, the chair of the meeting may have a second and deciding vote.

5.3 Only the members of the Committee present at the meeting (either in person or by virtual attendance) will be eligible to vote. Members not present, non-voting deputies and attendees will not be permitted to vote, nor will proxy voting be permitted. The outcome of the vote, including the details of those members who voted in favour or against the matter will be recorded in the minutes.

5.4 In making its recommendations, the Committee will take into account: o Provisions of any national guidance arrangements o Relevant legislation (in particular equal pay and anti-discrimination

legislation) o Best practice and affordability o Employee relations and relevant staffing matters within the CCG o Remuneration levels elsewhere in the NHS and other relevant labour

markets (subject to available benchmarking) o Trends and developments in non-pay benefits and terms & conditions o Organisational performance o Existing terms and conditions of service o Recommendations of Audit activity

6. Frequency of meetings 6.1 The Committee will be scheduled three times a year and will meet at least

twice each year. The Committee will be scheduled as and when required in line with the work plan of the Committee and any emerging organisational issues.

7. Reporting 7.1 This Committee will submit recommendations and a key issues report on

remuneration matters for approval to the private section of the Governing Body meeting. The Committee will also provide an annual report to the Governing Body as part of the Annual Report production.

8. Responsibility of Committee members and attendees 8.1 Members of the Committee have a responsibility to:

• Attend meetings, having read all papers beforehand • Identify agenda items to the secretary at least fifteen working days

before the meeting

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• Submit papers at least ten working days before the meeting • Make open and honest declarations of their interests at the start of

each meeting notifying the Committee Chair of any agreed management arrangements, or to notify the Committee Chair of any actual, potential or perceived conflict in advance of the meeting.

• Uphold the Nolan Principles and all other relevant NHS Code of Conduct requirements.

9. Administrative arrangements 9.1 The Committee will be supported by a secretary who will be responsible for

supporting the Chair in the management of the Committee’s business. The secretary will ensure:

• Correct minutes are taken and once agreed by the Chair, distributing minutes to the members within five working days of the meeting taking place

• A key issues report is produced following the meeting and submitted to the next meeting of the (Private) Governing Body

• An action log is produced following each meeting and any outstanding actions are carried forward until complete

• The agenda and accompanying papers are distributed to members at least five working days in advance of the meeting date

• Provision of appropriate support to the Chair and Committee members. • The papers of the Committee are filed in accordance with NHS Halton

CCG policies and procedures 10. Date and Review 10.1 The Committee will review its own performance, membership and terms of

reference annually. Any resultant changes to the Terms of Reference will be approved by Governing Body.

10.2 The Terms of Reference were reviewed and recommended by the Remuneration Committee on 27th February 2020.

10.3 The Terms of Reference were accepted and approved by NHS Halton CCG Governing Body on (to insert).

Date: February 2020 Review date: February 2021

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Primary Care Commissioning Committee Introduction

A . 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 NHS Halton CCG. The delegation is set out in Schedule 1 of the NHS Act.

B. The CCG has established the NHS Halton CCG Primary Care Commissioning Committee (“Committee”). The Committee will function as a corporate decision-making body for the management of the delegated functions and the exercise of the delegated powers.

C. The Committee is established in accordance with NHS Halton Clinical Commissioning Group’s (the CCG) Constitution, Standing Orders and Scheme of Reservation & Delegation. These Terms of Reference set out the membership, remit, responsibilities and reporting arrangements of the Committee. The Committee will act to review and assure the Governing Body in relation to effective commissioning of primary care.

Statutory Framework

1. 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.

2. Arrangements made under section 13Z may be on such terms and conditions

(including terms as to payment) as may be agreed between the Board and the CCG.

3. Arrangements made under section 13Z do not affect the liability of NHS

England for the exercise of any of its functions. However, the CCG acknowledges that in exercising its functions (including those delegated to it), it must comply with the statutory duties set out in Chapter A2 of the NHS Act and including: a) Management of conflicts of interest (section 14O);

b) Duty to promote the NHS Constitution (section 14P);

c) Duty to exercise its functions effectively, efficiently and economically (section 14Q);

d) Duty as to improvement in quality of services (section 14R);

e) Duty in relation to quality of primary medical services (section 14S);

f) Duties as to reducing inequalities (section 14T);

g) Duty to promote the involvement of each patient (section 14U);

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h) Duty as to patient choice (section 14V);

i) Duty as to promoting integration (section 14Z1);

j) Public involvement and consultation (section 14Z2).

4. The Committee is established as a committee of the Governing Body of NHS

Halton CCG in accordance with Schedule 1A of the “NHS Act”. 5. The members acknowledge that the Committee is subject to any directions

made by NHS England or by the Secretary of State.

Role of the Committee 6. The Committee has been established in accordance with the above statutory

provisions to enable the members to make collective decisions on the review, planning and procurement of primary care services in Halton, under delegated authority from NHS England.

7. In performing its role, the Committee will exercise its management of the

functions in accordance with the agreement entered into between NHS England and NHS Halton CCG, which will sit alongside the delegation and terms of reference.

8. The functions of the Committee are undertaken in the context of a desire to

promote increased co-commissioning to increase quality, efficiency, productivity and value for money and to remove administrative barriers.

9. 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.

10. This includes, but is not limited, to the following:

• GMS, PMS and APMS contracts (including the design of PMS and APMS contracts, monitoring of contracts, taking contractual action such as issuing branch/remedial notices, and removing a contract)

• Newly designed enhanced services (“Local Enhanced Services” and “Directed Enhanced Services”)

• Design of local incentive schemes as an alternative to the Quality Outcomes Framework (QOF)

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• Decision making on whether to establish new GP practices in an area • Approving practice mergers

• Making decisions on ‘discretionary’ payment (e.g. returner/retainer

schemes) 11. The CCG will also carry out the following activities:

a) To plan, including needs assessment, primary [medical] care services in Halton

b) To undertake reviews of primary [medical] care services in Halton

c) To co-ordinate a common approach to the commissioning of primary care services generally

d) To manage the budget for commissioning of primary [medical] care services in Halton in line with the scheme of reservation/delegation for the CCG.

Geographical Coverage 11. The Committee will comprise the NHS Halton CCG area.

Membership 12. The Committee shall consist of the following members:

• Two Lay Members of the Governing Body (one to be Chair and the other to be Deputy Chair)

• Chief Nurse (or deputy) • Chief Finance Officer (or deputy) • Secondary Care Doctor • Chief Commissioner (or deputy) • Director of Public Health (or deputy)

13. The Chair of the Committee shall be agreed by the Governing Body and will

be elected from its Lay Member representation. The Governing Body shall elect from the Lay Members on the Committee, the appointment will be reviewed annually.

14. The following will be included on the Committee as attendees:

• Clinical Chief Officer • Healthwatch representative • Health and Wellbeing representative (chair or elected member with

portfolio for health) • Primary Care Clinical Lead

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15. The Committee may call additional experts to attend meetings on an ad hoc basis to inform discussions.

16. The Committee may call additional lay members or CCG members to attend meetings as and when required so as to mitigate any possibility of decision-making being unable to take place due to arising conflict of interests

Meetings and Voting 17. The Committee will operate in accordance with the CCG’s Standing Orders.

The Secretary of the Committee will be responsible for giving notice of meetings. This will be accompanied by an agenda and supporting papers and sent to each member representative no later than five working days before the date of the meeting. When the Chair of the Committee deems it necessary in light of the urgent circumstances to call a meeting at short notice, the notice period shall be such as s/he shall specify.

18. Each member of the Committee shall have one vote. The Committee shall reach decisions by a simple majority of members present, but with the Chait having a second and deciding vote, if necessary. However, the aim of the Committee will be to achieve consensus decision-making wherever possible.

Quorum

19. A quorum necessary for the Committee to undertake its business is defined as at least four of the following members: • Chair or (Deputy Chair) • Three other members (with at least one being a member of the Integrated

Management Team and another to be a clinician)

20. Where the meeting is not quorate, owing to the absence of certain members, the meeting 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 CCG Conflicts of Interest Guardian regarding the action to be taken.

Conflicts of Interest 21. Members must make open and honest declarations of their interests at the

commencement of each meeting notifying the Chair of any agreed management arrangements or to notify the Chair of any actual, potential or

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perceived conflict in advance of the meeting.

22. The Chair will request any conflict of interests relating to individual agenda

items. Any noted conflicts of interest will be managed in accordance with

CCGs conflict of interest policy. The management of conflict of interest and

any actions taken to mitigate the conflict will be recorded in the minutes.

Frequency of meetings 23. The Committee shall meet on a bi-monthly basis during the financial year.

Additional Meetings may be called by the Chair of the Committee as and when required.

24. Meetings of the Committee shall: a. be held in public, subject to the application of 23(b); b. the Committee may resolve to exclude the public from a meeting that is

open to the public (whether during the whole or part of the proceedings) whenever publicity would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution and arising from the nature of that business or of the proceedings or for any other reason permitted by the Public Bodies (Admission to Meetings) Act 1960 as amended or succeeded from time to time.

25. Members of the Committee have a collective responsibility for the operation of

the Committee. They will participate in discussion, review evidence and provide objective expert input to the best of their knowledge and ability, and endeavour to reach a collective view.

26. The Committee may delegate tasks to such individuals, sub-committees or

individual members as it shall see fit, provided that any such delegations are consistent with the parties’ relevant governance arrangements, are recorded in a scheme of delegation, are governed by terms of reference as appropriate and reflect appropriate arrangements for the management of conflicts of interest..

27. The Committee may call additional experts to attend meetings on an adhoc

basis to inform discussions.

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28. Members of the Committee shall respect confidentiality requirements as set out in the CCG’s Constitution and/or Standing Orders.

29. The Committee will present its minutes to NHS England and to the Governing

Body of NHS Halton CCG for information, including the minutes of any sub-committees to which responsibilities are delegated.

30. The CCG will also comply with any reporting requirements set out in its

constitution. 31. It is envisaged that these Terms of Reference will be reviewed from time to

time, reflecting experience of the Committee in fulfilling its functions. NHS England may also issue revised model terms of reference from time to time.

Accountability of the Committee 32. Budget and resource accountability arrangements and the decision-making

scope of the Committee have been agreed and are laid out within the Scheme of Reservation and Delegation.

33. For the avoidance of doubt, in the event of any conflict between the terms of the Delegation and Terms of Reference and the Standing Orders of Standing Financial Instructions of any of the members, the Delegation will prevail.

34. The Committee will ensure the publication, in line with national requirements of all committee procurement decisions onto NHS Halton CCG Website. The Committee will ensure that the CCG engages and consults with the public and its members in the delivery of its functions.

Procurement of Agreed Services 35. The committee will ensure that all procurements are undertaken in a fair and

transparent way in accordance with i. Public procurement law and statutory guidance (as issued) ii. The Principles and Rules of Co-operation and Competition published by

the Department of Health. iii. The Primary Medical Care Policy and Guidance Manual iv. NHS Halton CCG Procurement Policy.

Decisions 36. The Committee will make decisions within the bounds of its remit.

37. The decisions of the Committee shall be binding on NHS England and NHS

Halton CCG.

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38. The Committee will produce an executive summary report which will be

presented to the Cheshire & Merseyside Area Team of NHS England and the Governing Body of NHS Halton CCG for information.

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Appendix 3: 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 Halton Clinical Commissioning Group so that the 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.

1.1.2 The standing orders, together with the group’s scheme of reservation and

delegation and the group’s prime financial policies, provide a procedural framework within which the group discharges its business. They set out: a) the arrangements for conducting the business of the group;

b) the appointment of member practice and Governing Body

representatives; c) the procedure to be followed at meetings of the group, the governing

body and any committees or sub-committees of the group or the governing body;

d) the process to delegate powers, e) the declaration of interests and standards of conduct.

1.1.3 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 appropriate9 of any relevant guidance.

1.1.4 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.

1.1.5 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.

9 Under some legislative provisions the group is obliged to have regard to particular guidance but under other

circumstances guidance is issued as best practice guidance.

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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 CCG Governance Handbook).

1.2.2 The CCG will comply with the 2006 Act and related regulations which set out provisions as to:

• Qualification and disqualification for membership and appointment of chairs of governing body’s and of their audit and remuneration committees

• How governing body members are to be appointed • Eligibility for reappointment

1.2.3 Application and variation and amendment of Standing Orders 1.3.1 This Constitution incorporating the Standing Orders can only be varied and

amended in two circumstances:

a) Where the CCG formally applies with the approval of the members, to NHS England and that application is granted;

b) Where in the circumstances set out in legislation, NHS England varies the CCG’s constitution other than on application by the CCG.

1.3.2 Any variation to the Constitution will be communicated to all members within

two weeks’ notice. 1.3.3 Standing Orders will be reviewed at least annually.

2. The Clinical Commissioning Group: Composition of Membership, Key Roles and Appointment Process

2.1 Composition of Membership 2.1.1 Chapter 3 of the CCG Constitution provides details of the membership of the

CCG. 2.2 Members of the CCG Governing Body 2.2.1 Section 5.6 outlines the roles required on the Governing Body. Further detail

about the key roles and processes in place to establish appointments is included below. The CCG will also refer and adhere to the guidance issued

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by NHS England in relation to senior appointments10 and governing body roles.11

2.2.2 Chair is subject to the following:

a) Nominations – self-nomination through application for position. b) Eligibility – a GP holding a patient list within the CCG geographical

boundary with more than 5 years practice experience and meeting the person specification approved by the Governing Body.

c) Appointment process – election managed via Local Medical Committee by Member Practices through Practice Leads.

d) Term of office - Three years. e) Time commitment – will be that outlined to undertake the duties aligned

to the role. f) Eligibility for reappointment – an individual will be eligible for

reappointment provided he/she continues to meet the eligibility criteria for the role.

g) Grounds for removal from office - any practice representative with the support of at least 50% of other practice representatives can at an Annual or Extraordinary General Meeting call a motion of no confidence in the Chair. If at least 75% of practice representatives approve such a motion the Chair must stand down.

h) Notice period – 6 months, informing in writing to the accountable officer. i) Remuneration – this will be as per the approved Remuneration

Framework, overseen by the Remuneration Committee. 2.2.3 Clinical Chief Officer is subject to the following:

a) Nominations – self-nomination through application for position; b) Eligibility – meeting the person specification outlined in NHS England

guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”;

c) Appointment process – interview and appointment by the chair, representatives of member practices and an external assessor [need to review this section]. Appointment is subject to ratification by NHS England;

d) Term of office - permanent; e) Eligibility for reappointment – not applicable for this position; f) Grounds for removal from office - the process for removal from office is

in line with the groups disciplinary policy and procedure and processes set out by the NHS England;

g) Notice period – 6 months, informing in writing to the chair; h) Remuneration – this will be as per the approved Remuneration

Framework, overseen by the Remuneration Committee. 2.2.5 Chief Finance Officer is subject to the following: 10 https://www.england.nhs.uk/wp-content/uploads/2015/10/ccg-snr-appt-guidance.pdf

11 https://www.england.nhs.uk/wp-content/uploads/2016/09/ccg-members-roles.pdf

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a) Nominations – self-nomination through application for position; b) Eligibility – meeting the person specification outlined in NHS England

guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”.

a) Appointment process – interview and appointment via the usual recruitment methods.

c) Term of office – permanent. d) Eligibility for reappointment - not applicable for this position. e) Grounds for removal from office - the process for removal from office is

in line with the groups disciplinary policy and procedure. f) Notice period – 6 months, informing in writing to the accountable officer. g) Remuneration – this will be as per the approved Remuneration

Framework, overseen by the Remuneration Committee. 2.2.6 Secondary Care Specialist is subject to the following:

b) Nominations – self-nomination through application for position; c) Eligibility – not currently employed by one of the main providers

commissioned by the group and meeting the person specification outlined in NHS England guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”.

d) Appointment process – interview and appointment via the usual recruitment methods.

e) Term of office - three years. f) Time commitment – will be that outlined to undertake the duties aligned

to the role; g) Eligibility for reappointment - an individual will be eligible for

reappointment provided he/she continues to meet the eligibility criteria for the role;

h) Grounds for removal from office - the process for removal from office is in line with the groups disciplinary policy and procedure;

i) Notice period – 6 months, informing in writing to the chair; j) Remuneration – this will be as per the approved Remuneration

Framework, overseen by the Remuneration Committee. 2.2.7 Registered Nurse is subject to the following:

a) Nominations – self-nomination through application for position; b) Eligibility – meeting the person specification outlined in NHS England

guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”.

k) Appointment process – interview and appointment via the usual recruitment methods.

c) Term of office – permanent. d) Eligibility for reappointment - not applicable for this position. e) Grounds for removal from office - the process for removal from office is

in line with the groups disciplinary policy and procedure. f) Notice period – 6 months, informing in writing to the accountable officer.

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g) Remuneration – this will be as per the approved Remuneration Framework, overseen by the Remuneration Committee.

2.2.8 Lay members will be required to undertake the role of chair and deputy chair of the Audit Committee, Remuneration Committee and Primary Care Commissioning Committee. They will also be required to take the role of chair and deputy chair for the additional assurance committees agreed and approved by the CCG. They are subject to the following:

a) Nominations – self-nomination through application for position; b) Eligibility – meeting the person specification outlined in NHS England

guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”;

l) Appointment process – – interview and appointment via the usual recruitment methods.

c) Term of office – three years. d) Time commitment – will be that outlined to undertake the duties aligned

to the role. e) Eligibility for reappointment - an individual will be eligible for

reappointment provided he/she continues to meet the eligibility criteria for the role.

f) Grounds for removal from office - the process for removal from office is in line with the groups disciplinary policy and procedure.

g) Notice period – dependent on reason for notice, informing in writing to the chair.

h) Remuneration – this will be as per the approved Remuneration Framework, overseen by the Remuneration Committee.

2.2.9 GP members on the Governing Body are subject to the following:

a) Nominations – self-nomination. b) Eligibility – a qualified GP currently on the General Medical Council GP

Register and on a national performer’s list held by NHS England working within a member practice in the Halton area and meeting the person specification outlined in NHS England guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”.

c) Appointment process – election by Member Practices through Practice leads, elections managed via Local Medical Committee.

d) Term of office – three years depending on individual agreement. e) Eligibility for reappointment - an individual will be eligible for

reappointment provided he/she continues to meet the eligibility criteria for the role.

f) Grounds for removal from office - the process for removal from office is determined by the representative member practice group or federations.

g) Notice period – dependent on reason for notice, informing in writing to the chair.

h) Remuneration – this will be as per the approved Remuneration Framework, overseen by the Remuneration Committee.

2.2.10 Practice Manager Member is subject to the following:

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a) Nominations – application. b) Eligibility – working within a Member Practice and must be able to

evidence appropriate skills and meet the relevant eligibility criteria set out in the National Health Service (Clinical Commissioning Groups) Regulations 2012

c) and meeting the person specification outlined in NHS England guidance “Clinical commissioning group governing body members: Role outlines, attributes and skills”.

d) Appointment process – nomination and election by Member Practices. e) Term of office – three years depending on individual agreement. f) Eligibility for reappointment - an individual will be eligible for

reappointment provided he/she continues to meet the eligibility criteria for the role.

g) Grounds for removal from office - the process for removal from office is determined by the representative member practice group or federations.

h) Notice period – dependent on reason for notice, informing in writing to the chair.

i) Remuneration – this will be as per the approved Remuneration Framework, overseen by the Remuneration Committee.

2.2.11 The appointment of Member Practice Representatives (Practice Lead) is

subject to the following process and criteria

a) Nominations – nomination by a Member Practice. b) Eligibility – must be a clinician working within a Member

Practice. c) Appointment process – by agreement with individual practice and CCG. d) Term of office – three years. e) Eligibility for reappointment – effective delivery of role and function. f) Grounds for removal from office –

i) Failure to work within the standards of governance for the CCG; or

ii) Upon being identified as not meeting the relevant eligibility criteria ; or

iii) No longer a practicing clinician in a Member Practice; or iv) Subject to an interim suspension by the GMC or NMC as

applicable for a period which exceeds 3 months g) Grounds for a temporary suspension –

i) an interim suspension by the GMC or NMC as applicable; ii) suspension from a Performers List is applicable.

h) Notice period – dependent on reason for notice, informing in writing to the chair.

2.2.12 The appointment of Clinical Lead roles is subject to the following process

and criteria:

a) Nominations – by application for role. b) Eligibility – must be a clinician working within a Member

Practice.

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c) Appointment process – application and interview by CCG Chair. d) Term of office – dependent on role. e) Eligibility for reappointment – effective delivery of role and function and

ongoing need for post still required. f) Grounds for removal from office –

i) Failure to work within the standards of governance for the CCG; or

ii) Upon being identified as not meeting the relevant eligibility criteria ; or

iii) No longer a practicing clinician in a Member Practice; or iv) Subject to an interim suspension by the GMC or NMC as

applicable for a period which exceeds 3 months g) Grounds for a temporary suspension –

i) an interim suspension by the GMC or NMC as applicable; ii) suspension from a Performers List is applicable.

h) Notice period – dependent on reason for notice, informing in writing to the chair.

i) Remuneration – this will be as per the approved Remuneration Framework, overseen by the Remuneration Committee.

3 Disputes with Member Practices 3.1 The CCG will agree a local dispute resolution process, supported by a

decision-making panel. The process will set out how to raise a dispute, the right of appeal and how to escalate to NHS England.

4 Meetings of the Clinical Commissioning Group 4.1 Calling meetings

4.1.1 Ordinary meetings of the CCG shall be held at regular intervals at such times and places as the CCG may determine.

4.2 Agenda, supporting papers and business to be transacted 4.2.1 Items of business to be transacted for inclusion on the agenda of a meeting

need to be notified to the chair of the meeting at least fifteen 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 ten working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least five working days before the date the meeting will take place.

4.2.2. Agendas and certain papers for the group’s governing body – including details about meeting dates, times and venues - will be published on the group’s website at www.haltonccg.nhs.uk

4.3 Petitions

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4.3.1 Where a petition has been received by the group, the chair of the governing body shall include the petition as an item for the agenda of the next meeting of the governing body.

4.4 Chair of a meeting 4.4.1 At any meeting of the group or its governing body or of a committee or sub-

committee, the chair of the group, governing body, committee or sub-committee, if any and if present, shall preside. If the chair is absent from the meeting, the 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 group, governing body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, and shall preside.

4.5 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 Quorum 4.6.1 No business will be transacted at the meeting of the Governing Body, unless

all of the following are represented:

• The Chair or Deputy Chair; • The Accountable Officer or Chief Finance Officer (or deputy); • At least one Lay Member; • At least three clinically qualified members of the Governing Body

(including Chief Nurse, Secondary Care Specialist and GPs). 4.6.2 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.

4.7 Decision making 4.7.1 Generally it is expected that at the CCG’s meeting decisions will be reached

by consensus. Should this not be possible then a vote of members will be required. In the event of a tied vote, the Chair of the meeting will have a second and casting vote.

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4.7.2 With prior notice, deputies for Governing Body posts can be agreed with the Chair or Deputy Chair. Individuals attending as deputies can cast a proxy-vote on behalf of those Governing Body members eligible to vote.

4.8 Disagreement with a decision 4.8.1 In exceptional circumstances, there may be disagreement within the

membership of the Governing Body with a decision that has been made by the Governing Body. In such circumstances those members taking a dissenting view may have their dissent recorded in the minutes.

4.9 Record of attendance 4.9.1 The names of all Governing Body members present at the meeting shall be

recorded in the minutes of the meeting. 4.9.2 Members or advisors of the Governing Body or its committees or sub-

committees may participate in meetings by telephone or by the use of video conferencing facilities where they are available and with prior approval by the Chair of the meeting or if the Chair of the meeting is not present, by the Deputy Chair of the meeting. Participation in a meeting by any of these means shall be deemed to constitute presence in person at the meeting.

4.10 Minutes 4.10.1 The minutes of the proceedings of a meeting shall be drawn up and submitted

for agreement at the next meeting where they shall be signed by the person presiding at it as a true record.

4.10.2 No discussion shall take place upon the minutes except upon their accuracy

or where the Chair considers discussion appropriate.

4.10.3 Minutes shall be made available to members and the public via the CCG website.

4.11 Emergency powers and urgent decisions

4.11.1 Subject to the agreement of the Chair, an emergency meeting can be called at any time. If an emergency meeting is called, an agenda will be produced which outlines the reason for the urgency.

4.11.2 Should an urgent item need to be added to the agenda once the agenda has been issued, the Chair or Deputy Chair in consultation with the Accountable Officer or Chief Finance Officer/Deputy Chief Officer may agree to add the item to the agenda.

4.11.3 The powers which the Governing Body has reserved to itself may, in an emergency or for an urgent decision, be exercised by the Clinical Chief Officer (or in his absence by the Chief Finance Officer) and the Chair (or in his absence by the Deputy Chair), after having consulted at least two other

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Governing Body members. The exercise of such powers by the Clinical Chief Officer and Chair shall be reported to the next meeting of the Governing Body in public session for formal ratification.

4.12 Suspension of Standing Orders

4.12.1 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 standing orders may be suspended at any meeting of the Governing Body, provided the majority of the Governing Body members are in agreement.

4.12.2 A decision to suspend Standing Orders together with the reasons for doing so shall be recorded in the minutes of the Governing Body meeting.

4.12.3 A separate record of matters discussed during the suspension shall be kept. These records shall be made available to the Audit Committee for review of the reasonableness of the decision to suspend Standing Orders.

4.13 Extraordinary General Meeting 4.13.1 An Extraordinary General Meeting of the group may be called for, in writing;

a) by the Governing Body; or b) by ten member practices to discuss an urgent matter.

4.13.2 The chair will give member practices and any other interested parties at least

fourteen days’ notice of any Extraordinary General Meeting with notice of the business to be discussed.

4.13.3 All voting decisions made by a member’s vote will follow the “one member

practice, one vote” principle. 4.13.4 For a decision to be made via a member vote a simple majority is required 4.14 Minutes 4.14.1 Minutes taken for the Governing Body meetings and Primary Care

Commissioning Committee meetings will be taken by corporate services administrative support and formally signed off by the Chair of the respective meeting.

4.14.2 Minutes of the meetings in 4.14.1 above will be made available to members

within ten working days of the meeting. 4.14.3 Minutes of the meetings in 4.14.1 will be made available to members of the

public via the CCG website. 4.15 Admission of the Public and the Press

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4.15.1 Meetings of the group’s governing body, annual general meeting and extraordinary general meetings will be in public unless the CCG considers that it is not in the public interest to permit members of the public to attend a meeting or part of a meeting.

4.15.2 The press and or the public may be excluded from the meeting or part of a

meeting to prevent disruption or to discuss a confidential issue or where publicity on a matter would be prejudicial to the public interest.

4.15.3 Where press or public are excluded, members and employees will be required

not to disclose confidential contents of papers or minutes, or content of any discussion at meeting on these topics, outside the clinical commissioning group without express permission of the CCG or its governing body.

4.15.4 General disturbances 4.15.5 The Chair 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. This is to ensure that the CCG’s business shall be conducted without interruption and disruption. The Chair or person presiding over the meeting can request a member of the public or press to leave the meeting should their presence be detrimental to the work of that meeting.

4.15.6 This action is 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:

4.15.7 ‘That in the interests of public order the meeting adjourn for (the period to be

specified) to enable the Governing Body of the CCG to complete its business without the presence of the public’.

5. Application of Standing Orders Committees and Sub-Committees 5.1 Appointment of committees and sub-committees 5.1.1 The CCG may appoint committees and sub-committees of the CCG, subject

to any regulations made by the Secretary of State12 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 of its Governing Body, are appointed, they are included in Chapter 5 of this Constitution.

5.1.2 Other than where there are statutory requirements such as in relation to the

Governing Body’s Audit Committee, Remuneration Committee and Primary Care Commissioning Committee meetings, the CCG shall determine the membership and terms of reference of committees and sub-committees and

12 See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act

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shall if required, receive and consider reports of such committees at the next appropriate meeting of the CCG.

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-committees and all committees and sub-committees unless stated otherwise in the committee or sub-committee’s terms of reference.

5.2 Delegation of Powers by Committees to Sub-Committees 5.2.1 Where committees are authorised to establish sub-committees, they may not

delegate executive powers to the sub-committee unless expressly authorised by the CCG.

5.3 Approval of Appointments to Committees and Sub-Committees 5.3.1 Other than where there are statutory requirements, such as in relation to the

membership of the CCG’s Governing Body’s Audit committee or Remuneration committee, the Governing Body shall approve the appointments to each of the committees and sub-committees which it has formally constituted. The CCG’s Governing Body shall define the powers of such appointees and shall agree such travelling or other allowances as it considers appropriate.

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 CCG and staff have a duty to disclose any non-compliance with these standing orders to the Clinical Chief Officer as soon as possible.

7 Use of Seal and Authorisation of Documents 7.1 Clinical Commissioning Group’s Seal

7.1.1 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, or their named deputy:

a) The Clinical Chief Officer

b) The Chair of the Governing Body

c) The Chief Finance Officer

7.1.2 An entry of every sealing shall be made and numbered consecutively in a book provided for that purpose and shall be signed by the persons who shall have approved and authorised the document and those who attested the seal.

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7.2 Use of Seal – General Guide

• All contracts for the purchase/lease of land and/or building • All contracts for capital works exceeding £100,000 • All lease agreements where the annual lease charge exceeds £10,000 per

annum and the period of the lease exceeds beyond five years • Any other lease agreement where the total payable under the lease

exceeds £100,000 • Any contract or agreement with organisations other than NHS or other

government bodies including local authorities where the annual costs exceed or are expected to exceed £500,000

7.3 Execution of a document by signature 7.3.1 The following individuals are authorised to execute a document on behalf of

the CCG by their signature: a) The Clinical Chief 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 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 Halton Clinical Commissioning Group. The decisions to approve such policies and procedures will be recorded in an appropriate CCG minute and will be deemed where appropriate to be an integral part of the CCG’s standing orders.

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Appendix 4: Standing Financial Instructions

Version number: 1.00 First published: April 2020 Approved date: XX/XX/XXXX

Prepared by Deputy Chief Finance Officer

Reviewed by Chief Finance Officer

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2 Contents

1. Introduction ........................................................................................................................................ 71

1.1. Purpose .............................................................................................................................................. 71

1.2. Authority ............................................................................................................................................. 71

1.3. Interpretation ..................................................................................................................................... 71

1.4. Statutory Framework ........................................................................................................................ 71

1.5. NHS Framework ............................................................................................................................... 72

1.6. Delegation of Function, Duties and Powers ................................................................................. 72

1.7. Compliance........................................................................................................................................ 72

2. Fraud, Bribery and Corruption (Economic Crime) ...................................................................... 73

3. Resource Limits, Allocations, Planning, Budgets, Budgetary Control ................................... 74

3.1. Financial Strategy ............................................................................................................................. 74

3.2. Resource Limits ................................................................................................................................ 74

3.3. Allocations ......................................................................................................................................... 74

3.4. Preparation of Plans and Budgets ................................................................................................. 75

3.5. Budgetary Delegation running costs .............................................................................................. 75

3.6. Budgetary Control and Reporting .................................................................................................. 75

3.7. Capital Expenditure .......................................................................................................................... 76

3.8. Monitoring Returns ........................................................................................................................... 76

4. Annual Report and Accounts ................................................................................................................. 77

5. Banking Arrangements .......................................................................................................................... 77

5.1. General .............................................................................................................................................. 77

5.2. Commercial Bank and Government Banking Service Accounts ............................................... 77

5.3. Procurement and Other Card Services ......................................................................................... 78

6. Fees and Charges ................................................................................................................................... 78

6.1. Income Systems ............................................................................................................................... 78

6.2. Fees and Charges ............................................................................................................................ 78

6.3. Income Contract and Contract Variation Approval and Signing ................................................ 79

6.4. Debt Recovery ................................................................................................................................. 81

6.5. Petty Cash ......................................................................................................................................... 81

7. Processing Payroll and expenses ........................................................................................................... 82

7.1. Payroll Payment ................................................................................................................................ 82

7.2. Expenses ........................................................................................................................................... 82

7.3. Relocation/Removal Expenses ...................................................................................................... 83

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8. Revenue Expenditure, Business cases, Procurement and Payments ...................................................... 83

8.1. Undertaking revenue expenditure .................................................................................................. 83

8.2. Business cases Health Care Investment ...................................................................................... 83

8.3. Procurement –Tenders .................................................................................................................... 84

8.4. Procurement – Quotations .............................................................................................................. 85

8.5. Requisition of goods and services: Non Health Care ................................................................. 85

8.6. Capital expenditure .......................................................................................................................... 86

8.7. Planning a Procurement Project .................................................................................................... 86

8.8. Contract Signing Approval Limits ................................................................................................... 86

8.9. Contract Variations and Extensions............................................................................................... 87

8.10. Continuing Health Care ............................................................................................................... 87

9. Payment of Accounts ............................................................................................................................. 88

9.1. System of Payment and Payment Verification ............................................................................. 88

9.2. Prepayments ..................................................................................................................................... 89

10. Losses & Special Payments ................................................................................................................ 90

10.1. General .......................................................................................................................................... 90

10.2. Losses and Write-Offs ................................................................................................................. 90

10.3. Special Payments ........................................................................................................................ 91

10.4. Losses and Special Payments Register ................................................................................... 92

11. Acceptance of Gifts by Officers and Members & Link to Standards of Business Conduct ................... 92

12. Authorised Signatory List ....................................................................................................................1

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1. Introduction

1.1. Purpose

1.1.1. These Standing Financial Instructions form part of NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Groups’ Joint Governance Manual. Together with documents such as the Standing Orders and Scheme of Delegation they fulfil the dual role of protecting both CCGs’ interests and provide guidance to Officers to allow them to act appropriately by following the correct procedures outlined within the relevant document.

1.1.2. All Executive / Non-Executive Members and all Officers should be aware of the existence of these documents and be familiar with their detailed provisions as applicable to their role.

1.1.3. These Standing Financial Instructions detail the financial responsibilities, policies and procedures adopted by all staff within delegated authority from the Governing Body of both CCGs. They are designed to ensure that all financial transactions are carried out in accordance with the Constitution of both CCGs and these delegated responsibilities facilitate the achievement of probity, accuracy, economy, efficiency, and effectiveness.

1.1.4. These Standing Financial Instructions identify the financial responsibilities that apply to everyone working within NHS Halton CCG and NHS Warrington CCG. The user of these Standing Financial Instructions must also consider relevant prevailing Department of Health and Social Care & Social Care and/or HM Treasury instructions and other legal duties placed on the CCG.

1.2. Authority 1.2.1. These Standing Financial Instructions have effect as if incorporated in the

Standing Orders of NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group.

1.3. Interpretation 1.3.1. Should any difficulty arise regarding the interpretation or application of any of

these Standing Financial Instructions, the advice of the Chief Finance Officer or their Deputy should be sought before acting.

1.4. Statutory Framework 1.4.1. NHS Halton Clinical Commissioning Group and NHS Warrington Clinical

Commissioning Group are statutory bodies established under the National Health Service Act 2006 (as amended) and are governed by that Act, the Health & Social Care Act 2012 and by secondary legislation made under these Acts.

1.4.2. The functions of NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group are also conferred by the legislation set out in the previous paragraph and when exercising its functions, NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group shall act in accordance with the duties imposed on it by relevant legislation.

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1.5. NHS Framework 1.5.1. In addition to the statutory requirements, the Secretary of State for Health and

Social Care through the Department of Health and Social Care & Social Care issues further directions and guidance, primarily in the form of the Mandate.

1.5.2. Other documents of significance are:

• The Code of Accountability for NHS Boards; • The Code of Conduct for NHS Boards; • The Code of Conduct for NHS Managers; and, • The Code of Practice on Openness in the NHS

1.6. Delegation of Function, Duties and Powers 1.6.1. The Constitutions of NHS Halton Clinical Commissioning Group and NHS

Warrington Clinical Commissioning Group details procedural requirements for inclusion within the Governance Manual. This includes Standing Orders, A Scheme of Reservation and Delegation and Prime Financial Policies which provide a procedural framework within which the group discharges its business. They set out: 1.6.1.1. the arrangements for conducting the business of the group 1.6.1.2. the appointment of member practice representatives 1.6.1.3. the procedure to be followed at meetings of the group, the

Governing Body and any committees or sub-committees of the group or the Governing Body

1.6.1.4. the process to delegate powers 1.6.1.5. the declaration of interests and standards of conduct.

1.7. Compliance 1.7.1. It is expected that all Governing Body Members, Committee Members,

Officers and employees will comply and failure to comply with the Standing Orders, the Standing Financial Instructions and the Scheme of Delegation may result in disciplinary action in accordance with the NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group’s disciplinary policy and procedure in operation at that time.

1.7.2. Any financial or other irregularities or impropriety in relation to these instructions, where there is evidence or suspicion of fraud, bribery or corruption will be reported to NHS Counter Fraud Authority with a view to a criminal investigation being conducted and potential prosecution being sought.

1.7.3. If for any reason these Standing Orders, Standing Financial Instructions or the Scheme of Delegation are not complied with, including the exercise of powers without proper authority, full details of the non- compliance, any justification for non-compliance and the circumstances around the non-compliance must be reported to the next formal meeting of the Audit Committee for action or ratification as appropriate.

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1.7.4. Notwithstanding the above, all Members of the respective Governing Body and all Officers must report any instance of non-compliance with these Standing Orders, Standing Financial Instructions, and the Scheme of Delegation to the Clinical Chief Officer, Chief Finance Officer and Deputy Chief Finance Officer immediately when they become aware of it.

2. Fraud, Bribery and Corruption (Economic Crime) 2.1.1. The Chief Finance Officer is responsible for overseeing and providing

strategic management and support for all counter fraud, bribery and corruption work in both CCGs. All counter fraud, bribery and corruption services are provided under arrangements proposed by the Chief Finance Officer and approved by the Joint Audit Committee, on behalf of the Governing Body.

2.1.2. The Chief Finance Officer may delegate the day-to-day oversight of the counter fraud function to the Deputy Chief Finance Officer who is also nominated as the CCGs’ Fraud Champion. The Counter Fraud Lead will manage the counter fraud, bribery and corruption services, to ensure that work in relation to counter fraud, bribery and corruption are appropriate and compliant with any applicable legislative requirements or guidance

2.1.3. The Counter Fraud Lead will produce an annual assessment of the effectiveness of counter fraud, bribery and corruption arrangements for NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group, in accordance with arrangements specified by NHS Counter Fraud Authority. The outcome of these assessments together with any annual report will be reported to the Joint Audit Committee], including details of action plans to address areas of weakness or non-compliance.

2.1.4. All Members of the Governing Body and Officers, severally and collectively, are responsible for ensuring NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group’s resources are appropriately protected from fraud, bribery and corruption.

2.1.5. Any Officer having evidence of, or reason to suspect, financial or other irregularities or impropriety in relation to these instructions, which involve evidence or suspicion of fraud, bribery or corruption, must report these suspicions by using one of the following options:

• The NHS Counter Fraud Authority confidential fraud reporting hotline powered by Crimestoppers on 0800 028 4060

• Completing an online form at https://cfa.nhs.uk/reportfraud • Contacting an NHS England Local Counter Fraud Specialist. Up-to-

date contact details are available on the organisations intranet. • Sending an email to: NHSFraud@nhscfa.gsi.gov.uk • or by posting a letter to the Central Intelligence Unit, NHS Counter

Fraud Activity, Skipton House, 80 London Road, London.SE1 6LH.

2.1.6. Under no circumstances should any Officer commence an investigation into suspected or alleged crime, as this may compromise any further investigation.

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2.1.7. Any Officer having evidence of, or reason to suspect, financial or other irregularities or impropriety in relation to these instructions, not involving evidence or suspicion of fraud, bribery or corruption, must report these suspicions to the Chief Finance Officer or Deputy Chief Finance Officer.

3. Resource Limits, Allocations, Planning, Budgets, Budgetary Control

3.1. Financial Strategy 3.1.1. The respective Governing Body will formulate the financial strategy for NHS

Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group.

3.2. Resource Limits 3.2.1. NHS Halton Clinical Commissioning Group and NHS Warrington Clinical

Commissioning Group are required by statutory provisions not to exceed Resource Limits. The Clinical Chief Officer has overall Executive responsibility for the activities of both CCGs and is responsible to both Governing Bodies for ensuring that each CCG stays within its defined limits.

3.2.2. The Chief Finance Officer will;

• Provide regular financial reports in the form agreed by the Governing Body;

• Ensure money drawn down does not exceed the agreed Revenue Resource Limit and cash forecasts; is required for approved expenditure only; and is drawn only at the time of need, following best practice as set out in HMT Managing Public Money; and

• Be responsible for ensuring that an adequate system for monitoring financial performance is in place to enable NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group to fulfil their statutory responsibilities not to exceed the annual revenue and capital resource limits and cash forecast unless explicit consent has been received from NHS Northwest.

3.3. Allocations 3.3.1. The Chief Finance Officer will:

• Provide both Governing Bodies with reports showing the total allocations receivable and their proposed distribution including any sums to be held in reserve through a financial plan and budget book;

• Regularly update the Governing Bodies on significant changes to the initial allocation and the uses of such funds; and

• Establish a system for management of the Capital Resource Limit and the approval of investment proposals.

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3.4. Preparation of Plans and Budgets 3.4.1. Prior to the start of the financial year the Chief Finance Officer will, on behalf

of the Clinical Chief Officer, commission and submit Budgets for approval by each Governing Body. Such budgets will;

• Be in accordance with the aims and objectives set out in the business plan;

• Accord with commissioning plans, workforce plans and other running cost plans taking into consideration any efficiency schemes;

• Be produced following discussion with appropriate Budget Holders; • Be prepared within the limits of available funds; and • Identify potential risks.

3.4.2. The Chief Finance Officer will commission arrangements for the monitoring of financial performance against budget and plan, periodically review them, and report to the Finance & Performance Committee.

3.4.3. All Budget Holders must provide information as required by the Chief Finance Officer to enable budgets to be compiled.

3.4.4. All Budget Holders will sign up to their allocated Budgets at the commencement of each financial year.

3.4.5. The Chief Finance Officer will support Budget Holders by making available training and other support to help them manage their budget successfully.

3.5. Budgetary Delegation running costs 3.5.1. The Clinical Chief Officer may delegate the management of a budget to permit

the performance of a defined range of activities. This delegation will be documented in the delegated budget and contain details of:

• The amount of the budget; • The purpose(s) of each budget heading; and • Individual and group responsibilities.

3.5.2. The delegated budget holders must not exceed the budgetary total or

virement limits set.

3.5.3. All Budget Holders will sign up to their allocated Budgets at the commencement of each financial year.

3.5.4. Any budgeted funds not required for their designated purpose(s) revert to the immediate control of the Clinical Chief Officer, subject to any authorised use of virement.

3.5.5. Non-recurring budgets should not be used to finance recurring expenditure without the authorisation in writing of the Clinical Chief Officer, as advised by the Chief Finance Officer.

3.6. Budgetary Control and Reporting 3.6.1. Non-recurring budgets should not be used to finance recurring expenditure

without the authorisation of the Clinical Chief Officer, as advised by the Chief Finance Officer.

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3.6.2. The Chief Finance Officer will devise and maintain systems of budgetary control. These will include regular financial reports to the Finance and Performance Committees and Governing Bodies in a form approved by that forum containing:

• explanations of any material variances from plan; • details of any corrective action where necessary including a view of

whether such actions are sufficient to correct the situation; • the provision of access to timely, accurate and comprehensible advice and

financial reports for each Budget Holder, covering the areas for which they are responsible;

• investigation and reporting of variances from budgets; • monitoring of management action to correct variances; and • arrangements for the processing of budget virements.

3.6.3. Each Budget Holder is responsible for ensuring that:

• any likely overspend or reduction of income which cannot be met by virement is not incurred without the prior consent of the Chief Finance Officer;

• they review the management information pack on a monthly basis and report any anomalies;

• the amount provided in the approved Budget is not used in whole or in part for any purpose other than that specifically authorised subject to the rules of virement; and,

• no employees are appointed without reference to the NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Groups’ Establishment Control.

3.7. Capital Expenditure 3.7.1. The rules applying to delegation and reporting as set our above also apply to

capital expenditure.

3.8. Monitoring Returns 3.8.1. The Chief Finance Officer is responsible for ensuring that the appropriate

monitoring forms are submitted to the requisite monitoring organisation.

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4. Annual Report and Accounts 4.1.1. The Chief Finance Officer, on behalf of the Governing Bodies, will:

4.1.2. Ensure the preparation of financial returns in accordance with the accounting policies and guidance given by the Department of Health and Social Care and HM Treasury, NHS England’s accounting policies and generally accepted accounting practice;

4.1.3. Ensure the preparation and submission of annual financial reports to the appropriate authorities approved and audited in accordance with current guidelines; and,

4.1.4. Ensure the submission of financial returns and accounts for each financial year in accordance with the timetable prescribed by NHS England.

4.1.5. Ensure that the audited annual report and accounts are presented to a public meeting and will be made available to the public, in accordance with guidelines on local accountability.

5. Banking Arrangements 5.1. General 5.1.1. The Chief Finance Officer is responsible for ensuring the effective

management of NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Groups’ banking arrangements and for advising the Governing Bodies on the provision of banking services and operation of accounts, including the provision and use of procurement or other card services. This advice will take into account guidance/directions issued from time to time by the Department of Health and Social Care and HM Treasury.

5.1.2. In line with Managing Public Money NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group should minimise the use of commercial bank accounts (which require the consent of HM Treasury in all instances) and consider using the Government Banking Service as its supplier for all banking services.

5.1.3. The Governing Body will approve the banking arrangements.

5.2. Commercial Bank and Government Banking Service Accounts

The Chief Finance Officer is responsible for:

5.2.1. Commercial bank accounts and accounts operated through the Government Banking Service;

5.2.2. Ensuring arrangements are in place that ensure payments made from commercial banks or Government Banking Service accounts do not exceed the amount credited to the account except where arrangements have been made;

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5.2.3. Reporting to the Governing Body all arrangements made with the respective CCG’s bankers for accounts to be overdrawn;

5.2.4. Ensuring there are arrangements in place for the monitoring of compliance with guidance on the level of cleared funds; and

5.2.5. Ensuring that to action transactions governed by the bank mandates there must be two approved signatories, which are listed on the mandates and one of the signatories, must be the Chief Finance Officer.

5.3. Procurement and Other Card Services 5.3.1. The Chief Finance Officer is responsible for recommending to both Governing

Bodies, for approval:

• whether procurement or other card services should be allowed; • for each card service that is associated with a dedicated bank account, the

type of card services that should be allowed on each account (debit, procurement, etc.); and

• the types of transactions that should be permitted on each card.

5.3.2. Where the Governing Body has approved the use of card services, the Chief Finance Officer is responsible for recommending to the Governing Body for approval:

• the posts who should be issued with a card, and the type of card; • the credit limit to be associated with each card; and • the uses to which the card can be put.

5.3.3. The Chief Finance Officer will ensure that systems are accurately updated

with card transaction details by cardholders to monitor actual use against authorised use in accordance with the approval given by the Governing Body.

6. Fees and Charges 6.1. Income Systems 6.1.1. The Chief Finance Officer is responsible for ensuring systems are in place for

designing, maintaining and ensuring compliance with systems for the proper recording, invoicing, and collection and coding of all monies due.

6.1.2. The Chief Finance Officer is also responsible for ensuring systems are in place for the prompt banking of all payable orders and negotiable instruments received.

6.1.3. The Chief Finance Officer will arrange to register with HM Revenue and Customs for VAT and payroll taxes.

6.2. Fees and Charges 6.2.1. The Chief Finance Officer is responsible for approving and regularly reviewing

the level of all fees and charges other than those determined by the Department of Health and Social Care or by Statute. Independent professional advice on matters of valuation should be taken as necessary.

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6.2.2. Where sponsorship income (including items in kind such as subsidised goods or loans of equipment) is considered, the guidance in the Department of Health and Social Care’s Commercial Sponsorship – Ethical Standards in the NHS should be followed.

6.2.3. All Officers must inform the Finance Team, in accordance with notified procedures, promptly of money due arising from transactions which they initiate/deal with, including all contracts, private patient undertakings and other transactions.

6.3. Income Contract and Contract Variation Approval and Signing 6.3.1. The following approval limits apply to the signing of income contracts and

contract variations, including service level agreements, memoranda of understanding (MOU).

6.3.2. The appropriate signing level for contract variations will be determined by considering the revised whole life value of the contract, including the variation. Please note the contract signing limits below:

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Table 1: Income Contract approval and signing limits

Description Governing Body Clinical Chief Officer /Accountable Officer and Chief Finance Officer

Chief Commissioners & Chief Nurse

Other CCG Officers – as approved by the Chief Finance Officer

Income contracts or amounts receivable under memoranda of understanding

Above £100M Over £10M Up to £10M Band 9 and 8D budget holders up to £500k

Band 8 and Band 7 budget holders up to £100k

Sales invoices and credit note request approval limits

Above £100M Over £10M Up to £10M Band 9 and 8D budget holders up to £500k

Band 8 and Band 7 budget holders up to £100k

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6.4. Debt Recovery 6.4.1. The Chief Finance Officer is responsible for ensuring systems are in place for

the timely recovery of all outstanding debts.

6.4.2. Where it is necessary to use the services of a professional debt recovery agency and/or the courts to recover an outstanding debt, NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group will seek to recover the associated costs from the debtor concerned.

6.4.3. Income not received should be dealt with in accordance with losses procedures.

6.4.4. Overpayments should be detected (or preferably prevented) and recovery initiated.

6.5. Petty Cash 6.5.1. A petty cash float of up to £100 may be set up for each site.

6.5.2. The authorisation limits are as follows:

Description Governing Body

Clinical Chief Officer /Accountable Officer and Chief Finance Officer

Chief Commissioners and Chief Nurse

Other CCG Officers – as approved by Chief Finance Officer

Authorisation to set up float

Up to £100

Replenish float

Up to maximum float

Issue petty cash

£50 per transaction – approved by manager as per authorised signatory list

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7. Processing Payroll and expenses 7.1. Payroll Payment 7.1.1. Regardless of the arrangements for providing the payroll service, the Chief

Finance Officer will ensure that the chosen method is supported by appropriate (contracted) terms and conditions, adequate internal controls and audit and review procedures, and that suitable arrangements are made for the collection of payroll deductions and payment of these to appropriate bodies.

7.1.2. The Chief Finance Officer is responsible for ensuring the contract with the relevant outsourced service provider covers:

• Maintenance of subsidiary records for superannuation, income tax, social security and other authorised deductions from pay;

• Security and confidentiality of payroll information; • Separation of duties of preparing records and inputs and verifying outputs

and payments; • The final determination of pay and allowances; • Checks to be applied to completed payroll before and after payment; • Ensuring payment occurs on agreed dates; and, • Arrangements for ensuring compliance with the provisions of the Data

Protection Act.

7.1.3. Appropriately nominated Officers have delegated responsibility for:

• Submitting associated records, and other notifications in accordance with agreed timetables;

• Completing time records and other notifications in accordance with the instructions and in the appropriate form;

• Submitting leaver/termination forms in the prescribed form immediately upon knowing the effective date of an Employee’s resignation, termination or retirement. Where an Employee fails to report for duty in circumstances that suggest they have left without notice, the relevant Director/Budget holder must be informed immediately; and,

• The recovery of property from leavers due by them to NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group.

7.2. Expenses 7.2.1. Expense claims system should only be used for expenses associated with

employees, i.e. those paid via payroll. Budget holders are accountable for checking and authorising only appropriate expenses incurred in line with the appropriate Expenses policy and based upon their financial delegations set out in these SFIs.

7.2.2. Expenses reimbursements to employees are processed via payroll and should never occur via accounts payable.

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7.2.3. The Expenses system is for the reimbursement of travel and subsistence expenses, relocation and removal allowances, and should not be used to reimburse items that could have been purchased via NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Groups’ purchasing systems.

7.2.4. NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group do not have an approved travel provider and bookings for hotels and some other forms of travel fees should, where possible, be booked and paid for by invoice or using a purchasing card. This expenditure should be approved by a budget holder in accordance with their delegated limits.

7.3. Relocation/Removal Expenses 7.3.1. Relocation or removal expenses for employees up to a maximum amount of

£8,000 for each employee may be approved by the Clinical Chief Officer and the Chief Finance Officer. Any amounts in excess of £8,000 must be approved by the Governing Body. This threshold is not intended to apply to reimbursements that are subject to exiting policies, for example management of change policies.

8. Revenue Expenditure, Business cases, Procurement and Payments

8.1. Undertaking revenue expenditure 8.1.1. All expenditure must be approved prior to the commitment being entered into.

The approval routes differ according to the value and type of expenditure with the revenue approval limits set out in the tables below and the rest of this section.

8.2. Business cases Health Care Investment 8.2.1. Where proposed expenditure in relation to business cases has already been

included in the Annual Commissioning Plan and in the approved budget, then these can be approved by officers up to the limits noted in the table below.

8.2.2. Where proposed expenditure in relation to business cases has not been included in the Annual Commissioning Plan and in the approved budget, then these can be approved by officers up to the limits noted in the table below and amounts in excess of that limit must be submitted to the Governing Body for approval prior to expenditure being incurred.

Description Governing Body

Clinical Chief Officer /Accountable Officer

Chief Finance Officer

Chief Commissioners and Chief Nurse

Other CCG Officers – as specified by the authorised signatory list

Proposed expenditure in business case included in annual commissioning

N/A Up to values included in Annual Budget/Plan Up to £10,000 or the amount agreed in the delegated budget if

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plan & budget higher Proposed expenditure in business case not included in annual commissioning plan & budget

Above £250k

Up to £250k Up to £100k

Up to £50k £Nil

8.2.3. All business cases and contract awards should be based on the whole life of the contract. This should include the cost of any extension periods and irrecoverable VAT. They should exclude recoverable VAT.

8.2.4. No commitment to expenditure, either verbal or written, should be made without appropriate approvals. This includes variations and/or extensions to contracts which must consider the whole life value of a contract.

8.3. Procurement –Tenders 8.3.1. All officers must procure, commission and contract manage goods, services

and works in accordance with the CCGs’ Procurement Policy and in accordance with appropriate legislation such as the Public Contract Regulations which prescribes the thresholds for the tendering of public sector contracts. In addition, offers must ensure that expenditure complies with the principles and guidance stated in HM Treasury Managing Public Money (2015). This requires all public-sector organisations to demonstrate Value for Money, which includes both financial and non-financial aspects, for their expenditure. Further information on Tendering and Procurement procedures is set out in the Prime Financial Policies.

8.3.2. For all revenue expenditure budget holders must ensure that they:

• have approval to commit NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group’s resources before undertaking procurement. Approval is either provided by an individual with the appropriate authority approving the expenditure (for lower value expenditure which is not subject to efficiency controls) or a business case which has been reviewed and approved by the appropriate individuals or groups;

• seek quotes / tenders for the procurement of your goods, services or works in a legally compliant manner as set out in the Procurement Policy that ensures the best value;

• utilise mandated suppliers and contracts in framework agreements that are available to NHS Halton Clinical Commissioning Group and NHS Warrington Clinical Commissioning Group to ensure best value;

• ensure that a signed contract is in place prior to the expenditure being incurred;

• adhere to the rule of aggregation when identifying the total value of the contracts. Budget holders must not split purchase orders and contracts to avoid procurement thresholds. Suspected disaggregation will be investigated and may lead to disciplinary action; and

• set the length of the proposed contract following a rigorous assessment of service need and value for money. Arbitrarily setting the length of a contract to avoid control processes will be subject to disciplinary action.

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8.3.3. Current thresholds as at 2019, which are the value of the contract over the lifetime of the contracts specified by the Public Contract Regulations Directive; are as follows:

Description Detailed description Threshold Threshold for schedule 1 services

These are all services except specifically exempt amounts such as health and social care services

£181,113

Threshold for schedule 3 services float

These are service subject to a light touch regime and include most health and social care services

£615,278

Works contacts

Usually this applies contracts that are capital in nature £4,551,413

8.4. Procurement – Quotations 8.4.1. For goods and services that are not required to be formally subject to tender

as set out in section 8.3 above, the following limits shall apply:

8.4.2. Description Threshold 3 written quotations required Goods and services exceeding £20,000 up to the

amount set out in the Public Contract Regulations Directive (see section 8.3 above)

No requirement to obtain quotes Up to £20,000

8.5. Requisition of goods and services: Non Health Care 8.5.1. Where goods and services have already been included within the budget

agreed by the Governing Body, these may be requisitioned by management in compliance with specific approval thresholds as required in the public contract regulations or as specified by NHS England.

8.5.2. For non health care good and services that have not been included in the budget, the following thresholds will apply.

Description Governing Body

Clinical Chief Officer /Accountable Officer

Chief Finance Officer

Chief Commissioners and Chief Nurse

Other CCG Officers – as approved by the Chief Finance Officer

Decision to appoint Agency staff or Management consultants

Above £250k

Up to £250k Up to £100k

Up to £50k Band 9 and 8D budget holders up to £50K

Services including IT, maintenance and support services where not already within agreed

Above £250k

Up to £250k Up to £100k

Up to £50k Band 9 and 8D budget holders up to £50K

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budgets Recharges from other public sector bodies

Above £250k

Up to £250k Up to £100k

Up to £50k Band 9 and 8D budget holders up to £50K

Approval for all other requisitions/ contracts

Above £250k

Up to £250k Up to £100k

Up to £50k Band 9 and 8D budget holders up to £50K

8.6. Capital expenditure 8.6.1. Capital expenditure proposals that are included in the annual plan and annual

budgets approved by the Governing Body should be approved by the Clinical Chief Officer or the Chief Finance Officer. Capital Expenditure proposals that are additional to the amounts set out in the Annual Financial Plan and Budget Book can be approved by the Clinical Chief Officer or the Chief Finance Officer but must be submitted to the Governing Body for ratification where these are in excess of £250,000.

8.7. Planning a Procurement Project 8.7.1. All budget holders are required to:

• to prepare all business cases in sufficient time to allow timely approvals and procurement activity;

• to plan well in advance of a contract ending; • to ensure the replacement procurement process is completed in sufficient

time; and • ensure competition is undertaken on all expenditure in line with the

Procurement policy.

8.7.2. Budget holders are accountable for any procurement activity in their area. Budget holders should plan business cases and procurement activity with appropriate support from clinical, finance and procurement teams as appropriate in order to provide assurance over compliance of procurement activity.

8.7.3. Any expenditure that is not included or is omitted from the pipeline will be deemed unplanned and may be subject to additional scrutiny by the Finance & Performance Committees.

8.8. Contract Signing Approval Limits 8.8.1. Contract signing approval limits will be consistent with the annual plans and

budgets and thresholds set out in section 8.2 Business Cases Health Care Investment and in section 8.5 requisitions for goods and services – Non Health Care. These thresholds are as follows:

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Description Governing

Body Clinical Chief Officer /Accountable Officer

Chief Finance Officer

Chief Commissioners and Chief Nurse

Other CCG Officers – as approved by the Chief Finance Officer

Annual contract value of healthcare contracts

N/A Unlimited within approved budget

Up to £150M Up to £20M N/A

8.9. Contract Variations and Extensions 8.9.1. All extensions and variations to an existing contract must be reviewed to

confirm that they are legally possible they represent best value for money, including financial and non-financial aspects, and they are not being instigated solely to avoid or delay the requirement to conduct procurement.

8.9.2. Extensions to existing contracts can only be approved where:

• the terms and conditions of the contract make provision for an extension; • contract performance is satisfactory; • the original business case included approval for the cost of the extension

period; and • the variation is in line with or complies with section 72 of the Public

Contracts Regulations 2015. Regulation 72 covers the extent to which contracts can be amended without the need for a new advertised tender process. Guidance should be sought from a procurement specialist in all cases.

8.10. Continuing Health Care 8.10.1. Decisions regarding eligibility for Continuing Health Care are restricted to

Individual Commissioning Nurses and any appeals panels, as determined by the Chief Nurse.

8.10.2. Individual Commissioning Nurses are authorised to Commission Health Care packages in respect of eligible patients for expenditure up to £1,000 per week or £52,000 per annum.

8.10.3. The Head of Individual Commissioning is authorised to Commission Health Care packages in respect of eligible patients for expenditure up to £100,000 per annum.

8.10.4. The Chief Nurse can approve packages of care with a cost of up to £250,000 per annum and the Clinical Chief Officer and Chief Finance Officer can approve packages with costs of up to £1,000,000 per annum.

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8.10.5. The Chief Nurse may determine a panel for complex cases or packages costing in excess of £52,000 per annum. The panel should be clinically led and decisions around the appropriateness of packages of care should be determined in accordance with the Continuing Healthcare / Complex Care Commissioning Policy.

8.10.6. Whilst the thresholds for quotations and tenders are intended to apply to such Continuing Health Care Services, it is not always possible or clinically appropriate to comply with the limits for tendering or obtaining three written quotations because this could lead to the commissioning of services that are not clinically appropriate or could infringe on the rights to family life. In these cases, the circumstances should be recorded, and this should be subject to approval by the Chief Nurse. Where the amount exceeds the threshold for schedule 3 services as set out in Table B of the Scheme of Reservation and Delegation (£615,278 as at July 2019), then a Tender Waiver needs to be completed and submitted to the Chief Finance Officer.

9. Payment of Accounts 9.1. System of Payment and Payment Verification 9.1.1. The Chief Finance Officer is responsible for ensuring systems are in place for

the prompt payment of accounts and claims. The term "payment" includes any arrangements established to settle payments upon a non-cash basis.

9.1.2. Payment should normally be made by bank credit transfer. Payment by other methods should only occur with the approval of Employees nominated by the Chief Finance Officer.

9.1.3. Payment of contract invoices should be in accordance with contract terms. All payments should comply with the Government's policy on prompt payment.

9.1.4. All authorised Officers should inform the Chief Finance Officer, or an Officer nominated by him, promptly of all money payable by NHS England arising from transactions which they initiate, including contracts, leases, tenancy agreements and other transactions.

9.1.5. The Chief Finance Officer is responsible for ensuring systems are in place for the design and maintenance of a system for the verification, recording and payment of all accounts payable. This system will provide for:

• A list of Officers authorised to certify requisitions and invoices; • Certification that goods have been duly received, examined, are in

accordance with specification and order, are satisfactory and that the prices are correct;

• Work done or services rendered have been satisfactorily carried out in accordance with the order, and, where applicable, the materials used were of the requisite standard and that the charges are correct;

• In the case of contracts based on the measurement of time, materials or expenses, the time charged is in accordance with the time sheets, that the rates of labour are in accordance with appropriate rates, that the materials have been checked with regard to quantity, quality and price and that the charges for the use of vehicles, plant and machinery have been examined;

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• Where appropriate, the expenditure is in accordance with regulations and that all necessary authorisations have been obtained;

• The account is arithmetically correct; and, • The account is in order for payment. • A timetable and system for submission of accounts for payment, including

provision for early settlement of accounts subject to settlement discount or otherwise requiring early settlement; and,

• Instructions to Officers regarding the handling and payment of accounts within the Finance Directorate.

9.1.6. Where an Officer certifying accounts relies upon other Officers to do preliminary checking, the Officer certifying accounts will ensure that those who check delivery or execution of work, act independently of those who have placed orders and negotiated prices and terms.

9.1.7. In the case of contracts which require payment to be made on account, during progress of the works, the Chief Finance Officer is responsible for ensuring systems are in place to make payment on receipt of a certificate from the appropriate qualified Officer or outside consultant. Without prejudice to the responsibility of any consultant, a contractor's account shall be subjected to such financial examination by Officers nominated by the Chief Finance Officer and such general examination by appropriately qualified Officers as may be considered necessary, before the person responsible to NHS England for the contract issues the final certificate.

9.1.8. The Chief Finance Officer is responsible for ensuring systems are in place to ensure that payment for goods and services is made only when the goods and services have been properly received.

9.1.9. Approval limits are as follows: Description Governing

Body Clinical Chief Officer /Accountable Officer

Chief Finance Officer

Chief Commissioners and Chief Nurse

Other CCG Officers – as approved by the Chief Finance Officer

Approval of healthcare contract payments

N/A Subject to relevant officer limits within approved budget

Subject to relevant officer limits within approved budget

Subject to relevant officer limits within approved budget

Subject to relevant officer limits within approved budget

9.2. Prepayments 9.2.1. Prepayments will be permitted for instances relating to payments for rent,

maintenance contracts and in those instances, where, as normal business practice, prepayments are required (e.g. training, publications, room hire, subscriptions, monthly contract amounts and certain grants etc).

9.2.2. Prepayments which fall outside of normal business practice (advance payments) are only permitted in exceptional circumstances. In such instances;

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• The financial advantages must outweigh the disadvantages; and, • The appropriate Chief must provide the Chief Finance Officer a case

setting out all relevant circumstances of the purchase. The report must set out the effects on NHS Halton Clinical Commissioning Group or NHS Warrington Clinical Commissioning Group if the supplier is at some time during the course of the advance payment agreement unable to meet their commitments.

• The Budget Holder is responsible for ensuring that all items due under an advance payment contract are received and must immediately inform the Chief Finance Officer if problems are encountered.

10. Losses & Special Payments 10.1. General 10.1.1. Losses and Special payments are items that parliament would not have

contemplated when it agreed funds for NHS England for distribution to Clinical Commissioning Groups or passed legislation. By their nature, they are items that ideally should not arise. They are therefore subject to special control procedures compared to the generality of payments, and special notation in the accounts to bring them to the attention of parliament.

10.1.2. All losses and Special Payments should be reported and submitted to the Audit Committee.

10.2. Losses and Write-Offs 10.2.1. The Chief Finance Officer is responsible for ensuring that detailed

procedural instructions for the recording and accounting for losses are prepared and notified to Officers.

10.2.2. All losses up to and including £50,000 can be approved by the Deputy Chief Finance Officer, and losses up to and including £100,000, can be approved by the Chief Finance Officer. Any losses above £100,000 up to the value £250,000 must be approved by the Clinical Chief Officer and any losses that exceed that limit should be approved by the relevant Governing Body.

10.2.3. Managing Public Money defines losses as including, but not limited to:

• Cash losses (physical loss of cash and its equivalents, e.g. credit cards, electronic transfers);

• Bookkeeping losses (un-vouched or incompletely vouched payments, including missing items or inexplicable or erroneous debit balances);

• Exchange rate fluctuations; • Losses of pay, allowances and superannuation benefits paid to

Employees (including Overpayments due to miscalculation, misinterpretation or missing information; unauthorised issue; and, other causes);

• Losses arising from overpayments; • Losses from failure to make adequate charges; • Losses of accountable stores (through fraud, theft, arson, other

deliberate act or other cause); • Fruitless payments and constructive losses; and,

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• Claims waived or abandoned (including bad debts). • Losses that are subject to insurance cover should be accounted for on

a net basis (i.e. after any insurance payout). • Fruitless payments include payments for rail fares and hotels that are

not required but could not be cancelled without a partial or full charge being incurred.

10.2.4. Any Officer discovering or suspecting a loss of any kind must either immediately inform their Head of Department, who must immediately inform the Clinical Chief Officer and the Chief Finance Officer or inform Deputy Chief Finance Officer charged with responsibility for responding to concerns involving loss.

10.2.5. This Deputy Chief Finance Officer will then appropriately inform the Chief Finance Officer and/or Clinical Chief Officer. Where a criminal offence is suspected, the Chief Finance Officer must immediately inform the police, if theft or arson is involved. In cases of fraud, bribery and corruption, or of anomalies that may indicate fraud, bribery or corruption, Chief Finance Officer must ensure the External Auditor and NHS Counter Fraud Authority have been informed.

10.2.6. For losses apparently caused by theft, arson, neglect of duty or gross carelessness, except if trivial, the Chief Finance Officer must immediately notify the Governing Body, and the External auditor.

10.2.7. The Chief Finance Officer is authorised to take any necessary steps to safeguard both CCG’s interests in bankruptcies and company liquidations.

10.2.8. For any loss, the Chief Finance Officer should consider whether any insurance claim could be made.

10.2.9. All losses and write offs should be approved in accordance with the procedure set out by the Chief Finance Officer.

10.3. Special Payments 10.3.1. The Chief Finance Officer is responsible for ensuring that detailed

procedural instructions for the recording and accounting for special payments are prepared and notified to Officers.

10.3.2. Special payments up to £50,000 can be approved by the Deputy Chief Finance Officer, with payments up to £100,000 requiring approval by the Chief Finance Officer. Special payments exceeding £100,000 and up to £250,000 will require approval by the Clinical Chief Officer with any special payments above that amount requiring approval from the relevant Governing Body.

10.3.3. All special severance payments and retention payments require the approval of the Remuneration Committee.

10.3.4. Managing Public Money defines special payments as: 10.3.5. Extra-contractual payments: payments which, though not legally due under

contract, appear to place an obligation on a public sector organisation which the courts might uphold. Typically, these arise from the organisation’s action or inaction in relation to a contract. Payments may be extra-contractual even

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where there is some doubt about the organisation’s liability to pay, e.g. where the contract provides for arbitration, but a settlement is reached without it. A payment made as a result of an arbitration award is contractual;

10.3.6. Extra-statutory and extra-regulatory payments are within the broad intention of the statute or regulation, respectively, but go beyond a strict interpretation of its terms.

10.3.7. Compensation payments: are made to provide redress for personal injuries (except for payments under the Civil Service Injury Benefits Scheme), traffic accidents, and damage to property etc. They include other payments to those in the public service outside statutory schemes or outside contracts;

10.3.8. Special severance payments are paid to employees, contractors and others outside of normal statutory or contractual requirements when leaving employment in public service whether they resign, are dismissed or reach an agreed termination of contract.

10.3.9. Ex gratia payments: go beyond statutory cover, legal liability, or administrative rules, including: payments made to meet hardship caused by official failure or delay; out of court settlements to avoid legal action on grounds of official inadequacy; and, payments to contractors outside a binding contract, e.g. on grounds of hardship.

10.4. Losses and Special Payments Register 10.4.1. The Chief Finance Officer is responsible for ensuring that a losses and

special payments register is maintained in which write-off action is recorded. All losses and special payments are to be recorded in the register.

10.4.2. All losses and special payments will be reported to the Joint Audit Committee of both CCGs.

11. Acceptance of Gifts by Officers and Members & Link to Standards of Business Conduct

11.1.1. The Chief Finance Officer will ensure that all Members and Officers are made aware of NHS England policy on acceptance of gifts and other benefits in kind.

11.1.2. This policy is defined in the policy document Standards of Business Conduct and is deemed an integral part of Standing Orders and these Standing Financial Instructions.

11.1.3. All hospitality and gifts accepted by Governing Body Members will be declared in accordance with the requirements of the Standards of Business Conduct Policy and will be published on the relevant CCG’s website on a quarterly basis.

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12. Authorised Signatory List

The Clinical Chief Officer and the Chief Finance Officer delegate certain functions to particular roles. A summary of the authorities delegated to the key staff by the Governing Body and in turn by the Clinical Chief Officer and Chief Finance Officer is as follows:

Authorised Signatory List (Delegated from Governing Body and Clinical Chief Officer)

Post Requistion Goods &

Services: Non Healthcare

Budget Changes

Staff Recruitment

E1,E2,E3,E4 G1 G2 H1 H2 H3 I1 I2 J1 J2 J3 J4 K1, K2£ £ £ £ £ £ £ £ £ £ £ £ £ £

Clinical Chief Officer 250,000 Unlimited within budget

250,000 Unlimited within budget

Unlimited within contract

250,000 1,000,000 1,000,000 As per Public Contract

Regulations

As per Public Contract

Regulations

Up to Public Contract

Regulations

25,000 Unlimited within budget

Unlimited within budget

Chief Finance Officer 100,000 Unlimited within budget

100,000 200,000,000 Unlimited within contract

250,000 1,000,000 1,000,000 As per Public Contract

Regulations

As per Public Contract

Regulations

Up to Public Contract

Regulations

25,000 Unlimited within budget

Unlimited within budget

Chief Nurse 75,000 Unlimited within budget

75,000 20,000,000 Unlimited within contract

100,000 250,000 250,000 As per Public Contract

Regulations

As per Public Contract

Regulations

Up to Public Contract

Regulations

25,000 Unlimited within budget

Unlimited within budget

Very Senior Manager (VSM) / Agenda for Change (AfC) Band 9

75,000 Unlimited within budget

75,000 20,000,000 Unlimited within contract

100,000 250,000 250,000 As per Public Contract

Regulations

As per Public Contract

Regulations

Up to Public Contract

Regulations

25,000 Unlimited within budget

Unlimited within budget

AfC Band 8d 50,000 250,000 50,000 5,000,000 Unlimited within contract

100,000 100,000 75,000 15,000 Unlimited within budget

Unlimited within budget

AfC Band 8c 50,000 Unlimited within budget

25,000 1,000,000 Unlimited within contract

100,000 100,000 50,000 10,000 Unlimited within budget

Unlimited within budget

AfC Band 8b 25,000 100,000 25,000 1,000,000 Unlimited within contract

100,000 50,000 10,000 Unlimited within budget

Unlimited within budget

AfC Band 8a 25,000 50,000 25,000 1,000,000 Unlimited within contract

50,000 50,000 50,000 10,000 Unlimited within budget

Unlimited within budget

Individual Commissioning Nurse for Care packages

£1,000 pw Unlimited within budget

Approval of Healthcare Investment Business Cases

Healthcare Contracts Approval of Adhoc Healthcare Payments

Quotations & Tenders

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Governing Body Report

Date: 5th March 2020

Report title: Organisational Development and Workforce

Lead Executive Suzanne Barker, Chief of Corporate Services

Purpose:

The purpose of the report is to provide members of the Governing Body with: • an overview of the current and planned mechanisms in

place in support of organisational development in NHS Halton CCG.

• an update in respect of organisational change activity. • an update on key workforce metrics (in Appendix 1). • assurance of the CCGs work to continuously develop

the organisational culture that meets the changing needs of our workforce.

The Governing Body is asked to:

Receive and endorse actions within the report.

This Report supports the following CCG Strategic Objectives One - To commission services which continually improve the health and wellbeing of Halton residents. Two - To deliver improvements in the quality of the health and care services accessed by the people of Halton within the resources available to us and our partner organisations. Three - To deliver all of our statutory duties and commissioning responsibilities effectively, whilst ensuring there are robust constitutional, governance and financial control arrangements in place. Four - To create a high performing organisation that seeks to create excellence in its skill base enabling the building of effective partnerships with our staff and key stakeholders. Commissioning Plan Implications Not Applicable Financial Implications None Board Assurance Framework and Corporate Risk Register The report provides updates on key areas of work relating to the strategic objectives of the CCG. National Policy, Guidance, Standards, Targets or Legislation Not applicable

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Equality and Diversity and Human Rights Throughout the development of this paper and the policies and processes cited NHS Halton CCG has: Given due regard to the need to eliminate discrimination, harassment and victimisation, to advance equality of opportunity, and to foster good relations between people who share a relevant protected characteristic (as cited under the Equality Act 2010) and those who do not share it; and Given regard to the need to reduce inequalities between patients in access to, and outcomes from healthcare services and to ensure services are provided in an integrated way where this might reduce health inequalities.

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The purpose of this report is to provide members of the Governing Body with: • an overview of the current and planned mechanisms in place in support of organisational

development in NHS Halton CCG. • an update in respect of organisational change activity. • an update on key workforce metrics (Appendix 1). • assurance of the CCGs work to continuously develop the organisational culture that meets the

changing needs of our workforce.

To support and develop our staff, teams and the wider organisation, the CCGs commissioned a robust programme of organisational development activity throughout 2019/20. This provided a range of developmental and supportive interventions for staff working in roles and teams in the CCG. The programme continues to roll out and includes: • Team development activities through structured facilitation and group coaching • Personal development activities in respect of 360 feedback and coaching • Development of innovation through a continued partnership with Knowledge Brief. Leading

external experts continue to deliver part of the sessions with follow up facilitated group work for staff. Recent sessions have including a focus on health & wellbeing, resilience and preparing for change with the March session focussed on working together in teams

• Access to the Chartered Management Institute Diplomas and Certificates in Management and Leadership

• Effective People Management skills for Line Managers (in line with roll out of refreshed HR Policy Directory)

• Support of on-going development programmes for individuals

During 2019/2020 we have also reviewed and aligned our mechanisms for staff engagement and communications across the CCGs in line with staff feedback. Current mechanisms in place include:

• A weekly joint staff team brief delivered by the Clinical Chief Officer via video link on a

Monday afternoon with members of the IMT at CCG locations • A weekly joint written staff brief that captures key messages and also pertinent points from

the IMT meeting held on the Monday morning • A monthly staff face to face briefing with a development session following in the afternoon

(as detailed above) • Be-spoke staff engagement events and activities in relation to particular matters e.g.

Organisational Change Launch and Health & Well-Being Survey (led by the Staff Engagement Group)

• Roll out of a staff survey (views in respect of leadership, health & well-being, learning and joint working arrangements) with a follow up survey planned for March/April 2020 following the Organisational Change Programme and in conjunction with the Staff Engagement Group

• Establishment of the Staff Engagement Group (SEG) with a cross representation of staff from all teams in both CCGs. The SEG meets monthly (since October 2019) and is making good progress in supporting collaborative working across the CCGs and teams. The SEG has a work plan for 2020 which includes focus on 5 key workstreams of staff feedback,

1) Purpose

2) Organisational Development 2019/20

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supporting the organisational development agenda, challenges & charity calendar, staff surveys and health & wellbeing initiatives.

Other activities in respect of the Organisation Development Work Plan continue to roll out and will be completed by the end of March 2020. This work will ensure consistency of approach and fit for purpose arrangements. The work programme includes:

• A review and refresh of the current induction, welcome and on-boarding process for all

staff, Governing Body members and Clinical Leads • A review and refresh of the current leavers process for all staff, Governing Body members

and Clinical Leads • A review and refresh of the current PDR processes • A review and re-refresh of the HR Policy Directory with a supporting awareness and

training plan (as appropriate) • Update and implementation of a range of mechanisms to support Member Engagement (as

discussed at recent Member Practice Events) • Update of the Communications and Engagement Strategies (including Stakeholder

Engagement Mapping)

The activities and mechanisms as detailed above will continue into 2020/2021. A new Organisational Development Plan for 2020/2021 is currently under development in line with priorities. The strands of the OD plan will be set in the current landscape of Commissioning at Scale, support the development of ‘place based’ working arrangements and ensure interventions support and align staff, partners and stakeholders in any change programmes. The Plan will focus on the key principles developed to underpin all design work in respect of implementing Commissioning at Scale (as discussed at recent Governing Body and Member Practice Meetings).

In line with the Commissioning at Scale work plan, the CCG has commenced the roll out of an Organisational Change programme in January 2020 to support the integration of working arrangements, fit for purpose structures across teams and ensuring clarity of job descriptions in line with organisational requirements. This work is being completed in line with the Organisational Change Policy and with the engagement of HR Colleagues and Staff Side representatives. The change programme was launched on the 23rd January 2020 with a 30 days consultation period ending on 22nd February. Team Meetings and 1-1s have taken place during this period as appropriate. Consultation feedback is currently being collated and will be shared with staff side colleagues with final structures being discussed with staff from 9th March 2020. This work is being supported by a review and gap analysis of personal files to ensure all relevant documentation is in place. A refresh of HR policies has also been undertaken in conjunction with the CSU HR service and staff side organisations.

Governing Body will continue to receive regular updates in respect of the CCG organisational development plans and engagement activity via the Clinical Chief Officers Report. A report in respect of this work strand was presented to Audit Committee in February 2020 to provide assurance against strategic objectives. A workforce report providing metrics, organisational development and engagement activity will be presented to the Governing Body twice a year as part of the work plan for 2020/21.

4) Assurance Reporting on the Organisational Development Programme

3) Organisational Change Programme – Jan to March 2020

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Members of the Governing Body are asked to:

• Receive and endorse actions within the report.

Suzanne Barker Chief of Corporate Services NHS Halton CCG Appendix 1 presents high level workforce metrics in respect of Staff in post, Staff Turnover and Sickness Absence.

5) Recommendations

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Appendix 1

Workforce Metrics 2019/20 (Data – December 2019)

Headcount

Staff in post figures for the CCG have decreased slightly throughout 2019/20. To December the average full time equivalent (FTE) number of staff in post is 58.47 with the latest FTE in December being 56.92. This equates to an average headcount for the year to date of 73.33 and the December 2019 headcount of 71 staff.

Staff Turnover The total leavers to date (6.62 FTE) represents 11.31% of the average FTE employed per month in 2019/20 in NHS Halton CCG. Of the total 6.62 leavers (FTE) for NHS Halton CCG on 2019/20 (to December):

o 27.44% were due to voluntary resignation (other reason) o 15.12% were due to retirement o 15.12% were due to voluntary resignation (due to relocation) o 15.12% were due to voluntary resignation (due to end of fixed term contract) o 15.12% were due to voluntary resignation (due to better reward) o 12.09% were due to voluntary resignation (due to promotion)

0

10

20

30

40

50

60

70

80

90

Apr 19 May 19

Jun 19 Jul 19 Aug 19 Sep 19 Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20

FTE

Halton CCG Staff in Post (FTE)

Halton CCG (FTE)

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The reasons for leaving are taken from the Leavers Form completed on the NHS Electronic Staff Record (ESR). Sickness Absence

The overall FTE sickness absence rate in the NHS in England is consistently around 4%. The total CCG FTE sickness rate is generally around 3%. These figures are included on the chart below to provide a reference rate. To December the average monthly absence rate in the CCG is 3.56% with a high of 6.05% and a low point of 1.43%. Due to the low numbers and confidentiality the reasons for absence are not detailed in this report but the overall themes and trends for 2019/20 will be summarised in the annual update report to Governing Body presented in quarter one 2020/21.

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

3.5%

4.0%

Apr 19 May 19

Jun 19 Jul 19 Aug 19

Sep 19

Oct 19 Nov 19

Dec 19

Jan 20 Feb 20

Mar 20

TUR

NO

VE

R R

ATE

Halton CCG Staff - FTE Turnover by Month

Overall Turnover Rate

0%

2%

4%

6%

8%

Apr 19 May 19 Jun 19 Jul 19 Aug 19 Sep 19 Oct 19 Nov 19 Dec 19 Jan 20 Feb 20 Mar 20

Sic

knes

s A

bsen

ce R

ate

Halton CCG - Monthly Sickness Absence Rates

NHS Halton CCG FTE Monthly Sickness Absence Rate

Total NHS FTE Monthly Sickness Absence Rate (England)

Total All CCG FTE Monthly Sickness Absence Rate

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