Assuring Service Change a Proposed Approach for NHS England

Transcription

1 Assuring Service Change a Proposed Approach for NHS England Purpose of the Document This document summarises the recommendations of a group of NHS England Directors, working together as a Task and Finish Group that was set up to consider how reconfiguration policy can best be implemented by the Operations Directorate. This work originated from a table top discussion at the Leadership Forum, whereby it soon became apparent that if NHS England is to adopt a truly transformational approach to the implementation of major change, and successfully take forward all its ambition and aspirations, there needs to be robust join-up across the organisation, and a stepchange in the way matrix-working is undertaken. These proposals have been drawn up in collaboration with the Policy Directorate and others, to ensure that they are consistent with the work associated with the Call to Action and the Service Reconfiguration Tool kit, and as such, are able to provide practical guidance for the whole organisation in working together. Revised guidance on service change is expected from Sir Ian Carruthers and whilst draft contents have been shared, there may be a need to refresh the approach and toolkit once this and the decision-making framework which is in development are finalised. Context It is recognised that in the past, a significant proportion of reconfigurations have run into difficulties, for a variety of different reasons. The learning from a recent report of the Independent Review Panel (need to cite the document) cites a number of reasons for this, including: poor initial decision making, accompanied by limited or challengeable information lack of public ownership of the need for improvement in care or health outcomes lack of clinical ownership of the rationale and evidence for change inconsistency in communication through changing environmental circumstances reliance on integration with the normal commissioning cycles during periods of exceptional change NHS England is committed to doing things differently, to a higher standard than ever before, and this means adopting a very different approach to service reconfiguration. This is going to be core business for the organisation, given that the NHS cannot go on as it is, with a major programme of change on the horizon. The Call to Action makes it clear that there are a number of significant trends that threaten the sustainability of the NHS our aging population, the building epidemic of long term conditions, lifestyle risk factors in the young, greater public expectations, rising costs and of course, constrained financial resources. In response, bold, transformational change is needed that will allow us to improve the quality of services, whilst at the same time, increasing efficiency. Doing nothing is simply not an option. The NHS as a whole is therefore about to embark on a sustained programme of change. In many cases, NHS England itself will be the major driver of this change, given its commitment to improving outcomes in respect of its directly commissioned services. However, service reconfiguration 1

2 proposals will come from a number of sources, and whatever the driver for change, NHS England has a vital role to play in assuring service reconfiguration - whether this emanates from the commissioning plans of the CCGs, the work programme of the AHSNs, or the activities of providers themselves as they seek to achieve efficiencies. Given this situation, NHS England must ensure that there is absolute consistency across the organization in respect of; (a) The standards that are required in terms of developing the case for change, (b) Ensuring that there has been real public/clinical/community engagement before any proposal is supported, and (c) Ensuring that a common approach is adopted in the way in which this assurance role is carried out. Most importantly, all processes carried out within the organization must be robust, open and transparent, so that NHS England is able to provide legitimate leadership in this area, and in doing so, build public confidence that the reconfiguration will indeed bring about a real improvement. The following sections describe the processes that need to be followed within NHS England as it oversees major service reconfiguration, and recommends that a new approach is adopted for these major changes to be implemented successfully. Principles for Service Change We will adopt a new approach to service change characterised by a number of guiding principles, applied consistently as part of an assurance process that will be light touch with the flexibility to be proportionate to the scale of the proposal in question. This combination of clear principles and robust, flexible application of process has been developed through dialogue with colleagues both leading service changes and those involved in undertaking assurance. All service change proposals require formal commissioner support and ownership, including where appropriate, NHS England as a direct commissioner and even if change is initiated by providers or other organisations. Commissioners will want, as a minimum, to ensure they fully understand and endorse any proposals and that the proposals align with their commissioning intentions. Commissioners will work with their communities to identify service development opportunities and would normally be responsible for leading the public engagement and/or consultation process supported where appropriate by representatives from other relevant organisations. Where services are commissioned by two or more organisations or teams, it is essential that any proposals for service change are aligned with each organisation s commissioning intentions. Irrespective of which organisation proposes a major service change, it is important that there is a robust single assurance process, based on agreed principles and the consistent application of common tests, by which NHS England can assure itself that proposals meet the appropriate standards. The assurance process should be as light touch as possible and avoid unnecessary bureaucracy. The process will need to be widely communicated and understood by all commissioners and provider organisations. 2

3 Service Change Assurance NHS England should be the focal point in the health system of assurance for service change proposals, applying a consistent process incorporating relevant national guidance and ensuring proposals adhere to relevant legislation. The Operations Directorate, with the support of a broad range of NHS England colleagues, will need to coordinate the assurance of service change proposals through a process operating at area, regional and national levels and providing opportunity for other interested organisations (e.g. NTDA, CQC, HEE, Monitor) to have influence in the process 1. Assurance is intended to be light touch, supportive and confidence building for all stakeholders, including those proposing change and those impacted by it. NHS England assurance adds value by ensuring the whole NHS is working together to address issues and helps to identify and mitigate risk. Service changes can be challenged through a referral to the Secretary of State (who may ask for advice from the Independent Reconfiguration Panel), or a request for judicial review. The risk of either challenge being successful can be greatly reduced through adopting a best practice approach. A reconfiguration toolkit is attached at (Attachment 1), this draft document is intended as a guide for CCGs, ATs and others who are seeking to progress service change. Designed with input from ATs, RT and NSC we would anticipate using this draft document as a foundation for further co-design work with interested CCGs and other colleagues (including Local Authorities and Scrutiny Committee representatives), beginning with a discussion at the Commissioning Assembly sub-group. The reconfiguration assurance process should not be reduced to satisfying a checklist of legal requirements (which are limited in number and relate to duties to involve and consult with the public and Local Authorities health scrutiny functions). Rather, the process set out should be seen as best practice to help organisations take forward complex programmes of service change whilst identifying and mitigating risk. NHS England should have received assurance and confirmed their support for a proposal to progress before any formal public consultation takes place. The premise of any service change is that it is clinically and patient led. NHS England will expect a minimum of compliance with the Department of Health s four tests for service change (referenced in the Mandate Para 3.4 and Putting Patients First ) throughout the pre-consultation, consultation and post-consultation phases of a service change programme. The four tests are: i) strong public and patient engagement; ii) consistency with current and prospective need for patient choice; iii) a clear clinical evidence base; and iv) support for proposals from clinical commissioners. As a proposal is developed and refined it should undergo a rigorous self-assessment against the four tests. In assessing proposals against the tests, organisations should ensure they have evidence that demonstrates the changes will bring improvement in quality, safety, effectiveness of care, and that proposals are clinically sustainable within available resources. A full range of proposed NHS England key tests for reconfiguration are identified in table 1, Appendix 1 of this paper. NHS England would seek assurance against these key tests, applied proportionately on a case-by-case basis. 1 NHS England London Region s structure varies from other Regions in that it does not have stand-alone Area teams but has a specific Service Reconfiguration team who will coordinate the assurance of service change proposals. 3

4 Service change assurance does not change accountabilities for decision making. It may raise issues and risks that NHS England would expect commissioners to want to fully consider and address before progressing their proposals. For this reason the formal assurance of proposals should be undertaken in good time before any formal public consultation exercise. The proposed assurance process A two stage assurance process is described below, the first stage is a strategic sense check and the second a detailed assurance checkpoint. The process will be applied proportionately to the change being proposed. The range and level of assurance required will be tailored to the service change; this would be discussed in early conversations between organisations and confirmed at the strategic sense check stage. Organisational roles and responsibilities should be agreed as early as possible. When considering the range and level of assurance required, NHS England will consider the following factors: These thresholds will need to be determined. NHS England will apply a principle of subsidiarity, assurance being exercised as locally as possible to the scheme in question, balancing the importance of local relationships against the level of assurance required. This will be considered by NHS England s area and regional teams on a case by case basis before being discussed and agreed with commissioners. Assurance would most often be undertaken at the next geographical layer from the proposal, thus CCG led schemes would be assured at Area Team level, schemes involving multiple areas would be assured at regional level, schemes crossing multiple regions being assured at national level. However 4

5 this approach will need to be flexible to specific circumstances and should be agreed following discussion between Area and Regional Teams within NHS England, taking the advice and guidance of the National Support Centre when required. Independent external advice may be sought as part of the process, potential sources of advice include Clinical Senates, the National Clinical Advisory Team, other independent clinical experts and the Health Gateway Team. 5

6 The flow diagram below outlines a process by which NHS England will assure itself that service change proposals meet the four tests and the appropriate key tests for service change as described in the reconfiguration toolkit. The process includes two formal stages, the first a strategic sense check and the second point a more detailed assurance checkpoint. 6

7 Assurance stage 1 Strategic Sense Check Stage 1 Key issues for discussion Organisations Strategic sense - Explore case for change and level of check consensus for change - Commissioner overlaps and strategic alignment of proposals - Identify support and resource requirements - range of options explored and appraised - Risks identified - Choice and competition issues - Role of Clinical Senate in providing advice - Best practice approaches shared - Establish organisational roles - Identify likely level of NHS England assurance required - Lead commissioner for proposals - NHS England, at the most appropriate level (usually Area Team) Timing: Once commissioners feel there is a case for significant service change and have a high level proposed approach Outputs: NHS England letter to lead commissioner capturing key discussions and assurances received. Outline of the NHS England assurance process and timeline for assurance. A formal discussion will take place between the commissioners leading the proposed changes and NHS England at the most appropriate level (usually Area Team). NHS England will want to explore the case for change and the level of consensus for change; ensure a full range of options are being considered and they are fully sighted on the potential risks associated with the proposals. The alignment between the proposed change and the strategic intent of NHS England, other key partners and neighbouring organisations will also be discussed. This is an opportunity to discuss the likely resource requirements for the change programme, including support requirements and sources of external support. If not already formalised this is the appropriate point to establish any inter-relationship or potential overlap between CCG and or NHS England initiated change proposals and to seek to align these elements (including establishing a lead commissioning arrangement for the purposes of assurance). This stage also allows for discussion regarding the role networks and clinical senates might offer in terms of providing advice or support in the development of proposals. Choice and competition implications of the proposals should be considered. The strategic sense check will clarify organisational roles (particularly relevant for complex multiorganisation schemes) and test the level of key stakeholder involvement and sign up. It provides an opportunity to outline NHS England s expectations in terms of a best practice approach and to identify any support needs that may exist. Following the strategic sense check NHS England will send a letter to the lead commissioner, capturing the key points raised including: NHS England s understanding of the case for change and the level of consensus for change; the assurances received and risks identified. The letter should also outline to the lead commissioner the level of assurance likely to be required by NHS England, the key 7

8 tests for service change that will apply and seek to agree a timetable for stage 2 Expert Panel assurance. For some small scale, non-contentious schemes it may be agreed that CCG self-assurance against the appropriate key tests (to include four tests as a minimum) is appropriate and no second stage process is required. Assurance stage 2 Expert Panel Assurance Stage 2 Key assurances Organisations Expert Panel - formal assurance checkpoint - Four tests for service change - The key tests for service change (as applicable) described in table 1 below. - Products of any external assurance also considered e.g. reports from Clinical Senate, National Clinical Advisory Team or Health Gateway Team. - Submission of evidence against key tests by lead commissioner for proposals - An NHS England Expert Panel, convened at the most appropriate level (usually Area Team or an alternative Area team as part of a peer review process) - Independent external assurance (e.g. Clinical Senate; NCAT; Gateway Team) Timing: Pre-formal public consultation Outputs: Expert Panel recommendation to the appropriate NHS England decision making forum* *This will be informed by work in progress on NHS England governance and decision making by a national task and finish group. A formal assurance of the proposals undertaken by an NHS England Expert Panel, convened at the level agreed at stage 1 of the assurance process (or changed due to subsequent analysis of the level of risk being carried by a particular proposal). The Expert Panel would be formed by a range of NHS England s functional experts who are suitably qualified to consider evidence submitted against the four tests for service change and the key tests. The Expert Panel would also consider the reports or findings received from external or independent assurance bodies. Typically these would have assured either the clinical case for change and clinical model, or the programme management arrangements. These assurances might have been sought from the Clinical Senate or National Clinical Advisory Team; and the Health Gateway Team respectively. Other organisations (e.g. LETB, TDA, Monitor, Healthwatch, CQC) might also be invited to share their views of the proposals to help inform the NHS England Expert Panel. They would not however be members of the NHS England Expert Panel. The key tests for service change are listed in Table 1 attached as Appendix 1. The Expert Panel would need to be made up of NHS England representatives with the skills and experience to assure evidence against these tests and to undertake analysis of the external assurances. The Chair of the Expert Panel needs to be of sufficient seniority and experience to draw together the Expert Panel s views and make a recommendation on its behalf. The Expert Panel would need to consider whether it was assured, partially assured or not assured against each of the relevant criteria. This would then form the basis of the panel s report, along with any risks, issues or other recommendations they identified. The Expert Panel s report should 8

9 conclude with a recommendation to NHS England on the next steps, this could be in one of three categories: 1) Overall Assured and NHS England offers support to proceed; 2) Overall Only Partly Assured and NHS England offers support to proceed subject to specified further work being undertaken (this may or may not need to be undertaken before public consultation begins); or 3) Overall Not Assured and NHS England cannot offer support to proceed at this point. For proposals that cannot be supported to proceed at this point the recommendation would be that NHS England would then initiate further discussions with the lead commissioners on how best to address the case for change. Each recommendation would be made to the appropriate decision-making forum within NHS England. This might be a decision made at Area Team Director, Regional Team Director or national Board level on behalf of NHS England. This needs to be informed by the on-going work on decision making and governance within NHS England being led by Richard Barker (Regional Director, NHS England North). The next stages The NHS England assurance decision should be promptly communicated to the commissioners, NHS England s Business Unit will also be informed. This will then enable the lead commissioner (be it a CCG, CCGs or NHS England) then take forward the proposal through their organisational decision making process. No scheme should progress to formal consultation without having received NHS England s support following a proportionately applied assurance process. NHS England will require on-going oversight and further assurance of service change proposals through the consultation, post-consultation and implementation phases. These oversight and assurance arrangements, including key milestones will need to be agreed between NHS England and the commissioners leading the change. NHS England will expect a best practice approach to be utilised in all instances. The principles of light touch assurance, flexibility and proportionate process will continue to apply 9

10 Assurance of directly commissioned services The assurance of changes to directly commissioned services raise potential issues for commissioners, not least the potential conflict for NHS England of both developing and assuring proposals for changes to directly commissioned services. The three main issues can be described as follows: 1. the potential impact of service changes on other commissioners (e.g. CCG led change impacts on directly commissioned services or NHS England led change impacts on CCG commissioned services). There may also be an overlap in patient pathways that have both CCG and NHS England commissioned elements (the impact on directly commissioned services will predominantly affect specialised however there may be some cases where there is an impact on offender or armed forces directly commissioned services); 2. commissioners requiring an awareness of one another s plans for service change so they can align their intentions and timescales; and 3. NHS England s potential or perceived conflict in leading and assuring changes to directly commissioned services. The proposed approach deals with each of these three issues in turn. 1. A key assurance test is adopted which all proposals will have to provide evidence against at the Expert Panel stage: A full impact analysis (of the proposal) across CCG / NHS England commissioned services and shared sign up of all parties to analysis. The evidence required would be an impact analysis on CCG and NHS England commissioned services, endorsed by the relevant parties. In practice this would mean: for a CCG led change, checking overlaps and impact on directly commissioned services with the appropriate AT(s); for an NHS England led change, checking overlaps and impact with the appropriate CCG(s) or lead CCG(s). 2. Sharing of the monthly reconfiguration tracking grid with RT and AT direct commissioning leads will provide a conduit by which the appropriate connections between commissioners and their proposals can be made. Issues of mutual interest can be identified early and ATs/RT can ensure early discussions are held to align or influence proposals. 3. AT and RT leads will manage the assurance requirements on a case-by-case basis, employing a consistent set of principles for the assurance of proposed changes to directly commissioned services. This is likely to need to consider: the various scales of change that might be proposed (in terms of population, geography, organisations involved); the nature of the case for change (clinical safety, quality improvement, introduction of new technology / techniques); and alternative approaches to assurance (different RT and AT roles, chinese walls, peer-review and external advice and assurance). When considering the assurance of proposals with an impact on directly commissioned services, NHS England will consistently ensure that consideration will be given to potential crosscommissioner impact of all proposed service changes. Clear commissioner leadership arrangements will be agreed for all schemes where a material cross-commissioner interest exists, with all commissioners retaining an appropriate input into the process, impact assessments and key decisions. 10

11 NHS England will be mindful of both potential conflict of interest and the perception of such conflicts when assuring service change proposals; this is particularly pertinent in its dealings with proposals that effect services it directly commissions. A robust assurance process, proportionate to the scale of the proposed changes, will be agreed following discussion between teams within NHS England on a case-by-case basis. The level of assurance required will be determined using the same principles as for purely locally-commissioned proposals. This provides the flexibility to respond pragmatically to the variation in scope, geographical scale, complexity and other factors that will characterise proposals with an impact on directly commissioned services. As part of this process it is likely that NHS England will want to take advantage of independent and impartial external advice, potential sources of advice include clinical senates, the National Clinical Advisory Team and the Health Gateway Team. Assurance will need to be undertaken and overseen by an Expert Panel with no links or interest in the proposals, their development, implementation or consequences. In practice this may mean that a geographically and/or functionally and/or organisationally separate team within NHS England s structures forms the Expert Panel to undertake the assurance process. The Expert Panel would apply a strict chinese wall around this assurance process to avoid any conflict of interest. It is proposed that these arrangements should be described to, and agreed with, all major stakeholders before the Expert Panel stage of the assurance process to ensure all are content that the Expert Panel are suitably insulated from any organisational conflict of interest. Draft Terms of Reference and supporting documentation are attached as Appendix 2 It is suggested that this approach is kept under review and learning from each assurance process used to inform future processes. NHS England will wish to revisit these arrangements if a national framework for reconfiguration is developed and published. Conclusion / Way Forward The proposed approach for assurance needs to be tested with key members of the NHS England team, across all directorates. It is proposed that the draft document be presented and discussed with; 1. The National Operations and Delivery Directorate Forum on 1 st August 2. Shared with Richard Barker the Regional Director leading on Governance and Decision Making Monday 29 th July 3. Andy Buck who is leading the work on decision making and Governance for Richard Barker 4. The Commissioning assembly steering group, AF to discuss with Alex Morton 5. Dame Barbara Hakin and Bill McCarthy, following feedback from the forum on 1 st August 6. Operations Directorate Business meeting on the 4 th September 7. The 5th September Leadership Forum following the process described above 8. NHS England Executive and Regional team meeting to be agreed 11

12 The work of the Task and Finish Group will continue to critically review the work to date and receive comments from colleagues in commissioning, ensuring alignment with the development of all of NHS England s key delivery functions. Appendices 1 and 2 12

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14 Appendix 1 Table 1. Key tests for service change Criteria Key Tests Example Evidence 4 key tests Support from GP commissioners will be essential Arrangements for public and patient engagement, including local authorities should be further strengthened Clarity about the clinical evidence base underpinning proposals Proposals should take into account the need to develop and support patient choice QIPP / Finance Does the reconfiguration improve quality and reduce cost? How (e.g. reduced duplication, increased efficiency)? What are the savings in financial terms? What capacity is being taken out of the system and where? How, when and where is a saving made? Is it a real (cash releasing) saving? Are the transitional costs (including non-recurrent revenue and capital) identified and properly accounted for? How will they be funded? Finance links consistently to workforce and activity models Documented evidence of GP support See communications and clinical quality and activity sections below Business case (if available) or strategic outline case including worked through financial models Evidence of aligned financial, workforce and activity models Clinical quality and strategic fit Clear articulation of patient, quality and financial benefits Clinical case fits with national best practice Fit with local H&WB strategy and aligned with local commissioning plans Options appraisal (inc. consideration of a network approach, cooperation and collaboration with other sites and/or organisations) Macro-impact is properly considered Alignment with QIPP workstreams Full impact analysis across CCG / NHS England commissioned services and shared sign up of all parties to analysis Clinical case for change including risk analysis Reference to national evidence base which could include NCD reports, NICE, Royal College or NHS Evidence. Options appraisal for network /collaborative / cooperative approach Analysis of macro-impact Identify links to local strategic plan and QIPP workstreams Analysis of impact on CCG / NHS England commissioned services endorsed by relevant parties. Activity All relevant patient flows and capacity are properly modelled, assumptions are clear and reasonable What are the changes in bed numbers? Activity and capacity modelling clearly linked to reconfiguration objectives Activity links consistently to workforce and finance models Modelling of significant activity, workforce and finance impacts on other locations / organisations Outputs of accurate modelling with assumptions clearly stated and sensitivity analysis Clear explanation of reduction in bed numbers Narrative explaining link between modelling and reconfiguration objectives Aligned financial, workforce and activity models Analysis of key risks and any mitigating actions 14

15 Criteria Key Tests Example Evidence Workforce Do you have a workforce plan -integrated with finance and activity plans? Are you making most effective use of your workforce for service delivery and is it compliant with all appropriate guidance? Consider the implications for future workforce Have staff been properly engaged in developing the proposed change? Travel Has the travel impact of proposed change been modelled for all key populations including analysis of available transport options, public transport schedules and availability / affordability of car parking? Resilience How will the proposed change impact on the Major Incident Plan and associated plans? Has a business impact analysis been conducted for all impacted organisations and appropriate changes made to Business Continuity Plans? Ambulance services Comms and Engagement Have the implications for ambulance services (emergency and PTS) been identified and impact assessed and appropriate discussions been held with ambulance service providers? Are there plans to appropriately and effectively engage and involve all stakeholders (to include: staff, patients, carers, the public, Healthwatch, GPs, media, local authority overview and scrutiny functions, Health and Wellbeing Boards, local authorities, MPs, other partners and organizations) and fulfil commitments under s.242 of the NHS Act? Supply high level workforce risks and mitigating actions Statement of assurance including reference to all appropriate standards Changes to provider Learning Development Agreements Evidence of appropriate staff engagement Travel impact assessment Statement of assurance Business impact analysis Statement of ambulance service engagement and impact assessment Consultation plan and draft consultation document Public / stakeholder involvement strategy Communications plan including full stakeholder map with timelines, key messages, named clinical spokespersons, sample materials and plans to reach seldom heard groups Equality Impact There has been an appropriate assessment of the impact of the proposed reconfiguration on relevant diverse groups? Has engagement taken place with any groups that may be affected? What action will be taken to eliminate any adverse impacts the assessment has identified? Completed EqIA and Action Plan TDA &Monitor Is proposal aligned with the TDA s / Monitor s approach Business case (if available) or strategic outline case IT Does proposal make best use of technology? Evidence of a review of how technology may support the Assessment of the impact on local informatics strategy & IT deployments reconfiguration been undertaken Are there likely to be any data migration costs? Detail of any changes to local informatics strategy and Are there any implications for specialist or network technology/equipment contracts associated with the service? deployment plan, inc. information flows and governance. Key risks are highlighted and mitigating actions identified Others Consistent with rules for cooperation and competition Assurance from commissioners 15

16 Appendix 2 Unified Terms of Reference Document for Expert Assurance Panels Reconfiguration Seeking Assurance: Insert programme name Chair of Panel: Insert name Area Team / Regional Team / National Team / NHS England Board (delete as applicable, must be one tier above the sponsoring clinician) Sponsoring Clinician: Insert Clinical leader of the proposed reconfiguration Area Team / Regional Team / National Team / NHS England Board (delete as applicable) Key Health Improvement enabled by the proposed reconfiguration: Insert the key improvement(s) in population health and outcomes designed to be delivered by the reconfiguration under consideration. Executive Summary Insert summary of planned change 16

17 1. Key Objectives of the NHS England Expert Panel This reconfiguration panel has been established in order to determine whether NHS England is assured that the case for change under consideration is the most appropriate to deliver the identified improvement(s) in population health and outcomes. The panel must be assured that there is strong public and patient engagement; consistency with current and prospective need for patient choice; a clear clinical evidence base; and support for proposals from clinical commissioners. The panel will explore each element of the key tests for service change (see Assurance Toolkit) and reach one of four decisions: Fully assured Partly assured (stating which element failed to give assurance) Not assured yet (stating what circumstances would need to change for assurance to improve) Not assured 2. Scope The panel will have each element of the assurance toolkit within its scope: The four tests Clinical quality and strategic fit Activity Finance and QIPP Workforce Access to Treatment & Travel Resilience Ambulance Services Ongoing Communications & Engagement Equality Impact Trust Development Authority / Monitor alignment IT Cooperation & Competition The full extent of the areas of scope must be considered in order that the assurance opinion has legitimacy and will be viewed with confidence by the public, patients and other stakeholders. 17

18 3. Panel Resources The panel will draw resources from across NHS England directorates in order to complete coverage of the full scope and to ensure that all directorates are involved: Operations Directorate Oversight of National work programme for service change Co-ordination of functions across directorates to support service change Assurance and Approval of cases for change using four tests and expertise of colleagues Alignment with NHS England Policy and delivery of the mandate Develop and approve implementation plans Liaison with all other key stakeholders Ministerial process Approval of resources against business cases Oversight of delivery A clerk to the panel will be appointed by the Chair to ensure that the duties of the panel are delivered. Independent clinical assurance and Health Gateway Team support should be accessed as appropriate. If other organisations are invited to contribute to the assurance process their views should be considered by the Expert Panel, they do not however become members of the NHS England Expert Panel. 4. Panel Governance Organisation & Membership The Expert Panel would need to be made up of NHS England representatives with the skills and experience to assure evidence against these tests and to undertake analysis of the external assurances. The Chair of the Expert Panel needs to be of sufficient seniority and experience to draw together the Expert Panel s views and make a recommendation on its behalf. The panel will report through the governance structure of NHS England. Its recommendation will be made to an appropriate decision making forum within NHS England. This will be informed by the output of the governance task and finish group, chaired by Richard Barker. 18

19 Date 1 Date 2 Date 3 Date 4 Date 5 Date 6 Panel members will be expected to conduct their business in accordance with best practice in respect of codes of conduct and good governance practice including practicing the Nolan principles of public life. 5. Panel Implementation Plan Insert the timetable of milestones to be achieved by the panel Action Panel Terms of Reference and Membership Agreed Panel Assurance Decision Reached 19