Northamptonshire Sustainability and Transformation Partnership: Governance Framework

Transcription

1 Foundation Trust Board of Directors 30 November 2017 G Northamptonshire Sustainability and Transformation Partnership: Governance Framework Situation The attached document sets out the proposed Sustainability and Transformation Partnership Governance Framework. The purpose of this paper is to present the governance framework to the Board for consideration and endorsement. Background Development of the Governance Framework is part of the STP reset process. The Governance Framework has been considered by the Sustainability and Transformation Partnership Board. This final draft has been updated to incorporate Partnership Board member comments. Assessment This Framework describes arrangements intended to provide a foundation of good corporate governance, enabling the Northamptonshire Sustainability and Transformation Partnership ( the Partnership ) to implement changes in the way that NHS services will be planned, delivered and experienced in Northamptonshire. Recommendation The Board is asked to consider and endorse the proposed Governance Framework. File: SBAR STP GOV FRAMEWORK Printed: 15:41, 23 November 2017 Page 1 of 2

2 Governance Table For Board and Board Committees: Paper sponsored by: Paper authored by: Angela Hillery, Chief Executive Sustainability and Transformation Partnership Board Date submitted: 23 November 2017 State which Board Committee or other forum within the Trust s governance Sustainability and Transformation Partnership Board 24 October 2017 structure, if any, have previously considered the report/this issue and the date of the relevant meeting(s): If considered elsewhere, state the level of N/A assurance gained by the Board Committee or other forum i.e. assured/ partially assured / not assured: State whether this is a one off report or, One-off report if not, when an update report will be provided for the purposes of corporate Agenda planning DIGB Q strategic alignment*: Develop Innovate Grow Build Quality Organisational Risk Register List risk number and No risk identified considerations: title of risk False and misleading information (FOMI) N/A considerations: Equality considerations: None believed go apply File: SBAR STP GOV FRAMEWORK Printed: 15:41, 23 November 2017 Page 2 of 2

3 Northamptonshire Sustainability and Transformation Partnership (STP) Governance Framework V 7.0 Date Version Summary of Changes Owner Circulation No. 25/08/ First cut formatting and CH Internal content 31/08/ Revisions to Sections 7, 8 CH Internal and 9 13/09/ Revisions to organogram CH Internal and section 11 15/09/ Minor revisions and formatting CH Strategic Executive, Chairs of Programme Board, Lay Scrutiny, Clinical Leaders and Finance Group 22/09/ Collated Comments from CH Internal initial consultation 12/10/ Revised copy based on CH Internal consultation comments and internal discussions 19/10/ Draft final for Partnership CH Partnership Board Membership Board 13/11/ Final draft incorporating Board member comments MC Partnership Board Membership 1

4 Contents 1 Introduction 3 2 Northamptonshire Sustainability and Transformation 4 Partnership 3 Corporate Governance Framework 4 4 Principles for Good Governance 5 5 Aims 6 6 Accountability 7 7 Roles and Responsibilities Individual Organisations 7.2 Officers of Individual Organisations 7.3 Partnership Board Chair 7.4 Collaborative Stakeholder Forum Chair 7.5 STP Programme Lead 7.6 STP Clinical Director 7.7 STP Finance Director 7.8 STP Programme Director 7.9 Delivery Support Unit 8 Organogram Diagram 8.2 Roles of committees Northamptonshire STP / ACS Partnership Board Collaborative Stakeholder Group Clinical Advisory Group Strategic Finance Group Strategic Executive 8.3 Programme Delivery 8.4 Workstreams aligned to the STP 9 Decision Making Urgent Decisions 9.8 Dispute Resolution 10 Managing Risk Information Sharing Cycle of Business Reporting Arrangements 21 Appendices Appendix 1: Terms of reference Partnership Board 22 Appendix 1: Terms of reference Collaborative Stakeholder Forum Appendix 3: Memorandum of Understanding 28 Appendix 4: Information Sharing Concordat 2

5 1. Introduction 1.1 This Framework describes arrangements intended to provide a foundation of good corporate governance, enabling the Northamptonshire Sustainability and Transformation Partnership ( the Partnership ) to implement changes in the way that NHS services will be planned, delivered and experienced in Northamptonshire. 1.2 The Partnership consists of the statutory agencies within the Northamptonshire health and social care system together with representatives of primary care: NHS Corby CCG Kettering General Hospital NHS Foundation Trust NHS Nene CCG Northampton General Hospital NHS Trust Northamptonshire County Council Northamptonshire Healthcare NHS Foundation Trust The Local Medical Committee Primary care representation to be confirmed via GP Federations/ superpractice. 1.3 The Partnership is tasked by NHS Improvement and NHS England with the delivery of a Sustainability and Transformation Plan ( the Plan ) as the vehicle for delivering system objectives in line with the 5 Year Forwards View and Next Steps documentation, for which statutory healthcare organisations will be held to account. 1.4 This Framework sets out the governance arrangements that the Partnership will adhere to in delivering its functions. It describes how the Partnership will 3

6 operate, confirms those matters reserved to individual organisations for decision, and describes the various Boards and committees through which the partners operate and where certain powers of those Boards and committees will be delegated to the Northamptonshire STP/ACS Partnership Board. 1.5 The Northamptonshire STP/ACS Partnership Board ( the Partnership Board ) is made up of the partner organisations who are jointly accountable for delivery of the Plan. The partner organisations will participate in the decision making processes of the Partnership Board to the extent that they are delegated authority by their respective organisations. 1.6 Patient and stakeholder engagement is key to shaping the work required to deliver the Plan. The Collaborative Stakeholder Forum will be responsible for ensuring the involvement and engagement of the broader group of stakeholders, and that their views inform the Partnership Board. 1.7 It is anticipated the Partnership Board and the Collaborative Stakeholder Forum partnership will meet regularly. 2. Sustainability and Transformation Partnership 2.1 The Partnership exists to identify and drive delivery of strategic changes to the Northamptonshire health and care system that will both improve outcomes for local people, support the population to become healthier and ensure that services are financially sustainable. The Partnership is responsible for the delivery of transformation across the system. 2.2 The Governance Framework applies to the whole lifespan of the Partnership. 4

7 3. Corporate Governance Framework 3.1 This Framework describes the governance arrangements that have been established to ensure that the Partnership will operate to deliver its role and functions. It describes how the Partnership will operate, the decision-making process and how the Partnership Board and its associated committees and workstreams will interact with the Boards and Committees of its statutory partners. 3.2 This Framework will be approved by the Boards, Governing Bodies and local authority Committees/Cabinets of all partner organisations, and will be reviewed on a regular basis, in the first instance, at a 6 month period from its approval. 4. Principles and Behaviours for Good Governance 4.1 This governance and management framework sets out systems, structures and processes supporting the delivery of the Plan. However, successful delivery also requires a commitment to effective personal, professional and organisational behaviour. This implies a shift in behaviour based on the following values: Selflessness, integrity, objectivity, accountability, openness, honesty and leadership by example (Nolan principles) A commitment to the Plan based on a belief that statutory organisations will meet their obligations through the Partnership A focus on the Northamptonshire pound Professionalism in business conduct Transparency. 4.2 As part of the roll out of this framework, a Memorandum of Understanding will be developed to provide a contract allowing organisations and individuals within the system to be held to account. 5

8 4.3 All members of the Partnership will observe the highest standards of probity in relation to the stewardship of public funds, the management of the Plan, and the conduct of its business. 4.4 Conflicts of interest will be managed in line with NHS statutory guidance. A register of interests for all staff attending formal meetings of STPa groups will be maintained by the DSU. All staff and stakeholders attending a formal meeting will be asked to declare their personal, professional and organisational conflicts of interest. Any member of staff or stakeholder with a material interest will either be excluded from the relevant parts of the meeting or join in the discussion but not participate in any decision making. 4.5 The Chair of the relevant meeting has responsibility for deciding whether there is a conflict of interest and the appropriate course of corresponding action. In making such decisions, the chair may wish to consult a member of a Governing Body or Board in the system who has responsibility for issues relating to conflicts of interest. 4.6 All decisions, and details of how any conflict of interest issue has been managed, should be recorded in the minutes of the meeting 5. Aims 5.1 The overarching ambitions of the Partnership as expressed in the Plan are: People live longer, healthier lives People live in strong and resilient families and communities People have improved mental health and wellbeing People can access care and support closer to home, when needed Children start life healthy and stay healthy Health inequalities are reduced A stronger economy and healthier workforce. 5.2 Through this Governance Framework, the Partnership aims to maximise its effectiveness to: 6

9 Improve the quality of care and outcomes for people in the county, Planning health and social care on the basis of population need, Ensure that people and communities are engaged and communicated with during the transformational changes needed to secure the system, Delivering the changes at sufficient pace to achieve the aims of the 5 Year Forward View, and Enable effective and efficient delivery of major projects, reducing waste, inefficiency and duplication. 6. Accountability 6.1 In line with NHS England guidance, accountability for performance (financial/ constitutional standards/ Next Steps deliverables/ quality) remains with statutory organisations: Nene CCG, Corby CCG, Kettering General Hospital NHS Foundation trust, Northampton General Hospital NHS Trust, Northamptonshire Healthcare NHSFT, Northamptonshire County Council. However, it is recognised that NHS England will increasingly expect an increased focus on system management and collective decision making. 6.2 The relationship between the Partnership Board and the Health & Wellbeing Board is determined by the priorities of the latter and the extent of overlap with Plan projects and will therefore focus on: partnership working, health inequalities, outcomes, mental health, children/ young people and resilient people/neighbourhoods 6.3 The Partnership is committed to openness and transparency in its work, in support of its accountability to patients and public. To that end, regular reports regarding its activity will be submitted to the Northamptonshire Health and Wellbeing Board, as well as to the Boards of statutory partners. Information about its activity will be published on its website. 6.4 The Partnership will demonstrate its accountability through: 7

10 Adhering to the Governance Framework and Memorandum of Understanding, Publishing the Sustainability and Transformation Plan, including a public facing summary, Publishing other relevant documentation, and Working within the Freedom of Information Act Policy DRAFTING NOTE: THE RELATIONSHIP BETWEEN THE PARTNERSHIP BOARD AND THE HEALTH & WELLBEING BOARD REQUIRES CLOSER DEFINITION 7. Roles and Responsibilities 7.1 Individual Organisations Each individual organisation being a Member of the Partnership remains at all times accountable for its own activity and decisions. 7.2 Officers from Individual Organisations Members need to ensure that they have all necessary delegated permissions to bind the authority on whose behalf they act when making decisions. They must ensure that they adhere to all internal processes when making those decisions. 7.3 Partnership Board Chair The Chair of the Partnership Board: Provides leadership to the Board steering the development of its strategy and vision, and holding partners to account for the delivery of the subsequent programme of work Ensure that the Partnership board functions efficiently and effectively to provide cohesive system leadership, and steers the development of an accountable care system. Holds members of the Board to account in order to ensure the right partnership working behaviours by organisations within the health and social care system 8

11 Provides a mixture of challenge and support to the STP Lead and hold him/her to account Represents the Northamptonshire health and social care system as figurehead, ambassador and spokesperson. 7.4 Collaborative Stakeholder Forum Chair The Chair of the Collaborative Stakeholder Forum: Provides leadership to the Collaborative Stakeholder Forum steering the development of its vision and relationship with the Partnership Board. Ensure that the Forum functions efficiently and effectively to empower stakeholders and ensure that the voice of the broader stakeholder group is heard at, and informs the Partnership Board Holds members of the Forum to account for demonstrating constructive partnership behaviours in order to further the ownership of the Plan across the county Provides advice and support to the STP Lead in matters relating to communication, engagement, consultation and stakeholder management Represents the Northamptonshire health and social care system as a figurehead, ambassador and spokesperson. 7.5 STP Lead The STP Lead: Supports the Partnership Board to set the vision for the partnership and its subsequent programme of work including its development towards ACS status Acts as champion and leader of the Partnership and the Plan Supports the work of the Partnership Board Is accountable for the success of the programme: development of the programme plan, securing the resources to ensure adequate capacity and 9

12 capability to deliver the programme, delivery of programme plan, achievement of specified outputs and outcomes (benefits) Establishes and provides assurance of the robustness of the governance and management framework for the programme including the mitigation of strategic risk Coordinates communication and engagement and manages key relationships including regulators 7.6 STP Clinical Lead The STP Clinical Lead: Provides visible and effective clinical leadership to the Partnership and its associated programme(s) of work Provides strategic clinical advice to support the health economy in determining short term opportunities to improve effectiveness and efficiency of care, medium term options for service reconfiguration and a long term visions for sustainable health and care. Has oversight of the activities of the Workstream Delivery Boards (or equivalents) to ensure that their activities are aligned to and support the emerging long term vision and that due consideration has bene given to clinical safety, high quality patient outcomes and patient experience. Has overall responsibility for clinical leadership for transformation of health and care services. 7.7 STP Finance Lead The STP Finance Lead: Chairs the Strategic Finance Group Leads the development and delivery of a financial strategy for the health and social care system based on the future introduction of a system control total Ensures that the outputs of the Plan are effectively integrated into the annual business planning and contracting rounds 10

13 Provides advice to the Partnership Board and its committees on the financial sustainability of the local health and social care system and reports upon monitoring and mitigating financial risk across the programme, in conjunction with relevant Directors of Finance. Provides assurance to the Board and its committees of benefits realisation and return on investment (ROI) across programme activities Manages the programme budget. 7.8 STP Programme Director The STP Programme Director: Provides visible and effective senior leadership to the programme and support to the STP Lead, developing systems, structures and processes to ensure the success of the partnership and its associated programme of work Manages these systems, structures and processes together with the associated resources on a day to day basis in order to achieve specified outputs and outcomes (benefits) Provides challenge and support to STP Lead, Chairs of Clinical Advisory Group and Collaborative Stakeholder Forum, CEO Sponsors, SROs and project managers Ensures effective delivery of core support to the partnership through management of the Delivery Support Unit and available programme resources Supports the STP Lead in the management of communications and key relationships. 7.9 Delivery Support Unit The Delivery Support Unit (DSU) has been established to oversee, on behalf of the Strategic Executive, a programme of work to deliver the Plan. The DSU is accountable to the Strategic Executive 11

14 7.9.2 The DSU provides the following functions for the programme Provision of the expert Programme Management Office (PMO) function including provision of advice and challenge, coordination, change control, quality control, risk and issue tracking, stakeholder communication, tracking of benefits realisation and reporting, Management and support to programme governance and infrastructure, including internal assurance and supporting the Strategic Executive to hold the programme team to account for delivery, Management of programme resources including coordination of matrix working across the programme, Administrative and secretariat support to programme team, committees and portfolio boards, Information and knowledge management on behalf of the programme, including the identification of opportunities for shared learning and development, and Sourcing and/or provision of specific technical advice as required by the programme. 8. Organogram This section sets out programme infrastructure, roles and responsibilities. The organogram overleaf provides an overview of governance arrangements. Notes: Governance is a not separate workstream but rather a continuing process of ensuring the smooth functioning of the Partnership and the mechanisms to deliver the Plan The STP s communications and engagement functions are hosted by the DSU 12

15 8.1 Organogram Health and Wellbeing Board Statutory Boards / Governing Bodies Collaborative Stakeholder Forum Advisory Northamptonshire STP / ACS Partnership Board Advisory Strategic Finance Group Strategic Executive Clinical Advisory Group STP Leads & Workstream SROs Delivery Support Unit Commissioning Development IM&T / LDR Urgent and Emergency Care Primary, Community and Social Care Workforce Unified Acute Model Accountable Care System Governance Modelling / Business Intelligence Back Office and Support Services Estates & Assets Mental Health Health and Wellbeing Elective Care Cancer Children, Young People & Maternity SYSTEM DEVELOPMENT SYSTEM ENABLERS NEW CARE MODELS 13

16 8.2 Committees Northamptonshire STP / ACS Partnership Board The role of the Partnership Board is described below: To provide strategic direction and leadership to the successful development of a Sustainability and Transformation Partnership and an Accountable Care System To lead the strategic re-design of health and care services for Northamptonshire such that there is convergence towards an accountable care system. To be collectively responsible for the development and implementation of the Plan ensuring significant organisation and partner commitment including adequate commitment of resources. To hold to account the Strategic Executive, and its associated groups for programme delivery To ensure that the programme has appropriate mechanisms for delivering its duties to consult with and engage stakeholders including patients and the public To ensure that programme delivers to high standards of patient safety, experience and clinical quality To ensure that the programme is able to meet its performance objectives and demonstrates realisation of benefits and return on investment. The Partnership Board is accountable to the statutory boards, governing bodies and specified council committees of statutory partners, and to regulators Collaborative Stakeholder Forum Working with the Partnership Board, the Collaborative Stakeholder Forum has a key role in the Partnership being responsible for ensuring both the involvement and engagement of the broader group of stakeholders, and that their views inform the Partnership Board. The role of the Collaborative Stakeholder Forum is described below: To understand and map the interests of key stakeholders to the Plan To lead the development of a communication and engagement strategy for the Partnership and its associated programmes of work. To utilise individual and collective networks to increase ownership of the Plan To ensure that the voice of the broader stakeholder group is heard at, and informs, the Partnership Board. Advise the Partnership Board and its committees on the objectives and process for stakeholder engagement/ involvement in the work of the Partnership and its associated workstreams and projects Review and critique the engagement /involvement processes employed throughout the programme To act as a sounding board and provide constructive challenge where appropriate To assess political, clinical and public issues from any emergent proposals and advise the Partnership Board and its committees accordingly. Page 14 of 33

17 8.2.3 Clinical Advisory Group The role of the Clinical Advisory Group (CAG) is to ensure that the Partnership and its associated programmes deliver transformational change that is both clinically safe and delivers optimal quality of outcomes and experience for service users. Its role is described below: To contribute to the overall delivery of the STP objectives by ensuring appropriate clinical involvement in care model re-design, reviewing care model design proposals, horizon scanning for innovations, ensuring that there is a robust evidence base behind decisions and making recommendations to the Strategic Executive accordingly To provide clinical advice the Partnership Board, Strategic Executive, Workstream Delivery Boards and project teams as required on all matters of clinical outcomes, patient safety and experience in order that the programme objectives are delivered safely including in the approval of new care models and business cases. To recommend clinical leaders to the relevant portfolio Workstream Delivery Boards such that clinical leadership is embedded throughout the programme. To seek expert advice as required Whilst the final decision regarding prioritisation rests with the Partnership Board, delegated through the Strategic Executive, the CAG will prioritise clinical issues to be considered and will make recommendations to the Strategic Executive. Understand transfers of clinical risk across the system, acting to mitigate these and escalating to the Strategic Executive as appropriate Strategic Finance Group The role of the Strategic Finance Group is to promote the overall financial sustainability of the Northamptonshire health and social care system, monitoring, mitigating and reporting on financial risk across the system. Its role is described below: Developing the financial strategy for the health and social care system assuming the future introduction of a system control total The provision of advice to the Partnership Board and Strategic Executive on the financial sustainability of the local health and social care system. Tracking the financial impact of the programme and overall financial performance of the health and social care system Page 15 of 33

18 Providing financial scrutiny of business cases and use of programme resources to ensure they represent value for money and adequate return on investment, and advising the Partnership Board and its committees accordingly. The provision of technical financial support/advice to portfolio workstreams, in particular the preparation of business cases in support of workstream activity The integration of the outputs of the Plan into the annual business planning and contracting rounds Strategic Executive The role of the Strategic Executive is described below To be responsible for the development and delivery of the Sustainability and Transformation Plan on behalf of the Partnership Board, providing regular reports regarding benefits realisation and improvements in outcomes, and returns on investment. To support the Partnership Board in the development of system approaches to the commissioning and provision of services moving towards an Accountable Care System. To determine areas of development and service reconfiguration for the Northamptonshire health and care system for the lifespan of the Partnership; to lead a process to prioritise these areas making recommendations accordingly to the Partnership Board To coordinate responses to system monitoring and performance management, providing a cohesive response to Regulator(s) for the delivery of system indicators To provide assurance to the Partnership Board that the Partnership has processes in place to enable it to adhere to its duties to consult and engage with stakeholders including patients and the public To provide assurance to the Partnership Board that the Partnership has processes in place to enable it to deliver high standards of patient safety, experience and clinical quality To monitor and mitigate risks to the programme, reporting and escalating system risks as required The Strategic Executive is accountable to the Partnership Board for activities relating to the Partnership and its associated programme(s) of work. 8.3 Plan Delivery Delivery of the Plan has been organised into three portfolios - recognising that there are interdependencies between these in delivering overall system Page 16 of 33

19 transformation, and that portfolios and their workstreams will need to operate in a matrix fashion to achieve maximum benefit to the system. These are System Development System Enablers New Care Models Each portfolio has a number of workstreams sitting within it. It is acknowledged that as the Plan evolves these may change or develop over time. This will be managed through a robust programme change control process The System Development Portfolio currently includes the following workstreams: Commissioning Development Unified Acute Model Accountable Care System Governance The System Enablers Portfolio currently includes the following workstreams: IMT/Local Digital Roadmap Workforce / LWAB Finance and Activity Modelling / Business Intelligence Back Office and Support Services Estates and Assets The New Care Models Portfolio currently includes the following workstreams: Urgent and Emergency Care Mental Health Primary, Community and Social Care Cancer Health and Wellbeing Children, Young People and Maternity Services Elective care NB the Elective Care workstream is managed as a subset of the Unified Acute Model workstream. The team working on elective care will report to the Delivery Board for the unified acute model Each workstream will be led by a Delivery Board. Where appropriate, an existing group such as the A&E Delivery Board will assume this function The function of the Workstream Delivery Board is to Oversee the development and delivery of the projects within the workstream, assigning local resources and ensuring the delivery of the benefits sought and returns on investments made To maintain effective programme management processes for their area including the reporting of progress, performance and benefits, and risk identification, mitigation and escalation as required. Page 17 of 33

20 To deliver the work programme across the matrix of portfolio and workstream groups so that activity is joined up and not replicated. To deliver system changes within their sphere of interest that provide high quality, safe and effective care for service users, and that comply with the duties to communicate, engage and consult with patients and the public Each workstream will report to the Strategic Executive through its Senior Responsible Officer (SRO). The SROs will meet on a monthly basis with the Strategic Executive as part of its regular business cycle Each Workstream Delivery Board will include the following roles: Chief Executive/ Executive Sponsor : Accountable for overall delivery of the workstream, ensures that adequate resources are available for the workstream and chairs the Delivery Board, provides executive representation for the workstream at the Partnership Board and Strategic Executive. SRO: responsible for delivery of the workstream including developing the vision and plan for the area, allocation of resources across the workstream, and providing assurance to the Strategic Executive regarding workstream progress, performance, benefits realisation and risk. Commissioning Lead: To ensure that there is interaction between the workstream and the commissioning of services through the annual cycle Other members will be selected according to the purpose of the group but it is anticipated these will include the appropriate technical, clinical and professional representatives as required. 8.4 Workstreams aligned to the Plan There are a number of aligned workstreams which also support the Plan such as the Better Care Fund Plan. Page 18 of 33

21 9. Decision Making 9.1 Statutory authorities and stakeholders have agreed to apply the arrangements set out in this framework on a voluntary basis. Decision making therefore remains with each organisation until / unless authority is delegated to the Partnership Board. 9.2 However, the 5YFV Next Steps report signals a commitment to integrated place based health and social care systems and population health management. The creation of the Partnership Board should be understood as a precursor to the creation of an Accountable Care System, creating an environment where statutory organisations and stakeholders are encouraged to act in ways consistent with the eventual creation locally of an ACS. 9.3 Decisions required by any group within the Partnership framework should therefore be made in line with the terms of reference of that group, and on the basis of: Ensuring that patient/service user safety, high quality clinical and care outcomes and patient / service user experience remain at the heart of our decision making and where appropriate service users and the public are involved in decision making, Ensuring that statutory organisations meet their obligations through the Partnership and the Plan Adherence to the Nolan principles of selflessness, integrity, objectivity, accountability, openness, honesty and leadership by example, The effective stewardship of public funds, Adherence to the highest standards of business conduct, and The principle that decisions are made as close to the people affected as possible, and that the Board and its committees and workstreams are empowered to make decisions where, on the balance of risk, it is safe and appropriate for them to do so. 9.4 As appropriate, individuals representing statutory and other organisations must ensure that they have all necessary delegated permissions to bind the organisation on whose behalf they act when making decisions within the Partnership Board, its committees and workstreams. 9.5 Escalation will apply in the event that any group within the framework is unable to reach consensus. Any decision not commanding consensus at the portfolio level will be referred to Strategic Executive. Any decision not commanding consensus at Strategic Executive will be referred to the Partnership Board. Any decision not commanding consensus at the Partnership Board will be referred to the Boards of statutory organisations and/or the regulator as appropriate. 9.6 Accountability for performance (financial/ constitutional standards/ Next Steps deliverables/ quality) remains with statutory organisations. It follows from this that any and all decisions relating directly or indirectly to Page 19 of 33

22 performance are reserved to the Boards of those organisations. 9.7 Urgent Decisions Due to the nature of the business cycle of individual organisations, there may be a requirement for Urgent Decisions to be taken. In these circumstances, leadership for the decision making process will fall to the Chair of the Partnership Board. Urgent Decisions should be taken by the Chair of the Partnership Board, the STP Lead and the Clinical Lead in consultation with the Chair, Chief Executive and Director of Finance (or their equivalent roles) in each partner organisation, and the Chair of the Health and Wellbeing Board. Urgent decisions should be recorded appropriately and reported to the partner organisations for formal ratificatio at the next available meeting Urgent Decisions required to be taken by the Council as a result of any decision exercised by the Partnership Board are subject to the individual council s constitutional arrangements. 9.8 Dispute and Conflict Resolution Any issues that cannot be resolved locally will be referred to through the escalation process to the Partnership Board If the partnership Board is not able to resolve an issue, then depending on the nature of the dispute or conflict it will be referred either to statutory boards, governing bodies or committees, or to the appropriate regulator(s). 10. Managing Risk 10.1 The STP Programme has prepared a Strategic Risk Register for review on a monthly basis at the Strategic Executive Group, at the Partnership Group All committees and working groups of the STP Programme will be expected to maintain operational risk registers for their specific areas of interest, developing mitigations and solutions as close to the risk as possible. Significant risks (scores over 16) will be escalated to the Strategic Executive for supported mitigation and/or information as required. 11. Information Sharing 11.1 An Information Sharing Concordat agreement will be drafted and included in the Governance Framework. Page 20 of 33

23 12. Cycle of Business 12.1 The Partnership will develop a cycle of business which will align with the individual organisation s business cycles / decision-making processes. Consideration to a monthly cycle of formal business for statutory boards and governing bodies will is given as part of the process. It is proposed that this will pertain to the committee structure The Strategic Executive currently meets on a monthly basis having functions pertaining to Partnership and Plan, system relationships and peer development/ support. It is suggested that Partnership and Plan management is factored into the monthly business cycle of this group as separate sessions pertaining to Performance and Development. 13 Reporting Arrangements 13.1 The Delivery Support Unit will prepare reports relating to Plan delivery and system performance. Page 21 of 33

24 Appendix 1 Terms of Reference Partnership Board DRAFTING NOTE: IT IS RECOMMEDED THAT THESE ToRs ARE REVIEWED IN APRIL 2018 Northamptonshire STP/ACS Partnership Board Terms of Reference (ToRs) Draft version th November 2017 Page 22 of 33

25 1. Purpose This document details the Terms of Reference (ToR) for the STP/ACS Partnership Board that will provide leadership for the development of the local Sustainability & Transformation Partnership and for delivery of the Sustainability & Transformation Plan for Northamptonshire. The Partnership Board will have oversight of the overall programme of work, ensure its delivery and make recommendations to the participating governing bodies regarding future health economy sustainability. Where agreement cannot be reached the Chair will facilitate discussion across Partnership Board members to reach resolution. 2. Role of the Board The role of the Partnership Board is to: Provide strategic direction and leadership to the development of a Sustainability and Transformation Partnership, moving towards an Accountable Care System Lead the strategic re-design of health and care services for Northamptonshire To be collectively responsible for the development of the Partnership and implementation of the Plan ensuring significant organisation and partner commitment including adequate commitment of resources. Hold to account the Strategic Executive, and its associated groups for programme delivery Ensure that the programme has appropriate mechanisms for delivering its duties to consult with and engage stakeholders including patients and the public Ensure that programme delivers to high standards of patient safety, experience and clinical quality Ensure that the programme is able to meet its performance objectives and demonstrates realisation of benefits and return on investment. The Partnership Board is accountable to the statutory boards, governing bodies and specified council committees of statutory partners, and to regulators 3. Responsibilities The responsibilities of the Partnership Board are to: Agree a Northamptonshire-wide approach to delivering healthcare services to quality standards that are financially sustainably Agree, review and revise the Plan s direction and scope, including o Agreeing the scope, plans, deliverables and benefits for individual portfolios and oversee implementation of the activities involved o Prioritising activities across the portfolios and workstreams Page 23 of 33

26 o o Identifying and enabling provision of resources for the workstreams, based on a clear definition of the type of person required, the providing organisation and the duration of the work Holding the CEO sponsor for each workstream to account for the delivery of the workstream in accordance with the terms of reference Broker any competing priorities, providing advice and support on the strategic management and direction of the Plan Remove barriers within participating organisations that are stopping the Plan from realising agreed and prioritised results and benefits Provide leadership for the Plan and act as advocates at a local or national level as necessary, including with bodies such as NHS England and NHSI and provide a senior management link between partners in the sector Oversee and ensure compliance with any regulatory frameworks that need to be observed Advise on managing stakeholder engagement as required (including public consultation where required) to support the programme Monitor progress of workstreams against agreed high level milestones, and agree any additional activities that might be required to support workstreams in delivery Monitor the benefits emerging from workstreams across the participating organisations, and ensure equitable use of benefits Monitor high level risks and issues, to ensure regular review of risks and issues that could impact on the Partnership and Plan. Each member of the Partnership Board has responsibility for representing the Partnership and Plan at their individual organisations Boards or equivalent governance structures. 4. Membership of the Board 4.1. Core Membership The STP Board shall comprise the following voting members: DRAFTING NOTE: FURTHER DISCUSSION IS REQUIRED ON THE APPOINTMENT OF A CHAIR OF THE BOARD REPRESENTATION FROM EMAS AND NHS ENGLAND Page 24 of 33

27 Position CHAIR Partnership Board STP Lead Chair, Northampton General Hospital NHS Trust Chief Executive, Northampton General Hospital NHS Trust Chair, Kettering General Hospital NHS Foundation Trust Chief Executive, Kettering General Hospital (KGH) NHS Foundation Trust Clinical Chair, Nene CCG Chief Executive, Nene CCG Clinical Chair, Corby CCG Chief Executive, Corby CCG Chair, Northamptonshire Healthcare Foundation Trust Chief Executive, Northamptonshire Healthcare Foundation Trust Director of Public Health and Wellbeing for Northamptonshire County Council Chief Executive, Northamptonshire County Council Chair, Health & Wellbeing Board LMC representative Primary care representative Chair, Collaborative Stakeholder Forum STP Clinical Lead Finance Lead Programme Director Member (as of formation) Angela Hillery Paul Farenden Sonia Swart Alan Burns Fiona Wise Darin Seiger John Wardell Joanne watt Carole Dehghani Crishni Waring Angela Hillery (also STP Lead) Lucy Wightman Damon Lawrenson Sylvia Hughes Jonathan Ireland TBC Tansi Harper TBC Richard Wheeler Mike Coupe 4.2. Additional Attendees Additional attendees will be invited if required to support specific agenda items. It is expected that where a workstream is sponsored by an Executive rather than a CEO, this Executive Sponsor will attend the Board as a matter of routine. The Partnership Board may request the attendance of further non-standing members as appropriate. 5. Decision-Making A quorum will be considered to exist if 60% or more of the formal membership are present. The Chair is a non-voting position. No business shall be transacted unless the Chair is present. The Partnership Board is responsible for making recommendations to the governing bodies of the participating organisations who have decision making authority for the partners in the STP. Page 25 of 33

28 6. Frequency of Meetings It is an expectation that the Partnership Board will meet monthly. 7. Confidentiality and conflicts of Interest All Board members have a duty of confidentiality regarding all information disclosed by NGH, KGH, Nene CCG, Corby CCG, NHFT, and Northamptonshire County Council. There will be occasions when selected information must not be disclosed outside the Board. The person disclosing such information to the Board is responsible for identifying it as confidential at the time it is given, and for ensuring that its confidential status is identified in all relevant written material. Any challenge to the confidentiality of information given to the Board will be referred to the Chair, whose decision on the matter will be final. A conflict of interest is where an individual has a direct or indirect pecuniary or non-pecuniary interest in a matter that is being discussed. These can be defined as follows: A direct pecuniary interest is when an individual may financially benefit from a decision (for example moving services to them from an alternative provider) An indirect pecuniary interest is when an individually may financially benefit from a decision though normally via a third party (for example where an individual is a Commissioner, member or shareholder in an organisation that will benefit financially from the consequences of a reconfiguration decision) A direct non-pecuniary interest is where an individual holds a non-remunerative or not-for profit interest in an organisation (for example, where an individual is a trustee of a voluntary provider that is bidding for a contract) An indirect non-pecuniary interest is when individual may enjoy a qualitative benefit from the consequence of a decision which cannot be given a monetary value (for example, a reconfiguration of hospital services which might result in the closure of a busy clinic next door to an individual s house) In addition, where an individual is closely related to, or in a relationship, including friendship, with an individual in the above categories, this will constitute a conflict of interest. The Partnership Board members must at all times follow the Conflicts of Interest Policy that applies to their appointing organisation. This includes the maintenance of a register of interests for all members. Interests must be declared at the beginning of every meeting. Where an interest is declared, that member (voting or in attendance) is then disqualified from taking any further part, or in any way influencing via proxy or otherwise, discussion and voting on that matter, subject to that matter not falling within the Secretary of State s waiver. Page 26 of 33

29 Appendix 2 Terms of Reference Collaborative Stakeholder Forum To be inserted once approved Page 27 of 33

30 Appendix 3 Memorandum of Understanding between Statutory Partners DRAFTING NOTE: THIS MOU WAS DEVELPED IN SUPPORT OF THE WORK OF THE STP PROGRAMME BOARD AND HAS BEEN SUPERCEDED BY THE STP RESET. IT WILL BE REVIEWED AND UPDATED OVER THE COMING WEEKS FOR REVIEW AND APPROVAL BY THE BOARD Northamptonshire s Sustainability and Transformation Plan (STP) Memorandum of Understanding 1.0 Introduction This Memorandum of Understanding sets out the Northamptonshire s Sustainability and Transformation Plan (STP) Programme criteria for working between NHS Nene CCG, NHS Corby CCG, Northampton General Hospital NHS Trust, Kettering General Hospital NHS Foundation Trust, Northamptonshire Healthcare Foundation NHS Trust, Northamptonshire County Council, General/Practice Alliance Ltd, Voluntary Impact Northamptonshire, Principal Medical Ltd, Lakeside Healthcare Group, 3Sixty, EMAS and NHS England, Specialist Commissioning. 2.0 Principles All partner organisations will collaborate with the sole purpose of delivering the Five Year Forward View and in particular the triple aim of improving patient experience of care, improving health and reducing cost taking due account of differential risks to partner organisations and parts of the system All decisions made will consider both the effect on individual organisations and the impact on the whole system All parties will adopt the following principles. To: Collaborate and co-operate to maintain a single system view for Northamptonshire Deliver the requirements laid out within the NHSE 5 Year Forward View Develop an agreed set of values, behaviours and principles for working collectively together in the best interests of the care system and service users. identify the internal talent (individuals) with the skills, competences and capabilities to drive forward change (Provider and Commissioner) Demonstrate willingness for large scale change that will be supported if the quantified outcomes are right for the system Constructively challenge and engage in a joint decision making process via the STP Board Page 28 of 33

31 Communicate openly and transparently Broaden the participation across the system, including involvement of GP Federations/Super Practice 3.0 Business Process The specific agreements of the MOU are as follows: Implement a distributed leadership model across CEO, Directors, Managers, Clinicians and Lay Members Ensure all organisations within the system play their part in delivery and achievement of financial system controls as set by NHSE and NHSI Put in place a financial controller function for the system (lead CFO) No one organisation can unilaterally make a material decision that would have a negative impact on the system delivery plan Embed the triple aim approach into the whole system delivery Have a single line of communications agreed which is underpinned by a system wide communication plan Programme budgets agreed through the STP Board will be managed by the relevant SRO 4.0 Business Governance The central governance body in the direction, decision making and assurance layer is the STP Programme Board; This board has overall responsibility and accountability for the delivery of the Northamptonshire STP, directly overseeing the delivery of the Northamptonshire-wide programmes and enablers STP Board will sign off on the alignment of individual Operational Plans which will constitute detailed year on year implementation delivery plan; of the STP agreed by all parties STP Board will receive system-wide reports in order to assess performance and progress Significant system and organisational development decisions will go through the STP Board and the impact to each organisation will be adjudged STP Board meets monthly and is attended by CEOs Each individual member is responsible for reporting back to their individual organisations. Page 29 of 33

32 The Health and Wellbeing Board will have a key role in providing cross-sector and Northamptonshire-wide challenge and scrutiny of STP implementation and impact The statutory bodies (CCGs, Providers and Local Authorities) will work towards delegating accountability for STP related business to the Northamptonshire STP Board; SRO group are responsible for delivering and implementing the programmes of work Lay Scrutiny group will ensure multi-organisational scrutiny to the STP delivery group and STP Board. They will ensure that the STP plans meet the national criteria that includes full public and patient consultation, all participant Boards are fully engaged in the STP process and that STP plans are developed and agreed to the national timescale; The Clinical reference group will test and challenge the clinical robustness of the developing plans and ensure integration and system wide working is fully assessed; To share clinical standards to operate across the health and care system; To share metrics across providers to track performance and improvement; To share clinical governance arrangements for providers; To review clinical governance and risk for new staff groups and increased voluntary sector involvement. Page 30 of 33