Title of Meeting: Governing Body Agenda Item: 7.4

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1 Title of Meeting: Governing Body Agenda Item: 7.4 Date of Meeting: 6 April 2017 Paper Title: HaRD CCG Draft Governing Body Assurance Framework Refresh Responsible Governing Body Member Lead Joanne Crewe, Executive Nurse / Director of Quality and Governance Session (Tick) Public Private Workshop Report Author and Job Title Sasha Sencier Corporate Governance Manager This Paper is for: To Approve To Accept To Assure To Note X X Has the report (or variation of it) been presented to another Committee / Meeting? If yes, state the Committee / Meeting: Yes. The draft GBAF has been reviewed and developed at the Senior Management Team Meeting and has been received by Audit Committee for assurance. Executive Summary Following a review of best practice at the request of the Chief Officer, an intensive review of the entire risk management system is being undertaken by the Corporate Governance Manager. The Governing Body Assurance Framework (GBAF) has been updated subsequent to a Governing Body Workshop held on 2 February The Corporate Governance Manager has met regularly with Directors and other members of SMT to review individual risks and update the GBAF accordingly. The proposed draft GBAF is being presented to the Governing Body in order to seek views and comments on the new approach to the management of risks that are aligned to the CCGs strategic objectives. The Governing Body will recognise that the GBAF is currently in its development phase and is being brought to the Governing Body in order to note progress made. Additional high level risks may be escalated to the GBAF by Committees where appropriate. The GBAF and updated Risk Management Strategy, which complete the review of the risk management system, will be brought to the Governing Body meeting in June 2017 for approval. Recommendations The Governing Body is asked to: Consider, comment and accept the proposed new approach to the GBAF. Monitoring The CCG is required to have a Board Assurance Framework which needs to be regularly reviewed by the Governing Body. 1

2 CCGs Strategic s supported by this paper CCG Strategic 1 Quality, Safety and Continuous Improvement X 2 Better Value Healthcare X 3 Well Governed and Adaptable Organisation X 4 Health and Wellbeing X 5 Active and Meaningful Engagement X X CCG Values underpinned in this paper CCG Values 1 Respect and Dignity X 2 Commitment to Quality of Care X 3 Compassion X 4 Improving Lives X 5 Working Together for Patients X 6 Everyone Counts X X Does this paper provide evidence of assurance against the Governing Body Assurance Framework? YES NO X If yes, please indicate which principle risk and outline Principle Risk No Principle Risk Outline Any statutory / regulatory / legal / NHS Constitution implications Management of Conflicts of Interest Communication / Public and Patient Engagement Financial / resource implications The CCG is required to have a Governing Body Assurance Framework. No conflicts of interest have been identified prior to the meeting. Not applicable. Not applicable. Outcome of Equality Impact Assessment Not applicable. Sasha Sencier Corporate Governance Manager

3 NHS Harrogate and Rural District Clinical Commissioning Group GOVERNING BODY ASSURANCE FRAMEWORK The Governing Body Assurance Framework (GBAF) for NHS Harrogate and Rural District CCG aims to identify the main risks to the delivery of the CCGs strategic objectives and its statutory obligations, as defined by the CCG Assurance Domains. The GBAF sets out the controls that have been put in place to manage the risks and the assurances that have been received that show if the controls are having the desired impact. It includes an action plan to further reduce the risks. Risks scored 12 and above that are aligned to the CCGs strategic objectives are included in the GBAF. All other risks scored 12 and above are included in the CCGs Corporate Risk Register. The GBAF is the key source of evidence that links strategic risks, controls and assurances and the main tool that the Governing Body should use in discharging its overall responsibility for internal control. For the Risk Matrix, see Appendix A. Strategic s The GBAF has been linked to the strategic objectives of the CCG (last revised February 2017) and the NHS England CCG Improvement and Assessment Framework assurance domains (last revised March 2016). NHS England has a statutory duty to conduct an annual performance assessment of every CCG. CCGs will be assessed in relation to four domains representing four key areas of their functions and responsibilities. These four domains are: 1 Better Health How the CCG is contributing towards improving the health and wellbeing of its population and bending the demand curve 2 Better Care Care redesign, NHS constitutional standards, NHS outcomes 3 Sustainability Financial balance and securing good value for patients 4 Leadership Quality of CCG leadership, quality of plans, work with partners, CCG governance arrangements. Harrogate and Rural District CCG Strategic s: 1 Quality, Safety and Continuous Improvement To ensure that the care we commission is of high quality/safe and sustainable, improves health outcomes and wellbeing and provides a good patient experience. 2 Better Value Healthcare To meet the economic challenges and changes in the NHS by commissioning efficient and cost effective services and better value healthcare. 3 Well Governed and Adaptable Organisation To be a well governed organisation with high standards of assurance, responsive to members and stakeholders in transforming services using innovative approaches to meet the future healthcare needs of our population. 4 Health and Wellbeing To shift the emphasis towards optimising opportunities for maintaining health and wellbeing, promoting patient responsibility to choose well, accessing the right services at the right time and in the most appropriate place, and empowering patients to be better able to self-manage their own long term conditions. 5 Active and Meaningful Engagement To work in close partnership with local people as well as all organisations that commission or provide care for our population to embed meaningful engagement into the CCGs decision making processes. 1 G overning Body Assurance Framework Version 0.7 DRAFT

4 Heat Map of Current Escalated Risks to GBAF RARE UNLIKELY POSSIBLE LIKELY ALMOST CERTAIN 5 CATASTROPHIC CONSEQUENCE MAJOR 3 MODERATE 2 MINOR 1 NEGLIGIBLE LIKELIHOOD 2 G overning Body Assurance Framework Version 0.7 DRAFT

5 Strategic 1: Quality, Safety and Continuous Improvement Strategic 2: Better Value Healthcare Strategic 2: Better Value Healthcare NO RISKS CURRENTLY ALIGNED TO THIS STRATEGIC OBJECTIVE 1: The scale of QIPP required to support delivery of the Financial Recovery Plan has increased and this could impact on capacity and opportunity to develop and implement achievable service change. Director of Transformation & Delivery Programme management function new and not fully embedded. Reliance on partners to implement service redesign. Capacity to deliver on full range of QIPP opportunities. Availability of validated data to accurately assess impact of schemes 2: Partnership Commissioning Unit (PCU) realignment could impact on quality or the ability to demonstrate effective use of resources and value for money in some of the services previously commissioned on behalf of the CCG by the PCU e.g. Continuing Healthcare, Mental Health services, Children and Young People services. Director of Quality and Governance / Executive Nurse Limited assurance given on Internal Audit reports. Delays in timely assessment of new patients and existing patient reviews SOPs or Commissioning policies require development or implementation Visibility on spend and progress on QIPP due to current capacity in CCG and PCU. Strategic 2: Better Value Healthcare 3: The CCG financial plan for 2017/18 will not be delivered resulting in deterioration in the in-year financial position and longer term financial sustainability. Chief Finance Officer 3 G overning Body Assurance Framework Version 0.7 DRAFT The Finance, Performance and Commissioning Committee (FPCC) provides assurance to the Governing Body on the CCG s financial position and performance against existing contracts, agreeing service performance actions and timescales to mitigate and recover performance as required. The Contract Management Board with Harrogate District Foundation Trust addresses all contractual concerns and in 2017/18

6 oversees the implementation of the Service Development Improvement Plan through the Joint Delivery Group with HDFT that has responsibility for delivering 6M of the CCG s savings plan. Transformation & Delivery (T&D) Programme Board established to lead all change projects including QIPP, reporting to FPCC Programme management expertise in place and new PMO being established to support change projects. Strategic 3: Well Governed and Adaptable Organisation NO RISKS CURRENTLY ALIGNED TO THIS STRATEGIC OBJECTIVE Strategic 4: Health and Wellbeing 1: The expectation of the public, patients or other stakeholders could impact on the CCGs strategy to improve health and wellbeing, promote and implement coproduction and develop the shift in culture that would support more effective self-care and selfmanagement. Director of Quality and Governance / Executive Nurse Engagement activity is not evaluated or impact monitored regularly Website statistics show public are not engaging with key CCG messages Increasing number of complaints or concerns being reported in response to implementation of health optimisation policy Business case process does not always include evidence of public and patient engagement Business case process does not include evaluation of patient experience evidence Implementation of Communications and Engagement Strategy is not monitored through Quality and Clinical Governance committee Stakeholder engagement is not routinely included in business planning process 4 G overning Body Assurance Framework Version 0.7 DRAFT

7 Strategic 5: Active and Meaningful Engagement 1: Relationships and the expectations of a range of stakeholders and partners or NHS regulators will impact on the CCGs ability to work effectively or engage to maintain a sustainable health economy for local people. Director of Quality and Governance / Executive Nurse HaRD CCG / HDFT Board to Board meetings need to be scheduled regularly Development of a relationship management strategy Patient experience data is not regularly provided for all commissioned services Acute contract remains unsigned due to outstanding agreement on contract value Failure to maintain successful engagement and achieve system wide approaches negatively impact on delivery of CCG operational plan 5 G overning Body Assurance Framework Version 0.7 DRAFT

8 GBAF REF: 2-1 Strategic 2: Better Value Healthcare To meet the economic challenges and changes in the NHS by commissioning efficient and cost effective services and better value healthcare. Executive Risk owner Director of Transformation & Delivery Principle Risk 1: The scale of QIPP required to support delivery of the Financial Recovery Plan has increased and this could impact on capacity and opportunity to develop and implement achievable service change. Positive Assurance and Existing Controls in Place Transformation & Delivery (T&D) Programme Board established to take oversight of all change projects including QIPP, reporting to FPCC Joint Delivery Group with HDFT established reporting to Contract Management Board Joint Service Development Improvement Plan (SDIP) agreed with HDFT with agreement to jointly deliver savings from 14 projects. Business case process agreed to robustly assess project viability before committing to implementation. NECS (North East Commissioning Support) undertaking a review of the QIPP programme to identify additional support that could be made available to the CCG to help with delivery of savings (however, at time of writing confirmation of the availability of this support has not been confirmed). RightCare have identified areas of variation that could provide further substantial opportunities. The two largest opportunities are being developed as part of the SDIP Programme. Programme management expertise in place and new PMO being established to support change projects. New Commissioning Managers have been recruited to fill vacant posts, bringing team to establishment. Former PCU staff to join CCG in April which will help identify further savings in related areas (e.g. CHC). Temporary Procurement expert in place to initiate the review of the Out-of-Hours service and other Community-based services. Gaps in Control and Assurance (where are we failing to put controls in place / failing to gain evidence that out controls are effective) Programme management function new and not fully embedded. Reliance on partners to implement service redesign. Capacity to deliver on full range of QIPP opportunities. Availability of validated data to accurately assess impact of schemes Last Reviewed: Next Review Due: NHSE Assurance Domain: 3 - Sustainability Risk Rating Initial Risk Current Risk Risk Target Mitigating Action Plan (plans to address gaps in control) Action Target Date Action Progress to Date Action Lead 1. Continue to embed PMO function and processes and work with NECS to identify available additonal support.. 30/4/17 Business Change Manager 2. Monitor progress on joint programme delivery through the SDIP Board. Ongoing Business Change Manager 3. Further significant savings opportunities to be discussed at T&D Programme Board. 4. Investigate options with BI team for identifying validated data to include in business cases and for use in monitoring impacts. Ongoing Director of Transformation and Delivery 31/5/17 Business Change Manager 6 G overning Body Assurance Framework Version 0.7 DRAFT

9 GBAF REF: 2-2 Strategic 2: Better Value Healthcare To meet the economic challenges and changes in the NHS by commissioning efficient and cost effective services and better value healthcare. Executive Risk Owner: Director of Quality and Governance / Executive Nurse Principle Risk 2: Partnership Commissioning Unit (PCU) realignment could impact on quality or the ability to demonstrate effective use of resources and value for money in some of the services previously commissioned on behalf of the CCG by the PCU e.g. Continuing Healthcare, Mental Health services, Children and Young People services. Positive Assurance and Existing Controls in Place Annual Internal Audit programme includes PCU audits Audit Committee review audit recommendations on a monthly basis Monthly discussion of financial position of CHC and Vulnerable people commissioning at FPCC Discussion at PCU Management Board. Exceptions and high cost weekly panel attended by CCG Identified Clinical Leadership and involvement in Vulnerable adult commissioning Contract management Board Achievement of Improvement and Assessment Framework indicators Gaps in Control and Assurance (where are we failing to put controls in place / failing to gain evidence that out controls are effective) Limited assurance given on Internal Audit reports. Delays in timely assessment of new patients and existing patient reviews No SOPs or Commissioning policies in place Visibility on spend and progress on QIPP due to current capacity in CCG and PCU. Last Reviewed: Next Review Due: NHSE Assurance Domain: 3 - Sustainability Risk Rating Initial Risk Current Risk Risk Target Mitigating Action Plan (plans to address gaps in control) Action Target Date Action Progress to Date Action Lead 1. CCG monitoring of Audit report compliance with schedule of findings and recommendations. 2. Review of CHC framework and alignment with CCG commissioning policies 3. Review current fast track pathway of provision and recommission more effective and responsive pathway 4. Implement a regular finance review to Ensure all CHC and FNC, Fast Track spend is monitored and reviewed in line with SOPs 5. Development and effective monitoring of QIPP plan and report monthly to Transformation Delivery Group Monthly report to Audit committee September 2017 September 2017 July2017 July2017 Head of CHC and Vulnerable People Commissioning Quality and Safety Manager Quality and Safety Manager Quality and Safety Manager Mental Health & Learning Disabilities Commissioning Mgr / Head of CHC and Vulnerable People Commissioning Mgr 6. Realignment of commissioning functions with CCGs September 2017 Head of CHC and Vulnerable People Commissioning 7 G overning Body Assurance Framework Version 0.7 DRAFT

10 GBAF REF: 2-3 Strategic 2: Better Value Healthcare To meet the economic challenges and changes in the NHS by commissioning efficient and cost effective services and better value healthcare. Executive Risk Owner: Chief Finance Officer Principle Risk 3: The CCG financial plan for 2017/18 will not be delivered resulting in deterioration in the in-year financial position and longer term financial sustainability. Positive Assurance and Existing Controls in Place The Finance, Performance and Commissioning Committee (FPCC) provides assurance to the Governing Body on the CCG s financial position and performance against existing contracts, agreeing service performance actions and timescales to mitigate and recover performance as required. The Contract Management Board with Harrogate District Foundation Trust addresses all contractual concerns and in 2017/18 oversees the implementation of the Service Development Improvement Plan through the Joint Delivery Group with HDFT that has responsibility for delivering 6M of the CCG s savings plan. Transformation & Delivery (T&D) Programme Board established to lead all change projects including QIPP, reporting to FPCC Programme management expertise in place and new PMO being established to support change projects. Operational Scheme of Delegation Gaps in Control and Assurance (where are we failing to put controls in place / failing to gain evidence that out controls are effective) CCG Savings/QIPP programme has identified risks to delivery which will impact on financial position. Potential that actual demand growth in acute services, prescribing and continuing healthcare exceed planned levels Last Reviewed: Next Review Due: NHSE Assurance Domain: 3 - Sustainability Risk Rating Initial Risk Current Risk Risk Target Mitigating Action Plan (plans to address gaps in control) Action Target Date Action Progress to Date Action Lead 1. Transformation & Delivery Programme Board leads the delivery of all change projects including QIPP and provides assurance on delivery to FPCC. 2. Renewed focus on contract management to ensure that demand risks and non-delivery of savings schemes are identified and highlighted to FPCC in order to identify mitigating actions. 3. FPCC ensures Transformation & Delivery Programme Board have sufficient action plans to mitigate risks of non-delivery. Ongoing Ongoing Ongoing Director of Transformation and Delivery Contract Management Board/CFO FPCC/CO 8 G overning Body Assurance Framework Version 0.7 DRAFT

11 GBAF REF: 4-1 Strategic 4: Health and Wellbeing To shift the emphasis towards optimising opportunities for maintaining health and wellbeing, promoting patient responsibility to choose well, accessing the right services at the right time and in the most appropriate place, and empowering patients to be better able to self-manage their own long term conditions. Executive Risk Owner: Director of Quality and Governance / Executive Nurse Principle Risk 1: The expectation of the public, patients or other stakeholders could impact on the CCGs strategy to improve health and wellbeing, promote and implement co-production and develop the shift in culture that would support more effective self-care and self-management. Positive Assurance and Existing Controls in Place Public relations report presented to Quality and Clinical Governance Committee on a quarterly basis Monthly scrutiny of performance dashboard at Governing Body Monthly reports from sub committees received by Governing Body Joint Health and Wellbeing strategy in place and refreshed Business case process includes integrated impact assessment Business case planning process includes need for service developments and redesign to go through FPCC and QCGC committees. Last Reviewed: Next Review Due: NHSE Assurance Domain: 1 Better Health Risk Rating Initial Risk Current Risk Risk Target Gaps in Control and Assurance (where are we failing to put controls in place / failing to gain evidence that out controls are effective) Engagement activity is not evaluated or impact monitored regualrly Website statistics show public are not engaging with key CCG messages Increasing number of complaints or concerns being reported in response to implementation of health optimisation policy Business case process does not always include evidence of public and patient engagement Business case process does not include evaluation of patient experience evidence Implementation of Communications and Engagement Strategy js not monitored through Quality and Clinical Governance committee Stakeholder engagement is not routinely implemented as part of business planning cycle Mitigating Action Plan (plans to address gaps in control) Action Target Date Action Progress to Date Action Lead 1. Establish Progremme management office for monitoring impmentation and evaluation of projects to optimise health and wellbeing and support self care interventions 2. Public and patient engagement process to be included as integral part of business planning process 3. Implementation of Communication and Engagement strategy action plan to be monitored quarterly at QCGC 4. Establish a robust PALs and complaints function that is responsive and appropriately resources to enable lessons learned from patient feedback and experience June 2017 June 2017 June 2017 July 2017 Business Change Manager Business Change Manager Communications Manager Deputy Executive Nurse 9 G overning Body Assurance Framework Version 0.7 DRAFT

12 GBAF REF: 5-1 Strategic 5: Active and Meaningful Engagement To work in close partnership with local people as well as all organisations that commission or provide care for our population to embed meaningful engagement into the CCGs decision making processes. Executive Risk Owner: Director of Quality and Governance / Executive Nurse Principle Risk 1: Relationships and the expectations of a range of stakeholders and partners or NHS regulators will impact on the CCGs ability to work effectively or engage to maintain a sustainable health economy for local people. Last Reviewed: Next Review Due: NHSE Assurance Domain: 4 - Leadership Positive Assurance and Existing Controls in Place Monthly Harrogate Health Transformation Board Harrogate and District Clinical Board HaRD CCG / HDFT Board to Board Health and wellbeing strategy agreed by all health and social care partners Primary Care Commissioning Committee in place Primary care is represented through Yorkshire Health Network and Council of members at CCG governance structures and clinical lead roles Performance issues are reported and monitored at FPCC Locality cluster structure in place to maintain relationships and support effective communication with PC. Gaps in Control and Assurance (where are we failing to put controls in place / failing to gain evidence that out controls are effective) HaRD CCG / HDFT Board to Board meetings need to be scheduled regularly Development of a relationship management strategy Patient experience data is not regularly provided for all commissioned services Acute contract remains unsigned due to outstanding agreement on contract value Failure to maintain successful engagement and achieve system wide approaches negatively will impact on delivery of CCG operational plan Risk Rating Initial Risk Current Risk Risk Target Mitigating Action Plan (plans to address gaps in control) Action Action Progress to Date Action Lead Target Date 1. Regular review of implmentation of comms & eng strategy at QCGC June 2017 Communications Manager 2. Implementation of patient advocate group to support effective eng and comms June 2017 Communications Manager 3. Develop a timetable for regular contact with key stakeholders for all projects or June 2017 Business Change Manager pathway redesign stakeholder engagement plan e.g. public, patients, politicians, GPs, providers 4. Involve stakeholders in pathway redesign and projects. June 2017 Business Change Manager 5. Monitor the implementation of risk management strategy and policy through QCGC Sept 2017 Deputy Executive Nurse 6. To establish quarterly Board to Board meetings with HDFT March 2017 Executive Assistant 7, To develop and implement a strategy for relationship management Sep 2017 Communications Manager 10 Governing Body Assurance Framework Version 0.7 DRAFT

13 Risk Matrix Appendix A Likelihood Broad Description of Frequency Time Frame Descriptors of Frequency 1 Rare This will probably never happen / recur Not expect to occur for years 2 Unlikely Do not expect it to happen/ recur but it is possible it may do so. Expected to occur at least annually. 3 Possible Might happen / recur occasionally. Expected to occur at least monthly. 4 Likely Will probably happen / recur but it is not a persistent issue Expected to occur at least weekly. 5 Almost Certain Will undoubtedly happen / recur, possibly frequently. Expected to occur at least daily Consequence Domain Quality Statutory Duty / Inspection Business s / Projects 1 Negligible Peripheral element of No or minimal impact or breech of guidance / statutory duty Insignificant cost increase / schedule slippage. treatment suboptimal 2 Minor Overall treatment or service suboptimal Breech of statutory legislation. Reduced performance rating. <5 per cent over project budget. Schedule slippage. 3 Moderate Treatment or service has significant reduced effectiveness. Single breech of statutory legislation. Challenging eternal recommendations / improvement notice percent over project budget. Schedule slippage. 4 Serious Non-compliance with national standards with significant impact to patients if unresolved. 5 Catastrophic Totally unacceptable level or quality of treatment / service. Enforcement action. Improvement notices. Multiple breeches in statutory duty. Non-compliance with national percent over project budget. Schedule slippage. Incident leading >25 percent over project budget. 11 Governing Body Assurance Framework Version 0.7 DRAFT