GREATER MANCHESTER HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD EXECUTIVE. Establishing Leadership and Accountability in Shadow Form

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1 5a GREATER MANCHESTER HEALTH AND SOCIAL CARE STRATEGIC PARTNERSHIP BOARD EXECUTIVE Date: 13 th November 2015 Subject: Report of: Establishing Leadership and Accountability in Shadow Form Liz Treacy PURPOSE OF REPORT: The purpose of this report is to update Strategic Partnership Board Executive on progress made towards establishing the governance and accountability framework that will be required to support a devolved health and social care economy in Greater Manchester. RECOMMENDATIONS: The Strategic Partnership Board Executive are asked to: Note the contents of this paper. To agree and provide the necessary support to the delivering the next steps. To note the draft terms of reference for Strategic Partnership Board, recognising that these will be updated when a scheme of delegation has been agreed. To note and agree the process for developing the assurance mechanism for Greater Manchester. CONTACT OFFICERS: Liz Treacy l.treacy@manchester.gov.uk 1

2 1. INTRODUCTION 1.1 The purpose of this report is to update the Strategic Partnership Board Executive are asked to: Note the contents of this paper. To agree and provide the necessary support to the delivering the next steps. To note the draft terms of reference for Strategic Partnership Board, recognising that these will be updated when a scheme of delegation has been agreed. To note and agree the process for developing the assurance mechanism for Greater Manchester. on progress made towards establishing the governance and accountability framework that will be required to support a devolved health and social care economy in Greater Manchester. 1.2 The report sets out progress made, and identified the key next steps, building upon the governance principles which were agreed by Greater Manchester at the Standing Conference on 10 th September CONTEXT 2.1 The Governance Group has a membership that is representative of the four main stakeholder groups (GMCA, NHSE, CCGs, and NHS Trust Providers). 2.2 The work plan that has been produced to support the delivery of the Governance, Leadership and Accountability workstream is detailed, and has therefore been broken into four distinct work packages: Strategic Partnership Board and Executive Joint Commissioning Board Legal and Accountability Framework Development of Memorandums of Understanding 2.3 In agreeing the principles by which the governance will be developed it was recognised that due to its complexity, it would be an iterative process, and the governance structures would be reviewed and refined throughout the shadow period. 2.4 In order to make significant and quick progress, a number of priority next steps have been identified and agreed by the Strategic Partnership Board Executive, these are set out at Section 3 of this report. 2.5 Greater Manchester is now operating in shadow form. To date both the Executive and Partnership Board have met, with future dates set for: 27 th November and 18 th December for Strategic Partnership Board. 13 th November and 7 th December for Strategic Partnership Board Executive 3. NEXT STEPS 3.1 As identified above, the principles that will support the governance arrangements to be put in place were agreed at the Standing Conference on 10 th September, and the Programme Board on 18 th September. To ensure that progress continues to be made at 2

3 pace, the immediate priorities have been identified as follows: i. Confirm the membership and Terms of Reference for the Strategic Partnership Board Executive. ii. iii. iv. Finalise a schedule of meetings for the Strategic Partnership Board, confirm its membership, and develop Terms of Reference for the Board. Draft Terms of Reference are appended to this report. Finalise the decision making framework and scheme of delegation for the Strategic Partnership Board. The decision making framework/scheme of delegation will be finalised through a focus session encompassing relevant stakeholders. To support this focus session a straw man document has been produced which outlines key challenges that need to be overcome, outstanding issues that require resolution. This focus session will be run in conjunction with the focus session for the Joint Commissioning Board (see below). Progress the establishment of a Joint Commissioning Board. This will be achieved by holding a focus session with relevant practitioners in early November. To support this focus session a straw man document has been produced which outlines key challenges that need to be overcome and that outstanding issues that require resolution. This focus session will be run in conjunction with the session for the decision making framework/scheme of delegation; both being held on the 19 th November. v. Make progress with regard to the establishment of an overarching Provider Forum. This will include defining its core membership, the criterion that will define its membership, the function of the Forum, and establishing how the Forum links back into the wider governance arrangements. vi. To support the development of relationships with the national bodies. In particular, to support the following officers work with the noted organisations: Katy Calvin Thomas Monitor Yvonne Rogers HEE Rob Bellingham CQC Warren Heppolette NICE It is expected that any MoU s that require development are done so in conjunction with the Governance Group. vii. Develop the processes by which the third sector, patient groups, and primary care are engaged with the governance structures. Interim solutions have been identified and put into place: GMCVO have been invited to sit on the Strategic Partnership Board whilst work is undertaken to identify how best to engaged with the VCS on a pan GM level; and, Tracey Vell, Chair GM LMC s, has been invited to represent 3

4 Primary Care until work has been completed to identify how Primary Care will be represented. viii. Develop the assurance framework within which GM will operate. In recognition of the need that Greater Manchester needs something that works for Greater Manchester the work is being jointly led by GM CCG s and NHSE. 4. FOCUS SESSIONS 4.1 As identified above the Governance Group will be facilitating a two part focus session to further develop the Joint Commissioning Board, and the decision making framework/scheme of delegation. 4.2 The purpose of these sessions, building upon the success of the session held to develop the governance principles, is to ensure that the precise function of the Joint Commissioning Bard are identified and agreed collectively; likewise the decision making framework/scheme of delegation. Joint Commissioning Board 4.3 There is a need to develop a clear framework of what is currently, and will be commissioned at the following levels: Greater Manchester; Integrated local level; CCG only; and, local authority only. 4.4 In addition to the above it will be important to understand and agree which of the Specialist Services will be commissioned on a broader than Greater Manchester footprint, ie North West, North, National. Greater Manchester and NHSE, via representatives of the Joint Commissioning Board, will need to establish how such decisions are taken with Greater Manchester. 4.5 The focus session will also need to identify whether the Joint Commissioning Board has an assurance role with respect of commissioning decisions and the outcomes associated with the same at a local level. Decision making framework/scheme of delegation 4.6 There are number of outstanding issues that will need to be resolved with respect to decision making capabilities of the various groups and boards. Whilst the principles that have been agreed broadly define the functions of the boards, further work is required to establish how decisions will be taken around issues such as: organisational change; use of capital and estate; transformational funding; and, setting of clinical standards. 5. PROVIDER GOVERNANCE 5.1 As was reported to the GM Health and Social Care Devolution Programme Board in September the Greater Manchester provider NHS trusts have made significant progress in moving to new governance in shadow form. Work has continued at pace, and both terms of reference and decision making procedures will be taken to the Federation Board on 20 th November for discussion and agreement. Proposals relating to both financial efficiencies and common pay rates for medical locum staff, developed by collaborative finance and HR sub groups respectively, will also 4

5 be taken to the Federation Board in November. 5.2 As part of the new governance arrangements, the Federation will be independently chaired, and it is anticipated that the appointment for this post will be made in March The Federation have also agreed their nominations to the Strategic Partnership Board Executive, with one year terms agreed for members. 5.3 Work also continues to progress with regard to Organisational Development which both the Director of Workforce and OD, and Head of OD, of Stockport FT are leading on behalf of Provider Trusts with the Kings Fund. 6. PRIMARY CARE 6.1 As the health and care transformation programme moves forward apace, it is increasingly clear that Primary Care will form a central part of the emerging models of care and new way of working. 6.2 Given this wide breadth of providers and volume of service delivery, it is recognised that effective engagement mechanisms need to be built to ensure primary care has a consistent, representative voice in the developing devolution governance framework. 6.3 To support this proposals are being developed and this will likely result in a Primary Care Advisory Group being being created. This will form part of the new governances structures that are being developed. To support its development a further workshop of the design group has been secduled for mid November. 7. LEGISLATION 7.1 Amendments to the Cities and Devolution Bill were published in mid October. The amendments are wide ranging, covering all of the devolution agenda and including specific amendments allow a combined authority to jointly exercise health with health bodies. 7.2 The amendments remove a number of obstacles that prevent the parties to health and social care devolution in Greater Manchester taking joint decisions and holding pooled funds. The main obstacles encountered thus far include: There is no legal basis for a combined authority to make strategic health decisions in a joint committee with the NHS, in particular combined authorities are unable to participate in s.75 partnership arrangements. Likewise there are certain functions that the NHS is unable to exercise jointly, or that the NHS is unable to exercise with a local or combined authority. NHSE s function of commissioning primary care services is not one that can be the subject of a partnership arrangement under s.75. Certain specialized services are excluded from s.75 arrangements. 7.3 In order to fulfill the aims of devolution a combined authority requires power to exercise local authority 5

6 health related functions. 7.4 The proposed amendments will therefore allow: A combined authority to make strategic health decisions in a joint committee with the NHS. For the NHS to jointly exercise specialised commissioning functions with a combined authority. For a combined authority to enter into s.75 partnership arrangements with NHS bodies. 7.5 In order to ensure that Greater Manchester is able to take responsibility for specialised commissioning, it is likely that a joint committee will be formed. 8. RELATIONSHIPS WITH NATIONAL BODIES 8.1 Greater Manchester continues to work to reengineer its relationship with national bodies, with the clear aim of creating bespoke relationships that meet the needs of Greater Manchester. 8.2 Monitor have established a team to work with the GM H&SC Devolution Team to progress the road map. A conversation with both legal teams has been initiated to underpin development of the more formal proposal by January Monitor are being invited to be part of the next stage of GM governance work in November and are being formally linked into the work on the Provider Federation. In addition the Strategic Plan framework has been shared, as has the early work on transformation initiatives. 8.3 In mid-october representatives drawn from across the GM health and social care economy met with the Senior Leadership Team from CQC. There is significant consensus between GM on the key issues and next steps; following on from this there is agreement to develop an MoU by early Work continues apace to develop a Memorandum Of Understanding with Health Education England to support education and co-commissioning arrangements for the GM healthcare workforce. The new infrastructure currently under development will also incorporate social care staff. Following extensive discussion and engagement with the wider system, a final document will be available in December for formal consideration by the Strategic Partnership Board Executive, and subsequent ratification at the Strategic Partnership Board. 8.5 Work is now progressing with NICE, and an initial scoping meeting is complete with further conversations lined up for early November. There is a national commitment to enter into an MoU, and work will now proceed to engage GM NHS Trust Providers and Directors of Adult Social Services across GM, and to develop a first draft of the document. 8.6 In July 2015 Greater Manchester entered into an MoU with Public Health England; the first of its type in the country. Greater Manchester is now implementing its core workstreams under a new Director for Population Health Transformation, who is leading the transition to a single unified public health leadership system. 6

7 8.7 The relationship with both TDA and the Department for Health is developing, with regular contact between the Department and Greater Manchester to discuss progress. Work that has been developed with Monitor including the road map has been shared with the TDA, with a view to developing a more formal range of workstreams. 9. ASSURANCE 9.1 NHSE England are currently developing proposals with the intention of assuring GM once as a whole system, with GM undertaking the internal assurance of its constituent parts. 9.2 Further work is required across GM to determine how GM will assure itself. CCGs will have a key role in shaping this, and initial discussions have taken place to support this work package. NHSE and GM (CCGs) will work jointly to ensure that their work aligns. 9.3 In order to utilise the governance structures that have been developed, a more detailed report on assurance will be developed through the Strategic Partnership Board Executive, for approval by the Strategic Partnership Board. 10. RECOMMENDATIONS 10.1 The Strategic Partnership Board Executive are asked to: Note the contents of this paper. To agree and provide the necessary support to the delivering the next steps. To note the draft terms of reference for Strategic Partnership Board, recognising that these will be updated when a scheme of delegation has been agreed. To note and agree the process for developing the assurance mechanism for Greater Manchester. 7

8 Appendix One Draft Terms of Reference (Strategic Partnership Board) The Greater Manchester Health and Social Care Standing Strategic Partnership Board AUTHORITY In February 2015 the Association of Greater Manchester Authorities (AGMA) and the Association of Greater Manchester Clinical Commissioning Groups (CCGs) signed a Memorandum of Understanding (MoU) with NHS England to create a framework for achieving the delegation and ultimate devolution of health and social care responsibilities to accountable and statutory bodies in Greater Manchester (GM). The MoU outlined a process for collaborative working across health and social care making provision for arrangements to be in place (in shadow form) from November 2015 It also made provision for a programme of work to be undertaken during 2015/16 to move to fully devolved system from April 2016.This includes work to develop and agree the supporting governance Following the creation of the Standing Conference in April 2015, it was agreed in subsequently agreed that the from the beginning of the Shadow Period this would be superseded by the formal establishment of a Strategic Partnership Board. PURPOSE AND OBJECTIVES The Strategic Partnership Board will be responsible for setting the overarching strategic vision for the Greater Manchester Health and Social Care economy. As it is not a legal body, its decisions are not binding, but recommendations for its members to formally adopt following their own governance procedures which may include delegation to a group of its members where possible. RESPONSIBILITIES The key responsibilities of the Partnership Board are: To set the framework within which the Strategic Partnership Executive will operate. To agree the GM Health and Social Care Strategic priorities in accordance with the NHS five year forward view. The priorities and vision as defined by the Strategic Partnership Board will be delivered by the GM Joint Commissioning Board and the localities. To approve the content of the GM Strategic Plan (for financial and clinical sustainability), and note the content of the 10 locality plans to deliver the Strategic Plan locally and the matters remaining for the GM Joint Commissioning Board s remit. To agree the criteria that determine access to the transformation funding and ask the fund allocators (NHS England and GMCA) and fund recipients (Local Authorities and CCGs) to adopt them. To ensure that there remains ongoing and significant organisational commitment across the GM health economy to both the devolution agenda and a devolved health system. To be responsible to the people of Greater Manchester and to each other for the financial and 8

9 clinical sustainability of the Greater Manchester health economy, through the agreement and the delivery of the Strategic Plan. The Board will receive regular update reports from the Executive on the ongoing progress of the delivery of the Strategic Plan. To provide a mutual assurance function over the outcomes linked to the commissioning decisions taken by members to deliver the Strategic Plan. The Board will receive regular reports from the Executive about the commissioning decisions of the GM Commissioning Board, and the performance (via agreed outcomes) linked to those decisions. To agree an assurance framework, developed jointly with regulators where required, that reflects the outcomes required by Greater Manchester, because the formal assurance that each individual party is delivering on their commitments to the Strategic Plan will be provided in the usual way by the SPB relevant statutory body. The Board will receive regular reporting of GM s performance against agreed assurance metrics. To provide leadership across the GM health economy to ensure that the key strategic priorities for a GM health system are achieved. MEMBERSHIP The membership of the Strategic Partnership Board is not a closed membership at this point but will include: GMCA (The Chair of the GMCA) 10 AGMA authorities (Leaders or Lead Members) 12 Clinical Commissioning Groups ( Chairs or Chief Officers) 15 providers - all acute NHS Trusts and Foundation Trusts, mental health and community providers and NWAS ( Chairs or Chief Officers) NHS England (as they determine). OTHER MEMBERS Monitor/TDA (NHS Improvement), CQC, Public Health England, Health Education England, Greater Manchester Fire and Rescue Service (Chair), and Greater Manchester Police and Crime Commissioner will be invited to attend as non-voting members of the Board. From October 2015 Primary care partners will be represented at the Board through the GMLMC. Further work will be undertaken from October to April 2016 the outcome of which will inform and determine the representation of primary care in the governance framework. This work will ensure that primary care is appropriately represented by accountable and representative bodies on an ongoing basis. GMCVO will attend to represent the voluntary sector pending further discussion on third sector representation as set out below. Any amendments to the membership of the Strategic Partnership Board will be agreed (by majority vote where necessary) by the Board. CHAIR The Strategic Partnership Board will have an independent chair. However, Lord Peter Smith (AGMA/GMCA) will act as chair 9

10 until such time that a process to appoint an independent chair is completed. QUORUM The quoracy of the meeting has yet to be defined. SUPPORT Officers from the Greater Manchester Integrated Support Team (GMIST) will provide policy and administrative support to the Partnership Board. MEETING FREQUENCY The Partnership Board will meet monthly or more frequently if required. ACCOUNTABILITY The Strategic Partnership Board is accountable to Greater Manchester. members are accountable to their own organisations and stakeholder grouping. It s REVIEW OF TERMS OF REFERENCE These terms of reference will be formally reviewed by the Partnership Board by mutual agreement of the membership. Such review will take place at any time to reflect any changes in circumstances which may arise. 10

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