APPENDIX A Leeds Health Commissioning and System Integration Board Terms of Reference Version: 15.0 DRAFT Approved by: Date approved: Date issued: Responsible Director: Review date: [+6 months from approval] 1
1. Introduction 1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing. It has a clear vision to be a healthy, caring city for all ages, where people who are poorest improve their health the fastest. To realise this vision, the CCGs and Leeds City Council need to change how we commission services so that the health and care system is sustainable, services are of high quality and we make best use of the Leeds pound. 1.2 The three CCGs aim to ensure more integrated care, based on the needs of local people. To do this, the Leeds CCGs and Leeds City Council will work together to change how care is commissioned, and work with current and future providers to develop a new, more integrated health and social care system. 1.3 The three CCGs have recognised that in a similar way to many healthcare economies around the world, it will be necessary to adopt a Population Health Management (PHM) approach. The key building blocks of PHM are: Commissioning needs to be more strategic and outcomes-based rather than activity-based. Some current commissioning functions would be more effectively used to develop a new provider landscape of integrated, accountable providers working towards common goals. This would be enabled by new payment and incentive mechanisms supported by better use of information and technology. 1.4 To enable progress towards this vision, the CCGs have established transitional governance arrangements that support joined-up, speedy and effective decision-making. To oversee some functions, joint committees have been established to enable greater co-ordination and integration of commissioning, whilst at the same time overseeing leadership of system integration to develop provider relationships and new commercial relationships. The governance arrangements will be reviewed after six months of operation. 1.5 To oversee this transitional phase, the three CCGs in Leeds have set up the Leeds Health Commissioning and System Integration Board ( the Board ). The Board is a joint committee of NHS Leeds North Clinical Commissioning Group, NHS Leeds South and East Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group. 2
2. Role of the Board 2.1 The Board will be responsible for ensuring that the three Leeds CCGs work together effectively to: improve the health and wellbeing of the poorest, the fastest; help people to live healthier, independent lives; and ensure that people have access to quality health and care services. 2.2 Through transition, the Board will also oversee the development of a blueprint for delivering PHM, which will clearly define the developmental journey for both strategic commissioning and system integration. 2.3 This means the CCGs working with partners, the public and patients to commission services that are high quality, sustainable, and make better use of scarce resources. It also requires the CCGs to support a more integrated health and care system and develop, with providers, new service models. 2.4 Bringing together strategic commissioning and innovative, integrated, provider responses will enable delivery of the Leeds Plan, within the West Yorkshire Sustainability and Transformation Plan. 2.5 The Board will be responsible for: a) ensuring delivery of a single set of joint priorities; b) driving the strategic, outcomes and needs-based commissioning of health and care services across Leeds; c) ensuring a focus on tackling health inequalities and improving the health and wellbeing of the poorest, the fastest; d) designing health and care provision around the needs of patients, with greater emphasis on prevention and self- care; e) shaping innovative approaches by health and care providers, which enable them to respond to our proposed approach to commissioning for outcomes; f) driving new service models, which provide more integrated care for a specific population, based on their needs and not disease pathways; and g) driving the better use of business intelligence and technology, which will provide the information that we need to commission effectively for outcomes. 2.6 The Board will be responsible for exercising the following functions, to the extent permitted, including: a) the strategic commissioning of health and care services that meet the reasonable needs of our population; 3
b) agreeing and monitoring the annual work programme to support the delivery of the Leeds Plan, shared CCG objectives and operational plans; c) reducing health inequalities, by identifying high risk, high priority populations and targeting resources, prevention and care to meet their needs; d) making efficient and effective use of our collective resources by developing new financial flows, monitoring the CCGs financial plans and the delivery of financial targets set by NHS England; e) ensuring continuous improvement in the quality of services commissioned on behalf of the CCGs through the development of a common quality assurance and reporting framework and quality improvement strategy; f) ensure that arrangements are in place to secure public involvement in the planning, development and consideration of proposals for changes and decisions affecting the operation of commissioning arrangements; g) supporting organisational development by establishing a single culture where our staff adopt one set of values and behaviours; h) promoting the integration of health and care services by driving new provider approaches and service models; i) monitoring provider performance and taking remedial action where necessary; j) driving a consistent approach to understanding the needs of our population through the better use of business intelligence and technology; k) establishing a single risk management and Board Assurance Framework and thereby ensuring all principal risks are identified, managed and mitigated with appropriate plans, controls and assurance reported; and l) setting up and overseeing the effectiveness of sub committees deemed necessary, agreeing terms of reference and membership of any such sub committees. 2.7 In exercising its functions, the Board will comply with the statutory duties set out in chapter A2 of the NHS Act and included within the CCG Constitutions. 3. Membership (Voting) 3.1 The membership of the Board will be as follows: The Chairs of each of the CCGs, one of which will be appointed as Chair and one as deputy Chair of the Board. This will be on a rotational basis as agreed by the Board. CCG Accountable Officer Chief Officer for System Integration CCG Chief Finance Officer CCG Director of Nursing CCG Medical Director CCG Director of Commissioning 4
Up to four CCG Lay Members Up to four CCG GP Representatives 3.2 In attendance (non voting): Director of Adults and Health, Leeds City Council Director of Children and Families, Leeds City Council Public Health representative Chief Information Officer Healthwatch Representative 3.3 Deputies may attend on behalf of executive members, with delegated voting rights. 3.4 Other directors and senior managers will be invited to attend where appropriate. 4. Quoracy and voting 4.1 To be quorate the following members must be present: The Chair or deputy Chair The Accountable Officer or deputy The Chief Finance Officer or deputy A minimum of 6 other members, including at least one lay member and one GP representative 4.2 Members and attendees of the Board will participate in discussion, review evidence and provide or seek objective expert input, to the best of their knowledge and ability, and endeavour to support the Board in reaching a collective view. 4.3 The Board will endeavour to make decisions by reaching a consensus, which should also take into account the view shared by the non-voting attendees. 4.4 Exceptionally, where this is not possible, the Chair of the Board (or in their absence a deputy Chair) may call a vote, using the following process: i) The meeting must be confirmed as quorate, once conflicts of interest have been accounted for, by the Chair; ii) Each member will have one equal vote; iii) A decision will be made by majority vote; and iv) Where a majority vote cannot be reached the Chair will have the casting vote. 5
5. Operation of the Committee 5.1 The Board will hold at least six meetings in public each year. Meetings of the Board shall be conducted as if the Public Bodies (Admission to Meetings) Act 1960 applied to the Board in the same way as it applies to the Governing Bodies of the CCGs. 5.2 Extraordinary meetings may be held at the discretion of the Chair. A minimum of seven working days notice should be given when calling an extraordinary meeting. 5.3 The agenda and supporting papers will be circulated to all members at least five working days before the date of the meeting. 5.4 With the agreement of the Chair, items of urgent business may be added to the agenda after circulation to members. 5.5 In the case of an emergency the Chair may take urgent action to decide any matter within the remit of the Board, subject to consultation with at least three other members of the Board, including a representative from each CCG. Any such action shall be reported to the next Board meeting and to the CCG Governing Bodies. 5.6 Minutes will be issued at latest 10 working days following each meeting and a Chairs summary will be submitted to the CCG Governing bodies. 5.7 Secretarial support will be provided to ensure appropriate support to the Chair and Board members in relation to the organisation and conduct of meetings 6. Conduct of the Board 6.1 Members of the Board shall at all times comply with the standards of business conduct and managing conflicts of interest as laid down in the CCGs Constitutions and the Managing Conflicts of Interest Policy. 6.2 The Board shall hold and publish a register of interests. This register shall record all relevant and material, personal or business, interests as set out in the CCGs Managing Conflicts of Interest Policy. 6.3 All declarations of interest will be declared at the beginning of each meeting and actions taken in mitigation will be recorded in the minutes. 6
7. Accountability and Reporting 7.1 As statutory bodies, the CCGs remain individually accountable for the delivery of their statutory functions. 7.2 As a committee of the CCGs the Board is accountable to the CCG member practices. 7.3 The Board will produce an annual work plan in consultation with the CCG Governing Bodies and Membership, and will submit regular reports on progress against delivery. 7.4 Minutes of the Board and a written summary will be submitted to the CCG member practices and Governing Bodies. 7.5 The Board is authorised by the CCGs to commission any reports or surveys or to create working groups as necessary to help it fulfil its obligations and will remain accountable for any working groups. The minutes of such groups will be presented to the Board. 8. Review of the Board 8.1 The Board will, after six months of operation, undertake a self-assessment of its performance against the annual plan, membership and terms of reference. Any resulting proposed changes to the terms of reference will be submitted for approval by the CCG s Membership. 7