Changes to the CCG Scheme of Reservation and Delegation October 2018 Members Forum

North East London Joint Commissioning Committee The North East London Commissioning Alliance (NELCA) Joint Commissioning Committee (JCC) has been meeting since May 2018 on a more formal footing; The JCC is comprised of members of the Governing Bodies (GB) from Barking & Dagenham CCG, City & Hackney CCG, Havering CCG, Newham CCG, Redbridge CCG, Tower Hamlets CCG and Waltham Forest CCG to jointly commission goods and services for the residents of the City of London Corporation and London Boroughs of Barking & Dagenham, Hackney, Havering, Newham, Redbridge, Tower Hamlets and Waltham Forest; The City and Hackney CCG members of the JCC are Mark Rickets (CCG Chair), Sue Evans (CCG Lay Member for Governance) and Jane Milligan (NEL CCGs Accountable Officer) and the decisions they may make in the NEL JCC are for the whole of North East London; The role of the JCC is to deliver the delegated functions and powers transferred to it by the seven NEL CCG Governing Bodies. These functions are where the Governing Bodies consider there is additional value in working collaboratively with other CCGs; A revised set of Terms of Reference and an outline Scheme of Reservation and Delegation (SORD), incorporating a formal request for the delegation of CCG decision making powers was submitted to, and agreed by the Governing Body on Friday 28 September 2018.

Scheme of Reservation and Delegation The JCC has requested delegation of CCG decision making powers in three main areas and four minor other areas: Commissioning of all services provided by the London Ambulance Service; Commissioning of Integrated Urgent Care services provided across providers or commissioned across CCGs in North East London. Note that this does not affect the integration of urgent care services within City and Hackney – only those services operating at a NELCA wide level; Commissioning of Mental Health acute beds related services provided across providers or commissioned across CCGs in North East London; Approval of any integrated care systems framework for operation in an area within North East London; The production of an overarching Commissioning Strategy and an overarching approach to capacity planning in Maternity acute services provided across providers or commissioned across CCGs in North East London; Commissioning of any Specialised Services the CCG should become responsible for. Note that NHS England currently hold responsibility for the commissioning of specialised services, but this entry has been added to the SORD should this position change; To produce and provide assurance to NHS England on performance, financial matters or other matters on the CCGs behalf.

Scheme of Reservation and Delegation (cont) Further minor changes to the SORD have been made to delegate decision making powers to the Managing Director, to bring their decision making powers on the CCGs operational scheme of delegation and urgent decisions alongside the Accountable Officer. These were agreed in the Constitution earlier in 2018, but were not actioned in the SORD due to the incoming JCC changes we have now received; The full SORD with the changes we are seeking Members Forum agreement of is available at http://bit.ly/2N8PXFv, marked up in track changes; The latest JCC Terms of Reference is available at http://bit.ly/2y7fXvd for information; The Members Forum needs to agree all changes to the SORD before they can be considered active, along with the Governing Body (whose agreement was secured on Friday 28 September 2018). Unlike changes to our Constitution, we do not need to submit these changes to NHS England as well. DECISION: The Members Forum is asked to consider and agree the changes to the CCGs Scheme of Reservation and Delegation to enable the JCC to make decisions on the CCGs behalf in these specific areas and to empower the Managing Director to make the same level of decisions as the Accountable Officer in several key areas.

Developing our Finance Capabilities City & Hackney CCG as one of three systems within NEL will continue to develop its financial capabilities as part of its integrated commissioning programme of work with the London Borough of Hackney and City of London. An independent review of the integrated commissioning governance structure is underway. Further pooling of budgets with system partners are being developed. Investments are being made in workforce development, IT, integrated commissioning and estates to develop and deliver future benefits to the system. Statutory funding allocations will continue to be received by City & Hackney CCG and plans formalised to ensure statutory obligations are delivered. Plans will include developing and working to a future City & Hackney system control total to manage risk as integrated commissioning matures. Risk share may be considered within the NEL system subject to exiting principals underpinned by an approved framework, supported by a business case, reviewed and scrutinised by GB members and external audit. City & Hackney CCG, as with other NEL CCGs, will only be able to enter into risk share if financial headroom is available and this would be determined locally. The executive DOF job description and objectives will have clear alignment to City & Hackney CCG and system deliverables. Wider strategic NELCA deliverables such as NHSE/NHSI interface, payment reform and JCC delegation will rest with the NELCA CFO detailed in slide 7.

Single Chief Finance Officer (for information) Members Forum approval is not required on internal CCG staff and structure changes – but approval is needed for new roles, appointments, or extensions to membership of the CCG Governing Body; The CCG Governing Body agreed to move to a single Chief Finance Officer (CFO) across NEL CCGs at its meeting on Friday 28 September 2018. This follows extensive Governing Body discussion and consultation with those involved in this change in the last few months; The Members Forum will be asked to approve the named appointment of a new single CFO to the Governing Body when we know who will be offered the role. We predict this will be before Christmas; The arrangements for the recruitment and how the role will work are still being confirmed, but it is expected to function in a similar fashion to the single Accountable Officer and Managing Director arrangements; The Governing Body agreed that the single CFO will be supported by a local Executive Director of Finance, which will be a new role. It has been suggested that this role will also have a voting role on the Governing Body; The Operating Model for North East London will the be 3 Managing Directors (City and Hackney, Waltham Forest, East London & Barking, Havering and Redbridge) with 3 Executive Directors of Finance; The paper agreed by the Governing Body is available at http://bit.ly/2OuAl3G.

Finance roles split of responsibilities The Governing Body was informed that the Single CFO will be supported by local Executive Directors of Finance within individual or clustered CCGs with clear strategic versus operational roles and responsibilities. Local Executive Directors of Finance will report to the Single CFO and have a dotted line to the Managing Directors. To illustrate the respective roles some examples are outlined below: NEL Single CFO CCG Executive DoF (C&H, WEL, BHR) Voting member of GB and JCC Voting member of GB and CCG committees Strategic Overview NEL Control Totals setting Local CCG / sub-system Control Total delivery NEL financial performance CCG financial plans NEL financial plans and sign off of Annual Accounts CCG / local financial performance NEL system triangulation management CCG Quarterly Returns NEL QIPP CCG QIPP NEL risk share governance CCG Risk Share business case PbR / contract reform Local Contract Strategy/management for acute and community contracts Overarching acute contracting strategy Integrated Commissioning arrangements with local boroughs (contract sign off up to £xm) NEL Estates Strategy / Major Sites Local Primary Care Estates & CCG Estates Implementation NEL Digital Strategy & Information Governance NEL wide Local Digital Roadmap implementation Primary Care at Scale & Primary Care Reform – financial strategy CCG Primary Care Co Commissioning NEL Internal Audit Approach/Review CCG internal Audit NEL External Audit sign-off CCG External Audit liaison NELCSU in housing Local RCA monitoring/control

Future Constitutional Changes Any new voting roles on the Governing Body will require changes to the CCGs Constitution, which will need agreement from the Governing Body, Members Forum and NHS England; The addition of another management role on the Governing Body will take the number of voting managers to three: Single Accountable Officer (who’s vote can be exercised by the Managing Director in their absence); Single Chief Finance Officer; Local Executive Director of Finance. The rest of the voting members on the Governing Body are made up of three GPs, three Lay Members and two Clinicians. To ensure our principle of clinical leadership is maintained, it is proposed that along with the addition of an Executive Director of Finance, an additional voting GP Governing Body member is recruited; If the Members Forum decides to increase the number of GP voting members of the Governing Body, the process as laid out in the Constitution is that all Governing Body GPs must be Consortia Lead GPs first. The Leads select / elect which of their number will sit on the Governing Body amongst themselves.

Future Constitutional Changes (cont) Any decision from the Members Forum would be worked up in a revised CCG Constitution and submitted to the CCG Governing Body, Members Forum and onwards to NHS England in October / November 2018 before any action to recruit a new voting member can start. The exact timing on this will depend on the arrangements for the Executive Director of Finance becoming clearer – these will need to also be fed into this process; DECISION: The Members Forum is asked to consider and agree whether the new Executive Director of Finance role should be created with voting powers on the Governing Body. This will require changes to the Constitution, which will be worked up in detail and returned to the Governing Body, Members Forum and NHS England in October / November 2018; DECISION: The Members Forum is asked to consider and agree to recruit an additional voting GP on the Governing Body. This will increase the voting GPs from three to four to retain clinical leadership and that the Clinical Lead GPs will be asked to elect / select another one of their number to step into this role.