Session 7: Foundation Trusts, CCGs and new models of care Claire Lea, Thursday 26 October 2016, 4pm My microphone is currently muted
Record session
Session 7: Foundation Trusts, CCGs and new models of care Claire Lea, Thursday 26 October 2016, 4pm
Today’s plan • Creation of Foundation Trusts • Members, Council and Board • Duties and powers of governors • Creation of clinical commissioning groups • Membership, governing bodies • Governance issues • Concluding remarks
Creation of foundation trusts • Public benefit corporations • Not subject to direction by the Secretary of State • Regulated by NHS Improvement • Membership organisation • Role of board to “promote success of trust with view to maximising benefits for members and the public’ • FT Code of Governance • FT model core constitution
The role of the council Duties of the council of governors are: • Hold the NEDs individually and collectively to account for the performance of the board; • Represent the interests of members and the interests of the public.
Be clear on the distinctions Question, challenge and assurance – not managing or supervising or doing the job of the NED or executive directors. It’s the NEDs role to scrutinise; It is the Council’s role to ensure that NEDs are doing this.
The role of the governor and NED
Powers of the council • Appointing, removing and deciding terms of office of the chair and non- executive directors • Approving the appointment of the CEO • Appointing/removing external auditors • Jointly approving constitutional changes with the board • Considering the Foundation Trust’s annual plan • Receiving the annual accounts, annual report and any auditors report
Powers of the council • Considering and approving major transactions (as defined in the constitution) – this could be board proposals for mergers, acquisitions and significant transactions • Considering and approving rationale for increasing non-NHS activity above 5% • Informing NHSI if the FT is at risk of breaching its terms of licence if these concerns cannot be resolved locally
Powers of the council • Receiving a report on the use of non-NHS income for the benefit of NHS patients; • Requiring one or more directors to attend a meeting to answer questions; • Receiving board agendas before the meeting and minutes a.s.a.p. after the meeting. • Receiving the independent auditor’s report on the annual quality account
In summary • Overall responsibility for running an NHS foundation trust lies with the board of directors. • Directors retain responsibility and accountability for the performance of the foundation trust, whereas governors do not take on this responsibility or accountability. • NEDs will obtain assurance that performance and quality are as they should be, that risks are properly controlled and that strategy is being implemented successfully and sustainably.
In summary • The Council is the collective body through which the non-executive directors explain and justify their actions, and the Council should not seek to become involved in running the trust. • Governors must act in the best interests of the NHS foundation trust and should adhere to its values and code of conduct • Governors represent members and the public and are one means of providing local accountability for the NHS foundation trust
The governance challenge of FTs What would you describe as the key governance challenges for a foundation trust?
Creation of clinical commissioning groups • Health and Social Care Act 2012 - responsibility for commissioning care given clinicians via clinical commissioning groups which replaced primary care trusts from April 2013. • Responsible for commissioning secondary and community care services, and have a legal duty to support quality improvement in primary care • Groups of general practices come together in each area to enable GPs, working with other health professionals, to commission services for their local communities. • April 2015 - 64 clinical commissioning groups (CCGs) take on fully delegated responsibility for commissioning general practice, while 87 CCGs take on joint commissioning responsibilities working with NHS England.
CCG structure CCGs are different entities from previous NHS arrangements, with each GP practice being a member and clinicians leading on commissioning decisions. The CCG is its member practices; the members are the authority and they appoint a governing body to act on their behalf. Local authorities and CCGs (coming together through health and wellbeing boards) will use Joint Strategic Needs Assessments (JSNAs), and Joint Health and Wellbeing Strategies (JHWSs) to agree local priorities for local health and care commissioning.
CCG relationships
Not a unitary board! Six core standards of good governance Source: Good governance standard
Governance guidance • Good Governance Standard for Public Services • Towards establishment: Creating responsive and accountable clinical commissioning groups • Clinical commissioning group governing body members: Role outlines, attributes and skills • The functions of CCGs • Managing Conflicts Of Interest: Revised Statutory Guidance For CCGs , NHSE June 2017 • Code of Governance for NHS CCGs ICSA, Nov 2013 • Remuneration Guidance for Chief Officers and Chief Finance Officers , NHSE • CCG Guidance on Senior Appointments, NHSE, March 2017 • Developing CCGs as High Performing Membership Organisations , Ashridge • Good Governance Institute – suite of of self evaluation tools to assess good governance
Structure of the governing body Not less than six members, consisting of: • the chair • representatives of member practices • other GPs or primary care health professionals • a minimum of two lay members (audit, remuneration and conflict of interest matters focus and patient and public participation focus* • a registered nurse and a secondary care specialist doctor • the accountable officer and the chief finance officer • any other individuals as required by the CCG * Superceded by 2017 guidance on managing conflicts which recommends 3 lay members
HSCA 2012 - Duty of the CCG governing body to: • exercise its functions effectively, efficiently and economically • obtain appropriate advice • promote education and training • promote integration • promote the NHS Constitution • promote innovation in the provision of health services (including innovation in the arrangements made for their provision) • promote patient choice
HSCA 2012 - Duty of the CCG governing body to: • promote research on matters relevant to the health service, and the use in the health service of evidence obtained from research • reduce inequalities in respect of access and outcomes • secure continuous improvement in the quality* of services provided or in the prevention, diagnosis or treatment of illness • (*quality is defined as the effectiveness and safety of the services, and the quality of the experience undergone by patients).
HSCA 2012 - CCG financial duty to: • ensure its expenditure does not exceed the aggregate of its allotments for the financial year • ensure its use of resources does not exceed the amount specified by NHS England for the financial year • take account of any directions issued in respect of specified types of resource used in a financial year to ensure the CCG does not exceed an amount specified by NHS England • publish an explanation of how the CCG spent any payment in respect of quality made to it by the NHS England.
Governance issues What would you identify as the key governance issues for a CCG?
The governance challenge • Managing conflicts of interest • Understanding the role of the governing body for a membership organisation • Clear processes for the election/appointment of governing body members • Independence of scrutiny and challenge • Relationship with health & wellbeing boards and STP’s • Procurement
New models of care ‘The challenge for all boards or governing bodies is to recognise that the drivers within the guidance for transformation and sustainability (5YFV) do not necessarily mean large-scale transactions and structural change. Networks and collaboration may be the better option, perhaps lessons learned from earlier major restructures have demonstrated that changing the structural form does not readily lead to the scale of transformation required for sustainable services.’ ICSA Handbook 2017
Governance principles for success • clarity of purpose, • objective setting • lines of accountability The corporate or contractual form clearly establishes the degree of integration the partner organisations in the new form are trying to create and will in turn affect the governance requirements.
New models of care • Buddying, federations and learning and clinical networks • Accountable care organisations (MCP, PACS, ACC, EHCH, UECN) • Foundation groups • Accountable Clinical Networks • Specialty franchises
Corporate forms • Corporate joint ventures • Committees in common • Mergers and acquisitions
Contractual forms • Contractual joint ventures • Alliance agreement • Integration agreement • MCP/PACS contract • Formal agreement
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