Session 7: Foundation Trusts, CCGs and new models of care Claire - - PowerPoint PPT Presentation

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

• 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

Creation of foundation trusts

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

• r 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
• ther 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
• btain 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
• rganisation
• 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,
• bjective 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

Governance, culture and behaviour

‘’[A]ny of the arrangements under consideration could bring benefits but it is not the organisational form that will determine the outcome, it is the quality of leadership alongside a culture of excellence in performance and accountability for results.’ ‘New organisational models for the NHS won’t be built in a day’, King’s Fund, Blog, 1 July 2014

Following this session

• Session slides and content
• Session 8: Risk and Assurance. Thursday 2 November 4pm.
• Reminder - November exam is Thursday 30 November
• Practice Task 2 – Due Monday 30 October (no webinar)
• Further questions

Thank you