CCG Organisational Structure

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1 Harrow CCG Title of Meeting : Harrow CCG Governing Body Agenda Item 2 Paper No 2 Date of meeting: 24 September 2013 Attachment B CCG Organisational Structure Purpose of the report To gain Board sign off to the required changes to the CCG Organisational Structure Executive Summary (to include outcome benefits) At the June 2013 Harrow QIPP and Finance Sub there was a request ensure that: Governance processes support the various workstreams/sub groups The QIPP needs to know how the workstreams report to Sub s so that decisions can be recorded formally and governance can be retained Need a shared understanding of all the work groups This paper outlines the revised CCG Organisational Structure which has been developed by the CCG Seminar and agreed for submission to the CCG Governing Body by the CCG Executive in August 2013 Decision required: The Board / is asked to: Agree to: Sign off the proposed structure outlined in this paper as recommended by the CCG Executive To submit to NHS England as part of the CCG Constitution update in year Corporate Objectives and Board Assurance Framework: (Reference to how the organisation s objectives for year are supported by this paper) Please list BAF and Corporate Risk reference no.) Manage resources effectively Develop robust and collaborative commissioning arrangements Equality and Diversity considerations and implications from which an Impact Assessment might be made: No EQIA assessment has been completed as part of this workstream

2 Resource implications: (Confirmation that any resource implications have been agreed with Finance) No additional resource expectations are proposed This is expected to for part of business as usual processes and funding streams Risks Attached to this initiative (Reference to Corporate Risk Register as appropriate) (This could include legal or other statutory implications or drivers) There are no highlighted risks associated with moving to this updated CCG Organisational Structure & Public Engagement Input to and/or Impact of this initiative and public engagement is maintained through the Equality and Engagement Sub work plan Safeguarding Implications: This updated CCG Organisational Structure will not cause any negative safeguarding implications By providing further clarity to the structure, the organisation is expected to navigate key information and make decisions more efficiently, reducing the risk of safeguarding issues occurring Communications Strategy: (How will this initiative be disseminated) This revised structure will be part of the CCG Constitution update submission to NHS England within 2013/14 Once ratified by NHS England the revised CCG Constitution will be available on the CCG website Clinical Director: Name: Dr Amol Kelshiker Job title: Chair Contact: Jason Antrobus Head of Unscheduled Care Recommendation Paper to Harrow CCG Executive 1. Overview of process The CCG Seminar 13 August 2013 discussed the options to support the revised structure List led to the development of a revised structure which was issued to the CCG Executive in August for review The structure is detailed below:

3 Harrow CCG Governance Structure 2013/14 Discussion at CCG Seminar 13 August 2013 NHS England Health and Wellbeing Board Adults Board CCG Governing Body Children's Board CCG Executive Audit Remuneration Quality, Safety & Clinical Risk Equality & Engagement QIPP, Finance & Research Peer Workstreams: Planned Care Primary Care Safeguarding Children s Working Group Communications Working Group QIPP Monitoring Meeting Participation Unscheduled Care Continuing Care CQGs Meetings Quality Meetings Financial Urgent Care Board actions reported to Unscheduled Care workstream CQGs discussions feed into all Sub s and workstreams where relevant Children s Medicines Management Mental Health Modernisation Board

4 Initial discussion paper: CCG Seminar 16 July 2013 DISCUSSION PAPER TO HARROW CCG SEMINAR ON GOVERNANCE PROCESS Presented by Jason Antrobus 1. Background/rational for paper: At the June 2013 Harrow QIPP and Finance Sub there was a request ensure that: Governance processes support the various workstreams/sub groups The QIPP needs to know how the workstreams report to Sub s so that decisions can be recorded formally and governance can be retained Need a shared understanding of all the work groups 2. Aim of paper This is a discussion paper This paper will be issued to the 16 July 2013 CCG Seminar for discussion, with an aim for CCG Seminar to develop and recommend a set of options to the CCG Executive on 23 July The following discussions are suggested: Recommended hierarchy structure to support a clear decision making and reporting process Outstanding/under developed workstreams These discussions are listed below 3. Discussion area one - Recommended hierarchy structure to support a clear decision making and reporting process 3.1. Current position Governance Structure On developing this paper the organisation can be described as having a number of views of the reporting structures. This on occasions has caused a level of confusion across varying documents and key reports to NHS England. For example: The NHS Harrow CCG Constitution (published on the organisational website) made between the members of NHS Harrow CCG, effective from 1st day of April 2013 illustrates the following organisational structure:

5 Figure 1: NHS Harrow CCG Structure as per 1 April 2013 Constitution The below diagram outlines the current structure of committees at NHS Harrow CCG This shows a much more complex governance structure Overview and Scrutiny NHS NCB Health & Wellbeing Board Adults Board CCG Governing Body Children s Board CCG Executive Audit Remuneration Quality, Safety & Clinical Risk Medicines Management Equality & Engagement Mental Health Modernisation Board QIPP, Finance & Research Unscheduled Care Workstream Peer Planned Care Workstream Safeguarding Children s Working Group Communications Working Group QIPP Monitoring Meeting Participation CQGs Meetings Financial Meetings Quality Figure 2: 2013/14 NHS Harrow CCG Structure of s as per 1 st round Authorisation Process More recently the June 2013 submission to NHS England as part of the responding to the remaining reds issued from being authorised with conditions, NHS Harrow CCG submitted the following structure:

6 5. External NHS England and other external organisations, e.g. Regulators 4. Governing Body (GB) Governing Body CCG-Executive Board Assurance Framework Risk Register Engagement Quality & Safety Finance 3. GB Sub- 2. Provider / Workstream / Programme 1. Service / Contract / / Users / Reports E&E and carer forums experience and feedback QSCRC CQG, Workstreams, Safeguarding, Peer QRFC PCE, Workstreams Escalate issues & risks Feedback E&E: Equality & Engagement QSCRC: Quality, Safety and Clinical Risk QRFC: QIPP, Research and Finance CQG: Clinical Quality Group PCE: Performance and Contracting Executive Experience Provider Performance Harrow commissions specific services from the NWL CSU, including contract management and clinical governance support. Figure 3: June 2013 submission to NHS England as part of the responding to the remaining reds issued from being authorised with conditions Finally as part of the June 2013 A&E Recovery and Improvement Plan the CCG issued instructions to develop the structure illustrated in figure 3 to show the CCG Clinical Led Workstreams as a higher authority body above the Sub s of the CCG. This is illustrated below in figure External NHS England and other external organisations, e.g. Regulators 4. Governing Body (GB) Governing Body CCG-Executive Board Assurance Framework Risk Register Where established CCG Workstreams: Unscheduled Care, Planned Care, Mental Health, Children's Engagement Quality & Safety Finance 3. GB Sub- 2. Provider / Workstream / Programme 1. Service / Contract / / Users / Reports E&E and carer forums experience and feedback QSCRC CQG, Workstreams, Safeguarding, Peer QRFC PCE, Workstreams Escalate issues & risks Feedback E&E: Equality & Engagement QSCRC: Quality, Safety and Clinical Risk QRFC: QIPP, Research and Finance CQG: Clinical Quality Group PCE: Performance and Contracting Executive Experience Provider Performance 15 Figure 4: Structure as defined in the June 2013 A&E Recovery and Improvement Plan

7 Overall the above structures are in circulation across NHS Harrow CCG each indicating a different governance process There is a requirement to recommend a hierarchy structure to support a clear decision making and reporting process, avoiding governance organisational confusion 4. Discussion area two - Outstanding/under developed workstreams 4.1. Current position The following workstreams are established: o Planned care o Unplanned care o Medicines management o Mental health 4.2. Developing additional workstreams: There are gaps as the following areas do not have established workstreams: o Children s o Carers o Continuing care o Community 4.3. On-going development discussion The CCG Seminar to discuss as an agenda item the requirement to set up clinically led workstreams covering children s, carers and continuing care services and recommend the preferred option to the CCG Governing Body.

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