Collaboration Agreement

Transcription

1 Collaboration Agreement Central London, West London, Hammersmith & Fulham, Hounslow, Ealing Clinical Commissioning Groups January 2014 Version 5 1

2 Context In December 2011 the eight North West London (NWL) CCGs (Clinical Commissioning Groups) met to present and debate emerging thoughts around geographic configuration, management structure and plans to source commissioning support services. The eight CCGs that participated in this process were: Brent, Ealing, Harrow, Hillingdon, Central London, Hammersmith & Fulham, Hounslow and West London. Following this process, discussions took place in relation to how individual CCGs plans aligned with each other and, in particular, how these might respond to potential risks to the NWL health system. The eight NWL CCGs agreed to form two collaborative management teams to best mitigate the risks that the CCGs identified. This decision was reached because the CCG chairs felt that this configuration would best: - Enable each CCG to tackle cross Borough issues and give the maximum influence over decisions that span multiple CCGs such as Trust FT applications or the on-going negotiation and management of contracts with key providers. - Enable CCGs to influence the shape of the provider landscape in NW London. - Facilitate the work required to ensure financial viability of the NW London Health system. - Enable the CCGs to achieve economies of scale and attract talented individuals to the key leadership roles in NWL CCG Executive structures. - Enable the CCGs to manage the performance of the Commissioning Support Service. As a result of this in April 2012 Central London; West London; Hammersmith & Fulham; and Hounslow CCGs formed a collaborative to share a leadership team and work together on these areas to enable them to become effective commissioners. Ealing CCG decided to join the Collaborative from 1 st December Principles and model for collaboration The organisation will work to the following principles: - Recognising the sovereignty of the CCGs and that CCGs are membership organisations. - Working as a collaborative when we can demonstrate that it will best serve the patients of the individual CCGs. - Having strong clinical leadership drawn from the CCGs and their Governing Bodies. - Demonstrating subsidiarity with the majority of decisions being made by the CCG members. - Having governance arrangements, such as succession planning and delegation procedures, that facilitate continuous and timely decision making. - The collaborative does not create an additional performance management structure in the system. - This Collaboration Agreement is refreshed on a quarterly basis in its first year of operation and thereafter being reviewed every 6 months, with the first review in October CCGs are membership organisations so the ways of working across the CCGs should enable the members to have a lead on all decisions. In practice this could mean that members agree with Chairs the parameters of decision making that the Chairs are delegated by the members to take on their behalf. Therefore decision making does not become an onerous task which requires extensive forums and complicated governance and 2

3 process. Chairs will be able to delegate authority to individuals in a CCG that can make decisions on their behalf. The decision making section below explores this in more detail. Figure 1 represents the interconnected relationship between the CCGs, the Elected Governing Bodies and the Collaborative. The CCGs will decide which decisions to delegate to the Elected Governing Bodies and the Collaborative. The Collaborative will act as a central facilitator and driver to the community supporting the CCGs and the Elected Governing Bodies to perform their duties in whatever ways are agreed by the CCGs. Figure 1: Model of the interconnected relationship between the CCGs, the Elected Governing Bodies and the Collaborative Collaborative management structure The proposed organisation structure for the Collaborative is outlined in figure 2. - The Chief Officer (CO) is accountable to the chairs - The Director posts are accountable jointly to the CCG chairs and CO - The Managing Directors are line managed by the CCG chairs and the Chief Officer 3

4 - The Directors working for the collaborative are line managed by the CO - The Chairs and CO have a duty to resolve any inconsistencies in the scope of work and requirements from the Directors. Figure 2: Collaborative team structure Decision making The individual CCGs agreed that the vast majority of decisions that relate to commissioning or operational issues will be determined locally by the relevant CCG. Each CCG will be responsible for meeting its statutory duties. These responsibilities will be more fully set out on the CCG s constitution and Scheme of Reservation and Delegation. Examples of decisions that will be considered and determined locally by individual CCGs include (this is not an exhaustive list): - Constitutional issues such as agreeing the constitution, election process etc - Committee and sub-committee structures and terms of references of the Governing Body and Committees - Commissioning intentions for providers solely operating within the CCG boundary - Approval of commissioning budgets and investment plans - Financial and performance - Strategic decisions such as agreeing Out of Hospital Strategy - Patient engagement strategies 4

5 - QIPP planning, business case sign off and delivery - Performance review and management of providers - Public health activity - Local council communications The CCGs are committed to working together in a collaborative way where a common approach is desired. The CCGs have agreed to work together on the following: - Addressing strategic and financial risks that apply across the CCGs and across NWL. - Implementing strategic changes that have an impact across NWL (e.g. strategic changes to the provider landscape). - Identifying commissioning intentions, priorities and plans that may impact on service provision across more than one of the CCGs. - Managing shared providers such as Imperial College Healthcare NHS Trust. - Managing relationships with the Commissioning Support Unit (CSU). - In any of the above situations, the CCGs have agreed to work together following the process set out in figure. The CCGs will establish joint committees or working groups with a clear remit and terms of reference to examine the available evidence, to consider various options and to make recommendations. Any joint committee or working group will have representatives from each CCG. The joint committee/working group will share its evolving work with the CCGs governing bodies / executive teams so that, where appropriate, each of the CCGs is able to consider the issues, plans or recommendations with its wider membership in good time before any decisions are made. The CCGs acknowledge that on significant issues this is likely to be an iterative process in which information and views are exchanged between the CCGs and the working group Each CCG will share the views and opinions of its wider membership with the joint committee/working group so that all views can be taken into account, suggestions explored and concerns addressed. The joint committee/working group will consider the views and opinions shared with it and will report to the Collaborative with options/recommendations for the strategic or commissioning decision or action to be taken. Having engaged their wider membership, each CCG will seek to empower its representative to make decisions on its behalf. Accordingly, each CCG will seek to ensure that its representative on the Collaborative or, indeed, on a joint committee or working group will have sufficient authority to attend on behalf of its CCG and make decisions on behalf of that CCG that relate to the issue in question. This authority is seen as desirable in order to facilitate timely and consistent decision making. At all times, the CCG will act in accordance with the terms of its constitution. The CCGs will strive to achieve a consensus view wherever possible. This is acknowledged by the CCGs as a driving principle reflecting the shared view that, by working together, they are more likely to reach better decisions aimed at addressing the risks and challenges faced by the North West London health system as a whole. Where there is a difference of opinion between the CCGs on an issue where a consensus is required, then the CCGs shall act in good faith and with all reasonable endeavours find a solution that is acceptable to all. The CCGs recognise that this may involve each of them consulting their respective Governing Body / Executive Teams or wider membership to canvass views and seek the necessary authority. To make this process effective a period of 4 weeks will be the normal time period for CCG Chairs to engage their CCG Governing Bodies / Executive Teams in the decision. 5

6 It is agreed that one or more CCGs should not have the right to veto or block a decision by another CCG and that no CCG can make a decision which binds another CCG to making a decision that the CCG does not agree with. Figure 3: Decision making process CCGs identify the need for a joint committee (e.g. strategic planning committee) or a joint working group (e.g. dealing with challenges during the 2012 Olympics). Membership and terms of reference for the committee or group to be confirmed. A joint committee or working group reviews the issues, risks and challenges and shares evolving options and potential recommendations with the CCGs. Each CCG considers the evolving options and recommendations with its membership and seek views and opinions from its membership. Views and opinions fed back to the joint committee/working group. Each CCG seeks authority from its membership for its representative on the joint committee/working group or the Collaborative (as appropriate) to make decisions for the CCG. In some cases the CCG may feel that the members of the joint committee or working group can make decisions: in other cases it may be necessary for the committee/group to make recommendations for review and decision by representatives on the Collaborative. In reaching decisions the committee/group and the Collaborative will follow the principles set out in this document. If a consensus is not achieved, then the Collaborative may issue revised terms of reference to the committee/group so as to build upon areas of common ground, may identify and make available additional resource to help resolve any outstanding issues, may propose a detailed action plan for next steps and/or may take such other steps as reasonably required to facilitate the reaching of a consensual and timely decision. The CCGs have already identified that joint committees/working groups should be established in the following areas: - Commissioning Support - Performance - Quality & Patient Safety - Investment (especially in relation to investments in primary care to deliver the Out of Hospital strategy) - Information Technology & Information Governance. The role of the Committees is as follows: Commissioning Support To develop a shared view across the collaborative on the SLA between the CCGs and the Commissioning Support Unit (CSU) including the scope of services commissioned. To agree Key Performance Indicators for the SLA and to monitor progress against these. To discuss future direction and opportunities for further partnership working with the Commissioning Support Unit. Performance 6

7 To consider performance issues affecting more than one CCG in the collaborative and recommend remedial actions. Quality & Patient Safety To keep under review and require assurance on issues affecting the quality of all services commissioned across the four CCG s in the collaboration, encompassing patient safety, clinical effectiveness and patient experience. The committee will advise and report to each respective governing body through exception reporting. The committee will seek assurance from the CCG Quality Committees through exception reporting. Areas of specific concern affecting all four CCG s will be discussed at the meeting. Outcomes from the meeting will be fed back to the constituent CCG Quality and Patient Safety Committees and in turn the CCG Executive Boards. Investment To provide a forum for making recommendations relating to decisions where the members of the CCG Boards face conflicts. Information Technology & Information Governance To develop and shape IT strategic developments for the CCGs, for taking back to respective CCGs for decision. To be the Information Governance Committee for each CCG with responsibilities for assuring governing bodies on information governance risk management and compliance. The CCGs have identified Thursday mornings as the best time in the week for the work of the collaborative to take place. All the meetings required to discharge these committees will be fitted into a cycle on Thursdays. In addition it is envisaged that joint committees would be established across the 8 CCGs in NW London in the following areas: - Research - Shaping a Healthier Future (reconfiguration programme), implementation including need to have a financial strategy across the 8 CCGs to ensure this programme can be delivered. This is likely to require the appointment of a team across the 8 CCGs (which would not be included within the 25 per head management cost envelope). Terms of reference exist for each of these joint committees and working groups. The collaborative will adopt an innovative approach to scheduling meetings to maximise the value of the clinical time that will be invested in these. The CCG chairs and relevant members of their Governing Bodies will set aside Thursday mornings to conduct these meetings. Each meeting will contain specific agenda items that require discussion in each of the topic areas so that decisions can be reached in a timely basis. The agenda and membership required for each part of the agenda will be set out clearly. A CCG which is a member of the Collaboration may only leave the Collaboration having given one year s notice. During this time the leaving CCG will work with the remaining CCGs to deal with any implications of their departure. The CCGs will work together to ensure that financial risks are managed. All CCGs in the Collaboration recognise their responsibility to fund the on-going costs of posts that operate across the Collaboration even though they are hosted (employed) by an individual CCG (usually Central London CCG). This includes a responsibility to share any termination costs. In the case of a CCG wishing to leave the Collaboration, all shared costs will be reviewed, staff will transfer according to TUPE rules where appropriate, and any costs associated with restructuring or termination will be shared between all CCGs in the Collaboration. In the event of a significant reduction in the management costs allowance, all CCGs will work together to review local CSU and collaborative structures to ensure that costs can be maintained within the new running costs allowance, taking care to ensure that no individual CCG is disproportionately affected. 7

8 A CCG may join the Collaboration only with the agreement of all the existing members of the Collaboration. Financial Risk Sharing The CCGs have made a risk sharing agreement which covers the following: 1) West London and Central London CCGs share risk relating to errors in the setting of the baseline for Queen s Park and Paddington; 2) Levels of acute over performance that a CCG cannot manage through internal acute reserves; 3) High cost episodes of care that are unpredictable and difficult to budget, such as critical care, some continuing care and some children s services. Further documentation This document forms part of a suite of documents to put in place sound governance. This includes: The terms of reference for the joint committees and working groups referred to in this document CCG constitutions / and committee structure which refer to and link with this collaboration agreement and the shared management arrangements that have been put in place CCGs individual clinical leadership and management structures to enable each to effectively deliver CSU Service Level Agreement setting out the commissioning services that the CCGs wish to purchase from the CSU. Agreements across the 8 CCGs that relate in particular to implementing the Shaping a Healthier Future reconfiguration programme 8