islington clinical commissioning group wednesday, 3 april 2013 … · clinical procurement policy...

AGENDA – PART I

Lead Action required

Appendix Page

1. Introduction 1.1 Apologies for Absence

and Declarations of Interest

Chair Note Oral --

1.2 Chair’s Introduction and Opening Remarks

Chair Note Oral --

1.3 Part 1 and Part 2 Minutes of the Meeting held on 6 March 2013

Chair For approval

Appendix 1.3a / 1.3b

1-12

1.4 Matters Arising Chair -- Oral -- 1.5 Questions from the Public Chair -- Oral --

NB: Members of the public will be given the opportunity to ask questions. These must relate to items that are on the agenda for this meeting and should not take longer than three minutes per person.

2. Islington Clinical Commissioning Group Constitution and Appendices

Appendix 2

Islington Clinical Commissioning Group Constitution

Director of Quality and Integrated Governance

For re-adoption

13-214

Standing Orders


For approval

Appendix D 69-82

Scheme of Reservation and Delegation

Director of Finance For approval

Appendix E 83-108

Prime Financial Policies Director of Finance For approval

Appendix F 109-120

The Nolan Principles Director of Quality and Integrated Governance

For re-adoption

Appendix G 109-12

The Seven Key Principles of the NHS Constitution


For re-adoption

Appendix H 121

Audit Committee Terms of Reference


For approval

Appendix I 123-127

Remuneration Committee Terms of Reference

Director of Quality and Integrated

For approval

Appendix J 128-130

Islington Clinical Commissioning Group Governing Body Wednesday, 3 April 2013 10.30-12.30pm Conference Room, Laycock Professional Development Centre, Laycock Street, N1 1TH


Appendix Page

Governance Quality and Performance

Committee Terms of Reference


For approval

Appendix K 131-134

Strategy and Finance Committee Terms of Reference


For approval

Appendix L 135-137

Patient and Public Participation Committee Terms of Reference


For approval

Appendix M 138-140

Clinical Procurement Policy

Director of Finance For re-adoption

Appendix N 141-160

Codes of Conduct Director of Quality and Integrated Governance

Appendix O 161-210

a) Code of Conduct for NHS Managers

For re-adoption

161-165

b) Standards of Business Conduct

For re-adoption

166-176

c) Code of Accountability for NHS Boards

For re-adoption

177-182

d) Code of Conduct for Trust Board Members

For re-adoption

183-187

e) Code of Practice on Openness in the NHS

For re-adoption

188-208

f) Code of Conduct: Managing conflicts of interests where GP practices are potential providers of CCG-commissioned services

For re-adoption

201-210

3. Risk Management Appendix 3 Risk Management Director of Quality

and Integrated Governance

For discussion

213-222

4. Policies Appendix 4 Policy Adoption including:

• Gifts & Hospitality

and Declarations of Interest Policy

• Individual Funding


For adoption

223-276


Appendix Page

Request Policy

5. Adoption of the Seal and Register of Interests Appendix 5 Adoption of the Seal and

Register of Interests Director of Quality and Integrated Governance

For adoption

Appendix 5a 277-282

6. Date of Next Meeting – 1 May 2013, 10.30-12:30pm

REGISTER OF INTERESTS A register of members’ interests is available. The register will be available at the

meeting or during working hours within the Executive Office, Islington Borough Office, 338-346 Goswell Road, London EC1V 7LQ

PART II MEETINGS To resolve that as publicity on items contained in Part II of the agenda would be

prejudicial to public interest by reason of their confidential nature, representatives of the press and members of the public should be excluded from the remainder of the meeting. Section 1 (2) Public Bodies (Admission to Meetings) Act 1960

NHS North Central London is a collaborative working arrangement between Barnet, Camden, Haringey, Enfield and Islington Primary Care Trusts.

Minutes – Part 1 Meeting of the Islington Shadow Clinical Commissioning Group Governing Body

6 March 2013 at 10:30am Seminar Room 5, London Resource Centre

Members Present: Dr Gillian Greenhough Chair, Islington Shadow Clinical Commissioning Group Dr Sharon Bennett Central Locality GP representative Alison Blair Chief Officer Sorrel Brookes Non-Executive Director (PCT) / Lay member (CCG) Dr Anjan Chakraborty North Locality GP representative Dr Katie Coleman Joint Vice Chair (Clinical) Jennie Hurley Practice Nurse representative Dr Sabin Khan Co-opted Salaried / Sessional GP Dr Rathini Ratnavel South Locality GP representative Dr Jo Sauvage Joint Vice Chair (Clinical) Dr Karen Sennett South Locality GP representative Deborah Snook Practice Manager representative Anne Weyman Vice Chair (PCT) / Vice Chair – non-clinical (CCG) Non-Voting Members Present:

Dr Robbie Bunt LMC Representative Simon Galczynski Director of Adult Social Care and Health, London Borough of Islington Jacky Kutner Interim Director of Information and Performance Sophie Lusby Associate Director of Strategic Commissioning and Planning Gerry McMullan Health Watch Observer Paul Sinden Director of Commissioning In Attendance: Paula Kahn Chair of NHS North Central London (Islington PCT) Jonathan O’Sullivan Deputy Director of Public Health (for Julie Billett) Apologies: Dr Mo Akmal Secondary Care Clinician Julie Billett Joint Director of Public Health for Camden and Islington Martin Machray Director of Quality and Integrated Governance Minutes: Sharon Jackson Board Secretary

Appendix: 1.3a ICCG GB - 1


1. INTRODUCTION Action 1.1 Apologies for Absence: The apologies were noted as above. Declaration of interests The Chair noted a potential conflict of interest for those on the Governing Body

working in GP practices for agenda item 4.1, the equality objectives. She further noted the updated Register of Interests and advised that members would be asked to complete new forms for the 2013/14 register.

1.2 Chair’s Introduction and Opening Remarks 1.2.1 The Chair welcomed all to the meeting in public of the NHS Islington CCG

Governing Body. She advised that this would be the last meeting to be attended by Jacky Kutner and Gerry McMullan and thanked them on behalf of the Governing Body and the CCG.

1.2.2 The Chair welcomed Paula Kahn, Chair of NHS North Central London, to the

meeting and thanked her for her contribution to improving healthcare in Islington. Paula Kahn wished the CCG well for the future and noted her confidence in its ability to achieve its goals.

1.2.3 With regard to the recent publicity about Section 75 of the Health and Social Care

Act, the Chair welcomed the decision for it to be revised and noted the CCG’s intention to be involved in shaping future arrangements. The matter had raised issues for Islington CCG about how it could influence policy to ensure improvements for patients locally.

1.3 Part 1 and Part 2 Minutes of the Meeting held on 5 December 2012 1.3.1 The part 1 and part 2 minutes were APPROVED as an accurate record of the

meeting subject to a change to the attendance. Sophie Lusby and Jacky Kutner should be recorded as ‘in attendance’ rather than ‘Non-voting members present’.

1.3.2 The Governing Body reviewed the action log and noted those marked as

completed. Action 12/12-6 on diagnostic tariffs had been removed from the log in error however it was noted as completed.

1.4 Matters Arising 1.4.1 There were no matters arising. 1.5 Questions from the Public 1.5.1 The Chair invited questions from the public which related to the agenda. 1.5.2 A member of public thanked the Governing Body for listening to previous

comments about part 2 meetings. She expressed concern about the proposed closures and reduction of nursing capacity at the Whittington prior to community services being developed enough to support the resulting additional activity. Alison Blair agreed to respond to this under agenda item 2.1, the Chief Officer’s Report.

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1.5.3 A member of the public noted concern about the effect of personal budgets on

care in the community for mental health patients. It was agreed that the issue would be discussed outside the meeting.

1.5.6 ACTION 03/13-1: To get contact details from the member of public raising

concerns about personal budgets. SJ

2. OVERVIEW REPORTS 2.1 Chief Officer’s Report 2.1.1 Alison Blair presented her report which provided an update to the Governing Body

on issues that were not elsewhere on the agenda.

2.1.2 Alison Blair noted the need for transitional arrangements for decision making prior

to the full establishment of the Governing Body at its meeting on 3 April 2013. It was proposed to delegate authority to the Chair, Chief Officer, Audit Chair and an appropriate director to take decisions in line with standing orders and these would be reported back to the next meeting of the Governing Body for ratification. It was noted that no decisions were planned for that period.

2.1.3 Alison Blair advised that Islington CCG would be required to authorise a transfer

scheme for contracts, assets and liabilities prior to the next meeting of the Governing Body. It was proposed to delegate authority to the Chair and Chief Officer to approve the transfer schemes under Chair’s action.

2.1.4 The Governing Body were updated on progress with the recruitment of the Joint

Medical Director which was to be a joint appointment with Camden CCG and was out to advert at that time. The post would provide an independent primary care clinical voice for the CCG and would support the primary care strategy.

2.1.5 Alison Blair reported that the Whittington Health was progressing with its

application for Foundation Trust status. The application had been delayed to allow time to develop its plans in more detail and to improve its stakeholder engagement. Islington CCG was generally supportive of the Trust’s strategic direction and it was noted that it was important that Whittington was a viable organisation long term as it was a key part of the plans for integrated care and care closer to home. In response to the question from the public, it was noted that quality of care and patient safety was paramount. The CCG was investing to ensure services were established and there was capacity for the activity moving out of hospitals.

2.1.6 With regard to NHS 111, Alison Blair noted the service would be launched publicly

on 12 March 2013. This had been delayed to ensure the telephone service had capacity to cope with demand. It was noted that the communications team were working with NHS North Central London to ensure the correct message was sent out. It was further noted that there had been no significant change in patient flows since the soft launch.

2.1.7 Alison Blair noted that there was a part 2 item to discuss the draft risk pooling

arrangements with other CCGs in the North Central London cluster. The outcome of the discussions would be reported back to a future meeting.

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2.1.6 The Governing Body: • NOTED the report; • APPROVED the arrangements for decision-making prior to the full

establishment of the CCG on 3 April 2013; and • DELEGATED AUTHORITY to the Chair and Chief Officer to approve the

Transfer Schemes under Chair’s action.

3. PERFORMANCE AND FINANCE 3.1 Integrated Quality, Finance and Performance Report – Period ending 31

January 2013

3.1.1 Ahmet Koray presented the finance section of the paper and noted for the record

that the report covered the period ending 31 January 2013. Islington CCG had delivered a surplus of £823,000 which was £66,000 above plan, leaving a cumulative surplus of £13.1million at month 10. The forecast outturn was £18million surplus and there were plans in place to mitigate this down to the control total of £9.1million surplus. There had been £800,000 Quality, Innovation, Productivity and Prevention (QIPP) savings made in January with forecast savings of £8million for the year against a plan of £13.5million. This was below plan due to slippage across the programmes and the UCLH QIPP stretch target.

3.1.2 In response to a question about progress against the investment plan for 2012/13,

Ahmet Koray advised that he was confident that most of the plan would be delivered by the end of March. A significant part of the investment was allocated to clearing the PCT balances which would help the CCG in future years.

3.1.3 Jacky Kutner presented the performance element of the report and noted there

had been some errors on the scorecard which would be re-issued for the record. She highlighted key areas of concern or improvement:

• 4 hour waits in Accident & Emergency (A&E) – There had been concerns with both University College London Hospitals (UCLH) NHS Foundation Trust and Whittington Health who were not maintaining the required levels consistently. Islington CCG was working closely with both Trusts to address the issues.

• Health visiting – Significant progress had been made in ensuring new birth visits took place within 14 days. There had also been an increase in the number of health visitors, although the target had not yet been achieved.

• 6 week waits for diagnostics – There had been an issue with the endoscopy services at both main providers. There was particular concern with Whittington Health and a serious incident had been raised to ensure there had been no patient harm. Dr Anjan Chakraborty was on the Clinical Review Panel and would report back to the next meeting on this matter.

3.1.4 Jacky Kutner reported that a range of key performance indicators (KPIs) were

being developed to support the service level agreement with the Commissioning Support Unit. She also noted, in response to a question about the detail behind the increase in GP referred first outpatient attendances, that from 1 April 2013 information would be provided to GPs on a monthly or quarterly basis depending on requirements.

3.1.5 It was suggested that an executive summary of the report be developed for the

public. Dr Katie Coleman advised that work had begun on an executive summary that was to be disseminated to patient and public participation groups.

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3.1.6 There was concern about the breach of 62 days referral to treatment for cancer. Jacky Kutner agreed to raise this at the special deep dive meeting to review cancer waits.

3.1.3 The Governing Body NOTED the report. 3.1.4 ACTION 03/13-2: To re-issue the performance scorecard for the record. JK ACTION 03/13-3: To report back to the next meeting on the findings of the

Clinical Review Panel on the issues with endoscopy services at Whittington Health.

AC

ACTION 03/13-4: To raise the issue of the breach of 62 days to referral to treatment for cancer at the deep dive meeting to review cancer waits.

JK

4. GOVERNANCE AND ASSURANCE 4.1 Equality Objectives 4.1.1 Dr Katie Coleman, Chair of the Patient and Public Participation Group, advised

that the CCG had a statutory obligation to set an equality objective for 2013/14. It was proposed to set three objectives which had been developed using the Department of Health’s Equality Delivery System which were: Access barriers due to language, cultural or disability within GP practices; Commission hospitals in North central London to improve access to healthcare for people with a learning disability, and people on the autism spectrum; and improve the data about our staff to identify patterns of potential discrimination and publish the data in the next annual equality report.

4.1.2 In response to a question about how information was captured from workshops,

Dr Katie Coleman advised that there had been a useful discussion at the Patient and Public Participation Working Group about the complaints process and how the CCG would ensure information was collected and responded to appropriately.

4.1.3 The Governing Body APPROVED the equality objectives for 2013/14. 4.2 Emergency Planning Arrangements 4.2.1 Sophie Lusby outlined the responsibilities for the CCG and noted the changes in

arrangements across the NHS with regard to emergency planning. Responsibility for surge planning would remain with the CCG. The Commissioning Support Unit had set up an on-call rota which had commenced from 18 February 2013 and Alison Blair, Paul Sinden and Martin Machray were on the on-call list. The NHS Commissioning Board was responsible for major incident planning and would require the CCG to coordinate the local response to a major incident. An incident room would be made available at Goswell Road.

4.2.2 With regard to section 2.3.1 increased demand under pressure surge

management arrangements, it was noted that NHS 111 should be the first access point for urgent care.

4.2.3 The Governing Body:

• NOTED the new arrangements; and • APPROVED the adoption of responsibilities as agreed in the Memorandum

of Understanding for emergency planning.

4.3 Francis Report – Process for Review of Recommendations

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4.3.1 Alison Blair presented the paper on behalf of Martin Machray and noted that the

Francis Report had raised a number of issues for the CCG in terms of oversight of quality and safety, and the availability of information. It was proposed to hold a series of discussions and events with stakeholders including member practices, patient groups and staff based around a set of questions. A quality framework would be developed from these discussions to address the issues.

4.3.2 The Governing Body commented on the process and reflected on issues that

needed to be taken in to account including: • Each provider had a Clinical Quality Review Group. The main contacts for

these should be publicised better. • Clinical Quality Review Groups should discuss how providers were

responding to the Francis Report. • Care homes should be considered in the processes for providers. • It was important to develop a culture that allowed thinking time for the

Governing Body. • The Joint Quality Committee across the CCGs in the North Central London

cluster would look at issues, complaints, patient stories, infection control and serious incidents. It was important to set this meeting up as soon as possible.

• Review of information needed to happen at both ends of the spectrum, through ‘soft intelligence’ from patients and GPs, but also through high level review of data to identify outliers.

• The report focused on hospitals and older people but the learning should be applied across the whole health system.

• The serious incident tracker for Clinical Quality Review Groups should include issues around soiled beds.

• There needed to be clear whistle-blowing processes. • A nursing strategy was being developed and would provide a framework to

be clear about what good looks like.


• ENDORSED the approach for considering the findings and recommendations of the Francis Report;

• NOTED that further reports would be received on the Francis Report and the development of a quality framework for the CCG.

4.4 Governance and Quality Group Report on the Meeting held on 26 February

2013

4.4.1 Sorrel Brookes, Chair of the Governance and Quality Group, provided an oral

update on the business of the Group. She reported that there had been a detailed discussed on the report from the Camden and Islington NHS Foundation Trust Clinical Quality Review Group. Meetings were held more frequently and were attended by senior members of staff and service users. The Group had also been assured that the Winterbourne View action plan was progressing well.

4.4 Patient and Public Participation Group Report of the Meeting held on 28

February 2013

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4.4.1 Dr Katie Coleman, Chair of the Committee, provided an oral update on the business of the Group and noted that discussions had centred on the equality objectives, complaints, patient experience and how information was captured.

5. STRATEGY 5.1 Operating Plan 2013/14 5.1.1 Paul Sinden provided an update on the development of the Operating Plan for

2013/14 which set out how the CCG would work towards its strategic objectives. In the new system the CCG would have a higher risk profile than the PCT due to the portfolio of services that remained in its remit and would be more financially challenged. The draft financial plan would deliver a 1% surplus including a 0.5% contingency for in-year cost pressures and a 2% top slice for risk pooling and service transformation.

5.1.2 Paul Sinden reported that risks to delivery of the financial targets included the

national changes to the commissioning system and also the alignment of contracts to providers with the move of services to other parts of the system such as the Local Authority or NHS Commissioning Board. All three parties would need to attend contract negotiations.

5.1.3 There was a discussion about the Quality Premium. It was noted that, in addition

to the agreed Quality Premium measures, payments were subject to the delivery of standards in the NHS Constitution such as 4 hour waits and 18 weeks referral to treatment. Payment was reduced by 25% for each national requirement that was not met.

5.1.4 In response to a question about whether local Trusts would meet the pre-

qualification criteria for Commissioning for Quality and Innovation (CQUIN) payments, Paul Sinden advised that it was anticipated that local providers would be eligible.

5.1.5 Contract negotiations had been delayed until the allocations from the unified PCT

budget had been agreed. Financial envelopes had been sent out to providers later than usual but the contracts team were still working to have all the contracts agreed by the end of March.


• NOTED progress on developing the Operating Plan for 2013/14; • APPROVED the QIPP savings and investment plan for 2013/14; • NOTED the performance framework set out in the Operating Plan for

2013/14; and • APPROVED the three local indicators for inclusion in the 2013/14 Quality

Premium.

5.2 Cancer Commissioning – Future Systems 5.2.1 Dr Karen Sennett, clinical lead on cancer, presented the report on London

Cancer’s Case for Change for specialist urological cancer pathways. She reported that there was good clinical evidence to support the centralisation of complex surgery. It was noted that the changes would benefit Islington residents as the proposed centres were nearby.

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5.2.2 With regard to more common cancers it was agreed that there would need to be strong evidence to support the case for change if it was proposed to centralise these services.

5.2.2 There was a discussion about patient and public involvement in the consultation.

It was noted that the consultation should only go to patient groups if there was the possibility to affect change.


• NOTED the new commissioning systems for cancer; and • APPROVED the proposed changes to the urology pathway for London

Cancer providers in North Central London, North East London and the City, and West Essex.

6. FOR INFORMATION 7.1 Approved Minutes of the Finance and Performance Group 7.1.1 The Governing Body RECEIVED the minutes from the January meeting of the

Finance and Performance Group.

7.2 Approved Minutes of the Governance and Quality Group 7.2.1 The Governing Body RECEIVED the minutes from the December meeting of the

Governance and Quality Group.

7.3 Approved Minutes of the Patient and Public Participation Group 7.3.1 The Governing Body RECEIVED the minutes from the December meeting of the

Patient and Public Participation Group.

7.4 Primary Care Information Technology (IT) Update 7.4.1 The Governing Body NOTED the report which was for information. 8. ANY OTHER BUSINESS 8.1 There was none. 9. DATE OF NEXT MEETING 9.1 Wednesday, 3 April 2013

These minutes are agreed to be a correct record of the meeting of the Islington

Shadow Clinical Commissioning Group Board held on 6 March 2013

Signed: ………………………………………. Date: ………………………….

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Minutes – Part 2 Meeting of the Islington Shadow Clinical Commissioning Group Governing Body

6 March 2013 at 12:30pm Seminar Room 5, London Resource Centre

Members Present: Dr Gillian Greenhough Chair, Islington Shadow Clinical Commissioning Group Dr Sharon Bennett Central Locality GP representative Alison Blair Chief Officer Sorrel Brookes Non-Executive Director (PCT) / Lay member (CCG) Dr Anjan Chakraborty North Locality GP representative Dr Katie Coleman Joint Vice Chair (Clinical) Jennie Hurley Practice Nurse representative Dr Sabin Khan Co-opted Salaried / Sessional GP Dr Rathini Ratnavel South Locality GP representative Dr Jo Sauvage Joint Vice Chair (Clinical) Dr Karen Sennett South Locality GP representative Deborah Snook Practice Manager representative Anne Weyman Vice Chair (PCT) / Vice Chair – non-clinical (CCG) Non-Voting Members Present:

Dr Robbie Bunt LMC Representative Simon Galczynski Director of Adult Social Care and Health, London Borough of Islington Jacky Kutner Interim Director of Information and Performance Sophie Lusby Associate Director of Strategic Commissioning and Planning Gerry McMullan Health Watch Observer Paul Sinden Director of Commissioning In Attendance: Paula Kahn Chair of NHS North Central London (Islington PCT) Jonathan O’Sullivan Deputy Director of Public Health (for Julie Billett) Apologies: Dr Mo Akmal Secondary Care Clinician Julie Billett Joint Director of Public Health for Camden and Islington Martin Machray Director of Quality and Integrated Governance Minutes: Sharon Jackson Board Secretary

Appendix: 1.3b ICCG GB - 9

8. Financial Risk Share Action 8.1 Ahmet Koray presented the proposal for a risk sharing agreement with the five

CCGs in the North Central London cluster required for the CCG’s authorisation as a statutory body. The risk share balance was £55.9million of which Islington CCG’s contribution amounted to £12million. This included pooling the 2% top slice of Islington’s allocation and a share of the PCT surplus. As part of the agreement Islington would have access to funds for primary care strategy implementation, the running cost error and funding the transformational change programme at the Whittington, as well as covering risk in 2013/14.

8.2 There was a discussion about the error in the running costs allowance made by

NHS North Central London. The issue had been flagged with the Cluster and escalated to the NHS Commissioning Board. The five CCGs in the Cluster would continue to lobby the NHS Commissioning Board.

8.3 Ahmet Koray advised that the £14.8million of unallocated funds would be

accessed through a bidding process following the principles of the previous “Challenged Trust Board”. There was concern about the governance processes for approval of access to the risk pool. It was agreed these would be worked up in more detail and the final agreement would be presented to a future meeting.

8.4 The Governing Body noted Ahmet Koray’s achievement in negotiating the risk

share agreement to ensure a reasonable way forward for Islington CCG.

8.5 The Governing Body:

· APPROVED in principle the risk share proposal, subject to further work on governance processes; and

· DELEGATED AUTHORITY to the Chair, Chief Officer and Chief Finance Officer to approve any changes following other CCG Governing Body discussions.

8.6 ACTION 03/13-5: To present the final risk sharing agreement to a future meeting. AK

These minutes are agreed to be a correct record of the meeting of the Islington Shadow Clinical Commissioning Group Board Part 2 meeting held on 6 March 2013

Signed: ………………………………………. Date: ………………………….

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Appendix: 1.3c

Meeting Date Action No. Minutes Reference Action Description Responsibility Target Date Progress details

06/02/2013 02/13-1 1.5 Questions from the Public

To meet with 38 Degrees to discuss the Islington CCG Constitution.

Martin Machray Martin Machray has had a phone call with 38 Degrees who advised that they were not yet ready to meet and would be in touch.

06/03/2013 03/13-1 1.5 Questions from the Public

To get contact details from the member of public raising concerns about personal budgets.

Sharon Jackson Action completed.

06/03/2013 03/13-2 3.1 Integrated Quality, Finance and Performance Report – Period ending 31 January 2013

To re-issue the amended performance scorecard for the record.

Jacky Kutner Action completed.


To report back to the next business meeting on the findings of the Clinical Review Panel on the issues with endoscopy services at Whittington Health.

Dr Anjan Chakraborty

May-13


To raise the issue of the breach of 62 days to referral to treatment for cancer at the deep dive meeting to review cancer waits.

Jacky Kutner Action completed.

ACTION LOG: Islington Clinical Commissioning Group Governing Body - Part I

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MEETING: Islington Clinical Commissioning Group Governing Body DATE: Wednesday, 3 April 2013 TITLE: Islington CCG Constitution and Appendices LEAD DIRECTOR: Martin Machray, Director of Quality and Integrated Governance AUTHOR: Sharon Jackson, Board Secretary CONTACT DETAILS:

[email protected]

SUMMARY: This report presents the Islington Clinical Commissioning Group (CCG) Constitution for adoption as part of establishing the CCG as a statutory organisation from 1 April 2013. The Constitution sets out the arrangements made by Islington CCG to meet its responsibilities for commissioning health care for the residents of Islington. The Constitution was originally adopted in October 2012 and at that time it was agreed to review it in 2013. That is still the intention but at this point the original constitution is presented with minor amendments only to reflect the organisational and governance arrangements as at establishment. The appendices to the Constitution have been updated since it was adopted by the Governing Body at its meeting in October to ensure that the CCG is established correctly in line with national guidance. It should be noted that there have been no changes to the intent of the Constitution, which would require approval by the membership of the CCG, however there have been some technical amendments to reflect the establishment of the new committee structure (Section 6.5.4 of the Constitution). Appended to the Constitution are the:

· Standing Orders; · Prime Financial Policies; · Scheme of Delegation and Reservation; · Codes of conduct; · Governing Body committee terms of reference; and · Clinical Health Care Procurement Policy.

SUPPORTING PAPERS: Appendix 2a: Islington Clinical Commissioning Group Constitution RECOMMENDED ACTION: The Governing Body is asked to:

· APPROVE the Standing Orders; · APPROVE the Scheme of Reservation and Delegation; · APPROVE the Prime Financial Policies; · RE-ADOPT the Nolan Principles;

Appendix: 2 ICCG GB - 13

· APPROVE the terms of reference for the: o Audit Committee o Remuneration Committee o Quality and Performance Committee o Strategy and Finance Committee o Patient and Public Participation Committee

· RE-ADOPT the Clinical Healthcare Procurement Policy; and · RE-ADOPT the codes of conduct including:

o Code of Conduct for NHS Managers o Standards of Business Conduct for NHS Staff o Code of Accountability for NHS Boards o Code of Conduct for Trust Board Members o Code of Practice on Openness in the NHS o Code of Conduct: Managing conflicts of interest where GP practices are

potential providers of CCG-commissioned services; · RE-ADOPT the Islington CCG Constitution.

GOVERNANCE:

Members with voting rights Members without voting rights Dr Gillian

Greenhough Chair

Simon

Galczynski Local Authority Representative

Alison Blair Chief Officer

Vacant Health Watch Representative

Dr Jo Sauvage/Dr Katie Coleman

Joint Vice Chairs (Clinical) Robbie Bunt LMC Representative

Dr Sharon Bennett Central Locality GP Representative

Paul Sinden Director of Commissioning

Dr Karen Sennett South Locality GP Representative

Dr Rathini Ratnavel South Locality GP Representative


North Locality GP Representative

Dr Sabin Khan Salaried GP Representative

Deborah Snook Practice Manager Representative

Jennie Hurley Practice Nurse Representative

Sorrel Brookes Lay Member

Anne Weyman Lay Member Vice Chair (Non-clinical)

Julie Billett Joint Director of Public Health for Camden

and Islington

Ahmet Koray Chief Finance Officer

Martin Machray Director of Quality & Integrated Governance

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Dr Mo Akmal

Secondary Care Representative

Objective(s) / Plans supported by this paper: The vision, mission statement and desired strategic outcomes for the Clinical Commissioning Group are supported by this paper. Audit Trail: All member practices have been consulted on and signed up to the Constitution. It was last adopted by the Governing Body on 3 October 2012. Due to the technical amendments to establish the committees of the Governing Body, the updated version of the Constitution will be circulated to member practices. Patient & Public Involvement (PPI): The requirement to involve patients and the public is encapsulated within the constitution. Equality Impact Assessment: The document is based on the model constitution issued by the Department of Health to support the enactment of the 2012 Health and Social Care Act. There is no adverse impact on Equality and Diversity. Risks: No new risks have been identified from this paper. Resource Implications: No new resource consequences have been identified. Next Steps: During 2013, views and opinions on the constitution will be sought from across the membership, stakeholders and the public. Dependent upon the responses received, recommendations will be developed for consideration. On the Procurement Policy, members will know that guidance and case law are leading to changes in the approach to clinical procurement and a revised policy will be developed over the coming months. In the meantime members are asked to adopt the current policy.

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1. INTRODUCTION

This report presents the Islington Clinical Commissioning Group (CCG) Constitution for adoption in order to establish the CCG as a statutory organisation from 1 April 2013. The Constitution sets out the arrangements made by Islington CCG to meet its responsibilities for commissioning health care for the residents of Islington.

2. APPENDICES TO THE CONSTITUTION

The Constitution is supported by a number of appendices which provide the governance arrangements by which the organisation works. In order for the Governing Body to adopt the Constitution these appendices must be approved first.

2.1. Appendices D, E, and F: Standing Orders, Scheme of Reservation and

Delegation, and Prime Financial Policies

These documents provide the procedural framework within which Islington CCG discharges its business.

· Standing Orders – The standing orders outline the arrangements for conducting the CCG’s business including the appointment of members, meeting procedures and processes for the delegation of powers and declarations of interest.

· Scheme of Reservation and Delegation – this document outlines the powers and decisions that are reserved to the membership and the Governing Body, and the powers that have been delegated to officers or committees.

· Prime Financial Policies – These policies set out the control environment for managing the organisation’s financial affairs.

The Governing Body is asked to approve these documents.

2.2. Appendix G: Nolan Principles

The ‘Nolan Principles’ set out the ways in which holders of public office should behave in discharging their duties.

The Governing Body is asked to re-adopt these principles.

2.3. Appendix H: The Seven Key Principles of the NHS Constitution

The Governing Body is asked to re-adopt the seven key principles of the NHS Constitution.

2.4. Appendix I, J, K, L M: Committee Terms of Reference

A review of governance arrangements was undertaken in the autumn of 2012 and the committee structure at table 1 was approved at the December meeting of the Governing Body. In addition to the two statutorily required committees (Audit Committee and Remuneration Committee) it was agreed to establish three further committees which are: the Quality and Performance Committee; the Strategy and Finance Committee and the Patient and Public Participation Committee. Terms of

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reference have been developed in consultation with Governing Body and Committee members. The Governing Body is asked to approve these terms of reference. Table 1:

2.5. Appendix N: Clinical Healthcare Procurement Policy

The Clinical Healthcare Procurement Policy sets out the principles and processes Islington CCG will use to ensure its clinical procurements are fair and transparent. It covers issues such as provider engagement, market management, sustainability, contestability and service specification.

The Governing Body are asked to adopt the policy.

2.6. Appendix O: Codes of Conduct

The Governing Body is asked to re-adopt the codes of conduct. These have previously been adopted by the Governing Body at its meeting on 3 October 2013. These are nationally defined documents and some of the wording is outdated, however the intent remains the same. These are the:

· Code of Conduct for NHS Managers · Standards of Business Conduct for NHS Staff · Code of Accountability for NHS Boards · Code of Conduct for Trust Board Members · Code of Practice on Openness in the NHS · Code of Conduct: Managing conflicts of interest where GP practices are

potential providers of CCG-commissioned services

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The Governing Body is asked to re-adopt these codes of conduct.

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NHS ISLINGTON CLINICAL COMMISSIONING GROUP

CONSTITUTION

Version: 2.0


2

CONTENTS

Part Description Page Foreword 5 1 Introduction and Commencement 7 1.1 Name 7 1.2 Statutory framework 7 1.3 Status of this Constitution 7 1.4 Amendment and variation of this Constitution 8 2 Area Covered 8 3 Membership 8 3.1 Membership of Islington CCG 8 3.2 Eligibility 9 3.3 Termination of membership 9 4 Mission, Values and Aims 9 4.1 Mission 9 4.2 Values 9 4.3 Aims 10 4.4 Principles of good governance 10 4.5 Accountability 11 5 Functions and General Duties 12 5.1 Functions 12 5.2 Other relevant regulations, directions and documents 12 6 Decision Making: The Governing Structure 13 6.1 Authority to act 13 6.2 Scheme of reservation and delegation 13 6.3 General 13 6.4 Joint arrangements 14 6.5 The Governing Body 15 7 Roles and Responsibilities 17 7.1 Role of member practice representatives 18 7.2 Role of other GPs or primary care health professionals 18 7.3 All members of the Islington CCG’s Governing Body 18 7.4 Role of the chair of the Governing Body 19 7.5 Role of the statutory vice chair of the Governing Body 20 7.6 Role of the lay member with a lead role in overseeing key elements

of governance 20

7.7 Role of the lay member with a lead role in championing patient and public participation

20

7.8 Role of the Vice Chair (Clinical) 21

7.9 Role of locality GP representatives 21 7.10 Role of salaried / sessional GP representative 21 7.11 Role of practice manager representative 21 7.12 Role of executive nurse 21

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Part Description Page 7.13 Role of practice nurse representative 22 7.14 Role of the Chief Officer 22 7.15 Role of the Chief Finance Officer 23 7.16 Role of secondary care specialist 23 7.17 Role of the Local Medical Committee representative 23 7.18 Role of other representatives 24 7.19 Joint appointments with other organisations 24 8 Standards of Business Conduct and Managing Conflicts of Interest 24 8.1 Standards of business conduct 24 8.2 Conflicts of interest 25 8.3 Declaring and registering interests 26 8.4 Managing conflicts of interest: general 27 8.5 Managing conflicts of interest: contractors and people who provide

services to Islington CCG 29

8.6 Transparency in procuring services 29 9 Islington CCG as Employer 30 10 Transparency, Ways of Working and Standing Orders 31 10.1 General 31 10.2 Standing orders 31 11 Islington CCG and its Member Practices 32 11.1 Communication and engagement with member practices 32 11.2 Governing Body GP Link 32 11.3 Principles of Collaborative working 32 11.4 Dispute resolution between member practices and Islington CCG as

a whole 34

Appendix Description Page A Definitions of Key Descriptions used in this Constitution 36 B List of Member Practices and Signatures 38 C Functions and General Duties of Islington CCG 40 D Standing Orders 51 E Scheme of Reservation and Delegation 65 F Prime Financial Policies 91 G The Nolan Principles 103 H The Seven Key Principles of the NHS Constitution 104 I Terms of Reference for Audit Committee 105 J Terms of Reference for Remuneration Committee 110 K Terms of Reference for Quality and Performance Committee 113 L Terms of Reference for Strategy and Finance Committee 116 M Terms of Reference for Patient and Public Participation Committee 120 N Clinical Procurement Policy 124 O Codes of Conduct

· Code of Conduct for NHS Managers · Standards of Business Conduct for NHS Staff

144 144 149

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· Code of Accountability for NHS Boards · Code of Conduct for Trust Board Members · Code of Practice on Openness in the NHS · Code of Conduct: Managing conflicts of interest where GP

practices are potential providers of CCG-commissioned services

161 167 172 186

P Member practices and attached Governing Body GP Link 195

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FOREWORD Every GP practice within the boundaries of the London Borough of Islington has elected to join the NHS Islington Shadow Clinical Commissioning Group, which became NHS Islington Clinical Commissioning Group (Islington CCG) on 1 April 2013. This Constitution was agreed in preparation for authorisation of Islington CCG. This Constitution applied from 21 February 2013, the date that the NHS Commissioning Board authorised Islington CCG. It will be treated as binding between the member practices with effect from that date. Each member practice has agreed to the terms of this Constitution. Each member agrees that it is a member of Islington CCG and will adhere to, and work in accordance with its terms. Additionally, those members of the Governing Body are ultimately accountable to Islington CCG as a collective, i.e. its member practices. In January 2011, each practice in Islington agreed to the following mission statement:

“As practices we are committed to working together as a Clinical Commissioning Group to ensure our communities receive the best evidence based care possible within the available resources. We will strive to ensure that patients’ views are heard and that their journey through our local health system is seamless through integration and partnership working”.

In addition to this, Islington CCG’s vision is:

“To develop a new partnership between patients and their clinicians that together commissions health services of high quality and good value for money and meets the needs of the population of Islington.”

At the heart of the vision for the Islington CCG is a strong clinically-driven local commissioning organisation that puts patients first and gives them a voice. There is a strong commitment to engaging and involving local people in decision making about how services are commissioned and with what outcomes. The vision recognises the current challenging economic environment and the need to reduce spend, especially in secondary care, by transforming and improving quality, impact and access to services. This means that the Islington CCG will have a vital role in developing and delivering the local Operating Plan. Member practices within the Islington CCG also appreciate the uniqueness of the local population with its significant levels of health inequality, and believe that as clinical leaders they are uniquely positioned to tackle these issues. Islington CCG will engage patients and the public on an ongoing basis when undertaking commissioning responsibilities. In turn, member practices will be supported to work closely with the patients and local communities they serve, by using Islington’s Healthwatch, and engaging with locality patient participation groups and community partners. Islington CCG will aim to improve patients’ experiences and health outcomes in a financially and clinically sustainable way by:

· Ensuring a patient centred approach to planned care, in particular the development of integrated approaches to management of long term conditions

· Promoting and improving patients’ self management both in the primary and secondary care interface

· Developing Integrated Primary Care teams including primary, community, mental health and social care services

· Developing models of care encompassing the diverse needs of our population which includes using public health intelligence in the commissioning cycle, seeking to address healthcare needs and priorities through joint working with the Health and Wellbeing Board and the Commissioning Framework including JSNA.

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· Provide leadership to both local health system and NHS Islington CCG by ensuring that clinical leadership is at the heart of our decision making.

· Being accountable for the effective use of resources and provision of high quality services by developing financial and performance management capability to deliver QIPP goals, clear commissioning plans, ensuring performance management systems are in place and having effective governance arrangements and management of quality.

The Constitution sets out the arrangements made by Islington CCG to meet its responsibilities for commissioning care for the residents of Islington, from the point it is agreed by its member practices, and beyond when it becomes a statutory organisation on 1 April 2013. It describes the governing principles, rules and procedures that Islington CCG will establish to ensure probity and accountability in the day to day running of Islington CCG; to ensure that decisions are taken in an open and transparent way and that the interests of patients and the public remain central to the goals of Islington CCG. The Constitution applies to the following, all of whom are required to adhere to it as a condition of their appointment: · Islington CCG’s member practices; · Islington CCG’s employees; · individuals working on behalf of Islington CCG; · anyone who is a member of Islington CCG’s Governing Body (including the Governing Body’s audit

and remuneration committees); · anyone who is a member of any other committee(s) or sub-committees established by Islington CCG

or its Governing Body. From time to time the structures and processes referred to in this Constitution may be subject to change, at which point such amendments will be made to this document and: · taken back to member practices for their approval of those amendments; and · sent to the NHS Commissioning Board for approval. This Constitution provides a clear, explicit, engaging basis on which to develop Islington CCG for the benefit of patients, carers and residents.

Alison Blair Dr Gillian Greenhough Chief Officer, Islington CCG Chair, Islington CCG

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1. INTRODUCTION AND COMMENCEMENT

1.1. Name 1.1.1. The name of this clinical commissioning group is NHS Islington Clinical

Commissioning Group (Islington CCG). 1.2. Statutory Framework 1.2.1. Clinical commissioning groups are established under the Health and Social Care Act

2012 (“the 2012 Act”).1 They are statutory bodies which have the function of commissioning services for the purposes of the health service in England and are treated as NHS bodies for the purposes of the National Health Service Act 2006 (“the 2006 Act”).2 The duties of clinical commissioning groups to commission certain health services are set out in Section 3 of the 2006 Act, as amended by Section 13 of the 2012 Act, and the regulations made under that provision.3

1.2.2. The NHS Commissioning Board is responsible for determining applications from

prospective groups to be established as clinical commissioning groups4 and undertakes an annual assessment of each established group.5 It has powers to intervene in a clinical commissioning group where it is satisfied that a group is failing or has failed to discharge any of its functions or that there is a significant risk that it will fail to do so.6

1.2.3. Clinical commissioning groups are clinically led membership organisations made up of

general practices. The members of the clinical commissioning group are responsible for determining the governing arrangements for their organisations, which they are required to set out in a Constitution.7

1.3. Status of this Constitution 1.3.1. This Constitution is made between the members of Islington CCG and has effect from

21 February 2013 when the NHS Commissioning Board established the group.8

1.3.2. This Constitution will be reviewed annually. 1.3.3. This Constitution will also be made available to patients and the public via the

following means:

a) It will be published on Islington CCG’s website at www.Islington.nhs.uk;

1 See section 1I of the 2006 Act, inserted by section 10 of the 2012 Act 2 See section 275 of the 2006 Act, as amended by paragraph 140(2)(c) of Schedule 4 of the 2012 Act 3 Duties of clinical commissioning groups to commission certain health services are set out in section 3 of the

2006 Act, as amended by section 13 of the 2012 Act 4 See section 14C of the 2006 Act, inserted by section 25 of the 2012 Act 5 See section 14Z16 of the 2006 Act, inserted by section 26 of the 2012 Act 6 See sections 14Z21 and 14Z22 of the 2006 Act, inserted by section 26 of the 2012 Act 7 See in particular sections 14L, 14M, 14N and 14O of the 2006 Act, inserted by section 25 of the 2012 Act

and Part 1 of Schedule 1A to the 2006 Act, inserted by Schedule 2 to the 2012 Act and any regulations issued

8 See section 14D of the 2006 Act, inserted by section 25 of the 2012 Act

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b) It will be made available upon request for inspection at our head office:

Islington Clinical Commissioning Group Headquarters 338-346 Goswell Road LONDON EC1V 7LQ

c) It will be made available upon application by post to the address provided above, or by email to [email protected]

d) It will be made available at local Islington libraries.

1.4. Amendment and Variation of this Constitution 1.4.1. This Constitution can only be varied in two circumstances:9

a) where Islington CCG applies to the NHS Commissioning Board and that application is granted;

b) where in the circumstances set out in legislation the NHS Commissioning Board

varies Islington CCG’s Constitution other than on application by Islington CCG.

1.4.2. An application pursuant to 1.4.1 (a) for an amendment to this Constitution may only be made where it has been approved by the Governing Body, and in the case of an amendment which affects the rights liabilities or duties of the Members, by an ordinary resolution of the Members.

2. AREA COVERED 2.1. The geographical area covered by Islington CCG is the London Borough of Islington.

2.2. The population covered by the Constitution and represented by Islington CCG is in the

first instance determined by people assigned to Islington General Practice Lists in line with Responsible Commissioner Guidance from the Department of Health. The same access to services will, in addition, be offered to Islington residents not assigned to a General Practice List.

3. MEMBERSHIP 3.1. Membership of Islington CCG 3.1.1. Islington CCG is comprised of all of the GP practices whose premises is located within

the geographical boundary of the Local Borough of Islington, and is available at Appendix B.

9 See sections 14E and 14F of the 2006 Act, inserted by section 25 of the 2012 Act and any regulations

issued

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3.2. Eligibility 3.2.1. Providers of primary medical services to a registered list of patients under a General

Medical Services, Personal Medical Services or Alternative Provider Medical Services contract whose premises is situated within the geographical boundary of the Local Borough of Islington will be eligible to apply for membership of Islington CCG10.

3.3. Termination of Membership

3.3.1. Membership of Islington CCG will automatically terminate where a practice ceases to hold a contract to provide primary medical services;

3.3.2. Islington CCG or its Governing Body may not expel practices on any grounds.

4. MISSION, VALUES AND AIMS

4.1. Mission 4.1.1. Islington CCG’s mission statement, which was agreed to by all member practices in

January 2011 is as follows: “As practices we are committed to working together as a Clinical Commissioning Group to ensure our communities receive the best evidence based care possible within the available resources. We will strive to ensure that patients’ views are heard and that their journey through our local health system is seamless through integration and partnership working”.

4.1.2. In addition, Islington CCG’s vision is:

“To develop a new partnership between patients and their clinicians that together commissions health services of high quality and good value for money and meets the needs of the population of Islington.”

4.1.3. Islington CCG will promote good governance and proper stewardship of public resources in pursuance of its goals and in meeting its statutory duties.

4.2. Values 4.2.1. Good corporate governance arrangements are critical to achieving Islington CCG’s

objectives. 4.2.2. The values that lie at the heart of Islington CCG’s work are:

a) Islington CCG will strive to deliver the best high quality, seamless, evidence-based

care for its local people;

b) Islington CCG will put patients at the heart of the NHS, and build partnerships with them, empowering patients with the ability to self manage where it is appropriate;

10 See section 14A(4) of the 2006 Act, inserted by section 25 of the 2012. Regulations to be made

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c) Islington CCG will commit to engaging its patients, public, and stakeholders in a meaningful way when carrying out its commissioning functions;

d) Islington CCG will value strong working and stable relationships and partnerships with other organisations;

e) Islington CCG will value clinical input in all it does;

f) Islington CCG will support and encourage education and training for its members;

g) Islington CCG will strive to work in a flexible and innovative way;

h) Islington CCG will strive to tackle health inequalities;

i) Islington CCG will strive to deliver the greatest value from every NHS pound

invested.

4.3. Aims 4.3.1. Islington CCG’s aims are the following:

a) Ensuring a patient centred approach to planned care, in particular the

development of integrated approaches to management of long term conditions

b) Promoting and improving patients’ self management both in the primary and secondary care interface

c) Developing Integrated Primary Care teams including primary, community, mental health and social care services

d) Developing models of care encompassing the diverse needs of our

population which includes using public health intelligence in the commissioning cycle, seeking to address healthcare needs and priorities through joint working with the Health and Wellbeing Board and the Commissioning Framework including JSNA.

e) Providing leadership to both local health system and Islington CCG –

Ensuring that clinical leadership is at the heart of our decision making

f) Being accountable for the effective use of resources and provision of high quality services – by developing financial and performance management capability to deliver QIPP goals, clear commissioning plans, ensuring performance management systems are in place and having effective governance arrangements and management of quality.

4.4. Principles of Good Governance

4.4.1. In accordance with section 14L(2)(b) of the 2006 Act,11 Islington CCG will at all times

observe “such generally accepted principles of good governance” in the way it conducts its business. These include:

11 Inserted by section 25 of the 2012 Act

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a) the highest standards of propriety involving impartiality, integrity and objectivity in

relation to the stewardship of public funds, the management of the organisation and the conduct of its business;

b) The Good Governance Standard for Public Services;12

c) the standards of behaviour published by the Committee on Standards in Public

Life (1995) known as the ‘Nolan Principles’13

d) the seven key principles of the NHS Constitution;14

e) the Equality Act 2010.15

4.5. Accountability 4.5.1. Islington CCG will demonstrate its accountability to its members, local people,

stakeholders and the NHS Commissioning Board in a number of ways, including by:

a) publishing its Constitution;

b) appointing 2 independent lay members and 2 non GP clinicians to its Governing Body;

c) holding meetings of its Governing Body in public (except where Islington CCG

considers that it would not be in the public interest in relation to all or part of a meeting);

d) consulting on and publishing for each year a commissioning plan;

e) complying with local authority health overview and scrutiny requirements;

f) meeting annually in public to publish and present its annual report (which must be

published);

g) producing annual accounts in respect of each financial year which must be externally audited;

h) having a published and clear complaints process;

i) complying with the Freedom of Information Act 2000;

j) complying with the 2012 Act in having a representative sit on the Health and

Wellbeing Board, and cooperating with the Health and Wellbeing Board in the exercise of that Board’s functions.

12 The Good Governance Standard for Public Services, The Independent Commission on Good Governance in

Public Services, Office of Public Management (OPM) and The Chartered Institute of Public Finance & Accountability (CIPFA), 2004

13 See Appendix G 14 See Appendix H 15 See http://www.legislation.gov.uk/ukpga/2010/15/contents

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k) providing information to the NHS Commissioning Board as required;

l) working in partnership with the NHS Commissioning Board to improve the quality of primary medical care and specialised services, as required by the NHS Commissioning Board;

m) being subject to the powers of Healthwatch, as detailed under the 2012 Act.

4.5.2. In addition to these statutory requirements, Islington CCG will demonstrate its

accountability by:

a) declaring conflicts of interests that arise in the course of conducting NHS business. A register of Islington CCG members’ interests will be held and will be available to the public;

b) holding engagement events with various key stakeholders including Health and Wellbeing Board, local authority, providers, voluntary groups and the public;

c) publishing its principal commissioning strategies and operating policies;

d) behaving with the utmost transparency and responsiveness at all times.

4.5.3. Islington CCG’s Governing Body will throughout each year have an ongoing role in

reviewing Islington CCG’s governance arrangements to ensure that it continues to reflect the principles of good governance.

5. FUNCTIONS AND GENERAL DUTIES 5.1. Functions 5.1.1. The functions that Islington CCG is responsible for exercising are largely set out in the

2006 Act, as amended by the 2012 Act. The functions, along with how they will be discharged by Islington CCG, are set out in Appendix C of this Constitution.

5.2. Other Relevant Regulations, Directions and Documents 5.2.1. Islington CCG will

a) comply with all relevant regulations;

b) comply with directions issued by the Secretary of State for Health or the NHS

Commissioning Board; and

c) take account, as appropriate, of documents issued by the NHS Commissioning Board.

5.2.2. Islington CCG will develop and implement the necessary systems and processes to comply with these regulations and directions, documenting them as necessary in this Constitution, its scheme of reservation and delegation and other relevant Islington CCG policies and procedures.

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6. DECISION MAKING: THE GOVERNING STRUCTURE 6.1. Authority to act 6.1.1. Islington CCG is accountable for exercising the statutory functions of Islington CCG. It

may grant authority to act on its behalf to:

a) any of its members;

b) its Governing Body;

c) employees;

d) a committee or sub-committee of the Islington CCG;

e) its Chief Officer;

f) any other officer of Islington CCG. 6.1.2. The extent of the authority to act of the respective bodies and individuals depends on

the powers delegated to them by Islington CCG as expressed through:

a) Islington CCG’s scheme of reservation and delegation; and

b) for committees, their terms of reference. 6.2. Scheme of Reservation and Delegation16 6.2.1. Islington CCG’s scheme of reservation and delegation sets out:

a) those decisions that are reserved for the membership as a whole;

b) those decisions that are the responsibilities of its Governing Body (and its committees), Islington CCG’s committees and sub-committees, individual members and employees.

6.2.2. Islington CCG remains accountable for all of its functions, including those that it has

delegated. 6.3. General 6.3.1. In discharging functions of Islington CCG that have been delegated to its Governing

Body (and its committees), committees, joint committees, sub committees and individuals must:

a) comply with Islington CCG’s principles of good governance,17

16 See Appendix E 17 See section 4.4 on Principles of Good Governance above

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b) operate in accordance with the Islington CCG’s Scheme of Reservation and Delegation,18

c) comply with Islington CCG’s Standing Orders,19

d) comply with Islington CCG’s arrangements for discharging its statutory duties,20

e) where appropriate, ensure that member practices have had the opportunity to

contribute to Islington CCG’s decision making process. 6.3.2. When discharging their delegated functions, committees, sub-committees and joint

committees must also operate in accordance with their approved terms of reference. 6.3.3. Where delegated responsibilities are being discharged collaboratively, the joint

(collaborative) arrangements must:

a) identify the roles and responsibilities of those clinical commissioning groups who are working together;

b) identify any pooled budgets and how these will be managed and reported in

annual accounts;

c) specify under which clinical commissioning group’s scheme of reservation and delegation and supporting policies the collaborative working arrangements will operate;

d) specify how the risks associated with the collaborative working arrangement will

be managed between the respective parties;

e) identify how disputes will be resolved and the steps required to terminate the working arrangements;

f) specify how decisions are communicated to the collaborative partners.

6.4. Joint Arrangements

6.4.1. Islington CCG has joint committees with Islington local authority:

a) Islington Children’s and Families Partnership Board;

6.4.2. Islington Local Authority has the following committees, on which representatives of Islington CCG sit: a) Islington Health and Wellbeing Board;

b) Islington Safeguarding Adults Partnership Board;

c) Islington Safeguarding Children’s Board.

18 See appendix E 19 See appendix D 20 See chapter 5 above

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6.5. The Governing Body 6.5.1. Functions - the Governing Body has the following functions conferred on it by

sections 14L(2) and (3) of the 2006 Act, inserted by section 25 of the 2012 Act, together with any other functions connected with its main functions as may be specified in regulations or in this Constitution.21 The Governing Body has responsibility for:

a) ensuring that Islington CCG has appropriate arrangements in place to exercise its

functions effectively, efficiently and economically and in accordance with Islington CCG’s principles of good governance22 (its main function);

b) determining the remuneration, fees and other allowances payable to employees or

other persons providing services to Islington CCG and the allowances payable under any pension scheme it may establish under paragraph 11(4) of Schedule 1A of the 2006 Act, inserted by Schedule 2 of the 2012 Act;

c) approving any functions of Islington CCG that are specified in regulations;23

d) leading the setting of vision and strategy;

e) approving commissioning plans;

f) monitoring performance against plans;

g) providing assurance of strategic risk;

h) approving consultation arrangements for Islington CCG’s commissioning plan;

i) agreeing the timetable for producing the annual report and accounts;

j) any further functions that are set out in the Scheme of Reservation and

Delegation. 6.5.2. Composition of the Governing Body - the Governing Body shall not have less than

19 members and comprises:

a) the Chair (Clinical lead) (voting member); b) two lay members (voting members), one of whom is the statutory vice chair and of

whom: i) one is to lead on audit, remuneration and conflict of interest matters, ii) one is to lead on patient and public participation matters;

c) Vice Chair (Clinical) (voting member);

d) four locality GP representatives (voting members), who represent as follows:

21 See section 14L(3)(c) of the 2006 Act, as inserted by section 25 of the 2012 Act 22 See section 4.4 on Principles of Good Governance above 23 See section 14L(5) of the 2006 Act, inserted by section 25 of the 2012 Act

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i) one North locality GP representative;

ii) one Central locality GP representative;

iii) two South locality GP representatives; which, in subsequent elections will be

one representative from South-East Islington, and one representative from South-West Islington;

e) one salaried / sessional GP representative (voting member);

f) one practice manager representative (voting member);

g) one executive nurse (voting member);

h) one practice nurse representative (voting member);

i) the Chief Officer (voting member),

j) the Chief Finance Officer (voting member);

k) one secondary care specialist doctor (non-voting member, subject to guidance);

l) Local Medical Committee observer (non-voting member);

m) three other individuals:

i) Director of Public Health (non-voting member);

ii) Healthwatch Observer (non-voting member);

iii) Local Authority Representative (non-voting member).

6.5.3. The above means that there are fourteen voting members on the Governing Body,

seven of which are general practitioners, and the other seven of which are drawn from other professions, with the Chair, who is also a GP, having the casting vote.

6.5.4. Committees of the Governing Body - the Governing Body has appointed the

following committees and sub-committees: a) Audit Committee – the Audit Committee, which is accountable to Islington CCG’s

Governing Body, provides the Governing Body with an independent and objective view of the Islington CCG’s financial systems, financial information and compliance with laws, regulations and directions governing Islington CCG in so far as they relate to finance. The Governing Body has approved and keeps under review the terms of reference for the Audit Committee, which includes information on its membership 24.

b) Remuneration Committee – the Remuneration Committee, which is accountable

to Islington CCG’s Governing Body, makes recommendations to the Governing

24 See Appendix I for the terms of reference of the Audit Committee

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Body on determinations about the remuneration, fees and other allowances for employees not on a national tariff and for people who provide services to Islington CCG and on determinations about allowances under any pension scheme that Islington CCG may establish as an alternative to the NHS pension scheme. The Governing Body has approved and keeps under review the terms of reference for the Remuneration Committee, which includes information on its membership25.

c) Quality and Performance Committee – the Governance and Quality Committee,

which is accountable to Islington CCG’s Governing Body, provides assurance on matters of quality, patient safety and performance of all services commissioned by, or on behalf, of Islington CCG. The Governing Body has approved and keeps under review the terms of reference for the Quality and Performance Committee, which includes information on its membership26.

d) Strategy and Finance Committee - the Strategy and Finance Committee, which

is accountable to Islington CCG’s Governing Body, provides oversight of financial performance and associated planning issues. It provides assurance that systems for financial control and for ensuring value for money within the Islington CCG operate effectively. This includes understanding of financial risk with appropriate management action and mitigation, and oversight of the development and delivery of the Commissioning Strategy Plan and the Quality, Innovation, Productivity and Prevention (QIPP) plan. The Governing Body has approved and keeps under review the terms of reference for the Strategy and Finance Committee, which includes information on its membership27.

e) Patient and Public Participation Committee – the Patient and Public

Participation Committee, which is accountable to the Governing Body, ensures that patient and public involvement, engagement and communications, as well as the Equality and Diversity Strategy is entrenched in the workings of Islington CCG. The Governing Body has approved and keeps under review the terms of reference for the Patient and Public Participation Committee, which includes information on its membership28.

6.5.5. Committees will only be able to establish their own sub-committees to assist them in

discharging their respective responsibilities, if this responsibility has been delegated to them by Islington CCG or the committee to which they are accountable.

7. ROLES AND RESPONSIBILITIES 7.1. Role of Member Practice Representatives 7.1.1. Member practice representatives represent their member practice’s views and act on

behalf of the practice in matters relating to Islington CCG. The role of each practice representative is to:

25 See Appendix J for the terms of reference of the Remuneration Committee 26 See Appendix K for the terms of reference of the Quality and Performance Committee 27 See Appendix L for the terms of reference of the Strategy and Finance Committee 28 See Appendix M for the terms of reference of the Patient and Public Participation Committee

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a) enable communications between member practices (within either the North, Central, or South locality to which they belong, or more generally across Islington), and between their own practice and Islington CCG’s Governing Body and other committees;

b) discuss and debate the views and wishes of their practice;

c) agree priorities for commissioning and review progress of commissioning with their

practice;

d) aid communication between the practices and health and social care providers through the delivery of integrated care;

e) encourage other members of the team both clinical and non-clinical to attend open

meetings and focus events which will be held by Islington CCG;

f) act as main contact to ensure their whole practice is engaged in the Governing Body link process ;

g) act as main conduit by which commissioning information from Islington CCG or the

Governing Body is communicated back to their practice members as appropriate;

h) make decisions on behalf of the member practice, with the ability to consult with the other members of their own practice where necessary.

7.2. Role of Other GP and Primary Care Health Professionals 7.2.1. In addition to the practice representatives identified in Section 7.1 above, Islington

CCG will identify a number of other GPs / primary care health professionals from member practices to either support the work of Islington CCG and / or represent Islington CCG rather than represent their own individual practices. These GPs and primary care health professionals will undertake the following roles on behalf of the Islington CCG: a) Various Islington Clinical Commissioning Partners, including GPs and practice

nurses as needed, to provide clinical advice, support, and leadership to various clinical work streams.

7.3. All Members of the Islington CCG’s Governing Body 7.3.1. Guidance on the roles of members of the Islington CCG’s Governing Body is set out in

a separate document29. In summary, each member of the Governing Body should share responsibility as part of a team to ensure that Islington CCG exercises its functions effectively, efficiently and economically, with good governance and in accordance with the terms of this Constitution. Each brings their unique perspective, informed by their expertise and experience.

29 Draft clinical commissioning group Governing Body Members – Roles Attributes and Skills, NHS

Commissioning Board Authority, March 2012

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7.4. Role of the Chair of the Governing Body 7.4.1. In addition to general responsibilities of all Governing Body members, the chair of the

Governing Body is responsible for:

a) leading the Governing Body, ensuring it remains continuously able to discharge its duties and responsibilities as set out in this Constitution;

b) building and developing Islington CCG’s Governing Body and its individual members;

c) ensuring that Islington CCG has proper Constitutional and governance arrangements in place;

d) ensuring that, through the appropriate support, information and evidence, the Governing Body is able to discharge its duties;

e) supporting the Chief Officer in discharging the responsibilities of the organisation;

f) contributing to building a shared vision of the aims, values and culture of the organisation;

g) providing overall strategic leadership and direction to Islington CCG;

h) leading and influencing clinical and organisational change to enable Islington CCG

to deliver its commissioning responsibilities;

i) overseeing governance, particularly ensuring that the Governing Body and the wider Islington CCG behaves with the utmost transparency and responsiveness at all times (led by Chair, delivered by Governing Body);

j) ensuring that public and patients’ views are heard and their expectations understood and, where appropriate as far as possible, met (led by Chair, delivered by Governing Body);

k) ensuring that the organisation is able to account to its local patients, stakeholders and the NHS Commissioning Board (led by Chair, delivered by Governing Body);

l) leading the formation, development, and maintenance of effective key partnerships by Islington CCG, particularly with the individuals involved in overview and scrutiny from the relevant local authority/ies (led by Chair, delivered by Governing Body);

m) ensuring that member practices are involved and engaged in Islington CCG’s

business (led by Chair, delivered by Governing Body);

n) taking clinical leadership for improving quality in primary care (led by Chair, delivered by Governing Body);

7.4.2. Where the chair is also the lead clinician, the chair will also be responsible for:

a) being the senior clinical voice of Islington CCG in interactions with all stakeholders including the NHS Commissioning Board; and

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b) having the respect and authority of the member practices.

7.5. Role of the Statutory Vice Chair of the Governing Body 7.5.1. In addition to general responsibilities of all Governing Body members, the vice chair of

Islington CCG is a lay member of the Governing Body, and is responsible for

a) deputising for the chair where he or she has a conflict of interest or is otherwise unable to act, and hence delivering the responsibilities of the Chair in that interim period in which they are deputising;

b) taking a lead in either overseeing key elements of governance under Section 7.6, or championing patient and public involvement under Section 7.7.

7.6. Role of the lay member with a lead role in overseeing key elements of governance

7.6.1. In addition to general responsibilities of all Governing Body members, the lay member

of the Governing Body with the lead role in overseeing key elements of governance is responsible for:

a) bringing specific expertise and experience to the work of the Governing Body, as

well as their insight as a member of the local community; b) providing strategic and impartial focus, so as to provide an external view of the

work of Islington CCG that is removed from the day-to-day running of the organisation;

c) overseeing key elements of governance including audit, remuneration and

managing conflicts of interest;

d) chairing the Audit Committee;

e) Ensuring the Governing Body and the wider Islington CCG behaves with the utmost probity at all times.

7.7. Role of the lay member with a lead role in championing patient and public

participation 7.7.1. In addition to general responsibilities of all Governing Body members, the lay member

of the Governing Body with the lead role in championing patient and public participation is responsible for:

a) bringing specific expertise and experience to the work of the Governing Body, as

well as their insight as a member of the local community; b) providing strategic and impartial focus, so as to provide an external view of the

work of Islington CCG that is removed from the day-to-day running of the organisation;

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c) helping to ensure that the public voice of the local population is heard in all aspects of Islington CCG’s business, and that opportunities are created and protected for patient and public empowerment in the work of Islington CCG;

d) ensuring that public and patients’ views are heard and their expectations

understood and met as appropriate;

e) ensuring that Islington CCG builds and maintains an effective relationship with Local Healthwatch and draws on existing patient and public engagement and involvement expertise; and

f) ensuring that Islington CCG has appropriate arrangements in place to secure

public and patient involvement. 7.8. Role of Vice Chair (Clinical)

7.8.1. In addition to general responsibilities of all Governing Body members, the vice chair

(clinical), as elected by his/her peers and accountable to Islington CCG via its member practices, is responsible for: a) acting as a representative and leader for Islington GPs;

b) having the respect and authority of the member practices.

7.9. Role of locality GP representatives 7.9.1. In addition to general responsibilities of all Governing Body members, the locality GP

representatives, as elected by their peers and accountable to Islington CCG via its member practices, are responsible for:

a) acting as representatives and leaders for their locality.

7.10. Role of salaried / sessional GP representative 7.10.1. In addition to general responsibilities of all Governing Body members, the salaried /

sessional GP representative, as elected by his/her peers and accountable to Islington CCG via its member practices, is responsible for:

a) acting as a representative and a leader for sessional / salaried GPs in Islington.

7.11. Role of practice manager representative 7.11.1. In addition to general responsibilities of all Governing Body members, the practice

manager representative, as elected by his/her peers and accountable to Islington CCG via its member practices, is responsible for:

a) acting as a representative and a leader for practice managers in Islington.

7.12. Role of executive nurse

7.12.1. In addition to general responsibilities of all Governing Body members, the executive

nurse on the Governing Body is responsible for:

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a) bringing a broader view, from their perspective as a registered nurse, on health

and care issues to underpin the work of Islington CCG, especially the contribution of nursing to patient care.

7.13. Role of practice nurse representative 7.13.1. In addition to general responsibilities of all Governing Body members, the practice

nurse on the Governing Body as elected by his/her peers and accountable to Islington CCG via its member practices, is responsible for:

a) bringing a broader view, from their perspective as a registered nurse, on health

and care issues to underpin the work of Islington CCG, especially the contribution of nursing to patient care.

b) acting as a representative and a leader for practice nurses in Islington.

7.14. Role of the Chief Officer 7.14.1. The Chief Officer of Islington CCG is a member of the Governing Body; he/she is

accountable to the Chair, the Governing Body, and to the NHS Commissioning Board.

7.14.2. In addition to general responsibilities of all Governing Body members, this role of Chief Officer has been summarised in a national document30 as: a) being responsible for ensuring that Islington CCG fulfils its duties to exercise its

functions effectively, efficiently and economically thus ensuring improvement in the quality of services and the health of the local population whilst maintaining value for money;

b) being responsible for setting strategic direction;

c) ensuring at all times that the regularity and propriety of expenditure is discharged, and that arrangements are put in place to ensure that good practice (as identified through such agencies as the Audit Commission and the National Audit Office) is embodied and that safeguarding of funds is ensured through effective financial and management systems;

d) working closely with the chair of the Governing Body, the Chief Officer will ensure that proper constitutional, governance and development arrangements are put in place to assure the members (through the Governing Body) of the organisation’s ongoing capability and capacity to meet its duties and responsibilities. This will include arrangements for the ongoing developments of its members and staff;

e) Fulfilling all duties required under statute or order of the Secretary of State, guidance from the NHS Commissioning Board and direction of the Governing Body that ensures good governance.

30 See the latest version of the NHS Commissioning Board Authority’s Clinical commissioning group governing

body members: Role outlines, attributes and skills

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7.15. Role of the Chief Finance Officer 7.15.1. The Chief Finance Officer is a member of the Governing Body, accountable to the

Chair, the Governing Body, and to the NHS Commissioning Board. In addition to general responsibilities of all Governing Body members, he/she is responsible for providing financial advice to Islington CCG and for supervising financial control and accounting systems.

7.15.2. This role of Chief Finance Officer has been summarised in a national document31 as: a) being the Governing Body’s professional expert on finance and ensuring, through

robust systems and processes, the regularity and propriety of expenditure is fully discharged;

b) making appropriate arrangements to support, monitor and report on Islington CCG’s finances;

c) overseeing robust audit and governance arrangements leading to propriety in the use of Islington CCG’s resources;

d) being able to advise the Governing Body on the effective, efficient and economic use of Islington CCG’s allocation to remain within that allocation and deliver required financial targets and duties;

e) producing the financial statements for audit and publication in accordance with the statutory requirements to demonstrate effective stewardship of public money and accountability to the NHS Commissioning Board; and

f) Fulfilling all duties required under statute or order of the Secretary of State, guidance from the NHS Commissioning Board and direction of the Governing Body that ensures good governance.

7.16. Role of secondary care specialist 7.16.1. In addition to general responsibilities of all Governing Body members, the secondary

care specialist on the Governing Body is responsible for:

a) bringing a broader view from their perspective as a specialist doctor, on health and care issues to underpin the work of Islington CCG;

b) bringing an understanding of patient care in the secondary care setting.

7.17. Role of Local Medical Committee representative

7.17.1. In addition to general responsibilities of all Governing Body members, the

representatives for the Local Medical Committee is responsible for: a) bringing a broader view from their perspective as a statutory representative of the

local medical profession;

31 See the latest version of the NHS Commissioning Board Authority’s Clinical commissioning group governing

body members: Role outlines, attributes and skills

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7.18. Role of other representatives 7.18.1. In addition to general responsibilities of all Governing Body members, the

representatives for public health, the Local Medical Committee, Healthwatch, and local authority is responsible for:

a) bringing a broader view from their perspective as a representative from their body,

on health and care issues to underpin the work of Islington CCG. 7.19. Joint Appointments with other Organisations 7.19.1. Islington CCG has the following joint appointments with other organisations:

a) Joint posts employed by Islington CCG:

i) Children’s Commissioning managers;

ii) Commissioning Manager, Prison Health;

iii) Commissioning Manager;

iv) Senior Joint commissioning manager;

v) Safeguarding policy officer.

b) Joint posts not employed by Islington CCG:

i) Assistant Director of Strategic Commissioning;

ii) Head of Joint Commissioning – joint appointment with Islington local

authority;

iii) Senior Commissioning Manager Islington Children’s Partnership;

iv) Senior Commissioning Manager, Substance Misuse;

v) Director Of Children’s Services. 7.19.2. All these joint appointments are supported by either a Section 75 agreement, a

Section 256 agreement, or a memorandum of understanding between the organisations who are party to these joint appointments.

8. STANDARDS OF BUSINESS CONDUCT AND MANAGING CONFLICTS OF INTEREST

8.1. Standards of Business Conduct 8.1.1. Employees, members, committee and sub-committee members of Islington CCG and

members of the Governing Body (and its committees) will at all times comply with this Constitution and be aware of their responsibilities outlined within it. They should act in

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good faith and in the interests of Islington CCG and should follow the Seven Principles of Public Life, set out by the Committee on Standards in Public Life (the Nolan Principles), which are incorporated into this Constitution at Appendix G.

8.1.2. They must comply with Islington CCG’s policy on business conduct, including the requirements set out in the policy for managing conflicts of interest. This policy will be available on Islington CCG’s website at www.Islington.nhs.uk.

8.1.3. Individuals contracted to work on behalf of Islington CCG or otherwise providing

services or facilities to Islington CCG will be made aware of their obligation with regard to declaring conflicts or potential conflicts of interest. This requirement will be written into their contract for services.

8.2. Conflicts of Interest 8.2.1. As required by Section 14O of the 2006 Act, as inserted by Section 25 of the 2012 Act,

Islington CCG will make arrangements to manage conflicts and potential conflicts of interest to ensure that decisions made by Islington CCG will be taken and seen to be taken without any possibility of the influence of external or private interest.

8.2.2. Where an individual, i.e. an employee, member practice, member of the Governing Body, or a member of a committee or a sub-committee of Islington CCG or its Governing Body has an interest, or becomes aware of an interest which could lead to a conflict of interests in the event of Islington CCG considering an action or decision in relation to that interest, that must be considered as a potential conflict, and is subject to the provisions of this Constitution.

8.2.3. A conflict of interest refers to any relevant and material personal or business interests

or positions of influence for themselves and those connected with them, which may influence or be perceived to influence their judgment. Relevant and material interests include:

a) Directorships, including non-executive directorships held in private companies or

PLCs (with the exception of those of dormant companies);

b) Ownership or part-ownership of companies, businesses or consultancies save that shareholdings of less than 5% of a publicly quoted company need not be registered;

c) Partnership, employment or holding a contract for services whether current or

prospective, other than with Islington CCG itself;

d) A position of authority (e.g. employee or trustee) in a charity or voluntary or social enterprise organisation in the field of health and social care;

e) Any connection with a voluntary or other organisation contracting for NHS

services;

f) Research funding/grants that may be received by an individual or their department or by Islington CCG or by their Practice;

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g) Interests in pooled funds that are under separate management (any relevant company included in this fund that has a potential relationship with any of the PCTs must be declared);

h) Any interests that arise from any joint working arrangements, or similar, such as

with the local authority;

i) Any interest that they (if they are registered with the General Medical Council) would be required to declare in accordance with paragraph 55 of the GMC’s publication Management for Doctors or any successor guidance;

j) Any interest that they (if they are registered with the Nursing and Midwifery

Council) would be required to declare in accordance with paragraph 7 of the NMC’s publication Code of Professional Conduct or any successor code;

k) where an individual is closely related to, or in a relationship, including friendship,

with an individual in the above categories.

8.2.4. If in doubt, the individual concerned should assume that a potential conflict of interest exists.

8.3. Declaring and Registering Interests 8.3.1. Islington CCG will maintain one or more registers of the interests of:

a) the member practices of Islington CCG; b) the members of its Governing Body;

c) the members of its committees or sub-committees and the committees or sub-

committees of its Governing Body; and

d) its employees. 8.3.2. The register will be made available via the following means:

a) It will be published on the Islington CCG’s website at www.Islington.nhs.uk;



c) It will be made available upon application by post to the address provided above, or by email to [email protected].

8.3.3. Individuals will at any point in time that they become aware of a conflict of interest, or

potential conflict of interest, declare it in writing to the Governing Body, as soon as they are aware of it and in any event no later than 28 days after becoming aware.

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8.3.4. Where a conflict or potential conflict of interest becomes apparent in the course of a meeting, the individual will make an oral declaration before witnesses, and the Chair will decide how to manage that conflict of interest at the time of oral declaration. A written declaration must be provided by that individual as soon as possible thereafter.

8.3.5. The Board Secretary will ensure that the Register of Interests is established and the

Register of Interests is reviewed regularly, and updated as necessary. The Register will be reported to every meeting of the Governing Body.

8.4. Managing Conflicts of Interest: general

8.4.1. Individual members of Islington CCG, the Governing Body, committees or sub-

committees, the committees or sub-committees of its Governing Body and employees will comply with the arrangements determined by Islington CCG for managing conflicts or potential conflicts of interest.

8.4.2. The Chair will ensure that for every interest declared, either in writing or by oral declaration, arrangements are in place to manage the conflict of interests or potential conflict of interests, to ensure the integrity of the Islington CCG’s decision making processes.

8.4.3. Arrangements for the management of conflicts of interest are to be determined at the

discretion of the Chair and will include the requirement to put in writing to the relevant individual arrangements for managing the conflict of interests or potential conflicts of interests, within a week of declaration. The arrangements will confirm the following:

a) when an individual should withdraw from a specified activity, on a temporary or

permanent basis;

b) possible monitoring of the specified activity undertaken by the individual, either by a line manager, colleague or other designated individual where appropriate.

8.4.4. Where an interest has been declared, either in writing or by oral declaration, the

declarer will ensure that before participating in any activity connected with Islington CCG’s exercise of its commissioning functions, they have received confirmation of the arrangements to manage the conflict of interest or potential conflict of interest from the Chair.

8.4.5. Where an individual member, employee or person providing services to Islington CCG

is aware of an interest which:

a) has not been declared, either in the register or orally, they will declare this at the start of the meeting;

b) has previously been declared, in relation to the scheduled or likely business of the meeting, the individual concerned will bring this to the attention of the chair of the meeting, together with details of arrangements which have been confirmed for the management of the conflict of interests or potential conflict of interests;

the chair of the meeting will then determine how this should be managed and inform the member of their decision. Where no arrangements have been confirmed, the chair of the meeting may require the individual to withdraw from the meeting or part of it.

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The individual will then comply with these arrangements, which must be recorded in the minutes of the meeting.

8.4.6. Where the chair of any meeting of Islington CCG, including committees, sub-

committees, or the Governing Body and the Governing Body’s committees and sub-committees, has a personal interest, previously declared or otherwise, in relation to the scheduled or likely business of the meeting, they must make a declaration and the statutory vice chair will act as chair for the relevant part of the meeting. Where arrangements have been confirmed for the management of the conflict of interests or potential conflicts of interests in relation to the chair, the meeting must ensure these are followed. Where no arrangements have been confirmed, the statutory vice chair may require the chair to withdraw from the meeting or part of it. Where there is no statutory vice chair, the members of the meeting will select one.

8.4.7. Any declarations of interests, and arrangements agreed in any meeting of Islington

CCG, committees or sub-committees, or the Governing Body, the Governing Body’s committees or sub-committees, will be recorded in the minutes.

8.4.8. Where more than 50% of the members of a meeting are required to withdraw from a

meeting or part of it, owing to the arrangements agreed for the management of conflicts of interests or potential conflicts of interests, the chair (or deputy) will determine whether or not the discussion can proceed.

8.4.9. In making this decision the chair will consider whether the meeting is quorate, in

accordance with the number and balance of membership set out in Islington CCG’s standing orders. Where the meeting is not quorate, owing to the absence of certain members, the discussion will be deferred until such time as a quorum can be convened. Where a quorum cannot be convened from the membership of the meeting, owing to the arrangements for managing conflicts of interest or potential conflicts of interests, the chair of the meeting shall consult with the Chief Officer on the action to be taken.

8.4.10. This may include:

a) requiring another of the Islington CCG’s committees or sub-committees, the

Islington CCG’s Governing Body or the Governing Body’s committees or sub-committees (as appropriate) which can be quorate to progress the item of business, or if this is not possible;

b) co-opting, on a temporary basis, one or more of the following to make up the quorum (where these are permitted members of the Governing Body or committee / sub-committee in question) so that Islington CCG can progress the item of business:

i) a member of the Islington CCG who is an individual;

ii) an individual appointed by a member to act on its behalf in the dealings

between it and Islington CCG;

iii) a member of a relevant Health and Wellbeing Board;

iv) a member of a Governing Body of another clinical commissioning group.

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c) These arrangements must be recorded in the minutes.

8.4.11. In any transaction undertaken in support of Islington CCG’s exercise of its

commissioning functions (including conversations between two or more individuals, e-mails, correspondence and other communications), individuals must ensure, where they are aware of an interest, that they conform to the arrangements confirmed for the management of that interest. Where an individual has not had confirmation of arrangements for managing the interest, they must declare their interest at the earliest possible opportunity in the course of that transaction, and declare that interest as soon as possible thereafter. The individual must also inform either their line manager (in the case of employees), or the Chair of the transaction.

8.4.12. The Chair will take such steps as deemed appropriate, and request information deemed appropriate from individuals, to ensure that all conflicts of interest and potential conflicts of interest are declared

8.5. Managing Conflicts of Interest: contractors and people who provide services to

Islington CCG 8.5.1. In any tendering or procurement process, Islington CCG will seek undertakings of

compliance with the requirements of good practice and procurement law from interested parties.

8.5.2. Anyone contracted to provide services or facilities directly to Islington CCG will be

subject to appropriate provisions in relation to managing conflicts of interests. This requirement will be set out in the contract for their services.

8.6. Transparency in Procuring Services 8.6.1. Islington CCG recognises the importance in making decisions about the services it

procures in a way that does not call into question the motives behind the procurement decision that has been made. Islington CCG will procure services in a manner that is open, transparent, non-discriminatory and fair to all potential providers.

8.6.2. Islington CCG will publish a Procurement Strategy32 approved by its Governing Body

which will ensure that:

a) all relevant clinicians (not just members of Islington CCG) and potential providers, together with local members of the public, are engaged in the decision-making processes used to procure services, unless clinicians have a relevant and material interest;

b) service redesign and procurement processes are conducted in an open,

transparent, non-discriminatory and fair way. 8.6.3. Copies of this Procurement Strategy will be available via the following means:

a) It will be published on Islington CCG’s website at www.Islington.nhs.uk;

32 See Appendix N – Clinical Procurement policy

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9. ISLINGTON CCG AS EMPLOYER 9.1. Islington CCG recognises that its most valuable asset is its people. It will seek to

enhance their skills and experience and is committed to their development in all ways relevant to the work of Islington CCG group.

9.2. Islington CCG will seek to set an example of best practice as an employer and is

committed to offering all staff equality of opportunity. It will ensure that its employment practices are designed to promote diversity and to treat all individuals equally.

9.3. Islington CCG will ensure that it employs suitably qualified and experienced staff who

will discharge their responsibilities in accordance with the high standards expected of staff employed by Islington CCG. All staff will be made aware of this Constitution, the commissioning strategy and the relevant internal management and control systems which relate to their field of work.

9.4. Islington CCG will maintain and publish policies and procedures (as appropriate) on

the recruitment and remuneration of staff to ensure it can recruit, retain and develop staff of an appropriate calibre. Islington CCG will also maintain and publish policies on all aspects of human resources management, including grievance and disciplinary matters

9.5. Islington CCG will ensure that its rules for recruitment and management of staff

provide for the appointment and advancement on merit on the basis of equal opportunity for all applicants and staff.

9.6. Islington CCG will ensure that employees' behaviour reflects the values, aims and

principles set out above. 9.7. Islington CCG will ensure that it complies with all aspects of employment law. 9.8. Islington CCG will ensure that its employees have access to such expert advice and

training opportunities as they may require in order to exercise their responsibilities effectively.

9.9. Islington CCG will adopt a Code of Conduct33 for staff and will maintain and promote

effective 'whistleblowing' procedures to ensure that concerned staff have means through which their concerns can be voiced.

33 See Appendix O

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9.10. Copies of this Code of Conduct, together with the other policies and procedures outlined in this chapter, will be available via the following means: a) It will be published on Islington CCG’s website at www.Islington.nhs.uk;




10. TRANSPARENCY, WAYS OF WORKING AND STANDING ORDERS 10.1. General 10.1.1. Islington CCG will publish annually a commissioning plan and an annual report,

presenting the Islington CCG’s annual report to a public meeting.

10.1.2. Key communications issued by Islington CCG, including the notices of procurements, public consultations, Governing Body meeting dates, times, venues, and certain papers will be available via the following means: a) It will be published on Islington CCG’s website at www.Islington.nhs.uk;




10.1.3. Islington CCG may use other means of communication, including circulating information by post, or making information available in venues or services accessible to the public.

10.2. Standing Orders 10.2.1. This Constitution is also informed by a number of documents which provide further

details on how Islington CCG will operate. They are Islington CCG’s:

a) Standing orders (Appendix D) – which set out the arrangements for meetings and the appointment processes to elect Islington CCG’s representatives and appoint to Islington CCG’s committees, including the Governing Body;

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b) Scheme of reservation and delegation (Appendix E) – which sets out those decisions that are reserved for the membership as a whole and those decisions that are the responsibilities of Islington CCG’s Governing Body, the Governing Body’s committees and sub-committees, Islington CCG’s committees and sub-committees, individual members and employees;

c) Prime financial policies (Appendix F) – which set out the arrangements for

managing Islington CCG’s financial affairs. 11. ISLINGTON CCG AND ITS MEMBER PRACTICES

11.1. Communication and engagement with member practices

11.1.1. Islington CCG is committed to effective communication and engagement with its

member practices.

11.1.2. We will use locality commissioning forums and other methods as appropriate to communicate, engage, and test strategic ideas and proposals.

11.1.3. Where appropriate Islington CCG will engage with the Local Medical Committee, in a

timely manner, as local statutory representatives of the medical profession. 11.1.4. Where decisions or developments have been made with regards to commissioning or

any issue affecting member practices, it will be the duty of Islington CCG to inform practices in a timely manner. Timely should mean as soon as practicably possible and generally no more than 3 months from the decision, unless there are extenuating circumstances.

11.2. Governing Body GP Link

11.2.1. In order to facilitate communication and engagement between member practices and

the Governing Body, each of the GP members on the Governing Body will act as a Governing Body GP link with a group of practices across Islington34. The aim of the linkage will be as follows: a) To build cohesiveness through the development of relationships between Islington

CCG and constituent practices, facilitating communication and the development of shared values;

b) To develop a primary care led approach to commissioning and engagement so as to ensure that all GPs, Clinicians and whole practice teams are empowered to drive commissioning forward in Islington;

c) To ensure information is available to practices to support their developmental and

educational needs, e.g. mentoring, the strategic needs of the practice, working within the Islington CCG;

34 See Appendix R

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d) Support practices to understand and utilise data to inform daily practice and helping the practice to form developmental goals and action plans where appropriate;

11.2.2. The list detailing linkages between each practice and individual Governing Body

members is available at Appendix R. 11.3. Principles of Collaborative working

11.3.1. The principles in Section 11.3.3 for general practices to work collaboratively in the

localities within Islington CCG are consistent with delivery of Islington CCG’s vision and strategic objectives set out in Section 4 of the Constitution.

11.3.2. The principles in Section 11.3.3 will support Islington CCG’s plans to develop primary and integrated care by building on the strengths of general practice through:

a) Providing more care in the community - investing in GP, practice nurse and front of

house staff training, and providing resources which allow GPs and their teams to improve access and offer a greater range of services;

b) Integrating health and social care by joining up care through alignment of community, mental health, social, and, where appropriate, acute services to the Islington Localities;

c) Recognising the value of generalism and ensuring that evidence based, high

quality, cost effective care is understood, recognised and implemented;

d) Supporting people to gain the knowledge, skills, tools and confidence to become active participants in their own care;

e) Where appropriate, commissioning services through general practice in

accordance with the latest policy and legal requirements.

11.3.3. We as GP member practices of NHS Islington Clinical Commissioning Group are committed to working collaboratively within our agreed Localities towards the following key principles: a) Reducing health inequalities across the registered population of our own locality

as well as across Islington;

b) Ensuring every patient registered with an Islington GP practice has access to all appropriate commissioned services;

c) Ensuring also that non-registered patients resident within Islington’s boundaries

have access to all appropriate commissioned services;

d) Promoting new ways of collaborative working within the established localities as groups of General Practices, and, where appropriate, with other key partners (providers in both the statutory and voluntary sectors), to deliver higher quality and better outcomes for patients as outlined in CCG plans;

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e) Where local services are commissioned from General Practice, consider delivering this at individual practice level and / or where appropriate at a locality level with services delivered through host practices;

f) Promoting high quality services and working collectively to improve standards of

care;

g) Using and promoting appropriate local services within the individual GP practice or directing patients so that they can access those appropriate services from host practices in the localities;

h) Promoting effective use of NHS resources;

i) Enabling patients to identify what is important to them and to obtain the support

they require within available resources so that they are effective in their own self care and their independence is promoted;

j) Embedding the organisational learning and development culture at practice and

locality level through “real learning” from peer-review education programmes and sharing best practice.

11.4. Dispute resolution between member practices and Islington CCG as a whole

11.4.1. As per the Constitution’s Scheme of Reservation and Delegation, the Governing Body

has authority to perform Islington CCG’s functions, or has authority to delegate these functions to its committees as appropriate.

11.4.2. As Islington has had a long history of successful collaboration with its practices, it is

expected that issues or grievances will be few and far between. Additionally, Islington CCG is committed to engaging with its member practices around strategic proposals and developments. However, where a member practice finds it has a dispute or grievance with the wider Islington CCG as whole, or its Governing Body or committees to whom it has delegated its powers, with regards to: a) matters of eligibility and disqualification; or

b) the interpretation and application of their respective powers and obligations under

this Constitution; or

c) a decision which the Islington CCG has made on behalf of its members; or

d) any other relevant matter that Governing Body considers fair and equitable to be the subject of a complaint or grievance;

it may follow the dispute resolution procedure outlined in 11.3.3.

11.4.3. If the member practice wishes to raise an issue with Islington CCG as a whole: a) In the first instance, the member practice may if they wish, raise such issue

through their Governing Body GP Link, in writing within 60 days of the issue arising, for resolution;

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b) If the member practice does not wish to raise the issue with their Governing Body

GP Link, or if the issue is not resolved by the Governing Body GP Link, the member practice should raise such issue through the elected GP locality representative on the Governing Body, in writing within 60 days of the issue arising, for resolution;

c) The locality GP representative on the Governing Body will respond to the member practice in writing within 30 working days, unless that locality representative is on leave or otherwise away, in which case the chair can direct any other elected board member to receive and resolve the issue;

d) If the locality GP representative is unable to resolve the issue, the member

practice may write formally to the Chair, or, if the Chair is unavailable, to the statutory vice chair (lay member), clearly outlining the issue/s and contact details. The chair, in conjunction with the Chief Officer where appropriate, will contact the member practice within 30 working days through the practice representative to resolve the dispute;

e) Where the dispute is unable to be resolved as above in (c), parties may decide to

refer to mediation, as described by Islington CCG’s dispute resolution policy. 11.5. Where a member practice wishes to make a complaint about the conduct of a member

of the Governing Body, accountability is detailed under Standing Orders section 2.3.3 and the Code of Conduct in Appendix Q.

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APPENDIX A DEFINITIONS OF KEY DESCRIPTIONS USED IN THIS CONSTITUTION

2006 Act National Health Service Act 2006

2012 Act Health and Social Care Act 2012 (this Act amends the 2006 Act)

Chief Officer an individual, as defined under paragraph 12 of Schedule 1A of the 2006 Act (as inserted by Schedule 2 of the 2012 Act), appointed by the NHS Commissioning Board, with responsibility for ensuring Islington CCG: · complies with its obligations under:

o sections 14Q and 14R of the 2006 Act (as inserted by section 26 of the 2012 Act),

o sections 223H to 223J of the 2006 Act (as inserted by section 27 of the 2012 Act),

o paragraphs 17 to 19 of Schedule 1A of the NHS Act 2006 (as inserted by Schedule 2 of the 2012 Act), and

o any other provision of the 2006 Act (as amended by the 2012 Act) specified in a document published by the Board for that purpose;

· exercises its functions in a way which provides good value for money.

Area the geographical area that Islington CCG has responsibility for, as defined in Chapter 2 of this Constitution

Chair of the Governing Body the individual appointed by Islington CCG to act as chair of the Governing Body

Chief Finance Officer the qualified accountant employed by Islington CCG with responsibility for financial strategy, financial management and financial governance

Clinical commissioning group

a body corporate established by the NHS Commissioning Board in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act)

Committee a committee or sub-committee created and appointed by: · the membership of Islington CCG · a committee / sub-committee created by a committee created / appointed

by the membership of Islington CCG · a committee / sub-committee created / appointed by the Governing Body

Note: up until and including 31 Mar 2013, all committees named in this Constitution are acting as ‘groups’ with no statutory delegated powers

Financial year this usually runs from 1 April to 31 March, but under paragraph 17 of Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act), it can for the purposes of audit and accounts run from when a clinical commissioning group is established until the following 31 March

Governing Body the body appointed under section 14L of the NHS Act 2006 (as inserted by section 25 of the 2012 Act), with the main function of ensuring that a clinical commissioning group has made appropriate arrangements for ensuring that it complies with: · its obligations under section 14Q under the NHS Act 2006 (as inserted by

section 26 of the 2012 Act), and · such generally accepted principles of good governance as are relevant to it.

Governing Body member any member appointed to the Governing Body of Islington CCG

Islington CCG NHS Islington Clinical Commissioning Group, which is a body corporate

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established by the NHS Commissioning Board in accordance with Chapter A2 of Part 2 of the 2006 Act (as inserted by section 10 of the 2012 Act)

Lay member a lay member of the Governing Body, appointed by Islington CCG. A lay member is an individual who is not a member of Islington CCG or a healthcare professional (i.e. an individual who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002) or as otherwise defined in regulations

Member a provider of primary medical services to a registered patient list, who is a members of Islington CCG (see tables in Chapter 3 and Appendix B)

Member Practice representatives

an individual appointed by a practice (who is a member of Islington CCG) to act on its behalf in the dealings between it and Islington CCG, under regulations made under section 89 or 94 of the 2006 Act (as amended by section 28 of the 2012 Act) or directions under section 98A of the 2006 Act (as inserted by section 49 of the 2012 Act)

NHS Commissioning Board

The Board as set up under the 2012 Act, existing as the NHS Commissioning Board Authority until such time that it is established as a statutory organisation in October 2012

Registers of interests registers which Islington CCG is required to maintain and make publicly available under section 14O of the 2006 Act (as inserted by section 25 of the 2012 Act), of the interests of: · the members of Islington CCG; · the members of its Governing Body; · the members of its committees or sub-committees and committees or sub-

committees of its Governing Body; and · its employees.

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APPENDIX B - LIST OF MEMBER PRACTICES AND SIGNATURES TO THIS CONSTITUTION

As member practices of Islington CCG, we sign up to this Constitution. Practice Name Locality Address Practice

Representative’s Signature & Date Signed

Andover Medical Centre North

270-282 Hornsey Road, N7 7QZ

Archway Medical Centre North

652 Holloway Road, N19 3NK

Dartmouth Park Practice North

18 Dartmouth Park Hill, NW5 1HL

Hanley Primary Care Centre North

52 Hanley Road, N4 3DU

St John's Way Medical Centre North

96 St John's Way, N19 3RN

Stroud Green Medical Clinic North

181 Stroud Green Road, N4 3PZ

The Beaumont Practice North

Hornsey Rise Health Centre, Hornsey Rise, N19 3XU

The Northern Medical Centre North

580 Holloway Road, N7 6LB

The Rise Group Practice North

Hornsey Rise Health Centre, Hornsey Rise, N19 3XU

The Village Practice North 115 Isledon Road, N7 7JJ

Wedmore Gardens Surgery North 5 Wedmore Gardens, N19 4DL

Dr Ko's Surgery Central 244 Tufnell Park Road, N19 5EW

Goodinge Group Practice Central 20 North Road, N7 9EW Highbury Grange Medical Centre Central 1-5 Highbury Grange, N5 2QB Holloway Medical Clinic Central 94 Holloway Road, N7 8JG

Mildmay Medical Centre Central 2a Green Lanes, N16 9NF Sobell Medical Centre Central 272 Holloway RoadN7 6NE

The Medical Centre Central 140 Holloway Road, N7 8DD

The Miller Practice Central 49 Highbury New Park, N5 2ET

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Practice Name Locality Address Practice Representative’s Signature & Date Signed

The Partnership Primary Care Centre Central 331 Camden Road, N7 0SL

The Tufnell Surgery Central 244 Tufnell Park Road, N19 5EW

Islington Central Medical Centre

South East 28 Laycock Street, N1 1SW

Mitchison Road Surgery

South East 2 Mitchison Road, N1 3NG

New North Health Centre

South East

287-293 New North Road, N1 7AA

River Place Health Centre

South East

River Place, Essex Road, N1 2SE

Roman Way Medical Centre

South East 58 Roman Way, N7 8XF

St Peter's Street Medical Practice

South East 16 ½ St Peter's Street, N1 8JG

The Family Practice South East 117 Holloway Road, N7 8LT

Barnsbury Medical Practice

South West

Bingfield Primary Care Centre, 8 Bingfield Street, N1 0AL

Bingfield Street Surgery

South West

Bingfield Primary Care Centre, 8 Bingfield Street, N1 0AL

City Road Medical Centre

South West

Unit 1-3 Grd Flr City House, 190-196 City Road, EC1V 2QH

Clerkenwell Medical Practice

South West

Finsbury Health Centre, Pine Street, EC1R 2QH

Elizabeth Avenue Group Practice

South West 2 Elizabeth Avenue, N1 3BS

Killick Street Health Centre

South West 75 Killick Street, N1 9RH

Pine Street Medical Practice

South West

Finsbury Health Centre, 4 Pine Street, EC1R 2QH

Ritchie Street Group Practice

South West 34 Ritchie Street, N1 0DG

Amwell Group Practice

South West 4 Naoroji Street, WC1X 0GB

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APPENDIX C – FUNCTIONS AND GENERAL DUTIES OF Islington CCG 1. FUNCTIONS AND GENERAL DUTIES 1.1. Functions 1.1.1. The functions that Islington CCG is responsible for exercising are largely set out in the

2006 Act, as amended by the 2012 Act. They relate to:

a) commissioning certain health services (where the NHS Commissioning Board is not under a duty to do so) that meet the reasonable needs of: i) all people registered with member GP practices, and ii) people who are usually resident within the area and are not registered with a

member of any clinical commissioning group;

b) commissioning emergency care for anyone present in Islington CCG’s area;

c) paying its employees’ remuneration, fees and allowances in accordance with the determinations made by its Governing Body and determining any other terms and conditions of service of the Islington CCG’s employees;

d) determining the remuneration and travelling or other allowances of members of its

Governing Body.

1.1.2. In discharging its functions Islington CCG will: a) act35, when exercising its functions to commission health services, consistently

with the discharge by the Secretary of State and the NHS Commissioning Board of their duty to promote a comprehensive health service36 and with the objectives and requirements placed on the NHS Commissioning Board through the mandate37 published by the Secretary of State before the start of each financial year by:

i) delegating overall decision making responsibility to its Governing Body.

ii) Carrying out its duties as per Islington CCG’s governance arrangements.

b) meet the public sector equality duty38 by:

i) eliminating unlawful discrimination harassment and victimisation and other

conduct prohibited by the Equality Act 2010;

ii) Advancing equality of opportunity between people who share a protected characteristic and those who do not;

35 See section 3(1F) of the 2006 Act, inserted by section 13 of the 2012 Act 36 See section 1 of the 2006 Act, as amended by section 1 of the 2012 Act 37 See section 13A of the 2006 Act, inserted by section 23 of the 2012 Act 38 See section 149 of the Equality Act 2010, as amended by paragraphs 184 and 186 of Schedule 5 of the

2012 Act

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iii) Fostering good relations between people who share one of the nine protected characteristics and those who do not;

iv) By entrenching notions of equality in all aspects of Islington CCG’s work and functions, including those relating to commissioning on behalf of its population and also as a model employer towards its staff;

v) By implementing the Equality Delivery System, as agreed by the NHS

Equality and Diversity Council (EDC) and the Department of Health to ensure that not only do we meet the legal requirements under the Equality Act 2010, but got further to make equality, diversity and human rights integral in all of its decisions;

vi) By carrying out Equality Impact Analysis on all proposals, i.e. policies,

procedures and strategies where and to the extent appropriate;

vii) Ensuring areas of equality are overseen by the Patient and Public Participation Committee which is a committee of the Governing Body, and addressed under the Patient and Public Participation, Equality and Diversity Strategy;

viii) Annually publishing sufficient information to demonstrate compliance with this

general duty across all their functions;

ix) Preparing and publishing specific and measurable equality objectives, revising these at least every four years.

c) work in partnership with its local authority to develop joint strategic needs

assessments39 and joint health and wellbeing strategies40 by:

i) identifying local health needs and feeding them into the Islington CCG, which will work jointly with the Islington Health and Wellbeing Board;

ii) supporting design and implementation of public health and well being initiatives.

iii) continuing and strengthening relationships with the Local Authority and its

social services colleagues;

iv) establishing relationships with bordering clinical commissioning groups to develop joint approaches and deal with cross-border issues.

v) supporting appropriate collaboration across providers; vi) supporting partnership-working with social care commissioners and providers

(including local authority, voluntary sector and independent providers).

39 See section 116 of the Local Government and Public Involvement in Health Act 2007, as amended by

section 192 of the 2012 Act 40 See section 116A of the Local Government and Public Involvement in Health Act 2007, as inserted by

section 191 of the 2012 Act

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1.2. General Duties - in discharging its functions Islington CCG will: 1.2.1. Make arrangements to secure public involvement in the planning, development and

consideration of proposals for changes and decisions affecting the operation of commissioning arrangements41 by:

a) Including two lay members and one Healthwatch observer in the membership of

the Governing Body;

b) Recruiting a minimum of one lay member to sit on relevant commissioning sub-committees of the Islington CCG as detailed in the governance structures;

c) Ensuring lay member involvement in other specific ad hoc steering groups and focus groups;

d) Engaging with patient groups in each locality to ensure patient involvement across

the borough, with appropriate feedback through commissioning teams;

e) Holding wider public engagement around prioritisation, service re-design, setting commissioning intentions and commissioning strategies;

f) Strengthening important connections with Islington’s many local and national

voluntary organisations;

g) Ensuring close working with Islington Local Involvement Network (LINk) which is developing into Healthwatch.

h) Engaging with and increasing the membership of the Islington Health Panel, a

virtual group of Islington patients with an interest in health services. This group is used as a pool of people from which to draw interested patients / lay members as volunteers to sit on various reading groups and panels, and whom have agreed to give their opinions and participate in surveys as needed.

i) Holding regular meetings of the Patient and Public Participation Committee, which steers the overall patient participation strategy for Islington. The group reviews and guides development of areas such as equality and diversity, increasing public awareness and engagement, improving communication between health services and the public, improving health literacy, monitoring of patient groups, engagement with wider groups such as voluntary organisations and seeking views from diverse groups within the Islington CCG.

j) Ensuring there is a wide range of methods by which residents can feedback their

opinions about services in order to inform commissioning.

k) Abiding by the duty of public involvement and consultation under Section 14Z2 of the 2006 Act, as amended by the 2012 Act and have regard to the obligations of providers under Section 242 of the 2006 Act.

41 See section 14Z2 of the 2006 Act, inserted by section 26 of the 2012 Act

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1.2.2. Fulfil its obligations to:

a) act with a view to securing that health services are provided in a way which

promotes the NHS Constitution, and b) promote awareness of the NHS Constitution among patients, staff and

members of the public; by exercising this function through the Chief Officer and the Governing Body with the Finance and Performance Committee reviewing performance against the duties within the NHS Constitution.

1.2.3. Act effectively, efficiently and economically42 by:

a) operating within the assurance framework in terms of accountability for financial management, Quality, Innovation, Prevention and Productivity (QIPP) delivery, and quality performance standards, through any established systems of performance management;

b) challenging inefficiency and championing innovative working via continuous monitoring of systems, processes, and services, and use of clinical input where necessary;

c) implementing the mobilisation / implementation plan which will drive and deliver

QIPP intentions for 2012/13 and beyond;

d) ensuring there is oversight of financial performance by the Chief Finance Officer and audit committee.

1.2.4. Act with a view to securing continuous improvement to the quality of services43

by:

a) ensuring continuous and robust contract and performance management of all services for which it has commissioning responsibility, to be undertaken by the relevant committees in the governance structure, such as the Governance and Quality Committee, Service Improvement Committee, Finance and Performance Committee, and following agreed governance arrangements;

b) ensuring appropriate feedback mechanisms and engagement is available for service users;

c) ensuring arrangements for handling complaints raised with Islington CCG are

compliant with the statutory framework for complaints handling, by following an agreed Complaints Procedure, and ensuring that we use this important feedback to improve the services Islington CCG commissions.

1.2.5. Assist and support the NHS Commissioning Board in relation to the Board’s duty to

improve the quality of primary medical services44 by:

42 See section 14Q of the 2006 Act, inserted by section 26 of the 2012 Act 43 See section 14R of the 2006 Act, inserted by section 26 of the 2012 Act 44 See section 14S of the 2006 Act, inserted by section 26 of the 2012 Act

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a) implementing a Governing Body GP link programme – each GP on the Governing

Body is assigned to a group of practices across Islington and will act with a view to drive up quality in primary care by:

i) encouraging a sense of cohesiveness and linkages between the governing

board and practices, and also between member practices, in order to foster a strong bottom-up approach to development, improve the ability of peer to peer developmental support, and importantly to provide a strong foundation for developing integrated care across the borough;

ii) helping practices to identify areas through use of performance data that could be further developed;

iii) supporting member practices to understand their own data and hence

empowering them to drive their own development;

iv) ensuring that necessary information is readily available to practices to support their developmental needs;

v) helping the practice to develop action plans to deliver any changes where

appropriate ;

vi) providing mentorship as needed.

b) supporting practices to deliver the QIPP agenda at practice level, to achieve financial balance in delegated budgets

c) ensuring regular peer support and education sessions are made available to networks of practices and localities in a range of areas informed by practice need and performance information

d) Assisting the NHS Commissioning board, where required, in conducting any

investigations it considers appropriate in connection with its duties in relation to the performers list.

1.2.6. Have regard to the need to reduce inequalities45 by:

a) challenging inefficiency and championing innovation to drive up quality in primary, community and secondary care environments and improving health outcomes by commissioning high quality, value-for-money services that play a positive role in reducing the significant health inequalities that exist locally;

b) engaging with various groups of the population in line with the Patient and Public Participation, Equality and Diversity Strategy, and as per the Communications and Engagement Strategy;

c) working in partnership with strategic partners, such as public health and the Health

and Wellbeing Board in delivering its vision for improving the health and reducing inequalities within the population of Islington, and commissioning in line with the

45 See section 14T of the 2006 Act, inserted by section 26 of the 2012 Act

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Joint Strategic Needs Assessment, Joint Health and Wellbeing strategy, and other local strategies;

d) delivering services in line with the Equality Act 2010, and via the Equality Delivery

System. 1.2.7. Promote the involvement of patients, their carers and representatives in

decisions about their healthcare46 by:

a) recruiting a minimum of two lay members to sit on relevant commissioning sub-committees of the Islington CCG as detailed in the governance structures;

b) ensuring lay member involvement in other specific ad hoc steering groups and focus groups;

c) engaging with locality patient groups in each locality to ensure patient involvement

across the borough, and appropriate feedback through commissioning teams;

d) supporting practices to deliver highly effective and representative patient participation groups, ensuring patients are involved in practice-specific services and issues

e) holding wider public engagement around prioritisation, service re-design, setting

commissioning intentions and commissioning strategies including consultation on the annual commissioning plan;

f) strengthening important connections with Islington’s many local and national

voluntary organisations who act on behalf of their users;

g) ensuring close working with Islington Local Involvement Network (LINk), due to transform into Healthwatch from 1 April 2013;

h) engaging with and increasing the membership of the Islington Health Panel, to

whom information is distributed and from whom opinion is sought on health services;

i) ensuring there is a wide range of methods by which residents can feedback their

opinions about services in order to inform commissioning.

j) working towards improving general health literacy across Islington, through supporting good access to general health information, decision aids, and evidence based information;

k) providing good access to information about the local services available to

Islington’s population, including information about available self management and peer support programmes;

l) ensuring that supported self management is a high priority, so that patients are

empowered to understand their own health, make informed decisions, and set

46 See section 14U of the 2006 Act, inserted by section 26 of the 2012 Act

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their own personal goals, and that clinicians work in such a way as to support the patient to self manage;

m) driving the above through the Patient and Public Participation Committee;

n) ensuring that carers are recognised as important stakeholders within the health

system and ensuring that they are properly included, including working closely with voluntary carer organisations.

o) requiring all providers under contract to involve patients as appropriate.

1.2.8. Act with a view to enabling patients to make choices47 by:

a) working towards improving general health literacy across Islington, through supporting good access to general health information, decision aids, and evidence based information;

b) providing good access to information about the services available locally, including

information about available self management and peer support programmes, voluntary sector support;

c) ensuring that supported self management is a high priority, so that patients are

empowered to understand their own health, make informed decisions, and set their own personal goals, and that clinicians work in such a way as to support the patient to self manage;

d) providing information about Healthwatch, whose signposting function aims to

assist patients to make choices;

e) ensuring that this is steered by the Patient and Public Participation Committee. 1.2.9. Obtain appropriate advice48 from persons who, taken together, have a broad range

of professional expertise in healthcare and public health by:

a) Collaborative, multi-professional working through the development of integrated care models;

b) Ensuring a clinical perspective is threaded through everything |CCG does;

c) Working closely and fostering good relationships with partners, such as the Health and Wellbeing Board, public health, local authority, LINk / Healthwatch, primary, secondary and community providers, voluntary organisations, local medical committee, and adjacent borough colleagues.

1.2.10. Promote innovation49 by:

a) collectively learning about what makes innovation work in commissioning and with Islington providers, and what does not;

47 See section 14V of the 2006 Act, inserted by section 26 of the 2012 Act 48 See section 14W of the 2006 Act, inserted by section 26 of the 2012 Act 49 See section 14X of the 2006 Act, inserted by section 26 of the 2012 Act

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b) working in a more integrated fashion to deliver more seamless innovative

healthcare;

c) keeping abreast of guidance, research and projects in Islington and other boroughs across England;

d) ensuring there is robust evaluation of our own services and reporting as per

governance arrangements in order to drive innovation where it is needed;

e) ensuring there is strong clinical involvement in planning services, including the use of Islington Clinical Commissioning Partners;

f) is to continue to work with partners to do this, lining up our future innovation work

alongside the transition work underway to support our practices, and Board as the leaders of commissioning.

1.2.11. Promote research and the use of research50 by:

a) abiding by the Islington CCG’s mission statement to provide the best evidence-based care possible;

b) keeping abreast of guidance, research, pilots, and innovative projects in Islington and other boroughs across England.

c) seeking to join the relevant Academic Health Science Network, and be involved to

the extent in the activities of the network to the extent appropriate to the role of the Islington CCG Group, as advised by any future regulation or guidance.

1.2.12. Have regard to the need to promote education and training51 for persons who are

employed, or who are considering becoming employed, in an activity which involves or is connected with the provision of services as part of the health service in England so as to assist the Secretary of State for Health in the discharge of his related duty52 by:

a) supporting the development of an ongoing educative process within integrated

networks, within localities, and across Islington where appropriate, entrenching this within strategies such as the Islington Primary Care Strategy;

b) taking collective responsibility for educational opportunities and continuous learning across the locality, including the use of peer support learning;

c) entrenching the importance of being an organisation supported by a learning

culture.

1.2.13. Act with a view to promoting integration of both health services with other health services and health services with health-related and social care services where

50 See section 14Y of the 2006 Act, inserted by section 26 of the 2012 Act 51 See section 14Z of the 2006 Act, inserted by section 26 of the 2012 Act 52 See section 1F(1) of the 2006 Act, inserted by section 7 of the 2012 Act

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Islington CCG considers that this would improve the quality of services or reduce inequalities53 by:

a) implementing system wide integrated care across health and social care in

Islington, including: i) implementation of geographical networks of practices across Islington, who

will work closely with other teams such as community teams, acute specialists, voluntary groups, non-traditional providers and other key stakeholders for those patients within the network who need it;

ii) implementation of risk profiling to identify complex patients requiring integrated care;

iii) support for the development of multi-disciplinary meetings and peer support to discuss such complex patients;

iv) the use of care service managers to coordinate patient care for each network;

v) aiming to implement timely sharing of information through shared information

systems as far as possible;

vi) ensuring appropriate patients have robust care plans to empower them to understand and take better control over their health and overall living;

vii) ensuring non-traditional providers and voluntary groups are kept engaged

where appropriate;

viii) ensuring there is cross-working with neighbouring CCGs where appropriate, especially where there are cross border flows and shared providers;

ix) overseeing the development, implementation, and monitoring of integrated

care via the Integrated Care Programme Board under the Governing Body.

1.3. General Financial Duties – Islington CCG will perform its functions so as to:

1.3.1. Ensure its expenditure does not exceed the aggregate of its allotments for the financial year54 by

a) Strong financial control overseen by the Chief Finance Officer, and through the

Finance and Performance Committee which has the delegated responsibility of overseeing monitoring against budgets;

b) Weekly updates of the risk register and QIPP delivery at the Executive Team

Meeting;

c) appropriate monthly monitoring and reporting to the Finance and Performance Committee from any other relevant committees, subcommittees or advisory groups;

53 See section 14Z1 of the 2006 Act, inserted by section 26 of the 2012 Act 54 See section 223H(1) of the 2006 Act, inserted by section 27 of the 2012 Act

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d) Where financial risks of exceeding allotments are identified, immediate remedial

action is recommended by the Finance and Performance Committee to the Governing Body for decision.

1.3.2. Ensure its use of resources (both its capital resource use and revenue resource

use) does not exceed the amount specified by the NHS Commissioning Board for the financial year55 by

a) strong financial control overseen by the Chief Finance Officer, and through the


b) weekly updates of the risk register and QIPP delivery at the Executive Team

Meeting;


d) Where financial risks of exceeding allotments are identified, immediate remedial


1.3.3. Take account of any directions issued by the NHS Commissioning Board, in respect of specified types of resource use in a financial year, to ensure Islington CCG does not exceed an amount specified by the NHS Commissioning Board 56 by

a) strong financial control overseen by the Chief Finance Officer, and through the


b) weekly updates of the risk register and QIPP delivery at the Executive Team

Meeting;


d) where financial risks of exceeding allotments are identified, immediate remedial


1.3.4. Publish an explanation of how Islington CCG spent any payment in respect of

quality made to it by the NHS Commissioning Board57 by

55 See sections 223I(2) and 223I(3) of the 2006 Act, inserted by section 27 of the 2012 Act 56 See section 223J of the 2006 Act, inserted by section 27 of the 2012 Act 57 See section 223K(7) of the 2006 Act, inserted by section 27 of the 2012 Act

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a) The Chief Finance Officer reporting to the Finance and Performance Committee on all payments for quality and how they are spent. This in turn will be reported to the Governing Body and then published at www.Islington.nhs.uk

1.4. Discharge of functions 1.1 to 1.3

1.4.1. Islington CCG will discharge its functions laid out under 1.1 to 1.3 by:

a) Delegating appropriate responsibility to its Governing Body or its Chief Officer or a

committee or a member with lead responsibility to oversee how it / they discharge the duty;

b) Specifying a policy which sets out how they intend to discharge this duty requiring progress of delivery of the duty to be monitored through performance monitoring; and / or

c) General reporting mechanisms

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APPENDIX D – STANDING ORDERS 1. STATUTORY FRAMEWORK AND STATUS 1.1. Introduction

1.1.1. These standing orders have been drawn up to regulate the proceedings of the NHS

Islington Clinical Commissioning Group (Islington CCG) so that it can fulfil its obligations, as set out largely in the 2006 Act, as amended by the 2012 Act and related regulations. They are effective from the date Islington CCG is authorised.

1.1.2. The standing orders, together with the Islington CCG’s scheme of reservation and delegation58 and the Islington CCG’s prime financial policies59, provide a procedural framework within which Islington CCG discharges its business. They set out:

a) the arrangements for conducting Islington CCG’s business;

b) the appointment of member practice representatives and Governing Body

members;

c) the procedure to be followed at meetings of Islington CCG, the Governing Body and any committees or sub-committees of Islington CCG or the Governing Body;

d) the process to delegate powers;

e) the declaration of interests and standards of conduct.

These arrangements must comply, and be consistent where applicable, with requirements set out in the 2006 Act (as amended by the 2012 Act) and related regulations and take account as appropriate60 of any relevant guidance.

1.1.3. The standing orders, scheme of reservation and delegation, and prime financial

policies have effect as if incorporated into Islington CCG’s Constitution. Islington CCG member practices, employees, members of the Governing Body, members of the Governing Body’s committees and sub-committees, and persons working on behalf of Islington CCG should be aware of the existence of these documents and, where necessary, be familiar with their detailed provisions. Failure to comply with the standing orders, scheme of reservation and delegation, and prime financial policies may be regarded as a disciplinary matter that could result in dismissal.

1.2. Schedule of matters reserved to Islington CCG and the scheme of reservation and delegation

1.2.1. The 2006 Act (as amended by the 2012 Act) provides Islington CCG with powers to delegate its functions and those of the Governing Body to certain bodies (such as committees) and certain persons. Islington CCG has decided that certain decisions may only be exercised by the Islington CCG in formal session. These decisions and

58 See Appendix E 59 See Appendix F 60 Under some legislative provisions the group is obliged to have regard to particular guidance but under other

circumstances guidance is issued as best practice guidance.

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also those delegated are contained in Islington CCG’s Scheme of Reservation and Delegation (see Appendix D).

2. Islington CCG: COMPOSITION OF MEMBERSHIP, KEY ROLES AND

APPOINTMENT PROCESS

2.1. Composition of membership

2.1.1. Chapter 3 of Islington CCG’s Constitution provides details of the membership of Islington CCG.

2.1.2. Chapter 6 of the Constitution provides details of the governing structure used in Islington CCG’s decision-making processes, whilst Chapter 7 of the Constitution outlines certain key roles and responsibilities within Islington CCG and its Governing Body, including the role of practice representatives (section 7.1 of the Constitution).

2.2. Key Roles

2.2.1. Section 6.5.2 of the Constitution sets out the composition of Islington CCG’s

Governing Body whilst Chapter 7 of the Constitution identifies certain key roles and responsibilities within the group and its Governing Body. These standing orders set out how Islington CCG appoints individuals to these key roles.

2.2.2. Practice representatives - Practice representatives of member practices are

nominated by the agreement of the partners in practice to whom they belong.

2.2.3. Remunerable time spent by member practice representatives on Islington CCG business, may be remunerated at a rate as agreed by the Remuneration Committee, chaired by a GP, and reviewed on an annual basis.

2.2.4. Elected members of Governing Body - The Chair, Vice Chair (Clinical), locality GP

representatives, salaried / sessional GP representative, practice manager, and practice nurse as listed in the Islington CCG’s Constitution, is subject to the following appointment process: a) Nominations – These roles undergo a selection and election process.

i) Interested candidates complete an application form. ii) Selection (shortlisting) occurs, followed by an interview, carried out by a

panel which includes;

· NHS Commissioning Board representative; · Chief Officer;

· Local Medical Committee representative; and

· Lay member.

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iii) Eligible applicants will be required to give a speech at a meeting to which eligible voters are invited to attend. Voting is subsequently opened to the members, as outlined below, via an online ballot for a period of time determinable by the Governing Body.

iv) Members are invited to vote as follows:

· Voting for the Chair role is open to all GPs on the Islington Performers List; · Voting for Vice Chair role is open to all GPs on the Islington Performers

List;

· Voting for Locality GP representative roles is open only to all GP principals on the Islington Performers List who practice in the corresponding locality as set out in Appendix B of the Islington CCG Constitution;

· Voting for salaried / sessional GP role is open only to all salaried /

sessional GPs in Islington;

· Voting for practice nurse representative role is open only to practice nurses of member practices;

· Voting for practice manager representative role is open only to practice

managers of member practices.

b) Eligibility – All GPs on the Islington Performers List, registered nurses of member practices, and practice managers of member practices are eligible to apply to stand for an elected position. Further eligibility to fulfil the role is stated in the job description and person specification for each role which will be assessed at the nominations stage. Persons who are disqualified from becoming eligible or remaining eligible are set out in Section 2.3 of these Standing Orders.

c) Appointment process – Appointment occurs upon a candidate receiving at

minimum 51% of the total votes received for that role. Each person eligible to vote may only vote for one candidate per role. If there is an equal vote between candidates, the voting will be re-opened. The returning officer for all election results is the Chief Officer only.

d) Term of office –

i) The initial term of office for the roles is 3 years from the day of announcement

to member practices, which is up until 13 June 2014, at which point all elected posts will be up for election (2nd election). This will be conducted in 2 waves over a period of 6 months. The members up for election in each wave will be randomly selected by the Chair, in the presence of the Chief Officer and the Local Medical Committee observer;

ii) The term of office following the initial term will be for a period of 4 years, notwithstanding that elections will then be held via a 2 year staggered process in the interests of continuity and organisational memory. 50% of the posts will be chosen at random to be elected to in 2016 (2 year term), and the remaining 50% of the posts will be elected to in 2018 (4 year term).

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All subsequent elections will follow a 4 year term process.

e) Eligibility for reappointment – Persons already in post will be eligible for

reappointment upon the end of their term of office, as long as they still fit the person specification and job role, and are re-elected by a vote of the members as described in (a);

f) Notice period – A member of the Governing Body may resign by giving 3 months

notice in writing. This period can be varied by the agreement of the Chair. 2.2.5. The number of days/sessions/hours per month required of all practice members of the

Governing Body will be agreed as part of the role specification. 2.2.6. Remuneration of elected positions will be determined by the Remuneration Committee

after consideration of any guidance from the NHS Commissioning Board, and in consultation with the Local Medical Committee. The rate of remuneration will be reviewed on an annual basis.

2.2.7. Chief Officer & Chief Finance Officer – The Chief Officer and the Chief Finance

Officer are appointed via a process determined by the NHS Commissioning Board and are subject to the grounds for removal outlined in Section 2.3 of these Standing Orders, and the disciplinary processes for the Governing Body.

2.2.8. Secondary Care Clinician on Governing Body - The secondary care clinician is

appointed via a process determined by the NHS Commissioning Board, but subject to the grounds for removal outlined in Section 2.3 of these Standing Orders, and the disciplinary processes for the Governing Body.

2.2.9. Lay members on Governing Body - The two lay members are appointed via a

process determined by the NHS Commissioning Board, but subject to the grounds for removal outlined in Section 2.3 of these Standing Orders, and the disciplinary processes for the Governing Body.

2.2.10. Other representatives on Governing Body - The Director of Public Health, the Local

Medical Committee observer, the Healthwatch observer, and the Local Authority representative are invited to attend by the Governing Body. Nomination of a representative is to be determined by the host organisation, subject to grounds for eligibility, removal, and notice period below.

2.2.11. Notice period – An appointed member of the Governing Body may resign by giving

not less than 3 months’ notice in writing.

2.2.12. Removal by appointing body - Where an appointing body gives notice in writing that it wishes to remove its appointee from the Governing Body the appointee shall be removed with immediate effect.

2.2.13. The roles and responsibilities of each of these key roles are set out either in Section

6.5 or Section 7 of the Constitution.

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2.3. Removal and disqualification

2.3.1. The following are not eligible to become or remain as a member of the Governing Body: People who a) are not eligible to work in the UK;

b) have received a prison sentence or suspended sentence of three months or more

in the last five years;

c) are the subject of a bankruptcy restriction order or interim order;

d) have been dismissed by a former employer (within or outside the NHS) on the grounds of misconduct within a five year period;

e) are under a disqualification order under the Company Directors Disqualification Act 1986; or

f) have been removed from trusteeship of a charity.

2.3.2. In addition, people will not be eligible for the lay roles if they are: a) a serving civil servant within the Department of Health, or members / employees

of the Care Quality Commission;

b) currently serving as a Chair or non-executive of an NHS body;

c) If a Governing Body member no longer meets all the criteria above, they will be deemed ineligible and may be removed from office by the Chair ;

2.3.3. A Governing Body member may also be removed from office pursuant to the

disciplinary process for Governing Body members set out in the Code of Conduct.61

3. MEETINGS OF THE GOVERNING BODY

3.1. Calling meetings

3.1.1. Meetings of the Governing Body shall be held at regular intervals at such times and places as the Governing Body may determine. Meetings of its committees or sub-committees shall be held as per the agreed Terms of Reference.

3.1.2. If member practices are required to vote on an issue, the Chair will determine whether a meeting of members needs to be called for this purpose or whether the issue can be approved by electronic vote.

3.2. Agenda, supporting papers and business to be transacted

3.2.1. Items of business to be transacted for inclusion on the agenda of a meeting need to be

notified to the Board Secretary at least 15 working days (i.e. excluding weekends and

61 See Appendix Q

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bank holidays) before the meeting takes place. Supporting papers must be submitted at least 5 working days before the meeting takes place. The agenda and supporting papers will be circulated to all members of a meeting at least 5 working days before the meeting.

3.2.2. All items of Any Other Business for the Governing Body must be advised in writing to the Chair.

3.2.3. Agendas and papers for Islington CCG’s Governing Body meetings held in public,

including details about meeting dates, times and venues, will be made available via the following means:

d) On Islington CCG’s website at www.Islington.nhs.uk;

e) Upon request for inspection at the Islington CCG head office:

Islington Clinical Commissioning Group Ground Floor 338-346 Goswell Road London EC1V 7LQ

f) Upon application by post to the address provided above or by email to [email protected]

3.3. Petitions

3.3.1. Where a petition has been received by Islington CCG, the Chair of the Governing

Body shall include the petition as an item for the agenda of the next meeting of the Governing Body.

3.4. Chair of a meeting

3.4.1. At any meeting of Islington CCG or its Governing Body or of a committee or sub-

committee, the Chair of Islington CCG, Governing Body, committee or sub-committee, if any and if present, shall preside. If the Chair is absent from the meeting, the deputy Chair, if any and if present, shall preside.

3.4.2. If the Chair is absent temporarily on the grounds of a declared conflict of interest, the statutory vice Chair (lay member), shall preside. If both the Chair and Vice-Chair are absent, or are disqualified from participating, a member of the group, Governing Body, committee or sub-committee respectively shall be chosen by the members present, or by a majority of them, to preside.

3.5. Chair's ruling

3.5.1. The decision of the Chair of the Governing Body on questions of order, relevancy and regularity and their interpretation of the Constitution, standing orders, scheme of reservation and delegation, and prime financial policies, shall be final.

3.6. Quorum of the Governing Body

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3.6.1. No business shall be transacted at a meeting unless at least one-third of the whole number of the Chair and members are present, including one clinical member and one officer member (either the Chief Officer or Chief Finance Officer).

3.6.2. The Chief Officer can only delegate Chief Officer duties to the Chief Finance Officer.

3.6.3. If the Chair or member has been disqualified from participating in a discussion and/or from voting on any resolution by reason of declaration of a conflict of interest that person shall no longer count towards a quorum. If a quorum is then not available for the discussion and/or the passing of a resolution on any matter, that matter may not be discussed further or voted upon at that meeting. Such a position shall be recorded in the minutes of the meeting.

3.6.4. The requirement for a quorum of the Governing Body is at least six Governing Body

members, including:

a) Chair, or if the Chair is not available, the Statutory Vice Chair (Non-clinical);

b) Lay Member (if the Statutory Vice-Chair is acting as Chair, the other lay member);

c) At least three voting GPs, not including the Chair; and

d) One Officer, either the:

i) Chief Officer; or

ii) Chief Finance Officer.

3.6.5. Where a situation arises in a Governing Body meeting that all GP Governing Body members declare a conflict of interest:

a) Those members will be asked to leave the room, and the vote will carry on

between the rest of the members. Quorum required as a minimum is:

i) One Lay Member, who will deputise as Chair

ii) Secondary Care Clinician

iii) Executive Nurse

iv) One Officer

b) If the required membership is not available, the Governing Body can co-opt members for the purpose of voting including62:

i) an individual from a member practice;

ii) a member of a relevant Health and Wellbeing Board;

62 See NHS Commissioning Board Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-commissioning services

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iii) a member of a Governing Body of another clinical commissioning group.

c) the Medical Director or secondary care doctor is permitted to give clinical advice as required for the non-clinical members of the Governing Body to be able to cast their vote;

d) in the event of an equal vote the lay member, acting as Chair, will have the

casting vote. 3.6.6. Where the Chair has been disqualified from participating in a discussion on any

member and/or from voting on any resolution by reason of declaration of a conflict of interest, in the case of an equal vote, the casting vote shall pass to the Statutory Vice Chair (Non-clinical), or a member chosen to act as Chair by a majority of members, unless the situation arises as described in Section 3.6.5.

3.6.7. For all other of Islington CCG’s committees and sub-committees, including the Governing Body’s committees and sub-committees, the details of the quorum for these meetings and status of representatives are set out in the appropriate terms of reference.

3.7. Decision making

3.7.1. Chapter 6 of the Constitution, together with the scheme of reservation and delegation,

sets out the governing structure for the exercise of Islington CCG’s statutory functions. 3.8. Decision making by Governing Body

3.8.1. For the Governing Body, generally it is expected that decisions will be reached by

consensus. Should this not be possible then a vote of Governing Body members will be required, the process for which is set out below:

a) Voting procedure - At the discretion of the Chair all questions put to the vote

shall be determined by oral expression or by a show of hands, unless the Chair directs otherwise, or it is proposed, seconded and carried that a vote be taken by paper ballot.

b) Eligibility

i) Only present Governing Body members may vote;

ii) In no circumstances may an absent member vote by proxy. Absence is defined as being absent at the time of the vote;

iii) A manager who has been formally appointed to act up for an Officer Member

during a period of incapacity or temporarily to fill an Executive Director vacancy shall be entitled to exercise the voting rights of the Officer Member;

iv) A manager attending the Governing Body meeting to represent an Officer

Member during a period of incapacity or temporary absence without formal acting up status may not exercise the voting rights of the Officer Member. An Officer’s status when attending a meeting shall be recorded in the minutes.

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c) Majority necessary to confirm a decision - every question put to a vote at a meeting shall be determined by a majority of the votes of members present and voting on the question.

d) Casting vote –

i) In the case of an equal vote, the person presiding (i.e. the Chair of the meeting) shall have a second, and casting vote.

ii) In the case of an equal vote where the Statutory Vice Chair (lay member) is acting as Chair for one reason or another, then the Vice Chair will have a second and casting vote.

iii) Where all GPs have been disqualified because of conflict of interest, Section

3.6.5 shall apply.

e) Dissenting views - members taking a dissenting view but losing a vote can ask for their dissent recorded in the minutes.

f) Joint Members – Voting by joint members shall count as one person.

i) Either or both of those persons may attend or take part in meetings of the

Board; ii) If both are present at a meeting they should cast one vote if they agree;

iii) In the case of disagreements no vote should be cast;

iv) The presence of either or both of those persons should count as the

presence of one person. 3.8.2. Should a vote be taken, the outcome of the vote and any dissenting views must be

recorded in the minutes of the meeting.

3.8.3. If at least one-third of the Governing Body members present so request, the voting on any question may be recorded so as to show how each member present voted or did not vote (except when conducted by paper ballot).

3.8.4. If a Governing Body member so requests, their vote shall be recorded by name.

3.9. Decision making by Committees and Sub-committees of Governing Body

3.9.1. For all other committees and sub-committees of the Governing Body, the voting

procedure detailed above in Sections 3.7.2 to 3.7.5 applies, except for Section 3.7.2(b)(ii) in as far as all of the members detailed in the relevant terms of reference are voting members.

3.10. Decision making by member practices

3.10.1. If a vote is required by Islington CCG member practices on an issue outlined in

Section 3.10.2, either at a members meeting or electronically, the following will apply:

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a) Each member practice will cast one vote. This vote will have a weighting of one vote per 1000 registered population, rounded to the nearest 1000 and based upon the most recent published practice list size;

b) The decision will be carried by a majority of votes;

c) If the result of the vote is tied, the outcome will be decided at the discretion of the

Islington CCG Chair either by:

i) application of a casting vote; or

ii) requesting a second vote by member practices be conducted following a review of the matter to be voted upon.

3.10.2. Member practices will be required to vote on the following issues, as described in the

Scheme of Reservation and Delegation: a) Amendment of the Constitution.

3.10.3. Member practices may be asked by Islington CCG’s Chair, at the Chair’s discretion, to vote on an issue, which may include the following:

a) Any proposal for a merger or change of the area of Islington CCG;

b) Any proposal to terminate a contract with an NHS body to the value of greater

than £10million per annum;

c) Approval of the annual report;

d) Approval of the annual commissioning plan;

e) Designation of services as essential in the insolvency of a provider under the provisions for trust special administration;

f) Approval of any scheme for the distribution of additional funds paid by the NHS

Commissioning Board;

g) Any other issue which the Governing Body determines needs to go to a vote of member practices.

3.10.4. Individuals in member practices will be required to vote on the following issues, as

described in the Scheme of Reservation and Delegation: a) Selection and election of Governing Body members, as detailed and via the

process in Section 2.2.4(iv) of these Standing Orders; 3.11. Emergency powers and urgent decisions

3.11.1. Any urgent matter requiring a Governing Body decision between meetings may, in an

emergency, or for an urgent decision, be exercised by the Chief Officer and the Chair after having consulted at least two voting non-officer members, bearing in mind that any joint roles only count as one vote. The exercise of such powers by the Chief

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Officer and Chair shall be reported to the next formal meeting of the Governing Body for formal ratification. Urgent decisions will only be taken in emergencies.

3.12. Suspension of Standing Orders

3.12.1. Except where it would contravene any statutory provision or any direction made by the Secretary of State for Health or the NHS Commissioning Board, any part of these standing orders may be suspended at any meeting, provided that at least two-thirds of the whole number of the members of the Governing Body are present (including at least one of the Chief Officer or Chief Finance Officer, and one other member), and that at least two-thirds of those members present signify their agreement to such suspension.

3.12.2. A decision to suspend standing orders together with the reasons for doing so shall be recorded in the minutes of the meeting.

3.12.3. A separate record of matters discussed during the suspension shall be kept. These

records shall be made available to the Governing Body’s audit committee for review of the reasonableness of the decision to suspend standing orders.

3.13. Record of Attendance

3.13.1. The names of all members of the Governing Body present shall be recorded in the

minutes of the Governing Body meetings. The names of all members of the Governing Body’s committees / sub-committees present shall be recorded in the minutes of the respective Governing Body committee / sub-committee meetings.

3.14. Minutes

3.14.1. The minutes of the proceedings of a meeting shall be drawn up and submitted for agreement at the next ensuing meeting, where they shall be formally signed by the Chair as a true record of that meeting.

3.14.2. The minutes shall record the names of the individuals in attendance, along with their role on the board. No discussion shall take place upon the minutes except upon their accuracy or where the Chair considers discussion appropriate.

3.14.3. Minutes shall be circulated in accordance with members’ wishes.

3.14.4. Minutes of Governing Body meetings held in public shall be made available to the

public, as required by the Code of Practice on Openness in the NHS, via the following means:

a) On Islington CCG’s website at www.Islington.nhs.uk;

b) Upon request for inspection at the Islington CCG head office:

Islington Clinical Commissioning Group Ground Floor 338-346 Goswell Road London EC1V 7LQ

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c) Upon application by post to the address provided above or by email to

[email protected] 3.15. Admission of public and the press

3.15.1. Admission and exclusion on the grounds of confidentiality of business to be transacted

The public and representatives of the press may attend all meetings of the Islington CCG Governing Body, but shall be required to withdraw upon the meeting as follows63: a) ‘that representatives of the press, and other members of the public, be excluded

from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’, Section 1 (2), Public Bodies (Admission to Meetings) Act 1960.”

3.15.2. General disturbances

The Chair (or Vice-Chairman) or the person presiding over the meeting shall give such directions as he/she thinks fit with regard to the arrangements for meetings and accommodation of the public and representatives of the press such as to ensure that the Governing Body’s business shall be conducted without interruption and disruption and, without prejudice to the power to exclude on grounds of the confidential nature of the business to be transacted, the public will be required to withdraw upon the Governing Body resolving as follows:

a) ‘that in the interests of public order the meeting adjourn for (the period to be

specified) to enable the Governing Body to complete its business without the presence of the public’. Section 1(8) Public Bodies (Admission to Meetings) Act 1960.”

3.15.3. Business proposed to be transacted when the press and public have been excluded

from a meeting

Matters to be dealt with by the Governing Body following the exclusion of representatives of the press, and other members of the public, as provided in 3.15.1(a) and 3.15.2(a) above, shall be confidential to the members of the Governing Body. Members and Officers or any employee of Islington CCG in attendance shall not reveal or disclose the contents of papers marked ‘In Confidence’ or minutes headed ‘Items Taken in Private’ outside of the Governing Body, without the express permission of the Governing Body.

3.15.4. Use of Mechanical or Electrical Equipment for Recording or Transmission of Meetings

Nothing in these standing orders shall be construed as permitting the introduction by the public, or press representatives, or recording, transmitting, video or other similar apparatus into meetings of the Governing Body. Such permission will only be granted only upon resolution of the CCG.

63 See section 14Z15(6) of the 2006 Act (inserted by section 26 of the 2012 Act) and paragraphs 4 and 8 of

Schedule 1A of the 2006 Act (inserted by Schedule 2 of the 2012 Act)

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4. APPOINTMENT OF COMMITTEES AND SUB-COMMITTEES

4.1. Appointment of committees and sub-committees

4.1.1. Islington CCG may appoint and dismiss committees and sub-committees of Islington CCG, subject to any regulations made by the Secretary of State64, and make provision for the appointment and dismissal of committees and sub-committees of its Governing Body. Where such committees and sub-committees of Islington CCG, or committees and sub-committees of its Governing Body, are appointed they are included in Chapter 6 of the Islington CCG’s Constitution.

4.1.2. Other than where there are statutory requirements, such as in relation to the Governing Body’s audit committee or remuneration committee, the Governing Body shall determine the membership and terms of reference of its committees and sub-committees and shall, if it requires, receive and consider reports of such committees at the next appropriate meeting of the group.

4.1.3. The provisions of these standing orders shall apply where relevant to the operation of

the Governing Body and its committees and sub-committees unless stated otherwise in the committee or sub-committees’ terms of reference.

4.2. Terms of Reference

4.2.1. Terms of reference shall have effect as if incorporated into the Constitution and shall

be added to this document as an appendix.

4.3. Delegation of Powers by Committees to Sub-committees

4.3.1. Where committees are authorised to establish sub-committees they may not delegate executive powers to the sub-committee unless expressly authorised by Islington CCG.

5. DUTY TO REPORT NON-COMPLIANCE WITH STANDING ORDERS

AND PRIME FINANCIAL POLICIES

5.1. If for any reason these standing orders are not complied with, full details of the non-compliance and any justification for non-compliance and the circumstances around the non-compliance, shall be reported to the next formal meeting of the Governing Body for action or ratification. All members of Islington CCG and staff have a duty to disclose any non-compliance with these standing orders to the Chief Officer as soon as possible.

6. USE OF SEAL AND AUTHORISATION OF DOCUMENTS

6.1. Islington CCG’s seal

64 See section 14N of the 2006 Act, inserted by section 25 of the 2012 Act

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6.1.1. Islington CCG may have a seal for executing documents where necessary. The following individuals or officers are authorised to authenticate its use by their signature:

a) the Chief Officer;

b) the Chair of the Governing Body;

c) the Chief Finance Officer;

d) such other persons who are members of the Governing Body and are specifically

authorised to so by a resolution of the Governing Body

6.1.2. Where it is necessary that a document be sealed, the seal shall be affixed in the presence of two authorised officers from 6.1.1.

6.1.3. The Chief Officer shall keep a register in which he or she, or someone authorised by the Chief Officer, shall enter a record of the sealing of any document.

6.1.4. Any use of the seal shall be reported to the next formal meeting of the Governing

Body. 6.2. Execution of a document by signature

6.2.1. The following individuals are authorised to execute a document on behalf of Islington

CCG by their signature.

a) the Chief Officer;

b) the Chair of the Governing Body;

c) the Chief Finance Officer;

d) such other persons who are members of the Governing Body and are specifically authorised to do so by a resolution of the Governing Body.

7. OVERLAP WITH OTHER Islington CCG POLICY STATEMENTS / PROCEDURES AND REGULATIONS

7.1. Policy statements: general principles

7.1.1. Islington CCG will from time to time agree and approve policy statements / procedures which will apply to all or specific groups of staff employed by Islington CCG. The decisions to approve such policies and procedures will be recorded in appropriate minutes and will be deemed where appropriate to be an integral part of Islington CCG’s standing orders.

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APPENDIX E – SCHEDULE OF MATTERS RESERVED TO THE CLINICAL COMMISSIONING GROUP AND SCHEME OF DELEGATION

1.1. The Governing Body has resolved that certain powers and decisions may only be exercised by the Governing Body in

formal session. These powers and decisions are set out in the ‘Schedule of Matters Reserved to the Governing Body’ and shall have effect as if incorporated into the Standing Orders. Those powers which it has delegated to officers and other bodies are contained in the Scheme of Delegation.

1.2. The arrangements made by the group as set out in this scheme of reservation and delegation of decisions shall have effect as if incorporated in Islington CCG’s constitution.

1.3. The clinical commissioning group remains accountable for all of its functions, including those that it has delegated.

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Islington CCG Scheme of Delegation – Schedule of Matters reserved or delegated by the Governing Body

Policy Area Decision Reserved to the Membership

Reserved or delegated to Governing Body

Chief Officer Chief Finance Officer

Audit Committee

Remuneration Committee

GENERAL ENABLING PROVISION

The governing body may determine any matter, for which it has been given delegated or statutory authority, it wishes in full session within its statutory powers.

P

REGULATION AND CONTROL

Determine the arrangements by which the members of the group approve those decisions that are reserved for the membership.

P


Consideration and approval of applications to the NHS Commissioning Board on any matter concerning changes to the group’s constitution, including terms of reference for the group’s governing body, its committees, membership of committees, the overarching scheme of reservation and delegated powers, arrangements for taking urgent decisions, standing orders and prime financial policies.

P


Exercise or delegation of those functions of the clinical commissioning group which have not been retained as reserved by the group, delegated to the governing body or other committee or sub-committee or [specified] member or employee

P


Prepare the group’s overarching scheme of reservation and delegation, which sets out those decisions of the group reserved to the membership and those delegated to the:

- group’s governing body - committees and sub-committees of the

group, or - its members or employees

P

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Audit Committee


and sets out those decisions of the governing body reserved to the governing body and those delegated to the:

- governing body’s committees and sub-committees,

- members of the governing body, - an individual who is member of the group but

not the governing body or a specified person for inclusion in the group’s constitution.


Approval of the group’s overarching scheme of reservation and delegation P


Prepare the group’s operational scheme of delegation, which sets out those key operational decisions delegated to individual employees of the clinical commissioning group, not for inclusion in the group’s constitution

P


Approval of the group’s operational scheme of delegation that underpins the group’s ‘overarching scheme of reservation and delegation’ as set out in its constitution

P


Prepare detailed financial policies that underpin the clinical commissioning group’s prime financial policies

P


Approve detailed financial policies P


Approve arrangements for managing exceptional funding requests P


Set out who can execute a document by signature / use of the seal P

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Audit Committee



Prepare the Annual Audit Arrangements for both Internal and External Auditors P


Receive External Audit’s Annual Management Letter and Internal Audit’s Head of Internal Audit Opinion, taking account of the advice, where appropriate of the Audit Committee

P


Receipt of such reports as the governing body sees fit from its committees in respect of its exercise of powers delegated

P

PRACTICE MEMBER REPRESENTATIVES AND MEMBERS OF THE GOVERNING BODY

Approve the arrangements for

- identifying practice members to represent practices in matters concerning the work of the group; and

- appointing clinical leaders to represent the group’s membership on the group’s governing body, for example through election (if desired)

P


Approve the appointment of governing body members, the process for recruiting and removing non-elected members to the governing body (subject to any regulatory requirements) and succession planning

P


Approve arrangements for identifying the group’s proposed accountable officer

P

STRATEGY AND Agree the vision, values and overall strategic P

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Audit Committee


PLANNING direction of the group

STRATEGY AND PLANNING

Approval of the group’s operating structure P


Approval of the group’s commissioning plan P


Approval of the group’s corporate budgets that meet the financial duties as set out in the main body of the constitution

P


Approval of variations to the approved budget where variation would have a significant impact on the overall approved levels of income and expenditure or the group’s ability to achieve its agreed strategic aims

P

ANNUAL REPORTS AND ACCOUNTS

Approval of the group’s annual report and annual accounts P

ANNUAL REPORTS AND ACCOUNTS

Approval of the arrangements for discharging the group’s statutory financial duties P

HUMAN RESOURCES

Approve the terms and conditions, remuneration and travelling or other allowances for governing body members, including pensions and gratuities.

P

HUMAN RESOURCES

Approve terms and conditions of employment for all employees of the group including, pensions remuneration, fees and travelling or other allowances payable to employees and to persons providing services to the group.

P

HUMAN RESOURCES

Approve any other terms and conditions of services for the group’s employees.

P

HUMAN RESOURCES

Determine pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the group

P

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Audit Committee


HUMAN RESOURCES

Recommend pensions, remuneration, fees and allowances payable to employees and to other persons providing services to the group

P

HUMAN RESOURCES

Approve disciplinary arrangements for employees, including the Chief Officer and for other persons working on behalf of the group

P

HUMAN RESOURCES

Approval of the arrangements for discharging the group’s statutory duties as an employer P

HUMAN RESOURCES

Approve human resources policies for employees and for other persons working on behalf of the group P

QUALITY AND SAFETY

Approve arrangements, including supporting policies, to minimise clinical risk, maximise patient safety and to secure continuous improvement in quality and patient outcomes

P

QUALITY AND SAFETY

Approve arrangements for supporting the NHS Commissioning Board in discharging its responsibilities in relation to securing continuous improvement in the quality of general medical services

P

OPERATIONAL AND RISK MANAGEMENT

Prepare and recommend an operational scheme of delegation that sets out who has responsibility for operational decisions within the group

P


Approve the group’s counter fraud and security management arrangements P


Approval of the group’s risk management arrangements P

OPERATIONAL AND RISK

Approve arrangements for risk sharing and or risk pooling with other organisations (for example P

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Audit Committee


MANAGEMENT arrangements for pooled funds with other clinical commissioning groups or pooled budget arrangements under section 75 of the NHS Act 2006)


Approval of a comprehensive system of internal control, including budgetary control, that underpin the effective, efficient and economic operation of the group

P


Approve proposals for action on litigation against or on behalf of the clinical commissioning group P


Approve the group’s arrangements for business continuity and emergency planning P

INFORMATION GOVERNANCE

Approve the group’s arrangements for handling complaints P

INFORMATION GOVERNANCE

Approval of the arrangements for ensuring appropriate and safekeeping and confidentiality of records and for the storage, management and transfer of information and data

P

TENDERING AND CONTRACTING

Approval of the group’s contracts for any commissioning support P

TENDERING AND CONTRACTING

Approval of the group’s contracts for corporate support (for example finance provision) P

PARTNERSHIP WORKING

Approve decisions that individual members or employees of the group participating in joint arrangements on behalf of the group can make. Such delegated decisions must be disclosed in this scheme of reservation and delegation

P

PARTNERSHIP WORKING

Approve decisions delegated to joint committees established under section 75 of the 2006 Act P

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Audit Committee


COMMISSIONING & CONTRACTING FOR CLINICAL SERVICES

Approval of the arrangements for discharging the group’s statutory duties associated with its commissioning functions, including but not limited to promoting the involvement of each patient, patient choice, reducing inequalities, improvement in the quality of services, obtaining appropriate advice and public engagement and consultation

P

COMMISSIONING & CONTRACTING FOR CLINICAL SERVICES

Approve arrangements for co-ordinating the commissioning of services with other groups and or with the local authority(ies), where appropriate P

COMMUNICATION Approving arrangements for handling Freedom of Information requests P

COMMUNICATION Determining arrangements for handling Freedom of Information requests P

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Islington CCG Scheme of Delegation - Schedule of matters delegated to Officers The Scheme of Delegation shows only the ‘top level’ of delegation within the Trust and indicates ultimate Governing Body member responsibility. The Scheme is to be used in conjunction with the system of budgetary control and other established procedures within the CCG. 1. Delegation of Authority

1.1. The Chief Finance Officer will approve the level of non-pay expenditure on an annual basis and the Chief Officer will determine

the level of delegation to budget managers.

1.2. The Chief Officer will set out:

a) the list of managers who are authorised to place requisitions for the supply of goods and services; b) the maximum level of each requisition and the system for authorisation above that level.

1.3. The Chief Officer shall set out procedures on the seeking of professional advice regarding the supply of goods and services.

2. Requisitioning, Ordering, Receipt and Payment for Goods and Services

2.1. The requisitioner, in choosing the item to be supplied (or the service to be performed) shall always obtain the best value for money for the group. In so doing, the advice of the group's adviser on supply shall be sought. Where this advice is not acceptable to the requisitioner, the Chief Finance Officer (and/or the Chief Officer) shall be consulted. The following limits shall apply with regard to obtaining quotations and tenders for orders: Under £4,999 Two Verbal quotes £5,000 - £19,999 Two written quotes £19,999 -£74,999 Four written quotes £75,000 and over Official tender process

2.2. The table below shows the current delegation hierarchy for authorisation limits for Islington CCG officers: Up to £5,000 Approved Staff Member

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Up to £15,000 Budget Holder / Heads of Service Up to £50,000 Assistant Director Up to £150,000 Executive Directors £150,000+ Chief Officer and Chief Finance Officer

3. Exceptions and instances where formal tendering need not be applied - Formal tendering procedures need not be applied where:

a) the estimated expenditure or income does not, or is not reasonably expected to, exceed £74,999; or

b) where the supply is proposed under special arrangements negotiated by the DH in which event the said special arrangements

must be complied with; c) regarding disposals as set out in Prime Financial Policies.

4. Formal tendering procedures may be waived in the following circumstances:

a) in very exceptional circumstances where the Chief Officer decides that formal tendering procedures would not be practicable or the estimated expenditure or income would not warrant formal tendering procedures, and the circumstances are detailed in an appropriate Islington CCG record;

b) where the requirement is covered by an existing contract;

c) where Buying Solutions/OGS agreements are in place and have been approved by the Governing Body;

d) where a consortium arrangement is in place and a lead organisation has been appointed to carry out tendering activity on

behalf of the consortium members;

e) where the timescale genuinely precludes competitive tendering but failure to plan the work properly would not be regarded as a justification for a single tender;

f) where specialist expertise is required and is available from only one source; when the task is essential to complete the project, and arises as a consequence of a recently completed assignment and engaging different consultants for the new task would be inappropriate;

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g) there is a clear benefit to be gained from maintaining continuity with an earlier project. However, in such cases the benefits of such continuity must outweigh any potential financial advantage to be gained by competitive tendering;

h) for the provision of legal advice and services providing that any legal firm or partnership commissioned by the Islington CCG is

regulated by the Law Society for England and Wales for the conduct of their business (or by the Bar Council for England and Wales in relation to the obtaining of Counsel’s opinion) and are generally recognised as having sufficient expertise in the area of work for which they are commissioned.

i) The Chief Finance Officer will ensure that any fees paid are reasonable and within commonly accepted rates for the costing of such work.

5. Monitoring and Audit of Decision to Tender a) The waiving of competitive tendering procedures should not be used with the object of avoiding competition or solely for

administrative convenience or be subject to awarding further work to a provider originally appointed through a competitive procedure.

b) Where it is decided that competitive tendering need not be applied or should be waived, the fact of the non-application or waiver and the reasons for it should be documented and recorded in an appropriate Islington CCG record and reported to the Audit Committee at each meeting.

c) Where Islington CCG proposes not to conduct a tender process in relation to a contract opportunity for a new health care service or a significantly changed health care service then the group shall consider such proposal at a meeting of the Board.

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DELEGATED MATTER

AUTHORITY DELEGATED TO COMMISSIONING FUNCTIONS OF THE CCG

REFERENCE DOCUMENTS

1. Management of Budgets Responsibility of keeping expenditure within budgets a) At individual budget level (Pay and Non Pay) b) At service level c) For the totality of services covered by Clinical Service Manager, Commissioning Manager Admin and Clerical Service Manager or equivalent. However payment of monthly commissioning SLAs invoices or service contracts can be authorised by ‘Heads of Service’ or ‘Commissioning Staff’ within the agreed limits (see below). d) For all other areas

Designated budget manager Heads of Service Chief Finance Officer or designated Executive Director including Clinical Commissioning Group Chief Officer Chief Finance Officer and Chief Officer

Prime Financial Policies Section 5 & 7

1. Maintenance / Operation of Bank Accounts

Chief Finance Officer Prime Financial Policies Section 11

2. Non Pay Revenue and Capital Expenditure / Requisitioning / Ordering / Invoices/ Payment of Goods & Services

a) - up to £5,000 - all requisitions from £5,001 to £15,000 - all requisitions from £15,001 to £50,000 - all requisitions from £50,001 to £150,000

Designated staff members Budget holders/Heads of Service Associate Directors of Service Executive Directors

Prime Financial Policies Section 17

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DELEGATED MATTER


REFERENCE DOCUMENTS

- all requisitions over £150,000 b) Approving expenditure >tender price up to 10% or £15,000, whichever is the higher c) Approving expenditure >tender price >10% >or £15,000.

Chief Officer or Chief Finance Officer Chief Finance Officer or Designated Executive Director Chief Officer

4. Capital Schemes

a) Appointment of architects, quantity surveyors, consultant engineer and other professional advisors within EU regulations

b) Financial monitoring and reporting on all capital scheme expenditure

c) Granting and termination of leases with annual rent less than £100,000

d) Granting and termination of leases more than £100,000

e) Capital works orders:

- Less than £250,000 - More than £250,000

Chief Officer and Chief Finance Officer Chief Finance Officer Chief Finance Officer Chief Officer and Chief Finance Officer Chair, Chief Officer and Chief Finance Officer Governing Body


5. Quotation, Tendering & Contract Procedures Authority to award after proper procedures :

a) Obtaining 2 minimum verbal quotations for goods/services up to

Designated staff member

Prime Financial Policies Sections 13

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DELEGATED MATTER


REFERENCE DOCUMENTS

£5,000

b) Obtaining 3 minimum verbal quotations for goods/services up to £15,000

c) Obtaining 3 written quotations for goods/services from £15,000 to £50,000

d) Obtaining 4 written quotations for goods/services from £50,000 to

£100,000

e) Obtaining 3 written competitive tenders for goods/services from £100,000 upwards

f) Waiving of quotations & tenders subject to Prime Financial Policies - up to £100,000 - over £100,000

g) Opening Tenders and Quotations

- From £50,000 to £100,000

- From £100,000 to £500,000

- Over £500,000

h) Signing of contracts

Designated budget holders/ Heads of Service Assistant Director Executive Director Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer Chair, Chief Officer and Chief Finance Officer Board Secretary and Chief Finance Officer Board Secretary, Chief Officer and Chief Finance Officer Board Secretary, Chair, Chief Officer and Chief Finance Officer

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DELEGATED MATTER


REFERENCE DOCUMENTS

- Up to £99,999

- £100,000 to £250,000

- Over £250,000 Service agreements with other NHS bodies, contracts with Foundation Trusts, partnership agreements with Local Authorities and contracts with voluntary organisations

a) For the commissioning of all healthcare services: - up to £1,000,000

- Over £1,000,000 and up to £3,000,000

- Over £3,000,000

b) For the purchase of other services:

- up to £1,000,000

- greater than £1,000,000 up to £3,000,000

- over £3,000,000

Chief Officer or Chief Finance Officer Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer after approval by CCG Governing Body approval Director of Commissioning and Chief Officer or Chief Finance Officer Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer after Governing Body approval Chief Officer, Chief Finance Officer and Chair after

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DELEGATED MATTER


REFERENCE DOCUMENTS

approval by the Board

a) Invoice certification - excluding commissioning healthcare (SLAs) expenditure:

- Up to £5,000

- Up to £15,000

- Up to £50,000

- Up to £150,000

- From £150,000 upwards

b) Invoice certification - commissioning expenditure (SLA’s): Commissioning expenditure: payments under SLA, contracts with Foundation Trusts, partnership agreements with Local Authorities, or contracts with voluntary organisations.

- up to £50,000

- Up to £150,000

- £150,000 + 6. Setting of Fees and Charges

Designated staff member Designated budget holder Assistant Director or equivalent Executive Director Chief Officer or Chief Finance Officer Assistant Director or equivalent Executive Director Chief Officer or Chief Finance Officer

Prime Financial Policies Section 5, 7, 12 and 17.

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DELEGATED MATTER


REFERENCE DOCUMENTS

a) Price of NHS Contracts (Charges for all NHS Contracts, be they block, cost per case, cost and volume, spare capacity, PBC, new investments)

Director of Commissioning and Chief Finance Officer

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6. Engagement of Staff Not On the Funded Establishment

a) Fixed term / temporary staff up to Band 6

b) Fixed term/temporary staff over band 6 and all permanent positions

c) Engagement of Trust's Solicitors

Director of Quality & Integrated Governance Chief Officer Director of Quality & Integrated Governance


8. Agreements/Licences

a) Preparation and signature of all tenancy agreements/licences for all staff subject to Trust Policy on accommodation for staff

b) Extensions to existing leases

c) Letting of premises to outside organisations

d) Approval of rent based on professional assessment

Chief Officer and Chief Finance Officer Prime Financial Policies Section 18

10. Banking a) Commercial Accounts

- Signatories for Commercial Bank account

- Payments over £10,000

- Payment below £10,000

b) Paymaster General

Chief Officer Chief Finance Officer North East London Commissioning Services Unit Director of Finance and Director of Financial Accounts & Governance Chief Finance Officer and one signatory (from above) One signatory (from above)

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- Signatories for cash limited paymaster account

- Authorised by

- Signatories for non-cash limited account

Chief Officer Chief Finance Officer North East London Commissioning Services Unit Director of Finance and Director of Financial Accounts & Governance Two from above Two from above

11. Condemning & Disposal of equipment including IT equipment Chief Finance Officer Prime Financial Policies Section 18

12. Losses, Write-off & Compensation a) Losses and Cash due to theft, fraud, overpayment & others - Up to

£50,000 b) Fruitless Payments (including abandoned Capital Schemes) - Up to

£250,000 c) Bad Debts and Claims Abandoned. d) Damage to buildings, fittings, furniture and equipment and loss of

equipment and property in stores and in use due to culpable causes (e.g. fraud, theft, arson) or other - Up to £50,000

Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer subsequent to Audit Committee approval Chief Finance Officer subsequent to Audit Committee approval Chief Officer or Chief Finance Officer subsequent to Audit Committee approval

e) Compensation payments made under legal obligation f) Extra Contractual payments to contractors - Up to £50,000

Chief Officer or Chief Finance Officer Chief Officer or Chief Finance Officer

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- Over £50,000 Ex-Gratia Payments g) Patients and staff for loss of personal effects - Up to £500 - Between £500 and £1,000 - £1,000 to £50,000 h) For clinical negligence - up to £249,999 (negotiated settlements including claimant’s costs) - over £250,000 i) For personal injury claims involving negligence where legal advice has

been obtained and guidance applied - Up to £249,999 (including plaintiff's costs) - Over £250,000 j) Other, except cases of maladministration where there was no financial

loss by claimant £50,000 k) Write off of NHS Debtors - Up to £2 million - Over £2 million

Governing Body approval Executive Director Chief Finance Officer Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer Governing Body approval Director of Quality & Integrated Governance, Chief Officer and Chief Finance Officer Governing Body approval Chief Officer and Chief Finance Officer Chief Officer and Chief Finance Officer Governing Body approval

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l) Write off of Non NHS Debtors - Up to £250,000 - Over £250,000

Chief Finance Officer subsequent to approval by Audit Committee Governing Body approval

13. Reporting of Incidents to the Police a) Where a criminal offence is suspected

- criminal offence of a violent nature - other

b) Where a fraud is involved

Executive Director Head of Service Local Counter Fraud Specialist

14. Petty Cash Disbursements

a) Expenditure up to £50 per item as per procedure

b) Reimbursement of patients monies up to £100

c) Reimbursement of patients monies in excess of £100

Petty Cash Holder Heads of Service Heads of Service and Chief Finance Officer


15. Receiving Hospitality Applies to both individual and collective hospitality receipt items.

- In excess of £25.00 per item received

All Staff and to notify respective Heads of Service and Board Secretary.

See policy on Standards of Business Conduct and Anti-Bribery Act

16. Implementation of Internal and External Audit Recommendations

Relevant Executive Director/Head of Service

17. Maintenance & Update on CCG Financial Procedures Chief Finance Officer Prime Financial Policies

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18. Personnel & Pay

a) Authority to fill funded post on the establishment with permanent staff.

b) Authority to appoint staff to post not on the formal establishment.

c) Authority to appoint fixed-term or temporary staff at Grade 7 or above

d) Authority to appoint fixed term or temporary staff at Grade 6 or below

e) Additional Increments The granting of additional increments to staff within budget f) Upgrading & Regrading All requests for upgrading/regrading shall be dealt with in accordance

with CCG Procedure and subsequent to HR approval. g) Establishments

i. Additional staff to the agreed establishment with specifically allocated finance.

ii. Additional staff to the agreed establishment without specifically

allocated finance.

Chief Officer & relevant Executive Director Chief Officer & relevant Executive Director Chief Officer & relevant Executive Director Executive Director Executive Director Executive Director or Heads of Service and Chief Finance Officer Executive Director or Heads of Service Chief Officer or Chief Finance Officer

h) Pay

i. Authority to complete standing data forms effecting pay, new starters, variations and leavers

ii. Authority to complete and authorise positive reporting forms

Director of Human Resources or nominated deputy Heads of Service Heads of Service

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iii. Authority to authorise overtime

iv. Authority to authorise travel & subsistence expenses

v. Approval of Performance Related Pay Assessment

Heads of Service Heads of Service Remuneration Committee

i) Leave

i. Approval of annual leave

ii. Annual leave - approval of carry forward (up to maximum of 5 days)

iii. Annual leave - approval of carry over in excess of 5 days

iv. Compassionate leave up to 3 days

Immediate line manager Immediate line manager Executive Director Immediate line manager/Head of Service

AFC terms and Conditions of Service

i. Compassionate leave up to 6 days

ii. Special leave arrangements (e.g. carers leave)

- up to 3 days

- up to 6 days

iii. Leave without pay

iv. Medical Staff Leave of Absence (paid and unpaid)

v. Time off in lieu

vi. Maternity Leave - paid and unpaid

Executive Director Immediate line manager/Head of Service Executive Director Immediate line manager Head of Service/Human Resources Immediate line manager Automatic approval with guidance

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h) Sick Leave

i. Extension of sick leave on half pay up to six months

ii. Return to work part-time on full pay to assist recovery

iii. Extension of sick leave on full pay

Executive Director in conjunction with Director of Human Resources / Occupational Health Executive Director in conjunction with Director of Human Resources / Occupational Health Executive Director in conjunction with Director of Human Resources / Occupational Health

j) Study Leave

- Study leave

Head of Service/Executive Director

k) Removal Expenses, Excess Rent and House Purchases

Authorisation of payment of removal expenses incurred by officers taking up new appointments (providing consideration was promised at interview

- up to £5,000

- over £5,000

Executive Director and Director of Human Resources Chief Officer/HR

l) Grievance Procedure

All grievances cases must be dealt with strictly in accordance with the Grievance Procedure and the advice of a Human Resources Officer must be sought when the grievance reaches the level of Director

Head of Service / CSU Director of Human Resources

CCG’s Grievance Procedure

m) Authorised Car & Mobile Phone Users

- Requests for new posts to be authorised as car users

Chief Officer

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- Requests for new posts to be authorised as mobile telephone users

Executive Director

n) Renewal of Fixed Term Contract

Heads of Service/Executive Director

o) Staff Retirement Policy

Authorisation of extensions of contract beyond normal retirement age in exceptional circumstances

Executive Director in conjunction with Director of Human Resources

p) Redundancy Executive Director plus CSU Director Human Resources

q) Premature retirement r) Ill Health Retirement

- Decision to pursue retirement on the grounds of ill-health

Executive Director plus Director Human Resources Executive Director and CSU Director Human Resources

s) Dismissal

Executive Directors or Heads of service (if under the probationary period, dismissal must be approved by a Director).

CCG’s Disciplinary Procedures and Recruitment policy

20. Monitoring and Reporting of New Drugs

- Estimated total yearly cost up to £75,000

- Estimated total yearly cost above £75,000

Medical Director Medicines Management Committee and referred to Audit & Assurance Committee for information

24. Insurance Policies and Risk Management Chief Officer and Chief Finance Officer Prime Financial Policies Section

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15

25. Patients & Relatives Complaints

a) Overall responsibility for ensuring that all complaints are dealt with effectively

b) Responsibility for ensuring complaints relating to a directorate are

investigated thoroughly.

c) Medico - Legal Complaints – Co-ordination of their management.

Director of Quality & Integrated Governance Director of Quality & Integrated Governance Director of Quality & Integrated Governance

26. Relationships with Press enquiries

- Within Hours

- Outside Hours

Director of Quality & Integrated Governance Officer on call or Executive Director

27. Management of Infectious Diseases & Notifiable Outbreaks Medical Director

28. The keeping of a Declaration of Interests Register Chief Officer SOs Section 7

29. Attestation of sealings in accordance with Standing Orders Chairman / Chief Officer and Chief Finance Officer SOs Section 8

30. The keeping of a Register of Sealings Chief Officer SOs Section 8

31. The keeping of the Hospitality Register Board Secretary

32. Retention of Records Chief Officer Prime Financial Policies Section 19

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APPENDIX F – PRIME FINANCIAL POLICIES

1. INTRODUCTION

1.1. General

1.1.1. These prime financial policies and supporting detailed financial policies shall

have effect as if incorporated into the Islington CCG’s (Islington CCG) constitution.

1.1.2. The prime financial policies are part of Islington CCG’s control environment for

managing the organisations financial affairs. They contribute to good corporate governance, internal control and managing risks. They enable sound administration, lessen the risk of irregularities and support commissioning and delivery of effective, efficient and economical services. They also help the Chief Officer and Chief Finance Officer to effectively perform their responsibilities. They should be used in conjunction with the scheme of reservation and delegation found at Appendix E.

1.1.3. In support of these prime financial policies, Islington CCG has prepared more

detailed policies, approved by the Chief Finance Officer known as detailed financial policies. Islington CCG refers to these prime and detailed financial policies together as Islington CCG’s financial policies.

1.1.4. These prime financial policies identify the financial responsibilities which apply

to everyone working for Islington CCG and its constituent organisations. They do not provide detailed procedural advice and should be read in conjunction with the detailed financial policies. The Chief Finance Officer is responsible for approving all detailed financial policies.

1.1.5. A list of Islington CCG’s detailed financial policies will be published and maintained on Islington CCG’s website at www.islington.nhs.uk and will also be available upon request via e-mail or in writing through the contact details on the website.

1.1.6. Should any difficulties arise regarding the interpretation or application of any of

the prime financial policies then the advice of the Chief Finance Officer must be sought before acting. The user of these prime financial policies should also be familiar with and comply with the provisions of Islington CCG’s constitution, standing orders and scheme of reservation and delegation.

1.1.7. Failure to comply with prime financial policies and standing orders can in certain circumstances be regarded as a disciplinary matter that could result in dismissal.

1.2. Overriding Prime Financial Policies

1.2.1. If for any reason these prime financial policies are not complied with, full details of the non-compliance and any justification for non-compliance and the

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circumstances around the non-compliance shall be reported to the next formal meeting of the governing body’s audit committee for referring action or ratification. All of Islington CCG’s members and employees have a duty to disclose any non-compliance with these prime financial policies to the Chief Finance Officer as soon as possible.

1.3. Responsibilities and delegation

1.3.1. The roles and responsibilities of Islington CCG’s members, employees, members of the governing body, members of the governing body’s committees and sub-committees, members of Islington CCG’s committee and sub-committee (if any) and persons working on behalf of Islington CCG are set out in chapters 6 and 7 of this constitution.

1.3.2. The financial decisions delegated by members of Islington CCG are set out in

Islington CCG’s scheme of reservation and delegation.

1.4. Contractors and their employees

1.4.1. Any contractor or employee of a contractor who is empowered by Islington CCG to commit Islington CCG to expenditure or who is authorised to obtain income shall be covered by these instructions. It is the responsibility of the Chief Officer to ensure that such persons are made aware of this.

1.5. Amendment of Prime Financial Policies

1.5.1. To ensure that these prime financial policies remain up-to-date and relevant, the Chief Finance Officer will review them at least annually. Following consultation with the Chief Officer and scrutiny by the governing body’s audit committee, the Chief Finance Officer will recommend amendments, as fitting, to the governing body for approval. As these prime financial policies are an integral part of Islington CCG’s constitution, any amendment will not come into force until Islington CCG applies to the NHS Commissioning Board and that application is granted.

2. INTERNAL CONTROL POLICY – Islington CCG will put in place a suitable control environment and effective internal controls that provide reasonable assurance of effective and efficient operations, financial stewardship, probity and compliance with laws and policies

2.1. The governing body is required to establish an audit committee with terms of reference agreed by the governing body. See Islington CCG’s constitution for further information.

2.2. The Chief Officer has overall responsibility for Islington CCG’s systems of

internal control.

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2.3. The Chief Finance Officer will ensure that:

a) financial policies are considered for review and update annually;

b) a system is in place for proper checking and reporting of all breaches of

financial policies; and

c) a proper procedure is in place for regular checking of the adequacy and effectiveness of the control environment.

3. AUDIT

POLICY – Islington CCG will keep an effective and independent internal audit function and fully comply with the requirements of external audit and other statutory reviews

3.1. In line with the terms of reference for the governing body’s audit committee the person appointed by Islington CCG to be responsible for internal audit and the Audit Commission appointed external auditor will have direct and unrestricted access to audit committee members and the chair of the governing body, Chief Officer and Chief Finance Officer for any significant issues arising from audit work that management cannot resolve, and for all cases of fraud or serious irregularity.

3.2. The person appointed by Islington CCG to be responsible for internal audit and the external auditor will have access to the audit committee and the Chief Officer to review audit issues as appropriate. All audit committee members, the chair of the governing body and the Chief Officer will have direct and unrestricted access to the head of internal audit and external auditors.

3.3. The Chief Finance Officer will ensure that:

a) Islington CCG has a professional and technically competent internal audit function; and

b) the governing body’s audit committee approves any changes to the provision or delivery of assurance services to Islington CCG.

4. FRAUD AND CORRUPTION POLICY – Islington CCG requires all staff to always act honestly and with integrity to safeguard the public resources they are responsible for. Islington CCG will not tolerate any fraud perpetrated against it and will actively chase any loss suffered

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4.1. The governing body’s audit committee will satisfy itself that Islington CCG has adequate arrangements in place for countering fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

4.2. The governing body’s audit committee will ensure that Islington CCG has

arrangements in place to work effectively with NHS Protect.

5. EXPENDITURE CONTROL

5.1. Islington CCG is required by statutory provisions65 to ensure that its expenditure does not exceed the aggregate of allotments from the NHS Commissioning Board and any other sums it has received and is legally allowed to spend.

5.2. The Chief Officer has overall executive responsibility for ensuring that Islington CCG complies with certain of its statutory obligations, including its financial and accounting obligations, and that it exercises its functions effectively, efficiently and economically and in a way which provides good value for money.

5.3. The Chief Finance Officer will:

a) provide reports in the form required by the NHS Commissioning Board;

b) ensure money drawn from the NHS Commissioning Board is required for

approved expenditure only is drawn down only at the time of need and follows best practice;

c) be responsible for ensuring that an adequate system of monitoring financial

performance is in place to enable Islington CCG to fulfil its statutory responsibility not to exceed its expenditure limits, as set by direction of the NHS Commissioning Board.

6. ALLOTMENTS66

6.1. Islington CCG’s Chief Finance Officer will:

a) periodically review the basis and assumptions used by the NHS

Commissioning Board for distributing allotments and ensure that these are reasonable and realistic and secure Islington CCG’s entitlement to funds;

b) prior to the start of each financial year submit to the governing body for approval a report showing the total allocations received and their proposed distribution including any sums to be held in reserve; and

c) regularly update the governing body and audit committee on significant

changes to the initial allocation and the uses of such funds. 65 See section 223H of the 2006 Act, inserted by section 27 of the 2012 Act 66 See section 223(G) of the 2006 Act, inserted by section 27 of the 2012 Act.

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7. COMMISSIONING STRATEGY, BUDGETS, BUDGETARY CONTROL AND MONITORING POLICY – Islington CCG will produce and publish an annual commissioning plan67 that explains how it proposes to discharge its financial duties. Islington CCG will support this with comprehensive medium term financial plans and annual budgets

7.1. The Chief Officer will compile and submit to the governing body a commissioning strategy which takes into account financial targets and forecast limits of available resources.

7.2. Prior to the start of the financial year the Chief Finance Officer will, on behalf of

the Chief Officer, prepare and submit budgets for approval by the governing body.

7.3. The Chief Financial Officer shall monitor financial performance against budget

and plan, periodically review them, and report to the governing body and audit committee. This report should include explanations for variances. These variances must be based on any significant departures from agreed financial plans or budgets.

7.4. The Chief Officer is responsible for ensuring that information relating to Islington

CCG’s accounts or to its income or expenditure, or its use of resources is provided to the NHS Commissioning Board as requested.

7.5. The governing body will approve consultation arrangements for Islington CCG’s commissioning plan68.

8. ANNUAL ACCOUNTS AND REPORTS

POLICY – Islington CCG will produce and submit to the NHS Commissioning Board accounts and reports in accordance with all statutory obligations69, relevant accounting standards and accounting best practice in the form and content and at the time required by the NHS Commissioning Board

8.1. The Chief Finance Officer will ensure Islington CCG:

a) prepares a timetable for producing the annual report and accounts and agrees it with external auditors and the governing body;

67 See section 14Z11 of the 2006 Act, inserted by section 26 of the 2012 Act. 68 See section 14Z13 of the 2006 Act, inserted by section 26 of the 2012 Act 69 See paragraph 17 of Schedule 1A of the 2006 Act, as inserted by Schedule 2 of the 2012 Act.

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b) prepares the accounts according to the timetable approved by the governing body;

c) complies with statutory requirements and relevant directions for the

publication of annual report;

d) considers the external auditor’s management letter and fully address all issues within agreed timescales; and

8.1.2. publishes the external auditor’s management letter on Islington CCG’s website

at www.Islington.ccg.uk and is made available upon request via e-mail at or in writing through the contact details on the website.

9. INFORMATION TECHNOLOGY

POLICY – Islington CCG will ensure the accuracy and security of Islington CCG’s computerised financial data

9.1. The Chief Finance Officer is responsible for the accuracy and security of Islington CCG’s computerised financial data and shall

a) devise and implement any necessary procedures to ensure adequate

(reasonable) protection of Islington CCG's data, programs and computer hardware from accidental or intentional disclosure to unauthorised persons, deletion or modification, theft or damage, having due regard for the Data Protection Act 1998;

b) ensure that adequate (reasonable) controls exist over data entry,

processing, storage, transmission and output to ensure security, privacy, accuracy, completeness, and timeliness of the data, as well as the efficient and effective operation of the system;

c) ensure that adequate controls exist such that the computer operation is

separated from development, maintenance and amendment;

d) ensure that an adequate management (audit) trail exists through the computerised system and that such computer audit reviews as the Chief Finance Officer may consider necessary are being carried out.

9.2. In addition the Chief Finance Officer shall ensure that new financial systems

and amendments to current financial systems are developed in a controlled manner and thoroughly tested prior to implementation. Where this is undertaken by another organisation, assurances of adequacy must be obtained from them prior to implementation.

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10. ACCOUNTING SYSTEMS POLICY – Islington CCG will run an accounting system that creates management and financial accounts

10.1. The Chief Finance Officer will ensure:

a) Islington CCG has suitable financial and other software to enable it to comply with these policies and any consolidation requirements of the NHS Commissioning Board;

b) that contracts for computer services for financial applications with another

health organisation or any other agency shall clearly define the responsibility of all parties for the security, privacy, accuracy, completeness, and timeliness of data during processing, transmission and storage. The contract should also ensure rights of access for audit purposes.

10.2. Where another health organisation or any other agency provides a computer

service for financial applications, the Chief Finance Officer shall periodically seek assurances that adequate controls are in operation.

11. BANK ACCOUNTS

POLICY – Islington CCG will keep enough liquidity to meet its current commitments


a) review the banking arrangements of Islington CCG at regular intervals to ensure they are in accordance with Secretary of State directions70, best practice and represent best value for money;

b) manage Islington CCG's banking arrangements and advise Islington CCG

on the provision of banking services and operation of accounts;

c) prepare detailed instructions on the operation of bank accounts.

11.2. The Chief Officer shall approve the banking arrangements.

12. INCOME, FEES AND CHARGES AND SECURITY OF CASH, CHEQUES AND OTHER NEGOTIABLE INSTRUMENTS. POLICY – Islington CCG will

· operate a sound system for prompt recording, invoicing and collection of 70 See section 223H(3) of the NHS Act 2006, inserted by section 27 of the 2012 Act

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all monies due · seek to maximise its potential to raise additional income only to the

extent that it does not interfere with the performance of Islington CCG or its functions71

· ensure its power to make grants and loans is used to discharge its functions effectively72

12.1. The Chief Financial Officer is responsible for:

a) designing, maintaining and ensuring compliance with systems for the

proper recording, invoicing, and collection and coding of all monies due;

b) establishing and maintaining systems and procedures for the secure handling of cash and other negotiable instruments;

c) approving and regularly reviewing the level of all fees and charges other

than those determined by the NHS Commissioning Board or by statute. Independent professional advice on matters of valuation shall be taken as necessary;

d) for developing effective arrangements for making grants or loans.

13. TENDERING AND CONTRACTING PROCEDURE POLICY – Islington CCG: · will ensure proper competition that is legally compliant within all purchasing

to ensure we incur only budgeted, approved and necessary spending · will seek value for money for all goods and services · shall ensure that competitive tenders are invited for

o the supply of goods, materials and manufactured articles; o the rendering of services including all forms of management

consultancy services (other than specialised services sought from or provided by the Department of Health); and

o for the design, construction and maintenance of building and engineering works (including construction and maintenance of grounds and gardens) for disposals

13.1. Islington CCG shall ensure that the firms / individuals invited to tender (and where appropriate, quote) are among those on approved lists or where necessary a framework agreement. Where in the opinion of the Chief Finance Officer it is desirable to seek tenders from firms not on the approved lists, the reason shall be recorded in writing to the Chief Officer or Islington CCG’s governing body.

71 See section 14Z5 of the 2006 Act, inserted by section 26 of the 2012 Act. 72 See section 14Z6 of the 2006 Act, inserted by section 26 of the 2012 Act.

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13.2. The governing body may only negotiate contracts on behalf of Islington CCG, and Islington CCG may only enter into contracts, within the statutory framework set up by the 2006 Act, as amended by the 2012 Act. Such contracts shall comply with: a) Islington CCG’s standing orders;

b) the Public Contracts Regulation 2006, any successor legislation and any

other applicable law; and

c) take into account as appropriate any applicable NHS Commissioning Board or the Independent Regulator of NHS Foundation Trusts (Monitor) guidance that does not conflict with (b) above.

13.3. In all contracts entered into, Islington CCG shall endeavour to obtain best value

for money. The Chief Officer shall nominate an individual who shall oversee and manage each contract on behalf of Islington CCG.

14. COMMISSIONING POLICY – working in partnership with relevant national and local stakeholders, Islington CCG will commission certain health services to meet the reasonable requirements of the persons for whom it has responsibility

14.1. Islington CCG will coordinate its work with the NHS Commissioning Board, other clinical commissioning Islington CCGs, local providers of services, local authorities, including through Health & Wellbeing Boards, patients and their carers and the voluntary sector and others as appropriate to develop robust commissioning plans.

14.2. The Chief Officer will establish arrangements to ensure that regular reports are provided to the governing body detailing actual and forecast expenditure and activity for each contract.

14.3. The Chief Finance Officer will maintain a system of financial monitoring to ensure the effective accounting of expenditure under contracts. This should provide a suitable audit trail for all payments made under the contracts whilst maintaining patient confidentiality.

15. RISK MANAGEMENT AND INSURANCE

POLICY – Islington CCG will put arrangements in place for evaluation and management of its risks

15.1. The Governing Body shall adopt arrangements for the identification, evaluation, discussion and management of risk that will include: · regular review by the Governing body and/or its committees of identified

risks and mitigating actions;

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· assurance of the effectiveness of mitigating actions.

15.2. Through the management of risk framework the Governing Body and associated committee structure, NHS Islington CCG shall ensure risk management is a core element of its overall approach to governance.

15.3. This will include the development and maintenance of a CCG risk register. The risk register will describe identified risks; existing and planned mitigating controls; and existing and planned assurance. Risk will be rated against a common mechanism adopted by the Governing Body.

15.4. The Governing Body shall retain oversight of the CCG’s risk register.

15.5. The risk register shall be presented to the Audit Committee, the Quality and Safety Committee, and any other committee as necessary, in order for committee members to discuss and review those risks that relate to the committee’s remit

15.6. In order to ensure the Governing Body and/or its committees are able to fulfil their duties to manage risk a NHS Islington CCG will undertake a programme of risk management that will include: · a process for identifying, quantifying and managing risks;

· appropriate training for staff in the identification, description and evaluation

or risk;

· an on-going programme of risk review;

· arrangements to review the risk management programme;

· a risk management strategy setting out the roles and responsibilities of key staff.

15.7. The risk management process shall inform the Statement of Internal Control

and Annual Report, or their equivalent successor reports.

15.8. Insurance - Islington CCG is a member of the NHS Litigation Authority’s Corporate and Public Liability Schemes, and for indemnity cover against liability schemes. Risks will be evaluated in terms of the clinical, financial and reputational impact and the Governing Body or Audit Committee shall consider recommendations for what further insurance may be required to support the mitigation of identified risks.

16. PAYROLL POLICY – Islington CCG will put arrangements in place for an effective payroll service

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16.1. The Chief Finance Officer will ensure that the payroll service selected:

a) is supported by appropriate (i.e. contracted) terms and conditions; b) has adequate internal controls and audit review processes;

c) has suitable arrangements for the collection of payroll deductions and

payment of these to appropriate bodies. 16.2. In addition the Chief Finance Officer shall set out comprehensive procedures for

the effective processing of payroll 17. NON-PAY EXPENDITURE

POLICY – Islington CCG will seek to obtain the best value for money goods and services received

17.1. The Chief Finance Officer will approve the level of non-pay expenditure on an annual basis and the Chief Officer will determine the level of delegation to budget managers.

17.2. The Chief Officer shall set out procedures on the seeking of professional advice regarding the supply of goods and services.


a) advise the Chief Officer on the setting of thresholds above which quotations (competitive or otherwise) or formal tenders must be obtained; and, once approved, the thresholds should be incorporated in the scheme of reservation and delegation;

b) be responsible for the prompt payment of all properly authorised accounts and claims;

c) be responsible for designing and maintaining a system of verification,

recording and payment of all amounts payable.

18. CAPITAL INVESTMENT, FIXED ASSET REGISTERS AND

SECURITY OF ASSETS POLICY – Islington CCG will put arrangements in place to manage capital investment, maintain an asset register recording fixed assets and put in place polices to secure the safe storage of Islington CCG’s fixed assets

18.1. The Chief Officer will:

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a) ensure that there is an adequate appraisal and approval process in place for determining capital expenditure priorities and the effect of each proposal upon plans;

b) be responsible for the management of all stages of capital schemes and for ensuring that schemes are delivered on time and to cost;

c) shall ensure that the capital investment is not undertaken without

confirmation of purchaser(s) support and the availability of resources to finance all revenue consequences, including capital charges;

d) be responsible for the maintenance of registers of assets, taking account of

the advice of the Chief Finance Officer concerning the form of any register and the method of updating, and arranging for a physical check of assets against the asset register to be conducted once a year.

18.2. The Chief Finance Officer will prepare detailed procedures for the disposals of

assets.

19. RETENTION OF RECORDS POLICY – Islington CCG will put arrangements in place to retain all records in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance

19.1. The Chief Officer shall:

a) be responsible for maintaining all records required to be retained in accordance with NHS Code of Practice Records Management 2006 and other relevant notified guidance;

b) ensure that arrangements are in place for effective responses to Freedom

of Information requests;

c) publish and maintain a Freedom of Information Publication Scheme.

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APPENDIX G - NOLAN PRINCIPLES 1. The ‘Nolan Principles’ set out the ways in which holders of public office should

behave in discharging their duties. The seven principles are:

a) Selflessness – Holders of public office should act solely in terms of the public interest. They should not do so in order to gain financial or other benefits for themselves, their family or their friends.

b) Integrity – Holders of public office should not place themselves under any

financial or other obligation to outside individuals or organisations that might seek to influence them in the performance of their official duties.

c) Objectivity – In carrying out public business, including making public

appointments, awarding contracts, or recommending individuals for rewards and benefits, holders of public office should make choices on merit.

d) Accountability – Holders of public office are accountable for their

decisions and actions to the public and must submit themselves to whatever scrutiny is appropriate to their office.

e) Openness – Holders of public office should be as open as possible about

all the decisions and actions they take. They should give reasons for their decisions and restrict information only when the wider public interest clearly demands.

f) Honesty – Holders of public office have a duty to declare any private

interests relating to their public duties and to take steps to resolve any conflicts arising in a way that protects the public interest.

g) Leadership – Holders of public office should promote and support these

principles by leadership and example. Source: The First Report of the Committee on Standards in Public Life (1995)73

73 Available at http://www.public-standards.gov.uk/

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APPENDIX H – THE SEVEN KEY PRINCIPLES OF THE NHS CONSTITUTION

The NHS Constitution sets out seven key principles that guide the NHS in all it does: 1. the NHS provides a comprehensive service, available to all - irrespective of

gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population

2. access to NHS services is based on clinical need, not an individual’s ability to

pay - NHS services are free of charge, except in limited circumstances sanctioned by Parliament.

3. the NHS aspires to the highest standards of excellence and professionalism - in

the provision of high-quality care that is safe, effective and focused on patient experience; in the planning and delivery of the clinical and other services it provides; in the people it employs and the education, training and development they receive; in the leadership and management of its organisations; and through its commitment to innovation and to the promotion and conduct of research to improve the current and future health and care of the population.

4. NHS services must reflect the needs and preferences of patients, their families

and their carers - patients, with their families and carers, where appropriate, will be involved in and consulted on all decisions about their care and treatment.

5. the NHS works across organisational boundaries and in partnership with other

organisations in the interest of patients, local communities and the wider population - the NHS is an integrated system of organisations and services bound together by the principles and values now reflected in the Constitution. The NHS is committed to working jointly with local authorities and a wide range of other private, public and third sector organisations at national and local level to provide and deliver improvements in health and well-being

6. the NHS is committed to providing best value for taxpayers’ money and the most

cost-effective, fair and sustainable use of finite resources - public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves

7. the NHS is accountable to the public, communities and patients that it serves -

the NHS is a national service funded through national taxation, and it is the Government which sets the framework for the NHS and which is accountable to Parliament for its operation. However, most decisions in the NHS, especially those about the treatment of individuals and the detailed organisation of services, are rightly taken by the local NHS and by patients with their clinicians. The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff. The Government will ensure that there is always a clear and up-to-date statement of NHS accountability for this purpose

Source: The NHS Constitution: The NHS belongs to us all (March 2012)74 74 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_132961

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APPENDIX I – NHS ISLINGTON CLINICAL COMMISSIONING GROUP AUDIT COMMITTEE

DRAFT TERMS OF REFERENCE 1. Introduction

The Audit Committee (the Committee) is established, and powers are delegated to it, by the Governing Body of Islington Clinical Commissioning Group (the CCG), in accordance with the CCG’s Constitution. The Committee is a non-executive committee of the Governing Body. It has no executive powers and it has no power to establish sub-committees. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the CCG’s Constitution.

2. Membership The Committee shall be appointed by the Governing Body as set out in the CCG’s Constitution. It shall consist of not less than three members of the Governing Body. The membership shall comprise:

· Two Governing Body Lay Members. The Lay Member with the lead role in overseeing

key elements of governance shall be the Chair of the Committee. · One Governing Body GP Member.

The Chair of the Governing Body may not be a member of the Audit Committee.

3. Frequency of meetings The Committee will meet at least four times a year. The External Auditor or the Head of Internal Audit may request that a meeting of the Committee is called if they consider that one is necessary. A minimum of seven working days notice is required to call for a meeting.

4. Quorum A quorum shall be two members.

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If a meeting of the Committee is not, or ceases to be, quorate the procedures set out in the CCG’s Constitution shall be followed.

5. Attendance by non-members The Chief Finance Officer and appropriate representatives from internal and external audit shall normally attend meetings. At least once a year the Committee should meet privately with the external and internal auditors. Other directors shall be invited to attend when the Committee is discussing areas of risk or operation that are their responsibility. If unable to attend in person, a director will nominate a suitable deputy to attend in his/her place. The Chief Officer shall be invited to attend, at least annually, to discuss the process for assurance that supports the Annual Governance Statement. He or she should also attend when the Committee considers draft internal audit plans and annual accounts. The Chair of the Governing Body and members of partner organisations may also be invited to attend when required.

6. Secretarial support The Secretary to the Governing Body will provide secretarial support to the Committee.

7. Conduct of business

The Committee shall apply best practice in its deliberations and in the decision-making processes. It will conduct its business in accordance with national guidance and relevant codes of conduct, the Constitution of the CCG, and good governance practice. The Committee will review its performance annually.

8. Remit and responsibilities of the Committee

Governance, risk management and internal control The Committee shall review the establishment and maintenance of an effective system of integrated governance, risk management and internal control, across the whole of the CCG’s activities, that supports the achievement of the CCG’s objectives. In particular, the Committee will review the adequacy and effectiveness of:

· All risk and control related disclosure statements (in particular the Annual Governance Statement), together with any appropriate independent assurances, prior to endorsement by the Governing Body.

· The underlying assurance processes that indicate the degree of achievement of corporate objectives, the effectiveness of the management of principal risks and the appropriateness of the above disclosure statements.

· The policies for ensuring compliance with relevant regulatory, legal and code of conduct requirements and related reporting and self-certification.

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· The policies and procedures for all work related to fraud and corruption as set out in Secretary of State Directions and as required by NHS Protect. In carrying out this work the Committee will primarily utilise the work of internal audit, external audit and other assurance functions, but will not be limited to these sources. It will also seek reports and assurances from directors and managers as appropriate, concentrating on the over-arching systems of integrated governance, risk management and internal control, together with indicators of their effectiveness. This will be evidenced through the Committee’s use of an effective Assurance Framework to guide its work and that of the audit and assurance functions that report to it. The Committee may also request reports from individual functions within the CCG arising from specific items in the Assurance Framework.

Internal audit The Committee shall ensure that there is an effective internal audit function that meets mandatory NHS Internal Audit Standards and provides appropriate independent assurance to the Committee, the Chief Officer and the Governing Body. This will be achieved by:

· Making recommendations to the Governing Body regarding the award or termination of contracts for the provision of the internal audit service.

· Review and approval of the internal audit strategy and annual audit plan, ensuring that this is consistent with the audit needs of the organisation, as identified through the Assurance Framework.

· Considering the major findings of internal audit work (and management’s response) and ensuring co-ordination between internal and external auditors to optimise audit resources.

· Ensuring that the internal audit function is adequately resourced and has appropriate standing within the CCG.

· An annual review of the effectiveness of internal audit. External audit The Committee shall review the work and findings of external audit and consider the implications and management’s response to their work. This will be achieved by:

· Consideration of the performance of external audit, as far as the rules governing the appointment permit.

· Discussion and agreement with the External Auditor, before the audit commences, on the nature and scope of the audit as set out in the annual plan, and ensuring co-ordination, as appropriate, with other external auditors in the local health economy.

· Discussion with the External Auditor of his/her local evaluation of audit risks and assessment of the CCG and associated impact on the audit fee.

· Review of all external audit reports, including the report to those charged with governance, agreement of the annual audit letter before submission to the Governing Body, and any work undertaken outside the annual audit plan, together with the appropriateness of management responses.

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Other assurance functions The Committee shall review the findings of other significant assurance functions, both internal and external, and consider the implications for the governance of the CCG. These will include, but will not be limited to, any reviews by Department of Health arm’s length bodies or regulators/inspectors (for example, the NHS Litigation Authority) and professional bodies with responsibility for the performance of staff or functions (for example, Royal Colleges and accreditation bodies).

The Committee’s work will dovetail with that of any committee established by the Governing Body whose remit is to seek assurance that robust clinical quality is in place.

Where the activities of partner organisations may have an impact on the ability of the CCG to achieve its corporate objectives, the Committee will seek formal assurances that the partner organisations have adequate arrangements in place for governance, risk management, and internal control.

Counter fraud The Committee shall satisfy itself that the CCG has adequate arrangements in place for reducing fraud and shall review the outcomes of counter fraud work. It shall also approve the counter fraud work programme.

Financial reporting The Committee shall monitor the integrity of the financial statements of the CCG and of any formal announcements relating to the CCG’s financial performance. The Committee shall ensure that the systems for financial reporting to the Governing Body, including those of budgetary control, are subject to review as to completeness and accuracy of the information provided. The Committee shall review the annual report and financial statements before submission to the Governing Body, focusing particularly on:

· The wording in the Annual Governance Statement and other disclosures relevant to the terms of reference of the Committee;

· Changes in, and compliance with, accounting policies, practices and estimation techniques;

· Unadjusted mis-statements in the financial statements; · Significant judgments in preparing the financial statements; · Significant adjustments resulting from the audit; · Letter of representation; and · Qualitative aspects of financial reporting.

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9. Reporting arrangements The Committee shall report regularly to Governing Body. The report will set out the main matters discussed and any decisions taken. It will also draw the attention of the Governing Body to any matters requiring disclosure to them, or requiring executive action. The Committee shall also report to the Governing Body annually on its work in support of the Annual Governance Statement, specifically commenting on the fitness for purpose of the Assurance Framework, the completeness and embeddedness of risk management, and the integration of governance arrangements.

10. Review of terms of reference

The membership and terms of reference shall be reviewed annually. Any proposals to change the terms of reference or membership must be approved by the Governing Body.

Drafted: February 2013 Adopted:

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APPENDIX J – NHS ISLINGTON CLINICAL COMMISSIONING GROUP REMUNERATION COMMITTEE

DRAFT TERMS OF REFERENCE

1. Introduction The Remuneration Committee (the Committee) is established, and powers are delegated to it, by the Governing Body of Islington Clinical Commissioning Group (the CCG), in accordance with the CCG’s Constitution. The Committee is a non-executive committee of the Governing Body. It has no executive powers and it has no power to establish sub-committees. The Committee is authorised by the Governing Body to investigate any matter within its terms of reference. It is authorised to seek any information it requires from any CCG member practice, provider of commissioning support services, of CCG employee. All employees are directed to co-operate with any request made by the Committee.

These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the CCG’s Constitution.

2. Membership The Committee shall be appointed by the Governing Body as set out in the CCG’s Constitution. It shall consist of not less than three members of the Governing Body. The membership shall comprise:

· The Governing Body Lay Member with responsibility for governance (Chair). · The Governing Body Lay Member with responsibility for Patient & Public Involvement. · A third member nominated from those Governing Body members who do not claim a

significant proportion of their income from the CCG. When considering the remuneration of lay members the membership shall comprise of three members of the Governing Body who do not claim a significant proportion of their income from the CCG.

The composition of the Committee shall be reported in the CCG’s Annual Report.

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3. Frequency of meetings The Committee will meet at least once a year, or more frequently as the need arises. A minimum of ten days notice is required to call a meeting.

4. Quorum

A quorum shall be two members. If a meeting of the Committee is not, or ceases to be, quorate the procedures set out in the CCG’s Constitution shall be followed.

5. Attendance by non-members The Chair of the Committee may invite other individuals to attend meetings on an ad hoc basis to enable the Committee to discharge its responsibilities. The Committee is authorised by the Governing Body to secure the attendance of experienced expert advisers from outside the CCG if it considers this necessary.

6. Secretarial and technical support The Secretary to the Governing Body will provide secretarial support to the Committee. Independent technical advice and support for the business of the Committee will be provided by a senior Human Resources professional. Advice and support will include drawing the Committee’s attention to best practice, national guidance, and other relevant matters as appropriate. The Committee is also authorised by the Governing Body to obtain external legal or other independent professional advice.


The Committee shall apply best practice in its deliberations and in the decision-making processes. It will conduct its business in accordance with national guidance and relevant codes of conduct, the Constitution of the CCG, and good governance practice. If any member has an interest, pecuniary or otherwise, in any matter and is present at the meeting at which the matter is under discussion, he/she will declare that interest at the earliest opportunity and shall not participate in the discussion. The Chair will have the power to request that member to withdraw until the Committee’s consideration has been completed. If the Chair is the member with a conflict of interests, arrangements should be made in advance to enable an alternative lay member to be present to ensure the Committee is quorate.

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The Committee shall make recommendations to the Governing Body on determinations about pay, remuneration and conditions of service for employees of the CCG and others who provide services to the CCG (such as clinical leaders), and allowances under any pension scheme it might establish as an alternative to the NHS pension scheme. Following the Chair’s review of the performance of the CCG leadership, the Committee shall make recommendations to the Governing Body concerning any annual salary awards or bonuses, or any severance payments requiring HM Treasury approval.

The Committee shall consider the remuneration of those roles not covered by agreed national pay frameworks.

9. Reporting arrangements The Committee shall report to Governing Body. The report will set out the main matters discussed and any recommendations made. It will also draw the attention of the Governing Body to any matters requiring disclosure to them, or requiring executive action. The Committee shall also report to the Governing Body annually.




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APPENDIX K – NHS ISLINGTON CLINICAL COMMISSIONING GROUP QUALITY & PERFORMANCE COMMITTEE


The Quality & Performance Committee (the Committee) is established, and powers are delegated to it, by the Governing Body of Islington Clinical Commissioning Group (the CCG), in accordance with the CCG’s Constitution. The Committee has no power to establish sub-committees. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the CCG’s Constitution.

2. Membership The Committee shall be appointed by the Governing Body as set out in the CCG’s Constitution and may include individuals who are not members of the Governing Body. The membership shall comprise:

· The Governing Body Lay Member with the responsibility for patient and public

participation shall act as Chair · Three Governing Body Elected Members · Director of Quality and Integrated Governance · Governing Body Chair (ex-officio) · Chief Officer (ex-officio)

3. Frequency of meetings

The Committee will meet monthly and a minimum of six times a year. If unable to attend in person, a member will nominate a suitable deputy to attend in his/her place.

4. Quorum A quorum shall be three members. If a meeting of the Committee is not, or ceases to be, quorate the procedures set out in the CCG’s Constitution shall be followed.

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5. Attendance by non-members Meetings shall be attended by:

· Director of Commissioning · One Public Health representative · Two patient representatives · One HealthWatch representative · One Local Authority representative · One Commissioning Support Unit Quality Lead

The Chair of the Committee shall invite other individuals to attend meetings on an ad hoc basis to enable the Committee to discharge its responsibilities.



The Committee shall apply best practice in its deliberations and in the decision-making processes. It will conduct its business in accordance with national guidance and relevant codes of conduct, the Constitution of the CCG, and good governance practice.


CCG Performance The Committee shall oversee the management of the CCG’s performance against service delivery indicators by:

· Monitoring performance against standards and national and local targets, including

any incorporated in the Operating Plan. · Reviewing the CCG’s benchmarked performance against the NHS Outcomes

Framework. · Ensuring action plans are developed and put in place to address any areas of

unsatisfactory performance, and monitoring progress on the implementation of these plans.

· Overseeing the continuous development of the scope, format, presentation and mechanisms of the system of performance reporting.

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Quality of commissioned services The Committee shall monitor the effective delivery of quality performance across the full range of commissioned services by:

· Monitoring the quality performance of all providers (those in the borough and those of

particular interest to the borough), including detailed reports on services that are commissioned across acute, community and primary care.

· Reviewing specific action plans or recovery plans as they relate to quality. · Reviewing quality performance with regard to QIPP.

Patient experience The Committee shall monitor the level of complaints and complaint resolution by:

· Receiving patient experience reports, including Patient Advice and Liaison Service (PALS) reports and complaints reports that identify themes and trends, and recommend areas for change in practice through the commissioning process.

· Conducting an annual review of trends in complaints received in relation to services provided in secondary and primary care settings.

· Monitoring the management of and compliance with the CCG’s complaints policy and procedures.

· Ensuring the learning from complaints and other feedback is translated into changes in the way services are provided.

· Receiving collated patient experience reports from all providers looking at themes and trends. These reports should cover a broad set of indicators including, where possible, “real time” data. Effectiveness The Committee shall monitor the effectiveness of commissioned services by:

· Monitoring the performance of Trusts against agreed Commissioning for Quality and Innovation incentives (CQUINS) and making recommendations for future CQUIN development.

· Supporting the development of new or amended CQUINS. · Reviewing the quality of primary care, working with Primary Care Contracting as part

of the NHS Commissioning Board. · Assessing the CCG’s performance against the relevant parts of the Commissioning

Outcomes Framework and reporting the results to the Governing body. · Considering regular reports from Joint Commissioning on Children’s and Adult

Services (including any Ofsted reports). Safety The Committee shall satisfy itself about the safety of services by:

· Overseeing the accreditation and annual review of GPs with specialist interests.

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· Making recommendations to the Governing Body on actions required following national inquiries and national and local reviews undertaken by the Care Quality Commission, and monitoring the implementation of actions..

· Reviewing reports of Serious Incidents and ‘Never Events’ in relation to commissioned services and ensuring that there is effective organisational learning, to ensure that patient safety is maximised through the commissioning process.

· Receiving assurance around the implementation and circulation of safety alerts. · Considering assurance reports in relation to safeguarding adults and children that

identify issues of compliance, and themes and trends. · Receiving and publishing the annual safeguarding reports for children and adults.

Risk management The Committee shall review those risks on the corporate risk register which have been assigned to it and ensure that appropriate and effective mitigating actions are in place.

9. Reporting arrangements

The Committee shall report regularly to the Governing Body. The report will set out the main matters discussed and any decisions taken. It will also draw the attention of the Governing Body to any matters requiring disclosure to them, or requiring Governing Body approval. The Committee will receive reports relevant to its remit from any group or working group as appropriate.




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APPENDIX L – NHS ISLINGTON CLINICAL COMMISSIONING GROUP STRATEGY & FINANCE COMMITTEE


The Strategy & Finance Committee (the Committee) is established, and powers are delegated to it, by the Governing Body of Islington Clinical Commissioning Group (the CCG), in accordance with the CCG’s Constitution. The Committee has no power to establish sub-committees. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the CCG’s Constitution.


· Joint Vice-Chair (Clinical) – Chair · Governing Body Chair (ex-officio) · Chief Officer (ex-officio) · Two Governing Body Elected Members · Governing Body Secondary Care Clinician · Vice-Chair (Non-clinical) · Chief Finance Officer


The Committee will meet monthly and a minimum of ten times a year. If unable to attend in person, a member will nominate a suitable deputy to attend in his/her place.

4. Quorum A quorum shall be three members.

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· One Commissioning Support Unit senior representative · The Joint Director of Public Health for Camden and Islington · Two patient representatives · One Local Authority representative






Planning The Committee shall:

· Oversee the review and development of the CCG’s three-year Commissioning Strategy Plan and associated financial plans.

· Oversee the review and development of the CCG’s four-year QIPP plan, and associated financial plans.

· Oversee the development of the CCG’s one-year Operational Plan and associated financial plan (the annual budget).

· Ensure that all plans are supported by robust activity and financial information. · Ensure that all plans are consistent with associated enabling strategies (workforce,

estates, IM&T, communications and engagement). · Consider all draft strategic and financial plans prior to their submission to the

Governing Body for approval. · Consider reports on the longer-term future strategic direction of the CCG.

Delivery of plans The Committee shall:

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· Monitor the overall implementation of the CSP and the delivery of the QIPP Plan. · Review business cases for specific service developments.

· Financial monitoring

The Committee shall:

· Monitor the CCG’s in-year financial performance against approved budget on a monthly basis, giving consideration to underlying activity data as appropriate.

· Ensure that where risks of exceeding expenditure limits are identified, recommendations for immediate remedial action are agreed by the Committee for consideration by the Governing Body.

· Monitor the delivery of any such action plans. · Monitor the CCG’s longer-term financial stability.

Risk management The Committee shall review those risks on the corporate risk register which have been assigned to it and ensure that appropriate and effective mitigating actions are in place.

9. Reporting arrangements

The Committee shall report regularly to the Governing Body. The report will set out the main matters discussed and any decisions taken. It will also draw the attention of the Governing Body to any matters requiring disclosure to them, or requiring Governing Body approval. The Committee will receive reports relevant to its remit from any group or working group as appropriate.




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APPENDIX M – NHS ISLINGTON CLINICAL COMMISSIONING GROUP PATIENT & PUBLIC PARTICIPATION COMMITTEE


The Patient & Public Participation Committee (the Committee) is established, and powers are delegated to it, by the Governing Body of Islington Clinical Commissioning Group (the CCG), in accordance with the CCG’s Constitution. The Committee has no power to establish sub-committees. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the Committee and shall have effect as if incorporated into the CCG’s Constitution.


· Joint Vice-Chair (Clinical) - Chair · Two Governing Body Elected Members · The Governing Body Lay Member with responsibility for Patient and Public

Participation · Director of Quality and Integrated Governance · Governing Body Chair (ex-officio) · Chief Officer (ex-officio)


The Committee will meet a minimum of 4 times a year.. If unable to attend in person, a member will nominate a suitable deputy to attend in his/her place.

4. Quorum A quorum shall be three members.

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· One Commissioning Support Unit Complaints representative · One Local Authority representative · One HealthWatch representative · Two appointed members of the public






The Committee’s overarching purpose is to ensure that the CCG fulfils its commitment to develop ‘a new relationship with our patients and public’ through reviewing the processes of, and the decisions and actions taken by, the organisation. It will therefore:

· Promote engagement with patient groups in order to involve interested patients in commissioning.

· Oversee the development and implementation of the Patient and Public Participation, Equality and Diversity Strategy 2011-15.

· Ensure that strategies relating to equality and diversity are embedded in the CCG’s structures and processes, including advising the Governing Body of their responsibilities under the Equality Act 2010.

· Promote engagement and partnership working with voluntary and community groups to develop new or existing services.

· Promote partnership working to support the development of services and seek assurance that this work is being undertaken.

· Ensure that new or developing services commissioned by the CCG have a good track record of patient experience.

· Monitor the effectiveness of participation.

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· Review the work of other committees of the CCG with other committees and groups to ensure that patient and public involvement is embedded in their structures and processes.

· Acknowledge that the Quality and Performance Committee has the responsibility of understanding and using patient experience as part of its fuller understanding of quality.

· Review those risks on the corporate risk register which have been assigned to the Committee and ensure that appropriate and effective mitigating actions are in place.

· Review the effectiveness of managing complaints in the local NHS.

9. Reporting arrangements The Committee shall report regularly to the Governing Body. The report will set out the main matters discussed and any decisions taken. It will also draw the attention of the Governing Body to any matters requiring disclosure to them, or requiring Governing Body approval. In addition, the Committee will report to the Governing Body every six months on progress in implementing the Patient and Public Participation, Equality and Diversity Action Plan 2011-15. The Committee will receive reports relevant to its remit from any group or working group as appropriate.




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APPENDIX N – PROCUREMENT POLICY

Islington Clinical Commissioning Group

CLINICAL HEALTHCARE SERVICES PROCUREMENT STRATEGIC POLICY

April 2013

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TABLE OF CONTENTS 1 Introduction 3 2 National Context 3 3 Legal Context 4 4 Organisational Values 5 5 The Commissioning Cycle 5 6 Islington Clinical Commissioning Group Clinical Procurement

Policy 6

6.1 Procurement Principles 6 6.2 Provider Engagement/Market Management 7 6.3 Service Specifications 7 6.4 Sustainable Procurement 8 6.5 Islington Clinical Commissioning Group Contestability

Principles 8

7 Islington Clinical Commissioning Group Clinical Procurement

Process 9

Appendices A Procurement Routes 10 B C

Islington Clinical Commissioning Group: Pilots guidance Islington Clinical Commissioning Group Clinical Procurement Process

13 14

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1. INTRODUCTION 1.1 Through excellent commissioning practice, Islington Clinical Commissioning Group

aims to best serve the local population and deliver the vision, strategic goals and improved health outcomes set out in the Operating Plan. Islington Clinical Commissioning Group’s approach to commissioning uses robust contracts and monitoring to incentivise providers to strive for continuous improvement in service delivery in terms of clinical quality, productivity and efficiency, and demonstrating value for money. Procurement is one of the levers that can be used to achieve these aims and so ensure that local people receive excellent and innovative healthcare. Where poor performance cannot be remedied through contractual mechanisms, formal tendering is one option that will be considered.

1.2 To demonstrate best practice commissioning, Islington Clinical Commissioning Group will need to: - • Manage the provider ‘market’ and commission services from a variety of providers. • Ensure strong clinical insight and engagement. • Use good quality contracts to assure the delivery of services. • Produce and make available to the public good quality information to support

decision making. • Make the public aware of their right to make choices in relation to their own health. • Have clear, robust and good quality procurement processes in place.

1.3 EU Principles require that the Procurement processes used to procure services are fair and transparent. Islington Clinical Commissioning Group therefore needs to ensure potential providers are given clear guidance on what services the Islington Clinical Commissioning Group wishes to procure and the process that will be used to select the provider. Islington Clinical Commissioning Group commissioners also have a duty to comply with Islington Clinical Commissioning Group’s “Standing Orders, Reservation and Delegation of Powers and Standing Financial Instructions.” These clearly set out tendering and contracting procedure, including waiver criteria and authorisation limits for the award and signing of contracts, whilst also requiring tenders to demonstrate that they achieve value for money. As there are an increasing number of independent, third sector organisations and NHS Foundation Trusts (which have greater autonomy including rights to holding legally binding contracts) who are keen and able to deliver quality clinical healthcare services, Islington Clinical Commissioning Group is likely to find ever increasing pressures to ensure appropriate procurement processes have been followed when commissioning services.

1.4 As Islington Clinical Commissioning Group is a new organisation, this document therefore will aim to set out: · The context within which Islington Clinical Commissioning Group’s planned clinical

healthcare service procurements will be undertaken · The principles governing those procurement processes · A clear clinical procurement process for Islington Clinical Commissioning Group

2. NATIONAL CONTEXT

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2.1. The new NHS White Paper “Equity & Excellence: Liberating the NHS” foresees Clinical Commissioning Groups taking lead responsibility for commissioning healthcare services. The paper also indicates that patients’ access to increased choice will be supported through use of Any Qualified Providers wherever relevant. Further guidance on this model of procurement is awaited. Indeed, the impact of any clarifications and/or revisions to the Health and Social Care Act on the development of an Islington Clinical Commissioning Group Procurement Strategy will need to be assessed.

2.2. The national financial context means that the NHS is operating in an extremely

challenging financial situation. The need for Islington Clinical Commissioning Group to demonstrate effective and efficient use of resources to deliver improved health outcomes through increased productivity and value for money remains a key priority. Formal procurement of services is a means to achieve this by testing the market and encouraging existing providers to focus on continual improvement of service efficiency, patient satisfaction and costs. The case to waive the need to tender will therefore need to be strong, considered on a case-by-case basis, consistent with Islington Clinical Commissioning Group Standing Financial Instructions and authorisation transparently recorded.

3. LEGAL CONTEXT

3.1. When Islington Clinical Commissioning Group proposes to award public contracts,

the procurement will be conducted in accordance with the EU Procurement Directives as implemented into UK law by the Public Supply Contracts Regulations 2006 [(as amended) (SI/2006/5)].

3.2. Islington Clinical Commissioning Group’s Clinical Procurement Strategy also aims

to comply with relevant national and regional guidelines and systems management tools issues by the Department of Health (DH) and NHS London. These include:

· Procurement Guide for commissioners of NHS-funded services (30 July 2010). · The Principles and Rules for Cooperation and Competition (PRCC) (July 2010) · Framework for Managing Choice, Co–Operation and Competition (May 2008).

3.3. Under EU Procurement rules, goods and services to be procured are divided into

Part A and Part B services. Part A services above certain financial values are subject to the full OJEU procurement regime including advertisement across Europe. However, health and social care services are classified as Part B services, and are therefore subject only to compliance with the general principles of equal treatment, transparency, objectivity and non-discrimination. It is expected that Islington Clinical Commissioning Group’s Clinical Procurement Team (through North and East London Commissioning Support Unit) will be procuring only Part B services. It is NHS policy that all Part B services contracts to be awarded by commissioners must be advertised on the Supply2Health website in order to meet transparency obligations around adequate advertisement.

3.4. When considering whether or not a service should be competitively tendered,

Islington Clinical Commissioning Group will follow the DH Procurement Guide (see 3.2 above) and Islington Clinical Commissioning Group Prime Financial Policies, taking into account the scale of the procurement, the degree to which the service specification

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and funding model have been developed, and the number of potential providers for the service.

4. ORGANISATIONAL VISION, VALUES AND PRINCIPLES 4.1. Islington Clinical Commissioning Group’s organisational values are at the heart of

everything we do; they have guided our approach to developing plans for the future and will remain central as we deliver their content. In the context of procurement policy, these are further underpinned by our local procurement principles (see 5.1 below) and the DH’s overarching procurement principles, which are consistent with these values.

· Our Vision:

o To improve the health outcomes of our population over the next 5 years compared with Londoners as a whole. In particular, we will improve health by addressing health inequalities within our population, focusing on our most deprived communities

o As a world class commissioner of healthcare, our population will have access to more services closer to home and the highest quality hospital services, delivered within a financially sustainable health economy

· Our Values: o Quality: improving quality through the implementation of redesigned care

pathways o Diversity & Inclusiveness: ensuring our interventions are effective by targeting

the most needy o Partnership working: working with all NHS organisations in the North and East

London Commissioning Support Unit o Delivering Value For Money: driving up productivity through contract

management, strategic commissioning and QIPP plans o Sustainability: ensuring all our organisations are robust and sustainable for the

long-term · Our Principles:

o Centralising the most specialist service provides better clinical outcomes and safer services for patients

o Localising routine medical services provides better access closer to home and improved patient experiences

o Where possible, care should be integrated between primary and secondary care, with involvement from social care, to ensure seamless patient care.

5. THE COMMISSIONING CYCLE 5.1 The diagram below sets out the commissioning cycle. This strategy is designed to

support the steps outlined in pink, from specification of required outcomes to contracting with providers and shaping the structure of supply.

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Figure 1: The Commissioning Cycle: 6. CLINICAL PROCUREMENT POLICY

6.1. CLINICAL PROCUREMENT PRINCIPLES

Islington Clinical Commissioning Group aims to conduct all clinical procurements in accordance with the following principles:

6.1.1. Transparency: commissioners should be clear and transparent in

communications with providers about commissioning intentions, decisions (or not) to tender, advertising of opportunities, procurement evaluation criteria, publication of decisions and mechanisms for feedback.

6.1.2. Efficiency: commissioners will work with providers to improve

productivity, efficiency and effectiveness of services without compromising clinical quality.

Primary Care Involvement

Public and Patient Engagement

Evidence Based

Practice

Contract with providers.

Design services and

pathways

Manage demand &

ensure appropriate

access to care

Clinical decision making

Manage quality, performance

and outcomes

Assess Needs

Review current service

Decide and agree

priorities

Specify and agree quality

outcomes

Strategic Planning

Specify outcomes

and procure services

Monitoring- managing,

demand, supply, performance

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6.1.3. Quality: Islington Clinical Commissioning Group will procure services to meet patient needs at the highest possible quality standard, and use appropriate measurable performance indicators to monitor provider performance. Commissioners will work with and support all providers to encourage continual improvement in the quality of services that are provided.

6.1.4. Continuity: commissioners will work in partnership with key

providers of NHS services but will continually test these services to ensure that the current providers deliver best value for money.

6.1.5. Equality of treatment and non-discrimination: Islington Clinical

Commissioning Group will clearly identify those services which will be put out for competition. All sectors and providers (NHS and non NHS) will be treated equitably in terms procurement rules, access to information, timescales, financial and quality assurance checks, and pricing and payment regimes.

6.1.6. Proportionality: commissioners will use procurement processes

that are proportionate to the value, complexity and risk/benefit to patients of services procured; different procurement routes for different types of services will enable this. Potential costs to bidders will also be considered when assessing procurement routes.

6.1.7. Consistency: commissioners will apply national and local principles

and rules consistently across the Islington Clinical Commissioning Group area and over time.

6.1.8. Professional Conduct: all procurement personnel will be subject to

the Professional Code of Conduct as published by the Chartered Institute of Purchasing and Supply (CIPS).

6.2. PROVIDER ENGAGEMENT/MARKET MANAGEMENT

6.2.1. Ongoing provider engagement is part of the Commissioning Cycle

(see Figure 1 above). Particular engagement activities (such as Information Events) will be undertaken that relate to individual procurement exercises, but Islington Clinical Commissioning Group is committed to maintaining an ongoing dialogue with providers in order to involve them in shaping Islington Clinical Commissioning Group’s commissioning intentions, and for providers to be clear about the shape and quality of service provision those commissioning intentions require.

6.3. SERVICE SPECIFICATIONS

6.3.1. Islington Clinical Commissioning Group is committed to developing

clear, outcome-focused service specifications as far as possible in partnership with clinicians and service providers in order to enable the Islington Clinical Commissioning Group to procure the services

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we need from our providers by giving them sufficient information to understand what we want to buy while allowing for innovation where this is required.

6.3.2. The degree to which the service specification has or can be

developed will also inform the procurement model followed, for example, for any qualified Provider rocurements, the service specification and funding model must be fully developed prior to procurement.

6.3.3. Governance: service specifications will, as a matter of course,

address the governance arrangements required of any service being procured in order that Islington Clinical Commissioning Group is assured that a clear and robust governance structure is in place both across the service specified and within the organisation which wins the tender.

6.3.4. Clinical engagement: as far as the chosen procurement route

allows, Islington Clinical Commissioning Group will engage with a range of clinicians within Islington Clinical Commissioning Group, constituent Islington Clinical Commissioning Groups and providers to develop service specifications that are driven by clinical quality and have clinical buy-in.

6.3.5. Provider engagement: again, as far as the chosen procurement

route allows, and in addition to ongoing engagement with providers, Islington Clinical Commissioning Group will engage with providers in terms of financial, estates and workforce implications of potential procurements.

6.3.6. Patient and public engagement: Effective engagement with local

patients and population will assist in identifying areas where health needs are not being adequately met, and where there is scope for improvement of services. This will include undertaking public and patient consultations before a procurement process begins, and engaging patient and public representatives where possible in procurement project groups. Service users should also inform the shape of planned changes to provision. Engagement will be ongoing through outcome measures and stakeholder events.

6.4. SUSTAINABLE PROCUREMENT

6.4.1. Islington Clinical Commissioning Group recognises the

responsibility and role it plays in reducing the impact it has as an organisation on the environment, and wishes to encouraging health providers to do the same through reducing use of natural resources and in particular carbon emissions. Islington Clinical Commissioning Group therefore intends to utilise e-procurement methods as far as possible, and include performance measures relating to environmental considerations in the contracts tendered.

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Islington Clinical Commissioning Group will encourage providers (and potential providers) to be innovative in reducing their environmental impact whilst maintaining excellent clinical quality standards and improved outcomes.

6.5. CONTESTABILITY PRINCIPLES

Islington Clinical Commissioning Group’s eight stated contestability principles which must be adhered to throughout all commissioning and procurement activity are as follows: 6.5.1 Islington Clinical Commissioning Group will consider all approaches

to contest a particular service 6.5.2 Islington Clinical Commissioning Group will engender patient

empowerment through choice

6.5.3 If Islington Clinical Commissioning Group does not consider contestability to be appropriate, it will substantiate why not. The decision-making processes ought to be clear, transparent and auditable

6.5.4 Islington Clinical Commissioning Group will ensure a level playing

field when utilising a competitive process. There can be no advantage afforded to in-house or other preferred providers

6.5.5 Islington Clinical Commissioning Group will not restrict choice

through collusive behaviour or the formation of monopolies within it locality

6.5.6 Islington Clinical Commissioning Group has responsibility for market

management and for identifying and encouraging plurality in healthcare suppliers, including new market entrants

6.5.7 Islington Clinical Commissioning Group has an obligation to work in

partnership with other organisations, in particular, Local Authorities

6.5.8 Islington Clinical Commissioning Group will continue to uphold the ‘any willing/qualified provider’ model.

7. Clinical Procurement Process

7.1 As part of the procurement process, all potential procurement routes will

be considered to ensure that the route chosen is the most appropriate to the scale of the service being procured and the outcomes the procurement is intending to deliver. Appendix A sets out the routes to be considered.

7.2 A standard procurement process will be followed in all cases. The

procurement process to be followed, which sets out the responsibilities of commissioners and the procurement team, is set out in appendix B.

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7.3 It should be noted that the procurement of contracts funded jointly between

Islington Clinical Commissioning Group and Local Authorities across the sector for both children’s and adults services will be subject to locally agreed procedures and the Prime Financial Policies of the organisation leading the tender.

7.4 For all procurement routes Islington Clinical Commissioning Group will

look to manage potential conflicts of interest so as to effectively manage the integrity of the NHS commissioning system and thereby protect itself and GP practices from any perceptions of wrong-doing. Islington Clinical Commissioning Group will follow the guidance set out in the National Commissioning Board’s Code of Conduct.

7.5 The Code of Conduct sets out a series of areas for consideration under the

following headings:

a) Factors to address when commissioning services from GP practices b) Providing assurance c) Preserving integrity of the decision making process when all or most

GPs have an interest in a decision d) Transparency- publication of contracts e) Role of commissioning support f) Role of the NHS Commissioning Board

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APPENDIX A: PROCUREMENT ROUTES: There are a number of procurement options available to Islington Clinical Commissioning Group commissioners. The most appropriate choice will depend on a number of factors, including contract value, the status of the provider market, geography, the needs of patients and patient choice. The following describes the procurement routes that could be used, with some of the advantages and disadvantages of each.

Procurement Routes

Potential Procurement Route

When it may be considered Advantages Disadvantages Estimated Timescale

Open tender · Limited competition anticipated (i.e. few suppliers in the market)

· Niche requirement · Patient/population need

identified · Outcomes and KPI’s

determined pre-procurement

· Open to all suppliers · Doesn’t restrict small /

medium enterprises · Contract currency

determined pre-procurement

· Volume of responses may be high and all will require evaluation

· 6 months (does not require PQQ stage; may require TUPE period before contract start)

Restricted tender

· Large market available for competition

· Patient/population need identified

· Outcomes and KPI’s determined pre-procurement but can be refined during preliminary stages

· Two-stage process that can minimise impact of resources by restricting the number competitors

· Contract currency determined pre-procurement

· Could limit the number of suitable bidders

· 6-9 months (may require TUPE consultation period before contract start)

Competitive · Insufficient suitable · Flexible approach to · Resource intensive · 12 months

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Dialogue suppliers available · Requires market

development

complicated procurements

· Increases competition and encourages innovation

· Specification and funding model are only developed during the process

to carry out dialogue phase

· Innovative approaches may vary making it difficult to evaluate bids on a like for like basis

Negotiated Procedure

· No valid or suitable response received under Open or Restricted procedures

· When only one supplier may provide the service for technical, artistic or intellectual property right reasons

· Requirement is for research, experiment, study or development

· Contract terms are negotiated upfront from a selection of potential suppliers

· Assists in clearly defining the requirement and a selected number of bidders

· Resources intensive to carry out negotiations

· 6 months – but often follows an Open or Restricted process which has not identified a suitable provider

Framework Call-off

· Where an existing framework has been implemented, that satisfies all service requirements

· Reduces timescales – key terms have been agreed with suppliers appointed under the framework

· Specification is fixed and cannot be varied once framework is implemented

· 9-12 months to establish the framework, but once implemented, call-offs can take 1-3 months

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Any qualified provider

· Community based activities where local tariff has been agreed

· Designed to be a quicker process

· Pre-qualifies potential providers, providing a ‘pool’ of potential supply

· Initial accreditation may involve processing a large volume of applications

· Stage 1 accredited providers may never qualify to supply

· May not generate large/sufficient interest, as no volume guarantees are given

· 4-6 months

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ALTERNATIVES TO PROCUREMENT:

Contract Variation

· When the value of a service development, re-design or expansion is within 10% or £500k (whichever is the higher) of the existing contract value (or service line/s in an acute contract)

· A relatively quick process where continuity is beneficial when a service or pathway would benefit from being delivered in a different way

· Does not test the market for innovation or cost

· Needs to be negotiated with the current provider to ensure it is acceptable to them

Waivers · When contract end dates need to be harmonised prior to a tender involving several services

· When a service or contract would benefit from extension and the circumstances set out in the Prime Financial Policies are met

· Enables developing or remodelled services further time to become established

· Continuity of service provider

· Where a market is developing or developed, may be regarded by potential providers as anti-competitive

· Does not test the market or demonstrate that VFM is being achieved

· Waiver process needs to be followed, with senior management authorisation obtained. Timescale depends on robustness of supporting evidence.

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APPENDIX B Islington Clinical Commissioning Group: Pilot Projects guidance

1.1. When to use a pilot

Pilots can be used to test a new service and or service delivery model. These should only be used where there are clear objectives and outcomes which require testing before being rolled out fully and must not be used as a means to avoid a procurement exercise.

1.2. Pilot Documentation Pilots should be formally structured and agreed by the parties prior to commencing. The documented agreement should cover the following points as a minimum: · Statement of purpose – clearly state what the pilot is trying to achieve/ test · Length of pilot – should be short term (weeks/months not years) · Funding arrangements – who is paying what, when and on what basis · Clear objectives – to focus the pilot activity · Ownership of data – the commissioner should own all data associated with the

pilot · Measures of success – what outcome will mean that the pilot was a success · Terminating the pilot – mechanism as to how the pilot can be cancelled /

terminated before expiry in the event that the results are known early or clearly not going to be achieved

· Documentation and information – pilot provider should document all activity and outcomes associated with the pilot to enable Islington Clinical Commissioning Group to use in any subsequent commissioning activity

· Reporting requirements – what is required during the course of the pilot

1.3. Appointing a Pilot Partner Where the cost of a pilot is above the competitive tendering threshold, the pilot activity should be subjected to a competitive tendering exercise. Depending on the scale of this, a shortened timescale can be used.

1.4. Post Pilot actions

At the end of the pilot, if a service is to be commissioned, this will be subject to a competitive tendering exercise. To ensure a fair and transparent process, all relevant information from the pilot must be shared with all potential bidders to avoid an uneven playing field which may open the Islington Clinical Commissioning Group up to legal challenge. The standard tendering process must be followed.

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APPENDIX C The following table sets out the sequential stages in a clinical procurement process, establishing what needs to be done, in what order and by whom. This table has been used to review the current process and identify any issues which need to be resolved for Islington Clinical Commissioning Group as a new organisation. The issues and recommendations set out in the covering paper to this document have been drawn from the exercise. This table is therefore likely to be revised once those recommendations have been considered. 1. Stage 1: Planning/pre-Advertisement

Who Issues 1.1. Project Initiation:

PID/Business Case presented to Senior Leadership Team (TBC) to provide authorisation to proceed; discussion at Clinical Procurement Steering Group to agree procurement route

Commissioner Establish Steering Group; role of Group in ratifying contract awards

1.2. Produce a Project Plan & Timetable with intended timescales and deliverables, including consultation plans

Commissioner with support from CSU

1.3. Initial discussion with Clinical Procurement Team to complete a procurement checklist: to be clear about what needs to be considered, potential issues and risks, documents to be developed, and procedures to be followed

Commissioner with support from CSU

Clinical Procurement develop checklist

1.4. Documentation is developed: · Equalities Impact

Assessment · Environmental Impact

Assessment? · Service specification · Memorandum of

Information · Risk assessment · PQQ · ITT · Financial Model · Contract · Advert

Commissioner supported by Project Group and Clinical Procurement

Clinical Procurement to develop standardised templates (where not already agreed e.g. EQIA)

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1.5. Establish Project Group: to develop and agree documentation including selection/award criteria. Membership to include: · Clinicians/GPs · Patients/service

users/public representatives etc.

· Finance representative

Conflict of Interest & Confidentiality forms will need to be signed

Commissioner; Clinical Procurement to provide training for members where necessary; Finance rep from initiating Islington Clinical Commissioning Group or sector if NCL-wide

Clinical Procurement to develop/update training for commissioners and Project Group members

1.6. Contract/project identification number

Clinical Procurement

Clinical Procurement to develop reference numbering system

1.7. Contact with Contracts Team and Legal Services: to draw up contract Terms & Conditions

Commissioner with support from Clinical Procurement

Process and cost of access to legal advice to be clarified. Contracts: clarify form of contract to be used: default use of DH contract – but can this be varied/extended?

1.8. Governance arrangements: ensure quality & safety issues are discussed and addressed from start of project

Clincial Procurement with support from CSU?

1.9. Request TUPE information from current providers (where relevant)


1.10 Advert: confirm wording and alert Communications; upload to Supply2Health, NCL & local presence websites – and elsewhere?

Clinical Procurement to draft, liaise with Communications and place advert; Commissioner to confirm wording

1.11 Procurement Register: on which all clinical procurements are logged and progress monitored


Share with Executive Management Team and Contracts Team on regular basis

2. Stage 2: Pre-Qualification (PQQ)/Invitation to Tender (ITT)

Who Issues

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2.1. Issue PQQ to all received Expressions of Interest (EOI)


2.2. Information Event: opportunity for interested parties to attend question and answer session

Commissioner with support from Clinical Procurement

Timing of event needs to be agreed; associated event costs identified as part of original Business Case

2.3. Evaluation of PQQ: shortlist bidders to be invited to submit ITT

Project Team

2.4. Issue ITT Clinical Procurement

2.5. Closing date for ITT submissions: · CEO Office for delivery · Opening of tenders in

accordance with SFI requirements


2.6. Evaluation of Tender: can include: · Individual scoring of

tenders by Project Team members

· Moderation meeting · Requests for further

information/clarification · Bidder

presentations/interviews

· Identification of preferred bidder/reserve bidder

Project Team

2.7. Negotiation: · Review contract terms · Confirm service

delivery model

Commissioner, Contract Manager

3. Stage 3: Approval/Contract Award

Who Issues 3.1 Contract Award:

· In accordance with SFI Scheme of Delegation, report recommending contract award to be compiled and submitted to Joint Boards for approval

· When approved, successful and

Commissioner Clinical Procurement Team

Timing of Joint Boards Report to minimise service start date; Corporate Governance to develop template for Contract Award process and associated

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unsuccessful providers notified

· Alcatel (10-day standstill) period begins

· Once contract awarded, TUPE consultation begins (if required)

Successful bidder

documentation to ensure due process is completed and signing of contract entered on Corporate Register

3.2 Contract: · Final version of contract

issued · Contract signed

Commissioner/ Contract Manager

4. Stage 4: Transition/Mobilisation

Who Issues 4.1 Mobilisation plan

developed; progress monitored and managed

Commissioner/ successful bidder

4.2 Communication Plan developed

Commissioner/ Communications

4.3 Contract management approach established

Contract Manager/ Commissioner

4.4 Service begins Successful bidder 4.5 Re-tender built into

Procurement Forward Plan Clinical Procurement

5. Stage 5: Post-procurement Contract Monitoring and Evaluation (see also Figure 1:

Commissioning Cycle above) Who Issues

5.1 Contract monitoring and performance management


5.2 On-going service reviews and evaluation of service quality and delivered outcomes · Will include requirement

to provide Clinical Procurement Steering Group with brief report 6-9 months after start, comparing actual performance & benefit realisation with original intentions


Clinical Procurement to develop report template

5.3 Decision on Strategic Fit and re-commissioning intentions/ priorities before re-tender process begins


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APPENDIX O – CODES OF CONDUCT

Code of Conduct

for NHS Managers

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Introduction The Code sets out the core standards of conduct expected of NHS managers. It will serve two purposes: 1. To guide NHS managers and employing health bodies in the work they do and the

decisions and choices they have to make to reassure the public that these important decisions are being made against a background of professional standards and accountability.

2. The environment in which the Code will operate is a complex one. NHS managers have very important jobs to do and work in a very public and demanding environment. The management of the NHS calls for difficult decisions and complicated choices. The interests of individual patients have to be balanced with the interests of groups of patients and of the community as a whole. The interests of patients and staff do not always coincide. Managerial and clinical imperatives do not always suggest the same priorities. A balance has to be maintained between national and local priorities.

Code of Conduct for NHS Managers The Code should apply to all managers and should be incorporated in the contracts of senior managers at the earliest possible opportunity. As an NHS manager, I will observe the following principles:

· make the care and safety of patients my first concern and act to protect them from risk;

· respect the public, patients, relatives, carers, NHS staff and partners in other agencies;

· be honest and act with integrity; · accept responsibility for my own work and the proper performance of the people I

manage; · show my commitment to working as a team member by working with all my

colleagues in the NHS and the wider community; · take responsibility for my own learning and development.

1. This means in particular that: I will:

· respect patient confidentiality; · use the resources available to me in an effective, efficient and timely manner having proper regard to the best interests of the public and

patients; · be guided by the interests of the patients while ensuring a safe working environment; · act to protect patients from risk by putting into practice appropriate support and disciplinary procedures for staff; and · seek to ensure that anyone with a genuine concern is treated reasonably and fairly.

2. I will respect and treat with dignity and fairness, the public, patients,

relatives, carers, NHS staff and partners in other agencies. In my capacity as

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a senior manager within the NHS I will seek to ensure that no one is unlawfully discriminated against because of their religion, belief, race, colour, gender, marital status, disability, sexual orientation, age, social and economic status or national origin. I will also seek to ensure that: · the public are properly informed and are able to influence services; · patients are involved in and informed about their own care, their experience is valued, and they are involved in decisions; · relatives and carers are, with the informed consent of patients, involved in the care of patients; · partners in other agencies are invited to make their contribution to improving health and health services; and · NHS staff are: valued as colleagues; properly informed about the management of the NHS; given appropriate opportunities to take part in decision making. given all reasonable protection from harassment and bullying; provided with a safe working environment; helped to maintain and improve their knowledge and skills and achieve their

potential; and helped to achieve a reasonable balance between their working and personal lives.

3. I will be honest and will act with integrity and probity at all times. I will not make, permit or knowingly allow to be made, any untrue or misleading statement relating to my own duties or the functions of my employer.

4. I will seek to ensure that:

· the best interests of the public and patients/clients are upheld in decision-making and that decisions are not improperly influenced by gifts or inducements;

· NHS resources are protected from fraud and corruption and that any incident of this kind is reported to NHS Protect;

· judgements about colleagues (including appraisals and references) are consistent, fair and unbiased and are properly founded; and

· open and learning organisations are created in which concerns about people breaking the Code can be raised without fear.

5. I will accept responsibility for my own work and the proper performance of

the people I manage. I will seek to ensure that those I manage accept that they are responsible for their actions to: · the public and their representatives by providing a reasonable and reasoned

explanation of the use of resources and performance; · patients, relatives and carers by answering questions and complaints in an open,

honest and well researched way and in a manner which provides a full explanation of what has happened, and of what will be done to deal with any poor performance and, where appropriate giving an apology; and

· NHS staff and partners in other agencies by explaining and justifying decisions on the use of resources and give due and proper consideration to suggestions for improving performance, the use of resources and service delivery.

6. I will support and assist the Accountable Officer of my organisation in his or

her responsibility to answer to Parliament, Ministers and the Department of Health in terms of fully and faithfully declaring and explaining the use of resources and the performance of the local NHS in putting national policy into practice and delivering targets. For the avoidance of doubt, nothing in

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paragraphs two to four of this Code requires or authorises an NHS manager to whom this Code applies to: · make, commit or knowingly allow to be made any unlawful disclosure; · make, permit or knowingly allow to be made any disclosure in breach of his or

her duties and obligations to his or her employer, save as permitted by law. 7. If there is any conflict between the above duties and obligations and this

Code, the former shall prevail. 8. I will show my commitment to working as a team by working to create an

environment in which: · teams of frontline staff are able to work together in the best interests of patients; · leadership is encouraged and developed at all levels and in all staff groups; and · the NHS plays its full part in community development.

9. I will take responsibility for my own learning and development. I will seek to:

· take full advantage of the opportunities provided; · keep up to date with best practice; and · share my learning and development with others.

IMPLEMENTING THE CODE

1. The Code should be seen in a wider context that NHS managers must follow the

‘Nolan Principles on Conduct in Public Life’, the ‘Corporate Governance Codes of Conduct and Accountability’, the ‘Standards of Business Conduct’, the ‘Code of Practice on Openness in the NHS’ and standards of good employment practice.

2. In addition many NHS managers come from professional backgrounds and must follow the code of conduct of their own professions as well as this Code. In order to maintain consistent standards, NHS bodies need to consider suitable measures to ensure that managers who are not their employees but who: (i) manage their staff or services; or (ii) manage units which are primarily providing services to their Patients also

observe the Code.

3. It is important to respect both the rights and responsibilities of managers. To help managers to carry out the requirements of the Code, employers must provide reasonable learning and development opportunities and seek to establish and maintain an organisational culture that values the role of managers. NHS managers have the right to be: · treated with respect and not be unlawfully discriminated against for any reason; · given clear, achievable targets; · judged consistently and fairly through appraisal; · given reasonable assistance to maintain and improve their knowledge and skills

and achieve their potential through learning and development; and · reasonably protected from harassment and bullying and helped to achieve a

reasonable balance between their working and personal lives.

Breaching the Code Alleged breaches of the Code of Conduct should be promptly considered and fairly and reasonably investigated. Individuals must be held to account for their own performance, responsibilities and conduct where employers form a reasonable and genuinely held

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judgement that the allegations have foundation. Investigators should consider whether there are wider system failures and organisational issues that have contributed to the problems. Activity, the purpose of which is to learn from and prevent breaches of the Code, needs to look at their wider causes. Local employers should decide whether to investigate alleged breaches informally or under the terms of local disciplinary procedures. It is essential however that both forms of investigation should be, and be seen to be, reasonable, fair and impartial. If Chief Executives or Directors are to be investigated, the employing authority should use individuals who are employed elsewhere to conduct the investigation. The NHS Confederation, the Institute of Healthcare Management and the Healthcare Financial Management Association are among the organisations who maintain lists of people who are willing to undertake such a role.

Application of Code This Code codifies and articulates certain important contractual obligations that apply to everyone holding management positions. These include Chief Executives and Directors who as part of their duties are personally accountable for achieving high quality patient care. For all posts at Chief Executive/Director level and all other posts identified as in paragraph 6 above, acting consistently with the Code of Conduct for NHS Managers Directions 2002, employers should:

· include the Code in new employment contracts; · incorporate the Code into the employment contracts of existingpostholders at the

earliest practicable opportunity. Employers are asked to: (i) incorporate the Code into the employment contracts of Chief Executives and

Directors at the earliest practicable opportunity and include the Code in the employment contracts of new appointments to that group;

(ii) identify any other senior managerial posts, i.e. with levels of responsibility and accountability similar to those of Director-level posts, to which they consider the Code should apply. The new framework for pay and contractual arrangements will help more tightly define this group in due course.

(iii) investigate alleged breaches of the Code by those to whom the Code applies promptly and reasonably as at paragraphs four to five;

(iv) provide a supportive environment to managers (see paragraph three above).

Published by DH October 2002. First review: April 2011 Date of next review: April 2012

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January 1993

Standards of business conduct

for NHS staff

Appendix: O2

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Part A Prevention of Corruption Acts 1906 and 1916 - summary of main provisions Acceptance of gifts by way of inducements or rewards 1. Under the Prevention of Corruption Acts, 1906 and 1916, it is an offence for employees

corruptly to accept any gifts or consideration as an inducement or reward for:

· doing, or refraining from doing, anything in their official capacity; or · showing favour or disfavour to any person in their official capacity.

2. Under the Prevention of Corruption Act 1916, any money, gift or consideration received

by an employee in public service from a person or organisation holding or seeking to obtain a contract will be deemed by the courts to have been received corruptly unless the employee proves the contrary.

3. In addition the Anti-Bribery Act enshrines certain offences against individuals and organisations in law and should be taken account of in consideration of the acceptance of any indicuements or rewards.

Part B NHS Management Executive (NHSME) - general guidelines Introduction 1. These guidelines, which are intended by the NHSME to be helpful to all NHS

employers (i) and their employees, re-state and reinforce the guiding principles previously set out in Circular HM(62)21 (now cancelled), relating to the conduct of business in the NHS.

Responsibility of NHS employers 2. NHS employers are responsible for ensuring that these guidelines are brought to the

attention of all employees; also that machinery is put in place for ensuring that they are effectively implemented.

Responsibility of NHS staff 3. It is the responsibility of staff to ensure that they are not placed in a position which

risks, or appears to risk, conflict between their private interests and their NHS duties. This primary responsibility applies to all NHS Staff, i.e. those who commit NHS resources directly (e.g. by the ordering of goods) or those who do so indirectly (e.g. by the prescribing of medicines). A further example would be staff who may have an interest in a private nursing home and who are involved with the discharge of patients to residential facilities.

Guiding principle in conduct of public business 4. It is a long established principle that public sector bodies, which include the NHS,

must be impartial and honest in the conduct of their business, and that their employees should remain beyond suspicion. It is also an offence under the Prevention of Corruption Acts 1906 and 1916 for an employee corruptly to accept any inducement or reward for doing, or refraining from doing anything, in his or her

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official capacity, or corruptly showing favour, or disfavour, in the handling of contracts (see Part A).

Staff will need to be aware that a breach of the provisions of these Acts renders them liable to prosecution and may also lead to loss of their employment and superannuation rights in the NHS. Principles of conduct in the NHS 5. NHS staff are expected to:

· ensure that the interest of patients remains paramount at all times; · be impartial and honest in the conduct of their official business; · use the public funds entrusted to them to the best advantage of the service,

always ensuring value for money. 6. It is also the responsibility of staff to ensure that they do not:

· abuse their official position for personal gain or to benefit their family or friends; · seek to advantage or further private business or other interests, in the course of

their official duties. Implementing the guiding principles Casual gifts 7. Casual gifts offered by contractors or others, e.g. at Christmas time, may not be in

any way connected with the performance of duties so as to constitute an offence under the Prevention of Corruption Acts. Such gifts should nevertheless be politely but firmly declined. Articles of low intrinsic value such as diaries or calendars, or small tokens of gratitude from patients or their relatives, need not necessarily be refused. In cases of doubt staff should either consult their line manager or politely decline acceptance.

Hospitality 8. Modest hospitality, provided it is normal and reasonable in the circumstances, e.g.

lunches in the course of working visits, may be acceptable, though it should be similar to the scale of hospitality which the NHS as an employer would be likely to offer.

9. Staff should decline all other offers of gifts, hospitality or entertainment. If in doubt

they should seek advice from their line manager. Declaration of interests 10. NHS employers need to be aware of all cases where an employee, or his or her

close relative or associate, has a controlling and/or significant financial interest in a business (including a private company, public sector organisation, other NHS employer and/or

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voluntary organisation), or in any other activity or pursuit, which may compete for an NHS contract to supply either goods or services to the employing authority.

11. All NHS staff should therefore declare such interests to their employer, either on starting

employment or on acquisition of the interest, in order that it may be known to, and in no way promoted to the detriment of, either the employing authority or the patients whom it serves.

12. One particular area of potential conflict of interest which may directly affect patients is

when NHS staff hold a self beneficial interest in private care homes or hostels. While it is for staff to declare such interests to their employing authority, the employing authority has a responsibility to introduce whatever measures it considers necessary to ensure that its interests and those of patients are adequately safeguarded. This may for example take the form of a contractual obligation on staff to declare any such interests. Advice on professional conduct issued by the General Medical Council recommends that when a doctor refers a patient to a private care home or hostel in which he or she has an interest, the patient must be informed of that interest before referral is made.

13. In determining what needs to be declared, employers and employees will wish to be

guided by the principles set out in paragraph 5 above. 14. NHS employers should:

· ensure that staff are aware of their responsibility to declare relevant interests (perhaps by including a clause to this effect in staff contracts);

· consider keeping registers of all such interests and making them available for inspection by the public;

· develop a local policy, in consultation with staff and local staff interests, for implementing this guidance. This may include the disciplinary action to be taken if an employee fails to declare a relevant interest, or is found to have abused his or her official position, or knowledge, for the purpose of self-benefit, or that of family or friends.

Preferential treatment in private transactions 15. Individual staff must not seek or accept preferential rates or benefits in kind for private

transactions carried out with companies with which they have had, or may have, official dealings on behalf of their NHS employer. (This does not apply to concessionary agreements negotiated with companies by NHS management, or by recognised staff interests, on behalf of all staff - for example, NHS staff benefits schemes).

Contracts 16. All staff who are in contact with suppliers and contractors (including external

consultants), and in particular those who are authorised to sign purchase orders, or place contracts for goods, materials or services, are expected to adhere to professional standards of the kind set out in the Ethical Code of the Institute of Purchasing and Supply (IPS), reproduced at Part C.

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Favouritism in awarding contracts 17. Fair and open competition between prospective contractors or suppliers for NHS

contracts is a requirement of NHS Standing Orders and of EC Directives on Public Purchasing for Works and Supplies. This means that: · no private, public or voluntary organisation or company which may bid for NHS

business should be given any advantage over its competitors, such as advance notice of NHS requirements. This applies to all potential contractors, whether or not there is a relationship between them and the NHS employer, such as a long-running series of previous contracts.

· each new contract should be awarded solely on merit, taking into account the requirements of the NHS and the ability of the contractors to fulfil them.

18. NHS employers should ensure that no special favour is shown to current or former

employees or their close relatives or associates in awarding contracts to private or other businesses run by them or employing them in a senior or relevant managerial capacity. Contracts may be awarded to such businesses where they are won in fair competition against other tenders, but scrupulous care must be taken to ensure that the selection process is conducted impartially, and that staff who are known to have a relevant interest play no part in the selection.

Warnings to potential contractors 19. NHS employers will wish to ensure that all invitations to potential contractors to tender

for NHS business include a notice warning tenderers of the consequences of engaging in any corrupt practices involving employees of public bodies.

Outside employment 20. NHS employees are advised not to engage in outside employment which may conflict

with their NHS work, or be detrimental to it. They are advised to tell their NHS employing authority if they think they may be risking a conflict of interest in this area: the NHS employer will be responsible for judging whether the interests of patients could be harmed, in line with the principles in paragraph 5 above. NHS employers may wish to consider the preparation of local guidelines on this subject.

Private practice 21. Consultants (and associate specialists) employed under the Terms and Conditions of

Service of Hospital Medical and Dental Staff are permitted to carry out private practice in NHS hospitals subject to the conditions outlined in the handbook "A Guide to the Management of Private Practice in the NHS". (See also PM(79)11). Consultants who have signed new contracts with Trusts will be subject to the terms applying to private practice in those contracts.

22. Other grades may undertake private practice or work for outside agencies, providing

they do not do so within the time they are contracted to the NHS, and they observe the conditions in paragraph 20 above. All hospital doctors are entitled to fees for other work outside their NHS contractual duties under "Category 2" (paragraph 37 of the TCS of

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Hospital Medical and Dental staff), e.g. examinations and reports for life insurance purposes. Hospital doctors and dentists in training should not undertake locum work outside their contracts where such work would be in breach of their contracted hours. Career grade medical and dental staff employed by NHS Trusts may agree terms and conditions different from the National Terms and Conditions of Service.

Rewards for Initiative 23. NHS employers should ensure that they are in a position to identify potential intellectual

property rights (IPR), as and when they arise, so that they can protect and exploit them properly, and thereby ensure that they receive any rewards or benefits (such as royalties) in respect of work commissioned from third parties, or work carried out by their employees in the course of their NHS duties. Most IPR are protected by statute; e.g. patents are protected under the Patents Act 1977 and copyright (which includes software programmes) under the Copyright Designs and Patents Act 1988. To achieve this NHS employers should build appropriate specifications and provisions into the contractual arrangements which they enter into before the work is commissioned, or begins. They should always seek legal advice if in any doubt in specific cases.

24. With regard to patents and inventions, in certain defined circumstances the Patents Act

gives employees a right to obtain some reward for their efforts, and employers should see that this is effected. Other rewards may be given voluntarily to employees who within the course of their employment have produced innovative work of outstanding benefit to the NHS. Similar rewards should be voluntarily applied to other activities such as giving lectures and publishing books and articles.

25. In the case of collaborative research and evaluative exercises with manufacturers, NHS

employers should see that they obtain a fair reward for the input they provide. If such an exercise involves additional work for an NHS employee outside that paid for by the NHS employer under his or her contract of employment, arrangements should be made for some share of any rewards or benefits to be passed on to the employee(s) concerned from the collaborating parties. Care should however be taken that involvement in this type of arrangement with a manufacturer does not influence the purchase of other supplies from that manufacturer.

Commercial sponsorship for attendance at courses and conferences 26. Acceptance by staff of commercial sponsorship for attendance at relevant conferences

and courses is acceptable, but only where the employee seeks permission in advance and the employer is satisfied that acceptance will not compromise purchasing decisions in any way.

27. On occasions when NHS employers consider it necessary for staff advising on the

purchase of equipment to inspect such equipment in operation in other parts of the country (or exceptionally, overseas), employing authorities will themselves want to consider meeting the cost, so as to avoid putting in jeopardy the integrity of subsequent purchasing decisions.

Commercial sponsorship of posts - "linked deals"

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28. Pharmaceutical companies, for example, may offer to sponsor, wholly or partially, a post for an employing authority. NHS employers should not enter into such arrangements, unless it has been made abundantly dear to the company concerned that the sponsorship will have no effect on purchasing decisions within the authority. Where such sponsorship is accepted, monitoring arrangements should be established to ensure that purchasing decisions are not, in fact, being influenced by the sponsorship agreement.

Under no circumstances should employers agree to "linked deals" whereby sponsorship is linked to the purchase of particular products or to supply from particular sources. "Commercial in-confidence" 29. Staff should be particularly careful of using, or making public, internal information of a

"commercial in-confidence" nature, particularly if its disclosure would prejudice the principle of a purchasing system based on fair competition. This principle applies whether private competitors or other NHS providers are concerned, and whether or not is prompted by the expectation of personal gain (see paragraphs 18 above and Part E).

30. However, NHS employers should be careful about adopting a too restrictive view on

this matter. It should certainly not be a cause of excessive secrecy on matters which are not strictly commercial per se. For example, the term "commercial in confidence" should not be taken to include information about service delivery and activity levels, which should be available. Nor should it inhibit the free exchange of data for medical audit purposes, for example, subject to the normal rules governing patient confidentiality and data protection. In all circumstances the overriding consideration must be the best interests of patients.

Action checklist for NHS managers References are to paragraphs in Part B of “Standards of business conduct for NHS Staff” (Annex to HSG(93)5)

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Part C YOU must:

· Ensure that all staff are aware of this guidance (2) and (4) · Develop a local policy and implement it (2 and 14); · Show no favouritism in awarding contracts to businesses run by employees, ex-

employees or their friends or relatives) (17 - 18); · Include a warning against corruption in all invitations to tender(19) · Consider requests from staff for permission to undertake additional outside

employment (20); · Apply the terms of concerning doctors' engagements in private practice (21); · Receive rewards or royalties in respect of work carried out by employees in the

course of their NHS work, and ensure that such employees receive due rewards (24);

· Similarly ensure receipt of rewards for collaborative work with manufacturers, and

pass on to participating employees · Ensure that acceptance of commercial sponsorship will not influence or jeopardize

purchasing decisions · Refuse "linked deals" whereby sponsorship of staff posts is linked to the purchase of

particular products or supply from particular sources · Avoid excessive secrecy and abuse of the term "commercial in confidence" (30).

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Part D Short guide for staff References are to paragraphs in Part B of "Standards of business conduct for NHS staff' (Annex to HSG(93)5) Do:

· Make sure you understand the guidelines on standards of business conduct, and consult your line managers if you are not sure;

· Make sure you are not in a position where your private interests and NHS duties may conflict (3);

· Declare to your employer any relevant interests (10 - 14). If in doubt, ask yourself:

I. am I, or might I be, in a position where I (or my family / friends) could gain from the connexion between my private interests and my employment?

II. do I have access to information which could influence purchasing decisions?

III. could my outside interest be in any way detrimental to the NHS or to patients'

interests?

IV. do I have any other reason to think I may be risking a conflict of interest? If still unsure - Declare it!

· Adhere to the ethical code of the Institute of Purchasing and Supply if you are involved in any way with the acquisition of goods and services (16);

· Seek your employer's permission before taking on outside work, if there is any

question of it adversely affecting your NHS duties (Special guidance applies to doctors);

· Obtain your employer's permission before accepting any commercial sponsorship

(26); Do not:

· Accept any gifts, inducements or inappropriate hospitality (see 7 – 9);

· Abuse your-past or present official position to obtain preferential rates for private deals (15)

· Unfairly advantage one competitor over another or show favouritism in awarding

contracts (18);

· Misuse or make available official "commercial in confidence" information.

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Part E Institute of Purchasing and Supply - Ethical Code (Reproduced by kind permission of IPS) Introduction 1. The code set out below was approved by the Institute's Council on 26 February 1977

and is binding on IPS members. Precepts 2. Members shall never use their authority or office for personal gain and shall seek to

uphold and enhance the standing of the Purchasing and Supply profession and the Institute by:

a. maintaining an unimpeachable standard of integrity in all their business relationships

both inside and outside the organisations in which they are employed;

b. fostering the highest possible standards of professional competence amongst those for whom they are responsible;

c. optimising the use of resources for which they are responsible to provide the

maximum benefit to their employing organisation;

d. complying both with the letter and the spirit of;

i. the law of the country in which they practise; ii. such guidance on professional practice as may be issued by the Institute from

time to time; iii. contractual obligations;

e. rejecting any business practice which might reasonably be deemed improper.

Guidance 3. In applying these precepts, members should follow the guidance set out below:

a. Declaration of interest Any personal interest which may impinge or might reasonably be deemed by others to impinge on a member's impartiality in any matter relevant to his or her duties should be declared.

b. Confidentiality and accuracy of information The confidentiality of information

received in the course of duty should be respected and should never be used for personal gain; information given in the course of duty should be true and fair and never designed to mislead.

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c. Competition While bearing in mind the advantages to the member's employing organisation of maintaining a continuing relationship with a supplier, any relationship which might, in the long term, prevent the effective operation of fair competition, should be avoided.

d. Business gifts Business gifts other than items of very small intrinsic value such as

business diaries or calendars should not be accepted.

e. Hospitality Modest hospitality is an accepted courtesy of a business relationship. However, the recipient should not allow him or herself to reach a position whereby he or she might be deemed by others to have been influenced in making a business decision as a consequence of accepting such hospitality; the frequency and scale of hospitality accepted should not be significantly greater than the recipient's employer would be likely to provide in return.

f. When it is not easy to decide between what is and is not acceptable in terms of gifts

or hospitality, the offer should be declined or advice sought from the member's superior.

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CODE OF

ACCOUNTABILITY

CODE OF ACCOUNTABILITY FOR NHS BOARDS Status ................................................................................................................ 1.1 Code of Conduct............................................................................................... 1.2 Statutory Accountability .................................................................................... 1.3 The Board of Directors...................................................................................... 1.4 The Role of the Chairman................................................................................. 1.5 Non-Executive Board Members........................................................................ 1.6 Reporting and Controls .................................................................................... 1.7 Declaration of Interests .................................................................................... 1.8 Employee Relations ......................................................................................... 1.9 1. CODE OF ACCOUNTABILITY FOR NHS BOARDS

This Code of Practice is the basis on which NHS organisations should seek to fulfil the duties and responsibilities conferred upon them by the Secretary of State for Health.

1.1 Status

NHS bodies are established under statute as corporate bodies so ensuring that they have separate legal personality. Statutes and regulations prescribe the structure, functions and responsibilities of the boards of these bodies and prescribe the way the Chairman and members of boards are to be appointed.

Appendix: O3

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1.2 Code of Conduct

All board members of NHS bodies are required, on appointment, to subscribe to the Code of Conduct. Chairmen and non-executive directors of NHS boards are responsible for taking firm, prompt and fair disciplinary action against any executive director in breach of the Code of Conduct. Breaches of the Code of Conduct by the Chairman or non-executive member of the board should be drawn to the attention of the appropriate Department of Health Directorate of Health and Social Care. All staff should subscribe to the principles of the NHS Code of Conduct and chairmen, directors and their staff should be judged upon the way the code is observed.

1.3 Statutory Accountability

The Secretary of State for Health has statutory responsibility to promote a comprehensive health service to secure improvement of the health of the people of England and to improve the prevention, diagnosis and treatment of illness. He uses statutory powers to delegate functions to Strategic Health Authorities, NHS trusts, Primary Care Trusts and Care Trusts, which are thus accountable to the Secretary of State and to Parliament. The Chief Executive and the Department of Health are responsible for directing the NHS, for ensuring national policies are implemented and for the effective stewardship of NHS resources. NHS trusts have responsibility to provide goods and services for the purpose of the health service. Strategic health authorities are responsible for: · Creating a coherent strategic framework · Agreeing annual performance agreements and performance management · Building capacity and supporting performance improvement.

The oversight of health authorities is set out in the NHS Act 1977 [now the Health and Social Care Act 2001] and subject to any directions or guidance issued by the Secretary of State. Primary Care Trusts (PCTs) are responsible for: · improving the health of the community, · securing the delivery of high quality services either directly or via other providers, · integrating health and social care locally.

From October 2002, subject to legislation, PCTs will assume responsibility for administering the provision of general medical, dental, ophthalmic and pharmaceutical services in accordance with regulations made by the Secretary of State. Care Trusts are Primary Care Trusts or NHS trusts which have been designated as a Care Trust. In addition to their NHS functions such organisations are responsible for prescribed health-related functions of a local authority for a specified area, as set out in the Health and Social Care Act 2001. Strategic health authorities', PCTs', NHS Trusts' and Care Trusts’ finances are subject to external audit by the Audit Commission. The Chief Executive and Director of Finance are directly responsible for the organisation's annual accounts.

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NHS boards must co-operate fully with the Department of Health and the Audit Commission when required to account for the use they have made of public funds, the delivery of patient care and other services, and comply with statutes, directions, guidance and policies of the Secretary of State. Chief Executives of NHS bodies are accountable officers whose duties are laid out in a memorandum signed on appointment. See Accountable Officer Memorandum, (section 1.2). The Chief Executive of the Department of Health, as Accounting Officer for the NHS, is accountable to Parliament through the Committee of Public Accounts.

1.4 The Board of Directors

NHS boards comprise executive board members, or officer members, and part-time non-executive board members, or non-officer members, under a part-time Chairman appointed by the Secretary of State as advised by the Independent Appointments Commission. PCT boards also comprise the Chairman of the PCT Executive Committee, at least one other member of the Professional Executive Committee and other members nominated by the Chairman of the Professional Executive Committee who are not necessarily members of that committee. Together they share corporate responsibility for all decisions of the board. There is a clear division of responsibility between the Chairman and the Chief Executive: the Chairman's role and board functions are set out below; the Chief Executive is directly accountable to the Chairman and non-executive members of the board for the operation of the organisation and for implementing the board's decisions. Boards are required to meet regularly and to retain full and effective control over the organisation: the Chairman and non-executive board members are responsible for monitoring the executive management of the organisation and are responsible to the Secretary of State for the discharge of these responsibilities. The Department of Health has a key role in maintaining the line of accountability to the Secretary of State. [Non-executive members of the Policy Board will always be available to chairmen and non-executive directors on matters of grave concern to them relating to the effectiveness of the board.] NHS boards have six key functions for which they are held accountable by the Department of Health on behalf of the Secretary of State:

1. to ensure effective financial stewardship through value for money, financial control

and financial planning and strategy; 2. to ensure that high standards of corporate governance and personal behaviour are

maintained in the conduct of the business of the whole organization; 3. to appoint, appraise and remunerate senior executives; 4. on the recommendation of the Professional Executive Committee to ratify the

strategic direction of the organisation within the overall policies and priorities of the Government and the NHS, define its annual and longer term objectives and agree plans to achieve them;

5. to oversee the delivery of planned results by monitoring performance against objectives and ensuring corrective action is taken when necessary; and

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6. to ensure that the Professional Executive Committee leads an effective dialogue between the organisation and the local community on its plans and performance and that these are responsive to the community's needs.

The boards of PCT are expected to discharge these functions differently from those of other NHS bodies. PCT boards should concentrate on the first four functions: for the latter two, the board’s role is to oversee the work of the professionally led PCT Professional Executive Committee and to consider proposals or initiatives generated by or on behalf of the PCT Professional Executive Committee. This is also true of Primary Care Trusts designated as Care Trusts. In fulfilling these functions each Strategic Health Authority, NHS Trust, PCT or Care Trust board should: 1. act within statutory financial and other constraints; 2. for PCTs (and PCTs designated as Care Trusts), establish the Professional

Executive Committee; 3. be clear what decisions and information are appropriate to the board and draw up

standing orders, a schedule of decisions reserved to the board or PCT Professional Executive Committee and standing financial instructions to reflect these;

4. ensure that management arrangements are in place to enable responsibility to be clearly delegated to senior executives for the main programmes of action and for performance against programmes to be monitored and senior executives held to account;

5. establish performance and quality targets that maintain the effective use of resources and provide value for money;

6. specify its requirements in organising and presenting financial and other information succinctly and efficiently to ensure the board can fully undertake its responsibilities; and

7. establish audit and remuneration committees on the basis of formally agreed terms of reference which set out the membership of the sub-committee, the limit to their powers, and the arrangements for reporting back to the main board.

1.5 The Role of the Chairman

The Chairman is responsible for leading the board and for ensuring that it successfully discharges its overall responsibility for the organisation as a whole. It is the Chairman's role to: • provide leadership to the board; • enable all board members to make a full contribution to the board's affairs and

ensure that the board acts as a team; • ensure that key and appropriate issues are discussed by the board in a timely

manner; • ensure the board has adequate support and is provided efficiently with all the

necessary data on which to base informed decisions;

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• lead non-executive board members through a formally appointed remuneration committee of the main board on the appointment, appraisal and remuneration of the Chief Executive and (with the latter) other executive board members;

• appoint non-executive board members to an audit committee of the main board; and

• [advise the Secretary of State through the member of the Policy Board on the performance of non-executive board members].

For Health Authorities and Trusts a complementary relationship between the Chairman and Chief Executive is important. The Chief Executive is accountable to the Chairman and non-executive members of the board for ensuring that its decisions are implemented, that the organisation works effectively, in accordance with Government policy and public service values and for the maintenance of proper financial stewardship. The Chief Executive should be allowed full scope, within clearly defined delegated powers, for action in fulfilling the decisions of the board. The other duties of the Chief Executive as accountable officer are laid out in the Accountable Officer Memorandum, (section 1.2).

1.6 Non-Officer Board and Lay Members

Non-officer (non executive) board i.e. lay members are appointed by the Secretary of State as advised by the Independent Appointments Commission to bring independent judgement to bear on issues of strategy, performance, key appointments and accountability through the Department of Health to Ministers and to the local community. Non-executive board members will be able to contribute to board business from wider experience and a critical detachment. They have a key role in working with the Chairman in the appointment of the Chief Executive and other board members. With the Chairman, they comprise the remuneration committee responsible for the appraisal and remuneration decisions affecting executive board members. Non executive board members normally comprise the audit committee. In addition, they undertake specific functions agreed by the board including oversight of staff relations with the general public and the media, participation in professional conduct and competency enquiries, staff disciplinary appeals and procurement of information management and technology. [Members of Strategic Health Authority, Trust, PCT and Care Trust boards play important roles in relation to the handling and monitoring of complaints. Being both informed and impartial, non-executives are able to act effectively as lay conciliators or adjudicators in relation to individual complaints. With the Chief Executive, they can also take responsibility for ensuring that their organisation's complaints procedures are operated effectively and that lessons learned from them are implemented].

1.7 Reporting and Controls

It is the board's duty to present through the timely publications of an annual report, annual accounts and other means, a balanced and readily understood assessment of

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the Authority's, PCT's or Trust's performance to: • the Department of Health, on behalf of the Secretary of State; • the Audit Commission and its appointed auditors; and • the local community.

The detailed financial guidance issued by the Department of Health, including the role of internal and external auditors, must be scrupulously observed. The Standing Orders of boards should prescribe the terms on which committees and subcommittees of the board may be delegated functions, and should include the schedule of decisions reserved for the board.

1.8 Declaration of Interests

It is a requirement that chairmen and all board members should declare any conflict of interest that arises in the course of conducting NHS business. That requirement continues in force. Chairman and board members should declare on appointment any business interests, position of authority in a charity or voluntary body in the field of health and social care and any connection with a voluntary or other body contracting for NHS services. These should be formally recorded in the minutes of the board, and entered into a register that is available to the public. Directorships and other significant interests held by NHS board members should be declared on appointment, kept up to date and set out in the annual report.

1.9 Employee Relations

NHS boards must comply with legislation and guidance issued by the Department of Health on behalf of the Secretary of State, respect agreements entered into by themselves or in on their behalf and establish terms and conditions of service that are fair to the staff and represent good value for taxpayers' money. Fair and open competition should be the basis for appointment to posts in the NHS.

The terms and conditions agreed by the board for senior staff should take full account of the need to obtain maximum value for money for the funds available for patient care. The board should ensure through the appointment of remuneration and terms of service committee that executive board members' total remuneration could be justified as reasonable. All board members' total remuneration for the organisation of which they are board members should be published in the annual report.

Originally published April 1994 First revision April 2002 Second revision July 2004 First reviewed: April 2011 Date of next review: April 2012

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CODE OF CONDUCT

FOR TRUST BOARD

MEMBERS

Appendix: O4

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CONTENTS INTRODUCTION SCOPE Public Service Values 3 General Principles 3 Openness and Public Responsibilities 3 Public Service Values in Management 4 Public Business and Private Gain 4 Hospitality and Other Expenditure 4 Relations with Suppliers 4 Staff 5 Compliance 5

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Introduction The Code of Conduct for Trust Board Members is based upon Code of Conduct, Code of Accountability for NHS Boards issued to all Non-Executive and Executive Directors on their appointment to the Board of any NHS organisation. Scope This Code of Conduct applies to all voting members of the Board. Public service values must be at the heart of the National Health Service. High standards of corporate and personal conduct based on a recognition that patients come first, have been a requirement throughout the NHS since its inception. Moreover, since the NHS is publicly funded, it must be accountable to Parliament for the services it provides and for the effective and economical use of taxpayers’ money. There are three crucial public service values which must underpin the work of the health service. Accountability – everything done by those who work in the NHS must be able to stand the test of parliamentary scrutiny, public judgments on propriety and professional codes of conduct. Probity – there should be an absolute standard of honesty in dealing with the assets of the NHS: integrity should be the hallmark of all personal conduct in decisions affecting patients, staff and suppliers, and in the use of information acquired in the course of NHS duties. Openness – there should be sufficient transparency about NHS activities to promote confidence between the NHS organisation and its staff, patients and the public. General Principles Public service values matter in the NHS and those who work in it have a duty to conduct NHS business with probity. They have a responsibility to respond to staff, patients and suppliers impartially, to achieve value for money from the public funds with which they are entrusted and to demonstrate high ethical standards of personal conduct. The success of this Code depends on a vigorous and visible example from boards and the consequential influence on the behaviour of all those who work within the organisation. Boards have a clear responsibility for corporate standards of conduct and acceptance of the Code should inform and govern the decisions and conduct of all board directors. Openness and Public Responsibilities Health needs and patterns of provision of health care do not stand still. There should be a willingness to be open with the public, patients and with staff as the need for change emerges. It is a requirement that major changes are consulted upon before decisions are reached. Information supporting those decisions should be made available, in a way that is understandable, and positive responses should be given to reasonable requests for information and in accordance with the Freedom of Information Act 2000. NHS business should be conducted in a way that is socially responsible. As a large employer in the local community, NHS organisations should forge an open and positive relationship with the local community and should work with staff and partners to set out a vision for the organisation

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in line with the expectations of patients and the public. NHS organisations should demonstrate to the public that they are concerned with the wider health of the population including the impact of the organisation’s activities on the environment. The confidentiality of personal and individual patient information must, of course, be respected at all times. Public Service Values in Management It is unacceptable for the board of any NHS organisation, or any individual within the organisation for which the board is responsible, to ignore public service values in achieving results. Chairs and board directors have a duty to ensure that public funds are properly safeguarded and that at all times the board conducts its business as efficiently and effectively as possible. Proper stewardship of public monies requires value for money to be high on the agenda of all NHS boards. Accounting, tendering and employment practices within the NHS must reflect the highest professional standards. Public statements and reports issued by the board should be clear, comprehensive and balanced, and should fully represent the facts. Annual and other key reports should be issued in good time to all individuals and groups in the community who have a legitimate interest in health issues to allow full consideration by those wishing to attend public meetings on local health issues. Public Business and Private Gain Chairs and board directors should act impartially and should not be influenced by social or business relationships. No one should use their public position to further their private interests. Where there is a potential for private interests to be material and relevant to NHS business, the relevant interests should be declared and recorded in the board minutes, and entered into a register which is available to the public. When a conflict of interest is established, the board director should withdraw and play no part in the relevant discussion or decision. Hospitality and Other Expenditure Board directors should set an example to their organisation in the use of public funds and the need for good value in incurring public expenditure. The use of NHS monies for hospitality and entertainment, including hospitality at conferences or seminars, should be carefully considered. All expenditure on these items should be capable of justification as reasonable in the light of the general practice in the public sector. NHS boards should be aware that expenditure on hospitality or entertainment is the responsibility of management and is open to be challenged by the internal and external auditors and that ill-considered actions can damage respect for the NHS in the eyes of the community. Relations with Suppliers NHS boards should have an explicit procedure for the declaration of hospitality and sponsorship offered by, for example, suppliers. Their authorisation should be carefully considered and the decision should be recorded. NHS boards should be aware of the risks in incurring obligations to suppliers at any stage of a contracting relationship. Suppliers should be selected on the basis of quality, suitability, reliability and value for money. The Department of Health has issued guidance to NHS organisations about standards of business conduct (ref: HSG(93)5).

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Staff NHS boards should ensure that staff have a proper and widely publicised procedure for voicing complaints or concerns about maladministration, malpractice, breaches of this code and other concerns of an ethical nature. The board must establish a climate: that enables staff who have concerns to raise these reasonably and responsibly with the

right parties; that gives a clear commitment that staff concerns will be taken seriously and investigated;

and where there is an unequivocal guarantee that staff who raise concerns responsibly and

reasonably will be protected against victimisation. (Ref: Whistleblowing in the NHS, letter dated 25 July 2003 from the Director of HR in the NHS) Compliance Board directors should satisfy themselves that the actions of the board and its directors in conducting board business fully reflect the values in this Code and, as far as is reasonably practicable, that concerns expressed by staff or others are fully investigated and acted upon. All board directors of NHS organisations are required, on appointment, to subscribe to the Code of Conduct. The Chairman and Non Executive Directors of the Board are responsible for taking firm, fair and appropriate displincinary action against any Executive or Associate Director in breach of the code of conduct. Breaches of the code by the Chairman or Non Executive Directors should be drawn to the attention of the Appointments Commission. Originally published April 1994 Code of Conduct, Code of accountability for NHS Boards, Department of Health. Second revision July 2004 Code of conduct to be reviewed on an annual basis: First review: April 2011 Date of next review: April 2012

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CODE OF PRACTICE ON OPENNESS IN THE NHS

Appendix: O5

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1. Introduction This Code of Practice sets out the basic principles underlying public access to information about the NHS. It reflects the Government's intention to ensure greater access by the public to information about public services and complements the Code of Access to Information which applies to the Department of Health. Because the NHS is a public service, it should be open about its activities and plans. So, information about how it is run, who is in charge and how it performs should be widely available. Greater sharing of information will also help to foster mutual confidence between the NHS and the public. The basic principle of this Code is that the NHS should respond positively to requests for information, except in certain circumstances identified in the Code. For example, patients' records must be kept safe and confidential.

2. Scope

The Code of Practice covers the following NHS organisations in England: Health Authorities, Special Health Authorities, NHS Trusts, Primary Care Trusts, the Mental Health Act Commission and Community Health Councils. It also covers family doctors, dentists, optometrists (opticians) and community pharmacists. Specific requirements for most of these organisations are detailed in separate annexes. Organisations not covered in the annexes must apply the general principles of the Code in their dealings with the public.

3. Aims

The aims of the Code are to ensure that people: · have access to available information about the services provided by the NHS, the

cost of those services, quality standards and performance against targets; · are provided with explanations about proposed service changes and have an

opportunity to influence decisions on such changes; · are aware of the reasons for decisions and actions affecting their own treatment; · known what information is available and where they can get it.

4. General Principles

In implementing the Code, the NHS must: · respond positively to requests for information (except in the circumstances

identified in paragraph 9); · answer requests for information quickly and helpfully, and give reasons for not

providing information where this is not possible; · help the public to know what information is available, so that they can decide what

they wish to see, and whom they should ask; · ensure that there are clear and effective arrangements to deal with complaints and

concerns about local services and access to information, and that these arrangements are widely publicised and effectively monitored.

5. Information Which Must be provided

Apart from the exemptions set out in paragraph 9 below, NHS Trusts, Primary Care

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Trusts and Health Authorities must publish or otherwise make available the following information (further details are given in Annexes A, B, C and D): · information about what services are provided, the targets and standards set and

results achieved, and the costs and effectiveness of the service; · details about important proposals on health policies or proposed changes in the

way services are delivered, including the reasons for those proposals. This information will normally be made available when proposals are announced and before decisions are made;

· details about important decisions on health policies and decisions on changes to the delivery of services. This information, and the reasons for the decisions, will normally be made available when the decisions are announced;

· information about the way in which health services are managed and provided and who is responsible;

· information about how the NHS communicates with the public, such as details of public meetings, consultation procedures, suggestion and complaints systems:

· information about how to contact Community Health Councils and the Health Service Commissioner (Ombudsman);

· information about how people can have access to their own personal health records.

6. Response to Requests for Information

Requests for information, whether made in person or in writing, must be answered promptly. An acknowledgement must be sent within 4 working days and, where possible, the information should follow within 20 working days. NHS organisations are not required to make available:

i. copies of the documents or records containing the information (although in some

cases it may be simpler to do so if they contain nothing but the information requested);

ii. information which the organisation does not possess (eg comparable data with

other organisations);

iii. individual copies of documents or other forms of information which are already widely publicly available. If the information is not to be provided under the terms of the Code, an explanation must be provided within 20 working days of receipt of the request.

Each NHS organisation must publish the name of an individual who has responsibility for the operation of this Code of Practice. This should be a senior officer directly accountable to the Chief Executive of the organisation. Details of how to request information through this individual must also be publicised locally.

7. Charging for Information

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NHS Trusts, Primary Care Trusts and Health Authorities may make a charge for providing information but are not required to do so. It is recommended that charging should be exceptional but that where charges are made the following ground rules should be observed:

a) no charge for individuals enquiring about services or treatment available to them;

press and other media; Community Health Councils; MPs; Local Authorities; Citizen's Advice Bureaux;

b) for requests from people not listed above, no charge for the first hour and a charge

not exceeding £20 per hour for each hour thereafter. 8. Personal Health Records

The NHS must keep patients' personal details confidential but people normally have a right to see their own health records. Depending on who made the records, patients can obtain access through the relevant Trust, Health Authority, family doctor or dentist. Access must be given within the timetable in the Access to Health Records Act 1990 (or, for records held on computer, the Data Protection Act 1984). Under these Acts patients may be charged for access to their records.

9. Information Which May be Withheld

NHS Trusts and Authorities must provide the information requested unless it falls within one of the following exempt categories:

i. Personal information. People have a right of access to their own health records

but not normally to information about other people.

ii. Requests for information which are manifestly unreasonable, far too general, or would require unreasonable resources to answer.

iii. Information about internal discussion and advice, where disclosure would harm

frank internal debate, except where this disclosure would be outweighed by the public interest.

iv. Management information, where disclosure would harm the proper and effective

operation of the NHS organisation.

v. Information about legal matters and proceedings, where disclosure would prejudice the administration of justice and the law.

vi. Information which could prejudice negotiations or the effective conduct of

personnel management or commercial or contractual activities. This does not cover information about internal NHS contracts.

vii. Information given in confidence. The NHS has a common law duty to respect

confidences except when it is clearly outweighed by the public interest.

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viii. Information which will soon be published or where disclosure would be premature in relation to a planned announcement or publication.

ix. Information relating to incomplete analysis, research or statistics where

disclosure could be misleading or prevent the holder from publishing it first. 10. Complaining About the Provision of Information

People may wish to complain about a decision to refuse to provide information, a delay in providing information or levels of charges. In the first instance, complaints should be made within 3 months to the local individual responsible for the operation of the Code (see paragraph 6 above). If the complainant remains dissatisfied, a complaint should be made to the Chief Executive of the organisation, or the Chief Executive of the Health Authority in the case of family doctors, dentists, pharmacists and optometrists (opticians). Community Health Councils may be able to help people to pursue their complaint. NHS Trusts and Authorities must acknowledge complaints within 4 working days and reply within 20 working days. The NHS Trust or Authority will provide people with information about how to take their complaint further to the Health Service Ombudsman if they remain dissatisfied. However, the Ombudsman does not investigate complaints about the withholding of information by family doctors, dentists, pharmacists, optometrists (opticians) or Community Health Councils.

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ANNEX A - NHS Trusts and Primary Care Trusts (PCTs) 1. Introduction

This annex describes the information which NHS Trusts and PCTs must publish or make available. It also lists examples of information which it is recommended should be made available as a matter of good practice, either through publication or on request.

2. Information Which Must be Published

The following are the documents which Trusts must publish by given dates: · an annual report describing the Trust's performance over the previous financial

year, and including details of board members' remuneration; the report should be written and presented in a way that can be readily understood by the general public:

· an annual summary of the Trust's business plan, describing the Trust's planned activity for the coming year;

· a summary strategic direction document (not published annually), setting out the Trust's longer term plans for the delivery of health care services over a five year period; and

· audited accounts published annually. In addition to the documents described above, NHS Trusts and PCTs must also make available, on request: · the register of board members' private interests required under the Code of

Accountability for NHS boards: 2.1 Public Meetings

NHS Trusts and PCTs are required to hold their board meetings in public. An agenda, papers, the accounts and the annual report must be publicly available at least 7 days in advance of the meeting. Provision must be made for questions and comments to be put by the public. Public meetings must be held in readily accessible venues and at times when the public are able to attend.

3. Good Practice in Providing Information 3.1 Examples of Additional Information Which May be Published

· quarterly board reports (financial, activity, quality and contract information); · information on service changes; · agenda and papers relating to other meetings held in public in addition to the

Annual Public Meeting. 3.2 Examples of Information Which May be Available on Request

The following list is a guide to some of the information which is routinely held by most NHS Trusts. Much of the information will be detailed in the previous year's annual report. Where more up-to-date information is available, this may be given: · patient information leaflets;

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· description of facilities (numbers of beds, operating theatres etc.); · waiting times by specialty; · detailed information on activity; · broad conclusions of clinical audit; · number and percentage of operations cancelled, by specialty; · price lists for extra-contractual referrals; · information about clinicians (including qualifications, areas of special interest,

waiting times for appointment); · areas which have been market-tested, with details of decisions reached; · tenders received by value, but not by name of tenderer; · information on manpower and staffing levels and staff salaries by broad bandings;

policies for Trust staff, e.g. equal opportunities, standards of conduct; · environmental items, e.g. fuel usage; · volume and categories of complaints and letters of appreciation (without identifying

individuals), and performance in handling complaints; · results of user surveys and action to be taken; · standing orders and waivers of standing orders; standing financial instructions;

external audit management letter, and Trust response, time when response is made:

· details of administrative costs; · funds held on trust, such as bequests and donations; · performance against quality standards in contracts; · clinical performance, by specialty, e.g. proportion of surgery done on day surgery

basis, by condition; · performance against national and local targets for inpatient and day case waiting

times; · names and contact (office) numbers of board members and senior officers; · basic salaries, i.e. excluding PRP and distinction awards, of staff, by bandings and

in anonymised form; · response times for ambulances; · information about the use of outside management consultants, including

expenditure. 4. Procedures for Obtaining Information

Trusts must ensure that people know whom to ask for information. They must publish the name of the person responsible, along with full details of how to go about obtaining information and how to complain if the information is not provided. The person responsible should be a senior officer who is directly accountable to the Chief Executive of the Trust.

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ANNEX B - Health Authorities 1. Introduction 1.1 Health Authorities have an essential role in the successful development of local

services and achieving a strategic balance of care. (Annexes C and D give complementary advice for General Practitioners.)

1.2 This Annex describes the information which they must publish or make available. It

also lists examples of information which it is recommended is made available as a matter of good practice, either through publication or on request.

2. Information Which Must be Published 2.1 Health Authorities

The following are the documents which Authorities must publish by given dates: · an annual report, describing the performance over the previous financial year, and

including details of board members' remuneration; the report should be in a form that can be readily understood by the general public;

· an annual report by the Director of Public Health; · a full list of General Medical Practitioners, General Dental Practitioners,

pharmacists and optometrists in their locality; · papers, agendas and minutes of board meetings held in public; · audited accounts published annually; · a strategy document (not published annually) setting out the heath authority's plans

over a five year period. They must consult with the public before and after developing the strategy.

In addition to the documents described above, authorities must also make available, on request: · annual purchasing plans; · contracts with providers, both NHS and non-NHS; · the register of board members' private interests required under the Code of

Accountability for NHS boards.

2.2 Public Meetings Health Authorities must hold all their board meetings in public, though there is provision of certain issues (eg personnel and commercial matters) to be taken in a private part of the meeting. The agenda for these meetings must always be provided to the press and on request to members of the public. Public meetings must be held in easily accessible venues, and at times when the public are able to attend.

2.3 Consultation

Health Authorities must consult with Community Health Council and other interested parties on any plans to change the services which they purchase or plan for their residents. They must publish well in advance a timetable to enable the public to know when and how they can influence to commissioning process.

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3. Good Practice in Providing Information 3.1 Examples of Additional Information Which May be Published

· information on services purchased by the Authority; · information about consultation exercises undertaken and outcomes; · full reports of any user or attitude surveys and action to be taken; · total available financial resources; · Health Authority allocation; · proposed and actual expenditure on services, analysed by: providers; contracts

(including by speciality, if available); · treatments purchased separately from contracts (extra contractual referrals); · changes in providers and contracts from previous years; · performance against quality standards in contracts; · clinical performance by speciality, of providers contracted with, eg proportion of

surgery done on day surgery basis, by condition; · performance against national and local targets for in-patient and day case waiting

times; · numbers of complaints dealt with and response times; · names and contact (office) numbers of Authority board members and senior

officers; · basic salaries, ie excluding PRP and distinction awards, of staff, by bandings and in

anonymised form; · information about the use of outside management consultants, including

expenditure. 3.2 Examples of Information Which May be Available on Request

· future year resource plans; · information about expenditure on different types of health care, such a primary,

secondary or community care; · price comparisons of all providers used by the purchaser; · total expenditure per head of population; · costs of authority administration; · standing orders and waivers of standing orders; · standing financial instructions; · external audit management letter, and response, at the time when the response is

made.

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4. Procedures for Obtaining Information Authorities must ensure that people know whom to ask for information. They must publish the name of the person responsible, along with full details of how to go about obtaining information and how to complain if the information is not provided. The person responsible should be a senior officer who is directly accountable to the Chief Executive of the Authority.

4.1 This annex describes the information which General Medical Practitioners, General

Dental Practitioners, Community Pharmacists and Optometrists must publish or make available.

4.2 General Medical Practitioners, General Dental Practitioners, Community Pharmacists

and Optometrists provide services to the public which are paid for by the NHS. The public should therefore have access to information about the services they provide. Although they are self-employed independent contractors, and cannot therefore be required to publish sensitive information about their businesses, their contracts for services specify information that is important to patients and which must be made available.

5. Information Which Must be Published

The following are the statutorily required documents which must be published. 5.1 General Medical Practitioners

Practice Leaflets - Essential information for patients about individual doctors' practices is published in practice leaflets which can be obtained from the practice. These must contain the following information:

· name, sex, medical qualifications and date and first place of registration of the General Practitioner;

· details of availability (including arrangements for cover when the General Practitioner is not available), appointments system and how to obtain an urgent appointment or home visit;

· arrangements for obtaining repeat prescriptions and dispensing arrangements; · frequency, duration and purpose of clinics; · numbers and roles of other staff employed by the practice, and information about

whether the General Practitioner works alone, part-time or in partnership; · details of services available – for example, child health surveillance,

contraception, · maternity, medical, minor surgery, counselling and physiotherapy; · details of arrangements for receiving and responding to patients' comments and · complaints; · geographical boundary of the practice area; · details of access for the disabled.

In addition, some leaflets also:

· contain information detailing any other professional staff employed by the

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practice, including their registration status; · are available in languages other than English which are commonly used locally.

2.2 General Dental Practitioners

Practice Leaflets Essential information for patients about individual dental practices is published in practice leaflets which can be obtained from the practice. These contain:

· name, sex and date of registration as a dental practitioner; · address, opening hours and details of partners/associates; · whether a dental hygienist is employed; · details of access to the premises; · whether only orthodontic treatment is available; · with consent, whether the dentist speaks any languages in · addition to English; · General Dental Practitioners are required to inform patients of any emergency

arrangements in place.

Charges · General Dental Practitioners must provide patients with individual costed

treatment plans. They must display a notice of the scale of NHS charges and information about entitlement to exemption from or remission of charges.

It is good practice:

· to provide information about their cross-infection control procedures, giving examples as appropriate.

3.3 Community Pharmacists

Practice Leaflets Pharmacists are not obliged to produce practice leaflets but those dispensing more than 1500 prescriptions a month normally do so. These leaflets detail the range of services available to the public and, if produced, must contain the following information:

· a list of services provided by the pharmacist; · name, address and telephone number of the pharmacy; · normal opening hours and arrangements for out of hours services and

emergencies; · procedures for receiving comments on services provided.

As good practice:

· an increasing number of Community Pharmacists make health promotion leaflets available to the public.

2.4 Optometrists

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Optometrists are not currently required to produce practice leaflets, but many do so as a matter of good practice. Results of Eye-Tests Optometrists must provide patients with a copy of the results of their eye-tests (ie their prescription) or a statement that no prescription is required.

3. Procedures for Obtaining Information 1.1 Information about individual General Medical Practitioners, General Dental

Practitioners, Pharmacists and Optometrists and their practice leaflets must be available from the practice. Health Authorities must ensure that people know whom to ask for additional information. The Authority should publish the name of the person responsible. This should be a senior officer who is directly accountable to the Chief Executive of the Authority.

3.2 Complaints about failure to obtain information should be dealt with as far as possible by the practice. If the complainant remains dissatisfied, he/she should be directed to the Family Health Services Authority. The assistance of the Community Health Council may also be sought. At present the Health Service Ombudsman does not investigate complaints against family doctors, dentists, optometrists (opticians) or pharmacists.

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ANNEX D General Practitioners 1 Introduction

This Annex extends Annex C and describes the additional information which General Practitioners must publish or make available.

2. Information Which Should be Published

The following are the documents which General Practitioners should publish or make available by given dates:

· plans for major shifts in purchasing; · annual practice plan describing how the practice intends to use its fund and

management allowances over the coming year and demonstrating the practice's contribution to national targets and priorities as well as any locally-agreed objectives. The plan should include an outline longer term view and may optionally include the practice's primary health care team charter (Practice Charter) and plans for the practice's general medical services (GMS) activity;

· Practice Charter (if available and not included above); · annual performance report; · audited annual accounts.

Consultation General Practitioners must ensure that a copy (or a summary) of their major shifts in purchasing intentions, annual plans, Practice Charter (if separate) and performance reports is available at their practice for consultation by patients. A copy of the above documents should be sent to the Health Authority and a copy (or a summary) to the local Community Health Council. In addition, General Practitioners are required to produce annual accounts for audit. Once audited, these are public documents and are available for inspection at the Health Authority.

3. Procedures for Obtaining Information 1.1 Information about individual practices should be requested direct from the practice.

Complaints about failure to provide information should be dealt with as far as possible by the practice.

1.2 If the complainant remains dissatisfied he/she should be directed to the Health

Authority. The assistance of the Community Health Council may also be sought. At present the Health Service Ombudsman does not investigate complaints against family doctors, dentists, optometrists opticians) or pharmacists.

1.3 Requests for information which is not about an individual practice should be directed

to the Health Authority. They must ensure that they publicise the name of the officer within the HA who is responsible for providing this information and for the operation of the Code of Practice. This should be a senior officer who is directly accountable to the Chief Executive of the Authority.

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NHS COMMISSIONING BOARD CODE OF

CONDUCT: MANAGING CONFLICTS WHERE GP

PRACTICES ARE POTENTIAL PROVIDERS OF CCG-

COMMISSIONED SERVICES Contents Managing conflicts of interest 2 Introduction 2 Background 2 Procurement requirements 3 Legislative requirements 3 Principles and main content 4 Code of Conduct 5 Template 8

Appendix: O6

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Managing conflicts of interest Introduction Managing potential conflicts of interest appropriately is needed to protect the integrity of the NHS commissioning system and protect clinical commissioning groups (CCGs) and GP practices from any perceptions of wrong-doing. The attached ‘Code of Conduct’ sets out additional safeguards that CCGs are advised to use when commissioning services for which GP practices could be potential providers. We anticipate that the NHS Commissioning Board (once established) will incorporate the ‘Code of Conduct’, alongside the general safeguards described in Towards establishment: Creating responsive and accountable CCGs75, into the guidance that it publishes for CCGs in relation to managing conflicts of interest. As best practice continues to evolve, the NHS Commissioning Board will reflect it in the guidance it gives to CCGs. Background The NHS Commissioning Board (NHS CB) will be responsible for commissioning primary care services under the GP contract. At the same time, it is an essential feature of the reforms that CCGs should be able to commission a range of community-based services, including primary care services, to improve quality and outcomes for patients. Where the provider for these services might be a GP practice76, CCGs will need to be able to demonstrate that those services:

· clearly meet local health needs and have been planned appropriately; · go beyond the scope of the GP contract; and · the appropriate procurement approach is used.

Such services will be commissioned using the NHS standard contract rather than the GP contract (as current ‘local enhanced services’ are). Subject to transitional arrangements (to be confirmed), the resources currently associated with local enhanced services (with the exception of public health services) will form part of CCGs’ baseline allocations, so that they can determine how best to use these resources. CCGs could also make payments to GP practices for:

75 http://www.commissioningboard.nhs.uk/files/2012/01/NHSCBA-02-2012-6-Guidance- Towards-establishment-Final.pdf 76 This could also be a provider consortium of practices, or a provider organisation in which GPs have a financial interest. The term ‘GP practice’ is generally used to denote any of these arrangements.

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· promoting improvements in the quality of primary medical care (e.g. reviewing referrals and prescribing)77; or

· carrying out designated duties as healthcare professionals in relation to · areas such as safeguarding.

Procurement requirements The Secretary of State for Health will make regulations under section 75 of the Act placing requirements on commissioners to ensure that they adhere to good practice in relation to procurement, do not engage in anti-competitive behaviour, and promote the right of patients to make choices about their healthcare. These regulations are likely to set out high-level requirements in relation to managing conflicts. The NHS CB will publish procurement guidance for CCGs to support them in meeting the requirements of the section 75 regulations. This will draw on the current Procurement Guide for commissioners of NHS-funded services, which includes guidance on managing conflicts of interest throughout the process: preprocurement, during procurement and post-procurement.78

CCGs will need to decide, subject to the proposed Department of Health (DH) regulations on procurement and choice, and subject to current procurement rules set out in the Public Contracts Regulations 2006, where it is appropriate to commission community-based services through competitive tender or an Any Qualified Provider (AQP) approach and where through single tender. In general, commissioning through competitive tender or AQP will introduce greater transparency and help reduce the scope for conflicts. There may, however, be circumstances where CCGs could reasonably commission services from GP practices on a single tender basis, i.e. where they are the only capable providers or where the service is of minimal value. Legislative requirements The Health and Social Care Act:

· places a duty on the NHS Commissioning Board to publish guidance for CCGs on managing conflicts and a duty on CCGs to have regard to such guidance; and

· requires that CCGs set out in their constitution their proposed · arrangements for managing conflicts of interest.

Towards establishment: Creating responsive and accountable CCGs and its supporting appendix on managing conflicts of interest sets out general safeguards that CCGs should have in place to manage conflicts of interest, including:

· arrangements for declaring interests; 77 The NHS Commissioning Board will give CCGs delegated powers to commission local enhanced services for these activities. 78 Under section 78 of the Act, Monitor will produce guidance on compliance with requirements imposed under section 75 of the Act.

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· maintaining a register of interests; · excluding individuals from decision-making where a conflict arises; and · engagement with a range of potential providers on service design.

The attached ‘Code of Conduct’ provides more specific, additional safeguards that CCGs are advised to have in place when commissioning services that could potentially be provided by GP practices. Principles and main content The proposed additional safeguards are designed to:

· maintain confidence and trust between patients and GPs; · enable CCGs and member practices to demonstrate that they are acting fairly and

transparently and that members of CCGs will always put their duty to patients before any personal financial interest;

· ensure that CCGs operate within the legal framework but are not bound by over-prescriptive rules that risk stifling innovation or slowing down the services they wish to commission to improve quality and productivity; and

· build on existing guidance, in particular the Procurement Guide for commissioners of NHS-funded services and Principles & Rules of Cooperation & Competition.

The Code adds to the general guidance in Towards establishment: Creating responsive and accountable CCGs by providing advice on:

· the additional factors that CCGs should address when drawing up plans for services that might be provided by GP practices;

· the steps that CCGs should take to assure their Audit Committee, Health and Wellbeing Board(s) and, where necessary, their auditors that these services are appropriately commissioned from GP practices;

· recommended procedures for decision-making in cases where all the GPs (or other practice representatives) sitting on a decision-making group have a potential financial interest in the decision;

· arrangements for publishing details of payments to GP practices; · the potential role of commissioning support services; and · the supporting role of the NHS Commissioning Board.

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Code of Conduct 1. Factors to address when commissioning services from GP practices The attached template sets out the factors on which CCGs are advised to assure themselves and their Audit Committee – and be ready to assure local communities, Health and Wellbeing Boards and auditors – when commissioning services that may potentially be provided by GP practices. Setting out these factors in a consistent and transparent way as part of the planning process will enable CCGs to seek and encourage scrutiny and enable local communities and Health and Wellbeing Boards to raise questions if they have concerns about the approach being taken. CCGs will be expected to make completed templates, or their equivalent, publicly available. The first set of questions are intended to apply equally to:

· services that a CCG is proposing to commission through competitive tender where GP practices are likely to bid;

· services that a CCG is proposing to commission through an Any Qualified Provider’ (AQP) approach, where GP practices are likely to be among the qualified providers that offer to provide the service; and

· services that a CCG is proposing to commission through single tender from GP practices.

These questions – most of which are also relevant when commissioning services from non-GP providers – focus on demonstrating that the service meets local needs and priorities and has been developed in an inclusive fashion, involving other health professionals and patients and the public as appropriate. These are matters on which the local Health and Wellbeing Board will clearly wish to take a view. The question on pricing applies to the AQP and single tender approaches. There are specific questions on AQP about safeguards to ensure that patients are aware of the range of choices available to them. These requirements apply also to GP practices as providers of services, but it is essential that CCGs too satisfy themselves and others that these safeguards will be in place before commissioning the service. The remaining questions are specific to single tenders from GP practices and focus on providing assurance that:

· there are no other capable providers, i.e. that this is the appropriate procurement route: Where relevant, commissioning support services (CSSs) should ensure that they provide robust advice to CCGs on this point; and

· the proposed service goes beyond the scope of the services provided by GP practices under their GP contract - CCGs are advised to discuss with their NHS CB local area team if they are in any doubt on this point.

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2. Providing assurance CCGs are advised to address the factors set out in the template when drawing up their plans to commission a service for which GP practices may be potential providers. This will provide appropriate assurance:

· to Health and Wellbeing Boards and to local communities that the proposed service meets local needs and priorities; and

· to the Audit Committee and, where necessary, external auditors that a robust process has been followed in deciding to commission the service, in selecting the appropriate procurement route, and in addressing potential conflicts.

CCGs are advised to set these factors out when fulfilling their duty in relation to public involvement. The factors include involving Health and Wellbeing Board(s), in accordance with duties on CCGs. 3. Preserving integrity of decision making process when all or most GPs have an interest in a decision Where certain members of a decision-making body (be it the governing body, its committees or sub-committees, or a committee or sub-committee of the CCG) have a material interest, they should either be excluded from relevant parts of meetings, or join in the discussion but not participate in the decision-making itself (i.e. not have a vote). In many cases, e.g. where a limited number of GPs have an interest, it should be straightforward for relevant individuals to be excluded from decision-making. In other cases, all of the GPs or other practice representatives on a decision-making body could have a material interest in a decision, particularly where the CCG is proposing to commission services on a single tender basis from all GP practices in the area, or where it is likely that all or most practices would wish to be qualified providers for a service under AQP. In these cases, CCGs are advised to:

· refer the decision to the governing body and exclude all GPs or other practice representatives with an interest from the decision-making process, i.e. so that the decision is made only by the non-GP members of the governing body including the lay members and the registered nurse and secondary care doctor;

· consider co-opting individuals from a Health and Wellbeing Board or from another CCG onto the governing body – or inviting the Health and Wellbeing Board or another CCG to review the proposal – to provide additional scrutiny, although such individuals would only have authority to participate in decision-making if provided for in the CCG’s constitution; and

· ensure that rules on forming a quorum (set out in the CCG’s constitution) enable decisions to be made.

Depending on the nature of the conflict, GPs or other practice representatives could be permitted to join in the governing body’s discussion about the proposed decision, but should not take part in any vote on the decision.

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4. Transparency - publication of contracts CCGs should ensure that details of all contracts, including the value of the contracts, are published on their website as soon as contracts are agreed. Where CCGs decide to commission services through AQP, they should publish on their website the type of services they are commissioning and the agreed price for each service. CCGs should ensure that such details are also set out in their annual report. Where services are commissioned through an AQP approach, they should ensure that there is information publicly available about those providers who qualify to provide the service. 5. Role of commissioning support Commissioning support services (CSSs) can play an important role in helping CCGs decide the most appropriate procurement route, undertake procurements and manage contracts in ways that manage conflicts of interest and preserve integrity of decision-making. CCGs are advised to ensure that any services they commission from CSSs, or that they secure through in-house provision, include this type of support. When using a CSS, CCGs should have systems to assure themselves that a CSS’s business processes are robust and enable the CCG to meet its duties in relation to procurement. Where a CCG is undertaking a procurement, it is likely to help demonstrate that the CCG is acting fairly and transparently if CSSs prepare and present information on bids, including an assessment of whether providers meet prequalifying criteria and an assessment of which provider provides best value for money. A CCG cannot, however, lawfully sub-delegate commissioning decisions to an external provider of commissioning support. Although CSSs are likely to play a key role in helping to develop specifications, preparing tender documentation, inviting expressions of interest and inviting tenders, the CCG itself will need to:

· sign off the specification and evaluation criteria; · sign off decisions on which providers to invite to tender; and · make final decisions on the selection of the provider.

6. Role of the NHS Commissioning Board The NHS Commissioning Board (NHS CB) will be able to support CCGs, where necessary, in meeting their duties in relation to managing conflicts of interest. Where, in particular, a CCG is commissioning any service from a primary care provider that is related to the services that some or all GP practices provide under the GP contract, CCGs should discuss the matter with the NHS CB local area team to ensure that the proposed arrangements do not cut across or duplicate the Board’s role in commissioning primary care services. The Board will also need to be able to assure itself that CCGs are meeting their statutory duties in managing conflicts of interest, including having regard to the guidance published by the Board. Where there were any concerns that a CCG was not meeting these duties, the Board could ask for further information or explanations.

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Template

[To be used when commissioning services from GP practices,

including provider consortia, or organisations in which GPs have a financial interest]

NHS [insert name]

Clinical Commissioning Group Service:

Question Comment / Evidence

Questions for all three procurement routes

How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and the estimated benefits?

How does it reflect the CCG’s proposed commissioning priorities?

How have you involved the public in the decision to commission this service?

What range of health professionals have been involved in designing the proposed service?

What range of potential providers have been involved in considering the proposals?

How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)?

What are the proposals for monitoring the quality of the service?

What systems will there be to monitor and publish data on referral patterns?

Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available?

Why have you chosen this procurement

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route?79

What additional external involvement will there be in scrutinising the proposed decisions?

What additional external involvement will there be in scrutinising the proposed decisions?

How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process?

Additional question for AQP or single tender (for services where national tariffs do not apply)

How have you determined a fair price for the service?

Additional questions for AQP only (where GP practices are likely to be qualified providers)

How will you ensure that patients are aware of the full range of qualified providers from whom they can choose?

Additional questions for single tenders from GP providers

What steps have been taken to demonstrate that there are no other providers that could deliver this service?

In what ways does the proposed service go above and beyond what GP practices should be expected to provide under the GP contract?

What assurances will there be that a GP practice is providing high-quality services under the GP contract before it has the opportunity to provide any new services?

79 Taking into account S75 regulations and NHS Commissioning Board guidance that will be published in due course, Monitor guidance, and existing procurement rules.

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APPENDIX R – MEMBER PRACTICES AND ATTACHED GOVERNING BODY GP LINK

GP F-CODE LEAD GP NAME PRACTICE NAME Name of GP Board Member

F83012 MULVIHILL Elizabeth Ave Group Practice Anjan Chakraborty

F83034 SKELLY New North Health Centre Anjan Chakraborty

F83064 COLEMAN The City Road Medical Centre Anjan Chakraborty

F83678 SEGARAJASINGHE Pine Street Medical Practice Anjan Chakraborty

F83031 FLINDERS Bingfield Street Surgery Anjan Chakraborty

F83010 MARSHALL Islington Central Medical Centre Gillian Greenhough

F83015 AARONS St Johns Way Medical Centre Gillian Greenhough

F83039 SALKIND The Rise Group Practice Gillian Greenhough

F83671 MONEEB The Beaumont Practice Gillian Greenhough

F83002 BUNT River Place Health Centre Jo Sauvage

F83021 HAZELWOOD Ritchie Street Group Practice Jo Sauvage

F83060 KINSELLA The Northern Medical Centre Jo Sauvage

F83686 CHAKRABORTY Stroud Green Medical Clinic Jo Sauvage

F83004 KOYA Archway Medical Centre Karen Sennett

F83053 WHEELER Mildmay Medical Practice Karen Sennett

F83056 RATNAVEL Mitchison Road Surgery Karen Sennett

F83648 HANS Dartmouth Park Practice Karen Sennett

F83681 ROSENTHAL Partnership Primary Care Centre Karen Sennett

F83013 WOOLF Holloway Medical Clinic Katie Coleman

F83033 HAFFIZ Barnsbury Medical Practice Katie Coleman

F83045 BENNETT The Miller Practice Katie Coleman

F83660 TROSSER Highbury Grange Health Centre Katie Coleman

F83008 BATTLE Goodinge Health Centre Rathini Ratnavel

F83063 SENNETT Killick Street Health Centre Rathini Ratnavel

F83664 MCDAID The Village Practice Rathini Ratnavel

F83673 EDOMAN The Medical Centre Rathini Ratnavel

F83680 GUPTA Sobell Medical Centre Rathini Ratnavel

F83007 SHAH Roman Way Medical Centre Sabin Khan

F83032 HAUGHEY St Peters Street Medical Centre Sabin Khan

F83051 KO Dr Ko’s Surgery Sabin Khan

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GP F-CODE

LEAD GP NAME PRACTICE NAME Name of GP Board Member

F83674 KATEB The Tufnell Surgery Sabin Khan

Y01066 CARVALHO Hanley Primary Care Centre Sabin Khan

F83027 BOWRY The Family Practice Sharon Bennett

F83624 BAINES Clerkenwell Medical Practice Sharon Bennett

F83630 HUSSAIN Wedmore Gardens Surgery Sharon Bennett

F83652 UPTON Amwell Group Practice Sharon Bennett

F83666 VARMA Andover Medical Centre Sharon Bennett

Key Principles of attaching Board members to GP practices

1. No Governing Body GP Link will be attached to their own practice 2. No Governing Body GP Link attached to any locality 3. All Governing Body GP Links are to have a mix of single-handed and group practices

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MEETING: Islington Clinical Commissioning Group Governing Body DATE: Wednesday, 3 April 2013 TITLE: Risk Management LEAD DIRECTOR: Martin Machray, Director of Quality and Integrated Governance AUTHOR: Michael Portman, Integrated Governance Manager CONTACT DETAILS: [email protected] SUMMARY: To help manage the safe, effective delivery of Islington CCG’s priorities, a corporate risk register has been developed to facilitate this and provide assurance to the Governing Body around risk management at the CCG.

To support this, a risk evaluation matrix has been developed to ensure risks are consistently scored against a common scale of likelihood and impact.

In addition a graphical representation of risks has been developed (‘heat map’) to give anyone reviewing the risk register an “at-a-glance” picture of the corporate risk profile both before and after risk mitigation.

The Executive Team and Audit Committee have reviewed and agreed the layout and structure of the risk register. The Governing Body is asked to review the risks set out in the risk register, and the proposed risk management process.

SUPPORTING PAPERS: Appendix 3a: Draft Islington CCG risk register Appendix 3b: Draft risk ‘heat map’

RECOMMENDED ACTION: The Governing Body is asked to:

· REVIEW and DISCUSS the risks set out in the risk register and provide their comments.

GOVERNANCE:


Greenhough Chair

Simon










Jacky Kutner Interim Director of Performance and

Information Dr Rathini Ratnavel South Locality GP

Representative Sophie Lusby Associate Director of

Strategic Commissioning and Planning








Penny Bevan Interim Director of Public Health



Dr Mo Akmal


Objective(s) / Plans supported by this paper: This paper describes the work being undertaken to prepare the CCG to take up its statutory responsibilities. Audit Trail: Updates have been provided to the Executive Management Team. Patient & Public Involvement (PPI): This report is for information only and has not required input from other stakeholders to compile. Equality Impact Assessment: Not required for this report. Risks: No new risks identified. Resource Implications: None Next Steps: The risk register will be updated with Governing Body comments, and will be considered by the next Audit Committee meeting and Executive Team meeting

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Risk Management Introduction To help manage the take-on and safe and effective delivery of Islington CCG’s priorities, a corporate risk register has been developed to facilitate risk management.

To complement this a risk evaluation matrix has been developed to ensure risks are consistently scored against a common scale of likelihood and impact.

In addition a graphical representation of risks has been developed (‘heat map’) to give anyone reviewing the risk register an at-a-glance picture of the corporate risk profile both before and after risk mitigation.

The Executive Team has reviewed and agreed the layout and structure of the risk register. The Governing Body is asked to review the risks set out in the risk register, and the proposed risk management process, and provide their comments. The Risk Register

The Risk Register is broadly similar in layout to that used by other organisations and is similar in structure to the corporate risk register of NHS NCL.

The risk register has a number of columns, each of which has a different function:

· ID: the risk identifier. · Heading: the name of the risk. · Objective: the objective(s) of the CCG, as set by the Governing Body, to which the

risk relates. · Category: it is proposed all risks will categorised as one or more of clinical,

financial or reputational consequences. · The principal risk: a description of the risk, ideally couched in terms of cause,

event and effect. Please note risks should always be described in indefinite terms. · Proximity Date: when is the risk expected to materialise? · Next planned review date: when is the risk owner proposing to do a full review of

the risk? · Old pre-mitigation risk consequence/likelihood: as risk ratings change within

review cycles it is useful to keep a record of previous ratings. This will help reviewers consider fully how risks have changed over time.

· Current pre-mitigation risk consequence/likelihood. · Pre-mitigation risk rating. · Existing and planned mitigation: what is being done, and what is planned to be

done, to manage and reduce the risk. Note sometimes mitigation will not be possible, but this should also be recorded in detail in this section.

· Gaps in controls and action plan. · Existing and planned assurance.

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· Old post mitigation consequence/likelihood: as mitigation has an impact over a review cycle it is useful to keep a record of previous ratings. This will help reviewers consider fully how risks have changed over time.

· Current post mitigation risk consequence/likelihood. · Post mitigation risk rating. · Date last reviewed. · Final target date: when is it aimed that the risk will be fully resolved. · Risk lead: the member of staff whose day to say work involves this risk. · Risk owner: the member of the Executive Team who the risk lead is accountable

to. · Committee: the name of the committee that has oversight of the area to which the

risk relates. In addition the risk rating is split into different functional areas e.g. Quality and Governance. Within these areas risks are ordered by pre-mitigation risk rating, high to low.

The initial risks have identifiers Xnn. X indicates a risk identified before 1 April 2013. The two digit number that follows (nn) is in order of risk identified and placed on the risk register. Should risks be split, they will be numbered Xnna, b, c etc.

Going forward it is proposed that risks identified in the first year of the CCGs operation will be number 1nn; in the second year 2nn and so on. The identifier will then provide a rough guide to a risks’ age.

As the risk register contains a great deal of information it will be difficult for reviewers to identify and review changes that have been made. Therefore a system of tracking changes has been developed:

· Cells that have been updated during a review cycle are highlighted in yellow. · Newly added text is in red. · Risks proposed for deletion are coloured pink until the relevant committee or the

Governing Body agrees their deletion. · Risks proposed for inclusion are coloured green until the relevant committee or the

Governing Body agrees their inclusion.

Reviewing the Risks

It is planned that the risk review cycle runs from Governing Body meeting to the next. It is proposed that the order of reviews is:

· Executive Team · Committee · Governing Body

It is planned that the risk register will be presented to the Governing Body at its meetings on:

· 3 July 2013 · 4 September 2013 · 6 November 2013

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· 15 January 2014 · 5 March 2014

The risks currently on the risk register were identified from review of the NCL risk register with the risk management lead at NCL, and by discussion with some staff at Islington CCG. The Executive Team reviewed the risk register at its meeting on 13th March 2013. The Governing Body will see that the risks on the risk register have not been fully populated, as this requires a further review of risks with risk leads and owners during April.

The Governing Body is invited to review the risk register and make amendments to the risks as it deems appropriate. In particular the Governing Body is asked to consider the risk ratings as marked and consider what appropriate pre-and post risk rating should be. Headlines

The draft risk register currently has 26 risks, four of which are currently rated red pre-mitigation. This reduces to two rated red post mitigation.

Three risks are proposed for addition,

· X24 – funded nursing care. This is a new red- rated risk relating to The Whittington Hospital.

· X25 – delivery of continuing healthcare. This is an amber rated risk relating to the possibility of increased costs for residential care.

· X26 – delivery of continuing healthcare. This is an amber rated risk relating to quality of care under the new framework for domiciliary care workers.

One risk is proposed for deletion, X13 Delivery of QIPP target for 2012/13. This is because we are now in the financial year 2013/14; and the risks did not become and issue. At present 19 of the 26 risks have the same risk rating pre- and post-mitigation. This is because the full impact of the mitigating actions for these risks cannot yet be measured. It is anticipated post-mitigation risk ratings will reduce once the effect of the mitigating actions is evaluated.

Risks by Functional Area

· Quality and Governance: eight risks · Commissioning: 11 risks · Chief Officer: three risks · Finance: three risks · Information and performance: one risk

Risk Rating Matrix It is common for risks to be rated one a scale of one to five for likelihood and impact, with five being the highest. A draft risk evaluation matrix providing guidance for the level of each point on the scale for both risk likelihood and risk impact. The draft guidance is not definitive or exhaustive. It is proposed that risks rated 1-6 inclusive are green; 8-12 inclusive are amber; and those rated 15 or higher are red.

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Likelihood Likelihood is a scale from highly unlikely to almost certain. Anything that is certain to occur is not a risk, and should not be managed using the risk register. Impact Risk impact is described in terms sub sets of clinical impact, financial impact, or reputational impact. The Governing body is asked to consider the guidance on risk impact, noting that a clinical impact of three is proposed as the minimum threshold for a risk that relates to an SI and a rating of five cannot be applied to anything that would not be considered an SI. Risk ‘Heat Map’ The enclosed risk ‘heat map’ is an illustrative snapshot of risks pre and post mitigation. The heat map colours risks by their functional area, and highlights those risks proposed for addition or inclusion. Risks that have had their ratings increased or decreased are marked with an arrow. Once Islington CCG’s risks have been reviewed and the register updated it is proposed a similar heat map is produced to facilitate the review of the CCG’s risks. The Review Cycle The review cycle should run from one meeting of the Governing Body to the next. Each cycle will start with a clean risk register and updates and changes recorded using the process set out above. The Integrated Governance Manager, in discussion with the risk owners and risk leads, will keep the risk register updated and draft papers for each review meeting. Review meetings will include: · Executive Team meetings · Committee meetings, looking at risks relating to each committee’s remit · The Audit Committee to consider the full risk register · The Governing Body to sign off the amended risk register and start a new cycle Skills for risk management at Islington CCG As part of the development of a good risk management culture the risk management training will be added to the suite of training staff will be expected to undertake whilst working at the CCG. It is proposed that in-house training on risk management is delivered annually, giving all staff the skills to identify, describe and evaluate risk. This risk management training will be useful in staff’s day to day programme and project management, and complement training in these areas.

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Conclusion and Next Steps The risk register will be updated to reflect any comments made by the Governing body before being discussed at the Audit Committee and the April Executive Team Meeting that follows.

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Risk Heat Map – Pre mitigation

2 3 4 5

3

4

5

Consequence

Likelihood risk to be removed new risk rating change

2

Quality & Governance

Chief Officer Commissioning Finance

1

1

X01b

X18 X01a

X24

X15

Information and Performance

X21 X10 X07

X11

X23

X20

X09 X16

X19

X06

X08

X14

X12

X02a X03a

X04a

X22 X13

X17 X25

X26

Appendix: 3b ICCG GB - 220

Risk Heat Map – Post mitigation

2 3 4 5

3

4

5

Consequence

Likelihood risk to be removed new risk rating change

2

Quality & Governance

Chief Officer Commissioning Finance

1

1

X01b

X18 X01a

X15

Information and Performance

X21

X10 X07

X11

X23

X20

X09 X16

X19

X06

X08

X14

X12

X02a X03a

X04a

X22 X13

X17

X24 X25

X26

ICCG GB - 221

ICCG GB - 222

MEETING: Islington Clinical Commissioning Group Governing Body DATE: Wednesday, 3 April 2013 TITLE: Policy Adoption LEAD DIRECTOR: Martin Machray, Director of Quality and Integrated Governance AUTHOR: Michael Portman, Integrated Governance Manager

Sharon Jackson, Board Secretary CONTACT DETAILS: [email protected] SUMMARY: This report presents the process by which NHS Islington Clinical Commissioning Group (CCG) will adopt and adapt policies inherited from NHS North Central London. These have been updated to reflect the transition from NHS North Central London to the CCG. The policies have not been changed in a way that affects the terms and conditions of employment of staff. Each policy has a review date and a work plan has been developed to undertake a full detailed review of policies in a series of tranches starting with policies with review dates that fell on or before 31 March 2013. Also presented with this report are two policies for adoption which supersede the previous NHS North Central London versions. These are:

· Gifts & Hospitality and Declarations of Interest Policy - This document sets out Islington Clinical Commissioning Group’s (CCG) Policy for maintaining high ethical standards in the acceptance of gifts and hospitality and declaring conflicts of interest. This is aligned with the Islington Clinical Commissioning Group Constitution and the Codes of Conduct.

· Individual Funding Request Policy - This policy sets out Islington CCG Governing Body’s decision making process for managing Individual Funding Requests (also known as exceptional funding requests), and the delegated responsibility and legal framework for decision-making within each CCG constitution. It is underpinned by a detailed operational procedure which describes how the process will be administrated on behalf of Islington and other CCGs by the North and East London Commissioning Support Unit.

SUPPORTING PAPERS: Appendix 4a: Gifts & Hospitality and Declarations of Interest Policy Appendix 4b: Individual Funding Request Policy


· NOTE the transfer and continuation of North Central London policies to and with Islington CCG;


· APPROVE the proposed work plan for policy review and update;

· APPROVE the Individual Funding Requests Policy; and

· APPROVE the Gifts & Hospitality and Declarations of Interest Policy.

GOVERNANCE:


Greenhough Chair

Simon









Jacky Kutner Interim Director of Performance and

Information Dr Rathini Ratnavel South Locality GP

Representative Sophie Lusby Associate Director of

Strategic Commissioning and Planning








Penny Bevan Interim Director of Public Health



Dr Mo Akmal


Objective(s) / Plans supported by this paper: This paper describes the work being undertaken to prepare the CCG to take on policies it is inheriting from NHS NCL. Audit Trail: Updates have been provided to the Executive Management Team. Patient & Public Involvement (PPI): This report is for information only and has not required input from other stakeholders to compile. Equality Impact Assessment: Not required for this report.

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Risks: No new risks identified. Resource Implications: None Next Steps: The Governing Body is asked to:

· NOTE the transfer and continuation of North Central London policies to and with Islington CCG;

· APPROVE the proposed work plan for policy review and update;

· APPROVE the Individual Funding Requests Policy; and

· APPROVE the Gifts & Hospitality and Declarations of Interest Policy.

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Policy Adoption

1. Introduction NHS Islington CCG is required to have in place a range of policies to help it manage the delivery of its functions from 1 April 2013. Up to them the CCG, as a subcommittee of NHS NCL, had been operating under NHS NCL’s policies and procedures. As part of statutory authorisation the CCG automatically takes on the policies of NHS NCL. As part of preparation for this these policies have been reviewed and amended to reflect the change from PCTs to the CCG. They have been rebranded and where necessary changes have been made to take account of the difference between a PCT and a CCG, in terms of structures and roles. The policies have not been changed in a way that affects the terms and conditions of employment of staff. The Policies A list of policies that are being adopted is at Appendix 1

2. Reviewing and Updating the Policies There remains work to be done to refine the policies that the CCG is inheriting. All policies have a review date by which time they should be reviewed and updated to reflect any changes that need to be taken into account i.e. changes in the law. It is proposed that the policies the CCG is inheriting are reviewed in line with stated review dates and at that the opportunity is taken to do a full, detailed review and update of policies.

3. Work Plan In order to plan for and manage the work involved in reviewing and updating policies a work plan has been developed to facilitate policy review. Primarily this splits the policies inherited into four tranches. A significant number of NHS North Central London policies have review dates that fall on or before 31 March 2013. It is proposed these form the first tranche of policies that are reviewed. These will then be reported back to the Governing Body at its July meeting. A second tranche of policies have review dates that fall on or before 31 July 2013. These will be reviewed reported back to the Governing Body at its September meeting. The third tranche has review dates that fall on or before 31 October 2013. These will be reported back to the Governing Body at its meeting in January 2014. The final tranche have review dates between November 2013 and January 2014 and these will be reported back to the Governing Body at its meeting in March 2014. The list of policies at Appendix 1 also lists policies’ review dates.

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4. Conclusion and Next Steps The Governing Body is asked to note the list of policies at Appendix 1 and agree the review time table as set out.

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Appendix 1 – List of NCL Policies Transferring To Islington CCG, with stated review date Flexible Working Guidelines Not

recorded Whistleblowing Policy Not

recorded Protection Of Pay Policy 30/03/2008 Appraisal Policy 16/11/2011 Induction Policy 31/09/2012 Smartcard Registration Policy 30/04/2012 Expenses Policy 30/06/2012 Data Protection Policy 31/07/2012 Procedures Of Limited Clinical Effectiveness Policy 24/08/2012 Risk Management Strategy 01/12/2012 Health And Safety Policy 26/01/2013 Anti-Bribery Policy 26/01/2013 Anti-Fraud Policy 26/01/2013 Recruitment & Selection Guidelines 28/02/2013 Suspension Information Pack 28/02/2013 Capability Policy 31/03/2013 Continuing Healthcare Policy 31/03/2013 Disciplinary Procedure 31/03/2013 Equalities Policy 31/03/2013 Essential Training Policy 31/03/2013 Family Leave Procedure 31/03/2013 Grievance Procedure 31/03/2013 Health And Well Being Policy 31/03/2013 Individual Funding Request Policy 31/03/2013 Induction And Probation Scheme Guidelines 31/03/2013 Information Security Policy 31/03/2013 Pay Protection Policy 31/03/2013 Prevention Of Bullying And Harassment Policy 31/03/2013 Protection Of Earnings Policy 31/03/2013 Special Leave Policy 31/03/2013 Staff Affected By Change 31/03/2013 Working Time Directive Guidance 31/03/2013 Bicycle Scheme Guidelines 30/04/2013 Family Leave Policy 30/04/2013 Managing Attendance And Absence Policy 30/04/2013 Stress Guidelines 31/05/2013 Data Encryption Policy 31/07/2013 Email Policy 31/07/2013 Information Lifecycle Management (Records Management) Policy 31/07/2013 Information Security Event Reporting Procedures 31/07/2013 Information Security Risk Assessment Policy 31/07/2013 Information Sharing & Disclosure Policy C/Ad/016 31/07/2013 Internet Service Policy 31/07/2013 Lone Worker 31/07/2013 Physical And End Of Day IG Security Policy 31/07/2013 PID Security Policy 31/07/2013 Drugs And Alcohol Policy 31/08/2013

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Freedom Of Information & Environment Information Regulations Policy 03/10/2013 Information Governance Policy 30/10/2013 Adverse Weather Condition Guidance 31/12/2013 Agenda For Change Process 31/01/2014 Annual Leave Guidelines 31/01/2014

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BEFORE USING THIS POLICY ALWAYS ENSURE YOU ARE USING THE MOST UP TO DATE VERSION

Gifts & Sponsorship and Hospitality Policy

Page 1 of 15

GIFTS & HOSPITALITY AND DECLARATIONS OF INTEREST POLICY 1 SUMMARY

This document sets out Islington Clinical Commissioning Group’s (CCG) Policy for maintaining high ethical standards in the acceptance of gifts and hospitality and declaring conflicts of interest.

2 RESPONSIBLE PERSON: Board Secretary

3 ACCOUNTABLE DIRECTOR:


4 APPLIES TO:

This Policy must be adhered to by all staff (whole or part time) and by Governing Body and Committee Members.

5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY:

RSM Tenon Internal Auditors Board Secretary

6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL:

Governing Body

8 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL:

Governing Body, 3 April 2013

9 VERSION: 1.0

10 AVAILABLE ON: Intranet Yes Website Yes

11 RELATED DOCUMENTS:

Anti-Fraud & Bribery Policy Prime Financial Policies Standards of Business Code of Conduct Code of Conduct: Managing conflicts of interest where GP practices are potential providers of CCG-commissioned services

12 DISSEMINATED TO: All staff

13 DATE OF IMPLEMENTATION: 3 April 2013

14 DATE OF NEXT FORMAL REVIEW: April 2014

Appendix: 4a ICCG GB - 230



Page 2 of 15

DOCUMENT CONTROL Date

Version

Action

Amendments

3 April 2013

1.0

Policy first implemented

N/A

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Contents Section Page 1 Summary 4 2 Introduction 4 3 Scope 5 4 Communication 5 5 Monitoring of the Policy 6 6 Declarations of interest 6

6.2 Declaring an interest 7 6.3 Interests which are relevant and material 7 6.4 Advice on interests 7 6.5 A personal family interest 7 6.6 Recording of interests 8 6.7 Conflicts of interest which arise during the course of a

meeting 8

6.8 The Register of Interests 8 7 Declarations of gifts and hospitality 9

7.1 Legal position – The Bribery Act 2010 9 7.2 Policy 9 7.3 What staff should do when they refuse a gift, loan, or offer of

hospitality or sponsorship 10

7.4 What staff may accept 10 7.5 Declaring a gift or the offer of sponsorship or hospitality 12

8 Related policies 12 Appendices Appendix A Declaration of Interest Form 13 Appendix B Register of Gifts and Hospitality Declaration Form 15

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1. SUMMARY 1.1.1. This document sets out Islington Clinical Commissioning Group’s (CCG) Policy for

maintaining high ethical standards in the acceptance of gifts and hospitality and declaring conflicts of interest.

1.1.2. The aim of this Policy is to ensure that the CCG is impartial and honest in the conduct of its business. Having a policy and carrying out that policy will protect staff from any suspicion of corruption, and protect the reputation of the CCG.

1.1.3. The policy explains what the CCG expects of organisations who work with the CCG in terms of standards of behaviour when conducting business. It also sets out the requirements with which each individual member of staff that falls within its scope must comply to ensure they are not placed in a position which risks or appears to risk a conflict between their private interests and their NHS duties. It cannot cover all situations or circumstances and therefore staff are required to be thoughtful in their dealings in matters that might compromise their own or the CCG’s reputation or ethical standards.

2. INTRODUCTION 2.1.1. The CCG’s Policy are underpinned by national guidance HSG (93) 5 and in statute

by the Bribery Act 2010 (the Act) which supersedes the Prevention of Corruptions Acts 1906 and 1916.

2.1.2. The CCG is a public body and as such has a duty to ensure that: § All its business dealing are conducted to the highest standards of openness,

honesty and probity; § The interests of the CCG and its patients come first; and § Public funds are properly safeguarded. In particular, staff should ensure they do not: § Abuse their official position for personal gain or to benefit their family or

friends; § Misuse any financial procedures of the CCG for personal gain; § Remove items of CCG property without authorisation; and § Seek to gain advantage or further private or business interests in the course

of their official duties. 2.1.3. Staff are expected to comply with this Policy and ensure they:

§ Declare conflicts that may arise between their NHS work and their personal interests;

§ Abide by the rules regarding the acceptance of gifts, hospitality and sponsorship;

§ Inform the Director of Corporate Services if they suspect they have been offered a gift or hospitality with corrupt intent.

2.1.4. The Bribery Act does not aim to criminalise reasonable or proportionate hospitality or to prevent activities that benefit the CCG and its patients. One of the objectives

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of this Policy is to ensure that staff are aware of their responsibilities and when doing business they take appropriate action to ensure they do not engage in any corrupt activities that could damage the reputation of the CCG.

3. SCOPE 3.1.1. This Policy must be adhered to by all staff (whole or part time) and by Governing

Body and Committee Members. 3.1.2. The term Staff includes individuals who are:

§ Employed under a contract of employment with the CCG; § unpaid volunteers of the CCG; § not employed by the CCG but who exercise functions on behalf of e.g. non-

NHS contract staff. 3.1.3. Where this Policy covers individuals whose main employer is not the CCG it will

seek assurance that their employing organisation has appropriate arrangements in place on bribery.

3.1.4. It also covers any persons associated with suppliers of goods or services to or on behalf of the CCG. The Procurement Directorate shall ensure that any person who is performing services or providing goods to the CCG understands its Policy.

3.1.5. Any breach of this Policy will be taken seriously and may lead to disciplinary action up to and including dismissal as outlined in the CCG’s disciplinary policy and procedures. Furthermore staff are advised that a breach of the provisions of the Bribery Act 2010 also renders them liable to criminal prosecution.

3.1.6. Where this Policy is not adhered to in reference to cases of fraud and corruption non-compliance by staff will be dealt with in accordance with the CCG’s counter fraud policy.

3.1.7. For the purposes of this Policy, the CCG has designated the Director of Quality and Integrated Governance as responsible for carrying out a range of functions. However it is important to note that none of the requirements in this Policy contradicts or conflicts with an individual’s rights as set out in the CCG’s whistleblowing (raising concerns and freedom of speech) policy nor is anything contained in this Policy deemed as overriding the CCG’s legal duty to comply with the Freedom of Information Act.

3.1.8. This Policy is deemed to be an integral part of the CCG’s Standing Orders (SO), and Standing Financial Instructions (SFI) and should be read in conjunction with them. These documents also require staff to act with integrity at all times.

3.1.9. Staff should note that this Policy does not replace or substitute any professional or other codes of conduct that members of staff or individuals connected with the CCG are obliged to follow.

4. COMMUNICATION 4.1.1. This Policy and all associated forms will be made available on the CCG’s Intranet

or copies of the forms can be requested from the CCG administrator. A copy of this Policy will be given to Governing Body members on appointment.

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4.1.2. This Policy will be drawn to the attention of newly appointed CCG employees in the staff induction programme. Reminders to raise awareness on key aspects of this Policy e.g. declaration of interest reminders will be sent via email or otherwise at least every six months.

4.1.3. Executive directors, other directors and divisional managers and equivalent staff will have responsibility for implementation and for ensuring that all staff under their direction are made aware of this Policy directly. Those departments involved in aspects of procurement will be asked to draw its content to the attention of suppliers and contractors where practicable and appropriate.

4.1.4. If staff are in any doubt about matters concerning this Policy they should seek advice from their divisional manager, divisional clinical director or executive director in the first instance. Any individual who provides advice to staff under this Policy should record the advice given in writing by either email or letter and keep a copy as this may be required for audit purpose.

4.1.5. Advice on this Policy and its applicability should be directed to the Director of Quality and Integrated Governance or Chief Finance Officer.

5. MONITORING OF THE POLICY 5.1.1. Two registers, the ‘Register of Interests’ and a ‘Gift and Hospitality Register’ will be

held centrally by the CCG Board Secretary. § The Register of Interests will record all business and commercial interests

declared by staff. § The Gift and Hospitality Register will record all offers of gifts, hospitality and

sponsorship accepted or refused by staff. § Details of what information is recorded on the two registers is described in

the guidance appended to this Policy. 5.1.2. Summaries of the respective registers will be provided to the Director of Quality

and Integrated Governance and will be subject to a corporate review. The review will take into account any significant changes to contracts or suppliers which may have resulted from or be perceived to have links with disclosed declarations of interests. A report of the review will be made annually to the audit committee.

5.1.3. Internal audit will be invited to undertake a periodic review of compliance with this Policy.

5.1.4. The outcome of audit findings and monitoring will be incorporated into a bi-annual review of the Policy.

6. DECLARATIONS OF INTEREST 6.1.1. When staff have personal interests for example in an equipment manufacturer or a

pharmaceutical company these must not conflict with their official duties nor impair their ability to carry out their duties. This guidance provides advice on what constitutes a conflict of interest and how to declare and register a conflict of interest.

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6.2. Declaring an Interest 6.2.1. Staff who have an interest in an organisation with which the CCG has a business

relationship (or if they have previously worked for such an organisation) may be vulnerable to allegations of impropriety. This also applies to partners, relatives and close associates of that member of staff.

6.2.2. Staff should exercise caution in areas where an interest might arise, or be perceived as arising. If their dealings or interests might influence or be seen by others to influence the CCG’s business relationships with that organisation the interest must be declared.

6.2.3. All relevant material interests should be formally declared.

6.3. INTERESTS WHICH ARE RELEVANT AND MATERIAL 6.3.1. Interests which should be regarded as “relevant and material” are:

§ Directorships, including non-executive directorships held in private companies or PLCs (with the exception of those of dormant companies*);

§ Ownership or part-ownership of private companies, businesses or consultancies;

§ Majority or controlling share holdings in organisations; § A position of authority in a charity or voluntary organisation; § Any connection with a voluntary organisation contracting NHS services; § Research funding/grants that may be received by an individual or their

department; § Interests in pooled funds that are under separate management (any relevant

company included in this fund that has a potential relationship with the CCG must be declared).

*those with directorships (including non-executive directorships) held in dormant private companies or PLCs should be declared if the company has only been declared dormant in the previous financial year.

6.4. ADVICE ON INTERESTS 6.4.1. If Governing Body members have any doubt about the relevance of an interest,

this should be discussed with the Chair of the CCG as appropriate, or with the CCG’s Board Secretary.

6.4.2. The influence rather than the immediacy of the relationship is more important in assessing the relevance of an interest. The interests of partners in professional partnerships including general practitioners should also be considered.

6.5. A PERSONAL FAMILY INTEREST 6.5.1. A personal family interest relates to the personal interests of a family member and

involves a current payment to the family member of the employee or member. The interest may relate to the manufacturer or owner of a product or service being evaluated, in which case it is regarded as ‘specific’, or to the industry or sector

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from which the product or service comes, in which case it is regarded as ‘non-specific’. The main examples include the following: § Any consultancy, directorship, position in or work for a healthcare industry, of

one that the NHS engages with that attracts regular or occasional payments in cash or in kind.

§ Any fee-paid work commissioned by a healthcare industry for which the member is paid in cash or in kind.

§ Any shareholdings, or other beneficial interests, in a healthcare industry which are either held by the family member.

§ Funds which include investments in the healthcare industry that are held in a portfolio over which individuals have the ability to instruct the fund manager as to the composition of the fund.

6.5.2. No personal family interest exists in the case of: § Assets over which individuals have no financial control (for example, wide

portfolio unit CCGs and occupational pension funds) and where the fund manager has full discretion as to its composition.

§ Accrued pension rights from earlier employment in the healthcare industry.

6.6. RECORDING OF INTERESTS 6.6.1. Staff are required to declare their interests using the Declaration of Interests Form

attached as Appendix 1 which is also available as an online form. All declarations must be evidenced by a signature and sent to the register holder.

6.6.2. The Director of Quality and Integrated Governance will assess the significance of interests that have been registered at least quarterly. If as a result of that assessment discussions are required regarding the significance of the interest this will be discussed with the Director of Quality and Integrated Governance.

6.6.3. Declarations should be made as soon as practicable.

6.7. CONFLICTS OF INTEREST WHICH ARISE DURING THE COURSE OF A MEETING

6.7.1. During the course of a CCG Governing Body meeting, if a conflict of interest is established, the Governing Body Member concerned should withdraw from the meeting and play no part in the relevant discussion or decision.

6.8. THE REGISTER OF INTERESTS 6.8.1. The Chief Executive will ensure that a Register of Interests is established to record

formally declarations of interests of CCG Governing Body Members. In particular the Register will include details of all Directorships and other relevant and material interests which have been declared by CCG Governing Body Members.

6.8.2. The Register will be available to the public and the Chief Officer will take reasonable steps to bring the existence of the Register to the attention of local residents and to publicise arrangements for viewing it.

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7. DECLARATIONS OF GIFTS AND HOSPITALITY 7.1. LEGAL POSITION – THE BRIBERY ACT 2010 7.1.1. Staff are required to exercise high standards of honesty and probity in the course

of all their dealings on behalf of the CCG to avoid corrupt practices. Additional requirements are placed on staff by the Bribery Act 2010. The Bribery Act 2010 defines bribery as: § Two general offences – 1) Offering or giving a bribe to induce someone to

behave, or reward someone for behaving, improperly and 2) requesting or accepting a bribe either in exchange for acting improperly, or where the request or acceptance is itself improper;

§ A new corporate offence – Negligently failing to prevent bribery by being given or offered by an employee or agent or other associated person on behalf of that organisation in order to obtain or retain business for that organisation;

§ Bribing a foreign official. 7.1.2. Bribery is a damaging practice that affects both private and public companies. The

CCG has a zero tolerance approach towards bribery and will uphold all laws relevant to countering bribery and corruption. See Appendix C for a summary explanation and examples of bribery.

7.1.3. If staff have personal, financial or other problems they may be more vulnerable to offers of inducement which may come in the form of gifts, hospitality and sponsorship than they would otherwise be. It is in the interest of staff to discuss such matters in confidence with our counselling service to avoid unwarranted suspicion.

7.1.4. Staff are encouraged to raise concerns about any issue or suspicion of bribery at the earliest possible stage. If they are unsure whether a particular act constitutes bribery, or have any other queries relating to bribery, they should raise them with the Director of Quality and Integrated Governance or their line manager.

7.1.5. Staff should tell the local counter fraud specialist for the CCG or the Director of Quality and Integrated Governance as soon as possible if they are offered a bribe, or are asked to make one or suspect that this may happen in the future or have knowledge of such activity.

7.2. POLICY 7.2.1. Other than in limited circumstances (see section 7.4) the receipt of goods,

hospitality, loans, benefits in circumstances and sponsorship that provide no direct benefit to the CCG is not acceptable and should generally be refused and declared. This includes but is not limited to: § Goods or services for private use e.g. maintenance work § Payment by business contacts to subsidise social events § Discounts on products – with the exception of those offered to all staff

through the communications unit § Tickets to cultural or sporting events - with the exception of those offered to

all staff through the Communications unit

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§ Use of a flat or other accommodation § The offer of a holiday or other similar inducement.

7.2.2. Staff must also refuse any offer of money whether in the form of cash, cheque or as vouchers for the purchase of goods. Any offer should be refused with a letter from the recipient explaining that staff are prohibited from accepting money.

7.2.3. Where exceptionally staff are offered and accept a gift in kind the acceptance of that gift must be justified (refer to paragraph 9). In accepting a gift staff should think about the context in which the gift has been offered and/or the affect accepting that gift will have on their position. If a gift is accepted or declined, it must be declared.

7.2.4. Offers to pay travel, subsistence and related costs to visit premises or attend events organised by a third party (e.g. a contractor or supplier) should be refused unless there is a clear benefit to the CCG and this can be demonstrated. Any offer must be declared whether it is accepted or refused.

7.2.5. Staff should also pay particular attention to the circumstances in which hospitality is offered. For example the acceptance of hospitality from an individual or organisation on occasions listed below is never acceptable and offers must be refused and reported. § During a related tendering exercise § Where a related contract is due to come to an end § Where the performance of a contract is in question § ‘linked sponsorship arrangements’ whereby external sponsorship is linked to

the CCG procurement of goods and services § Other circumstances where acceptance might compromise the member of

staff or the CCG. 7.2.6. Where staff believe an organisation has offered gifts or hospitality in expectation of

something in return this must be reported to the Director of Quality and Integrated Governance as this could be considered an inducement under the Bribery Act 2010.

7.3. WHAT STAFF SHOULD DO WHEN THEY REFUSE A GIFT, LOAN, OR OFFER

OF HOSPITALITY OR SPONSORSHIP 7.3.1. Any offer should be refused and must be returned with a letter from the recipient

explaining politely that staff are prohibited from accepting gifts etc. The offer should be declared using the Gifts and Hospitality Form and a copy of the letter attached.

7.4. WHAT STAFF MAY ACCEPT 7.4.1. Gifts from a patient - Staff may accept a gift from a patient up to a value of £25

(not money, vouchers or cheques) - which is offered as a token of appreciation for the care they have received – indeed in some circumstances it would be discourteous not to. These gifts do not need to be declared. If a gift from a patient is offered as a token of appreciation but is judged to have a value of above £25 the recipient must discuss with their line manager whether the

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gift can be accepted. Gifts of over £25 whether accepted or refused must be entered onto the Gift and Hospitality Register (see paragraph 6.1). Where staff believe they have been offered a generous gift to speed up treatment (for example offered the gift before treatment has commenced) the gift should both be refused and declared and the Director of Quality and Integrated Governance should be informed. These items should generally be retained in the workplace.

7.4.2. Gifts from external organisations – Staff may accept unsolicited small tokens to a value of £25; this might include: § Inexpensive or trivial promotional material such as diaries, calendars, mugs

or other stationery goods which display the provider’s name where the intention is general advertising not specifically related to the CCG;

§ A conventional personal gift such as chocolates or flowers; § Work-related publications. These items should generally be retained in the workplace and do not need to be declared. If several small tokens are given to an individual or department from the same source within any one year this matter should be referred to the line manager who should discuss the issue with the Director of Quality and Integrated Governance as soon as possible. Staff should also note that although the current limit is set at £25, they may be required to explain any acceptance of a gift even if it is of a lower value. There are occasions when it would not be proper to refuse a gift, for example if the CCG deals with a foreign company or organisation where the ‘cultural custom and practice’ is to exchange gifts. In these circumstances staff must seek guidance from the Director of Quality and Integrated Governance or the Chief Finance Officer.

7.4.3. Hospitality and Benefits – This Policy does not apply to hospitality provided to staff who are permitted to attend externally organised courses, conferences or seminars paid for by the CCG providing that the hospitality is included in the overall cost of the attendance fee and available to all the attendees or, if a ‘large event’, available to the majority of attendees. It also does not apply to permissible expense incurred whilst on official business (see Expenses Policy). Hospitality must be secondary to purpose of any meeting or event and should only be accepted by staff where there is a genuine link to the CCG’s working arrangements and/or a bona fide business purpose can be demonstrated. Some examples include: § Attending a corporate reception/event to network; § A meeting/event hosted by one of the CCG’s external partners to develop a

sounder working relationship; § An industry or society function e.g. HSJ or Royal College function (If one

attends a function as a registered member of that society there is no requirement to declare);

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§ Speaking in a professional capacity at a conference or event. The level of hospitality offered should be proportionate and not give rise to inference of impropriety. It must be reasonable and appropriate to both the occasion and to the business conducted by the CCG; and the costs involved must not exceed that level which the recipients would normally adopt when paying for themselves or that which could not be reciprocated by the CCG. As with gifts staff are expected to use their judgement when they are offered and accept hospitality from external organisations. They must be able to demonstrate that the appropriateness and/or frequency of hospitality can be justified.

7.5. DECLARING A GIFT OR THE OFFER OF SPONSORSHIP OR HOSPITALITY 7.5.1. Staff are required to declare any offer of a gift, declare offers of hospitality whether

accepted or refused using the Gifts and Hospitality Form attached as Appendix 2 which is also available on the Intranet.

8. RELATED POLICIES 8.1.1. This Policy should be read in conjunction with the following NHS Islington Clinical

Commissioning Group policies and procedure documents: § Anti-Fraud & Bribery Policy § Prime Financial Policies § Standards of Business Code of Conduct § Code of Conduct: Managing conflicts of interest where GP practices are

potential providers of CCG-commissioned services

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REGISTER OF INTERESTS

DECLARATION FORM This form should be completed and returned to Sharon Jackson (Board Secretary), Ground Floor, 338-346 Goswell Road, London EC1V 7LQ Declarations should include an explanation of the nature of the interest to enable identification of conflicts Please print Name: 1. Directorships, including non-executive directorships, held in private companies or

PLCs (with the exception of dormant companies): ………………………………………………………………………..……………………………….. ………………………………………………………………………………..………………………..

2. Ownership, part-ownership or directorships of private companies, businesses or consultancies likely, or possibly seeking, to do business with the NHS: ……………………………………………………………………………………..………………….. ……………………………………………………………………………………………..…………..

3. Majority or controlling shareholdings in organisations likely, or possibly seeking, to do business with the NHS: …………………………………………………………………………………………………………. ……………………………………………………………………………………………………..…..

4. Position of authority in a charity or voluntary organisation in the field of health and social care:

………………………………………………………………………………………………………….

Appendix: A

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………………………………………………………………………………………………………….

5. Any connection with a voluntary or other organisation contracting for NHS services

or commissioning NHS services:

……………………………………………………………………………….………………………… ……………………………………………………………………………………….…………………

6. Any connection with an organisation, entity or company considering entering into, or

having entered into, a financial arrangement with the Trust (including lenders or banks):

……………………………………………………………………………….………………………… ……………………………………………………………………………………….…………………

7. Any position of responsibility in a professional body, trade union, political or

campaigning group:

……………………………………………………………………………….………………………… ……………………………………………………………………………………….…………………

8. Any of the above interests held by a spouse or partner:

……………………………………………………………………………….………………………… ……………………………………………………………………………………….…………………

9. Any other interests you feel should be declared:

……………………………………………………………………………….………………………… ……………………………………………………………………………………….…………………

10. I have no interests to declare (Please tick if appropriate) Signed: …………………………………………………………………………… Date: ……………………………………………………………………………

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REGISTER OF GIFTS AND HOSPITALITY DECLARATION FORM

Date that gift or hospitality

received / declined

Details of gift / hospitality

Reason for acceptance / refusal

Signed: Countersigned: (Line Manager)

Name: Name:

Date:

Please return to: Board Secretary Islington Clinical Commissioning Group Ground Floor

338-346 Goswell Road London, EC1V 7LQ

Appendix: B

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Individual Funding Request – Interim Policy

1 SUMMARY

The policy sets out Islington CCG Governing Body’s decision making process for managing Individual Funding Requests (also known as exceptional funding requests), the delegated responsibility and legal framework for decision-making within each CCG constitution. It is underpinned by a detailed operational procedure which describes how the process will be administrated on behalf of Islington and other CCGs by the North and East London Commissioning Support Unit.

2 RESPONSIBLE PERSON: Director of Commissioning

3 ACCOUNTABLE DIRECTOR: Director of Commissioning

4 APPLIES TO: All individual funding requests made for those services commissioned by Islington CCG

5 GROUPS/ INDIVIDUALS WHO HAVE OVERSEEN THE DEVELOPMENT OF THIS POLICY:

Commissioning Directorate, Senior Management Team,

Executive Team

Chief Officers of CCGs in North Central London

6 GROUPS WHICH WERE CONSULTED AND HAVE GIVEN APPROVAL:

Other CCGs in the North and East of London

National Commissioning Board London

7 RATIFYING COMMITTEE(S) & DATE OF FINAL APPROVAL:

Islington CCG Governing Body,

3 April, 2013

8 VERSION: v1.0

9 AVAILABLE ON: Intranet Yes Website Yes

10 RELATED DOCUMENTS: NHS North and East London Commissioning Support Unit

11 DISSEMINATED TO: All Staff, member practices and significant providers of services.

13 DATE OF IMPLEMENTATION: 3 April 2013

14 DATE OF NEXT FORMAL REVIEW:

30 September 2013

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Individual Funding Request Policy 7 March 2013

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Executive Summary This policy is the product of collaboration between CCGs in north and east London to ensure that Individual Funding Requests are commonly managed to ensure fair and equitable service to the population we serve. The policy has been written to provide a framework for operating from 1 April 2013, when the new NHS commissioning arrangements come into force across England but it is recognised that this will need early review as the system becomes more established.

The policy, described in the pages following this summary, will be supported by the NHS North and East London Commissioning Support Unit and describes the general requirements on them and CCGs. However the policy also has specific requirements of Islington CCG. They are:

· To establish an Individual Funding Request Panel. Details of this are described on pages 17 and 18 of the main document.

· To establish an Individual Funding Request Appeals Panel. Details of this are described on pages 24 and 25 of the document.

· To receive regular reports on activity. For Islington these will be to the Strategy and Finance Committee of the Governing Body that has the delegated responsibilities required under the constitution to facilitate the policy.

· For the Governing Body to adopt the model terms of reference in the appendices of the main document.

This policy needs to be read in conjunction with the guidance letter issues by the London Specialist Commissioning Group on 12 March 2013 that describes how Individual Funding Requests will be managed for specialist commissioning1. The Commissioning Support Unit have undertaken to ensure rapid assessment of responsibility between the CCG and the National Commissioning Board. This will mean that the activity previously done by a primary care trust will fall to the Commissioning Board.

1 Individual Funding Requests for Specialised Services. NHS CB arrangements from April 1 2013. (London Specialised Commissioning Group, March 2013)

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Individual Funding Request Policy

Interim Policy Operational 3 April 2013 to 30 September 2014

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Document Control Date Status Summary of Changes Version Owner 30.1.13 First Draft for CCG

COs to review v.0.1 Anna Stewart

11.2.13 Updated to reflect NHS CB draft policy

Sections from draft policy inserted throughout. Some additions included from the NCL policy

v.0.2

13.2.13 Updated to include comments from Susan Aylen-Peacock

v.03

14.2.13 Updated to include comments from Capsticks

v.04

18.2.13 Updated to include comments from Capsticks

Changes made to reflect Capsticks Sections on page 17 on definitions moved

v.04.1

22.2.13 Updated to reflect additional phone call with Capsticks

v.05

7.3.13 Updated to reflect comments back from CCGs

v.06

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1. Introduction

The following policy has been adopted individually by the following Clinical Commissioning Group (CCG) Governing Bodies:

· Barking & Dagenham CCG · Barnet CCG, · Camden CCG · City & Hackney CCG · Enfield CCG, · Haringey CCG · Havering CCG · Islington CCG · Newham CCG · Redbridge CCG · Tower Hamlets CCG · Waltham Forest CCG

The policy sets out each individual governing body’s decision making process for managing Individual Funding Requests (also known as exceptional funding requests),the delegated responsibility and legal framework for decision-making within each CCG constitution. It is underpinned by a detailed operational procedure which outlines how the process will be administrated on each CCG’s behalf by the North and East London Commissioning Support Unit.

CCGs are from 1 April 2013 the statutory bodies responsible for commissioning healthcare services for their population. Provision and delivery of health care services are usually undertaken as a contract process underpinned by Service Level Agreements (SLAs). There are some treatments and services that fall outside these commissioned portfolios or where the approval for the treatment is dependent on specific criteria. From 1 April 2013 the NHS Commissioning Board will be responsible for directly commissioning a range of specialised services and this policy does noes cover those services.

In a changing health care economy there is a need to keep the Individual Funding Request (IFR) policy and related policies under review and to commission services in line with new guidelines, national policy and needs of the local population. This policy is guided by the legislative duties bestowed on CCGs under the Health and Social Care Act 2006 (as amended by the Health and Social Care Act 2012, NHS Constitution, The Human Rights Act 1998, and Equality Act 2010 amongst others. It also notes the relevant national guidance including “The Mandate” A mandate from the Government to the NHS Commissioning Board (NHS CB) April 2013 – March 2015 and “Developing and updating local formularies” NICE.

Given that this policy has been adopted at the point of major system transition, it will be adopted for a time limited period and reviewed by no later than September 2014 to ensure that it can be updated to reflect any feedback and learning from the way that the functional successor organisations, particularly the NHS CB and CCGs, work together to commission healthcare services.

2. Legal context to decision making The scope of this policy is to specify the principles, processes and procedures for considering whether or not to approve individual funding requests (IFRs) under these circumstances. This section sets out the legal and ethical considerations relevant to the IFR process.

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2.1 NHS Constitution The foremost amongst these considerations are the following patient rights, specified under the NHS Constitution2 and underpinned by law:

“You [the patient] have the right to access NHS services. You will not be refused access on unreasonable grounds.” “You [the patient] have the right to expect local decisions on funding of other drugs and treatments to be made rationally following a proper consideration of the evidence. If the local NHS decides not to fund a drug or treatment you and your doctor feel would be right for you, they will explain that decision to you.”

2.2 Legal and financial duties and the duty to provide services Under the NHS Act 20063 (amended 2012) the CCGs; the NHS CB and the Secretary of State have a concurrent duty to provide a comprehensive health service. For CCGs, the following applies:

“must provide …., to such extent as he considers necessary to meet all reasonable requirements: (c) medical, dental, ophthalmic, nursing and ambulance services, (e) such other services or facilities for the prevention of illness, the care of persons suffering from illness and the after-care of persons who have suffered from illness as he considers are appropriate as part of the health service, (f) such other services or facilities as are required for the diagnosis and treatment of illness.”

In addition to this duty to meet the above requirements, CCGs have a statutory obligation to maintain financial balance. When considering whether or not to commission specific treatments for groups of people with the same medical condition, CCGs will assess the clinical and cost effectiveness of the treatment, the benefits to patients in terms of quality of life and the priority of this treatment or service in relation to others already commissioned or proposed for commissioning. So a treatment of very little benefit is unlikely to be commissioned simply because it is the only treatment available, this ensures that limited resources are used to provide the greatest health benefit. At an individual or patient group level, treatment will not generally be funded solely because a patient requests it. CCGs will not normally fund treatment for one patient, which is not available to all other patients with the same clinical need, except in the context of this policy. CCGs will not discriminate on grounds of personal characteristics, such as age, gender, sexual orientation, race, religion, lifestyle, social position, family or financial status, intelligence or cognitive functioning and will act in compliance with duties under the Equality Act 2010. However, funding decisions will be made on the basis that the patient is more likely to benefit significantly differently from the cohort of patients with the same clinical condition. 2.2 Administrative Law

2 The NHS Constitution March 2010 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113645.pdf 3 The NHS Act 2006 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_063171.pdf

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Decisions made by public bodies including CCGs can be challenged in the Administrative Court by way of judicial review. The traditional grounds for judicial review are that the public body:

· acted beyond its lawful powers · came to a decision which no other reasonable CCG could have reached · acted unfairly, because it did not follow proper procedures · breached the patient’s human rights.

These grounds are the basis for the Appeals Process set out in this document. The main impact of the Equality Act 20104has been the duty on health bodies to monitor their compliance – extending the race equality monitoring to gender, religious belief and sexual orientation where this is relevant – and to give due regard to the public sector equality duty. This policy complies with the Equality Act 2010. 2.3. The Human Rights Act 1998 The Human Rights Act 19985, Article 6 requires a fair hearing for determining civil rights and proportionality of decision-making which the courts consider a fair balance between protection for individual rights and the interests of the community. The proportionality test involves balancing different interests – such as those of the individual applicant for treatment funding with those who await service improvements that depend on the availability of new funding. Other key considerations are Articles: 2 (the right to life); 3 (the right not to be subjected to inhumane or degrading treatment); 8 (the right to respect for privacy and family life); 12 (the right to marry); and 14 (the requirement for non-discrimination against groups because of their sex, race, religion, disability, disease). 2.4. Statutory duty of quality CCGs need to demonstrate compliance with a statutory duty of quality, in accordance with the NHS Health and Social Care Act 2006 (amended 2012) with specific consideration of the following points in section 14:

· s.14P (Duty to promote NHS Constitution); · s14Q (Duty as to effectiveness, efficiency and economically); · s14R (Duty as to improvement in quality of services); · s14T (Duties as to reducing inequalities); · s 14U (Duty to promote involvement of each patient) and · s 14V (Duty as to patient choice).

The process for assessing and making decisions about individual funding requests should be timely and flexible enough to respond rapidly where the health of an applicant mandates a more urgent decision. 2.5. Ethical Considerations The four principles widely used in medical ethics are:

· Autonomy: respecting the decision-making capacities of individual people to make their own reasoned informed choices

· beneficence: considering the balance between the benefits of an intervention against its risks and costs and choosing the one with greater benefit to the individual patient

4http://www.legislation.gov.uk/ukpga/2010/15/contents 5http://www.opsi.gov.uk/acts/acts1998/ukpga_19980042_en_3#sch1

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· non malfeasance: avoiding the causation of harm and ensuring any is proportionate to the benefits of treatment

· distributive justice: sharing benefits equitably, and risks and costs fairly; so that patients in similar positions should be treated in a similar manner irrespective of age, sex, race, disability and employment

2.6 Free Choice The Department of Health published guidance on ‘Free Choice’ in March 2008, effective from 1 April 2008. The guidance sets out a commitment to free choice in elective care meaning that all patients needing planned elective care will be able to choose to be treated by any provider that meets eligibility criteria and NHS clinical and financial standards. Exclusions to Free Choice include referrals from secondary and tertiary care, those living in Northern Ireland, Scotland or Wales, overseas treatments, prisoners and military personnel. Patients who wish to choose a service not commissioned locally and not listed on the national menu of providers will continue to need their commissioner’s agreement to do so. Maternity care and mental health services were excluded from this policy, however this could be subject to change in the future. The Free Choice policy explicitly states that it does not contravene local commissioning decisions about priority treatments. These guidelines need to be read in that context.

3. The Scope of this Policy This policy applies to any patient who is in circumstances where one of the North and East London CCGs is the responsible commissioner of NHS care for that person. This policy specifically excludes NHS services directly commissioned by the NHS Commissioning Board. The scope of this policy is to specify the principles, processes and procedures for considering whether or not to approve individual funding requests. This policy will be consistent with each CCG’s constitution and commissioning decision-making process in respect of:

· Operational commissioning through the annual Operating Plan for each CCG; · Clinical guidelines and policies adopted by each CCG; and · The interface with Specialised Commissioning in order that under the scope of this policy

CCGs do not make decisions on funding areas which fall outside of their statutory responsibility.

This policy also recognises the need for commissioners to review, regularly, the funding of particular interventions on the basis of value for money and cost effectiveness. Through the CSU the IFR administrative teams will be responsible for providing regular reports to CCG commissioners on the decisions made by the panels, including patterns and trends in requests for individual funding. They will also support a process for evaluating the clinical and cost-effectiveness of provider business-cases against with the same rigour as an IFR to enable CCGs to make commissioning decisions for a wider population. 3.1. Objectives Individual funding requests need to be understood in the context of routinely funded services. Most established treatments and services are subject to routine clinical commissioning arrangements: a portfolio of contracts and service level agreements, clinical commissioning policies, mandatory National Institute of Health and Clinical Excellence (NICE) technology appraisal guidance.

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This guidance note is intended to distinguish the broad types of request that may be received. These are where the request:

· Represents a service development for a cohort of patients · Is on grounds of clinical exceptionality where there are commissioning arrangements in place · Is on grounds of rarity and no commissioning arrangements exist · Is for a new intervention or for the use of an intervention for a new indication where no

commissioning arrangements exist The objectives of the Individual Funding Request (IFR) policy are to:

· summarise the groups of patients to which this policy applies · detail the information required and the decision making processes for individual patient

treatment funding requests, including the delegated accountability from CCG governing bodies and roles and responsibility of the IFR Panel members

· promote timeliness, fairness, transparency and rationality in how those requests are managed and how decisions are made

· describe the accountability of the IFR Panels and the IFR Appeal Panels and their relationship to each CCG governing body

· clarify the appeal process for Individual Funding Requests, including the role of each CCG IFR Appeal Panels

3.2. This policy applies to Patients and treatments that fall into the ‘not normally funded’ category that need to be considered on an individual patient basis. These include: Category 1: procedures of limited clinical value or effectiveness that require prior approval to confirm that the individual is eligible for treatment according to the agreed threshold criteria. Category 1 applications are managed by the CSU IFR team for Islington, City & Hackney, Newham, Tower Hamlets, Waltham Forest, Barking & Dagenham, Havering and Redbridge. For Barnet, Camden, Enfield and Haringey they are managed by CCG commissioned Referral Management Centres (RMCs). Category 2: Other CCG Contract Exclusions: · interventions prior to NICE evaluation · interventions that NICE has evaluated as not generally cost effective · treatments covered by NICE Technology Appraisal Guidance criteria that the patient does not

meet · treatments in Category 1 where the patient does not fulfil the agreed funding criteria · requests to continue funding for patients previously treated:

o within a clinical trial o by self-funding o through a decision made by another CCG commissioner where the patient has become

the commissioning responsibility of a CCG covered by the terms of this policy · requests for referral to a service not commissioned locally and not listed on the national menu · those which are not funded through CCG Operating Plans and commissioning contracts If overseas treatment is confirmed as in the CCGs’ commissioned portfolios, rather than the NHS CB, these categories would also apply to overseas treatment requests. To ensure clinical consistency of decision making the IFR Panel may be asked to review applications for overseas treatment.

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3.3. The Policy is designed to ensure that the IFR Panels will

· ensure consistency in decision making maintaining a record of prior decisions and referring to precedent where relevant

· share experience gained in dealing with requests for individual patients within and across CCGs

3.4. Policy Exclusions The IFR process is not the route through which CCG commissioning policy for a group of patients will be made. This would require CCG evaluation of a potential service development and any change to the CCG commissioned service portfolio would be prioritised through the annual Operating Plan process. The process for agreeing contract service variations is described in the NHS standard contracts, published by the Department of Health. The policy therefore excludes consideration of an IFR for a single patient that would be relevant to a group of similar patients, because as above CCGs will not fund treatment for one patient which is not available to all other patients with the same clinical need. The CCG member or manager with delegated authority to make IFR triage decisions will receive a summary of recommendations for determination of IFRs rejected or approved at the triage stage (see later) as a result of the application of the agreed policy exclusions for them to approve. This process will inform CCG commissioners where relevant that consideration should be given to developing or revising CCG commissioning policy. If, in exceptional circumstances, in-year evaluation and prioritisation of a service development is considered justified a separate CCG process, supported by the CSU would be convened to consider business cases from providers.

4. Patient Group Definitions

The UK Faculty of Public Health has published a statement describing the concept of exceptionality: “It is important to distinguish between an exceptional case and as an individual funding request. In an exceptional case, a patient seeks to show that he or she is an ‘exception to the rule’ or policy and so may have access to an intervention that is not routinely commissioned for that condition. In contrast, an individual funding request arises when a treatment is requested for which the commissioning organisation has no policy. This may be because:

· It is a treatment for a very rare condition for which the commissioners have not previously needed to make provision or

· There is only limited evidence for use of the treatment in the requested application or · The treatment has not been considered by the commissioners before because it is a new way

of treating a more common condition. This should prompt the development of a policy on the treatment rather than considering the individual request unless there is grave clinical urgency.”

Service developments and cohorts of similar patients A service development is any aspect of health care which the NHS has not historically agreed to fund and which will require additional and predictable recurrent funding.

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The term refers to all decisions which have the consequence of committing the CCGs to new expenditure for a cohort of patients including:

· new services · new treatment including medicines, surgical procedures and medical devices · developments to existing treatments including medicines, surgical procedures and medical

devices · new diagnostic tests and investigations · quality improvements · requests to alter an existing policy (called a policy variation). This change could involve adding

and in an indication for treatment, expanding access to a different patient subgroup or lowering the threshold for treatment.

· pump priming to establish new models of care · requests to fund a number of patients to enter a clinical trial commissioning a clinical trial.

It is normal to consider funding new developments during the annual commissioning round. An in-year service development is any aspect of health care, other than one which is the subject of a successful individual funding request, which the commissioning organisation agrees to fund outside of the annual commissioning round. When a commissioning organisation considers funding a service development outside the normal commissioning process it is particularly important that those taking the decision pay particular attention to the impact that this may have on the CCG’s opportunity to fund other areas of competing health needs. It is common for clinicians to request an individual funding request for a patient where a request is, when properly analysed, the first patient of a group of patients wanting a particular treatment. For example, a new drug has been licensed for a particular type of cancer and for patients with particular clinical characteristics. Any individual funding request which is representative of this group represents a service development. As such it is difficult to envisage circumstances in which the patient can be properly classified to have exceptional clinical circumstances. Accordingly the individual funding request route is usually an inappropriate route to seek funding for such treatments as they constitute service developments. These funding requests are highly likely to be returned to the provider trust, with the request being made for the clinicians to follow the normal processes to submit a bid for a service development. A request for a treatment should be classified as request for a service development if there are likely to be a cohort of quote similar patience quota who are:

a) in the same or similar clinical circumstances as the requesting patient; b) whose clinical condition means that they could make a similar request (regardless as to whether a request has been made) and c) who could reasonably be expected to benefit from the requested treatment to the same or a similar degree.

The concept of a cohort of similar patients There needs to be a distinction between cases where the clinical circumstances are genuinely exceptional and those where the presenting clinical circumstances are representative of a small group of other patients.

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Where the presenting clinical circumstances are representative of the small group of other patients, the policy of the North and East London CCGs is that the decision to fund or not is a policy decision and not just a funding decision for an individual patient i.e. that it has wider funding implications. This ensures the outcome of the decision is applied equally to all the other patients who have the same presenting clinical circumstances and the principle of privatisation is upheld. What is a “cohort of similar patients”? A cohort of similar patients for the purpose of this policy has been defined as five or more patients, or equalling an impact of £100k or more per annum in the population served by a single CCG. The IFR panels are not entitled to make policy decisions for the CCGs. Where a request has been classified as a service development, the IFR panel is not the correct body to make a decision about the individual funding request. In such circumstances the individual funding request will not be presented to the IFR panel. Where an IFR has been classified as a service development, the options open to the IFR panel include taking the following steps:

· To refer the case back to the provider and request it prioritises the service development internally within its provider organisation and, if supported, to invite the provider to submit a business case as part of the annual commissioning round for the requested service development.

· To refuse funding and initiate an assessment of the service development within the North and East London CCGs, with a view to determining its priority for funding in the next financial year.

· To refer the request for funding for immediate work-up of the service development as a potential candidate for in-year service development.

Exceptionality What is meant by exceptional circumstances? There can be no exhaustive definition of the conditions which are likely to come within the definition of an exceptional individual case. The word “exception” means “a person, thing or case to which the general rule is not applicable”. The IFR panel should bear in mind that, whilst everyone's individual circumstances are, by definition, unique, very few patients have clinical circumstances which are exceptional, so as to justify funding the treatment for that patient which is not available to other patients. The following points constitute general guidance to assist the panel. However, the overriding question which the panel needs to ask itself remains: has it been demonstrated that this patient’s clinical circumstances are exceptional?

a) It may be possible to demonstrate exceptionality where the patient has a medical condition or circumstance that is so rare that the result of the North and East London CCGs prioritisation process provides no established treatment care pathway for that treatment. b) If the patient has condition for which there is an established care pathway, the panel may find it helpful to ask itself whether the clinical circumstances of the patient are such that they are exceptional as compared to the relevant subset of patients with that medical condition.

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c) The fact that the patient failed to respond to, or is unable to be provided with, one or more treatments usually provided to a patient with his or her medical condition (either because of another medical condition or because the patient cannot tolerate the side effects of the usual treatment) may be a basis upon which panel could find that the patient is exceptional.

However, the panel would normally need to be satisfied that the patient's inability to respond to, or be provided with, the usual treatment was genuinely an exceptional circumstance. For example:

a) If the usual treatment is only effective for a proportion of patients (even if a high proportion), this leaves a proportion of patients for whom the usual treatment is not available or it is not clinically effective. If there is likely to be a significant number of patients for whom the usual treatment is not clinically effective or not otherwise appropriate (for any reason) the fact that the requesting patient falls into that group is unlikely to be a proper ground on which to base a claim that the requesting patient is exceptional. b) If the usual treatment cannot be given because of the pre-existing co-morbidity and its impact on treatment options, which could not itself be described as exceptional in this patient group, then the fact that the co-morbidity is present in this patient is unlikely to make the patient exceptional.

The most appropriate response in each of the above situations, is to consider whether there is sufficient justification (including consideration of factors such as clinical effectiveness, value for money, priority and affordability) to make a change to the policy adopted by the North and East London CCGs for funding that patient pathway so that a change can be made to that policy to benefit a sub-group of patients (of which the requesting patient is potentially one such person). This change needs to be considered as a service development. Non-clinical factors It is common for an application that individual funding be provided to be on the grounds that the patient's personal circumstances are exceptional. This assertion can include details about the extent to which other persons rely on the patient, or the degree to which the patient has contributed or is continuing to contribute to society. The North and East London CCGs understand that everyone's life is different and that such factors may seem to be of vital importance to patients in justifying investment for them in the individual case. However, including non-clinical factors in any decision-making raises at least three significant problems for the commissioning organisation:

a) Across the population of patients to make such applications, the Panel is unable to make an objective assessment of material put before it relating to non-clinical factors. This makes it very difficult for the panel to be confident of dealing in a fair and even-handed manner with incompatible cases.

b) The essence of an individual funding application is that the Panel is making funding available on a one-off basis to a patient where other patients with similar clinical conditions would not get such funding. If non-clinical factors are included in the decision making process, the Panel does not know whether it is being fair to other patients who were denied such treatment and whose non-clinical factors are not entirely unknown.

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c) The North and East London CCGs are committed to a policy of non-discrimination in the provision of medical treatment. If, for example, treatment was to be provided on the grounds that it would enable an individual to stay in paid work then this would potentially discriminate in favour of those working compared to those not working. The same can be said of many other non-clinical factors such as having children/not having children, being a carer/not being acarer and so on. Requests to fund treatment of adolescents on the grounds that not funding treatment would prevent the individual from fulfilling their true educational potential or because of a person's role in society are also potentially discriminatory and would contribute to inequality.

Generally, the NHS does not take into account non-clinical factors in deciding what treatment to provide. It treats the presenting medical condition and does not enquire into the background and risk factors which led to that condition as the basis on which to decide whether to make treatment available or not. The CCGs will therefore seek to commission treatment based on the presenting clinical condition of the patient and not based on the patient's non-clinical circumstances. In reaching a decision as to whether a patient's circumstances are exceptional, the panel is required to follow the principles set out above. Clinicians are asked to bear this policy in mind and not refer to non-clinical factors to support the application for individual funding. Proving the case that the patient's circumstances are exceptional The onus is on the requestor to set out the grounds clearly for the panel on which it is said that this patient is exceptional. The grounds will usually arise out of exceptional clinical manifestations of the medical condition, as compared to the general population of patients with the medical condition which the patient has. These grounds must be set out on the specified form and should clearly set out any factors which the clinician invites the panel to consider as constituting a case of exceptional clinical circumstances. If, for example, it is said that the patient cannot tolerate the usual treatment because of the side effects of another treatment, referring clinicians must explain how common it is that the patient with this condition would not to be able to be provided with the usual treatment. If a clear case as to why the patient's clinical circumstances are said to be exceptional is not made out, then the Panel may defer the application and request further information. The Panel recognises that the patient’s referring clinician and the patient together are usually in the best position to provide information about the patient’s clinical condition as compared to the sub-set of patient’s with that condition. The referring clinician is advised to set out the evidence in detail because the Panel will contain a range of individuals with a variety of skills and experiences that may well not contain clinicians of that speciality. The North and East London CCGs therefore require referring clinicians, as part of their duty of care to the patient, to explain where the patient’s clinical circumstances are said to be exceptional. The policy of the North and East London CCGs is that there is no requirement for the Panel to carry out its own investigations about the patients circumstances in order to try to find the ground upon which the patient may be considered to be exceptional nor to make assumptions in favour of the patient if one or more matters are not made clear within the application. Therefore, if a clear case of exceptionality is not made out by the paperwork placed before IFR Panel (and if further information requested fails to make this clear) the Panel would be entitled to turn down the application.

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Multiple claimed grounds of exceptionality There may be cases where clinicians and/or patients seek to rely on multiple grounds to show their case is exceptional. In such cases the panel should look at each factor individually to determine (a) whether the factor was capable of making the case exceptional and (b) whether it did in fact make the patient’s case exceptional. Rarity The assessment of requests to fund existing treatments experimentally for patients with rare clinical circumstances should be distinguished from requests on the grounds of exceptionality. A set of criteria need to be applied when a patient's medical condition is so rare, or their condition is so unusual, that the clinician wishes to use an existing treatment in an experimental way. This exception does not routinely apply to rare disorders or small sub-groups of patients with a more common disorder because here it would be normal to have a trial involving sufficient patients formally to evaluate the proposed treatment in the trial. In assessing these cases the panel should consider the following:

a) Can this treatment be studied properly using any other established method? If so then funding should be refused. b) Is the treatment likely to be clinically effective? c) In addition the usual considerations are included. Does the treatment provide value for money, and what is this patient’s priority compared to patient's whose care has not been funded.

Request for use of a new intervention, or the use of an intervention for a new indication, where no commissioning arrangements exist If the request is for a new intervention, or is a new application of an existing intervention, for which the patient represents a cohort of patients, then the IFR process is not appropriate and the requestor will be directed to the process requesting a service development. IFR Applications Clinicians, on behalf on their patients, are entitled to make an individual funding request to the CCG, via the North and East London Commissioning Support Unit, for treatment that is not normally commissioned by CCG under the following conditions:

· The request does not constitute a request for a service development, or · The patient is suffering from a medical condition in which the CCG has commissioning

responsibility, or · The patient is suitable to enter clinical trial which requires explicit funding by the CCG, or · The patient has a rare clinical circumstance that renders it impossible to carry out clinical

trials, and to whom the clinician wishes to use existing treatment on an experimental basis. The clinical applicant is expected to identify which of the above apply.

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Applications should be made by the:

· Patient’s GP or another GP from the practice · Clinician to whom the patient has been referred

Due to the level of detail required in the application form it is unlikely to be known by the patient and therefore applications from individual patients will not be accepted. The IFR panel needs to be assured that an NHS clinician can describe precisely why they consider the treatment to be appropriate for the particular patient and that an NHS provider has agreed to carry out the treatment for which funding is requested. Due to the highly sensitive nature of the information being sent (and for reasons of efficiency), applicants are required to make IFR applications between NHS net email accounts. 4.1. Information Required All applications must be accompanied by written support and evidence provided by the clinical team treating the patient. It is the clinician's responsibility to ensure that the appropriate information is provided to the panel according to the type of request being made. In all circumstances the lead treating clinician must state whether or not he or she considers there are similar patients and if so how many patients there are. All clinical teams submitting IFR requests must attempt to ensure that all information that is likely to be immaterial to the decision, including information about the social or personal circumstances of the patient or information which does not have a direct connection to the patience clinical circumstances, shall not be included in the application. If any immaterial information is included it shall not be considered by the IFR panel. Implementation of this policy requires extensive information on each patient to ascertain whether:

· the patient complies with the agreed threshold criteria for Procedures of Limited Clinical Value/Effectiveness OR

· there are valid reasons to consider that the CCG could justify funding the treatment for this patient when the treatment in question is not available for similar patients in the CCG area

IFR application forms are designed to capture all material information to enable due consideration according to this policy. Information requested will include but not be limited to:

· Details of the patient’s registered GP · Details on the patient’s condition, prior treatment and response to this · Details of the intervention including duration, how response to the treatment will be assessed,

criteria for stopping, whether the intervention is likely to lead to other types of treatment in addition to that for which the application is submitted

· The expected benefits of the treatment in the patient for whom it is requested · Potential alternative treatment and its expected benefit · The cost of the requested and potential alternative intervention including VAT where relevant · The clinical urgency of the decision (if relevant) · Confirmation of patient consent to contact relevant health professionals · An explicit statement of why the patient differs from others with the same clinical condition

such that the treatment should be considered for them when it is not available to others with a similar clinical condition

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Submission of the complete information will minimise avoidable delay in the assessment process. The application form should be accompanied by electronic copies of, or electronic links to, published evidence of clinical effectiveness and likelihood of benefit. These should be attached to the secure email. Triaging individual funding requests All cases referred to the CCGs via the IFR Team will be subject to initial triage to ensure sufficient information has been provided and whether consideration by the IFR Panel is the most appropriate route. A CCG member or manager with delegated responsibility for the triage process will be presented with recommendations from the Triage panel on which to make a determination. Screening for service developments All individual funding requests submitted to the IFR Team will be subject to screening to determine whether the request represents a service development. Service developments include, but are not restricted to:

· New services · New treatments including medicines, surgical procedures and medical devices · Developments to existing treatments including medicines, surgical procedures and medical

devices · New diagnostic tests and investigations · Quality improvements · Requests to alter an existing policy (called a policy variation). The proposed to change could

involve adding in an indication for treatment, expanding access to a different patient subgroup or lowering the threshold for treatment.

· Request to fund the number of patients to enter a clinical trial. · Commissioning a clinical trial.

Screening for incomplete submissions If the request is not categorised as a service development, it will be subject to screening to determine whether the request has sufficient clinical and other information in order for the individual funding request to be considered by the panel. Where information is lacking, the individual funding request will be deferred and returned to the provider specifying the information which would be required in order to enable this request to proceed. The request can be submitted at any point. Identification bias The IFR panel shall take care to avoid identification bias, often called the “rule of rescue”. This can be described as the imperative people feel to rescue identifiable individuals facing avoidable death or a preference for identifiable over statistical lives. The fact that the patient has exhausted all NHS treatment options for a particular condition is unlikely, of itself, to be sufficient to demonstrate exceptional circumstances. Equally, the fact that the patient is refractory to existing treatments were recognised proportion of patients with the same presenting medical condition at this stage are, to a greater or lesser extent, refractory to existing treatments is unlikely, of itself, to be sufficient to demonstrate exceptional circumstances.

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4.2. Urgent Applications The IFR process is designed for planned care and cannot give adequate consideration to cases in less than 3 working days. However, the North and East London CCGs recognise that there will be occasions when an urgent decision needs to be made to consider approving funding for treatment for an individual patient outside the CCG's normal policies. In such circumstances, an urgent decision may have to be made before a panel can be convened. The following provisions apply to such a situation:

· An urgent request is one which requires urgent consideration and a decision because the patient faces a substantial risk of death or significant harm if a decision is not made before the next scheduled meeting of the IFR panel.

· Urgency under this policy cannot arise as a result of a failure by the clinical team expeditiously to seek funding through the appropriate route and/or where the patient's legitimate expectations have been raised by commitment being given by the provider trust to provide a specific treatment to the patient. In such circumstances the North and East London CCGs expect the provider trust to proceed with treatment and for the provider to fund the treatment.

Provider trusts must take all reasonable steps to minimise the need for urgent request to be made through the IFR process. If clinicians from any provider trust are considered by the CCG not to be taking all reasonable steps to minimise urgent request to the IFR process, the CCG may refer the matter to the provider trust chief executive. If the clinical decision needs to be made within this timescale the trust should proceed at its own financial risk and submit an IFR application which will be considered at the next available IFR Panel meeting. In the event that a funding decision is requested between 3 working days and the next available IFR Panel meeting, the applicant should contact the IFR team so that the CCG lead with delegated responsibility for the IFR process can agree whether it is necessary to convene a virtual panel. The referring clinician for an urgent application should:

· Identify the application as urgent and confirm this by phone · Inform the IFR team of the clinical rationale for the urgency · Ensure their contact details are available to the IFR team so that the CCG lead with

delegated responsibility or a clinician within the IFR team can discuss the urgency and an accelerated timeline can be agreed should this be considered to be appropriate.

Procedures of Limited Clinical Value/Effectiveness will not be considered as urgent applications under any circumstances. 4.3. Validation of the IFR Application CCGs will only consider funding for patients registered with a General Practitioner in their area or demonstrably resident within the CCG geography and without a registered GP elsewhere in the UK, who is entitled to receive NHS treatment.

The CSU IFR team on behalf of the CCG (with access to commissioning, medicines management and public health advice as appropriate) will also:

· verify that the application is appropriate for consideration through IFR processes.

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· confirm that the requested intervention is not included within any CCG contract for clinical services and advise the applicant where another route is appropriate

· confirm that the application is appropriate for the IFR Panel - specifically that it is not a request for one patient that is representative of a group of similar patients (a ‘policy exclusion’). If this is the case, the referring clinician will be advised about the process for considering new service developments as part of the following year’s Operating Plan process.

o Category 1 applications: the onus is on the clinical applicant to fully demonstrate that the

patient meets eligibility criteria or detail why the patient differs from others with the same clinical condition such that the treatment should be considered for them when it is not available to others with a similar clinical condition;

o Category 2 applications: the onus is on the clinical applicant to demonstrate the reason why this patient is so different from others with the same condition that the CCG should consider funding a treatment that is not generally available;

4.4. Acknowledgement of the Application The timeline for completed and appropriate applications is described in the NELCSU standard operating procedure. For non-urgent cases, the referral will be acknowledged within 3 working days of receipt for applications received electronically and the process to be followed, including timetable for the next panel meeting date (usually within the next month depending on when the completed application is received in relation to Panel dates) will be confirmed.

5. Process for Procedures of Limited Clinical Value/Effectiveness

The IFR teams will review these applications against the agreed criteria or treatment threshold as appropriate as agreed by the relevant CCG. Recommendations which confirm patient eligibility will be presented to the member of manger within the CCG for determination and if approved for funding and the applicant notified. These discussions and recommendations will take place outside of the IFR Panel through a triage process. Applications where the patient is ineligible for funding will be referred to the IFR Panel provided that the applicant has completed the appropriate section relating to the reason why the CCG could justify funding the procedure for this patient when it is not available for similar patients in the CCG area. If this information is not submitted a recommendation will be made to the lead member or manager within the CCG with delegated responsibility for the IFR triage process that the application be rejected at the triage stage.

5. IFR Panels Accountability and Membership 5.1 Accountability The IFR Panel is the decision-making body that is a component of the CCG commissioning decision-making process. Each CCG will establish its own IFR panel as a committee of the governing body with decision-making capacity which will meet in common with other CCGs in the same Point of Delivery Group (POD).This policy complies with the CCG constitution. Accountability for the operational management of the IFR process within the CSU is through the Director of Contracting and Quality. 5.2 Limit on the financial value of decisions The upper limit on the financial value of decisions taken is £50k per annum per request: a decision for an individual patient that will result in a cost of over £50k per annum will be referred to the CCG

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Governing Body for formal approval, although very strong clinical reasons would be needed to overturn the recommendation of an IFR panel given that cost effectiveness will be one of the criteria explicitly taken into account in the decision-making process. 5.3 Membership of the IFR panels Each IFR Panel will be constituted as a committee of the CCG Governing Body and will have delegated authority to determine IFR requests for that CCG. A model terms of reference is included at Appendix A. The membership of each CCG’s IFR Panel is set out below:

Membership Chair

· Member of the relevant CCG governing body. (clinical director (GP), nursing director or secondary care consultant)

Full members · CCG member (panel chair), this could be a clinical director (GP), nursing director or secondary care consultant

· Chief pharmacist/senior medicines management lead (CSU/CCG) · Senior contracting representative (CSU/CCG) · Public health representative · Patient or lay representative

Associate members

· CSU administrative support · Pharmacy/medicines management · Public health · Contracting · Any other specialist as requested by the chair as necessary or beneficial to the

decision making process Quorum All full members must be present. Governance A committee of the CCG Governing body

Members may nominate a suitable deputy if they are unable to attend, but these must be named in advance and, in order to have the ability to vote, must be suitably experienced and trained. The membership will be subject to review, as required.

Meetings of the IFR Panel will be held in common with other CCG’s IFR Panels in the groupings set out below, which reflect the CSU point of delivery (POD) structures.

· Barnet, Camden, Enfield, Haringey and Islington · Barking and Dagenham, Havering and Redbridge · City and Hackney, Newham, Tower Hamlets and Waltham Forest

The business to be conducted for each CCG will be clearly segregated and during consideration of each CCG’s cases the members of other CCGs will be in attendance on an associate (non-voting) basis only.

There will be a clear separation of those presenting cases and the decision-making members of the panel. 5.4 Conduct of meetings In reaching a decision the Panel must take into account the principles of the NHS Constitution, which sets out the rights of NHS patients. These rights cover how patients access health services, the

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quality of care, the treatments and programmes available, confidentiality, information and the right to complain if things go wrong. The Panel must ensure that it has acted in good faith, weighed all the relevant evidence, given proper consideration to the claims of patients and Clinicians, and accorded proper weight to the needs of other groups, given the total resources available. The Panel should strive to reach consensus on a judgement, which is in every sense reasonable. Where there is not a consensus decision, a vote of the Panel’s membership should be taken, with decision agreed by a simple majority of the voting Panel members present. The Panel shall maintain accurate documentation of the whole process. It must take into account the implications of the Freedom of Information Act 2000, the Human Rights Act 1998, the Equality Act 2010 and any statutory codes of practice issued by the Equality and Human Rights Commission (EHRC), and other relevant legislation. It recognises its public sector duties under the Equality Act 2010 which came into force in April 2011. The Equality Act replaces all other equality legislation including the Race Relations Amendment Act 2000, and the Disability Discrimination Amendment Act 2003. The meeting of the IFR Panel is not a public meeting; patients, patient representatives or clinicians are also not allowed to attend. The IFR Panel meetings discuss and assess the clinical evidence provided by a clinical referrer. On request patients will be provided with all of the documentation put before the Panel and are encouraged to submit written evidence and information to the Panel to be considered in the assessment of their individual case. The Panel will comply in full with the Data Protection Act 1998 and the Caldicott Guidelines when handling patient identifiable information. In particular, patient identifiable information will be anonymised where possible. All electronic communication will be conducted using secure NHS.net email accounts to ensure patient confidentiality. The Chair is responsible for ensuring that:

· adequate data and intelligence were available to inform the decision; · all material factors have been taken into account and that immaterial factors have been

appropriately handled; and, · the rationale for the decision has been explicitly recorded, against the terms of this policy, and

that the conflicting arguments have been managed. The Chair will be accountable to their CCG Governing Body for the delivery of this role. If the patient’s clinical condition is such that a more urgent decision needs to be reached then a virtual panel (by conference call or email) will be organised, when sufficient information and evidence has been gathered to present the case. A virtual IFR Panel will comprise the relevant Chair for the CCG of patient’s case being considered and voting members of the panel as per actual panels to be quorate. The outcome of the proceedings will be submitted to the next panel for information.

5.5 Conflicts of interest If the application originates from a CCG panel member (or a practice in which they have an interest), then a replacement shall be sought to chair the meeting and that member should exclude themselves from the proceedings whilst that funding request is being discussed. In the event of any other panel member having a conflict of interest, they shall acknowledge this and will remove themselves from the proceedings whilst that funding request is being discussed. To avoid such a situation arising and risk making a panel inquorate, panel members are advised to check the meeting papers in advance and arrange for a deputy to be in attendance.

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6. IFR Processes Approval of individual funding requests The IFR panel shall be entitled to approve requests for funding for treatment of individual patients where all the following conditions are met:

· The IFR panel is satisfied that there is no cohort of similar patients. If there is a cohort of similar patients the IFR panel should decline to make a decision because the application is required to be treated as request for service development.

· There is sufficient evidence to show that, for the individual patient, the proposed treatment is likely to be clinically and cost-effective or that the clinical trial has sufficient merit to warrant NHS funding.

· Exceptional circumstances apply. The IFR panel is not required to accept the views expressed by the patient or the clinical team concerning the likely clinical outcomes of the individual patient of the proposed treatment but is entitled to reach its own views on:

· The likely clinical outcomes for the individual patient of the proposed treatment, and · The quality of the evidence to support that decision and/or the degree of confidence that that

IFR panel has about the likelihood of the proposed treatment delivering the proposed clinical outcomes for the individual patient.

The IFR panel shall be entitled but not obliged to commission its own reports from any duly qualified or experienced clinician, medical scientist or other person having relevant skills concerning the case that it is being made that the treatment is likely to be clinically effective in the case of the individual patient. The IFR panel may make such approval contingent on fulfilment of such conditions as it considers fit. There will be regular scheduled panels to ensure that delay to decision making is minimised. Frequency may be increased if necessary to accommodate unexpected peaks. Applications will be considered on the basis of the submitted evidence of the patient’s clinical circumstances, ability to benefit, and the clinical and cost effectiveness of the proposed treatment. It is the responsibility of the referring clinician to ensure that appropriate and sufficient evidence is provided; the panel’s role will be to evaluate, not research, the evidence submitted in support of the case. Anonymised patient case summaries will be sent to panel members in advance of the meeting, accompanied by available national (NICE, NHS Evidence, Cochrane Library, etc.) and/or regional (Scottish, Welsh, English regional including London New Medicines and Treatments; New Drugs or New Cancer Drugs) and/or local (agreed clinical policy or pathway) supportive evidence, where provided/available, together with an assessment of the evidence of clinical and cost effectiveness (evidence evaluation forms are used for this purpose, where necessary). This function and the timely preparation of papers will be undertaken on behalf of CCGs by the CSU.

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7. Factors that the panels will take into account in decision-making

7.1. The key issue for most IFR Panel patients will be:

On what grounds can the CCG justify funding this treatment for this patient when the treatment in question is not available for similar patients within the CCG area?

In order for funding to be agreed there must be some unusual or different (exceptional) clinical factor about the patient that suggests that they are:

· Significantly different to the general population of patients with the condition in question · Likely to gain significantly more benefit from the intervention than might be expected for the

average patient with the condition” The fact that a treatment is likely to be efficacious for a patient is not, in itself, a basis for funding. These will be a guiding principle in the IFR Panels’ decision making. 7.2. Legal Obligations As outlined in earlier in the policy. 7.3. In making a decision on funding the following will be taken into account: · Is the treatment lawful – i.e. within its legal powers and takes into consideration the principles of the Human Rights Act? · Is the treatment safe? – ('first do no harm').Commissioners must ensure it is not complicit in exposing patients to unsafe healthcare and will look to licensing Authorities (especially the Medicines and Healthcare Products Regulatory Agency (MHRA) and other organisations (such as the National Institute for Clinical Excellence (NICE) and the British National Formulary (BNF) for guidance. · Is the treatment effective – i.e. of proven benefit for this category of patient? · In what way is the clinical condition of this particular patient significantly different from the group of patients with the condition in question · What is the evidence that this particular patient is likely to gain significantly more health benefit than others with the same condition? · What is the comparable clinical and cost effectiveness of any reasonable alternative intervention and/or provider? · What are the equality considerations of funding this particular patient in relation to:

- precedent for funding other similar patients - previous decisions of the relevant panel or predecessor panels - reducing any inequality between this patient and others in a similar position

· What is the priority in relation to the opportunity costs and potential alternative spend to meet other needs of the whole population. Whilst specific economic assessments will not be carried out, the IFR panels will note the national (NICE) threshold of £30,000/QALY of generally acceptable cost effectiveness.

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· Is the treatment accessible – i.e. can people get to the service? 8.4. Clinical Trials Funding will not be granted for patients who started a drug or treatment as part of a clinical trial, unless such funding has been agreed prior to commencement of the trial. This follows the Medicines for Human Use (Clinical Trials) Regulation 2004 and the Declaration of Helsinki principles that the responsibility for ensuring a clear exit strategy from a trial and whether those benefiting from the treatment will have on-going access to it lies with those conducting the trial. The initiators of the trial (NHS Provider Trusts and drug companies) have a moral and ethical obligation to continue funding patients benefiting from treatment until such time as a CCG has agreed to commission the treatment.

8. IFR panels operation The panels will act in good faith to assess all the relevant evidence, giving proper consideration to the claims of patients and clinicians and the evidence prepared by the presenters (usually public health or medicines management) . It will avoid consideration of information irrelevant to the decision making principles above unless these specifically impact on the likelihood or otherwise of the patient gaining significantly more clinical benefit than other similar patients. The IFR panels will strive to reach consensus on a decision that is reasonable and would be perceived as such by other commissioning organisations, maximising the benefit gained from the resources the CCG has available. Where the decision is not unanimous the votes of individual members will be recorded and minuted in relation to their role rather than by name. The casting vote will be with the Chair who will be a member of the CCG who will sit on the IFR Panel Committee of the Governing body which will have delegated authority from the CCG Governing body to make decisions on IFR cases. The IFR panel chair with other IFR Panel members as assigned will ensure accurate documentation of the panel discussion. The CSU will be responsible for the administration of high-quality minuting and documentation of panel decisions. The documentation of individual cases will be archived securely and catalogued so that they can be made available when considering new applications. The IFR Panels do not meet in public and attendance by the patient or the referring clinician is not permitted. However patients have the right to submit written evidence and information to the panel to be considered in the assessment of their individual case.

9. Notification of the IFR Panel Decision 9.1. The referring clinician/GP The referrer will be notified of the IFR Panel decision including the reasons for the decision normally within 10 working days (2 working days for urgent decisions) and copied to the patient’s GP where appropriate. It is expected that, unless specifically requested, all communication between the CSU team administering the IFR process and the applicant clinician will be via the secure nhs.net email accounts. It is the responsibility of the clinician making the referral to inform the patient and any other relevant healthcare professionals of the decision; this is to ensure effective on-going arrangements for the patient’s care. The clinician making the referral is also responsible for notifying the patient of the outcome of the decision and appeal process (including the time frame for the appeal).

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9.2. The Patient It is the responsibility of the applicant clinician to notify the patient of the outcome of the panel decision. This is because in the event that the funding request is refused, the clinician is in the best position to convey this information and discuss alternative treatment options. It is the decision of the referring clinician as to whether they then share the outcome letter with the patient as part this discussion, noting the patient’s rights under the NHS Constitution. In the event of a decision not to approve funding, the notification will include the criteria by which applications are assessed and include details of the procedure for registering an appeal against the process by which the decision was taken. If the applicant clinician or patient feels that relevant information was not available to the IFR Panel when the decision was made, they should ask the Panel to reconsider the case specifically in the light of this further information. If the Panel has reconsidered and declined the application after further information has been submitted, then the applicant may seek to appeal the decision (see section xx: the appeals process).

10. Confidentiality The CSU will hold patient level information on behalf of the CCGs to support the IFR process. All patient information will be handled with confidence and stored in accordance with [xxx insert relevant policy reference] relating to person identifiable information. IFR panel members will take into account the need for confidentiality and operate under the Caldicott guidelines. All patient specific electronic communication will be via a secure nhs.net connection. The CSU will on behalf of CCGs, keep a full set of information electronically under a single record number. Telephone calls relating to IFR enquiries will be logged and notes kept with the case file, where appropriate. Relevant email communication and hard copy documents will be stored with the electronic file Electronic records and IFR Panel minutes will be saved securely and access will be available to authorised staff only. Panel member hard copy records must be disposed of as confidential waste.

11. The appeals process 11.1. The Remit of the Appeal Process The purpose of the appeals process is not to consider the clinical merits of the case, but whether due process has been followed in the IFR decision-making process (as described in this policy). This is a quality assurance scrutiny and as such is comparable to the Judicial Review and NICE Appeals processes. 11.2 Grounds for appeal The grounds for appeal are as follows:

· The CCG has acted beyond its lawful powers · The decision was one that no other reasonable CCG could have reached. · The CCG acted unfairly because it did not follow proper procedures (this policy). · The CCG breached the patient’s human rights.

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11.3 How to make an appeal In most circumstances it is anticipated that the original applicant (i.e. the referring clinician) would initiate an appeal. In rare circumstances it may be initiated by a patient, although they would still need to have the written support of the clinician who made the original application. Appeals should be made in writing, and clearly labelled “IFR Appeal” to the relevant email address or postal address given in section 1. The appeal should be made within 90 days of the date that the original IFR Panel decision was notified, stating the grounds on which the Appeal is based and submitting any supporting information. The date of notification is the date of the email or letter. The grounds for appeal must be reasonable or the case will not be considered by the appeal panel (see section 12.4, below). 11.4 Procedure The CSU IFR team, taking advice from the CCG Chair of the IFR Panel Committee of the Governing body where needed, will undertake a preliminary review of the appeal basis to ensure that if new information is submitted the Appeal is appropriately diverted back to the IFR Panel. The CSU IFR team will consider the grounds for appeal and make a recommendation to the CCG Chair of the IFR Panel Committee of the Governing body. If the Chair determines that these are not reasonable (for example, the applicant merely disagrees with the decision without putting up a reasonable argument as to why procedure was not followed) then an appeal panel will not be convened and the applicant will be informed why and of their right to make a complaint under the complaints process. In all other circumstances the CSU IFR Team will convene an Appeals Panel meeting as expeditiously as possible (ideally within 20 working days from receipt of the Appeal). The applicant or the patient may submit supporting information, however only supporting information relevant to the grounds for appeal will be considered. If the applicant considers that there is greater clinical urgency for the Appeal Panel this should be specified in the Appeal referral letter (sent by secure email) and a phone call to the CSU IFR teams to alert them to the urgent request. 11.5 Accountability and Membership of the Appeals Panel The IFR process operates under delegated authority from each CCG Governing body and the appeals panel will operate as a sub-committee of the full IFR panel although with completely different membership to ensure a separation of roles and decision-making.

Membership Chair · Member of the relevant CCG governing body. Lay member or clinical Full members · CCG member – suggested the clinical director (GP), nursing director or

secondary care consultant, not party to the original panel · Executive Director representative (CSU or CCG) · Public health representative

Quorum All full members must be present. Governance A sub-committee of the IFR Panel Committee of the CCG Governing body

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None of the members will have been involved in the decision-making related to the IFR in question, to date. Administrative support to the appeal panel will be provided by the CSU IFR team. 11.6 Appeal Panel Decision Making The Appeal Panel will review all relevant information including:

· the decision-making processes and procedures that informed the original IFR Panel decision, against the criteria set out in this policy

· the minutes of original IFR panel meeting and the factors taken into account in the original decision

· any supporting information submitted by the applicant or the patient The Appeal Panel will assess whether or not the IFR Panel decision:

· was made following the required standards set out in this policy · took into account all relevant information available at the time · was reasonable and in line with the evidence

If there is a question about the reasonableness of the IFR decision, the Chair may request additional expert input. The outcome of the appeal will either be to uphold the IFR Panel decision appealed against or to refer the decision back to the original IFR panel in light of the findings of the Appeal. 11.7 Notification of decision The process and timescale for notification of a decision will be the same as with the IFR Panel. The letter will detail the grounds for this decision and the circumstances under which the Complaints Procedure of the responsible CCG may be relevant.

12. Training Effective, fair and consistent decision making requires panel and appeal panel members and their deputies to be trained as well as other CCG and CSU staff directly involved in the IFR process. Given the complexity of NHS decision-making in the light of emerging case law, appropriate training will be given to all members of the IFR panels and appeals panels and those within the CSU responsible for the administration of the process, as well as public health colleagues within local authorities contributing to the process. The training will include the ethical and legal aspects of resource allocation. Training will be managed by the CSU IFR team as part of the function which they undertake on behalf of CCGs.

13. Monitoring 13.1 Monthly IFR report A monthly report summarising the case types, approval or rejection for funding, value of the approved cases and any themes arising from the panel’s work will be sent to the lead CCG member with delegated responsibility for the IFR process to present at CCG Governing Bodies or Sub-Committees. The CSU team will be available to present this report as required. The content of this report will be detailed separately in the CSU KPIs with CCGs.

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13.2 Annual IFR report The annual report will be prepared that summarises commissioning and governance issues. For example, types of case, volume by CCG and the decisions made, turnaround time, number of appeals, training. This report will feed into the relevant CCG governing body reporting processes as appropriate during the transition period to the new commissioning architecture.

14. Review This policy and procedure will be reviewed as required or at the latest by September 2014.

15. References [to be added]

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Model Terms of Reference Appendix A

Meeting

Individual Funding Requests Panel

Constitution

The Governing Body hereby resolves to establish a Committee of the Governing Body to be known as the Individual Funding Requests Panel (the Committee). The Committee is a non-executive committee of the Governing Body and has no executive powers, other than those specifically delegated in the Terms of Reference.

Role of the committee

The purpose of the Committee is to consider and determine eligible requests for individual funding in accordance with the CCG’s agreed policy.

Membership

· CCG member (panel chair) · Chief pharmacist/senior medicines management lead

(CSU/CCG) · Senior contracting representative (CSU/CCG) · Public health representative · Patient representative

Members may nominate a suitable deputy if they are unable to attend, but these must be named in advance and, in order to have the ability to vote, must be suitably experienced and trained. Attendees (non-voting)

· Associate CCG representatives (see meeting arrangements below)

· CSU administrative support · Pharmacy/medicines management · Public health · Contracting · Any other specialist as requested by the chair as necessary

or beneficial to the decision making process Quorum

The quorum shall be XXX members and a duly convened meeting of the Committee at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Committee.

Meeting arrangements

Meetings of the IFR Panel will be held in common with other CCG’s IFR Panels in the groupings set out below, which reflect the CSU point of delivery (POD) structures. Ø Barnet, Camden, Enfield, Haringey and Islington Ø Barking and Dagenham, Havering and Redbridge Ø City and Hackney, Newham, Tower Hamlets and Waltham

Forest The business to be conducted for each CCG will be clearly segregated and during consideration of each CCG’s cases the

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members of other CCGs will be in attendance on an associate (non-voting) basis only.

Frequency of meetings

Panel meetings will be scheduled regularly to ensure that delay to decision making is minimised.

Notice of meetings

Notice of meetings of the Committee shall be forwarded to each member, and any attendees, no later than XXX working days before the meeting. Notice of the meeting shall comprise venue, time and date of the meeting, together with an agenda of items to be discussed and supporting papers.

Administration and minutes of meetings

The CSU IFR team shall administer and support the Committee, shall attend to take minutes of the meeting and provide appropriate support to the Chair and Committee members.

Duties

The Committee shall consider and determine individual funding requests where the clinical commissioning group is the responsible commissioner of NHS care.

Reporting responsibilities

The minutes of the Committee meetings shall be reported to the Governing Body.

Other

The Committee will ensure that any conflicts of interest are dealt with in accordance with the NHS Code of Conduct, Code of Accountability and the CCG’s standing orders.

Meeting

IFR Appeals Panel

Constitution

The Governing Body hereby resolves to establish a sub-committee of the Individual Funding Requests Panel to be known as the IFR Appeals Panel (the Appeals Panel). The Appeals Panel is a non-executive sub-committee of the Governing Body and has no executive powers, other than those specifically delegated in the Terms of Reference.

Role of the committee

The purpose of the Appeals Panel is to receive determine whether due process has been followed in the IFR decision-making process.

Membership

· Lay Member (Appeals Panel Chair) · CCG Governing Body member (nurse or secondary care

clinician) · Executive Director representative (CSU or CCG) · Public health representative

None of the members of the Appeals Panel will have been involved in the decision-making related to the IFR in question. Attendees (non-voting)

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· CSU administrative support · Additional expert input as determined by the Appeals Panel

Chair Quorum

The quorum shall be XXX members and a duly convened meeting of the Appeals Panel at which a quorum is present shall be competent to exercise all or any of the authorities, powers and discretions vested in or exercisable by the Appeals Panel.

Frequency of meetings

Panel meetings will be scheduled regularly to ensure that delay to the IFR process is minimised.

Notice of meetings

Notice of meetings of the Appeals Panel shall be forwarded to each member, and any attendees, no later than XXX working days before the meeting. Notice of the meeting shall comprise venue, time and date of the meeting, together with an agenda of items to be discussed and supporting papers.

Administration and minutes of meetings

The CSU IFR team shall administer and support the Appeals Panel, shall attend to take minutes of the meeting and provide appropriate support to the Chair and members.

Duties

The Appeals Panel shall XXXXX

Reporting responsibilities

The minutes of the Appeals Panel meetings shall be reported to the Individual Funding Requests Panel.

Other

The Appeals Panel will ensure that any conflicts of interest are dealt with in accordance with the NHS Code of Conduct, Code of Accountability and the CCG’s standing orders.

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MEETING: Islington Clinical Commissioning Group Governing Body DATE: Wednesday, 3 April 2013 TITLE: Adoption of the Seal and Register of Interests LEAD DIRECTOR: Martin Machray, Director of Quality and Integrated Governance AUTHOR: Sharon Jackson, Board Secretary CONTACT DETAILS:

[email protected]

SUMMARY: This report presents the Islington Clinical Commissioning Group Seal and the Register of Interests for adoption. Seal Section 6.1.1 of the Islington CCG Standing Orders (see Appendix 2) provides that: “Islington CCG may have a seal for executing documents where necessary.” In line with the Standing Orders, it is now recommended to adopt the Seal for use for:

· All contracts for the purchase/lease of land and/or building · All contracts for capital works exceeding £100,000 · All lease agreements where the annual lease charge exceeds £10,000 per annum

and the period of the lease exceeds beyond five years · Any other lease agreement where the total payable under the lease exceeds

£100,000 · Any contract or agreement with organisations other than NHS or other government

bodies including local authorities where the annual costs exceed or are expected to exceed £100,000

A register of sealings will be kept and use of the seal will be reported for ratification to the next formal meeting of the Governing Body. Register of Interests The CCG is required to maintain a register of members interests which is reviewed regularly and updated every six months in line with the Gifts, Sponsorship and Hospitality and Conflicts of Interests Policy (see Appendix 3) and the codes of conduct appended to the Islington CCG Constitution (see Appendix 2). This is available at every meeting of the Governing Body and on the Islington CCG website www.islington.nhs.uk. SUPPORTING PAPERS: Appendix 6a: Islington Clinical Commissioning Group Register of Interests 2013/14



· ADOPT the Islington CCG Seal; and · ADOPT the Islington CCG Register of Interests.

GOVERNANCE:


Greenhough Chair

Simon









Dr Rathini Ratnavel South Locality GP Representative








Julie Billett Joint Director of Public Health for Camden

and Islington



Dr Mo Akmal


Objective(s) / Plans supported by this paper: The vision, mission statement and desired strategic outcomes for the Clinical Commissioning Group are supported by this paper.

Audit Trail: The Register of Interests is presented having been established from declarations made by all members of the Governing Body. Patient & Public Involvement (PPI): Once adopted the register of interests will be available to members of the public at Governing Body meetings held in public, through application to the Board Secretary or at www.islington.nhs.uk.

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Equality Impact Assessment: The document is based on the model constitution issued by the Department of Health to support the enactment of the 2012 Health and Social Care Act. Risks: No new risks have been identified from this paper. Resource Implications: No new resource consequences have been identified. Next Steps: The register of interests will be maintained and updated to reflect current declarations.

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Appendix: 5a

INTERESTS 2013-2014

NAME TITLE NAME OF ORGANISATION AND NATURE OF ITS BUSINESS

POSITION HELD/ NATURE OF INTEREST

DATE DECLARED

DATE UPDATED

Voting MembersDr Mo Akmal Secondary Care Clinician London Spine Unit Ltd, medical private

practice company.Director 01/11/2012 01/11/2012

Dr Sharon Bennett Elected GP Representative Miller GP Practice GP Partner 05/03/2012 05/03/2012Dictate IT, a web-based medical transcription practice and digital dictation

Shareholder 05/03/2012 12/10/2012

Wish Health Practice is a member - does not work or receive financial benefit

05/03/2012 12/10/2012

Local Medical Council Member 05/03/2012 05/03/2012Alison Blair Chief Officer Barnet and Southgate College -

Corporation member of a further education college based in Barnet and Enfield but with students from all other London boroughs

Governor 12/10/2012 14/03/2013

Sorrel Brookes Lay Member Whittington Health Husband is a Non-Executive Director

24/05/2012 12/03/2013

Dr Anjan Chakraborty Elected GP Representative Stroud Green Medical Practice GP Principal 09/03/2012 20/03/2013Dr Katie Coleman Elected GP Representative City Road Medical Centre, GP practice

in IslingtonPartner 25/05/2012 19/03/2013

South Islington GP Alliance (SIGPAL) - a company providing primary care and community services to the local population

Shareholder 19/10/2012 19/03/2013

Dr Gillian Greenhough Chair Clerkenwell Medical Practice, which is an Islington GP Practice

Partner 22/05/2012 19/03/2013


Shareholder (approx 1.7%) 22/05/2012 19/03/2013

Jennie Hurley Practice Nurse Representative Siam Care (UK Charity No. 1078017) Trustee 22/03/2012 19/03/2013

ISLINGTON CLINICAL COMMISSIONING GROUP REGISTER OF GOVERNING BODY MEMBERS'

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DATE DECLARED

DATE UPDATED

Dr Sabin Khan Salaried/sessional GP Mildmay Medical Practice Salaried GP 23/05/2012 20/03/2013Highbury Medical Services Director 31/10/2012 20/03/2013Highbury Medical Services Spouse is Director 31/10/2012 31/10/2012

Ahmet Koray (Started 3/9/12)

Chief Finance Officer Poplar Housing and Regeneration Community Association

Member of Finance and Audit Board

04/12/2012 04/12/2012

Camden and Islington NHS Foundation Trust

Partner on secondment as Chief Pharmacist

04/12/2012 04/12/2012

Martin Machray Director of Quality and Integrated Governance

South London Healthcare NHS Trust Staffing Bank contract 13/08/2012 14/03/2013

Dr Rathini Ratnavel Elected GP Representative South Islington GP Alliance (SIGPAL), a company providing primary care and

Director / Shareholder 13/03/2012 28/10/2012

Mitchison Road Surgery, a GP practice in Islington

GP Partner 28/10/2012 28/10/2012

Dr Josephine Sauvage Elected GP Representative Islington Practice, City Road Medical Centre

GP Partner 19/03/2012 12/03/2013


Shareholder 19/03/2012 12/03/2013

Dr Karen Sennett Elected GP Representative Killick Street Health Centre GP Partner 05/03/2012 03/09/2012

South Islington GP Alliance (SIGPAL), provider organisation Islington

GP member 03/09/2012 12/03/2013

Deborah Snook Practice Manager Representative Clerkenwell Medical Practice, which is an Islington GP Practice & Member of the South Islington GP Provider group SIGPAL

Employee 06/03/2012 24/10/2012

Mornington Grove Housing Co-Operative - a Full Mutual Housing Co-Operative where all members are voting members of the Management Committee

Member 06/03/2012 24/10/2012

Anne Weyman Lay Member / Vice Chair (Non Clinical)

Age UK Islington Spouse is Trustee 13/06/2012 13/03/2013

Non Voting MembersJulie Billett Joint Director of Public Health for

Camden and IslingtonNo interests declared 06/03/2013 18/03/2013

Dr Robbie Bunt LMC Observer London-wide Local Medical Committees (LMCs)

Director 05/03/2012 22/03/2013

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DATE DECLARED

DATE UPDATED

London-wide Enterprises, subsidiary of London-wide LMC providing education / training to GP practices

Director 05/03/2012 22/032013

South Islington GP Alliance - South Islington provider practice federation

Member 05/03/2012 22/03/2013

Islington Local Medical Committee Chairman 05/03/2012 22/03/2013Simon Galczynski Local Authority Representative -

Director of Adult Social ServicesLondon Borough of Islington Director of Adult Social

Services05/03/2013 05/03/2013

Paul Sinden Director of Commissioning No interests declared 13/03/2013 13/03/2013

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