CKWCB-12-190_Commissioning_Development___PHT_update_Sept_2012FINALpostcallover

DATE OF MEETING: 27th September 2012 Paper Title: Commissioning Development Report and Public Health Transition Update

Agenda Item: 15 Enclosure:CKWCB/12/190 Category of Paper Tick() Decision and Approval 

Position statement

Responsible Director: Ann Ballarini, Executive Director of Commissioning and Service Development

Discussion

Paper Author: Ann Ballarini, Executive Director of Commissioning and Service Development Danny Alba, Commissioning Programmes Manager

FOI Status: Open

Executive Summary:

This report provides an update on the latest developments in establishing the new commissioning system and progress of the commissioning development milestones the Cluster Board is responsible for ensuring delivery against. It also outlines the proposal to develop a section 75 agreement for Wakefield.

Outcome of Equality Impact Assessment:

No issues identified

Sub Group/Committee:

Not applicable

Recommendation (s):

It is recommended the Board:



Information

i)

ii) iii)

iv)

Note the progress made against the transition milestones; and update on progress towards transition; and Receive the Public Health exception report.

Delegate the authority to enter into a Section 75 agreement to transfer lead commissioning and establish a pooled budget agreement for defined public health services for the Shadow period 1 October 2012 to 31 March 2013.

Delegate

the

development

of

the

agreement to the Wakefield Public Health Transformation Steering group. v)

Note the work being undertaken to agree the most appropriate way forward in respect of public health contracts included in NHS and GP contracts.

1.0

Purpose of Report The paper has four purposes: 1.1

1.2

2.0

To provide an update on the developments in establishing the national new commissioning system and reporting the revised transition milestones for 2012/2013 that the Cluster is responsible for and our current position against them; To provide an update on the emerging Clinical Commissioning Groups (eCCGs);

1.3

To report in more detail on the progress towards the milestones relating specifically to Public Health (PH) transition; and

1.4

To seek board approval to Delegate the authority to enter into a Section 75 agreement to transfer lead commissioning and establish a pooled budget agreement for defined public health services for the Shadow period 1 October 2012 to 31 March 2013 to Wakefield Public Health Transformation steering group.

National Developments 2.1

NHS Commissioning Board (NHS CB)

The final six months of transition are now approaching with arrangements being put in place to enable the new organisations, including the NHS CB, to lead work relating to their future functions. This is to happen incrementally from 1 October 2012 to 1 April 2013 to ensure the process is coordinated and secure.

The NHS CB has published its full structure including details of the four Regional Directors that have been appointed. These are all available on request.

Local Area Teams (LAT) The following LAT Director appointments have been made by the NHS CB to the NoE: North Moira Dumma, Cheshire, Warrington and Wirral (currently Director of Commissioning Development at NHS Midlands and East SHA Cluster) Clare Duggan, Merseyside (currently Director of Strategic Change at NHS Merseyside PCT Cluster) Mike Burrows, Greater Manchester (currently CEO of NHS Greater Manchester PCT Cluster) Andy Buck, South Yorkshire and Bassetlaw (currently CEO of NHS South Yorkshire and Bassetlaw PCT Cluster) Chris Long, North Yorkshire and Humber (currently CEO of NHS North Yorkshire and York PCT Cluster and NHS Humberside PCT Cluster) Cameron Ward, Durham, Darlington and Tees (currently Director of Commissioning Development at NHS North of England SHA Cluster)

2.2 Commissioning Support Units (CSU) Andrew Kenworthy (currently Chief Executive of NHS South London) will be joining the NHS Commissioning Board Authority’s Commissioning Development Directorate via IMAS assignment as Director of CSU Transition Programme until a substantive appointment is made. A more detailed report on the establishment of the CSU for West Yorkshire is elsewhere on the agenda.

Discussion on the hosting arrangements for CSUs is underway. The need for stability for CSUs and their customers to ensure a successful transition to the new clinical commissioning system has been recognised as this will ensure: • • •

There is stability and continuity for CCGs as they prepare for and progress through the authorisation process and as they carry out the procurement of their choice of commissioning support post-April 2013.

The CSU development process is better aligned with the national HR transition process.

CSSs can ensure they are the “right size” – a process of ensuring their income covers their costs – in time for April 2013.

2.3 Public Health England (PHE) The PCT Cluster Board remains statutorily responsible for Public Health (PH) until 2013 with a joint governance plan for Public Health developed to manage the transition.

PHE is leading work during this final transition period relating to its future function and this is happening incrementally from 1 October 2012 to 1 April 2013.

The structure of PHE, which comes into being in April 2013, has now been published with a supporting factsheet that sets out how the new organisation will be structured to achieve its ambitions of protecting and improving health and wellbeing, while reducing health inequalities. The proposed structure will be used as the basis for transition and includes the first module of PHE People Transition Policy which describes the HR transition processes for establishing PHE and what can be expected to happen over the coming months of transition. David Heymann has been appointed Acting Chair of Public Health England to take the transition forward.

The next key step will be to agree arrangements for the transfer of PH functions which are in scope of PHE. This will include staff and contracts / legal agreements currently held in NHSNE that are expected to transfer to PHE. The date for actual transfer will be determined at a local level.

3.0

Local Developments 3.1

Public Health Transition

The three Public Health (PH) functions in Calderdale, Kirklees and Wakefield District PCTs each have a transition plan which was developed in partnership with their respective Local Authority and reflects the outputs from the national PH transition checklist. The PH functions continue to be accountable to the NHS Cluster Board during this transition year. Locally the governance of the process is being overseen by the joint Transition Board meetings with each respective Local Authority.

Work is also underway to develop a Section 75 Partnership Agreement between the Local Authority and Wakefield District Public Health function to agree what Public Health support will continue to be provided to NHS WD (see 3.1.2.) Section 75 Partnership Agreements are also being explored across Calderdale and Kirklees.

Across the Cluster, Joint Health and Wellbeing Strategies (JHWS) have been developed and they will form the basis for planning for 2013/14. These are the deliverables from the Joint Strategic Needs Assessments (JSNA) which are ‘live’ documents and will be continually updated. It is anticipated that the JHWSs will have at least a three year time frame with an annual refresh process build into them.

Progress is well underway with reviews of the JSNAs completed for the three districts and approved by their respective Health and Wellbeing Board (HWBB). The JHWSs will go to their respective HWBBs later this month for approval. HWBBs continue to work productively with their respective eCCGs. In terms of agreeing arrangements for Local Authorities to take on Public Health functions there is still a need for clarity regarding commissioning contracts, particularly those that will cut across one or more commissioning organisations in the new system and provide solutions for the future. The PH transition teams are currently investigating this issue.

The CKW Cluster Board Exception Report against delivery of the 2012/13 Public Health Transition Plan is appended at Appendix A. The Exception Report focuses on the area of Enabling Infrastructure for the three PCTs, specifically related to the identification and resolution of significant financial issues, the novation and handover of all agreed Public Health contracts, including contractual risk and indemnity issues, and lastly putting a plan in place for the development of a legacy handover documents during 2012/13.

3.1.2 Section 75 Agreement for Wakefield Public Health Transition Background In February 2012, Wakefield Cabinet and the board were advised of the statutory transfer of responsibility for Public Health Services from 1 April 2013, which would be led by Family Services in the local authority and gave approval for shadow period arrangements to be agreed through local delegation. Cabinet and the board were advised that the likely arrangement would be through a Section 75 Agreement.

Cabinet and the board were also advised of the duties and responsibilities that would transfer to the Council and the approximate public health expenditure and although this was not and is still not definitive, we now have a reasonably good understanding of the commissioning duties and employees who will transfer and the financial envelope, which is now estimated at £19,055m.

In addition to the services that will transfer by statute, it is anticipated that local areas will be able to agree that other duties can be delegated where appropriate.

The Transformation of Public Health services steering group and sub-groups have been considering options for the shadow period, including risks for both organisations and have concluded that to mitigate risks as far as possible and ensure a smooth transition, a formal delegation of lead commissioning with a pooled budget and associated responsibilities as appropriate should commence from 1 October 2012. This has not been an easy conclusion to reach, not least because transition guidance from the Department of Health has been equivocal in respect of arrangements for the shadow period.

Draft guidance issued late 2011 (Transition Planning Support for Primary Care Trusts (PCTs/Local Authorities) stated, “by the end of October 2012 we expect the substantial majority of PCTs with local agreement to have delegated public health duties and resources to Local Authorities, with robust governance arrangements in place for the remainder of 2012/13. We expect all remaining duties and resources to be delegated by December 2012. For the avoidance of doubt, delegation means formal delegation under a section 75 or other agreement”.

Guidance issued in January 2012 (Public heath transition planning support for Primary Care Trusts and Local Authorities), states: • • •

Transition plans must include how transfer of accountability from the NHS to Local Government will be enacted during the shadow year Many local areas will want to agree arrangements for Local Authorities to manage public health functions during the transition year Local Authorities should agree delegated responsibility for the delivery of public health services negotiated locally In their response to Wakefield’s Public Health transition plan, NHS North of England representatives stated, “the Department of Health is keen to see as many local teams operating within a local environment by October 2012 and use terms such as “operation” and “schemes of delegation”. More recent guidance is therefore far less clear than guidance issued in November of last year and leads us to a position where each shadow period should be agreed at a local level.

In their response to Wakefield’s Public Health transition plan, NHS North of England representatives stated, “the Department of Health is keen to see as many local teams operating within a local environment by October 2012 and use terms such as “operation” and “schemes of delegation”. More recent guidance is therefore far less clear than guidance issued in November of last year and leads us to a position where each shadow period should be agreed at a local level.

A risk assessment was undertaken by the steering group on 1 June 2012 in respect of all public health project work-streams. The group considered the risks associated with the transfer, the steps necessary to enact the transfer for 1 April 2013 and the extent to which a deployment/management agreement or Section 75 agreement would mitigate that risk. The following is a summary:

a) Finance There is concern from senior finance colleagues in both the PCT and Council that a management agreement will not mitigate the financial risks associated with the transfer and that a phased delegation of finance and financial duties will enable a smoother transition and clearer lines of accountability.

A Section 75 agreement, would enable a pooled budget and agreement on how under and overspend will be addressed in the context of yet to be agreed processes for PCT “close down”.

It is intended that from 1 April 2013 the following amounts of money will be transferred to the local Authority: £000s Whole Contracts 250 Part of Other Contracts 14,494 Direct Staffing Costs 3,221 Direct Non Pay Costs 568 Overheads 522 Total 19,055 Until 1 April 2013 the CCG will still be responsible for paying this expenditure, with the exception of the direct non pay costs. The reason that the direct non pay costs will not be paid by the CCG is that the Public Health staff will physically transfer and will not have access to the CCG’s financial systems.

It is therefore proposed that the local authority bill the CCG on a monthly basis 1/6th of the total amount for the period of the section 75 agreement.

The CCG then invoices the Local Authority on a monthly basis 1/6th of the total amount, less the direct non pay costs, for the period of the section 75 agreement.

Any over or under spends on the direct non pay costs will be the responsibility of the Local Authority. Any other over or under spends will be managed by the Joint Strategic commissioning Board. The financial position will be reported on a regular basis to Joint Strategic Commissioning Board. b) Human Resources Guidance in relation to transitional working arrangements was issued by the Public Health concordat steering group on 12 June 2012. This makes it clear that the shadow arrangements should not be by way of a TUPE transfer and public health employees should remain employed by the PCT until 1 April 2013.

All Public Health employees will have moved into Council accommodation (Wakefield One) by October 2012. The transfer of accommodation for employees has been undertaken through a Memorandum of Understanding under which Public Health employees will continue to be employed and managed from an employment perspective

by NHS Wakefield District until 1 April 2013, at which point there will be a statutory transfer to the Council, with all staff remaining on their NHS terms and conditions, including continued access to the NHS pension schemes.

c) ICT A detailed risk assessment in respect of ICT has been undertaken and most of the risks associated with ICT can be addressed through a robust due diligence process. Some key areas of risk are external, for example, access to health systems and will therefore not be mitigated through a Section 75 Agreement. d)

Contracts

A great deal of work has been undertaken by public health colleagues in providing significant detail on all contracts, prior to the due diligence process being in place.

Novation of contracts from NHS Wakefield District to the Council is not a straightforward matter as a number of contracts are tied up in NHS contracts with South West Yorkshire Foundation Trust (SWYFT) and Mid Yorkshire Hospital Trust (MYHT) or with General Practice/pharmacy contracts. From an estimated £14m expenditure on Public Health contracts transferring to the Council, it is estimated that £8m are tied up in other contracts, mostly those which transferred to SWYFT and MYHT as part of the Transfer of Community Services (TCS).

The PCT contracts department is working to a nationally prescribed transfer of contracts process (for all PCT contracts) based on a 3 stage process of stocktake, stabilize and shift and guidance on the final stage is not expected until September/October. It was initially thought that we did not have the authority to drive forward the transfer of public health contracts at a local level, but NHS Wakefield District has now accepted that it will be possible to begin the process of novation ahead of the guidance. In respect of the TCS contracts, we are currently working on options to manage any associated risks, but it is probable that we will request the PCT to vary and extract the public health element of those contracts in order that they can be novated to the Council during the shadow period.

A Section 75 agreement therefore will not be used as a vehicle to transfer employees but to manage the transfer of commissioning arrangements, including phased transfer of contracts, procurement of new contracts where appropriate and transfer of funding.

Resource Implication A ring fenced allocation for public health services will be made to the Council from 1 April 2013, based on joint returns from each locality. The approximate allocation is £19.055m, an increase of £319k on the Department of Health’s indicative grant allocation of £18.736m.

Funding for the Section 75 Agreement pooled budget for the shadow period will be agreed as work progresses, but it is expected by the Council that the value of all contracts would transfer into the pool from October 1st 2012. There will also be negotiation on how overheads for the shadow period will be managed, either by transfer of functions or purchased from the PCT.

Recommendations

Board members are asked to 1)

Delegate the authority to enter into a Section 75 agreement to transfer lead commissioning and establish a pooled budget agreement for defined public health services for the Shadow period 1 October 2012 to 31 March 2013.

2)

Delegate the development of the agreement to the Wakefield Public Health Transformation Steering group.

3)

Note the work being undertaken to agree the most appropriate way forward in respect of public health contracts included in NHS and GP contracts.

3.2

Transfer of Police Custody Healthcare from West Yorkshire Police to NHS CB and development of Sexual Assault Referral Centres (SARCs)

New DH policy is that commissioning responsibility for police custody healthcare will transfer from local police forces to the NHS CB. A number of pilot sites, including West Yorkshire Police (WYP), have established compliance change programmes to expedite this transfer as from 1 April 2013.

The key drivers for this policy change are that there has been widespread concern about the variable standards of healthcare in the police custodial setting, particularly the quality of assessment and care of police detainees and victims. Local commissioning partnerships between the NHS CB and the respective police force aim to integrate health and social care across the local criminal justice system, providing seamless endto-end care for detainees, offenders and victims of crime. Benefits of this approach have been supported by a national cost / benefit analysis and a local health needs assessment.

In addition, the development and establishment of SARCs is underway, which is a new service for victims of sexual violence and sexual abuse, including medical forensic examination.

Locally, this project is being taken forward by NHS CKW’s Public Health team in collaboration with NHS ABL and WYP. Judith Hooper, Director of Public Health, is the responsible director and senior responsible owner of the project. A small project team has been established to work with WYP during the project’s start-up stage to develop the business case, produce the health needs assessment, develop a delivery strategy including risk planning, and to help WYP develop its procurement strategy, including a detailed specification of requirements from a NHS perspective.

The key milestone is that by June 2013 a ‘statement of readiness’ to transfer responsibility for commissioning is to be provided by the West Yorkshire NHS/Police Partnership to the National Oversight Board. Budget transfer and risk sharing is supported by an initial local impact assessment using the national tool.

The Early Adopter phase for the West Yorkshire project has as its key priority the objective to tender the police healthcare custody services (annual contract value of c£3.5m) across the two clusters of NHS CKW and NHS ABL. Key project deliverables are to develop a clinical IT system to minimise clinical risk and improve information

governance, and a new service model to support the development of integrated delivery of healthcare across the community and criminal justice system at police custody level.

The overall cost of delivery for this project is £175,000, with NHS CKW contributing £43,000 which has been identified from current underspend.

Key risks to delivery relate to the challenges of partnership working and stakeholder engagement and developing an agreed procurement strategy.

The Board will be apprised of progress as the project moves from the start-up stage to delivery stage.

4.0

PCT Cluster Reform Milestone Tracker The full report for August 2012 is available on request. The sub domains at the August position are as follows: • •

• • • • •

Development of CCGs is on-track; Commissioning Support is on-track (note: the milestone to support the CSS in developing trajectories to move to freestanding status has been revised by NHSNE and put back from August 2012 to December 2012); Direct Commissioning is on-track; Any Qualified Provider (AQP) is on-track; HWBBs is on-track; Transfer to LAs is on-track; and Transfer to PHE is on-track.

There are no major issues or outstanding risks to delivery against any of the key milestones.

5.0

Emerging Clinical Commissioning Groups (eCCGs) The four key governance issues and corresponding approaches for the authorisation process at the national level are: • •

• • •

The appointment of panel chairs and the make-up of the authorisation panels; Establishing the governance arrangements, including a new sub-committee of the NHS CB which will meet from October 2012 and make all the authorisation decisions; The design of the moderation process for the outcomes of authorisation assessments; The approach to applying conditions to authorisation, the support that will be made available to CCGs, and the design of the corresponding rectification plans; and The authorisation decision-making and governance process is to be overseen by two national directors at the NHS CB: Dame Barbara Hakin, National Director of Commissioning Development, and Ian Dalton, Chief Operating Officer.

Locally, the Executive Director of Commissioning and Service Development is continuing to support the four e CCGs to become authorised. The following is an update on each CCG’s progress.

Wave one NHS Calderdale CCG Have submitted wave 1 application and have recently received their submission report with the key lines of enquiry that will be explored during the site visit on 25th September.

Good progress has been made in appointing to the governing body with the Clinical Lead (chair) Alan Brook, Designate Chief Officer Matt Walsh, Designate Chief Finance Officer Julie Lawreniuk (shared post with greater Huddersfield) and Consultant posts have all being recruited to. At the time of writing this report the interviews have not been held for the nurse and two lay member posts.

NHS Wakefield CCG Have submitted wave 1 application and have recently received their submission report with the key lines of enquiry that will be explored during the site visit on 26th September.

Progress has been made in appointing to the governing body with the Clinical Lead (chair) Phil Earnshaw and Designate Chief Officer Jo Webster being confirmed.. At the time of writing this report the interviews have not been held for the Designate Chief Finance Officer, consultant, nurse and three lay member posts but were expected to be completed by the end of September.

Wave two NHS Greater Huddersfield CCG Have submitted wave 2 application; good progress has been made in appointing to the governing body with the Clinical Lead ( chair) Steve Ollerton, Designate Chief Officer Carol McKenna, Designate Chief Finance Officer Julie Lawreniuk (shared post with Calderdale) Consultant Irvin Cobden, nurse Angela Monaghan, posts have all been recruited to. At the time of writing this report the interviews have not been held for the two lay member posts.

Wave four NHS North Kirklees CCG is on track to submit a wave 4 application. Progress has been made in recruiting to the governing body with the Designate Chief Finance Officer Steve Brennan confirmed. At the time of writing this report a process was in place but the interviews not yet held for all the other posts.

All four eCCGs have been out to consultation with their final management structures and the process of recruiting to these structures will commence mid September.

All four CCGs are working with the CSS to firm up the services that they will require from the CSS. 6.0

Recommendations It is recommended the Board: i) ii)

Note the progress made against the transition milestones; and update on progress towards transition; and Receive the Public Health exception report.

iii)

Delegate the authority to enter into a Section 75 agreement to transfer lead commissioning and establish a pooled budget agreement for defined public health services for the Shadow period 1 October 2012 to 31 March 2013.

iv)

Delegate the development of the agreement to the Wakefield Public Health Transformation Steering group.

v)

Note the work being undertaken to agree the most appropriate way forward in respect of public health contracts included in NHS and GP contracts.

Ann Ballarini Executive Director of Commissioning & Service Development Danny Alba Commissioning Programmes Manager

September 2012 7.0

Appendices

Appendix A PH Exception report