Collaborative Risk Sharing Arrangement between SW London CCGs

Transcription

1 1. Introduction Collaborative Risk Sharing Arrangement between SW London CCGs 1.1 SW London CCGs have agreed to collaborate on ensuring robust arrangements for the management of financial risk. This is not only to ensure the sustainable financial health of the local health economy and to promote collaborative working, it also supports the delivery of statutory financial obligations of individual CCGs both now and in the longer term. 1.2 At the meeting of the Chief Officers (21 March), the updated position for collaborative arrangements was discussed, following latest advice and clarification from NCB London, and a final RSA was agreed by 5 of the 6 CCGs. Subsequent information from NCB London, means that Croydon CCG is also now able to sign up to this arrangement. However this will be subject to the agreement of their financial position and latest financial plan by the NCB, who have indicated support for Croydon CCG joining the RSA. 1.3 This option and underpinning conditions for collaborative arrangements have been discussed by the 6 CCG Boards, and considered within their schemes of delegation; full details of the proposed arrangement are as set out in the latest paper to Boards dated 31 March Board approval/ Chair s action is required to ensure a Finance Review Group (FRG) can be established to manage the risk share arrangement. Terms of Reference for the FRG are attached at Appendix Principles of the SW London risk share arrangement 2.1 The basis of the RSA is that it will allow the management of variances (surplus and deficit) in year by a common, robust and documented approach to risk management and the use of risk reserves. It provides a means of holding each other to account as well as a support mechanism by the use of peer review. 2.2 The key principles of the RSA are set out as follows: The focus is on the risk pool as being held for risks occurring after agreed plans and control totals are set. It is not to cover known risks or deficits identified at the planning stage. It is subject to the sign off of operating plans, including agreed deficit control totals where appropriate, as well as agreement to release the 2% reserve (required by all CCGs) to be used towards funding the risk share arrangement. The RSA is not a support mechanism for CCGs in underlying deficit; financial balance should be addressed through discussion with London Regional Team and the planning submission process. Provider support costs are not covered by the RSA - funds are available for transformation scheme costs, such as BSBV, to incentivise service change and QIPP delivery. This will be managed under the proposed RSA governance process CCGs will also have local risk share arrangements in place, as well as collaborative commissioning risk share arrangements. The RSA shall run for 5 years, with an annual review of its working taking place before the start of each financial year. Contributions and draw downs from each CCG must balance out over the life of the agreement.

2 3. Proposal for RSA Collaborative Risk Sharing Arrangement between SW London CCGs 3.1 The proposal for contributions to the RSA and managing risk locally can be summarised as: Each CCG will contribute a minimum of 0.5% to a collaborative risk pool/transformation fund, plus Contribute their share of the BSBV programme costs. This is to for non-recurrent use as mitigation against in-year risks across the CCGs and to fund programme costs supporting transformational change and QIPP delivery, plus The balance of 1.2% will be held locally by CCGs to provide non-recurrently for local risks and transformation projects, along with the 0.5% contingency reserve. The Parties have signed this Agreement on the date shown below CCG Name - Croydon CCG Authorised Officer Paula Swann CCG Name - Merton CCG Authorised Officer Eleanor Brown CCG Name - Kingston CCG Authorised Officer David Smith CCG Name - Richmond CCG Authorised Officer Dominic Wright CCG Name - Sutton CCG Authorised Officer Chris Elliot CCG Name - Wandsworth CCG Authorised Officer Graham McKenzie

3 South West London CCGs Finance Review Group (FRG) Terms of Reference 1. Background The National Commissioning Board s (NCB) guidance for planning Everyone Counts 1, published in December 2012, sets out the requirements for how risks are managed, specifically that: Clinical commissioning groups must demonstrate that appropriate risk management and pooling arrangements are in place internally and between clinical commissioning groups to ensure budgets are achieved - (para 3.26). CCGs in South West London have joined together to create such a Risk Sharing Arrangement (RSA), the basis of which will be to allow the management of variances (surplus and deficit) in year by a common, robust and documented approach to risk management and the use of risk reserves. The RSA provides a means of holding each other to account as well as a support mechanism by the use of peer review. The management of the RSA is by the Finance Review Group (FRG), the terms of reference being as set out in this document. It should be noted, however, that Croydon CCG s membership is dependent on the agreement of their financial position and latest financial plan by the NCB, who have indicated support for Croydon CCG joining the RSA. 2. Purpose & Duties of the FRG The FRG has been jointly established by the SW London CCGs. Its key purpose is to monitor and manage the risk share arrangement in place as of 1 April, running for a period of no less than 5 years. It will provide positive leadership through a collaborative approach to risk management across South West London, delivered through an agreed code of behaviour: Aims SWL CCGs, as well as the wider SW London Economy, are financially sustainable in the longer term Requirements of the NCB authorisation process are met The FRG will have delegated responsibility (from individual CCG Boards) for the governance and implementation of the risk share arrangement Understanding That the CCGs start from different financial positions, including Distance From Target (DFT) and other allocation issues, That Financial Control Totals are to be met for each CCG, not just overall, The focus of the RSA is on the risks that might occur after an agreed plan/ control total is set, not to cover known risks or deficits identified at the planning stage, and 1 Page 3 of 7

4 The FRG is held to account by CCGs through representation on the group. Measures Recommending financial support for unforeseen risks, when backed by a robust recovery plan Approving the provision of recoverable financial support for transformation programmes Making recommendations for best practices on (for example): - Planning - Management of delivery - QIPP schemes and implementation - Commissioning - Contracting Providing Assurance That access to the funds will be by self-referral or Automatically when a CCG is unable to deliver its monthly financial plan (for 2 consecutive months) or its forecast control total That funds will be distributed based on credible recovery plans, which will monitored for progress Communicating Agenda and papers will be sent to all Chairs, COs/COO and CFOs five working days before the relevant meeting Notes & minutes shall be kept of all proceedings and agreements and will be shared with individual CCG Boards Copies shall be circulated to all CCGs (whether or not present or represented at the relevant meeting) by within ten working days the end of the meeting to which they relate. Updates and reports will also be provided to CCG Boards as appropriate 3. Membership The membership is comprised of a core group of 6 members, representing each of the current constituent CCG and each with voting rights All CCGs will nominate a representative from its Chair or CO/COO, each of whom will have a vote. The FRG Chair will be nominated from the CCG Audit Chairs (Lay member), plus a nominated deputy, and will be jointly agreed. They will be non-voting. CFOs may attend but will act in an advisory capacity only (non-voting) A senior officer of the Commissioning Support Unit (CSU) will also be in attendance in an advisory (non-voting) capacity. The group has no authority above that of individual CCGs but will act with the delegated authority of the individual representing the CCG. The FRG may establish sub groups with clearly defined terms of reference (which set out the arrangements agreed by the parties for matters such as membership and purpose) as it deems appropriate from time to time. If any member of the group has a paper on the agenda they should ensure that they are able to attend the meeting or send a representative to present the paper. Other Senior Managers may be invited to present papers as and when required. Page 4 of 7

5 4. Quorum and voting rules The quorum will comprise at least 4 members, being: The Chair or CO/COO from each CCG (with voting rights) Chair of the FRG (lay member), or their nominated deputy (non-voting) In addition, at least 1 CFO or CO from any of the CCGs being present at any given meeting, with CFO acting in advisory (non-voting) capacity Voting will require 2/3rds majority for a decision to succeed. Each CCG shall not have more than one vote. If a majority decision cannot be agreed, this is escalated to a meeting of all Chairs and COO/COs for decision. However, the FRG is part of a collaborative risk sharing process; the expectation is that there would be full attendance at the meetings, apart from in exceptional circumstances. 5. Contributions The contributions to this arrangement are refreshed annually and are as agreed jointly by the Board of the CCGs, in advance of the year may be set differentially at the discretion of individual CCGs but are subject to a minimum contribution of 0.5% of the current year starting allocation. Contributions will balance out over the period of the agreement such that, over time, contributions and withdrawals will even out. 6. Process The process for managing risks and financial support (as set out in Appendix A) will be carried out in 5 stages: Stage 1: Identifying risks and requests for support by CCG self-referral or automatically when a CCG is unable to deliver its monthly financial plan (for 2 consecutive months) or its forecast control total Stage 2: Understanding risks or additional costs CFO & CO present the case for receiving support, giving details of the financial risk/costs, as well as setting out actions already undertaken to manage within existing allocations Stage 3: Proposing actions CCG compiles a recovery plan or analysis of the benefits of the requested support and submits this to the FRG. The FRG may consider using an independent reviewer at this stage, to verify the plan and/or the stated financial position. Page 5 of 7

6 Stage 4: Recommendations The FRG assesses the plan provided and makes formal recommendations based on its enquiries and information supplied. CFOS will recommend the specific details of financial transactions and the phasing of support, which will be delivered/supported by CSU. CCG representatives must be in 2/3rds majority agreement for the plan to be accepted. Stage 5: Monitoring Financial support is provided, and the implementation and delivery of the plan is monitored at the monthly meetings of the FRG. 7. Frequency and content of meetings Meetings will take place monthly on a DAY from TIME TIME. The standing agenda items for this meeting will be; a) Individual CCGs financial positions b) Risks to the above, including QIPP progress, acute performance. c) Current performance against bids from the risk pool d) Business cases for future bids e) Value of unallocated risk pool to date The management of the FRG will be hosted by Richmond CCG, who will provide the appropriate administrative support services, with all reasonable costs being a call against the risk fund (agreed by the FRG). 8. Review The arrangements for this group will be reviewed after a period of 3 months to ensure that the membership is appropriate and the desired outcomes are being achieved. These Terms of Reference will be reviewed annually or as required. Page 6 of 7

7 Financial Recovery Process Appendix A Referral Self-referral Missing plan/control Total Dialog to establish reasons FRG CCG Actions FRG to consider Recovery/Other Plan FRG agrees proposal by vote Feedback to CCGs FRG supports and monitors CCG progress Page 7 of 7