NHS COMMISSIONING BOARD AUTHORITY
Minutes of a private meeting held on 19 July 2012
Present
Professor Malcolm Grant – Chair
Sir David Nicholson – Chief Executive
Lord Victor Adebowale – Non-Executive Director
Mr Ciaran Devane – Non-Executive Director
Dame Moira Gibb – Non-Executive Director
Mr Naguib Kheraj – Non-Executive Director
Mr Ed Smith – Non-Executive Director
Mr Paul Baumann – Chief Financial Officer
Mrs Jane Cummings – Chief Nursing Officer
Mr Ian Dalton – Chief Operating Officer/ Deputy Chief Executive
Mr Jim Easton – National Director: Transformation
Dame Barbara Hakin – National Director: Commissioning
Development
Tim Kelsey – National Director for Patients and Information
Mr Bill McCarthy – National Director: Policy
Ms Jo-Anne Wass – National Director: HR
Ms Lorraine Middlemas – Board Secretariat
Apologies: Ms Margaret Casely-Hayford – Non-Executive Director
Sir Bruce Keogh – National Medical Director
MINUTES OF MEETING – 31 MAY 2012
Item 1 - Minutes of previous meeting
1.
The minutes of the previous meeting, held on 31 May 2012, were
approved. Good progress against the action log from the previous
meeting was noted.
Item 2 – NHS Commissioning Board overarching programme update
2.
This paper provided an update on delivery of the NHS Commissioning
Board’s (NHS CB’s) development and implementation programme.
Board members were asked to note current progress on delivery.
3.
There had been no deterioration in reporting on the programme, and
work was progressing well. The key things worth noting were:
an improvement in specialised commissioning;
progress had been made on developing the relationships with
colleagues working on public health;
there was a risk relating to ensuring that the right people were
engaged on the authorisation process; and
the Department of Health (DH) would be conducting a state of
readiness review on the whole programme in October, with a view
1
to gaining assurance that the NHS CB would be able to manage
and deliver its work programme.
4.
The risk register showed a positive change on risk 30, the NHS CB
matrix process, with the risk moving from amber/red to amber. The
reason for the change was that the theory of the matrix working was
being put into practice, and there had been many discussions on how
the process would improve alignment towards outcomes.
5.
Further work was required by the executive team to understand how
they could contribute more to matrix working, particularly regarding
behaviours around collaborative working – this being taken forward
through two executive awayday sessions as well as ongoing
discussions through the future design groups (FDG).
Action: The executive team to consider how they can contribute further
to the matrix way of working, regarding behaviours and collaborative
working.
6.
Board members asked how team and individual objectives were set,
emphasising the importance of covering the issue of behaviours. This
work was progressing and would link to that being done by Tim Kelsey.
Board members agreed that good progress was also being made on
working with Local Government.
7.
Board members requested that all future programme updates be
submitted in a larger font and a format that could be used on the IPAD.
8.
The Board noted the current progress with delivery of the programme.
Action: Bill McCarthy to ensure that future programme updates have a
larger font and are in a format that could be used on an IPAD.
Item 2 – NHS Commissioning Board gateway review action plan
9.
In February 2012, the Cabinet Office conducted a gateway review of
the NHS CB’s establishment programme. This paper provided a
further update on delivery of the action plan.
10.
The Board asked about next steps with regard to the gateway process,
and it was noted that at present, there was no commitment to hold a
further gateway review of the establishment programme.
11.
The new non-executive directors asked to see the NHS CBA’s
response to the gateway review.
12.
The Board noted the progress made against actions in the Gateway
Review Action Plan, also noting there had been slippage on the testing
of contingency planning.
2
Action: Bill McCarthy to send the new non-executive directors the NHS
CBA’s response to the gateway review.
Item 3 – Corporate IT
13.
The Board received an update on progress to secure corporate IT
services for the NHS CB.
14.
Overall, the service offer from DH/ATOS had improved through
negotiation and matched the benchmark offers tested in other parts of
the NHS. However, DH had still not provided the NHS CBA with a final
price for the service, so the Board could not be asked to sign-off the
offer. It was hoped the price would be known by the end of July 2012
and anticipated this offer would be affordable within the NHS CBA’s
budget provision (£25m).
15.
It was agreed that prior to sign-off, the NHS CBA required an
agreement for direct access to ATOS, rather than mediating this
through DH.
Action: Tim Kelsey to work with the corporate IT team on gaining direct
access to suppliers.
16.
Advice had been sought from Tim Kelsey’s team on the offer, but,
given that Tim Kelsey had just joined the organisation, it had not been
possible to take his view, personally. The Board agreed that Tim
Kelsey should view the offer to ensure it stood up to scrutiny. The
review should cover flexibility of provision, value for money, the direct
relationship with suppliers, the size of any penalties, and the overall
quality of the package.
Action: Tim Kelsey to work with the corporate IT team to scrutinise the
corporate IT offer with DH and ATOS to ensure flexibility of provision,
value for money, the direct relationship with suppliers, the size of any
penalties and the overall quality of the package.
17.
Board members requested a Board development workshop covering:
informatics in the NHS; and
utilising information and technology across the system, to also
cover governance, security and privacy issues.
Action: Tim Kelsey to liaise with Jo-Anne Wass regarding holding a
Board development workshop on “informatics in the NHS” and “utilising
information and technology across the system, to also cover
governance, security and privacy issues.
18.
The Board agreed to delegate authority to sign-off the contract, on the
condition that final costs being submitted would be within budget, and
3
that a satisfactory memorandum of understanding (MOU) was in place
to underpin direct access to the supplier.
Item 4 – Proposal on the programme arrangements for hosting CSSs
19.
The Board received an update on the Commissioning Support Services
(CSS) hosting arrangements. At a previous meeting, the Board
decided that the NHS CB would host CSS. Based on this decision,
NHS CBA colleagues had approached colleagues at the NHS Business
Services Authority (NHS BSA) regarding a proposal for this
organisation to support this arrangement.
20.
The NHS BSA had been concerned about the huge undertaking the
“arms length” hosting arrangements would entail, mainly the financial
risk of future redundancies, and its capacity to deliver the work.
However, they had received reassurance both from a DH commitment
to underwrite the financial risk, and from an understanding that there
would be a minimal impact on capacity as the vast majority of functions
would be undertaken by the CSS themselves. Therefore NHS CBA
colleagues were expecting an offer from the NHS BSA on the hosting
arrangements.
Action: Barbara Hakin to keep the Board informed of progress on the
NHS BSA hosting arrangement.
21.
A project plan was being developed to support the CSS hosting
arrangements. This plan would be brought to the Board meeting in
September.
Action: Barbara Hakin to produce a project plan on the hosting
arrangements for CSS for the September Board meeting.
22.
Board members were informed that two further check points had been
added to ensure income and expenditure would match, that signed
SLAs were in place with CCGs, and that the CSS had clear, deliverable
business plans. They were also informed that the biggest risks for
CSS were the recruitment of staff and establishing the programme
team to support the work, as well as ensuring they had robust offers
from those commissioning services from them – including the NHS CB
itself.
23.
The Board would need to be clear about its appetite to allow some
CSS to become independent early, and to understand related potential
risks such as those related to IT systems and intellectual property.
Related to this, work would be required to investigate whether hosting
in the interim provided an opportunity to build commonality of systems
and avoid fragmentation.
4
Action: Barbara Hakin to consider the appetite to allow CSS to become
independent sooner, including the risks on IT systems and intellectual
property.
24.
Board members noted the progress to date on the CSS transition
programme, and noted the key milestones going forward, and the
current risks. The Board was also content to approve the proposal in
the paper on the governance assumptions.
Item 5 – The Mandate
25.
This paper provided Board members with an assessment of the draft
Mandate that has recently been published for consultation.
26.
The process relating to the Mandate had been difficult and although
Board members were still not happy with the document, it had
improved since the initial draft. Detailed financial and analytical work
was being undertaken on the deliverability and affordability of the
Mandate objectives, and informal discussion had also begun with
partner organisations.
27.
Board members debated the possibility of the NHS CBA writing its own
Mandate, not for publication but to use as a negotiating tool. However,
this could be a high-risk tactic, as the NHS CBA could be viewed as
negotiating itself a more favourable package. The approach should be
balanced, as suggested in the paper, and there was a need to build
confidence on delivery and share responsibility for the Mandate with
DH. The Mandate needed to be sharper and clearer, with clarity about
responsibilities that was readily understood by all.
28.
In conclusion the Board agreed that the draft mandate was a missed
opportunity on the part of DH to set out a clear and compelling vision
for an NHS focused on outcomes, giving greater freedom and
responsibility to clinical leaders, and revolutionizing the participation
and engagement ofpatients and the public. In its current form it risked
presenting a very managerial, process focused view of health reform.
29.
While members acknowledged that ultimately the form of the Mandate
is for Secretary of State to decide, they agreed that the NHS CBA
should respond publicly in the first half of September, and should
engage with partners including CCGs in formulating its response.
Action: Bill McCarthy to work closely with the chair, non-executive
directors and the executive team on the response to the Mandate,
ensuring the draft document is cleared by correspondence, before it is
sent to DH.
30.
The Board noted the publication of the draft mandate and the initial
assessment and the proposals for the NHS CBA to engage with and
respond to the consultation.
5
Item 6 – Proposal for strategy work
31.
This paper sought Board members views on initial steps in the agreed
work to develop and discuss a future vision for health services and to
note some early decisions to enable this phase of the work to proceed.
The Board were also alerted to concerns that the substantial changes
in NHS working may not happen locally at the pace and scale required.
32.
The strategy work would need to triangulate:
a national analysis of the case for change, working with DH.
Think tanks and academic partners and linked to the next phase
of the public spending review;
information on local cases for change emerging from the system
and CCGs; and
results of stakeholder engagement across the NHS and with key
partners, based upon the geographies of clinical senates and
Academic Health Science Networks (including road show events
supported by work with Nigel Edwards).
Action: Jim Easton to liaise with Tim Kelsey to ensure that public
commitment was included in the strategy proposal.
Action: Jim Easton to ensure that robust financial analysis is carried out
on the proposal, linking to the CSR negotiation and the overall
economic picture.
Action: Jim Easton to engage with NHS colleagues, partners and NHS
CBA colleagues on the strategy proposal.
33.
The Board endorsed the proposed approach, and acknowledged
progress, while noting that there was a risk to the proposed timetable.
To progress the work, Board members were invited to send comments
directly to Jim Easton.
Action: Board members to send any comments on the strategy
proposal directly to Jim Easton.
Item 7 – Any other business
34.
There was no other business.
6