GREATER MANCHESTER HEALTH AND SOCIAL CARE …

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GREATER MANCHESTER HEALTH AND SOCIAL CARE

STRATEGIC PARTNERSHIP BOARD

Date: 16 December 2016

Subject: North East Sector Framework: New Arrangements to Move towards a Single

Commissioning Arrangement for Acute Services

Report of: Denis Gizzi, Managing Director, NHS Oldham CCG

Stuart North, Chief Officer, NHS Bury CCG

Michael Owen, Chief Executive, Bury Metropolitan Borough Council

Steve Rumbelow, Chief Executive, Rochdale Borough Council

Dr Martin Whiting, Chief Clinical Officer, NHS North Manchester CCG

Dr Carolyn Wilkins OBE, Chief Executive, Oldham Metropolitan Borough

Council

Simon Wootton, Chief Officer, NHS Heywood, Middleton and Rochdale CCG

PURPOSE OF REPORT:

The report describes proposals to create a single commissioning arrangement for sector-

wide services in the North East of Greater of Manchester.

RECOMMENDATIONS:

The Strategic Partnership Board is asked to:

To note the contents of this report

Support the proposal to create a single commissioning arrangement for acute and

mental health services in the North East sector.

CONTACT OFFICERS:

Simon Wootton, Chief Officer, NHS HMR CCG

[email protected]

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1.0 BACKGROUND AND PURPOSE OF REPORT

1.1. North East Sector CCGs and Local Authorities have been working towards

consideration of a single commissioning arrangement for the acute footprint that

serves them. The aim of this is to establish a single commissioning arrangement to

underpin the transformation of Pennine Acute Hospitals NHS Trust and to optimise

the commissioning of other sector-wide services including those provided by

Pennine Care NHS Foundation Trust. It was agreed that a presentation and

supporting paper setting out the details of proposals would be presented to the

Strategic Partnership Board meeting on 16 December 2016. This report is intended

to fulfil that commitment.

1.2. The paper has been drawn up against the background of thinking across the sector

on the next steps for collaboration, informed by a paper prepared by Pennine Acute

Hospitals NHS Trust on the development of an infrastructure to support single

commissioning, which following consideration by the sector is likely to form the

basis of a sector-wide bid to the Transformation Fund.

2.0 CURRENT POSITION

2.1. NHS commissioners in the North East sector have a long history of collaboration,

and this has been of particular importance since the establishment of Pennine

Acute Hospitals NHS Trust in January 2002. Collaboration between local

authorities in the sector has been positive in recent years but largely informal.

2.2. The two major NHS trusts providing services to the populations of Bury, Heywood,

Middleton and Rochdale, and Oldham – Pennine Acute Hospitals NHS Trust

(PAHT) and Pennine Care NHS Foundation Trust (PCFT) – have been

commissioned through a variety of contracting mechanisms in recent years.

Currently, lead commissioning arrangements are in place with one CCG in the

sector taking co-ordinating responsibility for the main NHS contract (NHS Bury CCG

for PAHT, and NHS HMR CCG for PCFT).

2.3. Other commissioned services, including residential and nursing care, some crisis

intervention and home support services, and single points of access, should in the

very near future be considered for sector-wide commissioning.

2.4. At present, commissioning arrangements within the sector face a number of

challenges:

The forecast 2020/21 ‘do nothing’ financial gap for the North East sector (not

including North Manchester) is £229m

The Care Quality Commission have given an ‘inadequate’ rating for Pennine

Acute Hospitals NHS Trust (August 2016)

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There is a history of financial challenge at Pennine Acute Hospitals NHS Trust

and this remains a major issue for the sector, with the Trust forecasting a

£15.2m deficit (the agreed control total) for 2016/17

There is a varied pace of transformation in each locality, e.g., in relation to the

establishment of locality care organisations and integrated commissioning

arrangements between CCGs and local authorities

The main NHS providers report the challenges they face from varied

expectations and requirements from locality commissioners and from having to

seek approval from multiple bodies for service changes and developments

Correspondingly, there are duplicated processes and effort for providers and

commissioners across local authorities and the NHS

2.5. In addition, it should be noted that the North East sector itself is the process of

changing; whilst NHS North Manchester CCG is currently a CCG member of the

sector, and Manchester City Council an ‘interested party’, these arrangements will

change when North Manchester General Hospital becomes part of the single

hospital service in the city of Manchester during 2018/19. This change is itself

interconnected with the development of a single hospital service in Manchester, and

the establishment of the Manchester locality care organisation and single

commissioning system.

3.0 NORTH EAST SECTOR RESPONSE

3.1. CCGs and local authorities, together with the two main NHS providers, have agreed

to address these challenges in a new way by:

Accelerating the integration of health and social care services outside of the

hospital, closely linked to primary care (the locality care organisation)

Establishing consistently high quality and high performing acute hospital care

for people who need it (including people with mental health problems)

Proposing to put in place effective, streamlined commissioning arrangements

which have single decision-making structures across the sector wherever

necessary

Creating and establishing appropriate values and behaviours by all health and

social care organisations and their staff

Developing effective programmes which support and enable thriving and

resilient local communities

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Establish a clinically and financially sustainable future for the North East sector,

in the context of a sustainable Greater Manchester health and social care

system

3.2. Specifically, for the first time in the North East sector, CCGs and local authorities

are proposing to a create a single, integrated commissioning arrangement across

Bury, Heywood, Middleton and Rochdale and Oldham for the purposes of

commissioning sector-wide services ‘once’, i.e., through a single process.

3.3. The table below illustrates the proposed approach to commissioning, to Pennine

Acute Hospitals NHS Trust and to the development of locality care organisations

across the four local authority/CCG areas in the North East sector:

*Multi-speciality community provider

4.0 GOVERNANCE AND LEADERSHIP

4.1. In order to drive and oversee the achievement of the North East sector’s goals, it is

proposed to create a new governance structure for the sector between CCGs, local

authorities and the two key providers. This structure will replace current

arrangements, i.e., the North East Sector Commissioning Board and will mirror in

part the health and social care governance arrangements at Greater Manchester

level.

Theme Bury Oldham Rochdale

North

Manchester

Commissioning

Proposal to establish single NE sector

commissioning and contracting arrangement for

cross sector commissioning; each locality will

have integrated commissioning arrangements

between Council and CCG

Agreement to

create a single

commissioning

body for the city

Pennine Acute

Hospitals NHS

Trust

Proposal for single clinical strategy for the

sector and single commissioning arrangement

NMGH will

become part of

the Manchester

single service

Locality care

organisation

Provider

partnership

for older

people

Provider/

commissioner

partnership for

whole

population

Provider

partnership for

adults

Provider body for

whole population

with an MCP*

contract as the

likely contractual

arrangement

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4.2. It has been proposed to establish a North East Sector Health and Social Care

Strategic Leadership Group, and an Executive Group. The Strategic Leadership

Group will:

Identify the values, principles and frameworks by which services across the

sector are to be transformed.

Provide strategic advice to health and social care organisations, e.g., on the

development and contents of a clinical strategy for Pennine Acute Hospitals

NHS Trust.

Enable briefing to Council leaders and other elected members, Trust board

members and Governing Body members.

Maintain oversight of the complex programmes of transformation across the

sector, supporting existing programme governance and management

arrangements.

Ensure that decision-making amongst member organisations is aligned and

consistent.

4.3. The Executive Group will:

Design, obtain approval for, and operationalise the values, principles and

frameworks for the transformation of services across the sector.

Co-ordinate the development of strategies and plans across health and social

care organisations which are sector-wide.

Ensure effective engagement and involvement of all relevant stakeholders in

the development and implementation of sectoral transformation programmes.

Co-ordinate the programme management of the sector’s complex programmes

of transformation.

Ensure that appropriate arrangements exist for the design and delivery of

sector-wide programmes of transformation including single commissioning

arrangements for the sector, including engaging with staff and stakeholders.

This work may include option identification and appraisal in the light of agreed

outcomes and the availability of resources amongst organisations in the sector.

4.4. Membership of the Leadership Group will be at Chief Executive/Accountable Officer

level, and of the Executive Group at Executive Director/Chief Operating Officer

level. The terms of reference for the two groups have been developed and are

annexed as Annex 1 and Annex 2. The first meetings of the new groups will take

place in January 2017.

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4.5. The new governance arrangements can be portrayed diagrammatically as follows:

5.0 RECOMMENDATIONS

5.1. The Greater Manchester Health and Social Care Strategic Partnership Board is

asked:

To note the contents of this report.

Support the proposal to create a single commissioning arrangement for acute

and mental health services in the North East sector.

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TERMS OF REFERENCE

North East Sector Health and Social Care Strategic Leadership Group

Version 0.04

Status Draft

Approval Outstanding

Version control

7 December 2016 Amendments from Maggie Kufeldt, Jo Purcell and Simon Wootton incorporated.

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TERMS OF REFERENCE

North East Sector Health and Social Care Strategic Leadership Group A. Vision for the North East sector Health and social care organisations in the North East sector of Greater Manchester want to work together to

Support and enable local people to stay as healthy and well as possible

Commission and provide services which optimise prevention, early intervention, recovery and rehabilitation

Ensure that all services are safe, of high quality and which treat everyone with respect and dignity

Ensure that all services are sustainable in the long term, financially, clinically and in relation to their workforce

These goals will be achieved by:

Integrated health and social care services outside of the hospital, closely linked to primary care (the locality care organisation)

High quality and high performing acute hospital care for people who need it (including people with mental health problems)

Effective, streamlined commissioning arrangements which have single decision-making structures across the sector wherever necessary

Appropriate values and behaviours by all health and social care organisations and their staff

Effective programmes which support and enable thriving and resilient local communities

Establishing a clinically and financially sustainable future for the North East sector, in the context of a sustainable Greater Manchester health and social care system

B. Purpose of group The purposes of the North East Sector Health and Social Care Strategic Leadership Group (SLG) are to:

1. Identify the values, principles and frameworks by which health and social care services will be commissioned and provided across the sector in a manner that is consistent with the expectations of the Greater Manchester Health and Social Care Strategic Partnership, the needs of the population of the North East sector and each area’s Locality Plan

2. Provide strategic advice to health and social care organisations within the sector on the best and most appropriate means of achieving the

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sector’s vision, e.g., through the development of a clinical strategy for Pennine Acute Hospitals NHS Trust

3. Enable the provision of early information and briefing to Council

leaders and other elected members, Trust board members and Governing Body members, on key issues being addressed in the North East sector, including planned changes to services

4. Maintain oversight of the complex programmes of transformation

across the North East sector, providing challenge to senior responsible owners (SROs) and programme leads, in the design and delivery of major change

5. Ensure that decision-making amongst member organisations is aligned

and consistent and that decision-making and delivery structures working for the North East sector as a whole are effectively supported

A. Scope The SLG consists of the following organisational members:

Bury Metropolitan Borough Council

Oldham Metropolitan Borough Council

Rochdale Borough Council*

NHS Bury Clinical Commissioning Group

NHS Heywood, Middleton and Rochdale Clinical Commissioning Group

NHS North Manchester Clinical Commissioning Group**

NHS Oldham Clinical Commissioning Group

Pennine Acute Hospitals NHS Trust

Pennine Care NHS Foundation Trust *Manchester City Council is an interested party to the SLG for the same period as NHS North Manchester CCG remains a member (see below). City Council representatives will receive copies of the meeting papers and may attend meetings at their discretion. **NHS North Manchester Clinical Commissioning Group is expected to be a full member of the SLG until North Manchester General Hospital becomes formally part of the single Manchester hospital service, expected to be in 2018-19. D. Objectives of the group The objectives of the SLG are as follows:

1. Receive, consider and provide strategic advice, comment and challenge on proposals for the transformation of health and social care

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services which affect the North East sector, especially in relation to Pennine Acute Hospitals NHS Trust but not limited to this organisation

2. Ensure effective alignment between transformation proposals arising

from providers, and the commissioning intentions and contract arrangements of commissioners

3. Support and shape the creation of effective, streamlined arrangements

for commissioning across the North East sector in those areas where it is agreed it is appropriate to do so, including but not limited to commissioning acute services from Pennine Acute Hospitals NHS Trust and commissioning acute mental health services

4. Support and shape the establishment of locality care organisations in

each borough, as agreed by local services and leaders, ensuring that there is strategic coherence between the development of locality care organisations and the provision of cross-sector services especially by sector-wide organisations

5. Act as the accountable body for any Greater Manchester

transformation funding which is provided to the sector as a whole (as opposed to its constituent localities)

6. Identify challenging issues, and strategic opportunities, which need

early consideration by elected members, Trust board(s) and governing bodies and ensure that appropriate briefing and engagement is secured in a timely way

7. Receive, consider and review details of major change programmes

across health and social care services in the North East sector, providing advice, guidance and challenge to SROS and executive leads alongside and complementary to the governance arrangements within each programme

8. Review adherence to agreed high-level timetables for change across

the North East sector, providing challenge and inquiry where key milestones slip and seeking assurance from relevant leads that slippage is being addressed or corrected

9. Ensure that individual organisation’s decision making supports, and is

aligned to and consistent with, agreed programmes of change across the sector, and that each member organisation as far as possible fulfils its range of commitments to sector-wide agreements as these are made

10. Review and challenge as appropriate the design and delivery of sector-

wide arrangements for commissioning and provision, including any establishment of a sector-wide commissioning and contracting team, the creation of any sector-wide funding arrangements, and the

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provision of sector-wide health and social care services, e.g., relevant services provided by Pennine Acute Hospitals NHS Trust

11. Maintain intelligence about, and ensure adherence to, the achievement

of the formally agreed outcomes of the Healthier Together transformation programme, acorss the sector

12. Demonstrate through values and behaviours a tangible commitment to

effective collaboration between health and social care organisations, commissioners and providers, in order to achieve the vision for health and care in the North East sector

E. Accountability and reporting The SLG will be accountable, through its individual members, to the Cabinets, Governing Bodies and Trust board, of its constituent members. The SLG will produce a report following each meeting for submission to each of these bodies. The SLG will provide reports at an agreed frequency to the Greater Manchester Health and Social Care Strategic Partnership Board. The SLG will provide reports to the North East sector Joint Health and Wellbeing Scrutiny Committee as required. F. Membership The membership of the SLG will consist of:

Bury Metropolitan Borough Council: Chief Executive

Oldham Metropolitan Borough Council: Chief Executive

Rochdale Borough Council: Chief Executive

NHS Bury Clinical Commissioning Group: Accountable Officer

NHS Heywood, Middleton and Rochdale Clinical Commissioning Group: Accountable Officer

NHS North Manchester Clinical Commissioning Group: Accountable Officer

NHS Oldham Clinical Commissioning Group: Accountable Officer

Pennine Acute Hospitals NHS Trust: Chief Executive plus 1 x executive director

Pennine Care NHS Foundation Trust: Chief Executive plus 1 x executive director

The SLG may co-opt, or invite one-off attendance from, relevant senior officers including Directors of Finance/Chief Finance Officers and Chief Operating Officers. G. Chairing

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The chair of the SLG will be selected by the membership for a 6-month period and will alternate between a Council Chief Executive and a CCG Accountable Officer. A vice-chair will be selected by the membership for the same 6-month period, and will be a Council Chief Executive where the chair is a CCG Accountable Officer, and a CCG Accountable Officer where the chair is a Council Chief Executive. H. Deputies Deputies who have been named in advance by members and who are empowered to act on behalf of the officer for whom they are deputising, may attend meetings. I. Administration Administration of the meeting will be undertaken by the office of the chair who currently occupies the role. J. Meeting arrangements Meetings will alternate across Council and NHS venues in the North East sector Papers for each meeting will be circulated no fewer than five clear working days ahead of each meeting Meetings will normally be held bi-monthly Meetings will be held in private, but the report produced of the proceedings of each meeting will be published K. Quoracy Meetings shall be quorate if there are present at least 2 Council representatives and 2 CCG representatives. L. Voting The SLG is not a decision-making body. It is not therefore anticipated that it will need to vote. Where there is a need, e.g., in relation to the selection of a chair, the voting members will be the representatives of the CCGs and Councils present. Equal voting numbers must be maintained so that, if all four CCGs are present and all three Councils are present, one CCG (selected at random) shall not vote on that occasion. The current chair will have a casting vote. M. Conflicts of interest

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The SLG shall maintain a register of interests and members will be required to declare any interest in any matter under discussion and may not be permitted to take part in the discussion. The SLG is not a decision-making body but nevertheless, conflicts of interest may arise in appearance as well as in fact. N. Task and finish and other groups The SLG may create task-and-finish groups and other such working groups as it judges necessary to achieve its purposes and objectives. Reports will be provided to the SLG by the North East Sector Health and Social Care Executive Group at each meeting. O. Review These terms of reference will be reviewed in November 2017. P. Approval These terms of reference were approved by the North East Sector health and Social Care Strategic Leadership Group on XXXX Signatures






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Pennine Acute Hospitals NHS Trust: Chief Executive

Pennine Care NHS Foundation Trust: Chief Executive

1

TERMS OF REFERENCE

North East Sector Health and Social Care Executive Group

Version 0.04

Status Draft

Approval Outstanding

Version control

7 December 2016 Amendments from Maggie Kufeldt, Jo Purcell and Simon Wootton incorporated.

2

TERMS OF REFERENCE

North East Sector Health and Social Care Executive Group A. Vision for the North East sector Health and social care organisations in the North East sector of Greater Manchester want to work together to

Support and enable local people to stay as healthy and well as possible

Commission and provide services which optimise prevention, early intervention, recovery and rehabilitation

Ensure that all services are safe, of high quality and which treat everyone with respect and dignity

Ensure that all services are sustainable in the long term, financially, clinically and in relation to their workforce

These goals will be achieved by:

Integrated health and social care services outside of the hospital, closely linked to primary care (the locality care organisation)

High quality and high performing acute hospital care for people who need it (including people with mental health problems)

Effective, streamlined commissioning arrangements which have single decision-making structures across the sector wherever necessary

Appropriate values and behaviours by all health and social care organisations and their staff

Effective programmes which support and enable thriving and resilient local communities

Establishing a clinically and financially sustainable future for the North East sector, in the context of a sustainable Greater Manchester health and social care system

B. Purpose of group The purposes of the North East Sector Health and Social Care Executive Group (EG) are to:

1. Design, obtain approval for, and operationalise the values, principles and frameworks by which health and social care services aill be commissioned and provided across the sector in a manner that is consistent with the expectations of the Greater Manchester Health and Social Care Strategic Partnership; the needs of the population of the North East sector and each area’s Locality Plan

2. Co-ordinate the development of strategies and plans across health and social care organisations within the sector to achieve the sector’s

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vision, e.g., through the development of a clinical strategy for Pennine Acute Hospitals NHS Trust

3. Ensure effective engagement and involvement of all relevant

stakeholders in the development and implementation of transformation programmes across the sector, identifying key issues and challenges in bring them to the attention of the Strategic Leadership Group

4. Co-ordinate the programme management of the complex programmes

of transformation across the North East sector, providing assurance that appropriate programme and change management arrangements are in place for all programmes which affect the sector as a whole.

5. Ensure that appropriate arrangements exist for the design and delivery

of sector-wide programmes of transformation including single commissioning arrangements for the sector, including engaging with staff and stakeholders. This work may include option identification and appraisal in the light of agreed outcomes and the availability of resources amongst organisations in the sector.

A. Scope The EG consists of the following organisational members:

Bury Metropolitan Borough Council

Oldham Metropolitan Borough Council

Rochdale Borough Council*

NHS Bury Clinical Commissioning Group

NHS Heywood, Middleton and Rochdale Clinical Commissioning Group

NHS North Manchester Clinical Commissioning Group**

NHS Oldham Clinical Commissioning Group

Pennine Care NHS Foundation Trust

Pennine Acute Hospitals NHS Trust *Manchester City Council is an interested party to the EG for the same period as NHS North Manchester CCG remains a member (see below). City Council representatives will receive copies of the meeting papers and may attend meetings at their discretion. **NHS North Manchester Clinical Commissioning Group is expected to be a full member of the EG until North Manchester General Hospital becomes formally part of the single Manchester hospital service, expected to be in 2018-19. The EG will replace the North East Sector Commissioning Board.

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D. Objectives of the group The objectives of the EG are as follows:

1. Ensure the effective design, approval and delivery of programmes for strategic change across health and social care services which affect the North East sector, especially in relation to Pennine Acute Hospitals NHS Trust but not limited to this organisation

2. Manage alignment between transformation proposals arising from

providers, and the commissioning intentions and contract arrangements of commissioners, overseeing the work of any single contracting and commissioning team for the sector, and the relevant contract management boards, e.g., for Pennine Acute Hospitals NHS Trust and Pennine Care NHS Foundation Trust

3. Design, obtain approval for, and delivery effective, streamlined

arrangements for commissioning across the North East sector in those areas where it is agreed it is appropriate to do so, including but not limited to commissioning acute services from Pennine Acute Hospitals NHS Trust and commissioning acute mental health services.

4. Specifically, to take the lead on the the establishment of a single

commissioning arrangement for cross-sector services, ensuring that the chosen arrangements optimise efficiency and effectiveness and are developed through appropriate staff and stakeholder engagement

5. Ensure the effective co-ordination of the establishment of locality care

organisations in each borough, as agreed by local services and leaders, ensuring that there is strategic coherence between the development of locality care organisations and the provision of cross-sector services especially by sector-wide organisations and especially that appropriate commissioning arrangements are in place between CCGs and Councils in respect of locality care organisations.

6. Support the Strategic Leadership Group in its work, especially in

identifying challenging issues, and strategic opportunities, which need early consideration by elected members, Trust board(s) and governing bodies and ensure that appropriate briefing and engagement is secured in a timely way

7. Initiate, design, obtain approval for and contribute to the co-ordination

of transformation programmes across health and social care services in the North East sector, complementary to the governance arrangements within each programme

8. Obtain assurance that the requirements of transformation programmes

as they relate to the sector as a whole are translated into contracts with appropriate performance and quality regimes, and that the terms of these contracts are fulfilled within the contract envelope in each case.

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9. Stimulate innovation across the North East sector at all levels, including service design and delivery, service experimentation and testing, and arrangements for contracting and commissioning

10. Manage and co-ordinate high-level timetables for change across the

North East sector, ensuring that the commitments made for the sector in Locality Plans and any transformation fund bid are delivered

11. Co-ordinate individual organisation’s decision making so that it

supports, and is aligned to and consistent with, agreed programmes of change across the sector, and that each member organisation as far as possible fulfils its range of commitments to sector-wide agreements as these are made

12. Design, obtain approval for and implement as appropriate sector-wide

arrangements for commissioning and provision, including any establishment of a sector-wide commissioning and contracting team, the creation of any sector-wide funding arrangements, and the provision of sector-wide health and social care services, e.g., relevant services provided by Pennine Acute Hospitals NHS Trust

13. Manage to the sector’s implementation of the formally agreed

outcomes of the Healthier Together transformation programme, working with the Healthier Together team as required

14. Demonstrate through values and behaviours a tangible commitment to

effective collaboration between health and social care organisations, commissioners and providers, in order to achieve the vision for health and care in the North East sector

E. Accountability and reporting The EG will be accountable to the Strategic Leadership Group, to which it will provide regular detailed reports. The EG will provide reports to the Cabinets, Governing Bodies and Boards of member organisations, as required. By exception, the EG will provide reports to Health Overview and Scrutiny Committees within the North East sector, and to the Joint Health Overview and Scrutiny Committee. F. Membership The membership of the EG will consist of:

Bury Metropolitan Borough Council: Executive Director, Adult Social Care

Oldham Metropolitan Borough Council: Executive Director of Health and Wellbeing

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Rochdale Borough Council: Executive Director, Adult Social Care

NHS Bury Clinical Commissioning Group: Director of Commissioning

NHS Heywood, Middleton and Rochdale Clinical Commissioning Group: Director of Commissioning

NHS North Manchester Clinical Commissioning Group: Chief Operating Officer

NHS Oldham Clinical Commissioning Group: Director of PErformacne and Delivery

Pennine Acute Hospitals NHS Trust: Executive Director of Operations and 1 other executive director

Pennine Care NHS Foundation Trust: Executive Director of Operations and 1 other executive director

The EG may co-opt, or invite one-off attendance from, relevant senior officers including Directors of Finance/Chief Finance Officers and Directors of Governance. G. Chairing The chair and vice-chair of the EG will be selected by Strategic Leadership Group (SLG); the chair will be a existing member of the SLG, the vice chair will be an existing member of the EG only. H. Deputies Deputies who have been named in advance by members and who are empowered to act on behalf of the officer for whom they are deputising, may attend meetings. I. Administration Administration of the meeting will be undertaken by the office of the chair who currently occupies the role. J. Meeting arrangements Meetings will alternate across Council and NHS venues in the North East sector Papers for each meeting will be circulated no fewer than three clear working days ahead of each meeting Meetings will normally be held monthly Meetings will be held in private.

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K. Quoracy Meetings shall be quorate if there are present at least 2 Council representatives and 2 CCG representatives. L. Voting The EG is not a decision-making body. It is not therefore anticipated that it will need to vote. When and if there is a need, the voting members will be the representatives of the CCGs and Councils present. Equal voting numbers must be maintained so that, if all four CCGs are present and all three Councils are present, one CCG (selected at random) shall not vote on that occasion. The current chair will have a casting vote. M. Conflicts of interest The EG shall maintain a register of interests and members will be required to declare any interest in any matter under discussion and may not be permitted to take part in the discussion. The EG is not a decision-making body but nevertheless, conflicts of interest may arise in appearance as well as in fact. N. Task and finish and other groups The EG may create task-and-finish groups and other such working groups as it judges necessary to achieve its purposes and objectives. O. Review These terms of reference will be reviewed in November 2017. P. Approval These terms of reference were approved by the North East Sector health and Social Care Strategic Leadership Group on XXXX Signatures




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Pennine Acute Hospitals NHS Trust: Chief Executive

Pennine Care NHS Foundation Trust: Chief Executive

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GREATER MANCHESTER HEALTH AND SOCIAL CARE …