NHS HMR Clinical Commissioning Group (CCG) Governing Body
Quality and Safety Committee
Terms of Reference
January 2015
1. Introduction
The Quality and Safety Committee (the Committee) is established in accordance with NHS Heywood,
Middleton and Rochdale Clinical Commissioning Group (NHS HMR CCG)’s constitution, standing
orders and scheme of delegation. These terms of reference set out the membership, remit and
responsibilities and reporting arrangements of the committee and shall have effect as if incorporated
into the CCG’s constitution and standing orders.
2. Purpose of the Committee
The Committee will promote and assure quality so that patients have effective and safe care and a
positive experience of services commissioned by the CCG.
The Quality and Safety Committee is responsible for the development and implementation of the NHS
HMR CCG’s Commissioning for Quality Framework, which sets out its strategy for quality
improvement and quality assurance of commissioned services.
The committee will also work in collaboration with the Clinical Commissioning Committee ,the Patient
Experience Assurance Committee and the Finance Performance and Risk Committee to provide
assurance that commissioned services are delivered with due regard to patient safety, quality,
effectiveness and best practice, and excellent patient experience.
3. Objectives of the Committee
The Quality and Safety Committee will:
Ensure that the CCG Commissioning for Quality Framework is developed and implemented so as to
support the NHS HMR CCG Commissioning Strategy. In doing so, the Committee will seek assurance
that CCG commissioning incorporates and upholds the tenets of quality (patient safety, experience
and clinical effectiveness), that the quality priorities within the Operating Framework and
recommendations for the National Quality Board are met.
Provide assurance to the Governing Body that quality assurance and clinical governance
mechanisms are integral to monitoring commissioned services to ensure better outcomes for patients.
Ensure that the QIPP programme does not compromise patient safety and quality, and that it leads to
improvements in productivity and prevention through innovation, and also to provide assurance that
patient safety is paramount in all commissioning and decommissioning decisions.
Oversee processes concerning Never Events, Investigation of Serious untoward incidents (SUIs),
management of risk and subsequent compliance, informing the governing body of any escalation or
sensitive issues in good time.
Ensure investigation recommendations, including organisational learning process are actioned in
order to reduce the risk of recurrence within commissioned services.
Oversee the development and monitoring of quality indicators and metrics within commissioned
services and seek assurance of implementation through quality schedules.
Oversee the development and monitoring of CQUIN schemes and other incentive schemes to
promote quality improvement in commissioned services.
Oversee safeguarding arrangements to assure that the CCG‘s statutory responsibilities for
safeguarding children and vulnerable adults are met, and that the CCG fulfils its role as a member of
Local Safeguarding Boards.
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Receive assurance reports in relation to safeguarding children and vulnerable adults that identify
areas of compliance, themes and trends, and recommend areas for change through the
commissioning process. The Committee will task the HMR Safeguarding team to investigate or
address issues or areas of concern identified by the Committee. Where necessary the Committee will
escalate concerns through the Local Safeguarding Boards.
Receive assurance reports in relation to key providers, Acute, Community, Mental Health and
Independent Sector that identify areas of risk, compliance, themes and trends, and recommend areas
for change through the commissioning process.
Receive reports relating to Healthcare Associated Infections to provide the Committee with assurance
that all commissioned services are compliant with statutory regulations.
Receive reports relating to patient experience, including PALS and complaints, and surveys that
identify themes and trends and recommend areas for change through the commissioning process.
Review and provide commissioner response to provider annual Quality Accounts
Advise the Governing Body on actions required following national enquiries, national and local
reviews undertaken by external agencies (e.g. Care Quality Commission) in relation to commissioned
services and oversee the performance management of recommendations implementation.
Ensure a clear escalation process, including trigger points, is in place to enable appropriate
engagement of external bodies (e.g. National Reporting and Learning System, National
Commissioning Board, CQC) on areas of concern in commissioned services.
Seek assurance on the performance of commissioned services with regard to regulatory requirements
in relation to quality and safety, e.g. CQC, Monitor, NICE recommendations/guidelines.
Promote research and development within commissioned services and seek assurance of robust
research governance that is in accordance with the Research Governance Framework.
Maintain an oversight of transitional arrangements as determined by the National Quality Board to
ensure robust handover processes between organisations and in doing so safeguarding quality of
care.
Review reports from CCG conducted Provider visits, ensuring recommendations and appropriate
actions have been acted upon.
Receive reports from each CCG Locality, (Rochdale West, Rochdale East and Heywood and
Middleton) via CCG locality members (3), capturing real time information in relation to Quality of
services commissioned, Safeguarding and Patient Experience.
Review the Integrated Risk Management Strategy / Framework, Integrated Risk Management Policy
and associated documents to ensure objectives are achieved. Provide a quarterly risk report to the
Governing Body.
Oversee the management of policies; approve new and revised policies on behalf of the Governing
Body.
Review performance reports and oversee work streams relating to quality and safety provided by the
Commissioning Support Unit (CSU).
4. Membership
Membership will comprise:
 CCG Director of Quality and Safety /Executive Nurse (Chair)
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 CCG Governing Body member- clinical governance
 Quality and Safety Lead
 CCG Head of Operations and Engagement
 Healthwatch representative
 CCG locality clinical members (3)
 Patient Experience and Engagement Lead
Co-opted members may include, for example:
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Clinical representatives from commissioned services
Local Authority quality representation
CCG Governing Body Lay member
CCG Chief Officer
5. Quorum
The quorum will be a third of all members with at least two of those being members of the governing
body.
Additional members may be co-opted to contribute to specialised areas of discussion.
Fully briefed deputies with relevant decision making authority shall be permitted, where necessary,
with agreement of the chair.
All Committee members should attend at least four of the six meetings annually.
6. Frequency of Meetings
The Committee will meet every two months. The agenda for the meeting will be drawn up by the CCG
Executive Nurse. The agenda and papers will be distributed five working days in advance of the
meeting, unless there are exceptional circumstances for individual papers.
7. Conflicts of Interest
An up to date register of members’ interest will be retained. Members will be expected to declare any
conflicts of interest at all meetings and the Chair will determine how any conflict will be handled in line
with CCG guidelines.
8. Accountability
The Quality and Safety Committee is a committee of the Governing Body and is accountable to it. The
Committee shall report to the governing body bimonthly.
Reporting Groups
Minutes or updates from the following groups are reported through the Quality and Safety
Committee:
a) Infection Prevention & Control Operational Group
b) Rochdale Borough Safeguarding Children’s Board
c) Rochdale Borough Safeguarding Adults Board
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‘Part 2’ sessions
If the Committee needs to discuss matters of a confidential nature, the chair may convene a private
‘part 2’ session of the meeting. This may include for example, complaints and serious untoward
incidents.
9. Review Date
The Terms of Reference will be reviewed on an annual basis. Date of next review: November 2015.
10. Secretarial Support
Secretarial support will be provided to support the Chair in the management of the Committee’s
business and the collation and distribution of papers.
11. Conduct of Committee
The committee will assess its performance annually against the objectives as set out in the Terms of
Reference and report this to Governing Body.
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