Terms of Reference – Clinical Cabinet
The Clinical Cabinet (the Committee) is established in accordance with NHS Bury’s Clinical
Commissioning Group’s constitution, standing orders and scheme of delegation. These terms of
reference set out the membership, remit, responsibilities and reporting arrangements of the committee
and shall have effect as if incorporated into the clinical commissioning group’s constitution and standing
orders.
Terms of Reference
Introduction
This paper sets out the context for the establishment of the Committee as a formal
subcommittee of the NHS Bury Clinical Commissioning Group Governing Body.
All Committee functions will be determined by the Vision and Values of the NHS Bury Clinical
Commissioning Group.
Purpose of the subgroup
The Committee has been established as a subcommittee of the NHS Bury Clinical
Commissioning Group Governing Body. Its members will be active leaders of change, to set the
NHS Bury Clinical Commissioning Group’s Clinical Strategy and ensure that NHS Bury Clinical
Commissioning Group delivers high quality health care whilst remaining in financial balance and
ensure appropriate links to the wider Primary Care Regulatory function. e.g. NHS England.
To enable the Committee to carry-out its purpose and duties as stated below the Committee
may delegate some of its activities to agreed subgroups which will report directly to the
Committee. The delegation of these duties does not extend to the delegation of responsibility
and accountability.
Membership
All members will be voting members. The members are:
Chair / Vice Chair
Chair: – Clinical Board Member, Sector Lead or Clinical Workstream Lead
Vice Chair: Clinical Member of the Clinical Cabinet
In extraordinary circumstances, conflicts of interest may require a non clinician to
chair all, or part of, a meeting
Clinical Work stream Leads
Clinical Work stream Lead – Mental Heath
Clinical Work stream Lead – IM&T
Clinical Work stream Lead – Women’s and Children’s
Clinical Work stream Lead – Urgent Care
Clinical Work stream Lead – Long Term Conditions
Clinical Work stream Lead – Medicines Management
Clinical Work stream Lead – Cancer and Palliative Care
Clinical Workstream Lead – Learning Disabilities
Clinical Workstream Lead – Elective Care
Other Clinical Workstream Leads as appointed, at Cabinet’s discretion
Other Members
Practice Nurse Representative
Practice Manager Representative
Local Authority Representative
Public Health Representative
CCG Chief Finance Officer or nominated representative
CCG Sector Leads x2
CCG Head of Commissioning or nominated representative
Patient Cabinet Chair or nominated deputy
Cabinet Advisors (non-voting)
Providers delivering 5% of CCG turnover will be invited to nominate two
representatives (currently these are Pennine Acute Hospital Representative and
Pennine Care Foundation Trust Representative)
Providers delivering healthcare services within Bury equivalent to 2% of CCG
turnover will be permitted one representative
Clinical Commissioning Group – Chair
Clinical Commissioning Group - Chief Officer
Other advisory members will be invited as and when required for relevant agenda items.
Quorum
The quorum will be:
Seven members, four of whom are clinical members of the committee.
Frequency and notice of meetings
The Committee will meet monthly. If the Committee needs to discuss matters of a confidential
nature, then these will be considered in a private ’part 2’ session. The agenda for each meeting
will be sent to members at least five days before the meeting and supporting papers, whenever
possible shall accompany the agenda, but will certainly be dispatched no later than three days
before the meeting. Emergency items can be introduced outside these timescales at the
Committee Chair’s discretion (includes Vice Chair if the Chair is unable to attend).
Remit and responsibilities of the Committee
Clinical Leadership
The Committee has been established to ensure clinical leadership is at the heart of all
decisions about patient care and services. Its members will be active leaders of change,
to ensure that Clinical Commissioning Group commissions high quality integrated
services whilst remaining in financial balance.
Work stream leads have been appointed for priority areas and they alongside the Local
Authority, Providers and Patient Cabinet are responsible for setting the NHS Bury
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Clinical Commissioning Group Clinical Strategy in line with the Health and Wellbeing
Strategy for Bury.
Each Clinical Work stream lead, with managerial support, has established a clinical work
stream group. These are responsible for cross organisational engagement to deliver
service redesign, quality improvement, Health and Wellbeing, QIPP, Performance
Improvement and integration across organisations.
More details on the structure of these groups can be found in Appendix 1
Delegated Financial Responsibilities
Ensure assurances can be given on the value for money delivered by the NHS
Bury Clinical Commissioning Group in line with external regulation and within the
Governing Body’s financial envelope
Make decisions in relation to investment plans/disinvestment/re-prioritised spend
where the annual financial value is £250k and below and, above that figure,
make recommendations to the Governing Body
Delegated Clinical Responsibilities
Develop NHS Bury Clinical Commissioning Group’s Commissioning Intentions and
Strategic Plan
Approve the design and re-design of services commissioned by NHS Bury Clinical
Commissioning Group
Support Clinical Leads in considering opportunities for service redesign
Ensure that clinical workstreams have sufficient support to understand and
monitor current performance
Comment on strategies and pathways of partner organisation and assist in their
service redesign, as appropriate
Minutes of Meeting
Minutes of all meetings will be recorded and minutes circulated to CCG Governing Body
Other Matters
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These Terms of Reference, membership and performance will be reviewed on an annual basis
and will require approval by the Governing Body if any changes are made.
Quality and Performance:The Committee will:
Provide advice and guidance to the Quality and Risk Committee, programme leads and
sector leads with regard to performance concerns
Support the production of local development and training plans for individual practices, and
practice level interventions when performance is in question
Where appropriate, review and report on local trends in performance concerns relating to
the Inter Practice Agreement in their specialist area
Advise on the development of the strategic vision for patient safety and quality
Ensure that quality is at the heart of commissioning and reform programmes
Ensure that priority is given to patient experience in line with local, regional and national
priorities
Ensure that NHS Bury Clinical Commissioning Group complies with the CQC standards
relating to the quality of care
Ensure that NHS Bury Clinical Commissioning Group complies with their duties under the
Equality and Human Rights act (see below)
Hold Clinical Programmes to account for delivery via the Clinical Work stream leads, to
ensure delivery of clinical objectives, value for money, risks and opportunities are being
managed
Ensure commissioning intentions and contracts are negotiated and executed in line with
NHS Bury Clinical Commissioning Group intentions
Ensure services commissioned have appropriate safeguarding arrangements in place.
Review issues log from sector meetings to ensure actions are being appropriately escalated
or closed
Ensure the Communication and Engagement Strategy is met when making decisions about
patient care and services
Risk Management:The Committee will:
Ensure areas of risk have associated robust prevention and mitigation strategies in place.
Escalating any risks rated over 12 to the Quality and Risk Committee.
Equality and Non-Discrimination:NHS Bury Clinical Commissioning Group has a responsibility not to discriminate, promote
equality of opportunity and pay particular attention to groups or sections of society where
improvements in health and life expectancy are not keeping pace with the rest of the
population. As part of these legal requirements and principles of the NHS Constitution1,
NHS Bury Clinical Commissioning Group will carry out equality impact assessments to take
account of its diverse population and to ensure that no groups are adversely affected. Bury
1
https://www.gov.uk/government/publications/the-nhs-constitution-for-england
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CCG will also ensure that easily accessible information is available to all.
Member, Patient and Public Engagement:NHS Bury Clinical Commissioning Group has a duty to involve members, patients and the
public, whether by consulting or by other means in developing and improving services and
any proposals for change.
NHS Bury Clinical Commissioning Group will consult with Bury Local Authority through the
local Health Overview and Scrutiny Committee, Healthwatch and the Health and Wellbeing
Board when the redesign process identifies any proposal for a substantial development of
the health service or any substantial variation in the provision of such service that will trigger
the legal duty to consult.2
NHS Bury Clinical Commissioning Group is committed to actively engaging with Bury’s
patients and local population. In particular this will assist in identifying areas where health
needs are not being adequately met and where there is scope for improvement of services.
Service users should also inform the shape of planned changes to provision.
Engagement will be ongoing through stakeholder events.
Register of Interests:Members of the Committee will declare any conflicts of interest.
The NHS Bury Clinical Commissioning Group has a duty to publish registers which will be
published on the group’s website
Individuals will declare any interest that they have, in relation to a decision to be made in
the exercise of the commissioning functions of the group, in writing to the governing body,
as soon as they are aware of it and in any event no later than 28 days after becoming
aware
Where an individual is unable to provide a declaration in writing, for example, if a conflict
becomes apparent in the course of a meeting, they will make an oral declaration before
witnesses, and provide a written declaration as soon as possible thereafter.
The Governing Body will ensure that the register(s) of interest is reviewed every 3 months
and updated as necessary.
Interests previously declared that affect, or may affect an individual’s ability to perform a role
or inform a discussion must be restated and the Chair will decide whether an appropriate
action which may include being excluded from relevant parts of the meeting or may join in
the discussion or answer questions but not participate in the decision making itself. The
decision of the Chair will be minuted.
Reference to key policies:NHS Bury Clinical Commissioning Group Conflicts of Interest Policy
NHS Bury Clinical Commissioning Group Standards of Business Conduct
NHS Bury Clinical Commissioning Group Communication and Engagement Strategy
NHS Bury Clinical Commissioning Group Equality and Human Rights Strategy
NHS Bury Clinical Commissioning Group Clinical Quality Strategy
Other policies: http://www.buryccg.nhs.uk/your-local-nhs/Our-plans/Policies.aspx
2
CCGs have a duty to consult their local authority under Regulation 23(1) of The Local Authority (Public Health, Health and Wellbeing Boards
and Health Scrutiny) Regulations 2013.
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Relationship with the Governing Body
The Clinical Cabinet is a subcommittee of NHS Bury Clinical Commissioning Group
Governing Body.
The IM&T Steering Group is a sub group of the Cabinet and maintains links with the
Committee the IM&T Clinical Lead.
The PMO supports the Committee to ensure efficient working. Committee agenda papers
should be prepared two weeks before meetings and be considered by the PMO technical
group to ensure completeness of information and strategic fit. This group will then facilitate
implementation of the Committee decisions
The Committee maintains links with the Patient Cabinet, Procurement Committee, Quality
and Risk Committee (See appendix 1)
NHS Bury CCG Governing Body approved: [Insert Date]
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Appendix 1