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1 - Yorkshire and the Humber SCG


									                                                                  Enclosure E3


                         2010/11 – 2013/14

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Section                                                           Page

1      Background Information                                        3

2      Context to Specialised Commissioning                          4

3      How the Specialised Commissioning Group is organised and      5

4      The Specialised Commissioning Team                            6

5      Organisational Development: Journey to Date                   7

       5.1     Progress so far
       5.2     SCG Board Governance & Development
       5.3     Development of SCT resources and processes
       5.4     Self-assessment against National Specialised
               Commissioning Competencies

6      SCG Organisational Development: Goals & Initiatives          11

       6.1 Enabling Mechanism and Approaches

7      Performance Management                                       14

8      Implementation Plan                                          14

1      NHS Barnsley Organisation Development Strategy               23

2      NHS Barnsley Milestone Summary with “SCG-applicable”         44
       milestone highlighted

3      SCG Establishment Agreement                                  47

4      Scheme of Delegation                                         57

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                       SCG Organisational Development Vision

To achieve excellence in commissioning supported by the right culture,
capacity, capability and organisational processes, within an
organisation that supports and values staff.

This strategy sets out the context, journey to date, and specific
objectives in relation to delivery of the above vision.

1. Background Information

The SCG Organisational Development (OD) Strategy builds on our existing
work and is designed to ensure delivery of the national specialised
commissioning standards and the SCG Commissioning Strategy. Diagnosis of
our developments to date and future needs has been identified through self-
assessment (and confirm and challenge) against the national specialised
commissioning competencies, which mirror the PCTs’ World Class
Commissioning Competencies; and also a number of team time-out sessions.
These methods have allowed a multi-dimensional understanding of the areas
that need to be addressed within the OD agenda going forward.

This strategy is two-fold, as it deals with the entity that is the Specialised
Commissioning Group (SCG), made up of the 14 Primary Care Trusts in
Yorkshire & Humber, and also the development of the Specialised
Commissioning Team (SCT), the dedicated resource allocated to
commissioning of specialised services. The two need to be addressed in
bespoke ways, but cannot be seen separately from each other.

NHS Barnsley is host to the SCG and SCT, and has set up governance and
commissioning infrastructure to take account of the requirements of
specialised services in both capacity and capability terms. Throughout NHS
Barnsley’s OD Strategy, the organisational development needs of specialized
commissioning functions are reflected in the arrangements. Therefore the
SCG OD Strategy concentrates solely on the organisational development
needs that are bespoke to specialised commissioning, avoiding duplication of
the content within the host PCT’s own strategy. NHS Barnsley’s OD strategy
is therefore appended to the SCG strategy, to serve as explicit clarity that the
two should be seen in conjunction with each other; and the elements of NHS
Barnsley’s Implementation Plan that are specifically applicable to the SCG
and therefore underpin the SCG strategy, are highlighted at Appendix B. The
content of this SCG OD Strategy does not repeat or expand on these
elements, which can be considered in full within the appendices of NHS
Barnsley’s documentation.

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2. Context to specialised commissioning

Specialised services are those services provided in relatively few specialist
centres to catchment populations of more than 1 million people. These
services are not provided by every hospital, and tend to be found in larger
hospitals based in big towns and cities. In Yorkshire and the Humber, there
are three tertiary centres which are responsible for providing the majority of
specialised services, over a regional population of approximately 5 million. It
is estimated that specialised services account for about 10% of total PCT
expenditure on hospital services.

Specialised services are services where patient numbers are small and a
critical mass of patients is needed in treatment centres to:

       achieve the best outcomes and maintain clinical competence
       sustain the training of specialist staff
       ensure cost-effectiveness in provision
       make the best use of scarce resources (including staff expertise, high
        tech’ equipment, and donor organs)

Specialised services are high-cost, low-volume interventions and treatments.
The risk to an individual Primary Care Trust (PCT) of having to fund
expensive, unpredictable activity is reduced by PCTs grouping together to
commission such services collectively and share financial risk. PCTs therefore
group together to commission and share high cost, low volume specialised
services. The spend of the 14 Yorkshire and Humber PCTs on specialised
services overall is approx £600 million.

Therefore it is recognised that specialised services have unique
characteristics within the healthcare system at large. Similarly, effective
commissioning of these services requires unique skills and capabilities within
the regional SCT, and particularly strong governance and engagement
functions to be delivered by the SCG as a whole. Capability is required to deal
with the following issues, identified in the SCG & SCT time-outs held to date:

    -   Ownership of the SCG as an integral part of the 14 PCTs, not an arms-
        length entity
    -   the process for SCG decision making, and how to protect the interests
        and differing paces of change of individual PCTs within a regional
    -   maintaining the context of efficiency and VFM in the face of a national
        “must-be-done” ethos
    -   the need for clarity of roles and responsibilities where interfaces
        between specialised and non-specialised elements of pathways are
        inseparable, particularly regarding services supported by clinical
    -   focusing a finite regional resource to ensure delivery of Y&H priorities,
        versus the national direction to increase numbers of specialised
        services regionally commissioned
    -   establishment of SCT common aims and goals, across the diversity of
        services commissioned

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3. How the Specialised Commissioning Group is organised and

The SCG is established as a joint sub-committee of each of the Boards of
Primary Care Trust (PCT) Members in accordance with Regulations 9 and 10
of the National Health Service (functions of Strategic Health Authorities and
Primary Care Trusts and administrative arrangements) (England) Regulations

The SCG Establishment Agreement and Scheme of Delegation are

Each PCT is a member of the SCG through their Chief Executive or a named
deputy who is a member of the Executive Team.

The Board is chaired by the Chief Executive of NHS Barnsley.

Board Members

Ailsa Claire (Chair)                NHS Barnsley

Simon Morritt                       Bradford And Airedale Teaching PCT

Chris Stainforth                    NHS Doncaster

Andy Buck                           Rotherham PCT

David Cockayne                      NHS North Yorkshire and York

Ivan Ellul                          NHS East Riding of Yorkshire

Jan Sobieraj                        NHS Sheffield

Mike Potts                          NHS Kirklees

Steve Wainwright                    NHS Barnsley

Philomena Corrigan                  NHS Leeds

Maddy Ruff                          NHS Hull

Rob Webster                         NHS Calderdale

Caroline Briggs                     NHS North Lincolnshire

Sue Rogerson                        North East Lincolnshire CTP

Ann Ballarini                       NHS Wakefield District

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4. The Specialised Commissioning Team (SCT)

The work of the Yorkshire and the Humber SCG is delivered by a multi-disciplinary specialised commissioning team organised in sub-teams as shown below. NHS
Barnsley has the overall responsibility for the employment of staff and ensuring that all the arrangements are ‘fit for purpose’. All decision-making is supported by the
SCG Establishment Agreement (Appendix C).

                                                YORKSHIRE & THE HUMBER SPECIALISED COMMISSIONING GROUP

                                                                                        SCG Directors
     Support services
                                                                                   (Commissioning & Finance)
     from NHS
                                                                                            Executive Team
     Performance                                                                                                                                                  SCG
     Quality &                                                                                                                                                    Business
     Governance                                                                                                                                                   Manager
     Payroll                                 Secure Mental                      Acute                      Finance               Public Health
     HR                                      Health                             Commissioning              Team                  Team
     Information                             Commissioning                      Team
     Estate                                  Team

                                          Doncaster Admin Team                                        Barnsley Admin Team

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5. Organisational Development Journey to date

5.1 Progress so far

Since the Yorkshire & Humber SCG was formally created on 1 May 2007, a
wealth of achievements have been realized, which should be recognized as a
platform for this strategy to build upon. These include the following:

     The Establishment Agreement and Scheme of Delegation for SCG
      itself has been signed off by each of the 14 PCT Boards, which
      provides the framework for regional decision-making.
     Capacity and capability has been built within the SCT, via complex and
      challenging TUPE processes as well as external recruitment
     Where appropriate, corporate functions have been formally
      commissioned from the host PCT, to avoid duplication and maximize
      opportunities provided by NHS Barnsley’s organisational readiness in
      certain areas including PPI, performance monitoring and information
     Relationships have been strengthened with local sub-regional
      commissioning structures, and also through the development of a
      regional SCG finance network.
     The commissioning of numerous specialised services has been
      transferred to SCG, which is already realizing benefits in a number of
      areas, and there is a clear work programme for SCG going forward.
     Governance structures have been developed with the appointment of 3
      formally delegated SCG sub-groups, to streamline decision-making
      with regard to Clinical Standards, Performance Monitoring, and
     A regional SCG PPI Steering Group has been established to oversee
      the delivery of the SCG PPI Strategy

The progress made so far therefore serves as a robust foundation for further
organisational development, and allows this strategy to be aspirational and
ambitious in view of what has already been achieved.

5.2 SCG Board Governance and Development

The overall consensus is that the concept of SCG is indisputably valuable,
and the SCT needs to be able to realize the full potential of this and translate
it into tangible benefits for the whole health economy. There is recognition that
there is a considerable way to go before this is achieved, but also a growing
sense that it is increasingly a priority, in view of the current economic and
health challenges. In order to deliver, there is a need for clarity about SCG’s
role versus that of the local PCT, and about the routes for commissioning
decisions which span across a pathway and therefore affect both specialised
and non-specialised services. The landscape of commissioning infrastructure
is increasingly complex, and the SCG has a clear role in interpreting and
rationalizing this to avoid confusion and duplication, whilst still maintaining
robust governance.
Board time-outs and discussions held on this subject to date have highlighted
a number of key issues, including:

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    -   Ownership of the SCG as an integral part of the PCTs, not an arms-
        length entity
    -   A requirement for increased transparency and effectiveness of SCG
        decision making,
    -   recognition of the differing pace of change across PCTs
    -   the creation and handling of a disinvestment strategy for specialised
    -   credibility and robustness of SCT horizon scanning and prioritisation
    -   regularity of contract monitoring, review, and feedback
    -   context of efficiency and VFM against national “must-be-done” ethos

Additionally, specific requirements to develop the Quality, Innovation,
Productivity and Prevention (QIPP) programme for specialised services have
further identified issues to be addressed within the OD strategy, including the
joint approach required between SCT and on other parts of the system in
order to complete robust QIPP proposals; the need to focus SCT resource
effectively; and the need for an overall decision-making framework for
specialised services within which to prioritise objectives and proposals.

The actions described later within this strategy under the respective element
headings are intended to drive forward the above issues, and facilitate
achievement of the following success criteria in relation to Board development
(created by the Board in April 2010)

    1. SCG discharges its duty as a delegated Joint Committee of PCT
       Boards with the appropriate degree of public scrutiny and non-
       executive challenge
    2. The formal sub-groups which are accountable to SCG are empowered
       to act in such a way that the decision-making process at SCG is
       centred on gaining assurance on due process rather than debating the
       content of the proposal
    3. SCG Board is supported by an Executive Function, which is
       empowered to further streamline decision-making processes thereby
       allowing SCG Board to focus on strategic issues

Underpinning all of the above is the need for strong and clear communication
channels between SCT and all the sub-tiers of PCT organisations, to ensure
that SCG Board does not become, by default, a forum for information sharing.
This is incumbent on SCG, SCT and the PCTs to deliver improved
communication processes and interfaces across all parts of the system.

5.3 Development of SCT resources and processes

The second strand to this strategy is concerned with the development
requirements of the SCT as a team, and the way it operates within systems
and processes to deliver the expectations of the SCG Board. A number of
time-outs have been held within the SCT to give consideration to the recent
developments to SCG and SCT, the challenges faced, and some of the
changes to internal processes and behaviours required in order to deliver the
expectations of the wider system in the future. The following needs were

        Greater, more visible leadership within the SCT

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        Role clarity throughout all levels of the team
        Definition of steps required to take forward change and improvement
        Embedded, systemic commitment to continuously review and develop
         the team
        Priority given to increasing information analyst skills & resource for
         SCT, to building commissioning intelligence

The outputs of the time-outs have been structured around the definition of
relationships, both internal and external, in terms of desired outcome, mindset
required, and action to take. Table 1 shows the relationships that were
identified as priorities for focus, and the strategic “mindsets” that are agreed in
order to take them forward.

Table 1: Relationships and Mindsets
Relationship between:               Mindset Agreed:
SCT & Host PCT                      SCT needs its own identity, supported
                                    not defined by the host PCT

Internal sub-teams within SCT We are all one team, with a common
(Secure Mental Health, Finance, goal
Admin, Commissioning Leads)

SCT/SCG & NORCOM                                     NORCOM and SCG have equal
                                                     importance to those members of staff
                                                     paid for and involved in both
                                                     agendas; however separate identities
                                                     need to be established supported by
                                                     appropriate resources

SCT & Clinical Networks                              Clinical networks are enablers of
                                                     effective commissioning, and network
                                                     managers within the SCT are

SCT     and    PCTs,    consequently SCT adds value to PCTs, and is a
contributing to the strengthening of unique source of expertise; mutual
SCG as a whole                       respect should be the cornerstone of
                                     the relationship

A number of actions were also identified to progress and strengthen the
above prioritised relationships, which are incorporated within the action plan
of this strategy.

5.4 Self-Assessment against National Specialised Commissioning

Another important tool in developing this strategy has been the self-
assessment of the SCT against the national specialised commissioning
competencies. This exercise has been invaluable in identifying strengths and
weaknesses, quantifying gaps and creating a focus on actions for
improvement. Definitive national guidance was released in September, upon
which the SCT based their internal self-assessment, and subsequent confirm
and challenge from a delegated group of SCG Board. The scores against

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     each sub-competency are summarised in Table 2, with the full rationale for
     each score having undergone the scrutiny as described above.

     Table 2: Outcome of Assessment against National Specialised
     Commissioning Competencies

COMPETENCY                           MEASURE                                                               SCORE
1. Are recognised as the             1 (a) Reputation as the regional leader of commissioning for          LEVEL 2
regional leader for the              specialised services
commissioning of specialised         1(b) Reputation as a change leader for regional organisations         LEVEL 3
                                     1 (c) Reputation as an active and effective partner                   LEVEL 1
2. Work collaboratively with         2 (a) Creation of regional level commissioning plan for               LEVEL 2
community partners to                specialised services based on join needs
commission services that             2 (b) Ability to conduct constructive partnerships                    LEVEL 2
optimise health gains and
reduce health inequalities and       2 (c) Reputation as an active and effective partner                   LEVEL 2
deliver increased productivity
3. Proactively build                 3 (a) Support for PCT influencing of relevant local health            LEVEL 1
continuous and meaningful            opinions and aspirations
engagement with the public           3 (b) Public and patient engagement                                   LEVEL 2
and patients to shape service        3 (c) Improvement of patient experience                               LEVEL 1
and improve health
4. Conduct continuous and            4 (a) Clinical Engagement                                             LEVEL 3
meaningful engagement of all         4 (b) Dissemination of information to support clinical decision       LEVEL 1
clinicians to inform strategy
and drive quality, service
design and efficient and             4 (c) Reputation as leader of clinical engagement                     LEVEL 3
effective use of resources
5. Manage knowledge and              5 (a) Analytical skills and insights                                  LEVEL 2
undertake robust and regular
                                     5 (b) Understanding of health needs and trends                        LEVEL 1
needs assessments that
establish a full understanding       5 (c) Use of health needs benchmarks                                  LEVEL 2
of current and future local
health needs and
6. Prioritise investment of all      6 (a) Predictive modelling skills and insights to understand the      LEVEL 1
spend in line with different         impact of changing needs on demand
financial scenarios and              6 (b) Prioritisation of investment and disinvestment to improve       LEVEL 2
accordingly to local needs,          population’s health
service requirements and the
values of the NHS                    6 (c) Incorporation of priorities into strategic investment plan to   LEVEL 1
                                     reflect different financial scenarios
7. Effectively simulate the          7 (a) Knowledge of current and future provider capacity and           LEVEL 1
market to meet demand and            capability
secure required clinical and         (b) Alignment of provider capacity with health needs                  LEVEL 1
health and wellbeing                 projections
outcomes                             7 (c) Creation of effective choices for patients                      LEVEL 1
8. Promote and specify               8(a) Identification of improvement opportunities                      LEVEL 2
improvements in quality (eg
CQUIN, IQI) and outcomes             8(b) Implementation of improvement initiatives                        LEVEL 2
through clinical and provider
                                     8(c) Collection of quality and outcome information                    LEVEL 1
9. Secure procurement skills         9(a) Understanding of providers economics                             LEVEL 1
that ensure robust and viable        9(b) Negotiation of contracts around defined variables                LEVEL 2
                                     9(c) Creation of robust contracts based on outcomes                   LEVEL 2
10. Effectively manage               10(a) Use of performance information                                  LEVEL 2
systems and work in                  (b) Implementation of regular provider performance                    LEVEL 2
partnership with providers to        discussions
ensure contract compliance
                                     10(c) Resolution of ongoing contractual issues                        LEVEL 2
and continuous improvement
in quality and outcomes and
value for money
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The results of the assessment show that overall strengths of SCG lie in its
ability to lead and implement change, and its success in robust clinical
engagement and leadership within this. Key weaknesses include lack of
embedded PPI processes, information management systems and
infrastructure, and low levels of market management and stimulation. The
action plan within this strategy takes forward these issues, and each set of
actions is cross-referenced with the relevant competency that it addresses.
These actions will be updated and refreshed on an ongoing basis, the first
update to include the outcome of external panel scrutiny of the SCG’s
assessment and strategic plans, due in July 2010.

6.SCG Organisational Development: Goals & Initiatives

To address the requirements highlighted by the above insights into the SCG
and SCT’s development journey to date, the following goal and supporting
elements have been developed.

The goal of the SCG Organisational Development strategy, adopted from the
NHS Barnsley Strategy, is:

Excellence in commissioning supported by the right culture, capacity,
capability and organisational processes, within an organisation that
supports and values staff.

This is supported by the following elements, which are also adopted from the
NHS Barnsley Strategy in order to align the OD activities with those of the
host PCT to ensure mutual benefit and avoid contradictions:

Leadership & Clinical Engagement
Building on the leadership capability of SCG, its staff, managers, leaders and
clinicians, this element is predicated on the development of the SCG Board. It
is necessary to develop SCG as an active and effective partner, and support
PCTs in influencing local health opinion. This element supports achievement
of World Class Commissioning competencies 1a, 1b, 2, 4.

Values, Behaviours & Staff Engagement
The overall aim of the element is to establish the required level of staff
engagement and ‘buy-in’ to ensure that achieving the Commissioning strategy
is seen as, and becomes, the Corporate Mission. Predominantly this will be
led by the SCT. This element supports achievement of World Class
Commissioning Competency 1c and is necessary for the effective
implementation of competencies 1 – 10.

Workforce & Working Environment
Ensuring that the right staff with the right skills and in the right numbers are
identified, deployed and retained in an environment which facilitates workforce
well being and efficiency. SCT and NHS Barnsley will lead on this element.
This element supports achievement of World Class Commissioning
competencies 1c, 7 (priority development area), and 8.

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Service User Centred Commissioning Processes
SCG will continue to build upon the effective engagement of both its
Commissioning and Provider partners and will ensure that patient and public
engagement is increasingly integral to commissioning. This element therefore
emphasises how we improve on existing levels of engagement and how we
effectively stimulate the market to meet demand. This is a joint development
need for SCG and SCT alike. This element supports achievement of World
Class Commissioning competencies 2a, 2b, 2c, 3 (priority area), 5, 6, 7
(priority area), 8, 9, 10, 11.

Workforce Development
The overall aim of this element is to ensure that the knowledge, skills and
competence requirements of all staff in the SCT are identified and plans put in
place to meet those within the constraints of available resources. SCT relies
heavily on NHS Barnsley in taking forward this element of the plan, and as
such does not identify many additional actions not already covered within
NHS Barnsley’s overall OD strategy, This element supports achievement of
World Class Commissioning competency 1c and is necessary for the effective
implementation of competencies 1 – 10.

The above initiatives provide the organisational development fabric through
which the outcomes in the Commissioning Strategy will be delivered. The
implementation plan within the SCG OD Strategy however only describes
those actions that are over and above those that are already described in
NHS Barnsley’s Implementation Plan, which are applicable to SCG, and
highlighted in the Milestone Summary at Appendix B.

6.1 Enabling Mechanisms and Approaches

6.1.1 Commercial Professional Network

All PCTs have signed up to a work-plan being delivered by the Commercial
Professional Network, to include the SCG. The workplan forms the activities
that are being done collaboratively across PCTs, within the commissioning
side of the Commercial Support Unit. A range of activities are underway which
will equip us in addressing WCC competencies, particularly 7,9 and 10 with a
particular focus on the up-skilling of the commercial population.

This includes a swift response to some of the key areas of up-skilling that are
required. Modules have been developed to meet Y&H needs, focused on
some key areas of development which were identified from the PCTs’ World
Class Commissioning panel reviews in 2008. These modules are:
   - Performance Metrics
   - Market Analysis
   - Planning and Resourcing Healthcare Procurements

These modules include workshop attendance with a work-based learning
activity over a six week period. Participants have a remote mentor/ facilitator.
This structure enables swift practical application of the learning in the
workplace. Further roll-outs of these modules and other similar modules will
be scheduled throughout 2010. Staff from the SCT will register as appropriate
in these modules.

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In addition, SCT is being provided with an on-line system called the
‘Development Needs Analysis’ (DNA) tool. This is an on-line questionnaire
that enables assessment of individuals and groups of individuals against
World Class Commissioning competencies and Best Practice in Procurement
competencies. The system has already been piloted widely in the region. The
final refined system will be available use from Spring 2010. The reports from
this tool will provide information on the development needs of groups of the
commercial population as well as for individual staff members.

Work is underway for SCG to undergo the Organisational Diagnostic tool
being used in Y&H. This is a process which has been developed using
international benchmarks and assesses the organisation’s capacity and
capability against national competencies. It enables identification of what the
organisation needs to do holistically to address these competencies. This is
currently being taken forward by Leeds PCT and SCG is scheduled to
undertake this exercise over the winter of 2010-11 to revisit organisational
development needs some months down the line following the external WCC
panel assessment in July, and identify what training solutions and further
systems are required.

From May 2010 a database will also be available which will enable SCT to
view a range of learning programmes and training courses that are available
across the patch, particularly training available at no cost, to address all WCC
competencies. This will be used by SCT to identify training programmes to
meet our immediate and longer term needs in addressing national specialised
commissioning competencies. The training programmes selected will be
informed by issued identified from using the DNA tool.

6.1.2 Stakeholder Survey

It is imperative that SCG and SCT continually look outwards for confirmations
of and challenges to the perceptions of organisational development needs
reflected in this strategy, as part of continuous improvement. The Stakeholder
survey will provide further intelligence regarding SCG and SCT development
needs, and, repeated annually, will be a useful barometer of progress towards
our OD goal. This survey will be developed from the national guidance on
specialised commissioning, and administered at SHA level. Stakeholders will
include PCTs, acute Trusts, mental health providers, independent sector
contractors, the National Commissioning Group, the SHA, clinical networks,
the other 9 SCGs in England, universities and other academic institutions, and
the Criminal Justice System.

6.1.3 Communications & Participation Strategy

The area of weakness identified in the self-assessment relating to PPI will be
largely addressed through implementation of the Communications and
Participations Strategy, which incorporates the dedicated PPI strategy and
action plan. The SCG PPI Steering Group will be a key enabler in delivery of
this strategy, which is now established with clear terms of reference and an
ongoing work programme.

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6.1.4 Annual Programme of Protected Time

In direct response to the outcomes of each of the time-outs held in 2009-10,
the commitment to ongoing organisational development will be demonstrated
at one level in the form of a forward plan of time-out events and development
sessions, within which to continuously review and develop the SCT as a team
and the SCG as an entity. This programme will be a key enabler to the
delivery of this strategy in entirety, and consequently, the delivery of the SCG
Commissioning Strategy.

7. Performance Management

Ultimate responsibility for the implementation of this strategy will rest with
SCG Board. NHS Barnsley’s OD Programme Board, of which SCT is a
member, will support the implementation of this strategy and agree
appropriate reporting and monitoring routes in view of the unique SCG/SCT
nature of some of the actions.

In support of this, consideration will be given as to how the Programme
Management approach (based on MSP and PRINCE 2 methodologies)
adopted by NHS Barnsley to support the monitoring of its Strategic Plan and
associated strategies, will support the performance management of the SCG
OD Strategy. It is recognized that this approach provides a consistent and
transparent approach with clear reporting and accountability arrangements in
order to ensure that the initiatives identified are delivered effectively and to
provide assurance to the Board on implementation.

Each element of the OD Strategy will therefore be performance managed at
different levels, including:

   Understanding of responsibilities for achievement and ongoing review of
    outcomes and milestones will be agreed and monitored through the NHS
    Barnsley OD Programme Board and/or any other bespoke structures as
    agreed, with appropriate assurance reporting to SCG Board

   General progress and issues will be reported through SCT Exec Team and
    sub-team meetings.

8. Implementation Plan

This plan is structured around the 5 elements within NHS Barnsley’s OD
Strategy, as these provide overarching headings which allow the most holistic
description of the SCG’s OD requirements. Within each element, the action
plan lists the SCG-specific objective, arising from the context and OD
activities undertaken so far, as described above.

The elements of the plan are cross-referenced with the specific national
specialised commissioning competencies that they relate to, reflecting the
importance of the self-assessment in developing the plan.

The Implementation Plan should be viewed as a live document, continually
under development, review and refresh.

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                                                                              IMPLEMENTATION PLAN
    ELEMENT               SCG                  Action Required                     Outcome                 Measurement           WCC               Time scale   Named
                          Objective                                                                                              Competency                     Owner
Leadership &          Strengthen            Explore options for introducing       Increased robustness    Incorporation of      1                 Sept 2010    SCG
engagement            governance and         non-executive challenge to SCG        and transparency of     non-executive
                      effectiveness of       decision making                       SCG Board decision-     input to SCG
                      SCG Board                                                    making                  Board

                                            Explore options for public scrutiny   Increased robustness    Incorporation of      1                 Sept 2010    SCG
                                             and input to SCG decision making      and transparency of     public scrutiny and
                                                                                   SCG Board decision-     input to SCG
                                                                                   making                  Board
                                            Develop and synergise the             Strengthened, more      Regular               6 Prioritise      Summer       Frances
                                             Performance Monitoring Group          informed SCG            stakeholder           Investment;       2010         Carey &
                                             and SCG Finance Network               decision-making         survey; 360 degree                                   Laura
                                                                                                           analysis                                             Sherburn
                                                                                                           engagement and
                                                                                                           activity with PCTs
                                            Review PCT communication              Clarity regarding SCG   Numbers of            10 Manage         May 2010     SCG &
                                             routes through which to deliver       role, leading to        presentation          systems and                    SCT Exec
                                             common messages & celebrate           increased               sessions held,        work in                        team
                                             successes re: SCG role and work       effectiveness within    evaluation            partnership
                                             programme, ie to networks,            both PCTs and SCT       feedback from
                                             contract consortia, PCT teams,                                audiences
                                             key providers
                                            Explicitly articulate intention to    Increased assurance     Inclusion of “Pace    1 Recognised      March 2010   Laura
                                             recognize differing PCTs’ pace of     to PCT Boards           of Change” within     as leader of                   Sherburn
                                             change within commissioning                                   checklist for all     NHS; 2 work
                                             strategy; development of checklist                            services              collaboratively
                                             for all policies and developments                             transferred for       with
                                                                                                           SCG                   community
                                                                                                           commissioning         partners (ie
                      Maximise                Identification of senior SCT        Effective and           Feedback from         10 Manage         Ongoing      SCT Exec
                      effectiveness of          “Cluster” leads (Hull, Leeds,      equitable engagement    sub-regional          systems and                    Team
                      SCT                       Sheffield), to be first point of   with all PCTs and       commissioning         work in
                                                contact for sub-regional PCT       local agendas;          collaboratives;       partnership
                                                clusters and associates of sub-    strengthening of        balance of sub-
                                                regional commissioning             regional identity       regional dynamics
                                                collaboratives                                             within SCG
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    ELEMENT                SCG                  Action Required                      Outcome                   Measurement           WCC               Time scale   Named
                           Objective                                                                                                 Competency                     Owner
Leadership &          Continuously           Implementation of SCG Decision-        Maximum outcome for       Agreed                6 Prioritise      Ongoing      SCG
engagement            demonstrate             Making Framework across all            investment; shared        prioritisation tool   investments                    Board
                      robust and              specialised services                   ownership of
                      effective                                                      priorities; all things
                      prioritisation of                                              considered equally
                      investments &
                      Effective and          Embed Service Designation sub-         Grip on designation       Work programme        7 Stimulate       2010-2011    Cathy
                      competent               group                                  programme of work,        and membership of     market; 9                      Edwards
                      designation of                                                 increased                 sub-group             Secure
                      services                                                       governance,                                     procurement
                                                                                     increased focus of                              skills
                                                                                     SCG on identified

                      Active                 Lead discussions with NORCOM/          All networks have a       Level of              1 Recognised      Sept 2010    Cathy
                      participation in        WYCOM/ NEYHCOM to develop/             clearly defined role in   consistency           as leader of                   Edwards
                      and influence of        clarify the roles and                  relation to               between networks      NHS, ; 2 work                  & SCT
                      enabling                responsibilities of networks, with a   commissioning, with a     establishment         collaboratively                Exec
                      infrastructure          view to securing formal                lead PCT CE and are       agreements;           with                           team
                      surrounding             agreement to interfaces and            recognised as             number of             community
                      SCG                     implications for SCG                   accountable decision      networks with         partners, 10
                                             Consider all Y&H networks to be        making groups, with       defined               Manage
                                              managed by SCG                         consistent operational    accountability        system
                                                                                     processes and             frameworks; level
                                                                                     deliverables              of tri-network
                                                                                                               involvement in

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    ELEMENT                SCG                  Action Required                   Outcome                 Measurement            WCC             Time scale       Named
                           Objective                                                                                             Competency                       Owner
Leadership &          Maximise               Forward agenda-planning             Increased               Provision of list of   10 Manage the   April 2010       SCG
engagement            efficiency of                                               preparedness of SCG     future agendas         system                           Business
                      underpinning                                                members to progress                                                             Manager
                      systems                                                     items
                      supporting SCT
                      and SCG                Develop role of Performance         Strengthened            Action lists of        10 Manage the   ongoing          Performan
                                              Monitoring Sub-Group to             governance and          PMSG; collation of     system                           ce
                                              undertake detailed scrutiny of      contractual             contract                                                Monitoring
                                              activity for SCG Board              relationships in SCG    challenges within                                       Sub-
                                              consideration, and actively share                           PMG report                                              Group
                                              and compare approaches taken
                                              across contracts

                                             Develop role of Performance         Strengthened            Action lists of        10 Manage the   ongoing          Performan
                                              Monitoring Sub-Group to             governance and          PMSG; collation of     system                           ce
                                              undertake detailed scrutiny of      contractual             contract                                                Monitoring
                                              activity for SCG Board              relationships in SCG    challenges within                                       Sub-
                                              consideration, and actively share                           PMG report                                              Group
                                              and compare approaches taken
                                              across contracts

                                             Develop SCG Associate role in all   Strengthened            Inclusion of SCT in    10 Manage the   By Oct           Contract
                                              major Contracting Consortia         decision-making         all significant        system          2010, to         Leads
                                              across Y&H to ensure maximum        regarding contractual   contract consortia                     take effect in
                                              integration and partnership         models and              fora                                   2010-11
                                                                                  monitoring processes                                           contracting

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ELEMENT                          SCG Objective                    Action Required              Outcome               Measurement            National          Time           Named
                                                                                                                                            Competency        scale          Owner
Values, Behaviours & Staff       Maximise efficiency &             Establish Executive        Visible leadership    Agendas for            1 Recognised      March 2010     Cathy
Engagement                       effectiveness within SCT           Team and supporting        within SCT;           leadership             as leader of      and            Edwards
                                                                    mechanisms, including      improved              development            NHS; 8            ongoing
                                                                    weekly business            dissemination of      meetings;              Innovation &
                                                                    meeting and monthly        information           outcomes of            outcomes
                                                                    development meeting        throughout the        ongoing full team
                                                                                               team; increased       time-outs within
                                                                                               peer support;         annual
                                                                                               increased             programme;
                                                                                               flexibility of team   feedback from line
                                                                                               to respond to         reports in 1:1s
                                                                                               expectations and
                                                                                               emerging system

                                                                   To structure SCT           Empowered             Reduced                7 Market          January –      SCT Exec
                                                                    according to clearly       commissioning         duplication of         Stimulation;      April 2010     Team
                                                                    defined service            leads, all            effort/ attendance     10 Manage
                                                                    portfolios to be           elements of           at meetings;           systems & work
                                                                    delivered to WCC           commissioning         feedback from          in partnership
                                                                    standard                   cycle delivered/      team; external
                                                                                               co-ordinated          stakeholder
                                                                                               efficiently;          perspective
                                                                                               stimulation of
                                                                                               market and

                                                                   Develop action plan        Increased staff       Staff survey results   Supports          Sept 2010      SCT
                                                                    from results of 2009-10    engagement &          2011-12                delivery of all
                                                                    Staff Survey               fulfilment,                                  competencies
                                                                                               reputation and
                                                                                               identity of SCT

                                                                   Map connections            Sense of              Feedback from          1 Recognised      April – June   SCT Exec
                                                                    between sub-teams in       common purpose        ongoing full team      as leader of      2010           Team
                                                                    SCT, identify gaps and     across SCT,           time-outs; action      NHS
                                                                    actions to resolve;        clarity regarding     plan from map of
                                                                    implement mechanisms       role similarities     sub-teams and
                                                                    to share practice within   and differences,      connections;
                                                                    professional groups        maximisation of       number of
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                                                                    (admin, info analysis,   learning from        mechanisms
                                                                    etc)                     sub-teams,           established to
                                                                                             increased            improve internal
                                                                                             efficiency and       inter-relations
                                                                                             effectiveness of

                                                                   Align finance support    Increased            Audit trail for      6 Prioritise      March –        Frances
                                                                    function to              efficiency and       finance v.           Investment;       April 2010     Carey
                                                                    commissioning            effectiveness,       commissioning        financial
                                                                    structure                strengthened         decision/ sign-off   strategy &
                                                                                             relationships                             governance
                                                                   Clearly align resource   SCG relationship     Allocation of        1 Recognised      April – June   Cathy
                                                                    between SCG and          with NORCOM is       resource to          as leader of      2010           Edwards
                                                                    NORCOM business          same as              NORCOM and           NHS; ; 2 work
                                                                    and processes; define    WYCOM &              SCG respectively;    collaboratively
                                                                    boundaries and           NEYHCOM, as          contractual          with community
                                                                    implications; ensure     an effective         agreement;           partners
                                                                    ownership by team and    conduit for SCG;     feedback from
                                                                    clear communication to   clear NORCOM         ongoing full team
                                                                    system                   identity, separate   time-outs;
                                                                                             from SCG.            feedback from
                                                                                             clear NORCOM         NORCOM team
                                                                                             contractual          time-outs
                                                                                             relationship in

                                                                   Established programme    Strengthened         Morale in the        1 Recognised      April 2010     Cathy
                                                                    of team time-outs        team identity and    team, feedback       as leader of      ongoing        Edwards
                                                                                             effectiveness        through team         NHS
                                                                                                                  meetings & 1:1s

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ELEMENT          SCG Objective                Action Required           Outcome                                     Measurement           National          Timescale    Named
                                                                                                                                          Competency                     Owner

Workforce &      Maximise efficiency &         Embed Business          Support to the team, more appropriate       Feedback from         5 Manage          Jan 10       Laura
Working          effectiveness within           manager role            delegation of duties (ie SCG minute-        SCT and SCG           knowledge                      Sherburn
Environment      SCT                                                    taking, Programme Office function

                                               Consider placement      Streamlined processes; peer support;        Designation of        1 Recognised      March 2010   Laura
                                                of staff in virtual     improved communication and                  office space          as leader of                   Sherburn
                                                teams, according to     knowledge in team                                                 NHS;
                                                portfolios and
                                                common areas
                                               Support flexible        Increased efficiency and productivity       Number of agreed      1 Recognised      Ongoing      SCT Exec
                                                arrangements to                                                     work locations        as leader of                   team
                                                allow desk working in                                                                     NHS;
                                                the proximity of
                                                meetings where

                                               Introduce common        Reduced duplication                         Number of national    1 Recognised      Oct 09       SCT Exec
                                                approach to Y&H                                                     events attended by    as leader of                   team
                                                SCT attendance                                                      more than 1 SCT       NHS;
                                                national events                                                     member

                 Maximise efficiency of        Undertake               Informed understanding of                   Report of             7, stimulate      May-June     Laura
                 underpinning systems           Organisational          implications of SCG & SCT                   Organisational        market; 9         2010         Sherburn
                 supporting SCT and             Diagnostic of SCG &     infrastructure on delivery of               Diagnostic tool and   Secure
                 SCG                            SCT                     commissioning objectives                    resulting action      procurement
                                                                                                                    plan                  skills;10
                                                                                                                                          Manage system
                                               Access to SUS           SCT validate provider returns, fulfilling   Level of SUS          5 Manage          May 2010     Frances
                                                                        more comprehensive commissioning            access                Knowledge                      Carey
                 Active participation in       Discussion with         Mutual understanding between NHS            feedback from         1 Recognised      June 2010    Cathy
                 and influence of               Barnsley PCT            Barnsley & SCT/SCG;                         ongoing full team     as leader of                   Edwards
                 enabling infrastructure        Executives about        SCT representation in Barnsley              time-outs; number     NHS; 2 work
                 surrounding SCG                how to develop the      activities e.g. when reviewing policies;    of staff in SCT       collaboratively
                                                host PCT-SCT            greater clarity of SLA for support          involved in NHS       with community
                                                relationship to         functions;                                  Barnsley policy       partners
                                                achieve mutual          Clarity re employment “rules” for SCT.      groups; contractual
                                                benefits                                                            outcomes

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ELEMENT                          SCG Objective                    Action Required               Outcome              Measurement          National         Timescale   Named
                                                                                                                                          Competency                   Owner
Workforce Development            Maximise efficiency &             Link with host PCT in       Confidence of        Number of formal     8 Innovation &   Ongoing     Exec Team
                                 effectiveness within SCT           considering formal          staff in operating   PM qualifications    outcomes, 10
                                                                    project management          within a             held within SCT      manage system
                                                                    training for staff within   recognized
                                                                    appraisals                  framework,

                                 Continuous development            Implement                   Informed             DNA Report on        7, stimulate     Sept 2010   Paul
                                 of SCT skills &                    Development Needs           understanding of     skills and           market; 9                    Crompton
                                 competencies                       Analysis tool within        skills and           capability gaps;     Secure
                                                                    SCT                         capability gaps in   PDPs of individual   procurement
                                                                                                SCT                  staff                skills;10
                                                                                                                                          Manage system

                                                                   Participate in Learning     Key staff trained    Number of staff      7, stimulate     May 2010    All SCT
                                                                    Modules available           in procurement,      participating in     market; 9                    members
                                                                    through CPN                 market               Learning Modules;    Secure
                                                                                                management and       number of            procurement
                                                                                                performance          presentations to     skills;10
                                                                                                metrics, enabling    team meetings to     Manage system
                                                                                                effective delivery   disseminate
                                                                                                of commissioning     learning

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ELEMENT               SCG Objective              Action Required                 Outcome                            Measurement           National           Timescale   Named
                                                                                                                                          Competency                     Owner
Service User          Active participation in     Become active member of       Maximized SCT benefit from         Attendance at         9 Secure           2010-2011   Laura
Centred               and influence of             Commercial Professional       procurement expertise in the       CPN meetings;         procurement                    Sherburn
Commissioning         enabling                     Network                       region; synergy between            number of staff in    skills; 7 manage
Processes             infrastructure                                             regional collaboration and         SCT involved with     the market
                      surrounding SCG                                            SCG work                           CPN work
                                                  Implementation of PPI         Meaningful public influence        Extent of             3 Patient and      2010-2011   Laura
                                                   strategy and steering         on specialised commissioning       demonstrable PPI      public                         Sherburn
                                                   group                         decisions and policies;            activity; measures    engagement
                                                                                 delivery of patient satisfaction   within PPI strategy   and involvement
                                                                                                                    and action plan
                      Maximise efficiency         Development of Service        Comprehensive catalogue of         Encyclopaedia of      5 Manage           June 2010   Kevin Smith
                      of underpinning              Profiles and population of    SCG services; strengthened         service profiles      Knowledge
                      systems supporting           provider database             planning and negotiation of        and SCG-
                      SCT and SCG                                                contracts                          commissioned
                                                  Agreement of invoice          Strengthened financial             Agreed protocol       5 Manage           June 2010   Performance
                                                   validation protocol jointly   governance; maximisation of                              Knowledge                      Monitoring
                                                   between PCTs & SCT            value for money                                                                         Sub-Group

                                                  Development of checklist      Avoidance of confusion             Agreed checklist;     6 Prioritise       May 2010    SCG
                                                   against which to map all      between SCG & PCT role             numbers of            investment; 8      and         Business
                                                   transfers, demonstrating      going forward; clearly             completed             Innovation and     Ongoing     Manager
                                                   extent of added value         articulated benefits of regional   checklists against    improvement;
                                                                                 approach; clarity and              numbers of            10 Manage the
                                                                                 engagement                         services              system
                                                  Re-schedule SCG for last      Timely information reporting,      SCG Meeting           10 Manage the      October     Completed
                                                   Friday in the month           informed decisions                 dates in 2010;        system             2009
                                                                                                                    timelines for
                                                                                                                    performance report

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                           APPENDIX 1


       2009/10 – 2012/13

                                 Refresh 4
                            December 2009

SECTION                                                                           Page

     Foreword by the Chief Executive                                                2

1    Vision of NHS Barnsley                                                         3

2    Introduction                                                                   3

3    Purpose and Scope of the Strategy                                              7

4    Current Position                                                               8

5    Moving the OD Strategy Forward                                                16

6    Ownership                                                                     18

7    Investment & Savings                                                          18

8    Performance Management                                                        19

9    Equality & Diversity                                                          19

10   Implementation                                                                20

Appendix A:         Clinical Engagement Strategy                                    22
Appendix B:          NHS Barnsley SWOT Analysis                                     63
Appendix C:          World Class Commissioning Competency Panel Assessment          64
Appendix D:         Equality Impact Assessment                                      65
Appendix E:          OD Strategy Element Plans                                      72
Appendix F:         Milestone Summary and Leads                                    102


NHS Barnsley’s job is to support the population of Barnsley to maximise their health and
well-being. Our Commissioning Strategy, “Healthy Expectations, Supporting the Population
of Barnsley to Maximise Their Health and Well Being” describes how we and our partners
will work with Barnsley residents to achieve this goal. This builds on Healthy Ambitions the
strategic plan of the NHS Yorkshire and Humber NHS's Healthy Ambitions.' The
Commissioning Strategy firmly establishes the Vision and processes which are to be followed
to ensure local people have maximum control of their health and care and which ensures they
have access to the right support and to the highest quality services possible. Through this plan
we will tackle the major health issues in Barnsley and reduce the health inequalities within
Barnsley and between it and the rest of the UK.

NHS Barnsley is a high performing, ambitious commissioning organisation. Our strategy
challenges us to be even better.

We will rise to the challenges of supporting people to achieve better health, to being the best
commissioners by setting ambitious targets to achieve World Class Commissioning standards
and to the challenge of operating in an environment which is increasingly complex.

We have identified achieving the shift towards self directed care, the changing “contract”
with the population, the changes we must make to provider market management and
procurement, the increasing delivery via strong relationships with our partners and effective
clinical participation at all levels as our key immediate organisational development areas in
which we will achieve level four World Class Standard first.

This Organisational Development Strategy describes how NHS Barnsley will achieve its
commissioning ambitions. It describes how we will ensure the culture, capacity and
capability of the organisation is such that we have the necessary resources not just in terms of
people and skills but in respect of systems and processes to achieve our objectives. The
elements within the Organisational Development Strategy reflect the actions that will take
place at the Board, within the Commissioning Teams, Specialist Commissioning, Practice
Based Commissioning (PBC) and with our partner organisations with whom we share
commissioning initiatives.

The Organisational Development Strategy is viewed as a 'live document' and as such is being
regularly evaluated and refreshed in light of ongoing reviews and assessments, performance
management and risk assessment processes and the review of the Commissioning Strategy
and other supporting strategic processes. This current refresh also takes account where
necessary, of Year 2 Proposed Changes to World Class Commissioning Governance
Components and associated Assurance System.


The Commissioning Strategy of NHS Barnsley “Healthy Expectations – Supporting the
Population of Barnsley to Maximise their Health and Wellbeing” clearly sets out how NHS
Barnsley, working with partners will continue to support the population of Barnsley to
maximise their health and wellbeing and describes the vision and processes which are to be
followed to ensure local people have maximum control of their health and care.

The overall aim for Barnsley is clear. It is to support the population of Barnsley to maximise
their health and well being by enabling them to achieve the outcomes they want for
themselves, their families and their communities.

NHS Barnsley vision has three core values which also underpin the whole health and well
being agenda across the Barnsley strategic partnerships:

   We will help people control their own health and well being.
   We will enable and support independence and well being.
   We will ensure people have rapid and convenient access to high quality, cost effective

By focusing on individual responsibility NHS Barnsley will tackle a significant and inherent
obstacle to the reduction in health inequalities and life expectancy in Barnsley. In essence,
there will be an emphasis towards a cultural shift away from “doing” healthy solutions “to”
people towards supporting people to make healthier choices for themselves and helping to
remove barriers to adopting healthy lifestyles. This new “contract” with the public and care
providers is based on an assumption of self care and self determined care.

The vision changes the very nature of interaction between the public and commissioners,
clinicians and providers. A system that supports the vision of self care and self directed
support requires a different model of commissioning health and care.

This will require NHS Barnsley and its partners as commissioners to understand the
ambitions and beliefs of people and the social context within which they live, their
motivations and choices concerning their health, and to stimulate regulate and performance
manage a new market place.

To support this vision there must be a focus on programmes of work that increase life
expectancy, reduce inequalities and improve quality of life.


NHS Barnsley is a high performing, ambitious commissioning organisation. It has a
reputation locally, regionally and nationally as an organisation that leads, innovates and
forms strong partnerships. The strength of the regional and local partnerships which have
received national recognition as examples of best practice demonstrates both NHS Barnsley’s
philosophy of partnership working and its leadership role.

In addition, NHS Barnsley is an influential member of the Local Strategic Partnership, One
Barnsley, playing a significant role in the overarching programme “Remaking Barnsley”,
which recognises the importance of improving the health of the population if the economy is

to be regenerated. The health agenda is embedded in the Sustainable Communities Plan and
the Local Area Agreement. Partners are signed up to achieving the agreed health outcomes.

The strength of the strategic partnerships within Barnsley means that much of the
commissioning objectives are aligned to those of the organisation’s partners and the process
has many elements which are whole system and based on a strategic partnership philosophy
described within Every Adult Matters and Every Child Matters. This engagement in partners’
agendas is important to NHS Barnsley just as partner’s engagement in the health agenda is
critical to us. NHS Barnsley recognises that the commissioning process must support this
partnership agenda and NHS Barnsley commissioning staff must continue to be confident and
be skilled in working in arrangements where influence rather than power is a key

NHS Barnsley is proud of its track record of an ambitious and successful commissioner
which provides a firm foundation for achieving much more. However; it is acutely aware
that in terms of the crucial health outcomes of life expectancy and narrowing the gap between
Barnsley and the rest of the country, rapid improvements must be made.

In order to achieve NHS Barnsley’s aims, a new model of working is being embraced. A
profound change is required to move away from a culture of dependency with which services
have to some extent colluded. The new approach supports patient and carers to make
decisions for themselves and their families in order to improve their health and well-being.
This is part of a Barnsley wide transformation to raise the ambition and aspiration of young
people for a better education, of the adult population for better jobs and for everyone for
better health.

This shift will require NHS Barnsley to play a substantial leadership role and is central to
making NHS Barnsley a World Class Commissioner. This will drive the Commissioning and
supporting strategies – and is central to the purpose of this Organisational Development

NHS Barnsley has an excellent foundation for delivering this challenging agenda through
existing effective commissioning arrangements. It has already made significant inroads into
the development of World Class Commissioning (WCC) skills and competencies and indeed
intends to maintain its pursuit of this standard at an accelerated pace. It recognises that
achievement of WCC competencies is not simply aspirational but necessary in order to
achieve substantial and sustained improvements in the health and well being of the local
population, and in doing so reduce inequalities in health and well being and obtain better
value for money.

The WCC competencies are being applied to specialised services commissioning provided by
NHS Barnsley even though there is no current requirement to report them. The governance
and commissioning infrastructure are set up to take account of the requirements of specialist
services in both capacity and capability and thus throughout this plan the organisational
development needs of all NHS Barnsley commissioning functions including specialist
services and practice based commissioners are reflected in the arrangements. NHS Barnsley
also has formal commissioning arrangements with Barnsley Metropolitan Borough Council
(BMBC) in relation to children’s and adult services. The council operates on behalf of NHS
Barnsley in the commissioning of a range of children’s services and a range of adult services
are within joint commissioning arrangements with a pooled budget hosted by the council
known as Partnership in Action. The Adult services arrangements have used the World Class
Commissioning competency framework as their underpinning commissioning competency

framework and hence much of the process described in this document will be jointly
achieved. NHS Barnsley and BMBC also have a joint Director of Public Health and a joint
Public Health Directorate and have agreed to work towards establishing a joint role of
Director of Adult Social Services linked to the shared vision and Every Adult Matters

In recognition that the Commissioning Strategy cannot be achieved by NHS Barnsley alone,
the Organisational Development Strategy therefore extends its scope to encompass
Specialised Commissioning, BMBC and the Practice Based Commissioning consortia.
Actions required to achieve Organisational Development Strategy outcomes will be heavily
dependent on the collaboration of these areas and it is recognised that their inclusion in
strategy scope is therefore desirable for all concerned. Thus, OD Programme Board
membership will include the Partnership Director, the Director of Specialised Commissioning
and Commissioning Consortia Chairs.

In terms of moving forward, the Board commissioned Price Waterhouse Cooper to undertake
diagnostic work in the context of both the NHS Institute’s Board Development Tool and
World Class Commissioning. Diagnostic feedback was discussed with the Board in early
September 2009. The outcomes have been translated into new milestones to be achieved in
the refreshed Organisational Development Strategy and are also currently being considered in
relation to ongoing development which the Board will undertake during 2009/10 and beyond.
In addition, the Board has been working with Humana to establish the ‘brand essence’ of
NHS Barnsley and how this will underpin organisational values, behaviours – and
achievement of local leader of the NHS status.

Actions have already been taken with more in progress to strengthen clinical advice processes
including strengthening the role of the PEC and implementation of the Trust’s Clinical
Engagement Strategy (Appendix A). Together with initiatives such as Talent
Management/Induction programmes for GPs and establishment of further, dedicated support
for Practice Based Commissioning, NHS Barnsley is confident that its aim of embedding
clinical engagement will be fully realised.

In order to ensure that patient and public engagement also permeates every aspect of the
commissioning cycle, NHS Barnsley has undertaken an audit of current processes and
systems that facilitate involvement. This audit has identified areas where further progress can
be made using innovative techniques, whilst highlighting the excellent standards set in some
areas of patient and user involvement through tried and tested methods such as inclusion in a
variety of media including formal committee structures, ad hoc advisory groups and
consultative forums. NHS Barnsley has also started a major project with the aim of delivering
the ‘step change’ in organisational culture and performance that is required in its participation
and engagement work. The project, currently at the mapping and scoping stage, will look at
where NHS Barnsley is now with participation and engagement and identify the combination
of developing internal capacity and commissioning external work that is needed to bridge the
gap between where the organisation is now and where it needs to be in future

Workforce issues of workforce availability, talent and leadership, employment models and
staff involvement are critical to the success of NHS Barnsley, which now has an experienced
workforce planning manager to identify workforce risks including those of Provider
organisations. The workforce planning model must be flexible and responsive to service
change but at the same time inform education and training commissioning and models of

We recognise the strength of a diverse workforce and will proactively seek to build the
diversity of our workforce and encourage people from all backgrounds to see NHS Barnsley
as an employer of choice.

An important debate for any commissioner of services is its role and responsibility for the
'quality assurance' of providers in respect of workforce issues. From this perspective
discussions will take place locally in respect of not only the need to include the formal
employment law requirements within contracts but also workforce plans and indicators which
would provide valuable information in respect of the provider as a good employer including
turnover rates, sickness rates and staff satisfaction rates.

These are particularly pertinent to research which suggests a strong correlation between staff
and patient satisfaction. NHS Barnsley’s own staff survey results during recent years place it
in the top 20% of PCTs with mental health services. Building from this strategy it is our
intention to improve this position and therefore this year’s staff survey will be extended to all
Commissioning staff and a baseline assessment of the organisation will also be undertaken
against the Investors in People Standard.

NHS Barnsley strives to be a good employer and it is continually reviewing and revising its
approaches to people management in order to ensure that this goal continues to be met.
Strong emphasis is placed on leadership development both in terms of capacity and
competency which is seen as being integral to the organisation’s future success.

NHS Barnsley actively pursues the goal of being a healthy workplace supporting a healthy
workforce and provides a holistic approach to workforce wellbeing for all employees. This
recognises that over 80% of NHS Barnsley’s staff live and work in Barnsley and are therefore
potential ‘ambassadors’ within the local population who can promote healthy lifestyles. To
demonstrate progress, the Commissioning organisation has invested heavily this year to
support workforce well being initiatives in the Local Authority and Health Providers -
Barnsley’s 3 largest employers. NHS Barnsley has also been mentioned in the recent
Boorman Report as an exemplar of good practice for its work on promoting workplace well

The Board has recently signed up to a strategic partnership with Barnsley College to
recognise the potential impact that each organisation can have upon each other as well as the
wider population. The aim is to focus on joint programmes which will allow NHS Barnsley
to develop specific skills within its workforce, encourage succession planning in difficult to
recruit to areas as well as increase its standing as an employer of the local population. The
partnership is also providing healthcare professionals with direct access to an audience of
young people facilitating progress with smoke stop, teenage pregnancy, sexual health and
other related programmes.

The NHS is facing significant cuts in its funding from 2010/11 onwards. Now more than ever
before, NHS Barnsley needs to use its resources to best effect and avoid waste and
unnecessary costs. Against this backdrop where every penny counts, the demands on services
are rising; there is an ageing population, a significant and growing impact of ‘lifestyle’
diseases e.g. those related to obesity, alcohol and smoking and public expectations continue
to rise.

NHS Barnsley’s Commissioning Strategy - and the supporting Organisational Development
Strategy both take account of the existing financial position. They are therefore focussed on
improving the quality of services commissioned by supporting and developing innovation

that leads to improved productivity and prevention. A key development for year WCC year 2
in recognition of the quality, innovation productivity and prevention (QIPP) agenda, is
therefore the introduction of a new NHS Barnsley supporting strategy: the Quality and
Innovation Strategy.

The vision of this strategy is to place improvement across all the three dimensions of quality -
safety, effectiveness and patient experience, at the heart of everything NHS Barnsley does –
as ends in themselves and also because delivering the best quality of care will ultimately
yield the best value for the whole health care system in Barnsley.

NHS Barnsley’s aim is to work in partnership with patients, service users, the public,
clinicians and other organisations to commission and provide the best quality services; to
offer the tax payer the best value return on their investment, minimising inefficiency and
maximising productivity in delivering a high quality service. Having clarity about what is
meant by ‘quality’ provides a common purpose and language with which to facilitate quality
improvement and promote innovation to put quality improvement and innovation at the heart
of NHS Barnsley. Work to achieve this will commence in early December with an
Innovations workshop hosted by NHS Barnsley for our local Health and Social Care partners.

NHS Barnsley and its key partners aim to provide excellent care for all, improve
standards of safety, effectiveness, experience and efficiency. To achieve this, the
skills and commitment of staff to do the best job will be relied upon and an
environment in which innovation and excellence flourishes will be essential. An
important thread running through the Organisational Development Strategy – but
also that of all the associated WCC strategies – is therefore achieving and
demonstrating the desired organisational culture through our actions and behaviours.
This will be essential if NHS Barnsley’s ambitions are to be realised.


The Organisational Development Strategy describes as its goal:

Excellence in commissioning supported by the right culture, capacity,
capability and organisational processes within an organisation that supports
and values staff.

Barnsley recognises that strong organisational development is fundamental to the
achievement of its vision. Moreover, because our vision is ambitious, this strategy is just one
of a number of strategies and programmes which collectively set out how NHS Barnsley’s
Commissioning Strategy will be delivered. These include the:

   Commissioning Strategy
   Participation and Communications Strategy
   Finance Plan
   Clinical Engagement Strategy
   Self Directed Care Programme
   Quality and Innovations Strategy
   Information Management Strategy

The focus of the Organisational Development (OD) Strategy is to underpin and support these
strategies and to consider the overall capacity and capability of NHS Barnsley to achieve its

The OD Strategy ensures that there are the necessary resources not just in terms of people and
skills but in respect of systems and processes to enable operating in an environment which is
increasingly complex. The OD Strategy takes into account the shift towards self directed care
and the need to achieve World Class Commissioning and to continuously strive to forge
strong relationships with our partners including clinicians.

While the function of the OD Strategy is one of support, all of the strategies and associated
programmes are inter-dependent on each other. The ‘matrix’ nature of the suite of strategies
therefore requires a more sophisticated approach to Programme Management. NHS Barnsley
has therefore invested heavily in creating a programme management infrastructure and
associated training to effectively manage WCC into year 2. In the meantime, the various
inter-dependencies between the OD Strategy and other supporting strategies and programmes
are identified under the separate element headings throughout this document.

It has been seen that this strategy operates in the context of strong partnerships. The
initiatives within the OD Strategy therefore reflect not only the organisational development
requirements of the Board, but Commissioning Teams, Practice Based Commissioners,
Specialised Commissioning and the partnerships where the organisations share
commissioning responsibilities.


NHS Barnsley originally based the development of its OD Strategy on the McKinsey 7 S
Model. This was a key part of the self assessment against the World Class Commissioning
competencies. Using this approach the organisation identified the goal and related initiatives
needed to deliver it. The results were then used in a number of ways to help NHS Barnsley to
understand its organisational development needs.

The specific interventions used to develop the goal and initiatives included:

1)  One to one interviews with key staff
2)  One to one interviews with stakeholders
3)  Small facilitated workshops with key groups of staff
4)  3 large events with the all the staff in the commissioning organisation and partner
    commissioning organisations attending as part of the World Class Commissioning Self-
5) Board development sessions
6) Director development sessions
7) PEC and development sessions
8) Reviewing existing data in NHS Barnsley from previous assessment e.g. Fit for Purpose
9) Reviewing existing need and provision in the organisation
10) Reviewing best practice

Information obtained from these interventions was combined with information from
the Commissioning Strategy, Participation and Communication Strategy, Financial
Strategy, Operational Plan and Public Health data, Practice Based Commissioning
intentions and the strategic intents described within Specialist Commissioning. This
collective information built a picture of the key issues facing the organisation – and
therefore identified the original organisational development priorities.

The strength of the organisation from an internal perspective can be derived from past
performance, leadership and results of staff surveys. The SWOT analysis in Appendix B
together with a summary of the first panel assessment against the World Class
Commissioning Competencies for both NHS Barnsley (Appendix C) and the initial
assessment for Specialised Commissioning all contributed to the diagnosis which also formed
the basis of the Organisational Development Strategy and subsequent refreshes.

The first panel assessment (2008/9) placed NHS Barnsley in a strong position to be able to
move forward and become a World Class Commissioning organisation. The overall
assessment identified that NHS Barnsley was at Level 2 for the majority of the WCC
Competencies, with one Competency at Level 1 and one at Level 3. The three priority areas
for development were:

Competency 3 – Proactively build continuous and meaningful engagement with the public
and patients to shape services and improve health. Given the significant agenda NHS
Barnsley has set to engage the public in changing lifestyles and moving to self determined
care, this area requires significant development to meet this challenge. Central to this will be
establishing what influences the public to engage with and be positive about NHS Barnsley as
the local leader of the NHS.

Competency 4 – Lead continuous and meaningful engagement of all clinicians to inform
strategy and drive quality, service design and resource utilisation. On the element of clinical
engagement the assessment places us at Level 1, recognising that there is a need to do more
to ensure systematic clinical engagement at all Levels of the commissioning process.

Competency 7 – Effectively stimulate the market to meet demand and secure required
clinical and health and well being outcomes. The assessment identified NHS Barnsley to be
operating at Level 2, however, given the strategic direction to move to self directed care and
the potential impact this will have on the provider landscape it is imperative that development
in this competency continues to be fast tracked.

Since the Year 1 assessment, significant work has been undertaken towards achieving the
desired outcomes and priorities of the Organisational Development Strategy. Indeed, large
parts of this strategy refresh are about reviewing, embedding and reinforcing initiatives,
originally identified as development areas in previous versions of the strategy, but which are
gradually becoming mainstreamed.

Previous versions of the Organisational Development Strategy identified 5 Initiatives to
achieve the strategy goal:

Culture: Ensuring that NHS Barnsley is an organisation in which the culture reflects the core
values of the staff whose behaviours demonstrate its core values.

Capacity: Creating the organisational capacity to deliver the Commissioning Strategy, by
concentrating on the availability of the workforce including such issues as recruitment and
retention and workforce planning.

Capability: Recognising the key capability gaps in skills, knowledge and competence
identified as necessary in order to achieve organisational goals, setting out how they will be
resolved both at organisational and individual level.

Organisational Systems and Processes: Systems and processes around engagement with
partners, both commissioners and providers and considering how the organisation will obtain
expert advice in order to ensure it commissions excellent services in line with the
Commissioning Strategy.

Healthy Workplace and Environment: Considering the built environment, the way staff
use the space and the technology to be deployed. In addition, providing for a holistic
approach to workforce wellbeing.

Previous assessments demonstrated that NHS Barnsley was already in a very strong position
towards achieving the desired outcomes of each initiative - and these have since been
progressed and built upon. The current position and developments are summarised below and
further expanded upon throughout revised Element Plans at Appendix E.

4.1 Culture

NHS Barnsley, with partner organisations, especially BMBC has introduced the concept of
self directed care which fundamentally changes the nature of the relationship with the public
and all interactions both clinical and commissioning with them. Within health and adult care
this concept is being rapidly advanced and includes being a pilot site for individual budgets, a
pilot ‘In Control’ site and progression of health individual budgets. As a part of the Every
Adult Matters programme, care navigation has been introduced, together with maximum self
assessment, self referral and client accessed records. This has required an information rich
environment in which service users and carers can access information in ways that are
meaningful to them and where client evaluation of services is the norm. Since the previous
assessment, a contract with Humana has been signed to progress the necessary information
infrastructure and support required to make this happen.

The concept of self directed care fundamentally changes the nature of commissioning,
especially that of non urgent care. The role of NHS Barnsley is increasingly one of a
facilitator, supporting patients to navigate their health choices and stimulating the provision
of flexible and personalised services. Consequently the views and expectations of patients
and the public continue to be of primary importance to the organisation as it commissions
services, ensuring that the best possible outcome is achieved through the most effective and
efficient means.

This work is fundamental to NHS Barnsley’s commissioning philosophy and influences the
organisation’s practice and its requirements of providers and requires a major organisational
development programme in its own right in commissioning and across the partnerships,
service providers and with the public. NHS Barnsley has progressed support from Humana
Creative to embed this ethos in the working practice of our staff.

NHS Barnsley has a reputation locally, regionally and nationally as an organisation that
leads, innovates and forms strong partnerships. Examples include the partnership
arrangements which have been cited as national examples of best practice, the effective
implementation of LIFT pilots, Choose and Book early implementer site status, being one of
four pilot sites on Self Directed Care, and being one of ten pilots for Nurse Led Parenting. In
addition the Public Health Programme, Fit for the Future has received national recognition.

The model of Specialised Services commissioning developed locally and the subsequent
performance of the arrangements significantly influenced the model recommended in the
national review chaired by Lord Carter.

A recent survey of NHS Barnsley stakeholders run by the independent consultants, KPMG on
the organisation’s behalf found that it was highly regarded in terms of its local leadership of
the health agenda. Feedback from stakeholders in the survey suggested that NHS Barnsley
needs to show more effective leadership on a broader range of issues which impact on health
such as the economy – and this remains a priority area.

Clearly one of the key partnerships is with the Practice Based Commissioning Consortia as
active and skilled clinical participation is increasingly seen from this quarter. NHS Barnsley
originally achieved a score of one in competency 4 in line with its self assessment and this
reflected the state of PBC at the time which was undergoing significant organisational change
across Barnsley. It should be noted that the consortia have all subsequently fully engaged
with, and are supportive of the direction of NHS Barnsley. NHS Barnsley however, continues
to recognise that it needs to consider all opportunities to engage with and involve Practice
Based Commissioners in its operations including, in particular, pathway re-design and this is
being actively addressed through enhanced support for PBC and a new Clinical Engagement
Strategy launched during early Autumn.

NHS Barnsley strongly believes it is locally accountable to the population for achieving the
outcomes they want for themselves and their communities. It is strong in its engagement
with, and accountability to, services users and carers and with populations of specific need.
The organisation was involved in the scrutiny process of the council long before it was
required and has strong relationships with locally elected members. NHS Barnsley recognises
that further work needs to be done in ensuring the whole population are able to access
information about its role, its performance and services it procures as well as to manage its
reputation with the public locally. Indeed, since the previous assessment, significant work has
been undertaken with Humana Creative to enhance NHS Barnsley’s position as the ‘local
leader of the NHS’.

The Board of NHS Barnsley has already accepted responsibility for its own collective and
individual need for leadership development. A robust appraisal process is in place for non
executives as well as executive directors and in addition regular developmental sessions are
held. The Board also regularly meets with its local partner organisations in pursuing its
agenda as a local leader of health. The World Class Commissioning assessment process will
continue to be used to inform Board Development.

The need to develop and support both existing and aspiring leaders is recognised by the
organisation, alongside the recognition that the behaviours of its leaders are paramount to
setting the culture. Leadership development programmes are already in place which will be
further strengthened by the introduction of a Leadership Development Framework which will
actively promote the style of leadership and associated behaviours desired by the
organisation. This programme is open to primary care and NHS Barnsley is actively working
to support leadership within the PBC consortia.

Clinician feedback in the competency self-assessment, suggests NHS Barnsley’s approach to
clinical leadership and engagement can be strengthened, especially around dissemination of
information and active development of services. Actions have therefore already been taken to
strengthen its clinical advice processes including the review of the role of the PEC in relation
to its own role in setting and monitoring clinical standards. Further proposed actions have

also been embodied in the new Clinical Engagement Strategy with Talent Management and
Induction Programmes being established specifically for GPs.

In order to achieve the Commissioning Strategy, and to develop the organisation it is
necessary to understand not just the environment in which the organisation is operating and
the necessary organisational capabilities and competencies, but also what motivates teams
and people and what influences their behaviour. Simply giving people information and
urging them to be good commissioners is not sufficient. NHS Barnsley has therefore
embarked upon a challenging agenda.

The organisation needs to engage and communicate with its own staff and needs to
understand the means by which this can be done most effectively for different groups of staff.
While some tried and tested methods may work well for some staff, they may not for others
and the organisation needs to establish why and identify possible alternatives.

This may require a change of organisational culture but NHS Barnsley believes that sound
internal communications and engagement systems are necessary to create stronger and more
productive relations between staff and managers, to improve understanding and to support its
aims and achievements of its key objectives. In particular, it will be necessary to work with
staff to develop a better understanding of the new commissioning organisation including team
interactions and role fit.

If staff understand the challenges, goals, developments and achievements of the organisation,
their awareness will increase their effectiveness as ambassadors for the organisation and its
vision, inside and outside work. Asking for input to improve the way things are done will
encourage staff to participate in the organisation.

It is important to use all means available and appropriate to the various staff groups and seek
even more ways to ensure staff are involved in and informed of the organisation’s plans and
activities. This is currently being taken forward through extending the staff survey for the
first time to all staff and managers working in the Commissioning organisation and involving
staff in a baseline assessment of NHS Barnsley against the Investors in People standard.

There is a key overlap between the Organisational Development Strategy and the
Participation and Communications Strategy in the areas of internal communication which is
one of the tools of organisational development. In this sense the Organisational Development
Strategy does not address this area in depth but acknowledges the interaction that will be
necessary for both plans to succeed.

However, it is acknowledged that NHS Barnsley may need to use social marketing techniques
with segments of its own staff and with practice based commissioners so that dialogue is
more effective and meaningful. It is also acknowledged that staff can be ambassadors of the
organisation and so a well-informed and engaged workforce is important for NHS Barnsley
to achieve its goals.

4.2 Capacity

The PCT which was established in 2002, split into commissioner (NHS Barnsley) and
provider (Care Services Direct (CSD)) arms in February 2007. Some of the organisational
capacity since the separation has been shared between the two arms of the organisation.
While this has produced significant economies it has meant that two different parts of the
organisation were requiring a common function to undertake what evolved as very different
tasks. NHS Barnsley has always had a formal internal commissioning relationship with CSD
which reflects that which is in place for other providers. However, as CSD has developed as a
competitive business and the commissioning competencies have emerged, it became clear
that the infrastructure arrangements were in need of review.

An analysis of capacity demonstrated a need to separate out the functions of Information
Intelligence, Public and Patient Engagement and Participation, Performance Management,
and clinical advice so that distinct arrangements exist for NHS Barnsley and CSD.

The analysis supported the continuation of shared infrastructure for services such Information
Technology, Estates & Facilities, Human Resources and support services such as Supplies
and Payments to maintain economies of scale. These services are managed within the CSD
management structure and a Service Level Agreement (SLA) exists between NHS Barnsley
and CSD. The publication of Transforming Community Services will impact further on this
work. A significant development since the previous assessment however, has been the
establishment of a dedicated Human Resource/OD support team within the Commissioning
organisation in recognition of the additional workforce implications associated with the
Organisational Development Strategy and related work.

NHS Barnsley had previously provided commissioning support to Specialised Services
Commissioning arrangements across South Yorkshire/North Trent. In 2007 the creation of
Specialised Commissioning arrangements across Yorkshire and Humber dramatically
changed the impact on the organisation to deliver these arrangements. In addition to revising
the governance structures and processes, the needs of Specialist Commissioning were taken
account of when reviewing the arrangements relating to corporate functions.

In recognition of this and the wider analysis, the Finance function of the organisation has
separate arrangements at Deputy Director level to ensure the three finance functions required
by CSD, NHS Barnsley and Specialised Commissioning are met. The budget for Specialised
Commissioning is significant and will soon exceed the total financial allocation to NHS

NHS Barnsley is significantly below capitation and had for many years an underlying
financial deficit. As in all aspects of expenditure, commissioning resources were targeted
only at areas which had significant payback in terms of rectifying this situation. Until 2006
this affected the commissioning infrastructure and as a consequence there was limited
additional capacity in commissioning for a number of years. The exception to this was
procurement and contract monitoring and prescribing advice as these were seen as key
delivery components.

During 2007/8, additional resources were allocated to support the split of infrastructure
functions and to enhance commissioning capacity in Health Intelligence, Public and Patient
Engagement and Participation, Commissioning Performance Management and Strategy and
the core commissioning function. During 2008 work took place to refocus the role of the PEC
in the light of the new PBC consortia arrangements and to strengthen clinical advice. The

posts of Medical Director for Commissioning focusing on a clinical guardian role for primary
care and a Director of Nursing post have been appointed to. A Medical Director for
Secondary Care Commissioning is in the process of recruitment. Improved clinical
involvement through PBC will enable strengthened partnership working arrangements
through consideration of total pathway design including the social care aspects as well as
those within health care. The implications of this for the capacity in commissioning are being

Whilst resources have been allocated the organisation is competing in a limited market in
order to attract people with the necessary skills. Opportunities arising for existing staff in this
market place are also causing retention issues. The organisation is therefore revising its
Human Resources Strategy in order to attempt to mitigate this situation. Workforce and
Organisational Development implications will also be identified and built into all new

4.3 Capability

NHS Barnsley has reviewed its capability at all levels of the organisation. The Board
regularly assesses itself against national standards (NHS Institute Board Development) and
has an ongoing development programme which includes appraisal of Board members in the
role of a Board member, personal development and group learning and development sessions.
The competency framework for Boards developed as a part of the World Class
commissioning framework has been used to determine the organisational development needs
of the Board and its governance arrangements. As already mentioned, work has also been
completed to refocus the role of the PEC in the light of the new PBC consortia arrangements
and to strengthen clinical advice.

The need to develop and support both existing and aspiring leaders is recognised by the Trust,
alongside the recognition that the behaviours of its leaders are paramount to the future
success of the organisation. Achievements and initiatives in this context include:

   The establishment of Board development sessions
   The introduction of a local Directors of the Future Development Programme & support
    for SHA sponsored initiatives
   The preparation of a Leadership Development/Succession Planning Framework
   Roll out of Myers Briggs Type Indicator assessments for teams and their leaders

Where appropriate these initiatives are available to PBC and will be updated to take WCC
into account.

At an individual staff member level, NHS Barnsley has signed up to the ‘Skills Pledge’ to
support the achievement of a fully qualified workforce and a baseline assessment is underway
against the Investors in People standard to help determine how support for staff development
can be improved if necessary. The Knowledge and Skills Framework (KSF) is well
embedded in the organisation. In light of WCC however, there is a need to reflect the new
commissioning competencies in KSF Local Examples of Application and to integrate it with
local objectives. This work has been progressing alongside a comprehensive training needs
analysis of all staff to help determine how every member of the workforce can deliver their
part of WCC. Collectively, these exercises will provide further engagement opportunities for
staff – and reinforce an organisational culture of staff inclusion and support.

4.4 Organisational Systems and Processes

To support WCC NHS Barnsley is changing its interactions, both internal and external to the
organisation. These interactions based within a Programme Management Approach need to
be underpinned by rigorous systems and processes including robust information systems
which will contribute to improved commissioning.

As mentioned previously, NHS Barnsley has reviewed its corporate support functions in light
of the commissioner / provider split. As a result each function has been either placed within
NHS Barnsley or Care Services Direct and Service Level Agreements have been developed
to detail the relationship and services provided. These will be refined as the organisations
mature. In addition, a reorganisation has taken place to integrate Specialist Commissioning
financial systems with those of NHS Barnsley.

The organisation has been actively pursuing excellence in commissioning which has resulted
in new systems and processes to underpin this. NHS Barnsley has recognised the need to
have strong processes in place to ensure commissioning is based on best clinical practice and
health intelligence. It has therefore adopted robust processes relating to evidence based
commissioning, implementation of NICE guidance and works with other commissioning
organisations to share intelligence in these areas. South Yorkshire/North Trent NHS
commissioning organisations in particular have robust processes in place to develop common
commissioning strategies based on best practice and the outcome of the work of clinical
networks. Barnsley community has a single research network. NHS Barnsley has with the
Council developed a process and is a part of a local intelligence network with partners led by
the Director of Public Health. In addition it draws on intelligence from the regional processes.

Knowledge management systems are central to commissioning and NHS Barnsley has been
progressing improvements to information access and data base enhancement. The Board has
also agreed the creation of a new Director of Intelligence and Quality post. The purpose of
this post will be to lead the provision of high quality information, analysis and intelligence to
support commissioning decisions, ensure effective evaluation of initiatives, lead the research
interface and standard setting processes and ensure the development of quality metrics for
both NHS Barnsley and SCG.

The challenges of World Class Commissioning demonstrate areas for further development
including a move to even stronger contract management and ensuring that public
participation and engagement are an integral part of the evaluation processes. Public and
patient engagement has also been strengthened in GP practices with the provision of
dedicated support.

NHS Barnsley recognised its need to have greater clarity in relation to project/performance
management to achieve the new agenda facing the organisation. Clarity about objectives and
responsibility for delivery together with robust performance and risk management is at the
heart of any drive to secure continuous improvement and delivery of high quality services.
These arrangements have been further enhanced within the organisation with the inclusion of
Board level reports on all main providers.

NHS Barnsley is committed to working with a range of providers of services. A full partner
analysis will continue to be refined to identify strengths and weaknesses of these providers
and to support them in aligning their goals with NHS Barnsley’s. Issues of workforce
availability and employment models are critical to the success of these providers and are an
area that NHS Barnsley has strengthened with an experienced workforce planning manager

now well established in post. The workforce planning model must be flexible and responsive
to service change but at the same time inform education and training commissioning. In
addition discussions will take place with providers in respect of not only the need to include
the formal employment law requirements within contracts but also indicators which would
provide valuable information in respect of the provider as a good employer including
turnover rates, sickness rates and staff satisfaction rates.

4.5 Healthy Workplace and Environment

NHS Barnsley actively pursues the goal of having a Healthy Workplace and provides a
holistic approach to workforce wellbeing for all employees. This recognises that over 80% of
the organisation’s staff live and work in Barnsley and are therefore potential ‘ambassadors’
within the local population who can promote healthy lifestyles. Adoption of excellent
employment practices are seen as being central to achieving the goals in the Strategic Plan.
Non recurrent investment was made in the service during 08/09 with plans to provide further
resources to support health checks for all staff during 09/10. NHS Barnsley is accredited as a
Mindful Employer.

NHS Barnsley has already recognised the need to move to new premises where all staff can
be accommodated within one location. A user group of staff has been established to support
this move including consideration of new ways of working. The working environment is
recognised as being key to supporting the programme management approach and in particular
inter and intra department working.


Reflecting progress which has been made, the high level delivery plans within this
Organisational Development Strategy refresh have been structured under a new format as part
of improved programme, project and performance management methodologies introduced by
NHS Barnsley. This is to help facilitate compliance with year 2 requirements of increased
emphasis on risk management and mitigation – in addition to facilitating identification of
expected benefits. Consequently, the key programmes originally described as Initiatives in
earlier versions of the Strategy, are now labelled as Elements in this strategy refresh.

This refresh introduces a significant change to these elements. While the principles and
activities in relation to all 5 original initiatives above have been retained, the strategy has
been restructured from the ground up around new element headings. The rationale for this
restructuring is that:

   Based on the previous Panel report and subsequent Board diagnostic work undertaken by
    Price Waterhouse Cooper, there is a clear need to emphasise Leadership and Clinical
    Engagement. While these areas were described in original versions of the OD Strategy,
    these were spread and/or implicated across different, separate elements. To reinforce
    leadership and clinical engagement, it was therefore felt necessary to have a clear,
    dedicated element to improve clarity and promote more effective performance
    management of this area.

   There was considerable overlap between elements, outcomes and actions across different
    sections of the original OD strategy, resulting in repetition, overlap and possible unclear
    expectations of those groups responsible for delivering the associated programmes and

   It is useful to clearly show which World Class Commissioning competencies link to the
    OD strategy elements. This was difficult to achieve with previous versions of the strategy.

   A review of the original strategy highlighted a wide spread of work areas within a single
    element. Subsequent programme/project management of that element would therefore
    have been complicated because of disparate issues being covered, with a potentially wide
    range of disparate people needing to be involved.

   Because organisational culture is reflected by, and dependent on, all aspects of how the
    organisation and its people conduct business, it is difficult to encompass this within the
    scope of a single heading. It was therefore considered more practical and realistic to
    reflect desirable culture throughout all elements, as demonstrated through the sum total of
    actions all elements advocate.

Previous elements, outcomes and milestones in previous versions of the Organisational
Development Strategy have therefore been re-arranged and updated under the following new
Element headings to address these issues and reinforce revised organisational priorities:

Leadership & Clinical Engagement
Building on the leadership capability of NHS Barnsley, its staff, managers, leaders and
clinicians, including GPs. This element is necessary to reinforce NHS Barnsley’s position as
the Local Leader of the NHS, influence partners and promote clinical engagement. This
element supports achievement of World Class Commissioning competencies 1a, 1b, 2, 4
(priority area).

Values, Behaviours & Staff Engagement
The overall aim of the element is to establish the required level of staff engagement and ‘buy-
in’ to ensure that achieving the Commissioning strategy is seen as, and becomes, the
Corporate Mission. This element supports achievement of World Class Commissioning
Competency 1c and is necessary for the effective implementation of competencies 1 – 10.

Workforce & Working Environment
Ensuring that the right staff with the right skills and in the right numbers are identified,
deployed and retained in an environment which facilitates workforce well being and
efficiency. This element supports achievement of World Class Commissioning competencies
1c, 7, 8.

Service User Centred Commissioning Processes
Aiming for Best in Class Commissioning models, NHS Barnsley will continue to build upon
the effective engagement of both its Commissioning and Provider partners and will ensure
that patient and public engagement is increasingly integral to commissioning. This element
therefore emphasises how we improve on existing levels of engagement and how we
effectively stimulate the market to meet demand. This element supports achievement of
World Class Commissioning competencies 2a, 2b, 2c, 3 (priority area), 5, 6, 7 (priority area),
8, 9, 10, 11.

Workforce Development
The overall aim of this element is to ensure that the knowledge, skills and competence
requirements of all staff in the Commissioning organisation are identified and plans put in
place to meet those within the constraints of available resources. This element supports

achievement of World Class Commissioning competency 1c and is necessary for the effective
implementation of competencies 1 – 10.

This new structure, together with the need to remove reference to areas of the OD Strategy
which have already been achieved and shift of focus of some outcomes from ‘developing’ to
‘embedding’, have had a profound effect on the number and content of milestones seen
compared to the original OD Strategy. While the key themes and milestone dates have been
largely retained from the original, in some areas these have been re-described for clarity,
brought up to date to reflect the current position and added to to capture ongoing


By its very nature, the OD Strategy encompasses areas of work which are sufficiently
substantial to require new strategies and programme management structures in their own
right. Examples include Self Directed Care, Clinical Engagement and Quality and Innovation
– in addition to the pre-existing supporting strategies such as Participation and
Communication. The combined effect of this, and the complex partnership arrangements
within which NHS Barnsley operates, means that ownership of the OD Strategy is very wide
ranging and equally complex. The OD Programme will therefore require numerous Director-
level leads with agreed responsibility for some elements or parts of elements delegated to
Assistant Director level post holders. This approach is necessary to manage the very broad
scope of work involved and also to ensure ongoing consistency of ownership with the other
supporting strategies and programmes.

More detailed information regarding element ownership is provided under the individual
Element Delivery Plans in Appendix E. In the meantime, ownership of the Organisational
Development Programme is as follows:

 Initiative Sponsor   Chief Executive           Initiative Leads      Director of Human Resources
 (Accountable)                                  (Responsible)         Director of Performance &
                                                                      Director of Nursing
                                                                      Director of Strategy & Contracting
                                                                      Director of Finance & Health
                                                                      Partnership Director
                                                                      Director Specialised
                                                                      Chairs of Commissioning


Within the Financial Plan an amount of £500k has been allocated both for years 2009/10 and
2010/11 to support the delivery of the OD and other supporting strategies. Because other
supporting strategies are sufficiently complex to require their own dedicated programme
management arrangements, it is assumed that these will detail their own investment
requirements unless otherwise stated. It should also be noted that OD costs listed do not
include the costs of all OD-related activity undertaken across the organisation since defining

‘OD’ is difficult – and is in effect ongoing all the time as a result of continuous improvement
– and is therefore not possible to accurately quantify.

Known and projected OD support costs for 2009/10 and 2010/11 are summarised under the
relevant element heading in Appendix E. The total costs for 09/10 are anticipated to be
£242.4k and for 10/11 £270k. These figures however, need to be considered in the context of
the reduced sickness absence and turnover which may be achieved through increased job
satisfaction which delivery of the OD Strategy aims to create. Based on existing figures, it is
estimated that around £100k per year could realistically be saved on a recurrent basis through
reduced sickness absence, recruitment and agency costs - in addition to avoiding the loss of
productivity associated with absence and vacancy factors.


Ultimate responsibility for the implementation of this strategy will rest with NHS
Barnsley’s Board. The OD Programme Board will be responsible for the
implementation of this strategy.

NHS Barnsley has adopted a Programme Management approach to the monitoring
of its Strategic Plan and associated strategies based on MSP and PRINCE 2
methodologies. This approach provides a consistent and transparent approach with
clear reporting and accountability arrangements in order to ensure that the initiatives
identified are delivered effectively and to provide assurance to the Board on

Each element of the OD Strategy will therefore be performance managed at different levels,

   Understanding of responsibilities for achievement and ongoing review of outcomes and
    milestones will be agreed and monitored through scheduled meetings of the OD
    Programme Board.

   General progress and issues will be reported through Programme Managers meetings.

   Quarterly progress towards achievement of milestones will be reported to the Programme
    Office in preparation for feedback to Programme Sponsors/Directors meetings and NHS
    Barnsley Board.


During the preparation of this Strategy and when consulting the roles and responsibilities of
all agencies, organisations, departments and staff involved, care has been taken to promote
fairness, equality and diversity in the services delivered regardless of disability, ethnic origin,
race, gender, age, religious belief or sexual orientation.

NHS Barnsley has developed a Single Equality Scheme which includes the work already
done on race, disability and gender. The Organisational Development Strategy does take due
account of the need to embed equality and diversity principles into NHS Barnsley and
conversely will feed into the development of the Single Equality Scheme.

A full Equality Impact Assessment has been completed on this strategy (Appendix D) and
Programme and Project Management training rolled out to Programme and Project leads
includes Equality and Diversity-related scenarios to help ensure that this issue is considered
as programmes and projects are taken forward.


Individual high level Element Plans are detailed in Appendix E. These include an allocation
of a lead individual for each element and expected milestones and outputs that will be used to
monitor and evaluate the success of each element.

A summary of timelines and milestone leads derived from all Elements Plans is given in
Appendix E

                                                                                                                                                                                        Appendix 2
                                                                                                                                                                                        Area of commonality
                                                                                                                                                                                        between SCG & NHSB

                                                                                    2009                         2010                             2011

                                                                            0   1    1   1   0   0   0   0   0    0   0   0   0   1   1   1   0   0   0   0                      Lead
                                                                            9   0    1   2   1   2   3   4   5    6   7   8   9   0   1   2   1   2   3   4
 Mile-   Leadership & Clinical Engagement
M9       GP induction/talent programmes established                                                                                                           Director I,I &Q
M8       Final Clinical Engagement Strategy agreed and commenced                                                                                              Director Nursing
M10      Review of commissioning systems for clinical engagement                                                                                              Director Nursing
M12a     Support needs of PBC consortia reviewed                                                                                                              Director Nursing
M12b     Opportunities for PBC to be further involved reviewed                                                                                                Director Nursing
M13a     Participation and Communication Strategy reviewed                                                                                                    Director P&G
M14      GP support post recruited to                                                                                                                         Director P&G
M11      Clinical Director appointments made                                                                                                                  Director Nursing
M7       LQF 360 and MBTI promoted                                                                                                                            Director I,I &Q
M12c     Clarity on PBC governance arrangements achieved                                                                                                      Director S&C
M12d     Agreed programme management rules derived                                                                                                            Director P&G
M13b     NHS Barnsley Brand agreed                                                                                                                            Director P&G
M15      Service designation arrangements for SCG implemented                                                                                                 Director P&G
M5a      Leadership action plan from IiP self assessment agreed                                                                                               Director I,I &Q
M3       Board & Sub-committee development needs reviewed                                                                                                     Director P&G
M16      Review of how Board conducts business completed                                                                                                      Chief Exec/Chair
M2a      PDPs Governance Committee Members reviewed                                                                                                           Chief Exec/Chair
M2b      Methodology for ongoing assessment of effectiveness of PEC                                                                                           Director I,I &Q
M5b      Leadership action plan from staff survey agreed                                                                                                      Director I,I &Q
M6       Required leadership programmes identified and commissioned                                                                                           Director I,I &Q
M1       PDPs Board Members reviewed                                                                                                                          Chair
M4       Joint Exec Development with Partners in place and updated                                                                                            Chief Exec
 Mile-   Values, Behaviours & Staff Engagement
M3a      IiP steering group established                                                                                                                       Director P&G
M2a      Full staff survey completed                                                                                                                          Director I,I &Q
M4a      Values into behaviours programme specification developed                                                                                             Director I,I &Q
M3b      IiP baseline assessment completed & action plan agreed                                                                                               Director I,I &Q
M4b      Values into behaviours programme specification procured                                                                                              Director I,I &Q
M6       Review of internal comms/staff engagement undertaken                                                                                                 Director P&G
M1a      Humana work to identify & agree values complete                                                                                                      Director P&G
M1b      Dissemination of values initiated                                                                                                                    Director P&G
M2b      Survey results disseminated to all staff                                                                                                             Director I,I &Q
M5a      Staff Charter reviewed in light of IiP and staff survey findings                                                                                     Director I,I &Q
M2c      Benchmarking of results with staff and action plans agreed                                                                                           Director I,I &Q
M5b      Revised Staff Charter agreed with staff                                                                                                              Director I,I &Q
M2d      Repeat Staff Survey                                                                                                                                  Director I,I &Q
M4c      Values into behaviours programme undertaken all relevant staff                                                                                       Director I,I &Q
M3c      Achieve of the Investors in People Standard                                                                                                          Director I,I &Q

                                                                               2009                            2010                             2011

                                                                           0   1   1   1   0   0   0   0   0    0   0   0   0   1   1   1   0   0   0   0                     Lead
                                                                           9   0   1   2   1   2   3   4   5    6   7   8   9   0   1   2   1   2   3   4
 Mile-   Workforce & Working Environment
M5       New initiatives routinely include fully costed OD support                                                                                          Director I,I &Q
M7a      Review of HR indicators & workforce planning in specs/contracts                                                                                    Director I,I &Q
M2       Workforce plan for Commissioning organisation produced                                                                                             Director I,I &Q
M6       Review of internal HR indicators undertaken                                                                                                        Director I,I &Q
M3       New initiatives routinely include fully costed workforce plans                                                                                     Director I,I &Q
M1       HR Strategy signed off by NHS Barnsley Board                                                                                                       Director HR
M4       Workforce plans for the whole health economy identified                                                                                            Director I,I &Q
M7b      Workforce indicators in BHNFT & CSD contracts                                                                                                      Director I,I &Q
M8       Staff opinion regarding new accommodation established                                                                                              Director F &HI
M9       Review of workforce well being undertaken                                                                                                          Director HR
M7c      Workforce indictors included in contract monitoring discussions                                                                                    Director P&G
 Mile-   Service User Centred Commissioning Processes
M2       Post to support GPs in public/patient participation in place                                                                                       Director P&G
M6a      Review access to in depth independent advice and analysis                                                                                          Director I,I &Q
M8a      Database of providers established                                                                                                                  Director S&C
M3       Quality & Innovation Strategy launched                                                                                                             Director I,I &Q
M6b      External review of health info/systems undertaken                                                                                                  Director I,I &Q
M7       Improved Market analysis tools & modelling established                                                                                             Director S&C
M8b      Assessment of health economy market place undertaken                                                                                               Director S&C
M4       Programme management training delivered and understood                                                                                             Director I,I &Q
M5a      QIPP awareness training programme launched                                                                                                         Director P&G
M6c      Knowledge management requirements reviewed                                                                                                         Director I,I &Q
M6d      Director of Intelligence, Innovation & Quality recruited                                                                                           Chief Exec
M5b      Lean methodology reviewed                                                                                                                          Director I,I &Q
M9       Review of SLAs conducted for all corporate support services                                                                                        Director S&C
M10      New Board reports (input, quality & health outcomes) introduced                                                                                    Director P&G
M1       Participation and Communications Strategy fully implemented                                                                                        Director P&G
 Mile-   Workforce Development
M1       Baseline training needs analysis undertaken                                                                                                        Director I,I &Q
M2a      WCC competencies & strategy requirements mapped to KSF                                                                                             Director I,I &Q
M2b      KSF project plan agreed                                                                                                                            Director I,I &Q
M4a      Costed learning & development plans agreed                                                                                                         Director I,I &Q
M2c      All KSF outlines for staff reviewed and updated                                                                                                    Director I,I &Q
M2d      SDRs against updated outlines commenced                                                                                                            Director I,I &Q
M3a      Updated and simplified appraisal system drafted                                                                                                    Director I,I &Q
M4b      Planned learning & development activity commissioned                                                                                               Director I,I &Q
M3b      Updated appraisal system introduced                                                                                                                Director I,I &Q

                                                                    APPENDIX 3


1   Introduction

    1.1        The Yorkshire and the Humber Specialised Commissioning
               Group (YHSCG) is a formal joint sub-committee of the
               following Primary Care Trusts (PCT’s) hereafter referred to as

               Bradford and Airedale
               East Riding of Yorkshire
               North East Lincolnshire
               North Lincolnshire
               North Yorkshire and York
               Wakefield District

    1.2        The SCG is established as a joint sub-committee of each of the
               Boards of Members in accordance with Regulations 9 and 10
               of the National Health Service (functions of Strategic Health
               Authorities and Primary Care Trusts and administrative
               arrangements) (England) Regulations 2002.

    1.3        The Members therefore acknowledge that the SCG is subject
               to any directions which may be made by the Yorkshire and the
               Humber Strategic Health Authority or by the Secretary of State.

2   Functions of the Specialised Commissioning Group

    2.1        The SCG has been established in accordance with the above
               regulations to enable the Members to make collective
               decisions on the review, planning, procurement and
               performance monitoring of Specialised Services as set out in
               the National Specialised Services Definitions Set (2002)
               (Annex 1) or any revision thereto, and any other service where
               integrated commissioning across the PCT’s or a number of its
               PCT’s is required and has been agreed by the members. The
               services concerned specifically exclude those commissioned
               nationally by the National Commissioning Group (NCG) (Annex

    2.2        The functions of the SCG are undertaken in the context where
               NHS commissioning is increasingly focused on developing
               care standards and the quality assurance of provider services.

2.3   The SCG will undertake the following functions

             to plan, including needs assessment, procure and
              performance monitor Specialised Services, and
              other services, as defined and agreed by Members,
              to meet the health needs of the members

             to undertake reviews of Specialised Services and
              other agreed services, manage the introduction of
              new services, drugs and technologies and oversee
              the implementation of NICE and/or other national
              guidance or standards relating to Specialised

             to designate providers to ensure that Specialised
              Services and other agreed services are provided to
              the highest clinical standard, represent value for
              money and are accessible to everyone that needs
              them and to avoid unplanned, unsafe proliferation
              of specialised services provision

             to coordinate a common approach to the
              commissioning of Specialised Services and other
              agreed services from providers in the SCG area and

             to manage any budget delegated to it from the
              Members for commissioning Specialised Services
              and other agreed services to be held accountable
              and develop financial risk sharing arrangements

             to develop, negotiate, agree and monitor service
              level agreements/contracts for Specialised Services
              and other agreed services from providers in the
              SCG area and elsewhere as required by the

             to monitor and where agreed to fund the cost of
              non-contractual activity (NCA) for those services
              agreed by the Members

             to provide a coordinated Specialised Services
              commissioning input to clinical networks, local
              commissioning groups/fora and partnerships

             to maintain close links with PCTs and providers,
              and other statutory authorities, including local
              authorities and criminal justice system agencies, in
              the SCG area

             to work in partnership with other SCGs and act as
              lead commissioner on behalf of other SCG’s where
              agreed by those SCGs and their PCTs.

                         to be a member of the National Specialised
                          Commissioning Group (NSCG) and take account of
                          its decisions.

3   Principles upon which the SCG is based

    3.1       The SCG will support member PCT’s in striving to reduce
              the inequalities in access to and the quality of services for
              the populations they serve.

    3.2       The SCG will seek to share skills, knowledge and/or
              appropriate resources for the benefit of the total
              population served.

    3.3       The SCG will utilise the funds made available to it by
              Members to commission agreed services and support its
              management costs in a transparent and cost effective
              way, ensuring that the financial risks to individual
              Members of unforeseen/unplanned activity are minimised

    3.4       Decisions made by the SCG and by SCG members acting
              on behalf of the SCG under agreed terms of reference, will
              be binding on all members until the SCG agrees otherwise

    3.5       The SCG will review, plan, develop and monitor the agreed
              services in partnership with clinicians; providers and
              service users.

    3.6       The SCG will maintain close working links with service
              providers, clinical networks and other commissioners or
              commissioning groups, fora and partnerships

    3.7       A standard conciliation/arbitration procedure will apply
              when disputes between Members arise

4   Membership of the SCG

    4.1       Each PCT will be a member of the SCG through their Chief
              Executive or a named deputy preferably a Director who is a
              member of the Executive Team

    4.2       The full SCG will be quorate with either the Chair OR Vice
              Chair AND nine PCT Chief Executives (or named deputies) in
              attendance including three from each of the following
              groupings of PCTs.

               I         Barnsley, Doncaster Rotherham, Sheffield
               II        Bradford and Airedale, Calderdale, Kirklees, Leeds,
                         Wakefield District
               III       East Riding of Yorkshire, Hull, North East Lincolnshire,
                         North Lincolnshire, North Yorkshire and York.

              The groupings of PCTs can with the approval of their Boards
              agree that one Chief Executive can act on their behalf and
              where appropriate exercise their vote.

    4.3       The full SCG will meet at least quarterly (unless otherwise
              determined by the SCG)

    4.4       In attendance on a non-voting capacity at the meetings of the
              SCG will be a representative of the Strategic Health Authority

              Representatives of other organisations may attend with the
              agreement of the chair

    4.5       When the meeting is considering a confidential matter, non-
              members may be asked to leave the meeting at the discretion
              of the SCG Chair

    4.6       The meetings will be chaired by a designated Chief Executive
              with a nominated Vice Chair.

5   Conduct of the Meetings and Delegations of Business

    5.1       Notice of SCG meetings (which will be accompanied by an
              Agenda and supporting papers) shall be sent to member
              representatives no later than 7 days before the meeting. When
              the Chair deems it necessary in the light of urgent
              circumstances to call a meeting at short notice the notice
              period shall be such as he/she shall specify

    5.2       Decisions of meetings shall be taken by a simple majority of
              the SCG members in attendance (with the exception of the
              Chair who will not have a vote) save that any change to this
              Agreement shall require a unanimous decision of the

    5.3       Decisions made by the SCG and by SCG members acting on
              behalf of the SCG under agreed terms of reference, will be
              binding on all members until the SCG agrees otherwise

    5.4       The SCG may delegate tasks to such individuals, sub-groups
              or individual members as it shall see fit provided that any such
              delegations are recorded in a Scheme of Delegation and are
              governed by terms of reference

    5.5           The SCG may also delegate commissioning responsibility
              including procurement to another SCG and/or commissioner as
              it shall see fit provided that any such delegation is recorded in
              a Scheme of Delegation.

    5.6       Minutes of each meeting of the SCG or any sub-committees
              shall be circulated with the Agenda for the next meeting and
              their approval shall be considered as an Agenda item

6   Accountability of the SCG

    6.1 A)       At SCG Level
                 Each Primary Care Trust is accountable through its statutory
                 responsibilities to use its resources to improve the health of its
                 population. For a number of services, this can only be
                 achieved by working with other PCTs. The SCG is established
                 on the basis of a shared approach to commissioning.

    6.1.1        The SCG is a joint sub-committee of each of the Boards of the
                 Members and the designated member representatives can:-
                Commit resources within delegated responsibilities and agreed
                 resource limits;

                Decide commissioning policy

                Commission research / reviews to inform decisions

                Agree, review and update action plans

                Act as an agent for the SCG

                Commission and monitor service level agreements /contracts
                 between Members and between the SCG and other service

    6.1.2        As a member of SCG, each designated representative on
                 behalf of the Member will be able to commit resources within
                 the limits set out in their own Standing Financial Instructions.
                 By signing this Agreement each of the Members confirms that
                 its Standing Financial Instructions and Standing Orders are
                 consistent with this Agreement and empower their
                 representative to commit resources accordingly.

    6.1.3        For the avoidance of doubt, in the event of any conflict
                 between the terms of this Agreement and the Standing Orders
                 or Standing Financial Instructions of any of the Members, the
                 latter will prevail.

    6.1.4        In order to ensure that time is allowed for consultation with the
                 constituent PCT’s and with other key stakeholders wherever
                 possible, adequate notice will be given of proposals to change
                 commissioning policies, commit resources and/or enter into
                 service agreements and contracts.

    6.2 B)   At Pan-SCG Level
              In order to discharge its duties on behalf of Members, the SCG
              will be responsible for representing Members’ interests in
              commissioning Specialised Services, or other services as
              agreed by the SCG, that span a number of SCG areas. Such
              responsibility will be discharged through service specific
              groups/networks agreed by SCG in conjunction with other
              SCGs and their PCT’s and/or through the National Specialised
              Commissioning Group (NSCG)

              6.2.1   A nominated Member representative or officer of the
                      SCG will be delegated to represent the SCG and
                      ensure that the SCG’s views are properly taken into
                      account in reaching a decision at pan SCG or NSCG
              6.2.2   SCGs will take into account decisions taken at pan-
                      SCG or NSCG level
              6.2.3   SCGs will be given adequate notice regarding any
                      issues which entail decision-making at pan-SCG or
                      NSCG level meetings

7   Funding Arrangements

    7.1       Each Member will contribute an annual subscription (according
              to an agreed formula) to the SCG, based on the SCG’s
              commissioning portfolio of services and the management costs
              of supporting such commissioning.

8   Procurement of Agreed Services

    8.1       The     SCG      will   determine    which     commissioned
              services/products should be procured (“agreed” commissioned
              services/products) and from which provider(s) (“agreed”
              commissioning contracts) and advise the Specialised
              Commissioning Team accordingly.
    8.2       The providers of commissioned services/products may be any
              designated provider of agreed services which may not be
              restricted to the United Kingdom
    8.3       Each Member remains responsible for performing and
              exercising its statutory duties and functions for delivery of the
              commissioned services/products to its population and its
              patients, including:
                 Assessing individual patient cases;
                 Referrals;
                 Complaints and complaints procedures;
                 Individual contract exclusions;
                 Emergencies;
                 Managing waiting lists;
                 Obtaining legal advice if necessary (e.g. on the legality of a
                  specific treatment policy);
                  Patient and public involvement as appropriate for
                   Specialised Services (in conjunction with SCG where
                  Each PCT is responsible for managing appeals (supported
                   by the SCG).

      8.4      In 8.3 above it maybe appropriate for the SCG to support and
               act on behalf of the Members if the Members so agree. This
               will not negate each Members statutory responsibility to ensure
               the delivery of appropriate Health Care Services to its

9    Host Primary Care Trust

     9.1       One or more PCT’s will be designated by agreement as the
               Host PCT(s).

     9.2       The responsibilities of the Host PCT(s) are:
                  To appoint and employ such officers as may be required to
                   carry out the duties of the SCG and provide all necessary
                   corporate services and management support as maybe

                  To have in place Standing Orders, Standing Financial
                   Instructions     and   other   appropriate governance
                   arrangements and Schemes of Delegation necessary for
                   the delivery of the SCG Agenda

                  To provide full financial support to the specialised
                   commissioning functions, including the collection of any
                   subscriptions from Members and the making of payments
                   to providers of commissioned services/products where

                  To hold the management budget for the Specialised
                   Commissioning Team and make payments and receive
                   income as necessary on behalf of the Team.

     9.3       The SCG or any delegated sub-groups shall adopt the
               Standing Orders, Standing Financial Instructions and
               relevant Schemes of Delegation of the Host Primary Care

     9.4       A management charge, as agreed with the SCG, will be
               payable to the Host PCT(s) from the management budget for
               the costs incurred in acting as the Host PCT(s)
10   Support Arrangements

     10.1      The SCG will, through the nominated Host PCT(s) appoint and
               employ such officers as may be required to exercise its duties

   11    Involvement of service providers and clinicians

          11.1       Each service review group, clinical network and informal
                     network that plays a major role in the SCG’s strategy
                     development will need to demonstrate how they are involving
                     the   relevant    service  provider(s)  including   clinical
          11.2       The SCG will be responsible for ensuring public health input
                     into such groups and/or networks.

    12   User Involvement

          12.1       The SCG, each service review group and/or clinical network
                     will need to be able to demonstrate how they are involving
                     service users in the planning and commissioning process.

   13     Facilitation and Arbitration

         13.1        In the event of disputes between the SCG and any
                     Foundation Trust the procedure set out in the contract will be
         13.2      In the event of disputes with non-Foundation Trusts the process
                      to be used will be based on the agreement within individual

         13.3      In the event of a dispute between two or more SCGs, the NSCG
                     will be invited to facilitate and/or arbitrate according to its own
                     facilitation/arbitration process

   14     Communication

          14.1       Chief Executives (or their representatives) of each Member will
                     act as the overall communication link to their health
                     communities and shall present the approved minutes for each
                     SCG meeting to the next following meeting of the Board of
                     their PCT. These minutes will not include minutes of any SCG
                     meeting or part of any SCG meeting which is a closed Member
                     only session. Minutes of a Member only session will go to the
                     private part of PCT Board meetings.

          14.2       An SCG Annual Report will be produced for Member Boards
                     within six months of the end of the financial year.

SCG Establishment Agreement
19 June 2009

                                                                          Annex 1

as set out in the Specialised Services National Definitions Set (2002)

   1      Specialised cancer services (adult)
   2      Specialised services for blood and marrow transplantation (all ages)
   3      Specialised services for haemophilia and other related bleeding disorders
          (all ages)
   4      Specialised services for women’s health (adult)
   5      The assessment and provision of equipment for people with complex
          physical disability (all ages)
   6      Specialised spinal services (adult)
   7      Complex specialised rehabilitation services for brain injury and complex
          disability (adult)
   8      Specialised neurosciences services (adult)
   9      Specialised burn care services (all ages)
   10     Cystic fibrosis services (all ages)
   11     Renal services (adult)
   12     Home parenteral nutrition services (adult)
   13     Specialised cardiology and cardiac surgery (adult)
   14     HIV/AIDS treatment and care (all ages)
   15     Cleft lip and palate services (all ages)
   16     Specialised immunology services (all ages)
   17     Specialised allergy services (all ages)
   18     Specialised services for infectious diseases (adult)
   19     Specialised services for hepatology, hepatobiliary and pancreatic surgery
   20     Medical genetic services (all ages)
   21     Specialised learning disability services (adult)
   22     Specialised mental health services (adult)
   23     Specialised services for children
   24     Specialised dermatology services (adult)
   25     Specialised pathology services (all ages)
   26     Specialised rheumatology services (adult)
   27     Specialised endocrinology services (adult)
   28     Hyperbaric oxygen treatment services (adult)
   29     Specialised respiratory services (adult)
   30     Specialised vascular services (adult)
   31     Specialised pain management services (adult)
   32     Specialised ear surgery (all ages)
   33     Specialised colorectal services (adult)
   34     Specialised orthopaedic services (adult)
   35     Morbid obesity services (all ages)

                                                                    Annex 2

Services commissioned by the National Commissioning Group as at April 2009

Alström syndrome service
Amyloidosis service
Ataxia telangiectasia service for children
Bladder exstrophy service
Autoimmune paediatric gut syndromes service
Chronic pulmonary aspergillosis service
Choriocarcinoma service
Complex Ehlers Danlos syndrome service
Complex neurofibromatosis type 1 service
Complex tracheal disease service
Congenital hyperinsulinism service
Craniofacial service
Encapsulating sclerosing peritonitis surgical service
Epidermolysis bullosa service
Extra-corporeal membrane oxygenation service for adults
Extra-corporeal membrane oxygenation service for neonates, infants and
children with respiratory failure
Gender identity development service for children and adolescents
Heart and lung transplant service for adults and children
Islet transplant service
Liver transplant service
Lysosomal storage disorders service
Mental health service for D/deaf children and adolescents
Ocular oncology service
Ophthalmic pathology service
Osteo-odonto-keratoprosthesis service
Pancreas transplant service
Paroxysmal nocturnal haemoglobinuria service
Primary ciliary dyskinesia service
Primary malignant bone tumours service
Proton beam therapy service
Pseudomyxoma peritonei service
Pulmonary hypertension service for children
Pulmonary thromboendarterectomy service
Rare mitochondrial disorders service
Rare neuromuscular disorders service
Reconstructive surgery service for adolescents with congenital malformation of
the female genital tract
Retinoblastoma service
Secure forensic mental health service for young people
Severe combined immunodeficiency and related disorders service
Severe intestinal failure service
Severe obsessive compulsive disorder and body dysmorphic disorder service
Small bowel transplant service
Specialist paediatric liver disease service
Stem cell transplant service for juvenile idiopathic arthritis and related
connective tissue disorders
Vein of Galen malformation service
                                                                                                              APPPENDIX 4

                                SCHEME OF RESERVATION AND DELEGATION

THE PCT                                          DECISIONS RESERVED TO THE PCT

THE PCT   1   Decisions relating to service reconfiguration i.e. service changes requiring formal consultation.

          2   Decisions about the baseline budget for specialised services, including the inflation uplift.

          3   Formal adoption of a commissioning policy which has legal or budget implications e.g. restricted procedures

THE SCG                                          DECISIONS RESERVED TO THE SCG

THE SCG   General Enabling Provision
            1. The SCG may determine any matter, for which it has delegated authority, it wishes in full session within its
               delegated powers.

THE SCG   Regulations and Control
             1. Approve a scheme of delegation of powers from the SCG to other committees or officers.
             2. Require and receive the declaration of SCG members’ interests which may conflict with those of the SCG and,
                taking account of any waiver which the Secretary of State for Health may have made in any case, determining
                the extent to which that member may remain involved with the matter under consideration.
             3. Require and receive the declaration of officers’ interests that may conflict with those of the SCG.
             4. Approve arrangements for dealing with complaints.
             5. Adopt the organisation structures, processes and procedures to facilitate the discharge of business by the
                SCG and to agree modifications thereto.
             6. Receive reports from groups/sub-groups.
             7. Confirm the recommendations of the SCG’s groups where the groups do not have executive powers.
             8. Establish terms of reference and reporting arrangements of all groups and sub-groups that are established by
                the SCG.

THE SCG   Appointments/Dismissal
             1. Appoint the Chair of the SCG.
             2. Appoint the Director of the SCG.
             3. Appoint and dismiss other groups (and individual members) that are directly accountable to the SCG.
             4. Confirm appointment of members of any groups of the SCG as representatives on the outside bodies.

THE SCG   Strategy, Local Delivery Plan and Budgets
              1. Define the strategic aims and objectives of the SCG.
              2. Approve plans in respect of the application of available financial resources to support the agreed Local
                 Operational Plan.
              3. Approve (with any necessary appropriate modification) the SCG annual commissioning strategy or plan.
              4. Approve annually (with any necessary appropriate modification) the SCG Local Operational Plan (LOP).
              5. Approve the SCG’s policies and procedures for the management of risk.
              6. Approve the management budgets and agreed service budgets (defined by SCG to operate on a pooled basis)
              7. Approve annually SCG’s proposed organisational development proposals.

THE SCG   Annual Report
             1. Receipt and approval of the SCGs Annual Report.

THE SCG   Monitoring
            1. Receipt of such reports as the SCG see fit from the SCG Director in respect of his/her exercise of powers

THE SCG   Financial and Performance Reporting Management
             1. Receive and approve a schedule of NHS service level agreements and contracts signed in accordance with
                 arrangements agreed with the SCG Director.
             2. Receive and approve budgets.
             3. Receive and approve monitoring reports on performance against budgets and financial estimates and


SCG DIRECTOR   Strategy, Plans and Budgets
                   1. Prepare Strategy and Plans and Budgets for approval by the SCG. (Management budget and agreed service
                      budgets defined by the SCG to operate on a pooled basis).
                   2. Advise the Board on the strategic aims and objectives of the SCG.
                   3. Prepare and review annually draft plans in respect of the application of available financial resources to support
                      the agreed Local Delivery Plan and to further relevant and agreed elements of the SHAs Local Operational
                      Plan (LOP) for approval by the SCG.
                   4. Prepare and review annually the draft SCG annual commissioning strategy or plan for approval by the SCG.
                   5. Develop the SCGs policies and procedures for the management of risk.

SCG DIRECTOR   Financial and Performance Reporting Arrangements
                  1. Prepare a schedule of NHS service level agreements and contracts signed in accordance with arrangements
                      agreed with the SCG Director.
                  2. Prepare, consider and endorse the SCGs draft Annual Report (including the annual accounts) for approval by
                      the SCG.

  DELEGATED TO                                                          DUTIES DELEGATED

  SCG DIRECTOR         Ensure effective management systems that safeguard public funds and assist SCG Chairman to implement
                       requirements of corporate governance including ensuring managers:
                            Have a clear view of their objectives and the means to assess achievements in relation to those objectives;
                            Be assigned well defined responsibilities for making bet use of resources;
                            Have the information, training and access to the expert advice they need to exercise their responsibilities

  SCG DIRECTOR         Achieve value for money from the resources available to the SCG and avoid waste and extravagance in the
                       organisation’s activities.

                       Follow through the implementation of any recommendations affecting good practice as set out in reports from such
                       bodies as the Audit Commission and the National Audit Office (NAO).

                       Use to best effects the funds available for commissioning healthcare, developing services and promoting health to
                       meet the needs of the local population.

                                                  DUTIES DELEGATED BY THE SCG TO SCG SUB – GROUPS

  PERFORMANCE          Monitor and review all the performance information covering activity finance and quality, for all the services
   MONITORING          commissioned by the SCG.

     SERVICE           Receive and review all business relating to service designation to assure the SCG that agreed processes have been
   DESIGNATION         followed and to ensure designation submissions are received by the SCG at the agreed “gateway” decision points.

    CLINICAL    Act as the clinical reference group for considering clinical aspects of commissioning policy, designation standards and
STANDARDS GROUP clinical quality indicators.


 DELEGATED TO                                              AUTHORITIES/DUTIES DELEGATED

  SCG MEMBERS    SCG Members are responsible for monitoring the executive management of the organisation and are responsible to
                 the PCTs for the discharge of those responsibilities.

   CHAIRMAN      It is the Chairman’s role to:
                      1. provide leadership to the SCG;
                      2. enable all SCG members to make a full contribution to the SCGs affairs and ensure that the SCG acts as a
                      3. ensure that key and appropriate issues are discussed by the SCG in a timely manner;
                      4. ensure the SCG has adequate support and is provided efficiently with all the necessary data on which to base
                          informed decisions.

 SCG DIRECTOR    The Director is accountable to the Chairman and members of the SCG for ensuring that its decisions are
                 implemented, that the organisation works effectively, in accordance with Government policy and public service values
                 and for the maintenance of proper financial stewardship.

                 The Director will be allowed full scope, within clearly defined delegated powers, for action in fulfilling the decisions of
                 the SCG.


 DELEGATED TO                                             AUTHORITIES/DUTIES DELEGATED

      SCG        Appointment of Vice-Chairman.

     CHAIR       Calling meetings.

     CHAIR       Chair all SCG meeting and associated responsibilities.

     CHAIR       Give final ruling in questions of order, relevancy and regularity of meetings.

     CHAIR       Having a casting vote.


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