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GOVERNANCE ARRANGEMENTS FOR THE PCTs ARMS LENGTH PROVIDER

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					GOVERNANCE ARRANGEMENTS FOR THE PCTs                                                 ITEM 12
ARMS LENGTH PROVIDER ORGANISATION
                         Decision       Discussion      Information



Report written by: Maria O’Brien, Director of Operations, Provider Services


Report signed off by: Jill Cox, Executive Director Provider Services


Purpose of the report:
The inaurgral meeting of the Provider Services Board on 11 March 2008 considered the
documents detailed below which support the required new governance arrangements for the
provider arm. These documents were approved at the meeting. The PCT Board is asked to
ratify these to allow provider services to operate effectively as an Arms Length Provider
Organisation (APO) from 1 April 2008.
     •   Terms of Reference and Membership
     •   PCT – APO Statement of Accountability
     •   Conflict of Interest Policy and Declarations
     •   Scheme of Reservation and Delegation




RECOMMENDATIONS TO THE BOARD:


The Board is asked to:


1.   Ratify the Terms of Reference and Membership


2.   Ratify the PCT – APO Statement of Accountability


3.   Ratify the APO Conflict of Interest Policy and Declarations


4.   Ratify the APO Scheme of Reservation and Delegation




           Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                Page No 1
GOVERNANCE ARRANGEMENTS FOR THE PCTs                                              ITEM 12
ARMS LENGTH PROVIDER ORGANISATION
                                                            Contact Name: Maria O’Brien,
                                                            Director of Operations
                                                            Contact Tel No: 01895 452085
PURPOSE OF THE REPORT

1.   The inaugral meeting of the Provider Services Board on 11 March 2008 considered the
     documents detailed below which support the required new governance arrangements
     for the provider arm. These documents were approved at the meeting. The PCT Board
     is asked to ratify these to allow provider services to operate effectively as an Arms
     Length Provider Organisation (APO) from 1 April 2008

2.   Terms of Reference and Membership

3.   PCT - APO Statement of Accountability

4.   Conflict of Interest Policy and Declarations

5.   Scheme of Reservation and Delegation


TERMS/ACRONYMS USED IN THE REPORT

6.   APO – Arms length Provider Organisation
7.   DH – Department of Health

INFORMATION

8.   To enable PCTs to concentrate on their commissioning function, provider arms are
     required to operate at arms length by 1 April 2008. This is in line with a range of DH
     guidance including, “Commissioning a Patient Led NHS”, “Our Health, Our Care, Our
     Say”, and “The Operating Framework for the NHS in England 2008/09,”

9.   To accomplish this, NHS London requested all PCTs to produce a detailed plan against
     a number of set core standards, with timescales, describing how this will be achieved.
     This was submitted on 27 February 2008.

10. A core standard requirement was the establishment of a Provider Services Board (sub-
    committee of the PCT Board) with clearly defined governance arrangements to allow the
    provider arm to operate effectively as an APO from 1 April 2008.

11. The documents detailed in appendices 1-4 have been produced to enable Hillingdon
    PCTs provider arm to meet this requirement.

12. The Provider Services Board considered and approved these documents at its inaurgral
    meeting on 11 March 2008.




          Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                  Page No 2
13. The PCT Board are now requested to ratify these documents to support the reqired
    governance arrangements for Hillingdon’s APO.


IMPACT ON STRATEGIC DIRECTION

14. The operation of provider services as an Arms Length Provider Organisation is both a
    key requirement and strategic objective for the PCT. NHS London will performance
    manage delivery of this objective for all PCTs, (“NHS London Strategic Plan”).

15. The documents detailed in Appendices 1-4 are crucial to the required governance
    arrangements for the new APO.

COMMUNICATION REQUIRED

16. Communication will be required to NHS London as part of the planned performance
    management regime against the Provider Services Plan.

17. Notification to staff via the Provider Services Newsletter, roadshows and shaping the
    future meetings.

EQUALITY IMPACT ASSESSEMENT

17. There will be no negative impact upon equality.

RECOMMENDATIONS

The Board is requested to:

1. Ratify the Terms of Reference and Membership

2. Ratify the PCT – APO Statement of Accountability

3. Ratify the APO Conflict of Interest Policy and Declarations

4. Ratify the APO Scheme of Reservation and Delegation

APPENDICIES

Appendix 1 – Hillingdon PCT Arms Length Provider Organisation Terms of Reference
Appendix 2 – PCT – APO Statement of Accountability for Provider Services
Appendix 3 – Hillingdon PCT Arms Length Provider Organisation Conflicts of Interest
             Policy
Appendix 4 – Hillingdon PCT Arms Length Provider Scheme of Reservation and
             Delegation of Powers

BACKGROUND DOCUMENTS
“Commissioning a Patient Led NHS”, March 2005, DH
“Our health, our care, our say; a new direction for community services” Jan 2006, DH
“The Operating Framework for the NHS in England, 2008/09”, December 2007, DH
“NHS London Strategic Plan”, February 2008, NHS London


         Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                 Page No 3
                                                               APPENDIX 1

         HILLINGDON PCT ARMS LENGTH PROVIDER ORGANISATION

                    TERMS OF REFERENCE FROM 1 APRIL 2008
Constitution

In line with national requirements, Hillingdon PCT has agreed to the operation of its provider
arm as an Arms Length Provider Organisation (APO) from 1st April 2008.To support this
development, agreement has also been reached to the establishment of a Provider Services
Board, (sub-committee of the PCT Board) to oversee all aspects of the APO’s businsess,
governance and operations.

The principal purpose of the APO is to exercise on behalf of the PCT its functions that are
delegated to it relating to the provision of goods and services.

The APO’s responsibilities and functions are to:

   •   develop a Provider Services Strategy

   •   work with the PCT to develop and maintain a governance and regulatory framework
       to separate the PCT’s functions relating to commissioning and provider services

   •   provide goods and services for purposes related to the provision of health care

   •   operate economically, efficiently and effectively

   •   comply with the PCT’s standing orders and standing financial instructions

   •   Comply with the APO’s terms of reference and scheme of reservation and delegation
       of powers that the PCT has approved.

Membership

The members of the APO are:

   •   A Chair of the APO who is also a non-executive director of the PCT

   •   Not less than one but not more than two further non-executive directors

   •   Senior officers of the APO who will be a Managing Director, host PCT Chief
       Executive, Director of Finance and Senior Clinician (PEC Chair)

   •   The PCT will appoint the members of the APO in accordance with its standing
       orders.

Attendance

Two of the non-executive and two of the officer members must be present at any meeting of
the APO before any decisions can be made. (Appropriate cover arrangments will be made
between the non-executive directors)


          Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                   Page No 4
Frequency

The APO will meet monthly.

Authority

The APO will develop, maintain and review for the PCT Board’s approval, (and will operate
within the agreed authority therein):

   •   Terms of reference

   •   A Scheme of Delegation of responsibilities

   •   A statement of accountability

   •   A business framework between the APO and other PCT Directorates, including
       Service Level Agreements

   •   A conflict of interests policy

Reporting

The APO will report on a bi-monthly basis to the PCT Board. The minutes of the Provider
Service Board will be sent to the PCT Board.

Other Matters

   •   The APO will develop, maintain and review a business plan for the approval of the
       PCT.

   •   The APO will develop, maintain and review capability, capacity and fitness for
       purpose to manage the PCT’s functions to provide services.

   •   The APO will develop, maintain and review for the PCT Board’s approval a scope of
       services that the APO will propose to manage for the PCT in accordance with the
       PCT’s functions to provide goods and services.

   •   The APO will ensure that existing and new services within its scope of services will
       be maintained and developed according to a clinical governance framework based
       on legislation, Standards for Better Health and best practice guidance.

   •   The APO will commission and manage development and implementation of an action
       plan for the transition of services that the APO will propose to manage for the PCT
       with effect from 1 April 2008.

   •   The APO will commence work with the PCT to develop financial and accounting
       separation between them for implementation during 2008-09.

   •   The APO will commence work to commission and receive an options appraisal about
       its future management and corporate development for review during 2008-09.

         Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                 Page No 5
These terms of reference have been approved by the PCT Board at its meeting on March
2008




Signed..........................................................

Chair of Hillingdon PCT




              Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                   Page No 6
                                                                       APPENDIX 2

PCT – APO STATEMENT OF ACCOUNTABILITY FOR PROVIDER SERVICES

Purpose:

This document states the proposed accountability arrangements between the PCT Chief
Executive (Accountable Officer) and the Managing Director of the Arms Length Provider
Organisation Board (APO Board) from 1 April 2008.

The Managing Director (MD) is considered the Acting Accountable Officer for the APO,
subject to the direction of the APO Board and therefore has responsibility for the delivery of
health and social care provision and related support services for the APO.

This document should be read in conjunction with the APO Terms of Reference and the
Model Scheme of Reservation and Delegation.

Agreed Working Arrangements:

 1.    The PCT Chair and Chief Executive remain responsible for the whole PCT. In the
       event of the failure to discharge duties of the Provider Services, the PCT Chief
       Executive Officer (CEO) and the MD will be equally answerable to the PCT Board.

 2.    The PCT CEO will remain the Accountable Officer for the Trust in accordance with
       the Accountable Officer Memorandum for Chief Executives 2002.

 3.    The MD will assume the role of Acting Accountable Officer (for the APO) in
       accordance with the NHS Foundation Trust (Accounting) Officer Memorandum 2005
       and will be accountable to the PCT Accountable Officer. During the autonomous
       period of operation, the MD and Associate Director of Finance (ADF) will sign the
       final accounts for Provider Services (which are a sub set of the main PCT accounts).
       The CEO and Director of Finance will sign off as overall accountable officers.

 4.    The MD has delegated authority for performance, service delivery and staff of the
       Provider Arm and all related decision-making and in accordance with the PCT
       Standing Orders, Reservation and Delegation of Powers and Standing Financial
       Instructions. The delegated authority includes the signing of contracts, hiring and
       termination of personnel and other standard business functions. (Any contracts
       signed will be in the name of the PCT on behalf of the provider directorate.) The




           Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                   Page No 7
       sealing of documents will remain the responsibility of the PCT CEO. The APO will
       work within the PCT Corporate Governance framework.

 5.    Financial Management for Provider Services will be delegated from the PCT Board to
       the APO Associate Director of Finance who will work in partnership with the PCT
       DoF to ensure statutory duties are completed.

 6.    The APO will act autonomously and develop its own identity (subject to PCT Board
       approval) and internal and external business relationships

 7.    The APO is a sub committee of the PCT Board and operates as the Provider
       Services Board, providing assurance and transparency into the decision-making
       processes (see Terms of Reference). The relevant subset of PCT Standing Orders
       and Standing Financial Instructions will be adopted and the Scheme of Reservation
       and Delegation will be amended and adopted by the APO Board. The APO will
       prepare reports for the PCT Trust Board meetings as part of the obligation to share
       information and decision-making. The PCT Board will determine information and
       metrics required from the APO (as is required from other commissioned provider
       trusts and organisations).

 8.    The MD will have an authorisation for up to £10,000 of capital expenditure in any one
       invoice as agreed by the PCT Director Finance and Chief Executive. Any proposed
       capital expenditure over £10,000 would be taken to the APO Board and then to the
       PCT Board for approval.

 9.    The MD will ensure robust governance arrangements are in place within the Provider
       Directorate through the development and maintenance of an assurance framework,
       including the processes in place to support this to enable the Managing Director to
       sign the Statement of Internal Control (SIC) as Acting Accountable Officer. The CEO
       would also need to sign the SIC as overall Accountable Officer.

 10.   Service Level Agreement arrangements between the Provider Directorate and the
       PCT will be subject to the same governance as those applied to any other
       commissioned providers of NHS and Social Care (e.g. regarding notice periods,
       financial management of contracts and activity monitoring).




         Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                 Page No 8
 11.   The Provider Directorate will be free to enter into negotiation with any Commissioner
       regarding existing or new services, following standard SLA or contracting protocols.
       Regular reporting of prospective business planning intentions will be made to the
       PCT Board and relevant sub-committees prior to any formal agreement.

 12.   New, existing or substantially redesigned services, after due notice, may be offered
       out to open tender by the PCT Commissioner and the APO will be free to bid.

 13.   The APO will be encouraged to form its own strategic partnerships as an
       autonomous stakeholder within the local health and social care economy.

 14.   The APO will be free to enter into negotiations with local independent contractors and
       other providers of health and social care from the NHS, Local Authority, Independent
       and Third Sectors regarding the delivery of integrated pathways. The PCT
       Accountable Officer and Managing Director (or delegated personnel) will all be
       responsible for signing any formal contracts (subject to the proviso described in point
       4) related to provider services in accordance with the scheme of delegation. The
       APO is authorised to sign within the delegated authority described in PART C of the
       scheme of delegation

 15.   The APO members will delegate authority to the Managing Director as appropriate.

 16.   The Provider Directorate will work towards the establishment of an Audit Committee,
       (in the interim, the Managing Director will report bi-monthly to the PCT Audit
       Committee). The Audit Committee will monitor the integrity of the financial
       statements, review the internal financial controls and will review the effectiveness of
       the provider directorates internal audit function. The provider audit committee will
       report via the APO to the PCT audit committee who still holds overall responsibility
       for audit matters across the PCT.

 17.   The PCT Clinical and HR policies will be adopted by the Provider Services unless
       agreed otherwise by the PCT Board and APO, on an individual basis.

I hereby agreed to the above statement.

Signed:……………………………………                       Signed:………………………………….
CEO PCT                                     Managing Director
Dated: ……………………………………                       Dated: …………………………………



         Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                   Page No 9
                                                                          APPENDIX 3
HILLINGDON PCT ARMS LENGTH PROVIDER ORGANISATION CONFLICTS OF
INTERESTS POLICY FROM 1ST APRIL 2008

This policy sets out how Hillingdon PCT (the PCT) will manage conflicts of interest arising
from the operation of its Arms Length Provider Organisation (APO) that it has established. It
should also be used in conjunction with the host PCT’s Conduct of Business Code.

1.        For the purpose of the PCT’s standing orders membership of the APO shall be
          treated as being a relevant and material interest that a member of the PCT Board
          should declare.

2.        To avoid potential conflicts of interest between members who sit on both the APO
          and PCT Boards, details relating to potential bids/tenders will not be tabled at the
          APO. The APO will instead set the strategic direction and agree potential business
          areas in principle for the APO. Details concerning actual bids pursued thereafter will
          be taken forward by the MD.

3.        All conflicts of interest that cannot be resolved, will be formally recorded within the
          APO minutes. Where such conflict arises with external organisations, advice from the
          Strategic Health Authority and/or solicitors can be sought.

4.        If a conflict arises between the PCT and APO, after exhausting all normal routes, the
          chair of the PCT and APO will agree a resolution.

5.        The APO’s Managing Director will ensure that all objections to decisions considered
          or taken by the APO in matters of propriety or regularity and on issues relating to the
          wider responsibilities of the PCT’s Chief Executive as Accounting Officer for
          economy, efficiency and effectiveness are recorded within the APO minutes and
          logged by completion of the conflict of interest register using Form A.



Signed..................................................

Chair of Hillingdon PCT




              Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                    Page No 10
Form A
CONFLICT OF INTEREST REGISTER

Name of member of staff:          ___________________________________________
Post Title:                       ___________________________________________
Nature of Conflict of Interest:




Signature of member of staff:          ___________________________________
                       Date:           ___________________________________

Declaration by manager of above member of staff:

I have discussed this conflict of interest with _____________________________ (insert
name of above member of staff) and the following resolution has been agreed:




Signature:     ________________________________________________________

Full Name:      ________________________________________________________
(in block capitals)
Position:       ________________________________________________________

Date:          ________________________________________________________




          Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                              Page No 11
                                                                       APPENDIX 4


HILLINGDON PCT
ARMS LENGTH PROVIDER APO SCHEME OF RESERVATION AND DELEGATION OF
POWERS FROM 1ST APRIL 2008

The purpose of this Scheme of Reservation and Delegation of Powers is to describe what
Hillingdon PCT reserves to itself and delegates to its Arms Length Provider Organisation
(APO) in relation to the PCT’s duties, functions and powers to provide services. It is
intended to comply with the Department of Health’s requirements for provider services set
out in the Operating Framework 2008-09.

The Scheme should be read with the APO’s terms of reference and the PCT – APO
Statement of Accountability. The PCT’s Chief Executive remains the Accountable Officer for
the PCT’s provider services, but most operational responsibilities are delegated to the APO.

The Scheme has been approved by the PCT Board. It may be amended only with further
PCT Board approval.




Signed..................................................

Chair of Hillingdon PCT




              Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 25 March 2008                                                  Page No 12
SCHEME OF RESERVATION AND DELEGATION

    THE BOARD          DECISIONS RESERVED TO THE BOARD                                                  APO Board (only
                                                                                                        as applicable to     PCT Board
                                                                                                        the APO)

      THE BOARD        General Enabling Provision

                       1. The Board may determine any matter, for which it has delegated or
                          statutory authority, it wishes in full session within its statutory powers.
                                                                                                                             1.
                       2. The APO may determine any matter for which it has been given
                           delegated authority.                                                         2.

      THE BOARD        Regulations and Control
                       1. Approve Standing Orders (SOs), a schedule of matters reserved to the
                           Board and Standing Financial Instructions for the regulation of its
                           proceedings and business.
                       2. Suspend Standing Orders.
                       3. Vary or amend the Standing Orders.
                       4. Approve a scheme of delegation of powers from the Board to the
                           Executive Committee and other committees.
                       5. Require and receive the declaration of Board members’ interests which
                           may conflict with those of the PCT or APO and, taking account of any
                           waiver which the Secretary of State for Health may have made in any          1-4 and 14     not
                           case, determining the extent to which that member may remain                 applicable
                                                                                                                             1-16
                           involved with the matter under consideration.                                5-13 and 15
                       6. Require and receive the declaration of officers’ interests that may
                           conflict with those of the PCT or APO.
                       7. Approve arrangements for dealing with complaints.
                       8. Adopt the organisation structures, processes and procedures to
                           facilitate the discharge of business by the PCT or APO and to agree
                           modifications thereto.
                       9. Receive reports from committees including those that the PCT or APO
                           is required by the Secretary of State or other regulation to establish
                           and to action appropriately.
                       10. Confirm the recommendations of the PCT’s or APO’s committees
                                                                                                                                         13

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Date of meeting: 26 February 2008                                                         Page No
    THE BOARD          DECISIONS RESERVED TO THE BOARD                                            APO Board (only
                                                                                                  as applicable to     PCT Board
                                                                                                  the APO)
                           where the committees do not have executive powers.
                       11. Approve arrangements relating to the discharge of the PCT’s or APO’s
                           responsibilities as a corporate trustee for funds held on trust.
                       12. Establish terms of reference and reporting arrangements of all
                           committees and sub-committees that are established by the Board.
                       13. Approve arrangements relating to the discharge of the PCT’s
                           responsibilities as a bailee for patients’ property.
                       14. Authorise use of the seal.
                       15. Discipline members of the APO or APO employees who are in breach
                           of statutory requirements or SOs.
                       16. Approve any urgent decisions taken by the Chairman of the PCT and
                           Chief Executive for ratification by the PCT in public session in
                           accordance with SO 5.2.
      THE BOARD        Appointments/ Dismissal
                       1. Appoint and dismiss members of the Executive Committee. (Nb:
                           members of the Executive Committee shall be appointed by the
                           Chairman and at least two non-officer members of the PCT (Direction
                           2(7). The Chairman and non-officer members of the PCT may only
                           terminate the membership of professional members with the consent of
                           the Secretary of State, unless on account of a failure to declare a
                           pecuniary interest.                                                    1, 6 and 7     not
                       2. Appoint the Vice Chairman of the Board or APO.                          applicable
                       3. Appoint and dismiss sub committees (and individual members) that are                         1-7
                           directly accountable to the APO.                                       2-5
                       4. Appoint, appraise, discipline and dismiss APO officer members
                           (subject to SO 2.2).
                       5. Confirm appointment of members of any committee of the PCT as
                           representatives on outside bodies.
                       6. Appoint appraise, discipline and dismiss the APO Secretary (if the
                           appointment of a Secretary is required under APO Standing Orders).
                       7. Approve proposals of the Remuneration Committee regarding directors

                                                                                                                                   14

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Date of meeting: 26 February 2008                                                  Page No
    THE BOARD          DECISIONS RESERVED TO THE BOARD                                              APO Board (only
                                                                                                    as applicable to   PCT Board
                                                                                                    the APO)
                       and senior employees and those of the CE for staff not covered by the
                       Remuneration Committee.


      THE BOARD        Strategy, Local Delivery Plan and Budgets

                       1. Define the strategic aims and objectives of the APO.
                       2. Identify the key strategic risks, evaluate them and ensure adequate
                           responses are in place and are monitored.
                       3. Approve plans in respect of the application of available financial
                           resources to support the agreed Local Delivery Plan (LDP).
                       4. Approve proposals for ensuring quality and developing clinical
                           governance in services provided by the PCT or its constituent
                           practices, having regard to any guidance issued by the Secretary of
                           State.
                       5. Approve (with any necessary appropriate modification) the PCT annual
                           commissioning strategy or plan.                                          5, 6, 13-20not
                       6. Approve annually (with any necessary appropriate modification) the        applicable
                           PCT Local Delivery Plan (LDP).
                       7. Approve the PCT’s policies and procedures for the management of           1-4, and 7-12
                           risk.
                       8. Approve Outline and Final Business Cases for Capital Investment if
                           this represents a variation from the Plan.
                       9. Approve budgets.
                       10. Approve annually PCT’s proposed organisational development
                           proposals.
                       11. Approve contracts with the PCT to provide PMS or PDS, or have
                           contracts with PMS providers to provide services to some or all of the
                           PCT’s population.
                       12. Ratify PCT Executive Committee’s proposals for primary care
                           development, including the draft Primary Care Improvement Plan,
                           proposed GMS Local Development Scheme, proposed practice
                                                                                                                                   15

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Date of meeting: 26 February 2008                                                    Page No
    THE BOARD          DECISIONS RESERVED TO THE BOARD                                                APO Board (only
                                                                                                      as applicable to   PCT Board
                                                                                                      the APO)
                             incentive schemes and proposed new or changes in existing GMS
                             infrastructure reimbursement payments to GP practices.
                       13.   Ratify proposals for acquisition, disposal or change of use of land
                             and/or buildings.
                       14.   Approve PFI proposals.
                       15.   Approve the opening of bank accounts.
                       16.   Approve Executive Committee’s proposals on individual contracts
                             (other than NHS contracts) of a capital or revenue nature amounting
                             to, or likely to amount to over £100,000 over a 3 year period or the
                             period of the contract if longer.
                       17.   Approve Executive Committee’s proposals in individual cases for the
                             write off of losses or making of special payments above the limits of
                             delegation to the Chief Executive and Director of Finance (for losses
                             and special payments) previously approved by the Board.
                       18.   Approve individual compensation payments.
                       19.   Approve proposals for action on litigation against or on behalf of the
                             PCT.
                       20.   Approve Executive Committee's proposals for PCT or practice
                             incentive schemes, having regard to guidance by the Secretary of
                             State.

      The Board        Policy Determination
                       1. Approve management policies including personnel policies
                           incorporating the arrangements for the appointment, removal and            1Not applicable
                           remuneration of staff.

                       Policies so adopted shall be listed and appended to this document
      The Board        Audit
                       1. Approve the appointment and dismissal of external auditors                  1Not applicable
                       2. Receive reports of the audit committee and take appropriate action on
                          them                                                                        2-4
                       3. Receive the annual management letter received from the External
                                                                                                                                     16

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Date of meeting: 26 February 2008                                                        Page No
    THE BOARD          DECISIONS RESERVED TO THE BOARD                                             APO Board (only
                                                                                                   as applicable to     PCT Board
                                                                                                   the APO)
                          Auditor and agreement of Executive Committee’s proposed action,
                          taking account of the advice, where appropriate, of the Audit
                          Committee.
                       4. Receive an annual report from the Internal Auditor and agree action on
                          recommendations where appropriate of the Audit Committee.
      THE BOARD
                       Annual Reports and Accounts
                       1. Receipt and approval of the PCT's Annual Report and Annual
                          Accounts.                                                                1-3 Not applicable
                       2. Receipt and approval of the Annual Report and Accounts for funds         (only APO annual
                          held on trust.                                                           report)
                       3. Receipt of the Annual Report of the Director of Public Health.

      THE BOARD
                       Monitoring
                       1. Receipt of such reports as the Board sees fit from the Executive            but only APO
                          Committee and other committees in respect of its exercise of powers
                                                                                                   subcommittees
                          delegated.




                                                                                                                                    17

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Date of meeting: 26 February 2008                                                   Page No
            DECISIONS/DUTIES DELEGATED BY THE BOARD TO COMMITTEES AND BY THE EXECUTIVE COMMITTEE TO ITS SUB COMMITTEES

    COMMITTEE          DECISIONS/DUTIES DELEGATED BY THE BOARD TO COMMITTEES                           APO (only as    PCT
                       AND BY THE EXECUTIVE COMMITTEE TO ITS SUB COMMITTEES                            applicable to
                                                                                                       the APO)

   AUDIT COMMITTEE     The Committee will:

                       1. Advise the Board on internal and external audit services;
                       2. The Committee shall review the establishment and
                          maintenance of an effective system of integrated governance,
                          risk management and internal control, across the whole of
                          the organisation’s activities (both clinical and non-clinical), that
                          supports the achievement of the organisation’s objectives;
                       3. Monitor compliance with Standing Orders and Standing Financial
                          Instructions;
                       4. Review schedules of losses and compensations and making
                          recommendations to the Board;
                       5. Review the annual financial statements prior to submission to the
                          Board.


  REMUNERATION AND     The Committee will:                                                             1-5 not
  TERMS OF SERVICE                                                                                     applicable
     COMMITTEE         1. Advise the Board about appropriate remuneration and terms of service
                          for the Chief Executive, other executive directors and other senior
                          employees including:
                       • all aspects of salary (including any performance-related
                          elements/bonuses);
                       • provisions for other benefits, including pensions and cars;
                       • arrangements for termination of employment and other contractual
                          terms;
                       2. make recommendations to the Board on any proposed remuneration
                          for individual Executive Committee Members for specific work in
                          addition to their corporate PCTE role, so as to ensure that the individual
                          is fairly rewarded for their individual contribution to the PCT while
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Date of meeting: 26 February 2008                                                        Page No
     COMMITTEE           DECISIONS/DUTIES DELEGATED BY THE BOARD TO COMMITTEES                         APO (only as    PCT
                         AND BY THE EXECUTIVE COMMITTEE TO ITS SUB COMMITTEES                          applicable to
                                                                                                       the APO)
                            having proper regard to the PCT's circumstances and performance,
                            and to the requirements of fair and open tendering or recruitment
                            policies;
                         3. make recommendations to the Board on the remuneration and terms of
                            service of senior employees to ensure they are fairly rewarded for their
                            individual contribution to the PCT - having proper regard to the PCT's
                            circumstances and performance and to the provisions of any national
                            arrangements for such staff;
                         4. proper calculation and scrutiny of termination payments taking account
                            of such national guidance as is appropriate advise on and oversee
                            appropriate contractual arrangements for such staff;
                         5. report in writing to the Board the basis for its recommendations.

  Other committees       Other Committees will advise the APO according to their terms of reference
                         approved by the PCT Board and agreed with the APO:
   (including Clinical
      Governance)        [amend according to the specific Terms of Reference]




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Date of meeting: 26 February 2008                                                        Page No
SCHEME OF DELEGATION DERIVED FROM THE ACCOUNTABLE OFFICER MEMORANDUM



          PCT             DELEGATED TO                                          DUTIES DELEGATED

  CHIEF EXECUTIVE (CE)   Not applicable    Accountable through NHS Accountable Officer Memorandum to Parliament for stewardship of
                                           PCT resources.
  CE AND DIRECTOR OF     MD                Ensure the accounts of the APO are prepared under principles and in a format directed by the
    FINANCE (DOF)                          Secretary of State. Accounts must disclose a true and fair view of the PCT’s income and
                                           expenditure and its state of affairs.
                                           Sign the accounts on behalf of the APO Board.
          CE             MD                Sign a statement in the accounts in terms that they comply with the CE’s responsibilities as the
                                           Accountable Officer.
                                           Sign a statement in the accounts in terms that they comply with the CE’s responsibilities in
                                           respect of Internal Control.
          CE             MD                Ensure effective management systems that safeguard public funds and assist PCT Chairman to
                                           implement requirements of integrated 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 best use of resources;
                                           •   have the information, training and access to the expert advice they need to exercise their
                                               responsibilities effectively.

       CHAIRMAN          APO Chair         Implement requirements of corporate governance
          CE             MD                Achieve value for money from the resources available to the PCT 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 effect the funds available for commissioning healthcare, developing services and
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          PCT             DELEGATED TO                                           DUTIES DELEGATED
                                           promoting health to meet the needs of the local population.
          DOF            ADOF              Operational responsibility for effective and sound financial management and information.
          CE             MD                Primary duty to see that DoF discharges this function.
          CE             MD                Ensuring that expenditure by the PCT complies with Parliamentary requirements
          CE             MD                The Codes of Conduct and Accountability incorporated in the Corporate Governance
                                           Framework issued to NHS Boards by the Secretary of State are fundamental in exercising
                                           their responsibilities for regularity and probity. As a Board member they have explicitly
                                           subscribed to the Codes; and should promote observance by all staff.
      CE and DoF         MD                Chief Executive, supported by Director of Finance, to ensure appropriate advice is given to the
                                           Board and Executive Committee on all matters of probity, regularity, prudent and economical
                                           administration, efficiency and effectiveness.
          CE             MD                If MD considers the APO is doing something that might infringe probity or regularity, he/she
                                           should set this out in writing to the Chief Executive and the APO Board. If the matter is
                                           unresolved, he/she should ask the Audit Committee to inquire.
          CE             MD                If the APO is contemplating a course of action that raises an issue not of formal propriety or
                                           regularity but affects the MD’s responsibility for value for money, the MD should draw the
                                           relevant factors to the attention of the Chief Executive and the APO Board. If the outcome is
                                           that you are overruled it is normally sufficient to ensure that your advice and the overruling of it
                                           are clearly apparent from the papers. Exceptionally, the MD should inform the PCT Board.




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Date of meeting: 26 February 2008                                                    Page No
                                                 SCHEME OF DELEGATION DERIVED FROM THE CODES OF CONDUCT AND ACCOUNTABILITY


         PCT            DELEGATED TO                                  AUTHORITIES/DUTIES DELEGATED                                          APO

        BOARD          Not delegated      Approve procedure for declaration of hospitality and sponsorship
        BOARD          APO Board          Ensure proper and widely publicised procedures for voicing complaints, concerns about
                                          maladministration, breaches of Code of Conduct, and other ethical concerns.
 ALL BOARD MEMBERS     APO Board and      Subscribe to Code of Conduct
   AND EXECUTIVE       sub-Committee
 COMMITTEE MEMBERS     Members
        BOARD          APO Board          Board members share corporate responsibility for all decisions of the Board.

    CHAIR AND NON-     APO Board          Chair and non-officer members are responsible for monitoring the executive management of
   OFFICER MEMBERS
                                          the APO and are responsible to the PCT Board for the discharge of those responsibilities.

        BOARD          APO Board          For the APO only the APO Board will be accountable to the PCT Board for the exercise of the
                                          following functions:

                                                1. to ensure effective financial stewardship through value for money, financial control
                                                    and financial planning and strategy;
                                                2. to ensure that high standards of integrated governance and personal behaviour are
                                                    maintained in the conduct of the business of the whole organisation;
                                                3. to appoint, appraise and remunerate senior executives;
                                                4. on the recommendation of the Executive Committee, to ratify the strategic direction of
                                                    the organisation within the overall policies and priorities of the Government and the
                                                    NHS, define its annual and longer term objectives and agree plans to achieve them;
                                                5. to oversee the delivery of planned results by monitoring performance against
                                                    objectives and ensuring corrective action is taken when necessary;
                                                6. to ensure that the Executive Committee leads an effective dialogue between the
                                                    organisation and the local community on its plans and performance and that these are
                                                    responsive to the community's needs.
        BOARD          APO Board          It is the APO’s duty to:

                                          1. act within statutory financial and other constraints and the APO’s terms of reference;
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         PCT            DELEGATED TO                                      AUTHORITIES/DUTIES DELEGATED                                   APO
                                          2. be clear what decisions and information are appropriate to the APO Board and to
                                             recommend to the PCT Board Standing Orders and Standing Financial Instructions for the
                                             APO;
                                          3. ensure that management arrangements are in place to enable responsibility to be clearly
                                             delegated to senior executives for the main programmes of action and for performance
                                             against programmes to be monitored and senior executives held to account;
                                          4. establish performance and quality measures that maintain the effective use of resources
                                             and provide value for money;
                                          5. specify its requirements in organising and presenting financial and other information
                                             succinctly and efficiently to ensure the Board can fully undertake its responsibilities;
                                          6. work with the PCT’s Audit and Remuneration Committees on the basis of formally agreed
                                             terms of reference which set out the membership of the sub-committee, the limit to their
                                             powers, and the arrangements for reporting back to the main PCT Board and the APO
                                             Board.

      CHAIRMAN         APO Board Chair    It is the Chairman's role to:

                                          1. provide leadership to the APO Board;
                                          2. enable all APO Board members to make a full contribution to the APO Board's affairs and
                                                ensure that the Board acts as a team;
                                          3. ensure that key and appropriate issues are discussed by the APO Board in a timely
                                                manner;
                                          4. ensure the APO Board has adequate support and is provided efficiently with all the
                                                necessary data on which to base informed decisions;
                                          5. advise the PCT Chair on the performance of non-executive Board members.
         CE            MD                 The MD is accountable to the CEO for ensuring that the APO works effectively, in accordance
                                          with Government policy and public service values and for the maintenance of proper financial
                                          stewardship.
                                          The MD should be allowed full scope, within clearly defined delegated powers, for action in
                                          fulfilling the decisions of the APO Board and CEO directions.
     NON OFFICER                          Non-officer Board members are appointed to bring independent judgement to bear on issues
       MEMBERS
                                          of strategy, performance, key appointments and accountability through the PCT Board and to
                                          the local community.

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         PCT            DELEGATED TO                                    AUTHORITIES/DUTIES DELEGATED                                      APO

   CHAIR AND BOARD     APO Board          Declaration of conflict of interests.
      MEMBERS
        BOARD          APO                APO Board must comply with legislation and guidance issued by the Department of Health on
                                          behalf of the Secretary of State, respect agreements entered into by themselves or on their
                                          behalf and establish terms and conditions of service that are fair to the staff and represent
                                          good value for taxpayers' money.




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Date of meeting: 26 February 2008                                                 Page No
SCHEME OF DELEGATION FROM MODEL STANDING ORDERS
         PCT           DELEGATE TO                                   AUTHORITIES/DUTIES DELEGATED                                       APO

      CHAIRMAN         Not delegated    Final authority in interpretation of Standing Orders.
        BOARD          APO Board        Appointment of Vice-Chairman.
      CHAIRMAN         APO Chair        Calling meetings.
      CHAIRMAN         APO Chair        Chair all Board meetings and associated responsibilities.
      CHAIRMAN         APO Chair        Give final ruling in questions of order, relevancy and regularity of meetings.
      CHAIRMAN         APO Chair        Having a second or casting vote.
        BOARD          Not delegated    Suspension of Standing Orders.
                                        Audit Committee to review every decision to suspend Standing Orders (power to suspend
   AUDIT COMMITTEE     Not applicable
                                        Standing Orders is reserved to the Board).
        BOARD          Not delegated    Variation or amendment of Standing Orders
                                        Appoint one of the members of the Executive Committee (not including the Chief Executive or
      CHAIRMAN         Not delegated    Finance Director of the PCT) as Chairman of the Executive Committee, and another member
                                        as vice-Chairman, following nomination by that committee.
                                        The APO Board shall approve the appointments to each of the sub-committees which it has
     THE BOARD         APO Board
                                        formally constituted
                                        The powers which the Board has delegated to the APO Board may in emergency be
  CHAIRMAN & CHIEF     APO Chair and
                                        exercised by the APO Chair and MD after having consulted at least two non-officer members
     EXECUTIVE         MD
                                        of the APO Board
                                        Formal delegation of powers to sub-committees and approval of their constitution and terms of
        BOARD          APO Board
                                        reference.
                                        The MD shall prepare a Scheme of Delegation identifying his/her proposals, which shall be
   CHIEF EXECUTIVE     MD               considered and approved by the PCT Board, subject to any amendment agreed during the
                                        discussion.

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         PCT           DELEGATE TO                                   AUTHORITIES/DUTIES DELEGATED                                  APO
                                        Disclosure of non-compliance with Standing Orders to the Chief Executive as soon as
         ALL           ALL              possible.

    ALL BOARD AND                       Declare relevant and material interests.
      EXECUTIVE        ALL
 COMMITTEE MEMBERS
   CHIEF EXECUTIVE     MD               Maintain Register(s) of Interests.
    CHAIRMAN OF A                       Making a declaration on a declared interest.
                       ALL
       MEETING

                                        Comply with national guidance contained in HSG 1993/5 “Standards of Business Conduct for
      ALL STAFF        ALL
                                        NHS Staff” and the Code of Conduct for NHS Managers 2002.
         ALL           ALL              Disclose of relationship between self and candidate for staff appointment.
   CHIEF EXECUTIVE     Not delegated    Keep seal in safe place and maintain a register of sealing.
  CHIEF EXECUTIVE/                      Approve and sign all documents which will be necessary in legal proceedings.
                       Not delegated
 EXECUTIVE DIRECTOR




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                                                               SCHEME OF DELEGATION FROM MODEL STANDING FINANCIAL INSTRUCTIONS

           PCT                DELEGATED TO                               AUTHORITIES/DUTIES DELEGATED                                         APO

   DIRECTOR OF FINANCE      Not delegated       Approval of all financial procedures in APO.
   DIRECTOR OF FINANCE      ADOF                Advice on interpretation or application of SFIs in APO.
   ALL MEMBERS OF THE                           Have a duty to disclose any non-compliance with these Standing Financial Instructions to
                            All
  BOARD AND EMPLOYEES                           the Director of Performance and Finance as soon as possible.

     CHIEF EXECUTIVE                            MD responsible to the Accountable Officer to ensure financial targets and obligations are
                            MD
                                                met and have overall responsibility for the System of Internal Control.
    CHIEF EXECUTIVE &                           MD and ADOF responsible to the CEO and DOF for financial control but will, as far as
                            MD and ADOF
   DIRECTOR OF FINANCE                          possible, delegate their detailed responsibilities.
                                                To ensure all Board members, officers and employees, present and future, are notified of
     CHIEF EXECUTIVE        MD
                                                and understand Standing Financial Instructions.
                                                Responsible for:
                                                a) Implementing the PCT’s financial policies and co-coordinating corrective action;
                                                b) Maintaining an effective system of financial control including ensuring detailed
                                                   financial procedures and systems are prepared and documented;
                                                c) Ensuring that sufficient records are maintained to explain PCT’s transactions and
   DIRECTOR OF FINANCE      ADOF                   financial position;
                                                d) Providing financial advice to members of Board, staff and executive committee;
                                                e) Maintaining such accounts, certificates etc as are required for the PCT to carry out its
                                                   statutory duties;
                                                f) The design, implementation and supervision of systems of internal control.
                                                Responsible for security of the PCT’s property, avoiding loss, exercising economy and
   ALL MEMBERS OF THE
                            All                 efficiency in using resources and conforming to Standing Orders, Standing Financial
  BOARD AND EMPLOYEES
                                                Instructions and financial procedures.

     CHIEF EXECUTIVE        MD                  Ensure that any contractor or employee of a contractor who is empowered by the PCT to
                                                commit the PCT to expenditure or who is authorised to obtain income are made aware of

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           PCT               DELEGATED TO                                 AUTHORITIES/DUTIES DELEGATED                                         APO
                                                these instructions and their requirement to comply.
     AUDIT COMMITTEE        Not delegated       Provide independent and objective view to the APO on internal control and probity.
                                                Raise the matter at the Board meeting where Chair of Audit Committee considers there is
          CHAIR            APO chair
                                                evidence of ultra vires transactions or improper acts.
                                                a) Ensure an adequate internal audit service, for which he/she is accountable, is provided
                                                (and involve the Audit Committee in the selection process when/if an internal audit service
   DIRECTOR OF FINANCE     ADOF
                                                provider is changed.)
                                                b) Ensure the annual audit report is prepared for consideration by the Audit Committee.

                            Not delegated       Decide at what stage to involve police in cases of misappropriation and other irregularities
   DIRECTOR OF FINANCE
                                                not involving fraud or corruption.
                                                Review, appraise and report in accordance with NHS Internal Audit Standards and best
  HEAD OF INTERNAL AUDIT    Not delegated
                                                practice.
                                                Ensure cost-effective External Audit.
     AUDIT COMMITTEE        Not delegated

    CHIEF EXECUTIVE &       Not delegated       Monitor and ensure compliance with SofS Directions on fraud and corruption including the
   DIRECTOR OF FINANCE                          appointment of the Local Counter Fraud Specialist.
                                                Monitor and ensure compliance with Directions issued by the Secretary of State for
     CHIEF EXECUTIVE        Not delegated       Health on NHS security management including appointment of the Local Security
                                                Management Specialist.
                                                MD responsible to CEO for the APO’s activities and ensuring the APO stays within its
     CHIEF EXECUTIVE        MD
                                                resource limit.
                                                Will provide monthly reports to the SofS, ensure draw down is for approved expenditure
   DIRECTOR OF FINANCE      DOF
                                                and timely and follows best practice in Cash Management.
   DIRECTOR OF FINANCE      ADOF                Ensure monitoring systems are in place to enable the APO not to exceed its limits.
                                                Periodically review assumptions, submit a report to the PCT annually showing total
   DIRECTOR OF FINANCE      ADOF
                                                allocations received and their proposed distribution.
                                                Regularly update the APO on significant changes to the initial allocation and the uses of
   DIRECTOR OF FINANCE      ADOF
                                                such funds
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           PCT               DELEGATED TO                                 AUTHORITIES/DUTIES DELEGATED                                       APO
                                                 Compile and submit to the Board a local delivery plan which takes into account financial
                                                 targets and forecast limits of available resources. The plan will contain:
     CHIEF EXECUTIVE        MD                       • a statement of the significant assumptions on which the plan is based;
                                                     • details of major changes in workload, delivery of services or resources required to
                                                          achieve the plan.
                                                 Submit budgets to the APO Board for approval.
   DIRECTOR OF FINANCE      ADOF                 Monitor performance against budget; submit to the APO Board financial estimates and
                                                 forecasts.
   DIRECTOR OF FINANCE      ADOF                 Ensure adequate training is delivered on an ongoing basis to budget holders.
                            MD and APO budget    Delegate budget to budget holders.
     CHIEF EXECUTIVE
                            holders
     CHIEF EXECUTIVE        MD                   Must not exceed the budgetary total or virement limits set by the Board.

   DIRECTOR OF FINANCE      ADOF                 Devise and maintain systems of budgetary control.
                                                 Ensure that:
                                                 a) no overspend or reduction of income that cannot be met from virement is incurred

                                                 without prior consent of the Board;


     BUDGET HOLDERS         APO budget holders   b) approved budget is not used for any other than specified purpose subject to rules of
                                                 virement;
                                                 c) no permanent employees are appointed without the approval of the CE other than

                                                 those provided for within available resources and manpower establishment.



                                                 Identify and implement cost improvements and income generation activities in line with
     CHIEF EXECUTIVE        MD
                                                 the plan.
     CHIEF EXECUTIVE        MD                   Submit monitoring returns.
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           PCT                DELEGATED TO                                AUTHORITIES/DUTIES DELEGATED                                        APO

   DIRECTOR OF FINANCE      ADOF                Preparation of APO annual accounts and reports.
                                                Managing banking arrangements, including provision of banking services, operation of
   DIRECTOR OF FINANCE      Not delegated       accounts, preparation of instructions and list of cheque signatories.
                                                (Board approves arrangements.)
                                                a) review the banking arrangements of the PCT at regular intervals to ensure they
   DIRECTOR OF FINANCE      Not delegated       reflect best practice and represent best value for money.
                                                b) ensure competitive tenders are sought at least every 5 years.
                                                Income systems, including system design, prompt banking, review and approval of fees
                            Not delegated       and charges, debt recovery arrangements, design and control of receipts, provision of
   DIRECTOR OF FINANCE
                                                adequate facilities and systems for employees whose duties include collecting or holding
                                                cash.
      ALL EMPLOYEES         All                 Duty to inform DoF of money due from transactions which they initiate/deal with.
     CHIEF EXECUTIVE        MD                  Tendering and contracting procedure.
     CHIEF EXECUTIVE        Not delegated       Waive formal tendering procedures.
     CHIEF EXECUTIVE        MD                  Report waivers of tendering procedures to the Audit Committee.

                            Not delegated       Where a supplier is chosen that is not on the approved list the reason shall be recorded in
   DIRECTOR OF FINANCE
                                                writing to the CE or Executive Committee.
     CHIEF EXECUTIVE        Not delegated       Responsible for the receipt, endorsement and safe custody of tenders received.
     CHIEF EXECUTIVE        Not delegated       Shall maintain a register to show each set of competitive tender invitations despatched.
   CHIEF EXECUTIVE AND                          Where one tender is received will assess for value for money and fair price.
                            MD and ADOF
   DIRECTOR OF FINANCE
     CHIEF EXECUTIVE        Not delegated       Responsible for treatment of ‘late tenders’.

     CHIEF EXECUTIVE        MD                  No tender shall be accepted which will commit expenditure in excess of that which has
                                                been allocated by the PCT and which is not in accordance with these Instructions except

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           PCT               DELEGATED TO                                 AUTHORITIES/DUTIES DELEGATED                                        APO
                                                with the authorisation of the MD.
     CHIEF EXECUTIVE        MD                  Will appoint a manager to maintain a list of approved firms.
                                                Shall ensure that appropriate checks are carried out as to the technical and financial
     CHIEF EXECUTIVE        MD
                                                capability of those firms that are invited to tender or quote.
                                                The MD or his nominated officer should evaluate the quotation and select the quote which
     CHIEF EXECUTIVE        MD
                                                gives the best value for money.
                                                No quotation shall be accepted which will commit expenditure in excess of that which has
    CHIEF EXECUTIVE or
                            MD and ADOF         been allocated by the PCT and which is not in accordance with these Instructions except
   DIRECTOR OF FINANCE
                                                with the authorisation of the Chief Executive.

                            Not delegated       The Chief Executive shall demonstrate that the use of private finance represents value for
     CHIEF EXECUTIVE
                                                money and genuinely transfers risk to the private sector.
          Board             Not delegated       All PFI proposals must be agreed by the Board.
                                                The Chief Executive shall nominate an officer who shall oversee and manage each
     CHIEF EXECUTIVE        MD
                                                contract on behalf of the PCT.
                                                The Chief Executive shall nominate officers with delegated authority to enter into
     CHIEF EXECUTIVE        MD                  contracts of employment, regarding staff, agency staff or temporary staff service
                                                contracts.
                                                The Chief Executive shall nominate officers to commission service agreements with
     CHIEF EXECUTIVE        MD
                                                providers of healthcare in line with a commissioning plan approved by the Board.
                                                The Chief Executive shall be responsible for ensuring that best value for money can be
     CHIEF EXECUTIVE        MD
                                                demonstrated for all services provided on an in-house basis.
                                                The Chief Executive shall nominate an officer to oversee and manage the contract on
     CHIEF EXECUTIVE        MD
                                                behalf of the PCT.

     CHIEF EXECUTIVE                            Must ensure the APO enters into suitable Service Level Agreements (SLAs) with service
                            MD
                                                providers for the provision of NHS services.
     CHIEF EXECUTIVE        MD                  As the Accountable Officer, ensure that regular reports are provided to the Board detailing
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           PCT               DELEGATED TO                                AUTHORITIES/DUTIES DELEGATED                                      APO
                                                actual and forecast expenditure against the SLA.
                                                MD responsible to the CEO, as the Accountable Officer, to ensure secondary services are
     CHIEF EXECUTIVE        MD
                                                commissioned in line with the LDP and reach the required standards.
                                                MD responsible to the CEO, as the Accountable Officer, to ensure regular reports are
     CHIEF EXECUTIVE        MD
                                                provided to the Board detailing actual and forecast expenditure for each SLA.
                                                MD responsible to the CEO, as the Accountable Officer, to ensure that all agreements for
     CHIEF EXECUTIVE        MD
                                                provision of services with non-NHS providers achieve quality and are cost effective.
                                                Will maintain a system of control to ensure effective accounting of expenditure against
   DIRECTOR OF FINANCE      ADOF
                                                SLAs.
                                                Must account for Out of Area Treatments/Non Contract Activity in accordance with
   DIRECTOR OF FINANCE      ADOF
                                                national guidelines.
          BOARD             Not delegated       Establish a Remuneration & Terms of Service Committee.
                                                Advise the Board on and make recommendations on the remuneration and terms of
                                                service of the CE, other officer members and senior employees to ensure they are fairly
                                                rewarded having proper regard to the PCT’s circumstances and any national
                            Not delegated       agreements.
 REMUNERATION COMMITTEE
                                                Monitor and evaluate the performance of individual senior employees.
                                                Advise on and oversee appropriate contractual arrangements for such staff, including
                                                proper calculation and scrutiny of termination payments.

                                                Report in writing to the Board its advice and its bases about remuneration and terms of
 REMUNERATION COMMITTEE     Not delegated
                                                service of directors and senior employees.
                                                Approve proposals presented by the Chief Executive for setting of remuneration and
          BOARD             Not delegated       conditions of service for those employees and officers not covered by the Remuneration
                                                Committee.
     CHIEF EXECUTIVE        MD                  Approval of variation to funded establishment of any APO department.
                                                Approval of appointment of APO staff, including agency staff, appointments and re-
     CHIEF EXECUTIVE        MD
                                                grading within approved budget and funded establishment.
   DIRECTOR OF FINANCE      ADOF                Payroll:
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          Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
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           PCT               DELEGATED TO                                AUTHORITIES/DUTIES DELEGATED                                       APO
                                                a) specifying timetables for submission of properly authorised time records and other
                                                   notifications;
                                                b) final determination of pay and allowances;
                                                c) making payments on agreed dates;
                                                d) agreeing method of payment;
                                                e) issuing instructions (as listed in SFI 10.4.2).


                                                Submit time records in line with timetable;
                            NOMINATED           Complete time records and other notifications in required form;
  NOMINATED MANAGERS*
                            MANAGERS            Submitting termination forms in prescribed form and on time.

                                                Ensure that the chosen method for payroll processing is supported by appropriate
                                                (contracted) terms and conditions, adequate internal controls and audit review procedures
   DIRECTOR OF FINANCE      Not delegated       and that suitable arrangements are made for the collection of payroll deductions and
                                                payment of these to appropriate bodies.

                                                Ensure that all employees are issued with a Contract of Employment in a form approved
   NOMINATED MANAGER*       Not delegated       by the Board and which complies with employment legislation;
                                                Deal with variations to, or termination of, contracts of employment.
          BOARD             APO Board           The Board will approve the level of non-pay expenditure on an annual basis.

                                                Determine, and set out, level of delegation of non-pay expenditure to budget managers,
                                                including a list of managers authorised to place requisitions, the maximum level of each
     CHIEF EXECUTIVE        MD                  requisition and the system for authorisation above that level.
                                                [It is good practice to append such lists to the Scheme of Delegation document.]
                                                Set out procedures on the seeking of professional advice regarding the supply of goods
     CHIEF EXECUTIVE        MD
                                                and services.
                                                In choosing the item to be supplied (or the service to be performed) shall always obtain
      REQUISITIONER*        REQUISITIONER       the best value for money for the PCT. In so doing, the advice of the PCT's adviser on
                                                supply shall be sought.

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           PCT               DELEGATED TO                                 AUTHORITIES/DUTIES DELEGATED                                         APO

   DIRECTOR OF FINANCE      ADOF                Shall be responsible for the prompt payment of accounts and claims.
                                                a) Advise the APO Board regarding the setting of thresholds above which quotations        f)
                                                   (competitive or otherwise) or formal tenders must be obtained; and, once approved,
                                                   the thresholds should be incorporated in standing orders and regularly reviewed;
                                                b) Prepare procedural instructions [where not already provided in the Scheme of
                                                   Delegation or procedure notes for budget holders] on the obtaining of goods, works
                                                   and services incorporating the thresholds;
   DIRECTOR OF FINANCE      ADOF
                                                c) Be responsible for the prompt payment of all properly authorised accounts and
                                                   claims;
                                                d) Be responsible for designing and maintaining a system of verification, recording and
                                                   payment of all amounts payable;
                                                e) Be responsible for ensuring that payment for goods and services is only made once
                                                   the goods and services are received.
  APPROPRIATE EXECUTIVE                         Make a written case to support the need for a pre-payment.
                            MD or ADOF
       DIRECTOR
   DIRECTOR OF FINANCE      Not delegated       Approve proposed pre-payment arrangements.
                                                Ensure that all items due under a prepayment contract are received (and immediately
      BUDGET HOLDER         BUDGET HOLDER
                                                inform DoF if problems are encountered).
     CHIEF EXECUTIVE        MD                  Authorise who may use and be issued with official orders.
                                                Ensure that they comply fully with the guidance and limits specified by the Director of
  MANAGERS AND OFFICERS     MD or ADOF
                                                Finance.
                                                Ensure that the arrangements for financial control and financial audit of building and
     CHIEF EXECUTIVE                            engineering contracts and property transactions comply with the guidance contained
                            MD and ADOF
   DIRECTOR OF FINANCE                          within CONCODE and ESTATECODE. The technical audit of these contracts shall be
                                                the responsibility of the relevant Director.
                                                Lay down procedures for payments to local authorities and voluntary organisations made
   DIRECTOR OF FINANCE      Not delegated
                                                under the powers of section 28A of the NHS Act.
                                                Ensure that Board members are aware of the Financial Framework and ensure
   DIRECTOR OF FINANCE      ADOF
                                                compliance
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           PCT               DELEGATED TO                                  AUTHORITIES/DUTIES DELEGATED                                    APO

                                                Capital investment programme for the APO:
                                                a) ensure that there is adequate appraisal and approval process for determining capital
                                                   expenditure priorities and the effect that each has on plans;
     CHIEF EXECUTIVE        MD                  b) responsible for the management of capital schemes and for ensuring that they are
                                                   delivered on time and within cost;
                                                c) ensure that capital investment is not undertaken without availability of resources to
                                                   finance all revenue consequences;
                                                d) ensure that a business case is produced for each proposal.
                                                Certify professionally the costs and revenue consequences detailed in the business case
   DIRECTOR OF FINANCE      ADOF
                                                for capital investment.
     CHIEF EXECUTIVE        Not delegated       Issue procedures for management of contracts involving stage payments.
                                                Issue procedures for the regular reporting of expenditure and commitment against
   DIRECTOR OF FINANCE      ADOF
                                                authorised capital expenditure.
                                                Shall issue to the manager responsible for any scheme specific authority to commit
     CHIEF EXECUTIVE        MD
                                                expenditure, proceed to tender and accept a successful tender.
                                                Issue a scheme of delegation for capital investment management in accordance with
     CHIEF EXECUTIVE        MD
                                                Estate code and Standing Orders.
                                                Issue procedures governing financial management, including variation to contract, of
   DIRECTOR OF FINANCE      ADOF
                                                capital investment projects and valuation for accounting purposes.
                                                Demonstrate that the use of private finance represents value for money and genuinely
   DIRECTOR OF FINANCE      ADOF
                                                transfers significant risk to the private sector.
          Board             Not delegated       Proposal to use PFI must be specifically agreed by the Board.
     CHIEF EXECUTIVE        MD                  Maintenance of asset registers (on advice from DoF).
                                                Approve procedures for reconciling balances on fixed assets accounts in ledgers against
   DIRECTOR OF FINANCE      ADOF
                                                balances on fixed asset registers.
   DIRECTOR OF FINANCE      Not delegated       Calculate and pay capital charges in accordance with Department of Health requirements.
     CHIEF EXECUTIVE        Not delegated       Overall responsibility for fixed assets.
   DIRECTOR OF FINANCE      Not delegated       Approval of fixed asset control procedures.
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Date of meeting: 26 February 2008                                                    Page No
           PCT               DELEGATED TO                                  AUTHORITIES/DUTIES DELEGATED                                      APO

   BOARD, EXECUTIVE                              Responsibility for security of PCT assets including notifying discrepancies to DoF, and
                            APO Board and all
 MEMBERS AND ALL SENIOR                          reporting losses in accordance with PCT procedure.
                            senior APO staff
          STAFF

                                                 Delegate overall responsibility for control of stores (subject to ADoF responsibility for
                                                 systems of control). Further delegation for day-to-day responsibility subject to such
     CHIEF EXECUTIVE        MD
                                                 delegation being recorded. (Good practice to append to the scheme of delegation
                                                 document.)
   DIRECTOR OF FINANCE      ADOF                 Responsible for systems of control over stores and receipt of goods.
                            DESIGNATED           Responsible for controls of pharmaceutical stocks.
       DESIGNATED
                            PHARMACEUTICAL
 PHARMACEUTICAL OFFICER
                            OFFICER

   DESIGNATED ESTATES       DESIGNATED ESTATES   Responsible for control of stocks of fuel oil and coal.
        OFFICER             OFFICER
   NOMINATED OFFICERS*      NOMINATED OFFICERS   Security arrangements and custody of keys.
   DIRECTOR OF FINANCE      ADOF                 Set out procedures and systems to regulate the stores.
   DIRECTOR OF FINANCE      ADOF                 Agree stocktaking arrangements.
                                                 Approve alternative arrangements where a complete system of stores control is not
   DIRECTOR OF FINANCE      ADOF
                                                 justified.
                                                 Approve system for review of slow moving and obsolete items and for condemnation,
   DIRECTOR OF FINANCE      ADOF
                                                 disposal and replacement of all unserviceable items.
                                                 Operate system for slow moving and obsolete stock, and report to DoF evidence of
   NOMINATED OFFICERS*      NOMINATED OFFICERS
                                                 significant overstocking.
     CHIEF EXECUTIVE        MD                   Identify persons authorised to requisition and accept goods from NHS Supplies stores.
                                                 Prepare detailed procedures for disposal of assets including condemnations and ensure
   DIRECTOR OF FINANCE      ADOF
                                                 that these are notified to managers.

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Date of meeting: 26 February 2008                                                    Page No
           PCT               DELEGATED TO                                 AUTHORITIES/DUTIES DELEGATED                                       APO

   DIRECTOR OF FINANCE      ADOF                Prepare procedures for recording and accounting for losses, special payments.

                                                Discovery or suspicion of loss of any kind must be reported immediately to either head of
        ALL STAFF           ALL STAFF           department or nominated officer. The head of department / nominated officer should then
                                                inform the CE and DoF.
                                                Where a criminal offence is suspected DoF must inform the police if theft or arson is
                            Not delegated       involved. In cases of fraud and corruption DoF must inform the relevant Local Counter
   DIRECTOR OF FINANCE
                                                Fraud Specialist (LCFS) and NHS Counter Fraud Service (NHS CFS) Operational Fraud
                                                Team in line with SofS directions.
   DIRECTOR OF FINANCE      Not delegated       Notify CFSMS, LCFS and External Audit of all frauds.

                            Not delegated       Notify Board and External Auditor of losses caused theft, arson, neglect of duty or gross
   DIRECTOR OF FINANCE
                                                carelessness (unless trivial).
          BOARD             ADOF                Approve write off of losses (within limits delegated by DH).
   DIRECTOR OF FINANCE      ADOF                Consider whether any insurance claim can be made.
   DIRECTOR OF FINANCE      ADOF                Maintain losses and special payments register.
   DIRECTOR OF FINANCE      ADOF                Responsible for accuracy and security of computerised financial data.
                                                Satisfy himself that new financial systems and amendments to current financial systems
                                                are developed in a controlled manner and thoroughly tested prior to implementation.
   DIRECTOR OF FINANCE      ADOF
                                                Where this is undertaken by another organisation, assurances of adequacy must be
                                                obtained from them prior to implementation.
 DIRECTOR OF INFORMATION                        Shall publish and maintain a Freedom of Information Scheme.
                            Not delegated
       TECHNOLOGY
    RELEVANT OFFICERS       RELEVANT OFFICERS   Send proposals for general computer systems to DoF.
                                                Ensure that contracts with other bodies for the provision of computer services for
                                                financial applications clearly define responsibility of all parties for security, privacy,
   DIRECTOR OF FINANCE      Not delegated
                                                accuracy, completeness and timeliness of data during processing, transmission and
                                                storage, and allow for audit review.
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Date of meeting: 26 February 2008                                                   Page No
           PCT               DELEGATED TO                                  AUTHORITIES/DUTIES DELEGATED                                       APO

                                                Seek periodic assurances from the provider that adequate controls are in operation.

                                                Where computer systems have in impact on corporate financial systems satisfy himself
                                                that:
                                                a) systems acquisition, development and maintenance are in line with corporate
                                                     policies;
   DIRECTOR OF FINANCE      ADOF                b) data assembled for processing by financial systems is adequate, accurate, complete
                                                     and timely, and that a management rail exists;
                                                c) DoF and staff have access to such data;
                                                d) Such computer audit reviews are being carried out as are considered necessary.

                                                Responsible for ensuring patients and guardians are informed about patients' money and
     CHIEF EXECUTIVE        MD
                                                property procedures on admission.
                                                Provide detailed written instructions on the collection, custody, investment, recording,
                                                safekeeping, and disposal of patients' property (including instructions on the disposal of
   DIRECTOR OF FINANCE      ADOF
                                                the property of deceased patients and of patients transferred to other premises) for all
                                                staff whose duty is to administer, in any way, the property of patients.
                            DEPARTMENTAL        Inform staff of their responsibilities and duties for the administration of the property of
 DEPARTMENTAL MANAGERS
                            MANAGERS            patients.
                                                Shall ensure that each trust fund which the PCT is responsible for managing is managed
   DIRECTOR OF FINANCE      ADOF
                                                appropriately.
                                                Ensure all staff are made aware of the PCT policy on the acceptance of gifts and other
   DIRECTOR OF FINANCE      ADOF
                                                benefits in kind by staff.
                                                Ensure lists of all contractors are maintained up to date and systems are in place to deal
     CHIEF EXECUTIVE        MD                  with applications, resignations, inspection of premises etc. within contractors’ terms of
                                                service.
                                                Ensure only contractors included on the PCT lists receive payments; maintain a system of
   DIRECTOR OF FINANCE      ADOF
                                                control to ensure prompt and accurate payments and validation of same.

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          Hillingdon Primary Care Trust Board Meeting (PART ONE – PUBLIC MEETING)
Date of meeting: 26 February 2008                                                    Page No
           PCT               DELEGATED TO                                 AUTHORITIES/DUTIES DELEGATED                                            APO

     CHIEF EXECUTIVE        MD                  Retention of document procedures in accordance with Department of Health guidance.
     CHIEF EXECUTIVE        MD                  Risk management programme.
          BOARD             APO Board           Approve and monitor risk management programme for approval by the Board.
                                                Decide whether the PCT will use the risk pooling schemes administered by the NHS
          BOARD             Not delegated       Litigation Authority or self-insure for some or all of the risks (where discretion is allowed).
                                                Decisions to self-insure should be reviewed annually.
                                                Where the Board decides to use the risk pooling schemes administered by the NHS
                                                Litigation Authority the Director of Finance shall ensure that the arrangements entered
                                                into are appropriate and complementary to the risk management programme. The
                                                Director of Finance shall ensure that documented procedures cover these arrangements.

   DIRECTOR OF FINANCE      Not delegated       Where the Board decides not to use the risk pooling schemes administered by the NHS
                                                Litigation Authority for any one or other of the risks covered by the schemes, the Director
                                                of Finance shall ensure that the Board is informed of the nature and extent of the risks
                                                that are self insured as a result of this decision. The Director of Finance will draw up
                                                formal documented procedures for the management of any claims arising from third
                                                parties and payments in respect of losses that will not be reimbursed.




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Date of meeting: 26 February 2008                                                   Page No

				
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Description: GOVERNANCE ARRANGEMENTS FOR THE PCTs ARMS LENGTH PROVIDER