1

Minutes of the Audit and Governance Committee Meeting held on

19 September 2013 in the Shibden Meeting Room, F Mill, Dean
Clough, Halifax


Present:


John Mallalieu
Dr Majid Azeb
Jackie Bird
Dr Peter Davies
Kate Smyth

Lay Member (Chair)
GP Member
Registered Nurse
GP Member
Lay Member


Also present:

Sarah Antemes

Sam Byrnes
Julie Lawreniuk
Michelle Marsden
Martin Pursey

Judith Salter

Janet Smart
Penny Woodhead
Jane Brownlie

Head of Commissioning Continuing
Care/Funded Nursing Care (for item 34/13)
Associate WSYBCSU (for item 33/13)
Chief Finance Officer
Internal Audit Manager
Head of Contracting and Procurement (for items
40, 41 & 43/13)
Corporate and Governance Manager (for items 35,
36, 37 & 39/13)
Senior Associate WSYBCSU (for item 32/13)
Head of Quality (for item 38/13)
Governance Lead


26/13

DECLARATIONS OF INTEREST

Majid Azeb and Peter Davies declared an interest in items 35/13 (Local
Dispute Resolution Procedure, 40/13 (List of Tenders) and 41/13 (Contracts
Register).




27/13 MINUTES OF THE PREVIOUS MEETING HELD ON 8 AUGUST 2013

The minutes of the previous meeting held on 8 August 2013 were accepted
as a correct record.


28/13 STRATEGIC REVIEW (OUTSTANDING MATTER ARISING FROM MINUTES OF
30 MAY 2013)

Reference was made to an outstanding action from the minutes of the meeting held
on 30 May 2013 regarding the requirement for information on the total cost of the
contract for support to the Strategic Review and the authorisation procedures and
financial limits applied.

The Head of Contracting and Procurement advised that the total cost of the contract
was 951,000 split over NHS Calderdale and NHS Kirklees. It was reported that on
6 November 2012 the NHS Calderdale, Kirklees and Wakefield District Cluster
Board had approved a contract with PA Consulting, which had a ceiling of
600,000. It was reported that subsequently some diagnostic work was undertaken
and there was a re-scoping of what was required and this led to a contract













Agenda Item 14a
2
extension of 153,000 at the end of 2012. In response to questions from the Chair,
it was confirmed that the value of the extension was such that Cluster Board
approval had not been required, the cost had been split 50/50 with NHS Kirklees
and the Head of Contracting and Procurement confirmed that the correct
procurement processes (as specified within Standing Orders/Standing Financial
Instructions) had been applied. The extension had been granted on the basis of
there being clear benefit to an extension as opposed to starting the contracting
process again.

In preparation for the end of the contract there had then been discussions on the
handover of work from PA Consulting to the Commissioning Support Unit and this
had led to a further contract extension of 98,000 since the CSU had not been in a
position to take over the work until June 2013. It was noted that the first contract
extension had been approved by the PCT but the second extension had been
approved under the CCG's Standing Financial nstructions.

In response to a question from a GP Member, the Head of Contracting and
Procurement explained that in order to extend a contract it was necessary to waive
the usual competitive tendering requirements and Standing Financial Instructions
outlined the specific circumstances in which this could occur. He commented that
the waiver enabled a proportionate response to the situation, as the alternative of
going back out to the market to re-tender would not have been practical in view of
the timescales. The Chair commented that his understand was that this waiver had
occurred at the very end of a lengthy piece of work and where the Commissioning
Support Unit had not been in a position to take over the work immediately.

A GP Member referred to the cost of the entire contract and asked about whether
Value for Money had been obtained. The Head of Contracting and Procurement
referred to the fact that initially there had been a competitive tendering exercise, five
of the ten companies that had originally expressed an interest had submitted
tenders and they had ranged from 600,000 to 1,100,000, with the tender from PA
Consulting being the lowest. It had therefore been known, at the time the original
tender had been awarded, that the figure quoted was tight. The Head of
Contracting and Procurement added that it was quite common for a consultancy
brief to be clear at the outset, but to subsequently change and thus affect the
ultimate cost. He added that there was a governance process within the review and
for example there had been regular reports to the former Clinical Commissioning
Executive and subsequently the CCG Governing Body.

The Registered Nurse asked whether the waivers of Standing Orders to enable
contract extensions were audited. The Head of Contracting and Procurement
advised that historically, waivers rarely occurred (although there were two to be
considered later in this meeting). The Chief Finance Officer suggested that the
number of waivers be reviewed at the end of the financial year and that it then be
decided whether an Internal Audit review should be undertaken.

DECISIONS

1. That the oral report be noted.

2. That the number of waivers be reviewed and the end of the financial year
and that it then be decided whether an Internal Audit review should be
undertaken.









































ACTION






ACTION
3

29/13 INTERNAL AUDIT AND COUNTER FRAUD UPDATE REPORT

The Internal Audit Manager presented this report which provided an update
on recent activity by Internal Audit and Counter Fraud.

It was noted that although the 2013/14 work plans for Internal Audit and
Counter Fraud had been referred to at previous meetings they had not been
formally approved. Copies of the work plans were therefore appended to
this report for consideration and approval.

Summaries of two Internal Audit reports finalised since the previous meeting
were appended to the report. The first of these reports concerned
complaints and it was noted that an audit opinion of significant assurance
had been given. It was reported that the investigation had included a gap
analysis of the CCG's position against NHS England's "Guide to good
handling of complaints for CCGs, the Local Authority Social Services and
NHS Complaints (England) Regulations 2009 and recommendations in the
Francis Report regarding effective complaint handling. The Internal Audit
Manager advised that although some gaps had been found between the
CCG's Complaints Framework policy and the guidance, the way in which
complaints were being handled in practice was consistent with the
requirements in the guidance and it was not considered necessary to bring
forward the review of the CCG's Complaints Framework policy.

With regard to the Internal Audit work regarding the Francis report, it was
explained that in order to avoid duplication, the approach taken had been to
review the work already undertaken. In response to a question from the
Chair the nternal Audit Manager confirmed that the CCG's Action Plan on
the Francis report was sufficiently robust to be audited against. It was noted
that a further report would be submitted to a subsequent meeting.

The second finalised Internal Audit report related to the Assurance
Framework and the Internal Audit Manager advised that a formal audit
opinion had not been issued on this investigation, that overall the Assurance
Framework had been found to be satisfactory. Some gaps in assurance had
been identified however, so two recommendations for improvement had
been made, both of which had been accepted.

With regard to Counter Fraud, it was reported that the main focus had been
on fraud awareness and training. It was noted that one training session had
already taken place and more were scheduled. A GP Member commented
upon the importance of capturing feedback on the training.

The Internal Audit Manager commented that, although the Counter Fraud
annual work plan was being recommended for approval, it was intended that
this would be reviewed when NHS Protect issued its formal standards for
proactive work to be undertaken at commissioning organisations.

DECISIONS

1. That the report be noted.






























ACTION
4
2. That the Internal Audit Annual Work Plan for 2013/14 be approved
and progress on its implementation be noted.

3. That the Counter Fraud Work Plan for 2013/14 be approved and
progress on its implementation be noted.

30/13 EXTERNAL AUDIT TECHNICAL UPDATE

The Chief Finance Officer presented this update on behalf of the KPMG
Manager for Calderdale CCG, who was not able to attend this meeting. It
was noted that a KPMG Audit Manager would be expected to attend future
meetings and that provision of information concerning External Audit would
not ordinarily be presented by the Chief Finance Officer.
The Chief Finance Officer asked whether the Committee would like to
continue to receive these updates in the future. It was agreed that External
Audit Technical Updates should continue to be included on the Committee
Agendas, that there should not be detailed presentations on them, but that
Committee members be offered the opportunity to ask questions on their
content.

DECISIONS

1. That the update be noted.

2. That external audit technical updates be submitted to subsequent
meetings.

31/13 SUMMARY OF CCG ACCOUNTS REQUIREMENTS

The Chief Finance Officer presented this paper from HFMA which
summarised the statutory requirements for CCG accounts, the guidance
available, the expected format of accounts and key accounting issues for
CCGs in 2013/14.

Reference was made to the fact that the former Clinical Commissioning
Executive had shadowed the PCT's annual accounts process and the Chief
Finance Officer advised that the statutory requirements were similar to those
of the former PCT. However, she referred to a new financial ledger that had
been implemented from April 2013 and advised that although this was held
by the CCG, NHS England had access and could obtain reports from it
remotely.

The Chief Finance Officer reported that the CCG's opening balance sheet
had not yet been finalised, but that she hoped it would be available to be
presented to the next meeting. In response to a question from a GP
Member, she advised that although the CCG's budgets were agreed, the
opening balance sheet could not simply be based on the former PCT's
closing balance sheet because several other bodies, in addition to the CCG
had taken responsibilities from the PCT, such as NHS England and the Local
Authority.

The Chair referred to previous discussions he had had about the possibility
of a training session on the new format of the accounts (possibly in January
2014).

















ACTION









5

DECISIONS

1. That the report be noted.

2. That, if available, the CCG opening balance sheet be presented to
the next meeting.

3. That further consideration be given to a training session being held
on the new format of the accounts, possibly in January 2014.







ACTION



ACTION
32/13 HIGH LEVEL RISK REGISTER POSITION STATEMENT

The Commissioning Support Unit Senior Associate for Risk and Governance
presented this report which summarised the process for detailed review of
the CCG's risks and included at its appendix the high level risks captured on
the CCG's risk register as at 22 August 2013.

A GP Member asked about the sequence of the end of the risk log cycles
and the consideration of reports at this Committee and the Governing Body.
Concern was expressed at the time lag involved. The Corporate and
Governance Manager advised that she had previously looked at this, but
would give further consideration as to whether the cycles could be better
aligned.

The Registered Nurse referred to the start date of some of the risks, with one
dating back to 2007. It was confirmed that some of the risks had been
passed from the PCT to the CCG and that although those risks themselves
remained the same, the register included updated information on the action
being taken to address them. It was also explained that the Quality
Committee and the Finance and Performance Committee carried out the
review of the individual risks and so they received more detailed information
than this committee, which concentrated more of an overview and monitored
the processes.

A GP Member asked about the rationale for the scoring on risk 290
regarding Health Care Associated Infections. The Chair asked that the next
risk register report include a short explanation of the rationale behind the
scoring of risks as high level.

The Corporate and Governance Manager advised that the third paragraph of
section 3.5.1 regarding the risk on NHS 111 and West Yorkshire Urgent
Care was included in error and needed to be deleted/omitted from the report
to the Governing Body as the discussion had been at Quality Committee and
not Finance and Performance Committee (the same paragraph was correctly
included in section 3.5.2).

DECISIONS

1. That the High Level Risk Log and position statement be received.

2. That, subject to the deletion of the third paragraph of Section 3.5.1,
the review of the risks undertaken by the Finance and Performance



























ACTION






ACTION







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Committee and the Quality Committee be noted.

3. That, subject to the deletion of the third paragraph of Section 3.5.1,
the High Level Risk Log and position statement be recommended to
the Governing Body as a true reflection of the risk position as at 22
August 2013






ACTION
33/13 INFORMATION GOVERNANCE TOOLKIT: IMPROVEMENT ACTION
PLAN AND PROGRESS REPORT

The Commissioning Support Unit Associate Information Governance
Specialist presented this report which referred to the requirement for the
CCG to submit an annual information governance assessment, by
completing the Information Governance Toolkit performance assessment
tool.

It was reported that, by 31 March 2014, the CCG was required to achieve
level 2 performance against 28 specific requirements within the toolkit. An
assessment of the CCG's current position against each of the requirements
had been undertaken and an Improvement Plan drawn up to identify specific
actions needed to enable the CCG to achieve the minimum level 2 score by
31 March 2014 (and level 3 where level 2 had previously been achieved).
The assessment and improvement plan was appended to the report and the
Committee was being asked to approve this plan.

Reference was made to a number of key actions scheduled for September
and October 2013 and it was reported that some progress had already made
in implementing the Improvement Plan.

In response to a question from a GP Member it was confirmed that the
Toolkit applied to the work of the CCG as an organisation, rather than activity
within member GP practices.

The Registered Nurse asked about arrangements for assurance of progress
in implementing the Improvement Plan and it was reported that the Senior
Management Team was monitoring progress and it was intended to bring an
update report to the remaining Audit and Governance Committee meetings
in 2013/14. The Chair suggested that the progress reports include a RAG
rating.

DECISIONS

1. That NHS Calderdale CCG!s baseline position and forecast year end
Information Governance Toolkit scores be noted.

2. That the Information Governance Toolkit Assessment and
Improvement Plan 2013/14 be approved.

3. That the Information Asset Risk Management Plan and Work
Package be approved.

4. That the progress made to date and the next steps, as identified
within the report, be noted.






























ACTION















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5. That further update reports, including a RAG rating on progress
towards to required Information Governance Toolkit scores be
submitted to the next three meetings.





ACTION
34/13 PERSONAL HEALTH BUDGETS UPDATE REPORT

The Head of Commissioning Continuing Care/Funded Nursing Care
presented this report which referred to the government commitment that by
April 2014, people eligible for NHS Continuing Healthcare would have the
right to ask for a personal health budget, including a direct payment for
healthcare.

The report outlined the steps being taken to ensure that appropriate systems
and processes were in place to enable the introduction of Personal Health
Budgets and identified key areas of risk, both for the individual and for the
CCG.

It was noted that the Senior Management Team had approved a governance
structure, that included the establishment of a Project Board (which included
a lay member and a clinical member) to oversee the work streams and would
report in to Quality Committee and Finance and Performance Committee
when specific issues arose.

The proposal for the Audit and Governance Committee to take on the role of
overviewing the process was noted. The Chair commented upon the risks
associated with the implementation of this new form of commissioning and
commented that he believed it would be appropriate for the committee to
take on this role. It was suggested that the Chief Finance Officer and the
Head of Commissioning Continuing Care/Funded Nursing Care discuss
further the process for reporting back to this Committee.

DECISIONS

1. That the report be noted.

2. That the Audit and Governance Committee!s role in oversight of the
initial implementation of Personal Health Budgets be noted.


























ACTION
35/13 LOCAL DISPUTE RESOLUTION PROCEDURE

It was noted that Dr Majid Azeb and Dr Peter Davies had declared an
interest in this item.

The Corporate and Governance Manager presented this report which
referred to the commitment within the CCG's Constitution to develop and
agree a clear process for handling and resolving disputes between the CCG
and any of its 26 member practices. A proposed Local Dispute Resolution
Procedure was appended to the report and it was noted that this had been
based on the procedure that previously existed between the Primary Care
Trust and primary care contractors and the document "BMA commissioning:
Model dispute resolution procedure.













8

A GP Member referred to the Panel membership outlined at point 4.1 of the
procedure, which described the Administrator as non-voting and asked about
the status of the other panel members listed. It was reported that all the
other members would be voting members with the possible exception of the
two co-opted members described at point 4.4 whose voting status would be
determined by the Panel Chair in advance of the meeting.

A GP Member asked about feedback on the frequency of use of the
procedure. The Corporate and Governance Manager advised that an
integrated governance report was intended to be presented from November
2013 and she suggested that information on the use of this procedure could
be included within that report.

The Chair asked about Stage 3 of the procedure, where a dispute had not
been able to be resolved locally and it therefore had to be forwarded to NHS
England's West Yorkshire Area Team. t was understood that NHS England
had not yet developed a procedure for Stage 3, but it was agreed that further
information would be circulated once it became available.

DECISIONS

1. That further information be circulated on NHS England!s procedure
for Stage 3 once it became available.

2. That, subject to decision 1. above, the Local Dispute Resolution
Procedure be approved.



















ACTION
36/13 GOVERNING BODY ASSURANCE FRAMEWORK

The Corporate and Governance Manager presented this report which
referred to the purpose of the Assurance Framework being to identify the
principal risks to the CCG delivering its strategic objectives and action to be
taken to mitigate against those risks.

It was noted that the Governing Body had previously authorised the Audit
and Governance Committee to review the Assurance Framework on a six
monthly basis, with the first review being due in September 2013. Internal
Audit had therefore undertaken a review of the Assurance Framework and a
copy of the audit findings was appended to this report. It was noted that two
recommendations had been made following findings that assurances were
not sufficiently specific and a lack of evidence of action plans being in place
to address the identified gaps in assurance.

The Registered Nurse commented upon the significant proportion of
corporate risks and asked about the relationship with the corporate risk
register. It was commented that this tied in with the fact that the Assurance
Framework was based on the CCG's strategic objectives. However,
reference was also made to point 3.5 of the report which referred to further
work being carried out to test the Assurance Framework against the CCG
corporate risk register, the health and wellbeing priorities and any associated
risks and comments/recommendations from the Senior Management Team.


9
The Internal Audit Manager commented that copies of the Good Practice
Briefing Assurance for Boards were available for committee members on
request.

It was noted that an updated version of the Assurance Framework was
planned to be presented to the next meeting.

DECISIONS

1. That receipt of the Internal Audit report on the Assurance
Framework (also received under item 29/13) be noted.

2. That authority be granted to proceed to the next steps outlined in
the report.

37/13 UPDATE ON REVIEW OF REGISTER OF INTERESTS

The Corporate and Governance Manager advised that legislation required
the CCG to maintain registers of interests in respect of members of the CCG,
members of its Governing Body, members of its committees and sub-
committees and its employees.

It was confirmed that there was already a register of interests of Governing
Body members (which would shortly be updated) and a letter had been
drafted for clinical and lay associates. Consideration was being given to
whether the employees register should be restricted to those employees who
were in a position to influence CCG decisions. It was also reported that
further consideration was being given as to which individuals within member
practices were included in the definition of members of the CCG and work
would then begin on compiling that register.

DECISION

That the oral update be noted.


38/13 PROCESSES FOR THE MANAGEMENT OF SERIOUS INCIDENTS
ASSURANCE STATEMENT AND PERFORMANCE REPORT, QUARTER 1

The Head of Quality presented this report which had been considered by the
Quality Committee on 25 July 2013. This report was being presented to
demonstrate the application of governance systems in respect of Serious
Incidents and thus assist the Audit and Governance Committee in performing
its function of monitoring governance processes.

Reference was made to the policy and procedure for the performance and
management of Serious Incidents attached at Appendix B and it was
confirmed that this policy was consistent with the new NHS England
framework. The Head of Quality advised that Internal Audit was to review
the CCG's Serious ncident processes and she believed this would be
valuable, particularly in view of issues with providers concerning timeliness
of reporting. In terms of monitoring the Head of Quality advised that there
were monthly formal meetings with CHFT and SWYPFT regarding Serious
Incidents and weekly meetings between staff. The Chair asked about

10
possible sanctions and contractual levers where reporting was being
delayed. It was reported that the contracts with providers referred to the
requirement of complying with the policy and failure to do so would lead to
issues being escalated through the Quality Surveillance Group.

The Head of Quality reported that she was assured that the providers were
managing their incidents, but there were some issues on the classification of
the incidents and she added that the definition of a "serious incident was not
very specific.

The Chair expressed concern that delayed reporting damaged the CCG's
ability to see the wider picture of what was happening across Calderdale. A
GP member referred to learning from the Francis report and he commented
that, as with complaints, it was important that the occurrence of serious
incidents was given appropriate attention.

The Head of Quality advised that she was satisfied that when serious
incidents occurred the situation was being managed well and commented
upon improved transparency at CHFT, with its Quality Committee minutes
now being publicly available, so that it was possible to trace how a particular
incident had been handled.

DECISION

That the report be noted.

39/13 OPERATIONAL AMENDMENTS TO THE CONSTITUTION - UPDATE

The Corporate and Governance Manager presented this progress report
regarding proposed amendments to the CCG's Constitution accepted by the
CCG membership and the Governing Body in June/July 2013.

It was confirmed that the proposed amendments to be submitted to NHS
England for approval and an informal response had been received.
Reference was made to four areas in which variations were being suggested
by NHS England and it was reported that none of these suggestions
constituted a material change to the document. Three of the suggestions
had been accepted, but further discussions had taken place in respect of the
fourth suggestion that the description of the Director of Public Health and the
Director of Adult Health and Social Services be changed from "non-voting
member to "advisor.

It was agreed that the outcome of the discussions on the use of the
description "non-voting member or "advisor be reported to the next
meeting.

DECISIONS

1. That the report be noted.

2. That the outcome of the discussions on the use of the
description non-voti ng member or advi sor be reported to the
next meeting.


















ACTION







ACTION
11


40/13 LIST OF TENDERS

It was noted that Dr Majid Azeb and Dr Peter Davies had declared an
interest in this item.

The Head of Contracting and Procurement presented this report which
provided an outline of tenders under way, the progress made on each tender
process and key dates against outstanding actions on these tender
processes.

Particular reference was made to the procurements taking place under the
Any Qualified Provider framework. It was noted that a procurement process
had begun for a multi-disciplinary team to support Calderdale care homes for
older people. In response to a question from a GP Member it was confirmed
that there was a QIPP scheme for care homes in 2013/14, but that it had
always been anticipated that it would only have a part year effect.

DECISION

That the report be received and the activity and progress on
procurements be noted.


41/13 CONTRACTS REGISTER UPDATE

It was noted that Dr Majid Azeb and Dr Peter Davies had declared an
interest in this item.

The Head of Contracting and Procurement presented this report which
provided an update on the work on-going to maintain and update it. A copy
of the Contracts Register as at 12 September 2013 was appended to the
report.

The Chair commented upon significant progress having been made with
many contracts, but in discussion it was confirmed that contracts were
marked as "completed when the CCG/CSU had completed its work on the
contract rather than meaning that signed contracts had been returned.

A GP member pointed out that the description of service in contracts 799,
780, 784 and 865 868 should read Non Obstetric Ultrasound and not Non
Obstructive Ultrasound.

DECISION

That the report be noted.


42/13 WAIVERS OF STANDING ORDERS

The Head of Contracting and Procurement reported orally on a recent
decision to waive formal tendering procedures and invite a single source
tender for the provision of walk-in centres as Park Ward and Todmorden on
a fixed term contract for a maximum period of one year.

12

It was explained that in 2008/9 each PCT had been required to commission
at least one GP health centre in its area to be open from 8a.m. to 8p.m., 7
days a week and combining an "open access/walk-in element for
unregistered patients. Accordingly a contract had been awarded to Care UK
Ltd, which incorporated both GP services for registered patients and walk-in
services for Park Ward and Todmorden. It was reported that the contract
was due to end on 4 October 2013.

It was pointed out that, upon the abolition of PCTs in March 2013,
responsibility for commissioning Primary Medical Services had passed to
NHS England and the responsibility for the commissioning of primary care
services for non-registered patients and urgent care had passed to CCGs. It
was reported that NHS England was in the process of contracting with a new
provider (Locala CIC) to provide primary care services for patients registered
at the Park and Todmorden health centres. However a timeline had been
agreed for the new contract to commence in November/December and the
contract with the existing provider of registered and walk-in services was
being extended until that time.

With regard to future walk-in service provision, the CCG had commissioned
West and South Yorkshire and Bassetlaw Commissioning Support Unit to
help establish a longer term model for unscheduled care and potentially
including walk-in service provision. Public engagement and dialogue with
the Health and Wellbeing Board, the Local Authority Scrutiny Committee and
elected members had indicated that it would not be appropriate to completely
close the existing walk-in provision prior to a new model of provision being
available to take its place. The CCG had therefore committed to maintain a
walk-in service on weekends and Bank Holidays until the new model was
introduced (expected to be in the summer of 2014.

It was therefore intended to commission an interim service to cover
weekends and Bank Holidays until the new model was introduced. The
waiver of Standing Orders/Standing Financial Instructions was to enable a
single source tender to be invited from the organisation with which NHS
England was in the process of contracting with for the provision of primary
medical services at Park and Todmorden wards.

It was reported that, with regard to the rationale for compliance with Standing
Financial Instruction requirements, the following issues had been
considered;

The fact that NHS Calderdale had market tested for these services over
successive years and its experience had been that the capability and
availability to deliver to timescale had been limited.
There was a clear rationale to deliver a solution through which there was
a clear link between the GP contract and the Walk - In service in terms of
economies of scale and flexibility for providers.
The changes in commissioning responsibility consequent to the
establishment of the Health Act in April 2013 which split the
responsibilities for commissioning GP services and Urgent Care Services
had had an impact upon commissioning processes.

13
The Head of Contracting and Procurement referred to the provisions within
Standing Financial Instructions and specifically Section 16.11 which set out
the circumstances where formal tendering procedures could be waived by
the Chair and one other Governing Body Member. He advised that the
following Standing Financial Instructions were applicable in this case:
(a) the timescale genuinely precludes competitive tendering. Failure to
plan the work properly would not be regarded as a justification for
waiving the requirement to tender;
(b) there is a clear benefit to be gained from maintaining continuity with
an earlier project. However, in such cases the benefits of such
continuity must outweigh any potential financial advantage to be
gained by competitive tendering;

The Head of Commissioning and Procurement advised that the decision to
waive Standing Orders/Standing Financial Instructions had already been
taken by the Deputy Chair and another member of the Governing Body but
that Standing Orders/Standing Financial Instructions also required all such
waivers to be reported to the Audit and Governance Committee.

In discussion, reference was made to the absence of a written report on this
item and it was agreed that a written report be presented to the next meeting
on the rationale and the process for the waiving of competitive tendering
requirements.

DECISIONS

1. That the Head of Commissioning and Procurement!s oral report be
noted.

2. That in future all reports regarding the waiver of Standing
Orders/Standing Financial Instructions, other that nil returns, be
submitted to the Committee in advance of the meeting and in
writing.

3. That a report be presented to the next meeting on the rationale and
process for the waiving of competitive tendering requirements.

43/13 LOSSES AND COMPENSATIONS

It was noted that there had been no losses or compensations since the
previous meeting.


44/13 GIFTS AND HOSPITALITY

It was noted that there had been no gifts or hospitality reported since the
previous meeting.


45/13 ITEMS FOR THE GOVERNING BODY OR OTHER COMMITTEES

High Level Risk Register Position Statement for referral to the Governing
Body



14
Local Dispute Resolution Policy and Personal Health Budgets - to be
referred to in Chief Officer's report to the Governing Body






CHAIR


15
Audit and Governance Committee action sheet 19 September 2013

Report name Action
no. @
Action required Lead Current
status*
Comments (include,
expected completion
date, areas of concern
etc)
Strategic
Review
28/13 Number of waivers to be reviewed at end
of financial year and a decision to be
taken as to whether to be the subject of
an Internal Audit review
Julie
Lawreniuk
Not yet
due

Summary of
CCG Accounts
Requirements
31/13 1. CCG Opening Balance Sheet to be
presented to next meeting (if
available)
2. Consideration to be given to a training
session on the new format of the
accounts, possibly in January 2013
Julie
Lawreniuk



Underway
On Agenda for meeting
on 21.11.13
High Level
Risk Register
Position
Statement
32/13 1. Next Risk Register report to include a
short explanation of the rationale
behind the scoring of risks as high
level
2. Third paragraph of section 3.5.1 to be
deleted prior to presentation of report
to the Governing Body
3. Subject to 2. above, position
statement to be recommended to the
Governing Body as a true reflection of
the risk position as at 22 August 2013

Janet Smart



Janet Smart


Janet Smart



Complete



Complete


Complete

Information
Governance
Toolkit
33/13 Further progress reports (including a
RAG rating on progress) to be presented
to the next three meetings.
Sam Byrnes Underway
Personal
Health Budgets
Update Report
34/13 Chief Finance Officer and Head of
Commissioning Continuing
Care/Funded Nursing Care to discuss
further the arrangements for reporting
back to this committee
Julie
Lawreniuk/
Sarah Antemes
Underway
Local Dispute
Resolution
Procedure
35/13 Information on NHS England!s Stage 3 of
the procedure to be circulated when
available
Judith Salter Not yet
available

16
Operational
Amendments
to the
Constitution
39/13 Outcome of discussions on the reference
in the Constitution to the description
non-voting member or advisor to be
reported to the next meeting.
Judith Salter Item Agenda for
meeting on 21.11.13
Waivers of
Standing
Orders
42/13 Report to be presented to the next
meeting on the rationale and process for
the waiving of competitive tendering
requirements
Martin Pursey Item on Agenda for
meeting on 21.11.13